ATHLOS Healthy Aging Scale score as the predictor of all-cause mortality in Poland and Czechia.

Background: The ATHLOS consortium (Aging Trajectories of Health-Longitudinal Opportunities and Synergies) used data from several aging cohorts to develop a novel scale measuring healthy aging comprehensively and globally (ATHLOS Healthy Aging Scale). In the present study, we assessed the predictive performance of the ATHLOS Healthy Aging Scale for all-cause mortality in middle-aged and older adults. Methods: Data from the Polish and Czech HAPIEE (Health Alcohol and Psychosocial factors In Eastern Europe) prospective cohorts were used. There were 10,728 Poles and 8,857 Czechs recruited. The ATHLOS Healthy Aging Scale score was calculated for all participants using data from the baseline examination carried out from 2002 to 2005. The follow-up for all-cause mortality was completed over 14 years. The associations between quintiles of the ATHLOS Healthy Aging Scale and all-cause mortality were estimated using Cox proportional hazards models. Results: A total of 9,922 Polish and 8,518 Czech participants contributed ATHLOS Healthy Aging Scale and mortality data with 1,828 and 1,700 deaths, respectively. After controlling for age, the ATHLOS Healthy Aging Scale score was strongly associated with mortality in a graded fashion for both genders and countries (hazard ratios for lowest vs. highest quintile were 2.98 and 1.96 for Czech and Polish women and 2.83 and 2.66 for Czech and Polish men, respectively). The associations were only modestly attenuated by controlling for education, economic activity, and smoking, and there was further modest attenuation after additional adjustment for self-rated health. Conclusion: The novel ATHLOS Healthy Aging Scale is a good predictor of all-cause mortality in Central European urban populations, suggesting that this comprehensive measure is a useful tool for the assessment of the future health trajectories of older persons.

Melatonin and sleep disorders in patients with severe atopic dermatitis.

INTRODUCTION: Many atopic dermatitis (AD) patients suffer from insomnia. Out of numerous factors associated with sleep disorders, melatonin seems to play a significant role. AIM: To assess the relation between melatonin concentration and sleep disorders in adult patients with severe and very severe AD. MATERIAL AND METHODS: The study included 36 adult patients with severe and very severe AD and 20 healthy Caucasian volunteers. The severity of skin lesions was assessed by the EASI scale. Skin itch was evaluated by a visual-analogue scale (VAS), and sleep disorders were assessed by the Polish version of the Athens Insomnia Scale (AIS). Serum melatonin concentration of patients and controls was determined by ELISA. RESULTS: Melatonin concentration in patients with very severe AD was significantly (p < 0.001) lower than in patients with severe AD, however, melatonin concentration in the group of AD patients did not differ significantly (p = 0.33) from that observed in the control group. There was a significant negative correlation between the concentration of melatonin in the study group and the severity of itching (R = -0.54, p < 0.001). The intensity of sleep disorders was significantly higher (p < 0.001) in patients with a very severe form of AD compared to patients with severe AD. Moreover, there was a significant negative correlation between melatonin concentration and sleep disorders (R = -0.67, p < 0.001). CONCLUSIONS: Our results clearly showed that sleep disturbances are more expressed in very severe AD patients compared to subjects suffering from severe disease. We also suggest that melatonin serum concentration could play a role in the pathogenesis of sleep disturbances in AD patients.

Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland.

BACKGROUND: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. METHODS: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. RESULTS: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45-1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11-1.42 and IRR = 1.19, 95% CI 1.02-1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. CONCLUSIONS: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.

The influence of self-assessment of asthma control on the Asthma Control Test outcome.

