Trends in Mortality Due to Malignant Neoplasms of Female Genital Organs in Poland in the Period 2000-2021-A Population-Based Study

The aim of this study is to assess mortality trends due to malignant neoplasms of female genital organs (MNFGOs) in Poland between 2000 and 2021. For the purpose of the study, the authors used data on all deaths of Polish female inhabitants due to MNFGO between 2000 and 2021, obtained from the Statistics Poland database. The standardised death rates (SDR), potential years of life lost (PYLL), annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Between the years 2000 and 2021, 138,000 women died due to MNFGOs in Poland. Of this number, 54,975 (39.8%) deaths were caused by ovarian cancer, 37,487 (27.2%) by cervix uteri cancer, and 26,231 (19.0%) by corpus uteri cancer. A decrease in mortality due to cervix uteri cancer (APC = -2.4%, p < 0.05) was the most favourable change that occurred in the period 2000-2021, while the least favourable change was an increase in mortality due to corpus uteri cancer for the period 2005-2019 (APC = 5.0%, p < 0.05). SDRs due to ovarian cancer showed a decreasing trend between 2007 and 2021 (APC = -0.5%, p < 0.05). The standardised PYLL index due to cervical cancer was 167.7 per 100,000 women in 2000 and decreased to 75.0 in 2021 (AAPC = -3.7, p < 0.05). The number of lost years of life due to ovarian cancer decreased from 143.8 in 2000 to 109.5 in 2021 (AAPC = -1.3, p < 0.05). High values of death rates due to MNFGO in Poland, compared to other European countries, show that there is a need to promote preventive programmes and continue to monitor changes in mortality.

Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico-Thoracic Regions of the Spine

Background: Cervical spine disorders (CSDs) are a common cause of neck pain. Proper diagnosis is of great importance in planning the management of a patient with neck pain. Hence, the aim of this study is to provide an overview of the clinical pattern of early-stage functional disorders affecting the cervical and cervico-thoracic regions of the spine, considering the age and sex of the subjects. Methods: Two hundred adult volunteers were included in the study. Manual examination of segments C0/C1-Th3/Th4 was performed according to the methodology of the Katenborn-Evjenth manual therapy concept and the spine curvatures were assessed (cervical lordosis and thoracic kyphosis). Results: The most common restricted movement was lateral flexion to the left, and the least disturbed movement were observed in the sagittal plane (flexion and extension). The most affected segment was C7/Th1 (71.5% participants had problems in this segment), and the least affected segment was Th3/Th4 (69.5% participants had no mobility disorders in this segment). The number of disturbed segments did not differ between men and women (p > 0.05), but increased with age (r = 0.14, p = 0.04). Conclusions: Cervical mobility in adult population is frequently restricted. The number of affected segments increased with age and was not sex-dependent.

Correction: Paciej-Gołębiowska et al. Twenty-Year Mortality Trends in Patients with Kidney Disease in Poland with the Use of the Years of Life Lost Measure, 2000-2019. Int. J. Environ. Res. Public Health 2022, 19, 2649

Ilona Kurnatowska and Irena Maniecka-Bryła were not included as authors in the original publication [...].

Mortality Trends due to Falls in the Group of People in Early (65-74 Years) and Late (75+) Old Age in Poland in the Years 2000-2020

The aim of the study was to assess mortality trends due to falls in early (65-74 years) and late (75+) old age groups in Poland in 2000-2020. The study used a database of all deaths due to falls in two age groups. Per 100,000 men in early old age, the crude death rate (CDR) increased from 25.3 in 2000 to 25.9 in 2020. After 2012, a statistically significant decrease was observed (annual percentage change (APC) = -2.3%). Similar trends were noted for standardized death rates (SDR). Among men 75 years and older, the CDR values between the years 2000 and 2005 decreased (APC = -5.9%; p < 0.05), while after 2005, they increased (1.3%; p < 0.05). The SDR value decreased from 160.6 in 2000 to 118.1 in 2020. Among women aged 65-74, the CDRs values between 2000-2020 decreased from 13.9 and 8.2 per 100,000 women. The SDR value decreased from 14.0 to 8.3, respectively (2000-2007: APC = -7.2%; p < 0.05). Among women aged 75+, the CDR value decreased from 151.5 to 111.6 per 100,000 but after 2008, they began to increase (APC = 1.9%; p < 0.05). SDR decreased from 188.9 to 98.0 per 100,000 women. Further research on the mortality in falls is needed in order to implement preventive programs.

Changes in mortality of Polish residents in the early and late old age due to main causes of death from 2000 to 2019

Purpose

The aim of the study was to assess mortality trends in Poland between 2000 and 2019 in the early and late old age population (65-74 years and over 75 years).

Methods

The work used data on all deaths of Polish residents aged over 65 years (N = 5,496,970). The analysis included the five most common major groups of causes of death: diseases of the circulatory system, malignant neoplasms, diseases of the respiratory system, diseases of the digestive system and external causes of mortality. The analysis of time trends has been carried out with the use of joinpoint models. The Annual Percentage Change (APC) for each segments of broken lines, the Average Annual Percentage Change (AAPC) for the whole study period (95% CI), and standardized death rates (SDRs) were calculated.

Results

The percentage of deaths due to diseases of the circulatory system decreased in all the studied subgroups. Among malignant neoplasms, lung and bronchus cancers accounted for the largest percentage of deaths, for which the SDRs among men decreased, while those among women increased. In the early old age, the SDR value increased from 67.8 to 76.3 (AAPC = 0.6%, p > 0.05), while in the late old age group it increased from 112.1 to 155.2 (AAPC = 1.8%, p < 0.05). Among men, there was an upward trend for prostate cancer (AAPC = 0.4% in the early old age group and AAPC = 0.6% in the late old age group, p > 0.05) and a downward trend for stomach cancer (AAPC -3.2 and -2.7%, respectively, p < 0.05). Stomach cancer also showed a decreasing trend among women (AAPC -3.2 and -3.6%, p < 0.05). SDRs due to influenza and pneumonia were increasing. Increasing trends in mortality due to diseases of the digestive system in women and men in the early old age group have been observed in recent years, due to alcoholic liver disease. Among the external causes of mortality in the late old age group, the most common ones were falls.

Conclusions

It is necessary to conduct further research that will allow to diagnose risk and health problems of the elderly subpopulation in order to meet the health burden of the aging society.

The Burden of Suicide Mortality in Poland: A 20-Year Register-Based Study (2000-2019)

Objectives: The aim of the study was to assess mortality trends due to suicide in Poland in the years 2000-2019 with the use of joinpoint regression. Methods: The study analysed all suicide deaths in Poland in the years 2000-2019 (N = 113,355). Age-standardised death rates (SDRs), the annual percentage change (APC) and the average annual percentage change (AAPC) were determined. Results: In the male group, SDR was 29.3 in 2000 and 21.6 in 2019, in the female group, SDR decreased from 5.2 to 3.0. In 2019, the highest SDR values were noted in the group aged between 45 and 64 years. The most common method of suicide was hanging. In 2019, odds ratios (OR) of death due to suicide for age groups 15-24 years vs. 65 years or above were 51.47 among men and 181.89 among women. With regards to primary vs. tertiary education, OR values were 1.08 and 0.25, respectively; for single vs. widowed individuals 8.22 and 12.35; while for rural vs. urban residents 1.60 and 1.15. Conclusion: There is a need to implement educational programmes, primarily designed for young people.

Mortality Trends Due to Skin Melanoma in Poland in the Years 2000-2020

The aim of this article is to assess mortality trends due to skin melanoma in Poland between the years 2000 and 2020, taking into account gender and place of residence (urban, rural). The subject of the analyses was data on 25,061 deaths that occurred between 2000 and 2020 due to skin melanoma (C43 according to ICD-10). Mortality rates due to this cancer, both crude (CDR) and standardised (SDR), were calculated. Trends on the calculated rates were analysed using the annual percentage change (APC) and average annual percentage change (AAPC), obtained from joinpoint regression models. Over the study period, the standardised death rate (SDR) due to skin melanoma in Poland increased from 3.60 to 4.03 per 100,000 population (AAPC = 1.1; p < 0.05), for urban residents it increased from 3.56 to 3.91 (APC = 1.2; p < 0.05) and for rural residents it increased from 3.00 to 4.24 (APC = 2.2; p < 0.05). A higher growth rate in terms of the SDR value between the years 2000 and 2020 was recorded in men compared to women and in rural when compared to urban residents. In Poland, mortality due to skin melanoma is on the rise. The early diagnosis of this cancer should become common practice in the Polish population.

