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Introduction and objective: Diabetes, with its medical complications and societal consequences, is one the most difficult concerns for modern society. The purpose of this narrative review is to characterize the selected public health challenges and opportunities resulting from diabetes in Poland, as well as to identify public health measures that may be adopted to lower the diabetes burden in Poland. Review methods: This narrative review is based on the literature about diabetes in Poland. Scientific papers on diabetes published between 1 January 2010-31 January 2023, available in the PubMed database, were identified using a combination of the following key words: 'diabetes', 'Poland', 'public knowledge', 'management' and 'costs'. Particular attention was paid to the following diabetes-related issues: (1) current and forecast prevalence of diabetes in Poland, (2) diabetic care before and after the COVID-19 pandemic onset, (3) public knowledge of diabetes and diabetes risk factors, and (4) public health interventions to reduce the diabetes burden at the population level. Abbreviated description of the state of knowledge: A continuous growth of both the incidence and the prevalence of diabetes is predicted. Due to insufficient public awareness of diabetes risk factors and symptoms, and the health-debt caused by COVID-19 pandemic, a further rise in the number of diabetic complications is expected, as well as an increase in public spending on health care and social insurance systems. Summary: Public health interventions targeted at preventing diabetes and its complications should not be confined to reducing complications and improving diabetes care, but also include a wide range of initiatives aimed at addressing the fundamental causes of diabetes. Future study should look at the cost-effectiveness of such initiatives in order to mobilize different stakeholders and society.
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Background: Despite the transformative potential of chimeric antigen receptor T (CAR-T) therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH), to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Method(s): We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester.(Table Presented)Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS <= 6 months). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6months and <=6months groups (Table 1). Patients' ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, CRP, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9+/-11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt <= 100 X109/L, ALC <= 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1.(Figure Presented)Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Introduction - The SARS-CoV-2 pandemic is a major health crisis modern world has to counter. Due to the highly contagious nature of this virus and the rapid growth of infections in many countries specific medical recommendations have been formed to reduce spread of the virus. Aim of the study is determine the psychosocial factors related to obeying medical recommendations against SARS-CoV-2 pandemic during the stage of increasing government's restrictions and limitations. Method – The study included 319 participants (261 women and 58 men) aged 18-66 yrs (M=25). The study was carried out via the Internet from 21st March, 2020 to 27th March, 2020. The sample group included participants chosen using "snowball” effect. Results - It has been shown that the higher anxiety of falling ill, the higher tendency to obey health behaviors towards SARS-CoV-2 (r = .13, p < .001). In order to explain what factors undertaking health behaviors towards SARS-CoV-2 depends on, structural equation modeling was applied including HMB model variables. It has been shown that the benefits and barriers have a significant impact on compliance with health behavior towards SARS-CoV-2 (ß = 0.45, p <0.001). Conclusions – At the beginning of a pandemic, while increasing restrictions perceived barriers and perceived benefits of obeying health recommendations are significant for explaining health behaviors towards SARS-CoV-2 pandemic. Perceived risk is less important. Higher intensity of health anxiety, understood as a fear of infection (likelihood of illness) is related to obeying the health behaviors towards SARS-Cov-2. © 2022 Polish Academy of Sciences. All rights reserved.
