Registered incidence of acute upper respiratory tract infections diagnosed by primary care physicians in Poland - 5-year retrospective analysis of the national health insurance database.

INTRODUCTION AND OBJECTIVE: Upper respiratory tract infection (URTIs), caused by a variety of viruses and sometimes by bacteria, represents the most common acute illness in primary health care. The aim of the study was to explore the registered incidence of URTIs in Poland in the period between 2015-2019, and its burden on the health care system. MATERIAL AND METHODS: A retrospective analysis was carried out of all medical encounters in Poland registered within the national billing database of public healthcare services. Medical services provided due to acute URTIs were classified according to the ICD-10 codes. Registered Incidence Rate (RIR) was calculated yearly, in a 100,000 population. A generalised additive model was used to calculate the Incidence Rate Ratio (IRR). RESULTS: In the analysed 5-year period, acute URTI was diagnosed in 24.3 million patients (61.7% of the whole population registered in PHC). The RIR of all acute URTIs in PHC was 50,762/100,000/year. Nearly 99% of consultations in this group of patients were provided by PHC physicians. Only 0.8% were referred to an OSC consultation and 0.4% were hospitalised. In PHC, indeterminate URTIs were most frequently diagnosed. The estimated IRR for children aged 1-4 years was 1.65 (95% CI: 1.64; 1.66, p<0.01) and for men 0.79 (95% CI: 0.79; 0.79; p<0.01). In the studied period, the number of patients consulted for acute URTI decreased slightly in PHC, but significantly in specialist services. CONCLUSIONS: The registered incidence of URTIs in Poland burdens mainly PHC physicians. Women and children aged 1-4 years are more frequent users of medical services related to URTIs. It appears that strategies for increasing patient empowerment to provide efficient self-care reducing the utilisation of PHC services are needed.

Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe.

BACKGROUND: Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing. OBJECTIVES: To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD). METHODS: The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings. RESULTS: Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors. CONCLUSION: Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.

Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19.Periodontal treatment for optimal outcomes improves diabetes outcomes and surrogate measures of cardiovascular risk.Closer collaboration between oral health care professionals and family doctors is important in the early case detection and management of non-communicable diseases.Information on the reported associations should be made available to family doctors, oral health professionals, healthcare funders, patients, and the general population.

Association of body mass index and long-term mortality in patients from nationwide LIPIDOGRAM 2004-2015 cohort studies: no obesity paradox?

BACKGROUND: An obesity paradox has been described in relation to adverse clinical outcomes (e.g., mortality) with lower body mass index (BMI). AIMS: We sought to evaluate the association between BMI and weight loss with long-term all-cause mortality in adult populations under the care of family physicians. METHODS: LIPIDOGRAM studies were conducted in primary care in Poland in 2004, 2006, and 2015 and enrolled a total of 45,615 patients. The LIPIDOGRAM Plus study included 1627 patients recruited in the LIPIDOGRAM 2004 and repeated measurements in 2006 edition. Patients were classified by BMI categories as underweight, normal weight, overweight and class I, II, or III (obesity). Follow-up data up to December 2021 were obtained from the Central Statistical Office. Differences in all-cause mortality were analyzed using Kaplan‒Meier and Cox regression analyses. RESULTS: Of 45,615 patients, 10,987 (24.1%) were normal weight, 320 (0.7%) were underweight, 19,134 (41.9%) were overweight, and 15,174 (33.2%) lived with obesity. Follow-up was available for 44,620 patients (97.8%, median duration 15.3 years, 61.7% females). In the crude analysis, long-term all-cause mortality was lowest for the normal-weight group (14%) compared with other categories. After adjusting for comorbidities, the highest risk of death was observed for the class III obesity and underweight categories (hazard ratio, HR 1.79, 95% CI [1.55-2.05] and HR 1.57, 95% CI [1.22-2.04]), respectively. The LIPIDOGRAM Plus analysis revealed that a decrease in body weight (by 5 and 10%) over 2 years was associated with a significantly increased risk of death during long-term follow-up-HR 1.45 (95% CI 1.05-2.02, p = 0.03) and HR 1.67 (95% CI 1.02-2.74, p < 0.001). Patients who experienced weight loss were older and more burdened with comorbidities. CONCLUSIONS: Being underweight, overweight or obese is associated with a higher mortality risk in a population of patients in primary care. Patients who lost weight were older and more burdened with cardiometabolic diseases, which may suggest unintentional weight loss, and were at higher risk of death in the long-term follow-up. In nonsmoking patients without comorbidities, the lowest mortality was observed in those with a BMI < 25 kg/m2, and no U-curve relationship was observed.