Excess mortality in Poland during the first and second wave of the COVID-19 pandemic in 2020

Purpose

The aim of the study was to analyse excess deaths by major causes of death and associated changes in the mortality pattern of the Polish population in 2020 due to the impact of the COVID-19 pandemic.

Methods

The study used data on all deaths in Poland which occurred between 2010 and 2020 (N = 3,912,237). 10-year mortality trends for 2010-2019 were determined. An analysis of time trends has been carried out with joinpoint models and Joinpoint Regression Program. Based on the determined regression models, the number of deaths expected in 2020 and the number of excess deaths due to selected causes were calculated.

Results

The crude death rates of all-cause deaths increased from 2000 to 2019 at an average annual rate of 1% (p = 0.0007). The determined regression model revealed that the number of deaths in 2020 should have been 413,318 (95% CI: 411,252 to 415,385). In reality, 477,355 people died in Poland that year. The number of excess deaths was therefore 64,037 (15.5%). According to data from Statistics Poland the number of COVID-19-related deaths was 40,028, the number of non-COVID-19 deaths was 24,009. The largest percentage increase over the expected number of deaths was observed for suicide (12.5%), mental and behavioral disorders (7.2%) and diseases of circulatory system (5.9%). A lower than expected number of deaths was observed for malignant neoplasms (-3.2%) and transport accidents (-0.1%).

Conclusion

The difference between expected and observed non-COVID-19 deaths in 2020 indicates a need for further analysis of the causes of excess mortality.

Excess mortality during the coronavirus pandemic (COVID-19) in Poland

 

The COVID-19 pandemic, has begun a global changes in the mortality model, exceeding its predicted levels under standard conditions. The aim of the study was to assess the phenomenon of excess mortality in Poland in 2020 and in the first half of 2021 compared to 2016-2019 based on the data of the Central Statistical Office. The number of excess deaths was defined as the difference between the deaths in 2021 and the average number of deaths in the previous years. In accordance with the Eurostat methodology the 2016-2019 average was taken as the reference point. In 2020, the number of deaths in Poland amounted to 485,259 and was higher by 14.9% than expected on the basis of mortality in 2016-2019 (the absolute excess number of deaths amounted to 67,112). 43% of the excess deaths were deaths caused by Sars-Cov-2, 27% other deaths among infected people, and 30% deaths among those without confirmed infection. In this group, the highest increases were recorded for deaths due to cardiovascular diseases, neurological diseases and mental disorders. In the first half of 2021, 270,662 people died in Poland, i.e. 23.9% more than in the corresponding period in 2016-2019 and 22.9% more than in the first half of 2020, whereas 58,096 people died due to COVID-19 (22% of all deaths). The highest increases for non-viral deaths compared to 2016-2019 were recorded for blood diseases and immune mechanisms (121.53%), infectious and parasitic diseases (90.76%), mental disorders (34.93%) and cardiovascular diseases (11.65%). Excess mortality is a very serious problem of the public health. The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for the majority of the observed increases in mortality. However, attention should be paid to the growth in mortality related to other causes, mainly mental disorders, for which mortality increases most rapidly, which requires immediate action.

Key messages

• The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for approximately 90% of the observed increases in mortality in Poland.

• In the group of no-related with COVID-19 deaths the highest increases were recorded for mortality due to cardiovascular diseases, neurological diseases and mental disorders.

Twenty-Year Mortality Trends in Patients with Kidney Disease in Poland with the Use of the Years of Life Lost Measure, 2000-2019

Due to the significant socioeconomic burden of kidney diseases, we decided to analyse years of life lost (YLLs) from this cause in Poland between the years 2000 and 2019. The standard expected years of life lost (SEYLL) measure was used to calculate the number of YLLs, the value of which was related to the size of the study population and calculated per 100,000 persons (SEYLLp). A time trend analysis was performed using the Joinpoint regression method. In 2000, the number of YLLs for the entire population was 72,795 (SEYLLp = 190.3 years). After a period of minor changes between 2000 and 2011 (increasing at 0.9% per year), the YLL index rapidly declined between 2011 and 2015 (at −15.4% yearly) and then increased in the last years of the study period (at 12.5% yearly). These changes resulted in a decrease in the number of YLLs to 57,278 in 2019 (SEYLLp = 149.2). The deteriorating health status of Poles after 2015 most likely was caused by the aging of the population, as well as the increasing incidence of risk factors, in particular diabetes and arterial hypertension.

Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis

The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was -4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was -4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.

Years of life lost due to viral hepatitis in Poland, 2000-2014

INTRODUCTION

Viral hepatitis often affects young people; it therefore seems reasonable to analyze the phenomenon of premature mortality due to this reason, using Years of Life Lost (YLLs) measurement.

OBJECTIVE

The aim of the study was to analyze YLLs due to viral hepatitis in Poland in 2000-2014. For the years 2002 and 2011, socio-economic variables (marital status, level of education, working status, place of residence) were included.

MATERIAL AND METHODS

The research material was a database containing information from 5,601,568 death certificates of Polish citizens from 2000-2014. The data on deaths caused by viral hepatitis, i.e. coded as B15-B19 according to the ICD-10, was used for the analysis. The Standard Expected Years of Life Lost measure was used to calculate YLLs. Analysis of time trends was performed with the linear regression method using the joinpoint model.

RESULTS

In the studied period, 3.628 deaths of Polish citizens were caused by viral hepatitis (0.06% of all deaths), which translated to 92,845.70 YLLs (16.17 years per 100,000 inhabitants). The number of YLLs increased over time (p<0.05), reaching its highest value in the last analyzed year - 22.14 years per 100,000. The YLLs average per one death was 25.59 years. Among the risk group there were individuals living in urban areas, divorced/separated, with lower than secondary education, and economically inactive.

CONCLUSIONS

Despite the fact that Poland belongs to a group of countries with low mortality due to viral hepatitis, this disease is a serious social problem as measured with YLLs. The study provides the basis for policymakers to implement more effective methods to prevent premature deaths caused by this disease.

Informal Dementia Caregivers: Current Technology Use and Acceptance of Technology in Care

(1) Background: Given the increased social isolation caused by the COVID-19 pandemic, the challenges faced by informal dementia caregivers have increased. An increasing use of technology, both in care and dementia clinical trials, depends upon caregivers' abilities as a user. Accordingly, the aim of our study was to verify the current technology (smartphone and computer) use and acceptance in care, regarding socio-demographic variables; (2) Methods: Questionnaires were distributed to 102 dementia caregivers, mostly of patients with moderate dementia; (3) Results: The majority of participants were women (63%), and large number of them used technological devices such as a smartphone (91%) or computer (81%). Results revealed differences between age, gender, and education level on technology acceptance. Interestingly, smartphone use and acceptance seemed to be feasible, regardless of age, whereas computer use was negatively correlated with age. Technology was perceived by respondents as most useful for patients' activities including locomotion, toileting, and meals; (4) Conclusions: The future of technology use in dementia care should indicate solutions tailored to individual characteristics such as new technology solutions (GPS trackers, smartphone apps, dietary intervention, and meal planning apps).

Ten-year changes in adherence to a healthy lifestyle: the results of the WOBASZ surveys

INTRODUCTION

The evidence on the beneficial role of low‑risk characteristics is well established. However, data on trends in lifestyle patterns in Central Europe are limited.

OBJECTIVES

The aim of this report was to determine changes in lifestyle patterns among adults in Poland between 2003 and 2014.

PATIENTS AND METHODS

The study sample comprised 12 857 adults aged 20 to 74 years (5986 men and 6871 women) participating in 2 nationwide representative surveys, the WOBASZ (2003-2005) and WOBASZ II (2013-2014). Low‑risk characteristics included: nonsmoking, nonobese waist circumference, satisfactory physical activity, good-quality diet, and low saturated fat intake. The 5 characteristics cre‑ ated a lifestyle index ranging from 0 to 5. A poor lifestyle was defined as the lifestyle index from 0 to 1.