OBJECTIVE: The Asthma Control Test (ACT) consists of five items, one of which is self-assessment of asthma control. The goal of this study was to compare the responses to the first four ACT items with the response to the fifth item and determine whether this response affects the final ACT score. METHODS: Adult asthmatics (n = 417) were recruited from a specialty asthma center in Poland. Clinical data were collected by questionnaire. Spirometry and skin prick tests were performed for clinical evaluation. Asthma control was assessed through the ACT. The cutoff point for uncontrolled asthma was <20 points. RESULTS: Asthma was uncontrolled in 42.5% of patients. Based upon scores of the first four ACT items, three clusters of patients were identified. Cluster 1 comprised very well-controlled asthmatics [mean (sd) ACT total score 24.7 (0.7)]. Cluster 2 included both controlled and uncontrolled asthmatics [ACT total score 20.1 (2.5)]. Cluster 3 comprised poorly controlled asthmatics [ACT total score 12.1 (2.9)]. Misjudgment of asthma control in the fifth ACT item had no impact on the ACT total score in clusters 1 and 3. In cluster 2, the response to this item caused misclassification in 10.2% of patients. CONCLUSIONS: In patients with either very well or very poorly controlled asthma, the response to the fifth ACT item did not alter the assignment into the appropriate asthma control group. Only in a small group of patients with a total ACT score of approximately 20 points did the asthma group classification result in either controlled or uncontrolled.

Pruritus Characteristics in Severe Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is classified as a most common inflammatory skin disease. The condition is characterized by recurrent eczematous lesions and intense pruritus or itch, a hallmark of AD. The aim of this study was to identify the provoking factors of itch in severe AD adult patients. There were 34 adult patients suffering from AD of the median age of 40 years enrolled into the study and a control group that consisted of 20 healthy subjects. The severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) index, pruritus intensity was assessed on a visual analog scale (VAS), and itch aggravating factors were assessed with a questionnaire. Specific IgE (sIgE) antibodies and interleukin IL-33 were measured in venous blood. We found that all the patients with severe AD had intensive itch (VAS: 9-10 points) during the whole day and 30 (88.2%) patients had it during nighttime. The most significant factors aggravating itch were the following: dry skin (27 patients; 79.4%), exposure to dust mite (22 patients; 64.7%,), and emotional distress (17 patients; 50%). Moreover, there was a positive correlation between the intensity of itch and the level of sIgE antibodies to dust mite (p < 0.001). The content of IL-33 was significantly higher in AD patients with severe skin lesions. This exploratory study shows that skin dryness, dust exposure, and distress play an essential role in the exacerbation of AD in the adult population.

Adipokines as Biomarkers of Atopic Dermatitis in Adults.

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic skin inflammation and does not have a well-understood pathogenesis. In this study, we addressed the contribution of adipokines to AD eczema based on the assessment of blood levels of adiponectin, resistin, leptin, lipocalin-2, and vaspin in adult non-obese patients suffering from chronic extrinsic childhood-onset AD. We investigated 49 AD patients with a median age of 37 years. The control group consisted of 30 age-matched healthy subjects. Adipokines were assessed in the serum by ELISA assays and the severity of AD with the SCORing Atopic Dermatitis (SCORAD) index. We found that adiponectin and resistin decreased and leptin appreciably increased in AD patients when compared to those in healthy subjects. Further, the levels of adiponectin and resistin were inversely related to the intensity of eczema. In conclusion, apart from the formerly investigated role of leptin in AD, this study points to adiponectin and resistin as the potential candidate adipokine biomarkers involved in shaping eczema intensity and severity, which may help predict disease exacerbations and enable the development of effective targeted therapeutic interventions.

Can the blood tryptase be an indicator of the severity of atopic dermatitis?

