Changes in disease burden in Poland between 1990–2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017

Background Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990–2017, and compare Poland with other Central European (CE) countries

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries : a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND:Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS:The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS:Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS:There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed

Creating of New Value and Meaning of Garden in the Rural Landscape

The authors used three example variants of rural development solutions to present the problem of defining the space of the contemporary countryside gardens of small, local parish communities in the former GDR, taking into consideration its integrative function. The three design subjects pre-sented in the paper (each developed with two variants) concern spatial arrangement of a parish garden as a public space for: community meetings and recreation (example 1 - fig. 1, 2), studying and recreation (example 2 - fig. 3,4), and relaxation/ meditation (example 3 - fig. 5, 6). All of them in the same attempt to organize space of wastelands; areas devastated culturally and naturally, but still important in the spatial structure of the town. The relations between the presented places local their use by local parish communities served as an impulse to define the fundamental, conceptual presumptions that let the presented composition suggestions take into account their timeless role of humanization of open space, with their potential standard of usage. One essential value of the presented examples is their practical potential - expected investment decisions after their public presentation to entire local communities (with declared support)

Patient aggression towards health care professionals

Purpose: To estimate the frequency of aggressive behaviors in health care institutions, and determine their influence on emotional reactions of medical workers. Materials and methods: The study involved 201 health care professionals from the regions of Lower Silesia and Opole in Poland. The authors employed the exposure to patient aggression inventory, based on the questionnaires of Merecz and Nowicka & Kolasa; this inventory divides patient aggression towards medical workers into seven different forms. Results: In over 90% of cases, health care professionals fell victim to patient aggression in a workplace. It mostly took forms of verbal aggression, a raised voice and shouting. A physical attack was reported by 45.6% of the surveyed; it resulted in physical injuries in 27.9% of psychiatric hospital workers and 24.7% of general hospital workers. As a reaction to patients’ verbal aggression, medical workers usually calmly explained that such behavior was improper. Violence and aggressive behaviors of patients evoked workers’ anger, fear, a feeling of resignation and the loss of their sense of safety. In most case's victims of patient aggression either coped with the problem themselves or asked their co-workers and superiors for help. Conclusions: Aggressive behaviors of patients arouse in medical staff, mostly anger. Medical workers usually cope with patient aggression themselves; nurses more often than other health care professionals ask their superiors and co-workers for help. It is necessary to conduct further research into the problem of patient aggression towards medical staff so that actions ensuring safety for workers can be taken

Influence of cigarette smoking on hormone and lipid metabolism in women in late reproductive stage

Małgorzata Szkup,1 Anna Jurczak,2 Beata Karakiewicz,3 Artur Kotwas,3 Jacek Kopeć,4 Elżbieta Grochans1 1Department of Nursing, 2Department of Clinical Nursing, 3Department of Public Health, Pomeranian Medical University in Szczecin, Szczecin, Poland; 4School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada Background: The aim of the study was to analyze lipid and hormone metabolism, body mass index (BMI), and age parameters in late reproductive stage women in relation to cigarette smoking.Methods: The study enrolled 345 healthy late reproductive stage women living in Poland; 13.33% were smokers. The first part of the study assessed lipid metabolism (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and hormone metabolism (estradiol [E2], follicle-stimulating hormone [FSH], and anti-Müllerian hormone [AMH] levels) in women in the early phase of the follicular menstrual cycle. The second part of study was carried out using the diagnostic survey method, with a standardized questionnaire (Primary Care Evaluation of Mental Disorders [PRIME-MD]) and the authors’ own research tools.Results: The women were aged 42.3±4.5 years (mean ± SD). The BMI (24.8±4.04 kg/m2) did not differ significantly between the groups. The women who smoked cigarettes had a statistically significantly (p<0.05) lower level of HDL as well as higher LDL and triglyceride levels (p<0.05). Differences were also shown in hormone levels: non-smoking participants had statistically significantly higher levels of E2 and FSH (p<0.05). In the group of non-smoking women, age was a predictor exerting a significant positive impact on the levels of total cholesterol, LDL, triglycerides, and AMH (p<0.05). BMI contributed to a decline in HDL and triglyceride levels. In the group of smoking women, age significantly positively influenced the level of E2, and negatively influenced AMH. BMI was associated with a significant decrease in the HDL level.Conclusion: Smoking cigarettes affects the physical health of women in late reproductive stage through negative influences on lipid and hormone metabolism, among other factors. Age is an unmodifiable factor adversely affecting both lipids and hormones. Higher BMI has a negative influence on lipid metabolism in both groups of women in this study. Keywords: smoking, cholesterol profile, gonadal steroid hormone

Parenteral aluminium loading in critical care medicine part I aluminium content of infusion solutions and solutions for parenteral nutrition