Serum antinuclear autoantibodies are associated with measures of oxidative stress and lifestyle factors: analysis of LIPIDOGRAM2015 and LIPIDOGEN2015 studies.

Introduction: Oxidative stress is one of many factors suspected to promote antinuclear autoantibody (ANA) formation. Reactive oxygen species can induce changes in the antigenic structure of macromolecules, causing the immune system to treat them as "neo-antigens" and start production of autoantibodies. This study was designed to evaluate the relationship between oxidative stress markers, lifestyle factors and the detection of ANA. Material and methods: We examined measures of oxidative stress indices of free-radical damage to lipids and proteins, such as total oxidant status (TOS), concentration of protein thiol groups (PSH), and malondialdehyde (MDA), activity of superoxide dismutase (SOD) in 1731 serum samples. The parameters of the non-enzymatic antioxidant system, such as total antioxidant status (TAS) and uric acid (UA) concentration, were also measured and the oxidative stress index (OSI-index) was calculated. All samples were tested for the presence of ANA using an indirect immunofluorescence assay (IIFA). Results: The presence of ANA in women was associated with lower physical activity (p = 0.036), less frequent smoking (p = 0.007) and drinking of alcohol (p = 0.024) accompanied by significant changes in SOD isoenzymes activity (p < 0.001) and a higher uric acid (UA) concentration (p < 0.001). In ANA positive males we observed lower concentrations of PSH (p = 0.046) and increased concentrations of MDA (p = 0.047). Conclusions: The results indicate that local oxidative stress may be associated with increased probability of ANA formation in a sex-specific manner.

Expert opinion of the Heart Failure Association of the Polish Society of Cardiology, the College of Family Physicians in Poland, and the Polish Society of Family Medicine on the peri discharge management of patients with heart failure.

Despite advances in the treatment of heart failure (HF), the rate of hospitalisation for exacerbations of the disease remains high. One of the underlying reasons is that recommended guidelines for the management of HF are still too rarely followed in daily practice. Disease exacerbation requiring inpatient treatment is always afactor that worsens the prognosis, and thus signals disease progression. This is also akey moment when therapy should be modified for HF exacerbation, or initiated in the case of newly diagnosed disease. Inpatient treatment and the peri­discharge period is the time when the aetiology and mechanism of HF decompensation should be established. Therapy should be individualised based on aetiology, HF phenotype, and comorbidities; it should take into account the possibilities of modern treatment. According to the recommendations of the European Society of Cardiology (ESC), patients with HF should receive multidisciplinary management. Cooperation between the various members of the multidisciplinary team taking care of patients with HF improves the efficiency and quality of treatment. This document expands and details the information on the peri­discharge management of HF contained in the 2021 ESC guidelines and the 2022 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guidelines.

The influence of architecture, design and physical environment in residential buildings on cardiovascular disease - rationale and protocol for an overview of systematic reviews.

Introduction and Objective. Architecture and design solutions profile the environment and living conditions in residential housing and may have an impact on health. The aim of the study was to summarise all published systematic reviews (SRs) with or without meta-analysis (MAs), which assess the effect on cardiovascular disease (CVD) of the architecture, design and physical environment in residential buildings. Materials and method. This study presents the rationale and protocol of an overview of SRs. It was prepared according to Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). Four bibliographical databases will be searched. Eligible SRs can include RCTs, quasi-RCTs and observational studies. Results and Summery. The expected results of the completed overview of SRs will comprehensively summarise evidence concerning the influence of residential environment on cardiovascular health. This might be of importance to physicians, architects, public health professionals and politicians.

Metabolic syndrome is associated with similar long-term prognosis in those living with and without obesity: an analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 studies.

AIMS: We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. METHODS AND RESULTS: The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006, and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS, and obese patients with MetS. Differences in all-cause mortality were analysed using Kaplan-Meier and Cox regression analyses. A total of 45 615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14 202 (31%) by NCEP/ATP III criteria and 17 216 (37.7%) by JIS criteria. Follow-up was available for 44 620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese {hazard ratio, HR: 1.88 [95% confidence interval (CI) 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively} and non-obese individuals [HR: 2.11 (95% CI 1.85-2.40) and 1.7 (95% CI 1.56-1.85) according to NCEP/ATP III and JIS criteria, respectively]. Obese patients without MetS had a higher mortality risk than non-obese patients without MetS [HR: 1.16 (95% CI 1.10-1.23) and HR: 1.22 (95% CI 1.15-1.30), respectively in subgroups with NCEP/ATP III and JIS criteria applied]. CONCLUSIONS: MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS, obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised.

