Prevalence of diabetes in Poland: a combined analysis of national databases

AIMS

To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes.

METHODS

The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries.

RESULTS

In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013.

CONCLUSION

The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.

[Coordinated heart failure care in Poland: towards optimal organisation of the health care system]

Heart failure has becoming an increasing medical, economic, and social problem globally. The prevalence of this syndrome is rising, and despite unequivocal positive effects of modern therapy, reduction of mortality has been achieved at the cost of more frequent hospitalisations. Unlike in many European countries, in Poland heart failure is usually recognised later, at a more advanced stage of the disease, leaving less time for ambulatory treatment and resulting in a high number of hospitalisations. The current paper presents the most important data regarding morbidity and mortality due to heart failure in Poland. The experts in the field focus on the key source of high costs of therapy and highlight several critical organisational deficits present in the Polish health care system. This background information builds a basis for a concept of coordinated care for patients with heart failure. The paper discusses the fundamental elements of the system of coordinated care for patients with heart failure necessary to enhance the diagnosis, improve therapeutic effects, and reduce medical, economic, and social costs.

Analysis of changes in cancer health care system in Poland since the socio-economic transformation in 1989

BACKGROUND

The transformation period in Poland is associated with a set of factors seen as ‘socio-economic stress’, which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90’s. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project.

OBJECTIVE

Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989.

MATERIALS AND METHODS

This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations.

RESULTS

The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the ’Quick Oncological Therapy’ together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN.

CONCLUSIONS

(1) ‘Socio-economic’ stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.

Epidemiology of eye diseases and infrastructure of ophthalmology in Poland

ADMISSION

Untreated eye diseases are the leading cause of blindness in the world. Most people suffering from visual impairment is in the age group above 50 years of age. As many as 82% of people in this group is suffering from eye diseases.

OBJECTIVE

The aim of this work was to present the epidemiology of eye diseases and state of infrastructure of ophthalmology in Poland.

MATERIAL AND METHODS

Based on data by WHO prepared review of world and Polish literature on issues in the field of ophthalmology and epidemiology of eye diseases. On the analysis developed epidemiological situation of the most common eye diseases--cataract, glaucoma and AMD--leading to loss of vision in Poland. Using databases CSIOZ, the Central Statistical Office and WHO listed infrastructure resources of ophthalmology in Poland.

RESULTS

The main eye diseases leading to blindness indicated cataract, glaucoma and macular degeneration. In 80% of cases, vision loss can be avoided by early detection and treatment.

CONCLUSIONS

Prevention and early detection is an essential tool for reducing the incidence of blindness, especially in elderly.

Food supplement-related risks in the light of internet and RASFF data

OBJECTIVE

Based on legal acts and RASFF information, this paper aimed at evaluating available facts on food supplements in comparison to the most popular data accessible via Internet for future and present consumers.

MATERIAL AND METHODS

Having analyzed legal acts and RASFF (Rapid Alert System for Food and Feed) database, the authors attempted to verify what kind of information on food supplements may be found by an Internet user, using the first webpage of Google.pl. This search engine was used in this study as it gained the highest popularity among Internet users. It was decided that exclusively search results displayed on the first webpage would be subject to analysis as 91.5% of Internet users limit their search to the first 9-10 results. Internet was searched using the following two terms: 'supplement' and 'supplements' as well as terms suggested by Google. pl. Subsequently, the results were subject to qualitative and quantitative analyses.

RESULTS

On the Internet, the most frequently searched terms were: 'supplements' (243 000 000), 'supplement' (9 290 000), 'supplements shop' (8 200 000). Having analyzed the content of particular websites, information on certain products, given by their manufacturers may be found. Then, data on supplement itself were provided, i.e. what is a supplement and when it should be used. Expert articles (written by physicians, dieticians, pharmacists) on a risk resulting from these products, including therapeutic indications or the presence of unauthorized substances were identified considerably less frequently. No warnings regarding the necessity of purchasing the products in legal and verified places were found.

CONCLUSIONS

There is a necessity of systemic education of consumers on reasonable use of food supplements. It is also advisable to consider the organization of alert system whose objective would be to monitor adverse reactions caused by an intake of food supplements or novel food launched into the country. To obtain reliable information on the composition and effects of food supplements, potential consumer should contact physician or dietician. Additionally, complementary information, using different sources with an example being health-related portals, presenting articles written by physicians or pharmacists, may be also searched.