RESULTS

About 2% of the participants followed a healthy lifestyle, and 25%, a poor lifestyle in both surveys. The proportion of nonsmokers significantly increased (from 57.8% to 66.9% for men and from 72.6% to 77.1% for women). There was a significant decrease in the prevalence of nonobese waist circumference (from 75.4% to 71.3% among men and from 61.2% to 57.9% among women), adequate physical activity (from 37.5% to 27.5% among men and from 31.5% to 29% among women), and low saturated fat consumption (from 23.4% to 20.2% among men and from 26.1% to 23.7% among women). Lower educational attainment was the strongest sociodemographic factor contributing to a poor lifestyle (P <0.001).

CONCLUSIONS

The ultimate goal for the healthcare system should be to implement more effective interventions focused on promoting healthy lifestyle as a whole.

Effectiveness of the Open Screening Programs in Recruiting Subjects to Prodromal and Mild Alzheimer's Disease Clinical Trials

BACKGROUND AND OBJECTIVES

Due to the lack of scientific data comparing the success and cost-effectiveness of trial recruiting strategies, the main goal of this paper is to present our results and experiences in recruiting participants to prodromal and mild AD clinical trials from an open-access screening program.

DESIGN

The screening procedure includes the interview, and combined tests administration conducted by experienced neuropsychologist: Mini-Mental State Examination (MMSE) and Auditory-Verbal Learning Test (AVLT). The clinical evaluation was based on test scores, patient and/or caregiver interview, and the health questionnaire.

SETTINGS AND PARTICIPANTS

The open-access screening program was conducted in Wroclaw Alzheimer's Center for 18 months (2018-2019). We invited individuals age 50 or older with the caregivers. The total number of subjects was 730 (N=730).

MEASUREMENTS AND RESULTS

Due to our research, the detection rates in the screened population were 0,7% for severe dementia, 4,1% for moderate dementia, 18,6% for mild dementia, and 28,9% for mild cognitive impairment (MCI). From 347 individuals classified in our open-access screening programs as MCI or mild dementia patients, as many as 248 patients were screened in Alzheimer's disease clinical trials, which is 71,47%. Moreover, 63 from 347 individuals selected from our program as MCI or mild dementia patients were randomized into the clinical trials, which is 18,16%. Furthermore, 63 from total 730 (8,6%) patients were randomized in clinical trials.

CONCLUSIONS

Open-access screening programs can improve detection of MCI and dementia in society, help to distinguish demented from non-demented elderly, and improve recruitment of prodromal AD patients who would probably not have come to the memory clinic otherwise.

Years of life lost due to malignant neoplasms of the digestive system in Poland during 10 years of socioeconomic transformation

The aim of the study was to analyse years of life lost due to selected malignant neoplasms of the digestive system (colorectum, stomach, and pancreas) in Poland, a post-communist country in Central Europe, according to socioeconomic variables: sex, age, level of education, marital status, working status, and place of residence. The study included a dataset comprising death certificates of Polish citizens from 2002 (N = 359 486) and 2011 (N = 375 501). The data on deaths caused by malignant neoplasms of the digestive system, that is, coded as C15-C26 according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was analyzed. The standard expected years of life lost meter was used to calculate years of life lost. In 2002, malignant neoplasms of the digestive system caused 25 024 deaths among Polish citizens (7.0% of all deaths), which translated into a premature loss of 494 442.1 years of life (129.4 years per 10 000 people). In 2011, the number of deaths increased to 26 537 (7.1% of all deaths) and the number of years of life lost rose to 499 804.0 (129.7 years per 10 000). The most important causes of mortality and years of life lost were colorectal, stomach, and pancreatic cancers. In both studied years, the socioeconomic features with an adverse effect on years of life lost due to each considered malignant neoplasm of the digestive system included male gender, lower than secondary education, widowed marital status, economic inactivity, living in urban areas. Years of life lost analysis constitutes a valuable part of epidemiological assessment of health inequalities in society. It appears that the observed inequalities may have many causes; however, further research is needed to better understand their full extent.

Changes in mortality and years of life lost due to lung cancer in Poland, 2000-2016

BACKGROUND

The aim of the study was to evaluate trends of mortality and the number of years of life lost due to lung cancer in Poland, in the period 2000-2016.

METHODS

The study material was 375,151 death certificates of all inhabitants of Poland who died in the period 2000-2016 due to lung cancer. In order to calculate the number of years of life lost, the authors used indices: SEYLL_p (Standard Expected Years of Life Lost per living person), SEYLL_d (per deaths), APC (Annual Percentage Change) and AAPC (Average Annual Percentage Change).

RESULTS

The standardized death rate (SDR) due to lung cancer decreased in the analyzed period from 74.5 to 68.3 per 100,000 population (AAPC = -0.6%). The most rapid decrease was noted in the years 2008-2011 (APC = -2.2%). With regards to males, SDR decreased from 148.8 to 114.5 (AAPC = -1.7%), whereas in females, it increased from 25.7 to 37.6 (AAPC = 2.3%). The SEYLL_p index, calculated per 100,000 inhabitants, increased from 1189.9 in the year 2000 to 1250.5 in the year 2016. The trend and pace of changes fluctuated. In 2000-2008, the SEYLL_p index was increasing at a pace of 0.7%. This growth was followed by a decrease at a pace of -1.2%, noted in 2008-2011. After the year 2011, the indices started to grow at an annual pace of 0.4%. AAPC in the whole study period was 0.3%. Increased mortality in females was responsible for the increase in the number of lost years of life. SEYLL_p values in this sex group increased from 464.8 in the year 2000 to 774.7 in the year 2016 (APC = 3.3%).With regards to males, SEYLL_p values, calculated for 100,000 male population, decreased in the analyzed period from 1961.1 to 1758.3.

CONCLUSIONS

Lung cancer still poses a serious epidemiological problem in Poland and the number of years of life lost due to this cause reflects social and economic implications of premature lung cancer-related mortality. There is a great need to educate, particularly women, and show effective ways of quitting smoking.

[Trends in excess male mortality in the working age population in a region with the highest mortality rates in Poland]

BACKGROUND

The intensity of premature deaths in the Łódź region in 2014 amounted to 40 per 10 000, and was the highest in the country (the average rate for Poland was 32). Excess mortality of men aged <65 continues to be a major medical and social problem. The aim of the study is to analyze time trends of excess male mortality in the working age population in the Łódź region, both in general and due to the most important causes of deaths.

MATERIAL AND METHODS

The research material consists of information on 144 589 deaths of the Łódź region inhabitants aged 20-64 in 1999-2014. Crude and standardized mortality rates were calculated, as well as excess male mortality rates both in general and by cause of death. Standardization was carried out using the direct method according to the standard European population. A study of time trends was performed with the use of the joinpoint regression analysis. Average annual percentage rates of changes were estimated.

RESULTS

The excess mortality rate of men at the productive age decreased from 2.9 to 2.8 in the Łódź region in 1999-2014. The most important causes of death among men aged 20-64 in 2014 were (rates per 10 000): cardiovascular diseases (19.1), malignant neoplasms (16.6) and external causes of death (12.3). Among women, the most significant were malignant neoplasms (11.1), cardiovascular diseases (5.1) and diseases of the digestive system (2.1). The excess mortality rate of men aged 20-64 in the analyzed period reached the highest values due to external causes of death (5.1-7.3) and cardiovascular diseases (3.0-3.7). The highest rate of the decline in excess male mortality in 1999-2014 was recorded due to malignant neoplasms, on average 1.4% per year (p < 0.05). Meanwhile, the fastest growth concerned external causes of death, on average 1.0% per year (p < 0.05).

CONCLUSIONS

Despite the decline in the mortality rates among both sexes, excess male mortality due to external causes of death and cardiovascular diseases increased. Med Pr. 2020;71(3):325-35.

Trends of mortality due to breast cancer in Poland, 2000-2016

Background

The aim of the study was to assess trends in mortality and the number of lost years of life due to breast cancer in the female population in the years 2000–2016, with consideration given to differences regarding the level of education and place of residence.

Methods

The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 92,154 death certificates of all Polish female inhabitants who died in the period 2000–2016 due to breast cancer. The SEYLL_p (Standard Expected Years of Life Lost per living person), the SEYLL_d (per deaths), the APC (Annual Percentage Change), the AAPC (Average Annual Percentage Change) were calculated to determine years of life lost.

