Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence in the Polish population aged ≥ 65.

Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25-0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.Trial registration: NCT03243474.

Prevalence and determinants of psychotropic medication use in Poland. / Rozpowszechnienie i wybrane uwarunkowania stosowania leków psychotropowych wsród mieszkanców Polski.

OBJECTIVES: The aim of the study was to assess the prevalence of psychotropic medication use among adult population in Poland in past 12 months, and to analyse the relationship between psychotropic medication use and sociodemographic factors as well as mental health disorders experienced by respondents. METHODS: Composite International Diagnostic Instrument (WHO CIDI 3.0) was used in Polish survey of general population aged 18-64. Respondents were randomly selected from the population register. Ten thousand interviews were completed with a response rate of 50,4%. RESULTS: In the general population, psychotropic medicines were used by almost 5% of the respondents in the past 12 months. These medicines were used more often by women, respondents from the oldest age group, with low level of education, retirees, unemployed, singles and residents of small and large cities. Among those experiencing mental health problems in the past 12 months, psychotropic medications were taken by up to 17% of the respondents. Pharmacological treatment was most often endorsed by over 40% of persons with symptoms of major depression and any mood disorders, while approximately 25% of respondents with major depression confirmed antidepressant use. Gender differences were small and mostly insignificant. CONCLUSIONS: The results indicate the need to improve access to mental health treatment and to educate better general practitioners (GPs) for appropriate diagnosing and treatment of mental health disorders.

The COVID-19 Crisis and the Incidence of Alcohol-Related Deaths in Poland.

BACKGROUND Identifying risk and protective factors for excessive alcohol consumption can inform targeted health policies, reducing the impact of potential mental health crises. This study examined the validity and reliability of COVID-19-related death data and explored the correlations among age, sex, residential status, alcohol abuse, and healthcare access. MATERIAL AND METHODS This analysis of Polish residents' mortality relies on individual data from the register of deaths maintained by Statistics Poland. This study examined deviations in the number of deaths between 2020 and 2021 by analyzing specific causes of death. RESULTS Alcohol abusers had increased COVID-19 risk factors compared to the general population. F10 values were 22% higher than expected in 2020, aligning with predictions for 2021. Higher mortality rates were observed in the first year of the pandemic. In 2020, women and rural residents were more affected (31% and 25% higher than expected, respectively), while men and urban residents were less affected (21% and 20% higher than expected, respectively). In 2021, the trend reversed, with men 2% higher than predicted and women 4% lower. Urban area residents had a 77% lower than expected value, while rural area residents were similar (8% higher). Overall mortality exceeded expectations in both 2020 (13% higher) and 2021 (23% higher). In 2021, alcohol-related non-mental health problems increased by more than 40% in standardized death rates (SDRs). CONCLUSIONS Alcohol-related deaths reflect the hidden effects of the pandemic. Measuring the pandemic's impact on global excess mortality is hindered by inconsistencies in COVID-19 death reporting.

Clustering of the Adult Population According to Behavioural Health Risk Factors as the Focus of Community-Based Public Health Interventions in Poland.

Effective lifestyle health promotion interventions require the identification of groups sharing similar behavioural risk factors (BRF) and socio-demographic characteristics. This study aimed to identify these subgroups in the Polish population and check whether local authorities' health programmes meet their needs. Population data came from a 2018 question survey on a random representative sample of 3000 inhabitants. Four groups were identified with the TwoStep cluster analysis method. One of them ("Multi-risk") differed from the others and the general population by a high prevalence of numerous BRF: 59% [95% confidence interval: 56-63%] of its members smoke, 35% [32-38%] have alcohol problems, 79% [76-82%] indulge in unhealthy food, 64% [60-67%] do not practice recreational physical activity, and 73% [70-76%] are overweight. This group, with an average age of 50, was characterised by an excess of males (81% [79-84%]) and people with basic vocational education (53% [50-57%]). In 2018, only 40 out of all 228 health programmes in Poland addressed BRF in adults; only 20 referred to more than one habit. Moreover, access to these programmes was limited by formal criteria. There were no programmes dedicated to the reduction of BRF exclusively. The local governments focused on improving access to health services rather than on a pro-health change in individual behaviours.

Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by an increased risk of thromboembolic complications that can be markedly reduced with anticoagulation. There is a paucity of studies assessing the total prevalence of AF in national populations. AIMS: To assess the nationwide prevalence of AF in a population of adults ≥65 old and to determine the impact of duration of electrocardiogram (ECG) monitoring on the number of newly detected AF episodes. METHODS: The NOMED-AF study (ClinicalTrials.gov; NCT: 0324347) was a cross-sectional study performed on a nationally representative random sample of 3014 Polish citizens 65 years or older. Final estimates were adjusted to the national population. All participants underwent up to 30 days of continuous ECG monitoring. Total AF prevalence was diagnosed based on the patient's medical records or the presence of AF in ECG monitoring. RESULTS: The prevalence of AF in the Polish population ≥65 years was estimated as 19.2% (95% confidence interval [CI], 17.9%-20.6%). This included 4.1% (95% CI, 3.5%-4.8%) newly diagnosed cases and 15.1% (95% CI, 13.9%-16.3%) previously diagnosed cases and consisted of 10.8% (95% CI, 9.8%-11.9%) paroxysmal AF and 8.4% (95% CI, 7.5%-9.4%) persistent/permanent AF. The incidence of all paroxysmal AF events as a function of ECG monitoring duration increased from 1.9% (95% CI, 1.4%-2.6%) at 24 hours to 6.2% (95% CI, 5.3%-7.2%) at 4 weeks. CONCLUSIONS: The prevalence of AF in elderly adults is higher than estimated based on medical records only. Four weeks of monitoring compared to 24-hour ECG Holter allow detection of 7-fold more cases of previously undiagnosed paroxysmal AF.

Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework.

BACKGROUND: This study examined non-financial aspects of the organizational performance of public hospitals from the perspective of hospital physicians; the obtained results were analyzed to identify the necessary improvements in organizational performance. METHODS: This was a cross-sectional study of multidisciplinary public hospitals on a group of 249 randomly selected physicians from 22 in-patient departments or clinics operating in the Warsaw region. The study data was collected using the structured World Health Organization questionnaires (to be filled out by respondents) assessing the hospital's organizational performance variables qualified according to the McKinsey 7-S Framework. Epidata software version 3.1 was used for data entry, and the analysis was carried out in the SPSS software, version 19. The results of the organization evaluation are presented in the McKinsey 7-S Framework diagram. Key elements of the performance factors were grouped into 'stens', and the sten values were expressed as arithmetic means. Normal distribution of the stens was validated with the Kolmogorov-Smirnov test. 95% confidence intervals were calculated. The significance of differences between the analyzed stens was compared with the paired Student t-test. The interdependence of the variables was determined using the Pearson's correlation coefficient. RESULTS: The results revealed a significant difference (p <0.05) in the respondents' assessment of social (a mean score of 2.58) and technical (a mean score of 2.80) organizational aspects of the hospital operation. Scores for all variables were low. The social elements of an organization with the lowest score included 'staff', and in it the aspect - 'efforts are made to inspire employees at the lowest levels of the organization', 'skills' involving the learning style followed by the management/managerial staff, and 'management style' (average scores of 2.38, 2.56, 2.61, respectively). CONCLUSION: Consistently with the existing literature, social factors were shown to play a more significant role in the management and they therefore deserve careful attention and more recognition when identifying and improving the key aspects affecting the organizational performance of public hospitals. Technical elements (strategy, structure, system) are important, but were demonstrated to have limited effect on the organizational operations geared towards ensuring effective functioning of a public hospital.

Relationship between diabetes mellitus and atrial fibrillation prevalence in the Polish population: a report from the Non-invasive Monitoring for Early Detection of Atrial Fibrillation (NOMED-AF) prospective cross-sectional observational study.

BACKGROUND: The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent. METHODS: A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days. RESULTS: Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM-) [25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4-18.5% respectively, p < 0.001]. DM patients were commonly associated with SAF [9%; 95% CI 7.9-11.4 vs 7%; 95% CI 5.6-7.5 respectively, p < 0.001], and persistent/permanent AF [12.2%; 95% CI 10.3-14.3 vs 6.9%; 95% CI 5.9-8.1 respectively, p < 0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM- patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM- individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery. CONCLUSIONS: AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population. TRIAL REGISTRATION: NCT03243474.

Association between cardiovascular diseases and depressive symptoms in adults. A pooled analysis of population-based surveys: WOBASZ, NATPOL 2011, and WOBASZ II.

INTRODUCTION Psychosocial risk factors play an important role in the origins of cardiovascular risk. OBJECTIVES The aim of the study was to evaluate the prevalence of depressive symptoms (DSs) in relation to some sociodemographic characteristics and selected cardiovascular diseases (CVDs) and to assess the relationship between self­reported CVDs and the severity of DSs. PATIENTS AND METHODS Three cross­sectional population­based surveys: WOBASZ (2003-2005), NATPOL 2011 (2011), and WOBASZ II (2013-2014) covered a total sample of 20 514 participants (9614 men and 10 900 women), aged 20 to 74 years, who all completed the Beck Depression Inventory. RESULTS One­fifth of men and one­third of women had DSs. The prevalence of DSs increased with age, was higher in unmarried persons and in individuals with a medical history of CVDs, and decreased with increasing education level. Individuals with DSs, both men and women, even those with borderline depression, had from 1.5- to more than 2­fold higher odds of either coronary artery disease or arrhythmia, and 2- to almost 4­fold higher chance of previous stroke in their medical history. CONCLUSIONS This study showed that DSs were a frequently observed condition in the general Polish population including patients with CVDs. We also demonstrated that there is a relationship between self­reported CVDs and severity of DSs regardless of age, marital status, education, and concomitant disorders.

Occupational position and alcohol use disorders in Poland.

OBJECTIVES: The following analysis covers the role of the occupational structure in the prevalence of alcohol use disorders (AUDs). The authors investigated whether the occupational position affected the prevalence of AUDs among men and women, and how this relationship varied in lifetime and past year periods. MATERIAL AND METHODS: Data were taken from the General Population Survey on Mental Health in Poland (EZOP) utilizing the Composite International Diagnostic Interview questionnaire (N = 2806). Binary and multiple regression models were employed to assess the risk of AUDs adjusted for the occupational structure and socio-demographic variables. RESULTS: The occupational position affects the prevalence of AUDs in men, while it has no impact on AUDs in women. Skilled and non-skilled workers suffer from AUDs to a greater extent than those in higher occupational positions. However, the risk of alcohol harm in women seems to be equally distributed across the occupational structure. CONCLUSIONS: The uneven pattern of alcohol harm in men and women can be possibly explained by shifting working conditions and work environments, as well as traditional gender roles affecting alcohol behaviors. The findings of the study support further development of the occupational position concept in alcohol research. The problem of harmful alcohol drinking in women across the occupational structure warrants a more in-depth inquiry. Int J Occup Med Environ Health. 2021;34(5):591-602.

Motivation factors affecting the job attitude of medical doctors and the organizational performance of public hospitals in Warsaw, Poland.

BACKGROUND: This paper examines the relationship between selected motivation factors that affect the attitude to work among medical doctors at public hospitals and the organizational performance of hospitals. METHODS: This study was based on World Health Organization questionnaires designed to estimate motivation factors according to Herzberg's motivation theory and to measure the level of organizational performance of hospitals by using the McKinsey model. A survey was conducted among physicians (n = 249) with either surgical (operative) or nonsurgical (conservative) specialty in 22 departments/units of general public hospitals in Warsaw, Poland. The relationship between the chosen job motivation factors and organizational effectiveness was determined using Spearman's rank correlation. Furthermore, 95% confidence intervals were calculated. The independent samples t-test was used to confirm statistically significant differences between the independent groups. Normality of the data was tested by the Kolmogorov-Smirnov test. RESULTS: The survey revealed that motivation factors related to "quality and style of supervision" have the highest effect on the organizational performance of hospitals (Spearman's rank correlation coefficient = 0.490; p < 0.001), whereas "performance feedback" has the lowest effect on organizational performance according to the surveyed healthcare professionals (54% of physicians). CONCLUSION: The principles of Individual Performance Review should be incorporated into strategies designed to improve the organizational performance of hospitals (with NHS serving as a potential role model) in order to establish specific rules on how to share performance feedback with individual physicians. The present study contributes to literature on human resource management in the healthcare sector and highlights the importance of nonfinancial aspects in improving the organizational performance of hospitals.

Prognostic role of traditional cardiovascular risk factors in patients with idiopathic pulmonary arterial hypertension.

INTRODUCTION: Metabolic alterations have been recently associated with onset and progression of idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine the prevalence and prognostic role of cardiovascular risk factors in patients with IPAH. MATERIAL AND METHODS: Between February 2009 and January 2015 we recruited consecutive IPAH patients. Clinical assessment included medical history, fasting glucose, lipid profile, N-terminal pro-brain natriuretic peptide concentration, 6-minute walk test distance, WHO functional class and hemodynamic evaluation. Patients' risk was estimated based on the Swedish PAH Register grading system. RESULTS: The study group included 61 IPAH patients, and the control group included 2413 Polish residents. When compared to the general population, IPAH patients had lower low-density lipoprotein cholesterol (LDL-C) and a higher triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. Female patients were characterized by elevated glucose level, higher prevalence of diabetes and lower HDL-C than controls. PAH severity grade correlated positively with age and TG/HDL-C ratio (R = 0.29, p = 0.02) and inversely with LDL-C (R = -0.28, p = 0.03) and HDL-C (R = -0.39, p = 0.02) concentrations. After a follow-up of 48 (23-79) months we recorded 28 deaths in the IPAH group. In the regression analysis lower LDL-C (p = 0.002) and HDL-C (p = 0.0002) levels, and higher TG/HDL-C ratio (p = 0.003) and glucose level (p = 0.003) were associated with all-cause mortality after adjustment for age, sex or PAH severity grade. CONCLUSIONS: Patients with IPAH are characterized by an altered profile of lipid and glucose metabolism. Lowered levels of LDL-C and HDL-C and increased TG/HDL-C ratio correlate with disease severity and together with elevated plasma glucose level predict poor survival in IPAH.

Smoking ban in public places and myocardial infarction hospitalizations in a European country with high cardiovascular risk: insights from the Polish nationwide AMI-PL database.

INTRODUCTION: Previous studies demonstrated a possible positive effect of a smoking ban in public places on cardiovascular outcomes. However, little is known about the influence of such regulations in Poland, a country with a high cardiovascular risk. OBJECTIVES: We aimed to evaluate the association of hospitalization rates for acute myocardial infarction (AMI) in Poland before and after the introduction of the smoking ban in public places in November 2010. PATIENTS AND METHODS: The Nationwide Acute Myocardial Infarction Database (AMI­PL) was searched for the cases of AMI that occurred between 2009 and 2014. The analysis considered sex, age (20-64 years vs 65 years or older), and the place of residence (rural vs urban area). There were no specific exclusion criteria. RESULTS: The overall average number of AMI hospitalizations in the years 2009-2010, 2011-2012, and 2013-2014 was 79 323, 80 783, and 77 356, respectively. Age­standardized rates of AMI hospitalizations in both sexes and age groups decreased only slightly in the first 2 years and were more visible in the years following the implementation of the smoking ban. In men, the decrease was observed in both age groups and almost in the whole country. In younger women, the decrease was not observed in towns with more than 100 000 inhabitants. In large towns (over 500 000 inhabitants), mostly a nonsignificant decrease occurred. CONCLUSIONS: After the introduction of the smoking ban, a marked decrease in age­standardized AMI hospitalizations was observed in long­term follow­up both in men and women as well as both in younger and older patients, but with differences regarding the place of residence.

Nationwide General Hospital Morbidity Study as a source of data about Polish population health

The objective of this article is description of the important source of data on hospitalised morbidity collected in Poland within the frameworks of public statistics, and also underlying the significance of the quality of data collected at the hospital level for the purpose of the practical application of them. The Nationwide General Hospital Morbidity Study has been conducted by the Department of Population Health Monitoring and Analysis of the NIPH-NIH for more than 40 years within the frameworks of the Programme of Statistical Surveys of Official Statistics. Since the year 2000, it has had a complete character, collecting individual data for all cases of hospitalisation in Poland within the scope compliant with the MZ/Szp-11 form, among others, sex, age, place of residence of a patient, data on hospital, information about the course of treatment (length of stay in hospital, principal diagnosis and comorbidity, applied medical procedures, the mode of admission and discharge). The collected data are anonymous. In the recent years, annually, more than 8 million of the cases of hospitalisation have been documented. Almost all obliged hospitals (96%) participate in the study. Some weak point is the completeness of submitted data, in particular, regarding information about the external causes of injuries and poisonings (in the year 2017, 27% of the required data were missing). Interestingly, a high level of missing data is generated by a comparatively small number of hospitals. Significant differences are observed in the quality of data depending on the voivodship of hospital location. The collected data render it possible to, among others, determine the frequency of hospitalisations due to particular causes taking under consideration the localisation of a hospital, and also the sex, age and the place of residence of patients, the analysis of the duration of hospital stay or in-hospital fatality. The aggregated results are reported to international databases (WHO, OECD, Eurostat), and support the administrative authorities of various levels. They are also a basis for numerous published scientific papers. The most important results of routine analyses are presented of the web page of the Study (http://www.statystyka1.medstat.waw.pl/).

Screening of problem gambling among a homeless population in Warsaw.

BACKGROUND: While homelessness and problem gambling are both recognised as social and public health concerns and the prevalence of addictive disorders among homeless populations tends to be high. These questions have been studied predominantly independently. AIM: The aim of the study was to explore the co-occurrence of the two phenomena among the homeless population using shelters and night shelters in Warsaw, and, more specifically, to provide information about the forms and frequency of gambling in this homeless population. METHOD: Homeless persons (N = 690) were interviewed in rehabilitation-shelters (n = 17) and night-shelters (n = 2) in Warsaw from November 2015 until January 2016. The core component of the questionnaire was a screening test (Problem Gambling Severity Index). In addition, data regarding the intensity of gambling and various types of games or settings were collected. RESULTS: The prevalence of problem gambling in this population of homeless people was 11.3%, whereas the prevalence of problem gambling in the general population in Poland is much lower (0.7%). Similarly to the general population, the most prevalent gambling games in the homeless population were lotteries; however, homeless people gambled in lotteries almost three times more often compared to the general population. CONCLUSIONS: This is the first study examining the prevalence of problem gambling in the homeless population in Poland. The findings of the study suggest that problem gambling among the homeless is a significant social and public health concern. High rates of problem gambling in the homeless population show the need to identify and monitor this problem in shelters and consequently to provide easier access to gambling treatment or prevention programmes.

Depressive symptoms and cardiovascular diseases in the adult Polish population. Results of the NATPOL2011 study.

BACKGROUND: Poland is a country of high cardiovascular risk. Because depression was found to be a predictor of coronary artery disease and the prevalence of depressive symptoms (DSs) has risen worldwide, their monitoring in the population is desirable. AIM: We sought to evaluate the prevalence of DSs in relation to the socio-demographic status and selected types of cardio-vascular diseases in the adult Polish population. METHODS: A country-representative random sample of 2413 subjects, aged 18 to 79 years, was examined in 2011. Rates of self-reported cardiovascular conditions including hypertension (HT), coronary artery disease (CAD), previous myocardial infarction (MI), heart failure, atrial fibrillation (AF), and stroke were assessed by a questionnaire, and the prevalence of DSs was assessed by Beck Depression Inventory (BDI), separately in men and women. DSs were defined as BDI score ≥ 10 points. RESULTS: Depressive symptoms were found in 23.4% of men and 33.4% of women (p < 0.0001). The prevalence of DSs increased with age, from 16.5% in the youngest group of men to 48.3% in the oldest group of women. We found that DSs were significantly more prevalent in subjects suffering from HT, CAD, stroke, AF, and diabetes, and also in women after MI. The rates of DSs in women with a history of MI or stroke were extremely high (76.3% and 83.3%, respectively). Age and primary education level were associated with DSs, as was history of stroke in women. DSs were more often found in older persons and in those with primary level of education. CONCLUSIONS: Depressive symptoms were more prevalent in women compared to men, and they were significantly and inde-pendently associated with age and primary education level in both sexes, and with a history of stroke in women.

Variations in experience of social support and physical health among adult residents of Poland in urban versus rural areas

Background: A study reveals ­ against to common beliefs ­less support between rural area residents in comparison to town-dwellers and significantly higher support for healthy, not for poor health research participants. Objectives: The aim of our paper was comparing support from spouse/partner, relatives, friends and strangers among people with good and ill physical health. A next purpose was to find differences of social support and experience of social undermining in urban and rural residential settings. Material and methods: The study "Epidemiology of Mental Disorders and Access to Mental Health Care, EZOP ­ Poland" was carried out on random sample of 24 000 of Poland residents and a 50,4% response rate, 10 081 computerassisted personal interviews. Of those respondents, 4 000 constituted a sub-sample asked to complete the social networks and support section of the questionnaire. Data were analyzed by age, gender, residential setting and marital status for statistically significant differences in the percentage of functional and structural social support being reported, using the chi-squared test with a significance level of 0.05 used to reject the null hypothesis (H0 = lack of relationship between variables). Results: A majority of respondents maintain that in difficult life situations, family and a close network of friends and acquaintances make it possible to openly discuss problems and obtain help. However, respondents who rate their health as "poor" or "very poor" significantly less often than healthy individuals experience support coming from their relatives, friends, or strangers. In comparison to urban areas, the extent of social support in rural areas is significantly limited. The rural setting offers less support and even less opportunities for interaction with relatives, friends, acquaintances and strangers. Negative social factors­ low levels of trust, isolation from friends and family, lack of a social life, lack of a helpful neighborhood ­ are conditions significantly more often found in the countryside than in urban areas. Conclusions: Results obtained from the EZOP study shows that amount of social support received is higher in urban areas and among those who enjoy better physical health.

Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension.

Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6 ± 0.8 mmol/l) and CTEPH (2.7 ± 0.7 mmol/l) patients when compared to controls (3.2 ± 1.1 mmol/l, p < 0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1 mmol/l, 95%CI:0.26-0.74, p = 0.002) after a median follow-up time of 33(21-36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1-3.2] to 4.0[2.8-4.9]mmol/l, p = 0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2-2.7] vs 2.3[2.1-2.5]mmol/l, p = 0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels.

Prevalence of lipid abnormalities in Poland. The NATPOL 2011 survey.

BACKGROUND: Poland represents a country of high cardiovascular (CV) risk. The association between lipid abnormalities and increased CV risk is well established. Therefore, it is important to monitor the prevalence and control of dyslipidaemia. AIM: To evaluate serum lipids concentrations as well as the prevalence, awareness, and control of lipid abnormalities in a representative sample of adults in Poland. METHODS: In 2011, in a national cross-sectional survey blood samples were collected from 1168 males and 1245 females, aged 18-79 years, for measurement of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in blood serum. Low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS: Mean serum TC concentration was 197.1 mg/dL (95% CI 193.8-200.4) in males (M) and 198.6 mg/dL (95% CI 195.7-201.5) in females (F). Levels of LDL-C were 123.6 mg/dL (120.9-126.2) and 123.7 mg/dL (121.4-126.1), HDL-C - 45.8 mg/dL (44.7-47.0) and 54.1 mg/dL (53.1-55.1), TG - 140.9 mg/dL (133.0-148.8) and 104.0 mg/dL (99.8-108.2) for males and females, respectively. TC ≥ 190 mg/dL was found in 54.3% subjects (M 54.3%; F 54.4%). After adding patients on lipid-lowering treatment, hypercholesterolaemia was present in 61.1% of adults (M 60.8%; F 61.3%). LDL-C ≥ 115 mg/dL was detected in 57.8% of all subjects (M 58.3%; F 57.3%), while HDL-C < 40 mg/dL in 35.2% of males and < 45 mg/dL in 22% of females TG ≥ 150 mg/dL was found in 21.1% of subjects (M 28.4%; F 14.0%). The highest prevalence of elevated TC and LDL-C levels was present in the age group of 40-59-year-olds. Of those with hypercholesterolaemia 58.7% (M 61.5%, F 56.0%) were not aware of the condition; 22.0% (M 21.0%, F 24.5%) were aware but were not being treated; 8.1% (M 7.7%, F 8.5%) were treated but with TC ≥ 190 mg/dL; and only 10.9% (M 10.7%, F 11.0%) were being treated with TC < 190 mg/dL. CONCLUSIONS: The prevalence of dyslipidaemia in Poland continues to be high--over 60% of adults have hypercholesterolaemia, and control remains poor. The results of the NATPOL 2011 survey call for urgent preventive measures.