The scope and results of selected epidemiological studies conducted at the National Institute of Hygiene in the years 1945-1989

The authors present the first article in the series concerning the scope ofresearch, scientific, practical, educational and other achievements of the National Institute of Hygiene (PZH) since 1945. This article is limited to discussing selected studies conducted in the field of epidemiology until the year 1989. The selection was based on PZH annual reports on the accomplishment of planned objectives and the literature positins listed in these reports, as well as other documents. The criterion for selection was how the scope of the research matched the epidemiological situation within a historical context. The authors chose research that yielded practical results which made an impact on the epidemiological situation, particularly concerning infectious diseases in Poland. The significance of epidemiological research of non-infectious diseases was also stressed. In addition, research that was considered by scientists in Poland and abroad as contributing to the development of medical methodology was included in the selection.

"Health 2020"--new framework for health policy. Part II

The papers continues presentation of the new framework for health policy related to "Health 2020" strategy adopted in September 2012 unanimously by all member countries of EURO Region during the 62nd session of the World Health Organization Regional Committee for Europe. Four priority areas for action are presented.

"Health 2020"--new framework for health policy. Part I

The paper presents the new framework for health policy adopted in September 2012 during the 62nd session of World Health Organization (WHO) Regional Committee for Europe as the strategy "Health 2020". Four priority areas for policy action as well as prerequisites for achieving two interlinked strategic objectives; improving health for all and reducing health inequalities as well as improving leadership and participatory governance for health are presented and discussed.

Public health research in Horizon 2020. Results of the work of Independent Expert Group of the European Commission

The recommendations of Independent Expert Group of European Commission on the future public health research priorities for Horizon 2020 funding stream in 2014-2020 are herewith presented. The group was commissioned in September 2012 by DG Research & Innovation of (DG-RTD) of European Commission.

[Willingness of Warsaw inhabitants to cooperate with health service. III. Use of different types of treatment]

BACKGROUND

The global economic crisis led to the need to reduce the public expenditure, including health care. In a situation of reduction of the publicly guaranteed benefits, some services may be available only in private physicians for particular patients. Therefore, there is a need to examine factors determining the use of both types of health care.

OBJECTIVES

The aim of the study was to assess the association between the use of free treatment of general practitioner and the use of private physician services on one hand, and health and its disorders, assessment of physician, and expenditure on treatment of the Warsaw inhabitants on other hand.

MATERIAL AND METHODS

The data were collected from 402 Warsaw inhabitants by not-addressed questionnaire elaborated in Health Promotion and Postgraduate Education Department of the National Institute of Public Health-National Institute of Hygiene.

RESULTS

Our findings showed that the majority of respondents used the both types of health care. Males, people from the youngest and the oldest group, those having elementary education, students and unemployed were more likely to use only free treatment from general practitioner, whereas people aged 30-44 years, higher educated, employed and those depending on other people were more often treated only by private physicians. The beneficiaries of only private physician services higher evaluated their health, physically felt better, perceived stronger social support and rarely remained at home due to illness. Private physicians were evaluated more positively in comparison with general practitioner practicing in public health care, nevertheless, the difference was not large. With respect to their own financial situation, the people using private physician services did not find higher medical expenses than those using only the general practitioner of public health care. CONCLUSIONS. Our research indicates that uncontrolled development of private medical services market may increase inequality in access to health care, if not protected by appropriate access to public health care.

[The role of science in policy making--EuSANH-ISA project, framework for science advice for health]

Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.

Determinants of self-rated health of Warsaw inhabitants

BACKGROUND

Self-rated health is a one-point measure commonly used for recognising subjectively perceived health and covering a wide range of individual's health aspects.

OBJECTIVE

The aim of our study was to examine the extent to which self-rated health reflects the differences due to demographic characteristics, physical, psychical and social well-being, health disorders, occurrence of chronic disease and negative life events in Polish social and cultural conditions.

MATERIAL AND METHOD

Data were collected by non-addressed questionnaire methods from 402 Warsaw inhabitants. The questionnaire contained the questions concerning self-rated health, physical, psychical and social well-being, the use of health care services, occurrence of chronic disease and contact with negative life events.