Results

The mean age of women who died from breast cancer increased in the study period from 64.7 years to 69.7. The SEYLL_p index (per 100,000) increased to 776.8 years in 2016 (AAPC = 0.5%). The most unfavorable changes were observed in the group of women with secondary education. In 2004, the SEYLL_p values started to grow at a rate of 2.3% and since 2011, they have been higher than amongst women with elementary education. In the years 2000–2016, the authors observed that SEYLL_p was steadily declining (APC = -1.0%) in the group of inhabitants of rural areas, whereas with regards to city dwellers, the SEYLL_p index has been increasing since 2004 (APC = 0.5%), which has resulted in increased disproportions regarding the place of residence.

Conclusions

The results of this study showed that breast cancer is becoming a serious epidemiological problem in Poland. There is the need to intensify activities among women at highest risk group and it should be the starting point for making key decision in combating breast cancer.

Vitamin D - dietary intake, supplementation and metabolic status of Polish adults

OBJECTIVES

Contrary to popular opinion on the preventive properties of vitamin D, results of previous studies have been inconclusive. The aim of this research was to evaluate the associations between the intake of vitamin D and metabolic abnormalities in a representative sample of Polish adults.

MATERIAL AND METHODS

Within the framework of the Multi-Center National Population Health Examination Survey (referred to as WOBASZ), a random sample of 2381 adult residents of Poland (53.8% of whom were women) was examined. All the study subjects were extensively reviewed, including 24-h dietary recall. The intake of vitamin D was assessed on the basis of dietary and supplements reviews. Metabolic abnormalities were evaluated using measurements of waist circumference (WC), blood pressure (BP), serum triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and fasting glycemia. Metabolic syndrome was defined according to the International Diabetes Federation.

RESULTS

Of all the study participants, about 4.4 % of women and 2.6% of men declared a regular supplementation of vitamin D. Among women, a significant inverse correlation between vitamin D supplementation and the mean systolic BP was found (p < 0.01). A more substantial relationship was noted after dividing the study subjects according to their body mass. Among obese men, there was a significant inverse relationship between vitamin D intake and the mean systolic BP (p < 0.01) and diastolic BP (p < 0.05), as well as a positive correlation with HDL-C (p < 0.05). Among obese women, a negative correlation was found between vitamin D supplementation and the mean systolic BP (p < 0.01) and diastolic BP (p < 0.05), and a positive correlation with TG (p < 0.05). Among non-obese male subjects, a negative correlation between vitamin D intake and WC was observed.

CONCLUSIONS

The obtained findings suggest that the correlation between vitamin D intake and metabolic abnormalities may depend on the obesity status. A higher vitamin D intake may reduce BP and increase HDL-C in obese subjects. The positive relationship between vitamin D intake and TG concentration in women needs further investigation. Int J Occup Med Environ Health. 2020;33(1):107-18.

Effectiveness of the Open Screening Programs in Recruiting Subjects to Prodromal and Mild Alzheimer's Disease Clinical Trials

BACKGROUND AND OBJECTIVES

Due to the lack of scientific data comparing the success and cost-effectiveness of trial recruiting strategies, the main goal of this paper is to present our results and experiences in recruiting participants to prodromal and mild AD clinical trials from an open-access screening program.

DESIGN

The screening procedure includes the interview, and combined tests administration conducted by experienced neuropsychologist: Mini-Mental State Examination (MMSE) and Auditory-Verbal Learning Test (AVLT). The clinical evaluation was based on test scores, patient and/or caregiver interview, and the health questionnaire.

SETTINGS AND PARTICIPANTS

The open-access screening program was conducted in Wroclaw Alzheimer's Center for 18 months (2018-2019). We invited individuals age 50 or older with the caregivers. The total number of subjects was 730 (N=730).

MEASUREMENTS AND RESULTS

Due to our research, the detection rates in the screened population were 0,7% for severe dementia, 4,1% for moderate dementia, 18,6% for mild dementia, and 28,9% for mild cognitive impairment (MCI). From 347 individuals classified in our open-access screening programs as MCI or mild dementia patients, as many as 248 patients were screened in Alzheimer's disease clinical trials, which is 71,47%. Moreover, 63 from 347 individuals selected from our program as MCI or mild dementia patients were randomized into the clinical trials, which is 18,16%. Furthermore, 63 from total 730 (8,6%) patients were randomized in clinical trials.

CONCLUSIONS

Open-access screening programs can improve detection of MCI and dementia in society, help to distinguish demented from non-demented elderly, and improve recruitment of prodromal AD patients who would probably not have come to the memory clinic otherwise.

Standard Expected Years of Life Lost Due to Malignant Neoplasms in Poland, 2000-2014

The aim of the study was an analysis of mortality trends due to malignant neoplasms in Poland. The study material was a database, consisting of 1,367,364 death certificates of inhabitants of Poland who died during the period 2000-2014 due to malignant cancer. To calculate years of life lost, the SEYLLp index (Standard Expected Years of Life Lost per living person) was applied. We also calculated AAPC (Average Annual Percentage Change). The SEYLLp index (per 10,000 population) due to malignant neoplasms in Poland in males decreased from 586.3 in 2000 to 575.5 in 2014, whereas in females it increased from 398.6 in 2000 to 418.3 in 2014. The greatest number of lost years of life in 2014 was attributed to lung cancer (174.7 per 10,000 males and 77.3 per 10,000 females), breast cancer in females (64.5) and colorectal cancer in males (39.0). The most negative trends were observed for lung cancer in females (AAPC = 3.5%) and for colorectal cancer (AAPC = 1.8%) and prostate cancer (AAPC = 1.6%) in males. Many lost years could have been prevented by including a greater number of Polish inhabitants in screening examinations, mostly targeted at malignant neoplasm, whose incidence is closely connected with modifiable risk factors.

Years of life lost due to diseases of the digestive system in Poland according to socioeconomic factors: a cross-sectional study

OBJECTIVES

To analyse years of life lost (YLLs) due to digestive diseases in Poland according to: marital status, education, working status and place of residence.

DESIGN

A cross-sectional study.

SETTING

The study was based on a dataset containing information from death certificates of Poles who died in 2002 and in 2011.

PARTICIPANTS

The analysis covered records with codes K00-K93 according to the International Classification of Diseases and Related Health Problems, 10th Revision.

OUTCOME MEASURES

YLL values were calculated using the Standard Expected Years of Life Lost measure. For each socioeconomic variable, the rate ratio (RR) was calculated as the quotient of YLLs in the less privileged group to the more privileged group.

RESULTS

Among the categories of marital status, the smallest YLL values (per 10 000) were recorded among singles (men: 100.63 years in 2002, 121.10 years in 2011; women: 26.99, 33.33, respectively), and the most among divorced men (657.87, 689.32) and widowed women (173.97, 169.46). YLL analysis according to education level revealed the lowest values in people with higher education (men: 54.20, 57.66; women: 17.31, 18.31) and the highest in people with lower than secondary education (men: 178.85, 198.32; women: 104.95, 125.76). Being economically active was associated with a smaller YLL score (men: 39.93, 59.51; women: 10.31, 14.96) than being inactive (men: 340.54, 219.93; women: 126.86, 96.80). Urban residents had higher YLL score (men: 159.46, 174.18, women: 73.03, 78.12) than rural ones (men: 126.83, 137.11, women: 57.32, 57.56).In both sexes, RR according to education level and place of residence increased, and those according to marital status and working status decreased with time.

CONCLUSIONS

Activities aimed at reducing health inequalities in terms of YLL due to digestive diseases should be primarily addressed to inhabitants with lower than secondary education, divorced and widowed people, urban residents and those who are economically inactive.

Epidemiology of Mortality Due to Prostate Cancer in Poland, 2000-2015

The aim of the study was to assess trends in mortality and years of life lost due to prostate cancer (PCa) in Poland in 2000–2015. The crude death rates (CDR), standardised death rates (SDR), standard expected years of life lost per living person (SEYLL_p) and per death (SEYLL_d) values were calculated. Joinpoint models were used to analyse time trends. In the study period, 61,928 men died of PCa. The values of mortality rates in 2000 (per 100,000) were: CDR = 16.97, SDR = 16.17, SEYLL_p = 332.1. In 2015, the values of all rates increased: CDR = 26.22, SDR = 16.69, SEYLL_p = 429.5. However, the SEYLL_d value decreased from 15.62 to one man who died due to PCa in 2000 to 13.78 in 2015. The highest SEYLL_p values occurred in the group of men with primary education (619.5 in 2000 and 700.7 in 2015). They were respectively 2.24 and 2.96 times higher than in men with higher education (275.7 and 237.1). SEYLL_p values increased in urban areas (from 295.7 to 449.4), slightly changed in the rural areas (from 391.5 to 400.2). Unfavorable trends in mortality due to PCa in Poland require explanation of the causes and implementation of appropriate actions aimed at mortality reducing.

Years of Life Lost due to Diseases of the Digestive System in Poland in 2000-2014

BACKGROUND AND AIMS

Diseases of the digestive system substantially contribute to premature mortality of the Polish population. Years of Life Lost (YLLs) are more and more commonly used in order to evaluate social and economic aspects of these deaths. The aim of the study was to analyse YLLs due to diseases of the digestive system in Poland between 2000-2014.

METHODS

The study material included a database which contained information gathered from 5,601,568 death certificates of Poles who died between 2000-2014. Data on deaths due to diseases of the digestive system were used for the analysis (i.e. coded as K00-K93 according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Standard Expected Years of Life Lost (SEYLL) was used to calculate YLLs.

RESULTS

In 2000-2014 diseases of the digestive system contributed to 239,176 deaths of Poles (4.3% of all deaths), which corresponded to 5,470,096.8 YLLs (95.2 years per 10,000 population). Each death due to the above cause was responsible for the average loss of 22.9 years. Diseases of the liver, including alcoholic liver disease and fibrosis and cirrhosis of the liver, contributed to the highest number of YLLs (54.1%).

CONCLUSIONS

Of all digestive diseases, the dominant causes of YLLs are alcohol-related liver diseases. In order to minimize this phenomenon, it is important to intensify public health activities, aimed at combating alcohol addiction in Poland.

Years of life lost due to malignant neoplasms of the digestive system in Poland in the years 2000-2014

Background

Every fourth death that occurs in Poland is caused by a malignant neoplasm. A particularly negative epidemiological situation relates to colorectal cancers; in 2015 they constituted the fifth most important cause of years of life lost (YLL) in Poland.

Objective

We aimed to analyse YLL due to malignant neoplasms of the digestive system in Poland in between 2000 and 2014.

Methods

The study material included a database containing information gathered from 5,601,568 death certificates of Poles who died in 2000-2014. YLLs were calculated with the use of the standard expected years of life lost index (SEYLL).

Results

In the 15-year study period, malignant neoplasms of the digestive system contributed to 213,041 deaths in males and 177,644 deaths in females, which corresponded to a loss of 158.6 years per 10,000 men and 105.3 years per 10,000 women. Neoplasms of the large intestine (23.6%), stomach (22.0%) and pancreas (17.4%) contributed the most. A time trend analysis revealed (p < 0.05) a growing tendency of YLLs due to neoplasms of the large intestine and pancreas, and a decreasing trend due to neoplasms of the stomach.

Conclusion

Malignant neoplasms of the digestive system, especially of the large intestine, are becoming a more common cause of premature mortality in Poland.

[Comparison of Cmac vs Vivasight devices in terms of time and effectiveness of intubation among medical students]

While analysing the use of the new videolaryngoscopes in the hands of the well experienced anaesthesiologists it is difficult to get answers to all intriguing questions and gain insights that might arise only from the untrained users. We can form a thesis that if a manikin, with the use of a particular device, is intubated quickly and effectively by the novices, it is probable that the more experienced operators will be even more satisfied with its use.

AIM

The aim of our study was to evaluate the effectiveness of the use of these devices in the hands of the users untrained in intubation. We also wanted to find out what are the subjective perceptions of using the devices by unsuccessful users. We investigated intubation times, effectiveness as well as parameters such as tooth damage. The aim of the secondary and obvious benefit to students was familiarity Them with new advanced methods of clearing the upper respiratory tract with which they will probably meet in the future.

MATERIALS AND METHODS

The study included 104 medical students. Every participant took three attempts to intubate the manikin using each device. The technical parameters of the devices have been studied by the experts from the Lodz University of Technology.

RESULTS

The average time of intubation in the case of the Cmac was 28,3±10,1, while as regards the Vivasight the average time of intubation was 30,9±9,0. In order to check the statistical significance, the Mann - Whitney U test was used (p <0,005). A larger proportion of successful attempts that amounted to 60% were observed while using the CMAC.

CONCLUSIONS

According to the subjective opinion of the students, the Cmac is easier to operate than the Vivasight. This study proved that videolaryngocopes can be a great tool for training new methods of intubation even during studies.

[Socioeconomic inequalities in mortality due to all causes in the working age population of Poland in 2002 and 2011]

BACKGROUND

The aim of the study was to evaluate the influence of education, marital status, employment status and place of residence on mortality in the working age population of Poland in 2002 and 2011.

MATERIAL AND METHODS

All deaths of Poland's inhabitants aged 25-64, in 2002 (N = 97 004) and 2011 (N = 104 598) were analyzed. For individual socio-economic groups standardized mortality rates (SDR) per 100 000 and rate ratio (RR) were calculated.

RESULTS

In the group of economically inactive men SDR decreased from 2244.3 in 2002 to 1781.9 in 2011, while in the group of economically active population increased from 253.8 to 298.9 (RR drop from 8.8 to 6). In the group of economically inactive women SDR decreased from 579.5 to 495.2, and among the economically active women population it increased from 78.8 to 90.9 (RR drop from 7.4 to 5.4). In the group of men with higher education SDR decreased from 285.7 to 246, while among men with primary education it increased from 1141 to 1183 (RR increase from 4 to 4.8). In the group of women with higher education SDR decreased from 127.2 to 115.6 and among women with primary education it increased from 375.8 to 423.1 (RR increase from 3 to 3.7). In the group of divorced/separated SDR also increased - from 1521.4 to 1729.8 among men and from 365.5 to 410.8 among women.

CONCLUSIONS

Future prevention and educational programs should be addressed primarily to the population economically inactive, with primary education and those divorced/separated. Med Pr 2017;68(6):771-778.

Fifteen-year mortality trends due to cardiovascular diseases in Poland using standard expected years of life lost, 2000-2014

BACKGROUND

Measures presenting the number of years of lost life point out social and economic aspects of premature mortality.

AIM

The aim of the study was to determine trends and pace of changes in years of life lost, in inhabitants of Poland, in 2000-2014, due to cardiovascular diseases (CVD).

METHODS

The study material was a database including 2,587,141 death certificates of Polish inhabitants who died of CVD in 2000-2014. We applied the standard expected years of life lost (SEYLL) indicators per living person (SEYLLp) and per death (SEYLLd) to calculate life years lost. We also estimated annual percentage changes (APC) and average annual percentage changes (AAPC) in the SEYLL indicators.

RESULTS

In 2000 the SEYLLp index due to CVD was 860.3 years per 10,000 males and 586.9 years per 10,000 females. In 2000-2004 the indices were decreasing and the average annual rate was -0.8% in the male group and -1.2% in the female group. Eventually, in 2014 its values were 721.4 years per 10,000 males and 475.6 years per 10,000 females. The respondents were losing years of life due to ischaemic heart disease (IHD) most rapidly (AAPC = -3.3% in the male group and -3.2% in the female group) and due to cerebrovascular diseases (AAPC = -2.5% in the male group and AAPC = -3.3% in the female group). On the other hand, there was an increase in the number of years of life lost due to heart failure (HF) (AAPC = 5.7% in the male group and AAPC = 4.4% in the female group). In 2014 SEYLLp due to IHD were 207.3 per 10,000 males and 99.1 per 10,000 females, due to cerebrovascular diseases - 124.3 and 102.2, and due to HF - 155.3 and 104.9. Each male who died of CVD lost on average 19.1 years in the year 2000 and 17.0 years in the year 2014 (AAPC = -0.5%). Regarding women, SEYLLd values were 12.6 years in 2000 and 10.4 years in 2014 (AAPC = -1.4%). A decrease in the SEYLLd value was observed in all analysed causes of mortality, in both males and females.

CONCLUSIONS

Among CVDs, IHD and cerebrovascular diseases contribute to the highest number of years of life lost in inhabitants of Poland. The constant decline in the average number of years of life lost by each person who died of CVD might result from implementation of more effective prophylaxis and more effective treatment, which extend lifespan.

ears of life lost due to bladder cancer among the inhabitants of Poland in the years 2000 to 2014

Introduction

The aim of the study is to evaluate the number of years of life lost in inhabitants of Poland due to bladder cancer (BC), identify trends of the mortality and calculate the pace of change which has happened over the period of the first fifteen years of the 21^st century.

Material and methods

The study material was a database including 44,283 death certificates of Polish inhabitants who died due to bladder cancer in the period 2000–2014. The number of years of life lost were calculated using the SEYLL indices: SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (Standard Expected Years of Life Lost per death).

Results

The crude death rates (CDR) index increased from 10.79 per 100,000 males in 2000 to 14.30 in 2014 (Annual Percentage Change [APC] = 2.1%, p <0.05). In women, the group value of the CDR index increased from 2.50 in 2000 to 3.83 in 2014 (APC = 2.9%, p <0.05). The standardized death rates (SDR) index fell from 23.27 in 2000 to 22.48 in 2014 (APC = -0.1%, p >0.05) in men, but rose from 3.54 in 2000 to 3.83 in 2014 (APC = 0.4%, p <0.05) in women.

The SEYLLp index (per 100,000 population) due to bladder cancer in Poland increased from 202.9 in 2000 to 243.4 in 2014 (APC = 1.3%, p <0.05) in men, and from 40.4 in 2000 to 60.1 in 2014 (APC = 2.7%, p <0.05) in women.

Conclusions

Despite the prolongation of patient life, as shown by the SEYLLd factor, Polish patients still lose too many years of life due to BC than compared to United States patients.

Territorial differences in years of life lost due to premature mortality in inhabitants of Poland

INTRODUCTION

Reduction of social and territorial differences with regards to health of a population is one of the most crucial global problems of public health. An analysis of years of life lost focuses on social and economic aspects of premature mortality.

AIM

The aim of the study is to analyze territorial differences in years of life lost due to premature mortality in inhabitants of various regions of Polan d, according to the most important causes of death, with consideration given to classification categories of ICD-10.

METHODS

The study material included a database which contained information gathered from 387,312 death certificates of inhabitants of Poland in 2013. The SEYLLp index (Standard Expected Years of Life Lost per living person) was used to calculate standard expected years of life lost.

RESULTS

The absolute number of years of life lost in inhabitants of Poland for the year 2013 was 4,168,256 in males and 2,536,447 in females, which corresponded to 2,237 years per 10,000 males and 1,277 per 10,000 females. Inhabitants of the Lodz Province are characterized with the highest number of years of life lost (2,858 years per 10,000 males and 1,544 per 10,000 females), whereas inhabitants of the Subcarpathian Province are characterized with the lowest number of years of life lost (1,833 years per 10,000 males and 1,039 per 10,000 females). In the male group, the highest SEYLLp values were contributed by: ischemic heart disease (217 years), malignant neoplasms of the trachea, bronchi and lungs (175 years) and cardiac insufficiency (156 years), whereas in the female group, the causes included: cerebral diseases (106 years), cardiac insufficiency (105 years) and ischemic heart disease (103 years)

CONCLUSIONS

There are huge territorial differences in Poland with regards to a number of years of life lost. Thus, there is a need to continue studies in order to find an explanation for these differences and gradually eliminate them.

Years of life lost of inhabitants of rural areas in Poland due to premature mortality caused by external reasons of death 1999-2012

INTRODUCTION

External causes of death are the third most common causes of death, after cardiovascular diseases and malignant neoplasms, in inhabitants of Poland. External causes of death pose the greatest threat to people aged 5-44, which results in a great number of years of life lost.

OBJECTIVE

The aim of the study is the analysis of years of life lost due to external causes of death among rural inhabitants in Poland, particularly due to traffic accidents and suicides.

MATERIAL AND METHODS

The study material included a database created on the basis of 2,100,785 certificates of rural inhabitants in Poland in the period 1999-2012. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (per death) indices were used to determine years of life lost due to external causes of death. Joinpoint models were used to analyze time trends.

RESULTS

In the period 1999-2012, 151,037 rural inhabitants died due to external causes, including 27.2% due to traffic accidents and 25.2% due to suicides. In 2012, the SEYLL_p was 1,817 per 100,000 males and 298 per 100,000 females. Among males, suicides (SEYLL_p = 633 years per 100,000) and traffic accidents (SEYLL_p = 473 years per 100,000) contributed to the largest number of years of life lost. Among females, SEYLLp values were: 109 years due to traffic accidents and 69 years due to suicides (per 100,000). Among males, SEYLL_p values started to decrease in 2008 at the average annual rate of 3.2%. In the group of females in the period 1999-2012, SEYLL_p values were decreasing by 2.4% per year.

CONCLUSIONS

The decreasing trend of the number of lost years of life due to external causes among rural inhabitants does not apply to suicides among men. The SEYLL_p due to this group of causes has been steadily increasing since 1999. Analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes.

Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study

BACKGROUND

The aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011.

METHODS

The analysis included all deaths among inhabitants of Poland, aged 25-64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression.

RESULTS

The SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9).

CONCLUSIONS

Educational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.

Years of Life Lost due to Premature Mortality in a Province with the Shortest Life Expectancy in Poland

AIM

The aim of the study was to evaluate years of life lost for citizens of the Lodz Province, which is characterized by the lowest life expectancy in Poland, and to identify current trends in this area according to the most common causes of death.

METHODS

The study material included a database containing information gathered from 470,000 death certificates of Lodz Province inhabitants, who died between 1999 and 2011. In order to calculate years of life lost, the authors applied the SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (per death) indices. The analysis of time trends was carried out with the application of joinpoint models.

RESULTS

The SEYLLp measure was 2,300 years per 10,000 males and 1,500 years per 10,000 females in 2011. Cardiovascular diseases contributed to the highest number of years of life lost (SEYLLp=682 years per 10,000 males and 559 years per 10,000 females). Next were malignant neoplasms (SEYLLp=505 years per 10,000 males and 437 years per 10,000 females), external causes of death (SEYLLp=361 years per 10,000 males and 83 years per 10,000 females). The number of years of life lost due to acute myocardial infarction decreased most rapidly, the Annual Percent Change (APC) was -10.1% in males and -3.7% in females. However, heart failure contributed to the highest increase in the number of years of life lost (APC=10.8% in males and 10.9% in females).

CONCLUSIONS

A further decrease in the mortality rate due to cardiovascular diseases might contribute to the highest reduction of years of life lost. The most effective preventive activities are those aimed at reducing productive years of life lost due to a particular cause of death, i.e. road traffic accidents, suicides, cirrhosis of the liver, alcoholic liver disease, and malignant neoplasms of the trachea, bronchi and lungs.

The burden of premature mortality in Poland analysed with the use of standard expected years of life lost

Background

Despite positive changes in the health of the population of Poland, compared to the EU average, the average life expectancy in 2011 was 5 years shorter for males and 2.2 years shorter for females. The immediate cause is the great number of premature deaths, which results in years of life lost in the population. The aim of the study was to identify the major causes of years of life lost in Poland.

Methods

The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 375,501 death certificates of inhabitants of Poland who died in 2011. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (SEYLL per death) measures were calculated to determine years of life lost.

Results

In 2011, the total number of years of life lost by in Polish residents due to premature mortality was 2,249,213 (1,415,672 for males and 833,541 for females). The greatest number of years of life lost in males were due to ischemic heart disease (7.8 per 1,000), lung cancer (6.0), suicides (6.6), cerebrovascular disease (4.6) and road traffic accidents (5.4). In females, the factors contributing to the greatest number of deaths were cerebrovascular disease (3.8 per 1,000), ischemic heart disease (3.7), heart failure (2.7), lung cancer (2.5) and breast cancer (2.3). Regarding the individual scores per person in both males and females, the greatest death factors were road traffic accidents (20.2 years in males and 17.1 in females), suicides (17.4 years in males and 15.4 in females) and liver cirrhosis (12.1 years in males and 11.3 in females).

Conclusions

It would be most beneficial to further reduce the number of deaths due to cardiovascular diseases, because they contribute to the greatest number of years of life lost. Moreover, from the economic point of view, the most effective preventative activities are those which target causes which result in a large number of years of life lost at productive age for each death due to a particular reason, i.e. road traffic accidents, suicides and liver cirrhosis.

Life years lost due to cardiovascular diseases

BACKGROUND

When evaluating the health status of a population, an increasingly important role is played by measures aiming to access premature mortality in lost lifetime units. There is a considerable number of life years 'to be recovered' provided cardiovascular disease (CVD) mortality is reduced, as CVD cause the highest absolute number of years lost.

AIM

To access life years lost by the inhabitants of the Lodz region due to CVD and to determine the rank of each disorder within this ICD-10 class, which causes most life years lost, as well as to identify trends in this regard.

METHODS

Our research was based on a dataset consisting of 313,144 death certificates, including 146,852 due to CVD, of the inhabitants of the Lodz region from 1999 to 2008. We applied the standard expected years of life lost (SEYLL) indicators per living person (SEYLLp) and per death (SEYLLd) to calculate life years lost. Joinpoint models were used to analyse changes in time. We also estimated average annual percentage changes in the SEYLL indicators.

RESULTS

In 2008, the number of life years lost amounted to 754 per 10,000 males and 595 per 10,000 females. The most important contribution to life years lost among males was from ischaemic heart disease (IHD) (SEYLLp = 200), particularly acute myocardial infarction (AMI) (SEYLLp = 128). Nearly the same number of years lost was due to other heart disease (SEYLLp = 199), especially heart failure (SEYLLp = 121). Cerebrovascular disease caused 191 life years lost per 10,000 males, while diseases of arteries, arterioles and capillaries caused the loss of 98 life years per 10,000 males. In women, the highest number of life years lost was attributed to cerebrovascular disease (SEYLLp = 176) and other heart disease (SEYLLp = 152), especially heart failure (SEYLLp = 95). IHD contributed to the loss of 113 life years per 10,000 females (including AMI: SEYLLp = 62), while diseases of arteries, arterioles and capillaries led to 112 life years lost per 10,000 females.

CONCLUSIONS

The highest number of life years lost resulted from IHD among males and cerebrovascular disease among females. A growing trend in the number of life years lost due to CVD was noted since 2002 for males and since 2003 for females. These unfavourable trends decelerated considerably after 2006. The highest decrease in life years lost for both sexes in 1999-2008 was noted for IHD.

Application of biochemical markers CA 19-9, CEA and C-reactive protein in diagnosis of malicious and benign pancreatic tumors

INTRODUCTION

We would save many lives and spare a lot of suffering if we could only detect and accurately determine the character and TMN staging of pancreatic tumors (PTs). With improved diagnosis, we could offer specific treatment that would result in better treatment outcome. The aim of study was to determine the significance of neoplastic markers CA 19-9 and CEA for prognosis in inflammatory and carcinomatous PTs.

MATERIAL AND METHODS

We based our research upon a group of 170 patients. The patients were treated in our Oncologic Surgery Department from January 2007 to December 2010 for PTs. The patients were divided into four groups depending on the character of the tumor and underwent the following treatments: group 1 - 34 patients with carcinoma of the ampulla of Vater, group 2 - 64 patients with PTs at different stages (1, 2, 3) according to TMN classification, group 3 - 62 patients with PTs at stage 4 on the TMN scale (unresectable tumors), group 4 - 28 patients with inflammatory PTs.

RESULTS

The results of Ca 19-9 in group 2 were 736.00 (25-75% 220.40-4285.00) ng/ml before surgery, 53.00 (25-75% 12.60-84.00) ng/ml in the 7 days after surgery, 29.4 (25-75% 7.90-113.00) ng/ml at day 30, and 119.00 (25-75% 96.30-621.00) ng/ml 3 months after the operation. These results were significantly higher than the control group but were significantly lower than the results for group 3 (unresectable tumors). The highest average concentration and median for CA 19-9 and CEA were noted in patients with unresectable PTs (the 3(rd) group). The average concentration for CEA was lowest in group 4, but much higher than the lab limits.

CONCLUSIONS

The sensitivity of the CA 19-9 marker may be as high as 88%. Values of CA 19-9 above 852 U/ml may indicate TNM stage 4, consistent with an unresectable PT. In the cases where CA 19-9 is within normal limits but C-reactive protein is above normal limits (often thirty times the upper limit), in comparison to the control group and to patients with pancreatic neoplasms, strong consideration should be given towards the inflammatory characteristics of the pancreatic changes and conservative treatment should be applied.

Health inequalities among rural and urban inhabitants of Łódź Province, Poland

INTRODUCTION AND OBJECTIVE

The aim of the study was to compare the state of health of the inhabitants of the countryside and city dwellers in the Łódź province, measured with the real and standardized death rate and years of life lost, as well as the analysis of causes of deaths distinguishing these two populations.

MATERIALS AND METHODS

The study material included a database containing information gathered from 313,144 death certificates of the inhabitants of Łódź province who died between 1999-2008. Real and standardized death rates were determined. The standardization was carried out by a direct method. The Standard Expected Years of Life Lost (SEYLL method) was used to compute years of life lost. Analysis of time trends of death rates and life span in the Łódź province was conducted with jointpoint models. The intensity of mortality computed with standardized death rates in the province was higher in the countryside than in the city.

RESULTS

In 2008, the standardized death rate in the countryside was 904.5 per 100,000 inhabitants, and in the city - 903.4 per 100,000 inhabitants. Inhabitants of the countryside more often died of cardiovascular diseases (SDR=418.7 vs. 367.9) and from external causes (SDR=90.2 vs. 63); those from the city and towns died from malignant neoplasms (SDR=204.5 vs. 195.6) and diseases of the alimentary tract (SDR=55.6 vs. 34.6). In 2008, SEYLL calculation for 1,000 people was 204 years for the inhabitants of the city and towns and 190 years for the inhabitants of the countryside.

CONCLUSION

It is necessary to introduce more effective prophylactic and health promoting activities in order to lessen the differences in the state of health state in the Łódź province and the rest of the country.

Commuting physical activity and prevalence of metabolic disorders in Poland

OBJECTIVES

The aim of this study was to examine the relationship between walking or cycling to work and prevalence of metabolic syndrome (MetS) and its components.

METHODS

Cross-sectional analysis of 6401 randomly selected individuals (3297 men and 3104 women) aged 20-74 years, who participated in the National Multicentre Health Survey WOBASZ, Poland (2002-2005). Commuting physical activity (PA) was assessed by asking about type and time spent on transportation to/from work using an interviewer-administered questionnaire. Weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), triglycerides (TG) and high-density cholesterol, (HDL-C) were measured by standard methods. MetS was defined according to the NCEP-ATP III and IDF criteria.

RESULTS

Active commuting was associated with decreased likelihood of abdominal obesity (WC≥94 cm), lower HDL-C and elevated TG in men and abdominal obesity (WC≥80 cm) in women. In a subgroup of postmenopausal women (n=317) active commuting was favourably associated with abdominal obesity, low HDL-C and elevated FPG. Prevalence of MetS was significantly lower among those who spent above 30 min/day daily on walking/cycling to work than among other gender subgroups.

CONCLUSION

Increasing of commuting PA level may have an important influence on reducing the prevalence of metabolic disorders.

Socio-demographic and lifestyle correlates of commuting activity in Poland

OBJECTIVES

The aim of this study is to analyse the epidemiology of active transportation and to investigate the relationship between commuting physical activity (PA) and socio-demographic and lifestyle characteristics in Poland.

METHODS

A cross sectional analysis was conducted among 7280 randomly selected individuals (3747 men and 3533 women) aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2002-2005). Socio-demographic, smoking and physical activity details were assessed by an interviewer-administered questionnaire.

RESULTS

Only 36% of the participants (30% men and 42% of women) are active commuters. Moreover, 55.4% of them spend less than 15 min/day on walking or cycling. The highest risk of commuting inactivity was noticed among residents of large urban settings, with university education, the highest income and low occupational PA in both genders. Smoking and leisure-time PA were not significantly associated with commuting activity.

CONCLUSIONS

Active commuting is not common in Poland. There are several differences in commuting patterns as compared with the US or Western European populations. Due to important differences between various socio-demographic groups, future interventions should be specific for the targeted subpopulations.