Metabolic syndrome (MetS) is used to describe a constellation of metabolic disturbances such as elevated blood glucose, increased levels of triglycerides and decreased level of high density lipoprotein cholesterol. They are often accompanied by elevated blood pressure and central obesity, defined as increased waist circumference. Usually, those metabolic disturbances occur in obese individuals, but sometimes, they can also occur in lean subjects. This relatively recent concept is often referred to as lean MetS. A key conclusion from our paper is that MetS, when it occurs in lean patients, is associated with similarly unfavourable long-term prognosis as in obese patients. Additionally, our analysis shows that lean patients with MetS are less often treated with lipid-lowering drugs despite having higher low density lipoprotein cholesterol levels (LDL-C). An additional finding, which is important from a public health perspective, is that obese patients who do not fulfil MetS criteria have higher long-term all-cause mortality than their lean counterparts without MetS. This finding should be an argument to encourage maintenance of normal body weight.

Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe).

AIM: To explore the implications for dentists and family doctors of the association between periodontal and systemic diseases and the role of dentists and family doctors in managing non-communicable diseases (NCDs) and promoting healthy lifestyles. MATERIALS AND METHODS: The consensus reports of the previous Focused Workshops on the associations between periodontitis and diabetes (2017) and periodontitis and cardiovascular diseases (2019) formed the technical reviews to underpin discussions on both topics. For the association with respiratory diseases, a systematic review was specifically commissioned for the Workshop discussions. Working groups prepared proposals independently, and then the proposals were discussed and approved at plenary meetings. RESULTS: Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea and COVID-19 complications. Dentists and family doctors should collaborate in managing NCDs, implementing strategies for early detection of periodontitis in primary care centres and of cardiovascular diseases or diabetes in dental settings. Family doctors should be informed about periodontal diseases and their consequences, and oral health professionals (OHPs) should be informed about the relevance of NCDs and the associated risk factors. CONCLUSIONS: Closer collaboration between OHPs and family doctors is important in the early detection and management of NCDs and in promoting healthy lifestyles. Pathways for early case detection of periodontitis in family medicine practices and of NCDs in dental practices should be developed and evaluated.

Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries.

This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.

The reliability of patient blood pressure self-assessments - a cross-sectional study.

OBJECTIVE: Home blood pressure monitoring (HBPM) is an increasingly important tool in managing hypertension (HTN); however, its efficacy depends on its accuracy. This study aimed to explore the differences between blood pressure (BP) measurements conducted by patients and medical professionals and the patient demographic factors correlating with inaccurate self-measured BP levels. METHODS: One hundred hypertensive patients completed a questionnaire inquiring about their health status and HBPM procedures and were filmed while measuring their BP using their own devices. A researcher then measured the patients' BP using a calibrated sphygmomanometer to assess the accuracy of patient-performed readings. This cross-sectional study was conducted in five primary healthcare centers in Kraków, Poland. RESULTS: The mean differences in systolic and diastolic BP readings by patients and researchers were 8.36 mmHg (SD = 10.90 mmHg) and 2.16 mmHg (SD = 9.12 mmHg), respectively. Inaccuracies in patient BP measurements were associated with a less than high school education level, patients' age, and a family history of HTN. CONCLUSION: Patient self-measured BP levels were higher than researcher values, likely due to a higher patient error rate. Healthcare providers must increase training regarding correct HBPM techniques offered to patients; such efforts should be directed at all hypertensive patients, emphasizing the most error-prone demographics.

Diagnosis and Treatment of Lower Extremity Arterial Disease-A Survey among Family Medicine Trainees in Poland.

Guidelines point to the ankle-brachial index (ABI) as a non-invasive tool for the initial diagnosis of lower extremity artery disease (LEAD). Questions have been raised whether primary practices should perform ABI. An online questionnaire was distributed among family medicine trainees in two academic centers in Poland. The questionnaire aimed to establish their knowledge about LEAD management and their opinion on the usefulness of ABI measurement and other LEAD diagnostic methods in primary care. ABI measurement was found either very or moderately useful in LEAD diagnosis by 94.5% of the respondents. Among the three most important elements of LEAD management, lifestyle changes, secondary prevention of atherosclerosis and exercise treatment were chosen, respectively, by 98.6%, 83.6% and 72.6% of them. ABI was seen as a useful diagnostic method at the primary care by 74% of the participants; however, 82.2% of them do not have access to ABI measurement in their workplace. The residents have good knowledge of the diagnostic methods of LEAD and consider ABI measurement as useful in LEAD diagnosis. However, most of them do not have access to ABI measurements in their clinical practices. Future discussion and potential financial changes will be needed for the introduction of ABI measurements into Polish primary care.

COVID-19 vaccine short-term adverse events in the real-life family practice in Krakow, Poland.

BACKGROUND: In manufacturers' trials, vaccination against COVID-19 proved to be safe and effective. The officially reported frequency of vaccine adverse events (VAEs) in Poland is lower than that declared by the manufacturers. The anti-vaccination activists questioned the trustworthiness of official data. OBJECTIVES: The aim was to explore the real-life prevalence of VAEs in general practice settings and the factors that may influence it. METHODS: In this pragmatic, mixed prospective and retrospective study, patients vaccinated against COVID-19 between May and October 2021 in three GP practices in Krakow, Poland, were enrolled. Their demographic (age, sex, level of education) and clinical data (weight and height, smoking status, history of allergies, COVID-19 and chronic diseases) were collected. Then, they were interviewed about VAEs they experienced. RESULTS: Out of 1530 patients invited to participate, 1051 (69%) agreed and were eligible for analyses. Only 8.8% did not report any VAE. Pain at the injection site was the most frequently reported reaction (800, 76.2%). The most prevalent systemic ones were excessive fatigue/lethargy (527, 50.6%), sleep/circadian rhythm disturbances (433, 41.6%) and headache (399, 38.3%). Fifty required medical assistance - 39 experienced presyncope (3.7%) and 11 loss of consciousness (1.1%). Only two others were hospitalised. Females, younger adults, those with higher education and with a history of COVID-19 reported systemic VAEs more frequently, while those who were older and obese were less likely to report local reactions. CONCLUSION: Although more than 90% of patients vaccinated against COVID-19 in general practice settings may experience VAEs, in short-term observation, the vast majority are localised and mild.

The response of primary care practices in rural and urban settings in Poland to the challenges of the COVID-19 pandemic.

INTRODUCTION: In the wake of COVID-19 primary care practices have had to overcome and to adapt to several challenges in providing quality care. An international consortium led by Ghent University, Belgium, set up the PRICOV-19 project to study how primary care practices in 38 countries responded to the new challenges. OBJECTIVE: The aim of the study was to describe how Covid-19 impacted the organisation of primary care practices in rural and urban environments in Poland, including the organisation of patient flows, infection prevention, information processing, and communication. MATERIAL AND METHODS: This is cross-sectional questionnaire-based survey among primary care practices. In Poland, the survey was distributed among primary care practices in 16 Polish regions. 180 practices participated in the study. In the analysis of the data U-Mann Whitney or t-test for independent groups, and Wilcoxon test were used to compare the organisation of care before and since the pandemic. RESULTS: Over two-thirds of practices made considerable changes in their structure due to COVID-19; over three-quarters introduced security procedures for phone registrations, but only a quarter still offered consultations without a prior appointment. The use of video consultation quadrupled, and teleconsultations became almost universal. Rural practices were significantly more likely to offer active care for deprived patient groups. A significant increase in infection prevention measures occurred in both urban and rural practices. CONCLUSIONS: COVID-19 brought challenges that spurred changes to the organisation of primary care practices as they sought to continue offering quality care. Despite these hardships, new opportunities for effective changes to clinical operations and organization have emerged and will benefit global health systems in the face of new crises.

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries.

COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

Associations between myeloperoxidase and paraoxonase-1 and type 2 diabetes in patients with ischemic heart disease.

BACKGROUND: The phrase "dysfunctional high-density lipoprotein" has been developed in the literature to describe the particle which loses its basic role- anti-oxidative and anti-inflammatory activity. In this porcess, the significance of enzymes- pro-oxidant myeloperoxidase (MPO) and antioxidant paraoxonase-1 (PON-1) from the perspective of HDL-C function has been noted. AIMS: The objective of this study was to analyze the associations between two enzymes -MPO and PON-1 and type 2 diabetes (T2DM) in patients with ischemic heart disease (IHD). METHODS: An observational cross-sectional study including 70 patients with IHD of whom 35 had also T2DM, and 35 had no T2DM. Laboratory tests (MPO, PON-1, fasting glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and high-sensitivity C-reactive protein) were performed. RESULTS: The study revealed a significant difference in the serum concentration of the enzymes between patients with IHD with and without T2DM. Our results showed increased MPO concentration levels in diabetic patients. The analysis also revealed that T2DM is independently associated with an increase in MPO levels. Simultaneously, a decrease in PON-1 levels was observed in patients with T2DM. The study also revealed that T2DM is independently associated with a decrease in PON-1 levels. CONCLUSIONS: In patients with type 2 diabetes the profile of enzymes involved in high-density lipoprotein metabolism in patients with IHD is worse than in patients without T2DM. The increase in the levels of MPO, an enzyme with oxidative and atherogenic properties and on a decrease in PON-1 levels, an enzyme with antioxidant and atheroprotective properties is observed.

Practice and System Factors Impact on Infection Prevention and Control in General Practice during COVID-19 across 33 Countries: Results of the PRICOV Cross-Sectional Survey.

Infection prevention and control (IPC) is an evidence-based approach used to reduce the risk of infection transmission within the healthcare environment. Effective IPC practices ensure safe and quality healthcare. The COVID-19 pandemic highlighted the need for enhanced IPC measures and the World Health Organization (WHO) emphasized the need for strict adherence to the basic principles of IPC. This paper aims to describe the IPC strategies implemented in general practice during the COVID-19 pandemic and to identify the factors that impact their adoption. Data were collected by means of an online self-reported questionnaire among general practices. Data from 4466 practices in 33 countries were included in the analysis. Our results showed a notable improvement in IPC during COVID-19 with more practices reporting that staff members never wore nail polish (increased from 34% to 46.2%); more practices reporting that staff never wear a ring/bracelet (increased from 16.1% to 32.3%); and more practices using a cleaning protocol (increased from 54.9% to 72.7%). Practice population size and the practice payment system were key factors related to adoption of a) range of IPC measures including patient flow arrangements and infrastructural elements. An understanding of the interplay between policy, culture, systemic supports, and behavior are necessary to obtain sustained improvement in IPC measures.

Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions.

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.

Design and rationale of a nationwide screening analysis from the LIPIDOGRAM2015 and LIPIDOGEN2015 studies.

Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality throughout the world. The LIPIDOGRAM2015 study was performed to estimate the prevalence of risk factors for atherosclerotic diseases as well as cardiovascular and related disorders in the primary care setting in Poland. The LIPIDOGEN2015 sub-study was designed to include a random cohort of patients in order to analyse parameters related to lipid metabolism, oxidative stress, inflammatory responses, autoimmune disorders, and gene variants that confer susceptibility to cardiometabolic and atherosclerotic diseases. Material and methods: The recruitment was carried out by 438 primary care physicians in Poland. The expected number of patients recruited for the LIPIDOGRAM2015 study was 13,000-14,000 with 13-15% (1700-2000) also participating in the LIPIDOGEN2015 sub-study. Each patient had to complete a questionnaire concerning medical and family history, concomitant diseases, and pharmacotherapy. Anthropometric measurements were performed at the doctor's office. For the LIPIDOGEN2015 sub-study, saliva samples for DNA isolation and blood samples for measurement of glycated haemoglobin, oxidative stress parameters, autoantibody levels, and inflammatory cytokine profile and apolipoprotein profile were collected. Follow-up data will be obtained from the National Health Fund in Poland. Results: The LIPIDOGRAM2015 and LIPIDOGEN2015 study cohort reflects the prevalence of cardiovascular risk factors and concomitant diseases, markers of oxidative stress, the presence of autoantibodies, inflammatory cytokine profile, and apolipoprotein profile, as well as genetic variants potentially conferring susceptibility to cardiometabolic and atherosclerotic diseases. Conclusions: This study presents the prevalence of different CV risk factors, with special emphasis on lipid disorders, and it assesses the relationship between inflammation, oxidative stress, and mutations in genes encoding proteins regulating lipid metabolism, as well as genes conferring susceptibility to cardiovascular, cardiometabolic, and related diseases.