Difficulties in diagnosing angiomatoid fibrous histiocytoma of the head and neck region: A case report.

BACKGROUND: Angiomatoid fibrous histiocytoma (AFH) is a rare, slow-growing soft tissue tumor. It appears mostly on the limbs and trunk in children and young adults. The biology of AFH remains unclear because of the small number of reported cases. Diagnostic testing does not provide definitive results. It has two clinical forms, that differ in terms of gene expression and clinical prognosis. It is important to inform the laboratory which specific gene testing is necessary. Here, we describe a case of rare AFH in the submandibular region using a full genetic panel. CASE SUMMARY: A 13-year-old boy who had been misdiagnosed in the past 6 mo by his dentist visited our clinic because of a lesion in the submandibular area on the right side. The lesion was homogeneous and painless upon palpation. No skin discoloration was observed. Due to the non-specific radiological picture computed tomography (CT), magnetic resonance imaging (MRI), cone-beam CT (CBCT), and ultrasound-guided biopsy were performed. A venous malformation was suspected on the MRI. None of the tests provided a definitive diagnosis. Owing to the non-specific radiological findings, the patient qualified for surgical treatment. The surgical procedure included an excisional biopsy. The diagnostic testing was extended using gene rearrangements. The most distinctive gene translocation in diagnosing AFH is within the EWS RNA-binding protein 1 (EWSR1)-CREB-binding protein. However, in this case, the diagnosis was confirmed by a rearrangement within the EWSR1 gene testing. CONCLUSION: AFH in the submandibular location is rare, and surgical treatment with genetic evaluation defines AFH type that affects subsequent procedures.

A temporally and spatially explicit, data-driven estimation of airborne ragweed pollen concentrations across Europe.

Ongoing and future climate change driven expansion of aeroallergen-producing plant species comprise a major human health problem across Europe and elsewhere. There is an urgent need to produce accurate, temporally dynamic maps at the continental level, especially in the context of climate uncertainty. This study aimed to restore missing daily ragweed pollen data sets for Europe, to produce phenological maps of ragweed pollen, resulting in the most complete and detailed high-resolution ragweed pollen concentration maps to date. To achieve this, we have developed two statistical procedures, a Gaussian method (GM) and deep learning (DL) for restoring missing daily ragweed pollen data sets, based on the plant's reproductive and growth (phenological, pollen production and frost-related) characteristics. DL model performances were consistently better for estimating seasonal pollen integrals than those of the GM approach. These are the first published modelled maps using altitude correction and flowering phenology to recover missing pollen information. We created a web page (http://euragweedpollen.gmf.u-szeged.hu/), including daily ragweed pollen concentration data sets of the stations examined and their restored daily data, allowing one to upload newly measured or recovered daily data. Generation of these maps provides a means to track pollen impacts in the context of climatic shifts, identify geographical regions with high pollen exposure, determine areas of future vulnerability, apply spatially-explicit mitigation measures and prioritize management interventions.

Home Environment in Early-Life and Lifestyle Factors Associated with Asthma and Allergic Diseases among Inner-City Children from the REPRO_PL Birth Cohort.

OBJECTIVE: We hypothesized that, in our REPRO_PL cohort, exposure to indoor allergens and lifestyle factors in early life are associated with risk of asthma, atopic dermatitis, and allergic rhinitis at ten years of age. METHODS: We only examined children who had lived in the same house from birth. Children's exposure to tobacco smoke was assessed based on cotinine levels in urine. House dust samples were collected. RESULTS: Higher Fel d1 concentration in house dust was associated with significantly higher risk of developing asthma at age 10 years (95% CI,10.87 to 20.93; p < 0.001). Frequent house cleaning was associated with development of atopic dermatitis (odds ratio 0.61; 95% CI 0.37 to 0.99; p = 0.045). Clustering of exposure to HDM revealed two types of environment. Cluster 1, defined as lower HDM (dust), in contrast to Cluster 2, defined as higher HDM, was characterized by old-type windows, lower fungus and dampness levels, as well as more frequent house cleaning. CONCLUSION: Exposure to cat allergens and new-type buildings that limit air flow while increasing the condensation of steam on the windows and thereby stimulating the growth of fungi are risk factors for the development of asthma.

Bioaerosols on the atmospheric super highway: An example of long distance transport of Alternaria spores from the Pannonian Plain to Poland.

Alternaria spores are pathogenic to agricultural crops, and the longest and the most severe sporulation seasons are predominantly recorded in rural areas, e.g. the Pannonian Plain (PP) in South-Central Europe. In Poland (Central Europe), airborne Alternaria spore concentrations peak between July and August. In this study, we test the hypothesis that the PP is the source of Alternaria spores recorded in Poland after the main sporulation season (September-October). Airborne Alternaria spores (2005-2019) were collected using volumetric Hirst spore traps located in 38 locations along the potential pathways of air masses, i.e. from Serbia, Romania and Hungary, through the Czech Republic, Slovakia and Ukraine, to Northern Poland. Three potential episodes of Long Distance Transport (LDT) were selected and characterized in detail, including the analysis of Alternaria spore data, back trajectory analysis, dispersal modelling, and description of local weather and mesoscale synoptic conditions. During selected episodes, increases in Alternaria spore concentrations in Poznan were recorded at unusual times that deviated from the typical diurnal pattern, i.e. at night or during morning hours. Alternaria spore concentrations on the PP were very high (>1000 spores/m3) at that time. The presence of non-local Ambrosia pollen, common to the PP, were also observed in the air. Air mass trajectory analysis and dispersal modelling showed that the northwest part of the PP, north of the Transdanubian Mountains, was the potential source area of Alternaria spores. Our results show that Alternaria spores are transported over long distances from the PP to Poland. These spores may markedly increase local exposure to Alternaria spores in the receptor area and pose a risk to both human and plant health. Alternaria spores followed the same atmospheric route as previously described LDT ragweed pollen, revealing the existence of an atmospheric super highway that transports bioaerosols from the south to the north of Europe.

The impact of data assimilation into the meteorological WRF model on birch pollen modelling.

We analyse the impact of ground-based data assimilation to the Weather Research and Forecasting (WRF) meteorological model on parameters relevant for birch pollen emission calculations. Then, we use two different emission databases (BASE - no data assimilation, OBSNUD - data assimilation for the meteorological model) in the chemical transport model and evaluate birch pollen concentrations. Finally, we apply a scaling factor for the emissions (BASE and OBSNUD), based on the ratio between simulated and observed seasonal pollen integral (SPIn) to analyse its impact on birch concentrations over Central Europe. Assimilation of observational data significantly reduces model overestimation of air temperature, which is the main parameter responsible for the start of pollen emission and amount of released pollen. The results also show that a relatively small bias in air temperature from the model can lead to significant differences in heating degree days (HDD) value. This may cause the HDD threshold to be attained several days earlier/later than indicated from observational data which has further impact on the start of pollen emission. Even though the bias for air temperature was reduced for OBSNUD, the model indicates a start for the birch pollen season that is too early compared to observations. The start date of the season was improved at two of the 11 stations in Poland. Data assimilation does not have a significant impact on the season's end or SPIn value. The application of the SPIn factor for the emissions results in a much closer birch pollen concentration level to observations even though the factor does not improve the start or end of the pollen season. The post-processing of modelled meteorological fields, such as the application of bias correction, can be considered as a way to further improve the pollen emission modelling.

Extension of WRF-Chem for birch pollen modelling-a case study for Poland.

In recent years, allergies due to airborne pollen allergens have shown an increasing trend, along with the severity of allergic symptoms in most industrialized countries, while synergism with other common atmospheric pollutants has also been identified as affecting the overall quality of citizenly life. In this study, we propose the state-of-the-art WRF-Chem model, which is a complex Eulerian meteorological model integrated on-line with atmospheric chemistry. We used a combination of the WRF-Chem extended towards birch pollen, and the emission module based on heating degree days, which has not been tested before. The simulations were run for the moderate season in terms of birch pollen concentrations (year 2015) and high season (year 2016) over Central Europe, which were validated against 11 observational stations located in Poland. The results show that there is a big difference in the model's performance for the two modelled years. In general, the model overestimates birch pollen concentrations for the moderate season and highly underestimates birch pollen concentrations for the year 2016. The model was able to predict birch pollen concentrations for first allergy symptoms (above 20 pollen m-3) as well as for severe symptoms (above 90 pollen m-3) with probability of detection at 0.78 and 0.68 and success ratio at 0.75 and 0.57, respectively for the year 2015. However, the model failed to reproduce these parameters for the year 2016. The results indicate the potential role of correcting the total seasonal pollen emission in improving the model's performance, especially for specific years in terms of pollen productivity. The application of chemical transport models such as WRF-Chem for pollen modelling provides a great opportunity for simultaneous simulations of chemical air pollution and allergic pollen with one goal, which is a step forward for studying and understanding the co-exposure of these particles in the air.

High Ambrosia pollen concentrations in Poland respecting the long distance transport (LDT).

High Ambrosia pollen concentrations in Poland rather rarely come from the local sources. The aim of this study was to define the temporal and spatial differences of the high Ambrosia pollen concentrations by creating models for the pollen transport from the distant sources. This study was thought to determine the direction of the air masses inflow into Poland, carrying Ambrosia pollen, from areas of the bordering countries with the pollen concentrations higher than iSTOTEN_n Poland. Pollen and meteorological datasets at 8 monitoring sites in Poland, and daily pollen concentrations at 11 sites in the Czech Republic, 5 sites in Slovakia and 3 sites in Ukraine were analysed recently. Days with concentrations ≥10 Pollen/m3 and concurrent meteorological situations were analysed in great deal. The HYSPLIT model was applied to compute backward trajectories up to 4 days backward (96 h) and at three altitudes: 20, 500 and 1000 m above ground level (a.g.l.). High pollen concentrations occur most frequently when the air masses inflow into Poland from southerly (S, SE, SW, 44%) and easterly (E, 6%) directions and in no advection situations (25%). In years with the highest frequency of days over 10 Pollen/m3, the prevailing directions of the pollen influx into Poland were from the South (2004-2006, 2008, 2011) but in one year (2014) from the East. Trajectories for the studied period show that air masses come most frequently from Slovakia and the Czech Republic. Sometimes, the Ambrosia pollen transport happens from Ukraine.