[Behaviour concerning smoking among people from the closest environment of students who begin their studies at the Health Science Department]

It can be seen from many researches that popularity of smoking among the students is still high. Due to that fact, there is a necessity to search for factor that would influence the behavior and attitude to smoking among female and male students as early as their first year at university, and also include this in preventive programmes. The aim of the work is to present the behavior concerning smoking among people from the closest environment of students who begin their studies at the Health Science Department and determine their influence on behavior and attitudes of the tested towards smoking. The subject matter of the analysis are selected fragments of research carried out between the years 2007/2008 and 2008/ 2009 among students who began their studies at The Health Science Department at the Medical University of Łódź. For collecting the empirical material, auditorial questionnaires were used. In every academic year that was studied, over 470 people took part in the test, which is over 93% of students who are on dean's lists. Among the people smoking in the closest environment, respondents pointed to their friends most frequently: in 2007/2008 it was 49.1% of the surveyed (235 people) and in 2008/2009 57.1% (270 people). The second place belonged to "one smoking parent". In 2007/2008, 31.7% of the tested students (152 people) lived with one parent inhaling tobacco smoke before beginning their studies at university and the year after that, 30.2% (143 people). In 2007/2008, 16.1% of the tested (77 people) claimed that no-one smoked in their closest environment and a year later, the same answer was given by 15.2% of the tested (72 people). Among the surveyed on the first years of studies, the ratio of smoking students in whose closest environment there was no-one smoking, was different significantly to the ratio of smoking students who had people inhaling tobacco smoke in their environment.

[Knowledge about influence of smoking tobacco on health condition and developing fetus of the patients of women health center in urban and rural areas]

Chemical compounds that are present in tobacco smoke negatively affect the health of everyone, but most of all it damages the organism of the developing and young bodies. Both passive and active smoking is harmful. The level of knowledge in the society concerning smoking increases systematically. However, many people choose to ignore warnings and prohibitions concerning smoking. From the findings it results that 60% of the pregnant women is threatened with inhaling tobacco smoke at work place or at home, and almost every third pregnant woman smokes. The aim of the research was to recognize the knowledge about the influence of smoking tobacco on the developing fetus of the patients of health centers in Lodz and in Opoczno. Between 1st and 15th April 2007, there were studies carried out using an auditory survey among 240 female patients who came for advice at the health center. One health center in Lodz was chosen at random and one in Opoczno. Subsequently, people queuing to the doctor's were asked to fill the survey, until 120 patients completed it. Collected material was then analysed statistically. The questionnaire consisted in total of 28 questions, including 11 concerning patients' knowledge about the influence of smoking tobacco on health. Almost 21% of the questioned was of a mistaken opinion that not everyone can quit smoking. Over 16% of them did not know that smoking may lead to vascular diseases and 2% of women did not see the connection between smoking and respiratory system diseases, 11% of the surveyed did not know that smoking is harmful and over 10% did not know that passive smoking has negative effect on the developing fetus. Defects in knowledge concerning influence of smoking, particularly passive smoking on the frequency of illnesses occurrence and the development of fetus, among some of the respondents, requires the increase of didactic activities of health care workers.

[Arterial hypertension as a medical and social problem in the older urban population. The CINDI WHO Program study]

Increasing lifespan and progressive aging of the Polish population results in rising demands on health care. Chronic diseases with a leading position of arterial hypertension (HA) prevail in morbidity rates of adult seniors. The aim of the study is to characterize hypertension in the elderly with regard to other risk factors, complications and therapeutic control. The study was carried out in 2002 within the framework of the CINDI WHO Programme. A total of 1460 persons were randomly selected among residents of Lodz aged > or = 65 years. The response rate was 57%. All participants underwent questionnaire interview, two blood pressure (BP) measurements, anthropometric and physical examination, ECG and laboratory tests. After final verification, we analysed data collected from 828 persons (289 men and 539 women). Mean values of systolic and diastolic BP were 147.6 and 83.6 mmHg, respectively. The increase of systolic BP with age of studied seniors was observed. Hypertension was diagnosed in 669 persons (79% men, 82% women). In most cases there were systolic-diastolic or isolated systolic hypertension. About 60% of seniors with elevated BP declared suffering from HA, while 73% were under antihypertensive treatment. Normalization of BP (< 140/ 90 mmHg) was achieved in 28% of treated patients. Most often prescribed medications were: ACE-inhibitors (51%), beta-blockers (40%), calcium channel blockers (31%) and diuretics (30%). Mean values of plasma lipids and prevalence of lipid disorders were comparable in hypertensive and normotensive persons. Among patients with HA there were significantly smaller percentage of smokers (8.6% vs 18.7%, p < 0.05). The prevalence of obesity, visceral obesity and metabolic syndrome was higher in hypertensive seniors. As a result, incidents of myocardial infarction and morbidity due to coronary artery disease were twice as cantly more often hospitalised and visited family doctors (7 vs 4.6 visits/year) in comparison to normotensive subjects.

Health evaluation of the 2nd International "Quit and Win" Antinicotine Campaign participants ten years later

Smoking is one of the most often noticed types of negative behaviour among the Poles. In the work, the results of the health evaluation are presented of the participants of the 'Quit and Win' competition ten years after making a decision to refrain from smoking, also the dependency between this evaluation and behaviour connected with smoking among the people living in big cities and small towns and villages was analysed. Among the 648 respondents, majority, which is 302 people (46.6%) evaluated their health as good, 236 (36.4%) as average, and 76 of the questioned (11.7%) as very good, 29 people (4.5%) as bad, and 5 of the questioned (0.8%) as very bad. The respondents most often evaluated negatively their health in the group of the still smoking living in the big cities, and the least often in the group of the non-smokers living in small towns and villages.

[How to decrease smoking among people? The experience of international anti-tobacco campaign Quit&Win in Poland in 2000-2006]

Findings imply the importance of smoking cessation at all ages, including those over the age of 65. Quitting reduces risks of dying from cardiovascular disease and several smoking-related cancers, improves mobility and quality of life among the elderly. Since 1994 all adult smokers over the world have been encouraged to quit by attending the Quit&Win contest, supported by WHO CINDI Program. The aim of our study was to analyze participation and effectiveness of quitting smoking among elderly (> or = 65 years) men and women in Poland. Data of Quit&Win contests from 2000 to 2006 in Poland among the elderly participants. One-year follow up survey of a random sample (640 respondents, response rate = 66%) in 2001. In Poland 508 elderly smokers have participated in Quit&Win from 2000 to 2006 (3.4% of 14.465 total number of participants). The oldest participants were more likely to be men than women (72% and 28% respectively), inhabitants of big cities than small towns or villages (66% and 34% respectively). Participants' history of smoking before the contest was as following: mean = 21 cigarettes/ day, higher consumption rates among elderly men than among elderly women (p < 0.05) and more years of smoking among men than among women (p < 0.001). The participants attended the contests sending press entry forms or printing entries mostly, but only 3% via the Internet. In one-year follow up the oldest participants were more likely than the younger participants: being the complete continuos abstains (p < 0.01), choosing the contest as a way of quitting (p < 0.001), having the support from family during their attempt to quit (p < 0.05). Attendance of the oldest smokers in Quit&Win is unsatisfied for organizers in Poland. To improve an access for the elderly the organizers, sponsors and media should maintain the traditional ways of entries distribution by newspapers and magazines. The Internet hasn't been popular so far among elderly people in Poland as a source of information and communication. Given the projected increase in the elderly population the medical and economic consequences of smoking will become a greater burden in the next decades. Therefore, focusing attention on cessation among the elderly is an immediate and urgent priority for public health professionals and physicians.

[The significance of social support in the maintenance of smoking abstinence in the population smoking cessation program]

According to I.G. Sarason social support is the help provided to the individual in difficult and stressful situations. In this study we have assumed that quitting smoking is a very stressful situation for the smokers. Therefore, they need social support from the others (family, friends, co-workers, health personnel).

DATA SOURCES

1. One-year follow up survey of a random sample (n=993) of the Quit & Win 2000 participants in Poland. The data collection method was obtained through mail questionnaire (response rate = 65.6%). 2. Results of the comparative data analysis of one-year follow up survey from 20 countries-organizers of the Quit & Win 2000. The aims of the study were to recognize: 1. impact of social support on the quitting smoking process from the decision to participate in the campaign till the maintenance of one-year abstinence, 2. lack of social support as the reason for relapse.

RESULTS AND DISCUSSION

In Poland the Quit & Win 2000 participants achieved the highest continuous complete abstinence rate (43%, mean=26.3) and the lowest social support (no support 42%, mean= 25.9) out of 20 countries. Analysis of data suggested that the social support was the important factor for smokers in encouraging them to participate in the campaign and try to quit. There aren't statistical relationships between social support and one-year abstinence (p>0.05) as well as between lack of support and relapse (p>0.05).

CONCLUSIONS

The significance of social support in quitting smoking process needs the further exploration.