RESULTS

The analysis showed that worse self-rated health increased exponentially with age and less sharply with lower level of education. Pensioners were more likely to assess their own health worse then employed or students. Such difference was not found for unemployed. Compared to married, the self-rated health of divorced or widowed respondents was lower. Gender does not differentiate self-rated health. In regard to well-being, self-rated health linearly decreased for physical well-being, for social and, especially, for psychical well-being the differences were significant, but more complicated. Hospitalisation, especially repeated, strongly determined worse self-rated health. In contrast, relationship between self-rated health and sickness absence or frequency of contact with physician were lower. Chronic diseases substantially increased the risk of poorer self-rated health, and their co-morbidity increased the risk exponentially. The patients with cancer were the group, in which the risk several times exceeded that reported for the patients of other diseases. Regarding negative life events, only experience with violence and financial difficulties were resulted in worse self-rated health.

CONCLUSIONS

Our findings confirmed the usefulness of self-rated health for public health research.

[Willingness of Warsaw inhabitants to cooperate with health service. II. Evaluation of health and retirement security]

Providing citizens with health security is one of the main challenges for health policy. For the effective modifying the health an social care system it is very important to recognize how citizens themselves perceived their health and retirement assurance. The article presents the analysis of assessment of health care system, out-of-pocket payments for treatment, and retirement system by Warsaw inhabitants in relation to demographic characteristics and health indicators. Data were collected using not-addressed questionnaire. Our findings indicated that women, people aged 30-64 years, those having vocational education and unemployed, the others out of work as well as employed more negatively assessed health care system in comparison to the other demographic groups. The youngest and oldest people, those having elementary education and those who were economically inactive relatively frequently declared bearing very high expenses for treatment. The retirement system was more negatively assessed by women, people under 45 years, unemployed and the others out of work. The analysis of the relationship between perceived health and out-of-pocket payments for treatment and selected health indicators showed that people, who positively assessed existing health care and declared low expenses for treatment, higher evaluated their health, less frequently stayed at home because of ill-health, less frequently were in contact with physician and rarely were treated in hospital. Such differences were not noted (except one) for retirement security.

[Willingness of Warsaw inhabitants to cooperate with health service. I. Opinions on health reforms]

Social participation in undertaking public decisions is one of the main determinants of good governance. Recognizing to what extent people are ready to participate in the process of reforming health care as an active partners seems to be necessary. Therefore, in Health Promotion and Postgraduate Education Department of NIPH-NIH the study aimed at examining citizen's willingness to cooperate with health staff and gathering their opinions on health reform was carried out. The not-addressed questionnaires were conveyed to 1700 households in Warsaw and 402 correct completed were received. Our findings indicate that one of four Warsaw citizens was ready to participate jointly with health workers in health reform. The willingness was higher in women, older people, higher educated and pensioners. From perspective of their own health, respondents perceived the following issues as requiring a change in the time of health reform: easier access to specialist treatment (60,9%), changing the health insurance system (17,3%), reduction in medicines price (14,8%), improving the quality of medical services (14,0%), easier access to diagnostic tests (13,6%) and to primary care physicians (10,7%), improving the health and social security of old people (9,0%), easier access and wider range of preventive examinations (7,4%), facilitate the sanatorium treatment (4,1%) and rehabilitation (3,7%).

[Initiative of introducing the applications of genetics for public health purposes in Poland]

An integration of scientific associations involved in public health and genetics to apply genetics achievements might create new perspectives of public health and health promotion in Poland and allow to apply genomic applications that are currently in transition from research to public health practice. Activities might enable to undertake preventive actions as population screening programs based on genome-based knowledge and technologies as targeted preventive interventions. The achievements in the field of public health genetics or genomics have been taking place in several countries and have begun to have an impact on population health status.

[Depression, overweight and perceived body image among adolescents living in suburban areas]

The aim of the article is to explore the association between depression and overweight among adolescents living in suburban areas and to verify to what extend the acceptance of body image may be a mediating factor. The study was conducted on the sample of 322 students (girls--51.2%, boys--48.8%) aged 16 - 19 years attending two senior high schools in Radzymin. Overweight was measured by Body Mass Index (BMI) and according to WHO recommendations the following categories were established: BMI < 20--underweight, 20 < BMI < 25--normal weight, BMI > 25--overweight or obese. A question about the acceptance of body image contained four possible answers: I'm okay/I do not weight properly, but I accept myself/I do not accept myself, I'm too thin/I do not accept myself, I'm to thick. Beck Depression Inventory (BDI) was used for measure the level of depression. Unexpectedly, our investigations found association between depression and overweight only for boys. In turn, the girls, as expected, lower accepted their body image than boys. Moreover a considerable percents of girls whose weight was normal, and even those with underweight, perceived themselves as thick. The association between acceptance of body image and depression was confirmed only for girls. Our study suggests that the lack of acceptance of body image, especially by girls, to greater extend causes the appearance of depression than real overweight.

