Clustering of the Adult Population According to Behavioural Health Risk Factors as the Focus of Community-Based Public Health Interventions in Poland.

Effective lifestyle health promotion interventions require the identification of groups sharing similar behavioural risk factors (BRF) and socio-demographic characteristics. This study aimed to identify these subgroups in the Polish population and check whether local authorities' health programmes meet their needs. Population data came from a 2018 question survey on a random representative sample of 3000 inhabitants. Four groups were identified with the TwoStep cluster analysis method. One of them ("Multi-risk") differed from the others and the general population by a high prevalence of numerous BRF: 59% [95% confidence interval: 56-63%] of its members smoke, 35% [32-38%] have alcohol problems, 79% [76-82%] indulge in unhealthy food, 64% [60-67%] do not practice recreational physical activity, and 73% [70-76%] are overweight. This group, with an average age of 50, was characterised by an excess of males (81% [79-84%]) and people with basic vocational education (53% [50-57%]). In 2018, only 40 out of all 228 health programmes in Poland addressed BRF in adults; only 20 referred to more than one habit. Moreover, access to these programmes was limited by formal criteria. There were no programmes dedicated to the reduction of BRF exclusively. The local governments focused on improving access to health services rather than on a pro-health change in individual behaviours.

Analysis of diabetic patients hospitalizations in Poland by gender, age and place of residence.

Background: There are few updated data on rates of hospital mortality of diabetic patients and length of their hospital stay on a country level. To determine such rates we provided analysis using claims data from a Nationwide General Hospital Morbidity Study carried out by the National Institute of Public Health - National Institute of Hygiene (NIPHNIH) in Warsaw from 2010 to 2018. Objective: The aim of the study was to analyze the nine years changes of in-hospital morbidity and mortality in diabetic patients and length of hospital stay using a comparative approach by gender, age and place of residence. Material and methods: The data on all patients from general hospitals in Poland treated because of diabetes were taken from a nationwide database, kept since 1979 by the Department for Monitoring and Analyses of Population Health of NIPH-NIH. This database contains information gathered under the Statistical Research Program of Public Statistics. Hospitalization rates were used to evaluate the 'hospitalized' incidence of diabetes (number of hospitalization cases due to diabetes per year by the analyzed unit of population). In-hospital mortality was calculated as the percentage of deceased patients out of all patients hospitalized due to diabetes. Results: The number of cases and hospitalization rates of diabetic patients was rapidly declining by 18.8% for type 2 (E11) and 23.7% for type 1 (E10) diabetes. The downward tendency in the scope of hospitalization affected mainly older women and rural residents. Hospital mortality due to diabetes rose up dangerously to 3.77% exceeding the rates recorded eight years earlier. Conclusions: The recent reduction in hospitalization rates of people with diabetes in Poland may be associated with an unexpected increase in hospital mortality.

Factors determining adherence to guidelines and restrictions during the initial period of the COVID-19 pandemic in Poland before the vaccination rollout.

INTRODUCTION: In Poland, like in many other countries, guidelines and certain restrictions were introduced in order to reduce the impact of the pandemic and curb the spread of the virus. These related to such behaviours as washing and disinfecting hands, wearing face masks in designated places, keeping social distance and frequently ventilating rooms. However, not all people follow the guidelines, which can lead to both health and social ramifications. The key objective of this study was an in-depth analysis of how safety rules (SR) were complied with in Poland during the initial pandemic period before the vaccines were rolled out, as well as determining factors that could affect the compliance with SR. METHODS: The study was conducted in the form of a series of cross-sectional surveys using the CATI method on a representative Polish sample in 8 rounds of interviews. Random sampling was applied. The first round was carried out from 2 to 6 July 2020, the last from 17 to 21 August 2020. The authors' original survey questionnaire was used. Factors affecting the compliance with SR were analysed using the multivariate logistic regression method on a combined group of participants from all the study rounds. RESULTS: In total, 4,800 subjects participated in the study, of which 2,512 were women (52.3%) and 2,288 were men (47.7%). Compliance with guidelines was defined based on four survey questions relating to: disinfecting hands when not at home, not touching items with bare hands when not at home, wearing face masks or covering mouth and nose, as well as washing hands after coming back home. Two affirmative answers to these questions or wearing a face mask alone (covering mouth and nose) were interpreted as compliance with SR. SR were more frequently followed by women OR=1.234 95% CI (0.988-1.543), persons over the age of 65 OR=2.098 95% CI (1.409-3.122), people with university education OR=1.315 95% CI (0.950-1.820) and residents of large cities OR=2.179 95% CI (1.382-3.437). Factors that supported compliance with SR were older age, fear of contracting COVID-19 and knowledge of SR. DISCUSSION AND CONCLUSIONS: During the first wave of the pandemic, the SR compliance level was high. Nevertheless, the study identified social groups with a higher risk of non-compliance. This indicates a need for properly addressing communication to these groups, especially that, as was demonstrated, the knowledge alone of pandemic-related messages significantly increased the likelihood of following SR and restrictions. The study of infection-preventing behaviours and their context may provide essential information to guide public policies and communication strategies that would support these behaviours in order to control the spread of the virus more effectively.

Variations in experience of social support and physical health among adult residents of Poland in urban versus rural areas

Background: A study reveals ­ against to common beliefs ­less support between rural area residents in comparison to town-dwellers and significantly higher support for healthy, not for poor health research participants. Objectives: The aim of our paper was comparing support from spouse/partner, relatives, friends and strangers among people with good and ill physical health. A next purpose was to find differences of social support and experience of social undermining in urban and rural residential settings. Material and methods: The study "Epidemiology of Mental Disorders and Access to Mental Health Care, EZOP ­ Poland" was carried out on random sample of 24 000 of Poland residents and a 50,4% response rate, 10 081 computerassisted personal interviews. Of those respondents, 4 000 constituted a sub-sample asked to complete the social networks and support section of the questionnaire. Data were analyzed by age, gender, residential setting and marital status for statistically significant differences in the percentage of functional and structural social support being reported, using the chi-squared test with a significance level of 0.05 used to reject the null hypothesis (H0 = lack of relationship between variables). Results: A majority of respondents maintain that in difficult life situations, family and a close network of friends and acquaintances make it possible to openly discuss problems and obtain help. However, respondents who rate their health as "poor" or "very poor" significantly less often than healthy individuals experience support coming from their relatives, friends, or strangers. In comparison to urban areas, the extent of social support in rural areas is significantly limited. The rural setting offers less support and even less opportunities for interaction with relatives, friends, acquaintances and strangers. Negative social factors­ low levels of trust, isolation from friends and family, lack of a social life, lack of a helpful neighborhood ­ are conditions significantly more often found in the countryside than in urban areas. Conclusions: Results obtained from the EZOP study shows that amount of social support received is higher in urban areas and among those who enjoy better physical health.

[Are rheumatic complaints significantly related to functional ability after 60 year of age?]. / Czy dolegliwosci reumatyczne istotnie ograniczaja sprawnosc po 60. roku zycia? Wyniki ogólnopolskiego badania epidemiologicznego.

INTRODUCTION: Medical care focused on functional abilities gives the elderly with arthritis a possibility of living an independent, active life and participating in social activities, and thus it is seen as the policy of equal chances. OBJECTIVES: The aim of the current paper is the assessment of the Polish adult population mobility level, the changes coming with age, and the statistical significance of relations between rheumatic complaints and a decrease in functional abilities in the elderly. PATIENTS AND METHODS: The results of the all-Poland epidemiological research are presented. The survey conducted on a random sample of adult Poles with arthritis took place in 2002. A total of 4017 respondents answered questionnaires prepared by professional investigators. RESULTS: A significant deterioration of functional abilities can be noticed after the age of 40 and it becomes even more severe after 60. A negative assessment of musculoskeletal functions was declared by 70% of the investigated arthritis elderly people. Respondents did not take into account cognitive dissonance when comparing themselves with a peer group. That is why every second patient considered himself mobile enough for his/her age. A low functional assessment relates significantly to the awareness of having arthritis. Higher education increases chances of maintaining functional abilities up to older age. Exercises "for health" are more popular among older men than older women. CONCLUSIONS: Effective preventing the elderly from physical unfitness should be the duty of individuals, medical care and social policy. Popularizing information on the benefits of physical exercises, awareness of the disease, and shifting the time of intervention to the middle age generation can help achieve this aim.

[Spinal pain in school children]. / Bóle spondylogenne u dzieci.

The investigation was carried out to determine the prevalence of back pain among the population of the school-children aged from 6 to 17 yrs. 3386 children from primary Warsaw schools randomly chosen, were investigated according to the questionnaire based on the diagnostic criteria of juvenile spondyloarthropathies (JSA). Total prevalence of spinal pain was 10.14%. Back pain occurred more frequently than the low - back and cervical pain (5.1% vs 3.44% and 3.04%). The incidence of painful episodes was highest between the age 12 - 15 yrs. Although no definite spondyloarthropathy was found among the investigated children - spinal pain occurred most frequently in those who showed one of the signs included into JSA criteria. This may imply the presence of a risk factor for developing spondyloarthropathy in the future.