Atopic dermatitis (AD - atopic eczema) is a chronic inflammatory dermatosis resulting from complex genetic, epigenetic and environmental interactions with an overlapping defect in the epidermal barrier.AD is one of the most common inflammatory dermatoses in children and adults. AIM: The aim of the study was to assess the relationship between serum basal tryptase (sBT) and total IgE (tIgE) level in blood serum and the severity of lesions (SCORAD; SCORing atopic dermatitis). MATERIALS AND METHODS: The study was performed in the group of adult patients (57 people, F/M: 30/27; average age: 37.5 years) and in the control group (10 people, K/M: 6/4; average age: 44 years). Diagnosis of atopic dermatitis was established by a dermatologist-allergist specialist based on the criteria of Hanifin and Rajka. The severity of lesions was determined on the SCORAD scale (SCORing atopic dermatitis). RESULTS: The distribution of tryptase concentration did not differ statistically significantly between patients with various disease severity and the control group also the severity of skin lesions was significantly higher (p<0.001) in patients whose tIgE level exceeded 3500 IU / ml. Conclusion. sBT did not prove to be a useful biomarker in assessing. CONCLUSIONS: sBT did not prove to be a useful biomarker in assessing severity of AD. The present study demonstrated that in the patients with atopic dermatitis the concentration of total IgE was correlated with severity of the disease symptoms.

Is the presence of a fur animal an exacerbating factor of atopic dermatitis in adults?

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. To date, no clear relationship between the severity of AD and the exposure to dog and guinea pig-derived allergens has been established. AIM: The aim of the study was to assess the association between the specific serum immunoglobulin E levels (against dog and guinea pig) and the grade of skin symptoms measured with the SCORAD and VAS scales in the population of adult patients suffering from atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 47 patients suffering from atopic dermatitis since infancy (30 women and 17 men). Concentration of IgE was measured by the fluoroenzymatic immunoassay. The Mann-Whitney's test was used to compare the distribution of specific IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD and VAS scales, and the measured specific IgE concentrations for investigated fur animals was found. CONCLUSIONS: The study demonstrated that in the patients with atopic dermatitis the concentration of specific IgE was correlated with severity of the disease symptoms, including itch. This enables forecasting the course of the disease and selecting a group of patients who should immediately reduce their contact with allergen.

Depression and Serum Content of Serotonin in Adult Patients with Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic skin disease with the etiology not yet conclusively established. Recent reports demonstrate the role of serotonin (5-hydroxytryptamine; 5-HT) in the pathogenesis of AD. The aim of this study was to investigate the relationship between the serum content of serotonin and depression in adult patients suffering from severe AD. There were 31 patients of the median age of 41 years enrolled into the study, who suffered from AD since childhood, and a control group that consisted of 14 healthy subjects. AD was diagnosed on the basis of Hanifin and Rajka criteria. The severity of skin lesions was assessed with the SCORing Atopic Dermatitis (SCORAD) index and that of depression with the Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire. We found that all of the patients with severe AD characterized by SCORAD >50 had depression. Depression was classified as mild and moderate according to the MADRS score. Serotonin content was significantly lower in the patients with severe AD (MADRS >12), and there was an adverse relation between the serotonin content and the score of depression, the features not noticed in the control group. We conclude that severe AD, as expressed by the intensification of skin lesions, associates with depression and with the lowering of serum serotonin content. The findings point attention to the cognitive and affective problems in AD patients which could worsen the course of the skin disease.

Cat Allergy as a Source Intensification of Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is characterized by exacerbations and remissions of eczematous skin, underlain by impaired skin barrier and aberrant Th2-type and Th-22 cytokine production. A number of allergens, in particular contact with fur animals, may aggravate the disease. This study seeks to define the influence of having a regular contact with a pet cat at home on the severity of symptoms and signs of AD. We addressed the issue using the SCORing Atopic Dermatitis (SCORAD) and visual analog (VAS) scores to assess the intensity of pruritus and by measuring the blood content of specific IgE and IL-4, IL-13, and IL-22 cytokines. The study group consisted of 47 adult patients suffering from AD since childhood, 18 of whom declared having regular contact with a cat and the remaining 29 who denied it. There also was a control group consisted of 16 healthy volunteers with no AD signs. The SCORAD and VAS scores were significantly higher in patients in contact with a cat than in those without it (median SCORAD 61.0 vs. 50.4 and VAS 9.0 vs. 4.0 points, respectively). The sIgE of a majority of patients (94.4%) in contact with a cat was in Class V-VI, compared with just a few patients (3.4%) with no such contact, having sIgE in the same classes (p < 0.001). Significant correlations were revealed between SCORAD and VAS scores and the class level of serum sIgE value. In addition, IL-22 was a single elevated cytokine, only in the patients in contact with a cat, and it correlated with pruritus severity. The results of the study underline the need to beware of the cat fur allergen, and they stress forethought and caution in acquiring and keeping a pet cat by patients suffering from AD.