[Position of health at international relations. Part I. Structural dimensions of health]

In the article, the health is perceived as complex, multidimensional concept and not as absence of disease. This is consistent with public health perspective, where public health is regarded as public as well as political activity. It aims to solve health and social problems, depends on analysis of phenomena, needs the negotiations and relies on making decision on feasible directions of changes--what, why, how, where, when and by whom should be done. Public health policy developed as a result of international relations, and UN family fora especially, is regarded as significant for creating of health position. The aim of this article was: (1) the analysis of selected concepts and definitions related to structural dimensions of health, used in UN international arrangements; (2) an attempt to explain the evolution of health structure notions at worldwide agenda. The UN main bodies, programmes and funds working on the health field are mentioned and voting rules in UN General Assembly and World Health Assembly are reminded. The following structural dimensions were considered: (a) well-being, (b) human rights, (c) everyday resource, health potential, (4) equity. All were explored in WHO Constitution, Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, Ottawa Charter for Health Promotion and numerous WHA and UN GA resolutions, decisions as well as other documents. Some remarkable differences in English and Polish language versions and meanings were pointed out. It was argued that present perception of structural dimension of health is strongly derived from the preamble of the WHO Constitution adopted and signed on 22 July 1946 by the representatives of 61 States. It is an evidence of the strength of this document and wisdom of its authors. The greater progress is associated. with concepts and notion of organizational dimensions of health perceived as action and processes leading to health. Long-term efforts to strengthen the image of health was compared to positioning known in marketing as creating an identity in the minds of a target market.

[Position of health at international relations. Part II. Organizational dimensions of health]

The aim of this article was: (1) the analysis of some concepts and definitions related with "set up of health", used in UN international arrangements; (2) an attempt to explain the evolution of organizational dimensions of health at worldwide agenda. The following organizational dimensions of health were discussed: (a) health for all, (b) health promotion, intersectoral and multisectoral actions, health in all policies, (c) health development, health as an element of human development, (d) investment for health, (e) health diplomacy and (f) mainstreaming of health. The analysis was based on World Health Assembly and UN General Assembly resolutions as well as supranational reports and statements available through conventional channels, not grey literature. It is apparent that some of notions are not in common use in Poland, some seems to be unknown. It was argued that some general and discreet thoughts and statements concerning organizational aspects of health were expressed in the preamble of WHO Constitution. Nevertheless they are not comparable with later propositions and proceedings. The first modern concepts and notions related as process were developed at late seventies. They originated from efforts to realize a vision of health for all and formulate national policies, strategies and plans of action for attaining this goal. The turning point was in 1981, when WHA adopted Global Strategy for Heath for All by the Year 2000. Since then one can observe considerable progress and new concepts came into existence, more and more precise and better reflecting the sense of health actions. The evolution of organizational dimensions of health was described in the context of brand positioning. It was assumed that first step of positioning was concentrated on structural dimensions of health. That served to awareness raise, attitudes change and motivation to action. That made a foundation to the next step--positioning based on process approach to health. Among others the following processes are described: (a) health for all, (b) health promotion, health in all policies, (c) health development, (d) health diplomacy, and (e) mainstreaming of health.

[School stress and health disorders of post-elementary school adolescents]

The aim of the study was to examine influence of school stress on level of health and health disorders in adolescence. The data were collected from students often post-elementary schools in Warsaw The investigation were carried on in two stages, when adolescents attended second grade (783 students aged 14-15 years), and in the next year, when they attended third grade (804 students aged 15-16 years). Four indicators measured severity of school stress: (1) change of school, (2) difficulties in learning, (3) lack of support from teacher (4) dislike to go to school. Seven indicators were accepted as indicators of the level of health and health disorders: (1) self-assessment of health status, (2) physical well-being, (3) psychical well-being, (4) sick absenteeism during the last month, (5) frequency of staying at home or in hospital during the last year due to health disorders, (6) frequency of being in contact with physician during the last year (7) frequency of intake medicines. The first three of them were assumed as subjective indicators, and the further four as objective indicators. The analysis found out that: (1) relatively more girls than boys experienced dislike to go to school, (2) students, who changed school, had difficulties in learning, had negative relation with teacher or dislike to go to school, in comparison to those, who did not notice these problems, in general, lower assessed their health and well-being and more frequently suffered from health disorders, (3) subjective indicators of health were much more associated with school stress than objective indicators. Simultaneously, the summarized rank scale of school stress was elaborated.

[Changes of hierarchy among causes of death in some European Union countries]

Mortality from malignant neoplasms and diseases of circulatory system in the countries of European Union is on decline, though this trend is much slower in the case of neoplasms. In some EU countries the mortality from neoplasms is already higher than mortality from diseases of circulatory system, which until recently occupied the first position in the cause of death hierarchy. This trend is more significant among males and in France, the Netherlands and Spain where malignant neoplasms became the first cause of death. The forecast for next years predicts the continuation and deepening of this tendency.

[Evaluation of health systems]

Article presents problem of healthcare systems evaluation. Definitions of health system and healthcare system are introduced in the first part, which is followed by presentation of basic principles of healthcare systems evaluation, and commonly used and recommended indicators. Specific examples of healthcare systems evaluation methods implemented in selected European countries are described in the last part.

[The Tallinn Charter: health systems for health and wealth]

The article presents main issues of Tallinn Charter (2008) that concerns functioning health systems, theirs influence on health and wealth of society. Health systems are diverse, but share common set of functions. Theirs effective performance contribute, not only to improving health, but also to participation in labour market and socioeconomical development of country.

[Healthy life years (HLY) comprehensive indicator of health situation--recommended by European Union]

This article presents Healthy Life Years (HLY) indicator of functional health status, its application in the field of public health research and monitoring, method of calculation, idea of its construction and relation of HLY to other health status indicators e.g. life expectancy, quality adjusted life years. Current data on HLY in the EU member states are also presented. HLY indicator is one of structural indicators, recommended by European Council to deliver information on the progress of implementation of the Lisbon Strategy resolutions, which main principle is development of knowledge-based economy characterised by growth, social cohesion and respect for environment. HLY shifts the focus from quantity of years of life to its quality, full-productivity health of the population, thus conveying information not only on health status but also referring to the fields--other than medicine or social sciences--such as: finances, economy, politics, development.

[Development and dilemmas of health impact assessment]

Health impact assessment (HIA) is defined as a combination of procedures, methods and tools which may be used to evaluate policy, program or project in the context of its potential impact on the population health or the distribution of health determinants. This approach is used under the assumption that policy, program or project may have an impact on health determinants. Authors of this paper presented origin, history and short description of this methodology as well as basic steps of the decision making process in which HIA is being used. The difficulties and challenges faced by experts using this approach as well as problems related to the measurement of it's effectiveness are also described. In conclusion authors express the view that HIA may become the universal tool used at all levels of decision making and in all sectors.

[Direct and indirect treatment cost of patient with ischaemic heart disease]

Authors of this paper attempted to evaluate the cost of treatment of hypothetical patient with ischaemic heart disease during the period 16 years. The medical costs (costs of medicines, diagnostic procedures, coronary angioplasty and bypass surgery) and indirect costs of lost productivity have been estimated.

[Epidemiology of chronic non-infectious diseases in Poland in the second half of 20th century]

The development of epidemiology of non infectious diseases in Poland during the second half of 20th century has been presented. Epidemiological studies of chronic non specific respiratory diseases, cardiovascular diseases, cancer, diabetes, conditions related to the environmental pollution, psychiatric conditions and rheumatic diseases and complaints have been discussed.