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In patients with COVID-19-associated acute respiratory distress syndrome (ARDS), decreased pulmonary compliance, increased pulmonary vascular resistance and micro pulmonary thrombosis increase the right heart burden, which can lead to right heart failure. However, the impact of lung transplantation for ARDS on the right heart is unclear. Therefore, we evaluated changes in heart function and structural abnormalities with pre- and postoperative transthoracic echocardiography (TTE). This study was a retrospective review of the institutional lung transplantation database from June 2020 to June 2022. Pre- and postoperative TTE were performed, and postoperative TTE beyond 90 days was recorded. Right ventricular (RV) function and size were evaluated and scored. The Wilcoxon signed-rank test was used to compare pre- and postoperative TTE values. During the period, 42 patients underwent lung transplantation for COVID-19-associated ARDS: 10 were excluded (two single-lung, one lobar, one dual-organ transplant, and six patients with missing postoperative TTE data);and 32 were included in the study. TTE was evaluated at a median of 15 days preoperatively (IQR 9.5-30) and 144.5 days postoperatively (IQR 112-210). Pre- and postoperative TTE showed significant changes in mitral A, lateral E', RV estimated systolic pressure (RVSP), RV function and size (Figure 1 and Table 1). In patients with severe right heart dysfunction due to COVID-19-associated ARDS, RV function and structure normalized within a relatively short period after lung transplantation. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Severe right heart failure (RHF) is a known complication of pulmonary hypertension, which increases mortality before lung transplantation. The safety and feasibility of venovenous (VV)-extracorporeal oxygenation (ECMO) using ProtekDuoTM (CardiacAssist Inc., Pittsburgh, PA) as a bridge to lung transplantation in severe RHF caused have not been well studied. This study aimed to evaluate the safety and feasibility of VV-ECMO using ProtekDuoTM as a bridge to lung transplantation in patients with severe RHF. This study was a prospective review of the institutional lung transplantation database from June 2020 to June 2022. Patients who underwent lung transplantation with VV-ECMO using ProtekDuoTM for COVID-19 associated acute respiratory distress syndrome (ARDS) were prospectively enrolled;and preoperative and postoperative transthoracic echocardiographic (TTE) data were analyzed. RV function and size were evaluated and scored. The Wilcoxon signed-rank test was used to compare pre- and post-operative TTE values. During the study period, 20 patients underwent lung transplantation for COVID-19-associated ARDS with preoperative VV-ECMO using ProtekDuoTM. TTE was assessed at a median of 15 days preoperatively (IQR, 7.75-31) and 155.5 days postoperatively (IQR, 112-210). Pre and post-operative median RVSP was 45.4 mm Hg (IQR, 29.4-49.0) and 30.0 mm Hg (IQR, 28.0-35.0), p=0.02, and the median mitral valve A was 0.70 cm/s (IQR, 0.70-0.80) and 0.55 cm/s (IQR, 0.50-0.70), p=0.03 (Table1). All patients were hemodynamically stable with active rehabilitation and did not require inotropes or inhaled nitric oxide. VV-ECMO with ProtekDuoTM for patients with COVID-19-associated ARDS before lung transplantation can stabilize patients without significant complications and allows active rehabilitation of patients with severe RHF. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Issue Overweight and obesity are public health challenges of growing importance in Poland. The fastest increase has been observed in children and adolescents. Some studies show that 22% of elementary school children are currently (2013) overweight or have obesity (IZZ), compared with no more than 15% in 1990 (WHO Europe, 2012). Description of the problem The “6-10-14 for Health” is the first comprehensive health programme implemented in Poland, focused on long-term health behaviour change both among children with obesity and their families. Screening tests are carried out at Gdańsk schools. Children who are diagnosed with excess body weight are invited to the second level of programme. Target groups are children in Gdansk, aged 6, 9-11 and 14 years, their parents and the school environment. Timeline: 2011-2021 Results effects: Approximately 400-450 new patients join the programme every year. Programme participants receive annual care from an interdisciplinary team of specialists including a paediatrician, dietitian, specialist in physical activity and a psychologist. The effect of one year's participation in the programme is the reduction of excess body weight in 75% of participants. More then 2000 patients have complieted the Programme. The programme is accredited by the European Association for the Study of Obesity and is funded by the City of Gdańsk. changes: Further implementation of the Programme depends on providing funds from the City of Gdańsk. However, it seems that the 6-10-14 for Health is one of the city's health priorities. The challenge in the field of weight reduction programs is to provide care that will not lead to stigmatization of patients Lessons The work on designing the model has already resulted in creation of network of specialists from different backgrounds and allowed sharing different scopes, how to use limited resources for the benefit of children and adolescens. Key messages The proposed care model is fully possible to implement in the care system. So far, sharing knowledge and experience, the program has been implemented in several other local governments. In the era of the COVID19 pandemic, all activities aimed at the prevention and early treatment of obesity become even more important.
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Study Objectives: Consolidation of health care systems in the United States has created integrated enterprises with large geographical reach and complex interacting components. Specialty services vary among sites, and patients often need to travel between facilities for different aspects of care. Network science is an established method employed to investigate these complex systems, and can be used to identify bottlenecks, opportunities to increase value and patient-centeredness in health care. The COVID-19 pandemic changed care demand patterns unexpectedly. We wanted to investigate if network analysis would allow us to better understand these changes and challenges - where our patients receive hospital-based care, what services they used and how far they travelled. We focused this analysis on a multispecialty, tertiary care academic center emergency department (“AC_ED”), with 70,000 patient visits annually. Methods: We extracted patient location information from electronic health records, including originating location and level of care, to create a network representation of all care pathways that passed through our ED. The volume of transfers between nodes and the distance travelled were encoded as weighted/colored edge attributes, with edges between nodes in closer proximity being darker. Nodes include: communities within our service area, EDs, and academic center units, and an outcome of mortality. They are sized/colored by betweenness centrality, reflecting the importance of the node in the integrity of the network. Results: The figure shows the overall network structure was similar for pre- and post-pandemic onset with some changes in details. AC_ED receives patients from many home locations and referring hospitals. A large proportion of visits come from the local area reflected by M16 and M12. There are many patients who travel far to access emergency care at AC_ED, bypassing local EDs though the average distance travelled to access care reduced from 114 to 85 miles. During the pandemic there was more traffic to the AC_ED from the local area (M16), fewer connections to surrounding hospitals and disproportionately reduced visits from distant areas (O and OT). Low ED volumes and restricted outpatient clinic availability during the pandemic time frame likely affected this. Inter-hospital transfer volumes declined overall, several sites transferred very few patients to AC_ED post-pandemic start, and other sites increased their transfer rate (eg, CAH13). Conclusions: Looking at hospital systems through the lens of network science can reveal changes in patterns of referrals, allows for identification of unexpected results by presenting data visually and can assist identifying crucial components of a health care system. Application of this methodology to other variables has the potential to identify new areas of improvement to increase value, outcomes and services to improve patient-oriented care. [Formula presented]
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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the novel coronavirus. The role of environmental factors in COVID-19 transmission is unclear. This study aimed to analyze the correlation between meteorological conditions (temperature, relative humidity, sunshine duration, wind speed) and dynamics of the COVID-19 pandemic in Poland. Data on a daily number of laboratory-confirmed COVID-19 cases and the number of COVID-19-related deaths were gatheredfrom the official governmental website. Meteorological observations from 55 synoptic stations in Poland were used. Moreover, reports on the movement of people across different categories of places were collected. A cross-correlation function, principal component analysis and random forest were applied. Maximum temperature, sunshine duration, relative humidity and variability of mean daily temperature affected the dynamics of the COVID-19 pandemic. An increase intemperature and sunshine hours decreased the number of confirmed COVID-19 cases. The occurrence of high humidity caused an increase in the number of COVID-19 cases 14 days later. Decreased sunshine duration and increased air humidity had a negative impact on the number of COVID-19-related deaths. Our study provides information that may be used by policymakers to support the decision-making process in nonpharmaceutical interventions against COVID-19.
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Introduction: COVID-19 cases have rarely been reported in children. We sought to analyse the attack rate in paediatric population in Poland, focusing on local variations among the provinces, correlation with the number of tests per capita, and test positivity rate. Material and methods: This cross-sectional study involved the 38.38 million population and detected 17,921 cases (age known in 17,822). Data were collected from publicly available registries and were analysed by age group and province of the country.