The knowledge of issues associated with topical corticosteroids using in patients with atopic dermatitis.

Atopic dermatitis (AD) is the most common inflammatory dermatitis, always accompanied by the pruritus. First line treatment comprise of topical steroids, however, there is a particular concern among patients with atopic dermatitis - "steroid phobia", which results in lack of efficacy of the therapy. Steroid phobia arises usually from insufficient knowledge of these drugs. AIM: The aim of the study was to evaluate the knowledge of topical corticosteroids (TCS) and familiarity with so called safe therapy methods among atopic dermatitis patients. MATERIALS AND METHODS: In the study participated 143 adult patients with AD diagnosis made by a specialist dermatologist-venereologist and allergist in accordance with Hanifin and Rajka's diagnostic criteria. Patients filled anonymously authorial survey which included questions concerning disease duration, severity of pruritus, frequency of skin lubrication, understanding of topical steroid therapy and practical aspects of safe TCS application. RESULTS: Correct answers responding incidence to questions related to TCS diminished with the patients age, while on the other hand, it increased statistically significantly with the level of education. What responders were afraid of most frequently were the skin atrophy (56,6%), cataract (52,4%) and teleangiectasias (44,8%), in opposite to neoplasms (16,8%) and obesity (22,4%). Concerns were dependent to the treating physician- patients under the care of dermatologists more often were worried about the skin atrophy, teleangiectasias and cataract. Among participating patients just 3,5% of them (5 patients) knew the finger tip unit term, whereas the majority (56%) had been informed about safe TCS therapy methods. Amidst respondents who answered questions about TCS correctly statistically significantly lower pruritus intensity was observed. CONCLUSIONS: Results of our study indicate on necessity of taking action to improve cooperation between patients and doctors insofar as topical therapy of atopic dermatitis.

Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases.

Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25-64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25-64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.

Socioeconomic status and pulmonary function, transition from childhood to adulthood: cross-sectional results from the polish part of the HAPIEE study.

OBJECTIVE: Previous studies have reported inverse associations between socioeconomic status (SES) and lung function, but less is known about whether pulmonary function is affected by SES changes. We aimed to describe the relationship of changes of SES between childhood and adulthood with pulmonary function. DESIGN: Cross-sectional study. PARTICIPANTS: The study sample included 4104 men and women, aged 45-69 years, residents of Krakow, participating in the Polish part of the Health, Alcohol and Psychosocial Factors in Eastern Europe Project. MAIN OUTCOME: Forced expiratory volume (FEV1) and forced vital capacity (FVC) were assessed by the standardised spirometry procedure. Participants were classified into three categories of SES (low, moderate or high) based on information on parent's education, housing standard during childhood, own education, employment status, household amenities and financial status. RESULTS: The adjusted difference in mean FVC between persons with low and high adulthood SES was 100 mL (p=0.005) in men and 100 mL (p<0.001) in women; the differences in mean FEV1 were 103 mL (p<0.001) and 80 mL (p<0.001), respectively. Upward social mobility and moderate or high SES at both childhood and adulthood were related to significantly higher FEV1 and FVC compared with low SES at both childhood and adulthood or downward social mobility. CONCLUSIONS: Low SES over a life course was associated with the lowest lung function. Downward social mobility was associated with a poorer pulmonary function, while upward mobility or life course and moderate or high SES were associated with a better pulmonary function.

Association between carotid-femoral pulse wave velocity and overall cardiovascular risk score assessed by the SCORE system in urban Polish population.

BACKGROUND: The Systemic COronary Risk Estimation (SCORE) system is recommended for the assessment of cardiovascular disease (CVD) death risk in individuals free of CVD. AIM: We sought to determine the association between carotid-femoral pulse wave velocity (CFPWV) and SCORE. METHODS: The study involved 1008 Krakow residents, and a random subsample of 3424 men and 3205 women who participated in Wave 2 of the Polish part of the Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study. At baseline we performed a medical interview, physical examination, evaluation of present comorbidities, medications using standardised methods. A follow-up of 4.9 years included measurement of CFPWV using an automatic, computerised Complior® system. RESULTS: Final analysis included 720 patients (378 women), aged 58.5 ± 6.5 years at baseline. In 488 individuals without his- tory of CVD and/or diabetes, SCORE was calculated. Median CFPWV was higher (p = 0.002) in men (12.5 m/s; interquartile range [IQR] 10.3-15.7) than in women (11.7 m/s; IQR 10.1-13.7). High CFPWV (> 10 m/s) was observed in 270 men (78.9%) and in 285 women (75.4%). We observed a strong association between high CVD risk (SCORE ≥ 5%) and high CFPWV (odds ratio 2.29; 95% confidence interval 1.17-4.46). The CFPWV cut-off value to differentiate between patients with low and high CVD risk was 11.7 m/s (with 58.6% sensitivity and 71.3% specificity, AUC = 0.68). CONCLUSIONS: Our study is the first to describe the distribution of CFPWV in the adult Polish population. SCORE ≥ 5% pre- dicted high CFPWV in 4.9 years of follow-up, which was independent of other risk factors. CFPWV > 11.7 m/s was most valid in relation to high CVD risk.

The level of total immunoglobulin E as an indicator of disease grade in adults with severe atopic dermatitis.

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. The disorder is associated with significant worsening of quality of life. Due to the frequently suggested pathogenetic relationship with atopic dermatitis, immunoglobulin E seems to be an adequate indicator of the disease. AIM: The aim of the study was to assess the association between the total serum immunoglobulin E levels and the grade of skin lesions measured with the SCORAD and oSCORAD scales in the population of adult patients suffering from severe atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 31 patients suffering from atopic dermatitis since early childhood (17 women and 14 men) in 2017. Total IgE was measured by the fluoroenzymatic immunoassay. The Spearman's rank correlation coefficient was used to determine the power of the relationship between the concentration of total IgE and atopic dermatitis severity. The Kruskal-Wallis and Mann- Whitney's tests were used to compare the distribution of IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD/ oSCORAD and the measured IgE levels was found in the patients with the IgE level above 3500 IU/ml (19 subjects). CONCLUSIONS: The present study demonstrated that in the patients with severe extrinsic atopic dermatitis, the concentration of total IgE was correlated with the severity of the disease. This suggests an opportunity of employing IgE as an atopic dermatitis biomarker.

Knowledge of cardiovascular disease (CVD) risk factors in population of Malopolska voivodeship in two independent cross-sectional studies