[Changes in adolescents' alcohol drinking in the time of accession to European Union: Polish and Lithuanian experiences]

The greatest increase in the late nineties in adolescent's alcohol consumption in Europe were in the countries that were candidates for European Union. The aim of the papers is: 1) to examine the changes of adolescent's alcohol drinking in fife-year period preceding the accession of Poland to European Union and 2) to compare regular alcohol drinking and attitude toward alcohol drinking among Polish and Lithuanian adolescents. The surveys in 1999 and 2004 in Warsaw junior secondary schools and in 2004 in Vilnius junior secondary schools were carried out, and the data from 14-15 years old adolescents were obtained. The analysis confirmed significant increase in frequency of alcohol consumption as well as in more positive attitude toward usefulness of alcohol drinking. This process took place more dynamically among girls. The comparison of Warsaw and Vilnius samples showed that Lithuanian girls were more likely to drink alcohol regularly and Lithuanian adolescents were more likely to access higher the usefulness of alcohol drinking for coping with everyday troubles. The findings were widely discussed in respect to other studies and changes in alcohol control policy.

[Health promotion and health care system reform in Poland]

The development of health promotion is determined by the defined changes of health situation of population, which occur in time. Contemporary methods of health promotion were initiated in 1970's, when the problem of increase of civilization (behavioural) diseases strongly related to lifestyles, was noticed. Health promotion programmes in Poland in spite of many achievements in the conceptualization phase, encounter difficulties in implementation, because of lack of appropriate structural solutions and financial support for this important public health area.

[Lalonde's paradigm, World Health Organization and new public health]

The authors present the origins and evolution of the New Public Health idea assuming the fundamental significance of Lalonde's health field concept in this process. The other crucial events which contributed to it was the formulation and implementation of WHO strategy HFA 2000, publication of Ottawa Charter, defining by WHO the essential public health functions and concepts of Gro Harlem Bruntland from 1998-1999 when she was the Director General of WHO. Authors present for discussion their working definition of New Public Health, which is based of the public health definition of J. Nosko et al. from 2001.

[Diabetes mellitus as a cause of hospitalization in Poland, 1980-1999]

The objective of this paper was to assess the frequency and trends of hospitalization of patients with diabetes in Poland between 1980 and 1999. The analysis of data from 10% annual systematic random samples of all hospitalised cases revealed that patients hospitalized because of diabetes make 1.5% of all hospitalized cases. The respective hospitalization rates per 10,000 population for males were 7.9-16.4 for males and 10.9-20.4 for females in the years under study. Frequency of hospitalization of patients with diabetes for males and females was steadily increasing between 1984 and 1993 whereas certain decline was observed from 1994 onwards. In all analysed years the diabetes hospitalization rates were higher among females than males and among urban inhabitants than those living outside cities. The hospital fatality rate from diabetes (around 3% in last years) is higher than overall hospital fatality rate (1%) which may indicate that patients with diabetes admitted to hospital are in the greater risk of serious vascular complications and coexisting diseases. Over 50% of hospitalized cases were diagnosed with insulin-dependent diabetes.

Estimates of the years-of-life-lost due to the top nine causes of death in rural areas of major states in India in 1995

BACKGROUND

Years-of-life-lost (YLL) contribute nearly two-thirds of the disability-adjusted life-years (DALYs) worldwide and are especially Important for India where infant and child mortality is still high. These were estimated for India under the Global Burden of Disease study for the year 1990. No estimates are available for the different states of India. We aimed to prepare state-wise estimates of YLL for different causes of death in rural areas and to determine the causes responsible for a higher burden in different states.

METHOD

Percentage deaths of the top 9 causes reported in the Registrar-General's Survey of Causes of Deaths (Rural)--1995 in 13 major states of India and different age groups was applied to the expected number of total deaths. The life lost according to the standard life-table was age-weighted and discounted using the methodology of the Global Burden of Disease 1990 study. The causes of death were based on lay reporting which otherwise seem reliable.

RESULTS

The all-cause YLL in rural India in 1995 were 207 per 1,000 population. The minimum was 74 in Kerala and maximum 276 in Madhya Pradesh. Pneumonia was the top cause responsible for 15 YLL. The inter-state variation was high as Tamil Nadu had only 1.6 and Uttar Pradesh 30.5 YLL from this cause. Cancers were a uniform burden across the states. Heart attack, and bronchitis and asthma cut across the more and less developed states. Suicides were a heavy burden in Andhra Pradesh and vehicular accidents in Haryana and Rajasthan. Bihar, Gujarat, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh had communicable and nutritional conditions as predominant causes while Kerala and Punjab had non-communicable diseases as the predominant cause of YLL due to premature mortality.

CONCLUSION

These results provide a new perspective about the causes of death that need more attention in rural areas of different states of India. These will also help prioritize areas which require more inputs at the state-level and hence will be useful for health policymakers.