Background For patients with disturbed aluminum Al excretion, a high Al intake is not without risk. As main aluminum sources infusion solutions and solutions for parenteral nutrition have been identified. This study will give current survey of aluminum loading of the above mentioned preparations. Material and Methods The aluminum loading of 139 different infusion solutions and solutions for parenteral nutrition was determined. The solutions were from the clinical pharmacy of the Klinikum Steglitz of the Free University Berlin or were bought in a public pharmacy. The aluminum content was determined by means of two different, independent analytical methods a graphite furnace atomic absorption spectroscopy GFAAS and b inductively coupled plasma atomic emission spectroscopy ICP AES . The agreement of the measured values was good except for five samples, where different values were found. Mistakes due to contamination were excluded on the basis of the results of measuring standard reference materials. Results Small volume additives of TPN total parenteral nutrition formulations were highly contaminated with aluminum, e.g. Ca and phosphate solutions 29 12,000 g l , vitamin C solutions 700 1,200 g l and trace element solutions 67 6,200 g l . Furthermore about 44 of the crystalline amino acid solutions and lipid emulsions had an aluminum content of 25 to 55 g l. Low aluminum levels were found in carbohydrate solutions, NaCl and KC1 solutions and in distilled water aqua ad injectabilia . Conclusions Many of the solutions for parenteral nutritional support have an aluminum content which exceeds, in part considerably, the suggested threshold concentration of 25 g l 0.93 mol l , recommended by the American Society for Clinical Nutrition ASCN and the American Society for Parenteral and Enteral Nutrition ASPEN . The pharmaceutical industry should be required to check the manufacturing process for avoidable sources of contamination, and threshold values for aluminum loading by intravenously applied pharmaceuticals should be laid down in the German and European pharmacopeia. In cases where contaminations cannot be eliminated during the manufacturing process after careful checking, the aluminum content of the infusion solution should be declared for the use

Ageing society – a review of strategies for action

It is expected that during 1980 – 2020 the population of older people worldwide will increase by 240%. The objective of the study was to review strategies undertaken in various countries in association with the ageing of society. This analysis may be used for the selection of actions, which are necessary for the construction and performance of social and health policy in Poland. A method of choice was an analysis of academic literature. The WHO specified health promotion as the most important goal of the policy for seniors. Individual countries adopt many varied strategies of action. In Poland, the introduction of nursing insurance and development of geriatric medicine are primarily proposed. In Japan, the emphasis is placed on enabling the elderly the longest occupational activity possible, and the development of primary health care. For the Swedish, the priority is guaranteed support for family caregivers, while in the United States - an increase in the accessibility of environmental care. There are many strategies developed on an international forum whose purpose is to provide care for the growing number of seniors. The strategies adopted by individual countries are much varied. The basic postulates are a development of geriatric medicine and integration of the systems of health services and social security. The literature lacks reports on the effectiveness of the implemented strategies

Influence of Pb and Cd levels in whole blood of postmenopausal women on the incidence of anxiety and depressive symptoms

Introduction. To-date, the influence of heavy metals such as Pb or Cd on mental functioning, and especially on the occurrence of depressive and anxiety-related disorders, has not been well understood. Objectives. 1) Assessment of Pb and Cd levels in whole blood of postmenopausal women. 2) Assessment of the severity of anxiety and depressive symptoms depending on Pb and Cd levels in whole blood of postmenopausal women. Materials and method. The survey-based study involved 198 healthy postmenopausal women from West Pomeranian province in Poland. It was performed using the Primary Care Evaluation of Mental Disorders (PRIME-MD), Beck’s Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The second part of the study was based on biochemical analysis of the levels of heavy metals (Pb, Cd). Results. The mean level of Pb was 19.85 ± 8.99 μg/l and Cd 0.87±0.98 μg/l; these levels were within normal ranges. Analysis of the mean levels of Pb and Cd in whole blood of postmenopausal women in relation to the severity of depressive symptoms did not reveal statistically significant differences. Correlation analysis demonstrated a statistically significant (p<0.05) negative correlation (-0.22) between the level of Pb and the severity of anxiety as a state. Correlations between the levels of Pb and Cd and the severity of anxiety as a trait were not statistically significant. Conclusions. The mean Pb and Cd levels in whole blood of healthy postmenopausal women did not exceed acceptable limits. The study did not confirm a relationship between the levels of selected heavy metals and the severity of anxiety and depressive symptoms in healthy women. However, there was a relationship between the level of Pb and the severity of anxiety as a state

Analysis of Sociodemographic, Psychological, and Genetic Factors Contributing to Depressive symptoms in Pre-, Peri- and Postmenopausal Women

Depressive symptoms that are faced by women in the pre-, peri-, and postmenopausal periods are determined by a wide array of sociodemographic, psychological, and biological variables. The aim of our study was to identify factors that contribute to depressive problems at this stage of life. The study included 815 healthy Polish women aged 45–60 years. The survey part was conducted using the Beck Depression Inventory (BDI), the State–Trait Anxiety Inventory (STAI), the Neuroticism–Extroversion–Openness Five Factor Inventory (NEO-FFI), and a self-developed questionnaire. Genetic analysis was also performed. Depressive symptoms were observed in 25.5% of participants. 70% of the women were postmenopausal. No statistically significant differences in the severity of depressive symptoms were demonstrated with regard to genetic variables (p > 0.05). Reproductive capacity (p < 0.001), employment (p < 0.001), and being married (p < 0.018) were found to reduce the incidence of depressive symptoms. The contribution of personality and anxiety as a trait to depressive symptoms varied. Conclusions: The factors predisposing pre-, peri-, and postmenopausal women to depressive symptoms include lower education, lack of a life partner, unemployment, high anxiety, and neurotic personality. No evidence was found for the contribution of genetic factors to depressive symptoms in the examined women.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult