Cigarette smoking in Poland in 2019: the continuing decline in smoking prevalence

The aim of the study: To present comprehensive national estimates of prevalence of cigarette smoking by sociodemographic characteristics in Poland in 2019 and to analyse the changes in smoking prevalence in the Polish population after 2014. Material and methods: A cross-sectional survey on a representative sample of adult Polish population was conducted on 4-11 July 2019 by the Public Opinion Research Center (Centrum Badania Opinii Społecznej). A total of 1016 adults (42.4% men and 57.6% women) aged 20 years and older were included in the analysis. Data for smoking prevalence were analysed according to gender, age groups, birth cohorts, place of residence and education. Statistical analysis was done using Statistica 13.1 and assumed a significance level of p < 0.05. Results: Of the total sample population, 21.8% of Polish adults declared they are daily smokers (in the general population this would translate to 6.8 million Poles, including 3.9 million men and 2.9 million women), 27.8% that they are ex-smokers and 50.4% that they never smoked tobacco. More men than women declared they are daily smokers (26.9% vs 18.1%) and ex-smokers (36.2% vs 21.5%), and women were more likely to declare they are never smokers than men (60.3% vs 36.9%). Conclusions: Poland has experienced a decrease in smoking prevalence since 1976 in men and since 1982 in women. In 2019 the most important factor shaping smoking prevalence in Poland was education. Sex differences in smoking rates have been converging since late 1970s. Those with lower levels of education, as well as middle-aged men and women (45-64 years old) were found to have the highest levels of daily smoking and should be offered targeted support promoting smoking cessation. There is an urgent need to bring back and strengthen a national tobacco control strategy in Poland. This should include systematic annual surveys of smoking behaviours on a representative sample of Polish population using a standardised methodolog

Driving to Harper's Corner

Raft on top of truck on dirt road to Harper's Corner, near the confluence of the Yampa and Green Rivers, Eggert-Hatch River Expedition, 1955

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable