Factors predicting early stroke fatality in Poland. Preliminary report of the Polish National Stroke Registry.

Poland has one of the highest rates of death due to stroke in Europe, which, in contrast to many industrialized countries, has not changed since at least 1984. To improve this unfavorable situation, the entire approach to stroke management needs to be recognized. For this purpose, an analysis of stroke epidemiology regarding regional differences was one of the the strategic points of the Polish National Project of Stroke Prevention and Treatment. The Polish National Stroke Registry was maintained from 1 January to 31 December 2000 in 59 Neurological Department in all 16 districts of Poland. In total 11,107 patients were included: 11% with intracerebral hemorrhage, 63.4% with ischemic stroke, and 25.6% with unclassified stroke. Computed tomography (CT) was performed in 73.6% of patients. Analysis of in-hospital deaths showed great differences between the centers (from 8% to 36%). According to multifactorial analysis, not only well-known predictors of early death (decrease in consciousness at the onset of stroke, decrease in functional state prior to stroke, and severity of stroke) influence the prognosis. In centers with high risk of death, CT, especially CT on admission, was performed significantly less often (4.2% vs. 62.6%), early rehabilitation was delayed (38.3% vs. 73.4%), and secondary prevention treatment was prescribed to fewer patients (antiplatelettherapy 36.4% vs. 77.4%; antithrombotic therapy 4.9% vs. 13%).

Stroke mortality rates in Poland did not decline between 1984 and 1992.

BACKGROUND AND PURPOSE: Stroke mortality has decreased in most industrialized countries in recent decades. In Poland, as in other eastern European countries, mortality rates for stroke remain high. METHODS: The Warsaw Stroke Registry (WSR) registered patients in the Mokotów district of Warsaw from 1991 through 1992. The Warsaw Pol-MONICA study registered stroke patients in the North and South Praga regions of Warsaw from 1984 through 1992. Stroke incidence rates, case-fatality rates, and stroke mortality rates were computed based on both studies and compared with published mortality rates based on death certificates. Eight-year trends of stroke incidence, case-fatality rate, and mortality were derived from the Warsaw Pol-MONICA study. RESULTS: The WSR and Warsaw Pol-MONICA studies showed similar incidence rates, mortality rates, and 28-day case-fatality rates for stroke. Mortality rates from the WSR and the Warsaw Pol-MONICA study were similar to rates from death certificate data. Mortality rates in the group aged 35 to 64 years were higher in men (47.5 to 50/100000 per year) than in women (30/100000 per year). CONCLUSIONS: Two different population-based studies suggest that stroke mortality is high in Poland because of high 28-day case-fatality rates. Stroke mortality failed to decline in Poland in the period 1984 through 1992 because neither case fatality nor stroke incidence declined in this period.

Assessment of the impact of changes related to the system transformation on the evolution of the process of mortality in Poland.

"The article presents an attempt to make a quantitative evaluation of the impact of the environment on the rate of mortality, focusing on the group of stress-bearing factors that, according to some hypotheses, make up the set of potential, indirect determinants in the process of mortality. According to these opinions, the environment can be a source of different forms of stress. One stressor can be the social and economic status of individuals, being the function of the economic development of the region, another the instability of the social situation in the region. Both types of stress sources seem to be particularly adequate in the evaluation of the impact of this type of factor on the process of mortality in Poland in the period of system transformation."

Remarks on the mechanism of demographic behaviour.

The main idea, on which discussion presented in this work is concentred cosists in the conviction, that the observed demographic regularities are the result of individual struggle with the daily difficulties of the units constituting populations, and the belief, that the essence of human existence is rooted in the permanent process of adaptations. On the base of above, it has been assumed that demographic transformations are result of two forces. First of them is formed by biological determinants, forcing human sociates to function in the environment in a way which would maximize both--ability to survive and multioly, and the result of these strifes in expressed by the guarantees of population existence. Resistance of environment is another force influencing demographic transformations.

An attempt at evaluation of the economic and social factors [influencing] the Polish population's fertility formation.

PIP: This analysis of economic determinants of fertility in Poland shows that couples' fertility decisions are negatively influenced by factors affecting family income. Social and demographic factors were found to be unrelated to fertility. 17 socioeconomic measures were grouped as those expressing the level of economic development and determining family income size, those reflecting the level of socioeconomic development and determining the level of children's education, and those characterizing the level of social development and determining the need for health care and social security. The level of actual fertility is modeled as a linear function of variables in a main components factor analysis. Average monthly pay in the national economy (37.6%), the sold industrial production per person (13.8%), and the global agricultural production per person (13.2%) account for 64.6% of the variance. Among the social factors, findings indicate that a higher feeling of security is related to lower fertility, but economic factors have a stronger influence. Voivodeships are grouped as having low levels of economic development (24), as having high educational levels (24), and as having low levels of social security (24). Voivodeships with low levels of economic development and high parity include all the grouped voivodeships with the exception of three. Low-security voivodeships showed mixed patterns of fertility. High-education voivodeships showed a weak correlation with high fertility. Only three voivodeships have low economic and security factors and high education factors, and only one voivodeship has high fertility. Of the three voivodeships with high security and economic factors and low education factors, all have low parity.^ieng

[Demographic forecast for Poland 1983-1990 and 1995]. / Prognoza demograficzna dla Polski na lata 1983-1990 orza 1995.

PIP: The premises and results of a forecast f Poland's population are discussed. The forecast consists of 3 parts. The 1st concerns the size and composition (by age, sex, and place of residence) of Poland's population, 1 version being purely biological and the other allowing for migration. A 2nd concerns the number and structure fo households (by size of household, age of household head, and place of residence) established on the basis of headship rates. The last part is a biological forecast of the size and composition of the population (by sex and age) for 9 established urban agglomerations. (author's modified)^ieng

[A model of demographic transformation in graph presentation]. / Model transformacji demograficznej w ujeciu grafu.

PIP: This article attempts to provide a model of demographic transformation giving various possibilities of its realization with constant socioeconomic factors. To this end, some elements of the theory of graphs were used. On the basis of the described cycle of demographic transformation, a graph was established and its features used to show possible ways of demographic transition, with specific socioeconomic factors. The example presented is to show that various observed forms of demographic transformation come into being directly as an evolution of the classical model. The evolution of the 2nd and 3rd stages (the differentiation of forms of transformation appears mostly during these 2 stages) especially in the developing case of countries can be caused by the fact that in thies group of countries, demographic transformation is much delayed as compared with countries which have already attained a high level of industiralization and terminated the transformation cycle as described in the classical definition. The possibility of quick flows of information in the world and the universality of transferring various technologies to developing countries allow a marked shortening or superposition of successive stages of transformation, and even the elimination of certain elements contained in the classical model.^ieng