INTRODUCTION: Low level of knowledge of cardiovascular disease (CVD) risk factors is related to higher risk of death and health educational programs are of particular importance in CVD prevention. Monitoring the level of knowledge of CVD risk factors is necessary to verify the effectiveness of education and to facilitate the right choice of education methods. AIM: to compare the assessment of knowledge of CVD risk factors in the population of Malopolska Voivodeship from the two independent cross-sectional studies. MATERIAL AND METHODS: Data of 973 respondents of M-CAPRI Study and 333 respondents of WOBASZ II Study, at age 20-69, were included to analysis. M-CAPRI study was carried out in 2014 and WOBASZ II - in the years 2013-2014. Knowledge of CVD risk factors was assessed by the same standard questionnaire in both studies. Multivariate logistic regression was used to assess the differences in knowledge of CVD risk factors between participants of M-CAPRI and WOBASZ II studies. RESULTS: There were 80% of women and 71% of men, respondents of M-CAPRI Study who recognized theterm ,,risk factor" compared to 73% and 78% respectively in respondents of WOBASZ II Study. However, after adjustment for age and education the difference was statistically significant only in men. Respondents of M-CAPRI Study had knowledge of hypertension, high level of blood cholesterol, alcohol and unhealthy diet less frequently compared to respondents of WOBASZ II Study. Men from M-CAPRI Study had knowledge of diabetes and smoking less frequently but knowledge of low physical activity more frequently compared to men from WOBASZ II Study. CONCLUSIONS: The use of standard questionnaire in two independent cross-sectional studies appeared to be not sufficient to obtain reliable information on knowledge of CVD risk factors in Malopolska Voivodeship. In the studies that differed in the method of recruitment, participation and the technique of interview, the differences in the assessment of knowledge were substantial and it is impossible to assess which assessment was closer to the reality. However, the results of both M-CAPRI and WOBASZ II studies indicate that knowledge of CVD risk factors in Malopolska Voivodship is poor and there is a strong need to intensify health education.

Study on changing patterns of reproductive behaviours due to maternal features and place of residence in Poland during 1995-2014.

INTRODUCTION: The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland. MATERIAL AND METHODS: Information about live births in Poland in the years 1995-2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used. RESULTS: In 1995-2014, a shift in the age of highest fertility from 20-24 years to 25-29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15-29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30-49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5-29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005-2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped. CONCLUSIONS: The postponement of births and reduction of fertility in women aged 15-29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas. ABBREVIATIONS: APC - annual percentage change; AAPC - average annual percentage change; CSO - Central Statistical Office; TFR - total fertility rate.

Cardiovascular risk assessment, cardiovascular disease risk factors, and lung function parameters.

BACKGROUND: Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. AIM: The aim of the study was to assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk, and pulmonary function. METHODS: The analysis included 4104 men and women aged 45 to 69 years, participants of the Polish part of the Health, Alcohol, and Psychosocial factors In Eastern Europe (HAPIEE) Project, who provided valid measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) using a Micro-Medical Microplus spirometer. The prevalence of CVD risk factors was defined as follows: hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking hypertension medication), diabetes (glucose ≥ 7.1 mmol/L or self-reported diabetes), and hypercholesterolaemia (total cholesterol ≥ 5 mmol/L or low-density lipoprotein-cholesterol ≥ 3 mmol/L or taking lipid lowering medication). Categories of total CVD risk were defined according to the 2016 European Guidelines on CVD prevention in clinical practice. The analysis of covariance was used to compare the lung function in the CVD risk factors and the total CVD risk categories. RESULTS: Mean values of FEV1 and FVC, adjusted for age and height, were significantly higher in men than in women (3.02 L; 95% confidence interval [CI] 2.96-3.08 L vs. 2.52 L; 95% CI 2.45-2.63 L for FEV1 and 3.62 L; 95% CI 3.56-3.69 L vs. 3.05 L; 95% CI 2.98-3.12 L for FVC). Obesity was significantly associated with FVC in men and women; it was associated with FEV1 only in men. Compared with participants with normal body mass index, obese men and women had 280 mL and 112 mL lower mean FVC, respectively. Men without hypertension had almost 100 mL higher mean FVC than those with hypertension. The difference in FVC in women was approximately 80 mL. Diabetes was associated with lower values of FVC in both sexes and with FEV1 in women. A significant negative trend was observed in the mean FVC and FEV1 by the considered CVD risk categories. CONCLUSIONS: Impaired lung function was associated with higher CVD risk, which could be explained partly by an adverse association between lung function and prevalence of obesity, hypertension, and diabetes.