[The prevalence of common mental disorders in the population of adult Poles by sex and age structure - an EZOP Poland study]. / Rozpowszechnienie wybranych zaburzen psychicznych w populacji doroslych Polaków z odniesieniem do plci i struktury wieku - badanie EZOP Polska.

AIM: The article presents lifetime (LT) prevalence of common mental disorders (CMD) in accordance with the DSMIV classification, based on assessment of representative population sample of 10,081 Poles aged 18-64. METHODS: Computer based WHO CIDI3.0 was adapted for the Polish population according to WMH protocol. The survey was performed by certified and supervised interviewers. RESULTS: Out of the 18 CMDs analyzed the most common was alcohol abuse, significantly more often in males (18.6%) than in women (3.3%), (p<0.01). The second most common disorder was panic, also more frequent in women (8.5%) than in men (3.9%), (p<0.01). Similarly, depression occurred in women (4.0%) two times more often than in males (1.9%), (p<0.01). GAD, agoraphobia, panic, specific phobia (p<0.01), and dysthymia (p<0.05) were also more prevalent in women. On the other hand, alcohol abuse, alcohol and drug dependence (p<0.01), and hypomania (p<0.05) were more common in males. For most analyzed disorders significantly higher prevalence was found in the older age groups. Social phobia, specific phobias, and drug abuse occurred most often in men from the youngest group. No significant differences related to age were found for the prevalence of hypomania both in men and women. CONCLUSIONS: Indices of prevalence obtained in the EZOP Poland study differ from the indices of prevalence of mental disorders described earlier in other countries. Lower values were found in Poland for affective disorders and some anxiety disorders. Only alcohol abuse was diagnosed more often than in other studies using similar methods except Ukraine, where this disorder was diagnosed with similar frequency.

["Epidemiology of mental disorders and access to mental health care. EZOP - Poland" - research methodology]. / "Epidemiologia zaburzen psychiatrycznych i dostepnosc psychiatrycznej opieki zdrowotnej. EZOP - Polska" - metodologia badania.

AIM: Since the second half of the twentieth century, with the development of structured diagnostic tools, population based studies on epidemiology of mental disorders are carried out. A special role is played by World Mental Health Survey Initiative which brings together a group of countries from different continents in order to carry out research projects according to standard methodology using the Composite International Diagnostic Interview. Polish EZOP study, which was conducted in accordance with the guidelines of WMH joined that group. The project was implemented under the Norwegian Financial Mechanism and the Financial Mechanism of the European Economic Area. Its aim was to estimate the prevalence of mental disorders in the Polish population of adults, assess the distance to mental disorders and to obtain knowledge about the perception of psychiatric disorders and treatment. METHODS: The research tool was the Polish version of CIDI-WHO ver.3.0., which was developed for the project. The study was performed in accordance with the guidelines of WMH (cognitive interviews, interviewers training, standardization of field procedures) using electronic version of CIDI questionnaire (CAPI) within the 2-stages procedure in randomly selected representative sample of the Polish population aged 18-64. The quality of the study was systematically controlled and reported by MB SMG/KRC, and completed data (10,081 interviews) were sent to the Department-Centre of Monitoring and Analyses of Population Health NIPH-NIH. After the initial analysis data were sent to the analytical center of WMH, which applied additional cleaning tools and added new variables representing psychiatric diagnoses in DSM-IV and ICD-10.