[Evaluation of renal lesions in children with tuberous sclerosis - summary of the first year of follow-up program]. / Ocena zmian w nerkach u dzieci chorych na stwardnienie guzowate ­ podsumowanie pierwszego roku programu opieki.

Tuberous sclerosis complex (TSC) is a genetic disease that leads to formation of tumors i.e. in brain kidneys, heart, lungs, and skin. AIM: The aim of the study was to summarize center's experience in the first year of program of nephrologic follow-up in patients with TSC. MATERIALS AND METHODS: During 12 months 30 children with TSC (14 boys and 16 girls aged from 3 months to 17 years 11 months, mean 7.57±5.02 years) were hospitalized. Following parameters were evaluated: genetic and biochemical tests, blood pressure in ambulatory blood pressure monitoring (ABPM), kidney lesions in ultrasonography (30 patients) and in magnetic resonance (14 patients). RESULTS: Genetic tests were performed in 6 children - in 5 TSC2 mutation was found, in one boy with TSC and numerous renal cysts only PKD1 mutation was revealed. Mean GFR was 130.81±23.23 mL/ min/1.73 m2. Four children (13.3%) had arterial hypertension. Renal lesions were found in 28 (93.3%) children: 18 patients had angiomyolipomas (AML) (mean diameter 15.4±12.5, max 38 mm), 23 patients had renal cysts (mean diameter 7.6±7.0, max 30 mm); 13 patients had AMLs and cysts. A dysplastic lesion (39x26x15 mm) in right kidney was found in one girl. Children with AML were older than remaining patients (10.08±4.55 vs. 4.25±3.50 [years], p<0.001). Children with cysts were characterized by higher systolic (p=0.017), diastolic (p=0.027) and mean (p=0.014) arterial pressure, and mean arterial pressure Z-score (p=0.025) in ABPM. Maximal kidney cyst diameter correlated positively with systolic, diastolic, mean arterial pressure, mean arterial pressure Z-score, and diastolic blood pressure load in ABPM (r = 0.61-0.75, p = 0.033-0.005). Two children with numerous AML with diameter >30 mm were treated with sirolimus. CONCLUSIONS: Because of common focal lesions in kidneys children with TSC should be kept under regular nephrologic follow-up. Presence of large renal cysts may predispose children with TSC to arterial hypertension.

Forecasting model of Corylus, Alnus, and Betula pollen concentration levels using spatiotemporal correlation properties of pollen count.

The aim of the study was to create and evaluate models for predicting high levels of daily pollen concentration of Corylus, Alnus, and Betula using a spatiotemporal correlation of pollen count. For each taxon, a high pollen count level was established according to the first allergy symptoms during exposure. The dataset was divided into a training set and a test set, using a stratified random split. For each taxon and city, the model was built using a random forest method. Corylus models performed poorly. However, the study revealed the possibility of predicting with substantial accuracy the occurrence of days with high pollen concentrations of Alnus and Betula using past pollen count data from monitoring sites. These results can be used for building (1) simpler models, which require data only from aerobiological monitoring sites, and (2) combined meteorological and aerobiological models for predicting high levels of pollen concentration.

Environmental factors affecting seasonality of ambulance emergency service visits for exacerbations of asthma and COPD.

OBJECTIVE: The aim of this study was to assess the association of severe exacerbations of asthma and Chronic Obstructive Pulmonary Disease (COPD) requiring ambulance emergency service (AES) visits with meteorological parameters and influenza outbreaks. METHODS: The records of patients calling the AES in 2007 and 2008 in the urban area of Lodz due to dyspnea were analyzed. Information on 25 daily reported meteorological parameters was obtained from the local meteorological service and data on influenza outbreaks obtained from the national surveillance service. RESULTS: During the winter months, a significantly higher mean daily number of AES visits for both COPD and asthma were noticed when compared to the summer. Interestingly, the number of daily AES visits correlated with several weather parameters, and the multiple regression analysis confirmed a negative correlation with minimum temperature, mean temperature and the dew point for both diseases (R = 0.526; p < 0.01; R = 0.577; p < 0.01 and R = 0.589; p < 0.01). Furthermore, the increased number of AES visits also correlated with a new number of cases of influenza infections as reported by local influenza surveillance system (rs = 77.6%; p < 0.001 and rs = 80.8%; p < 0.001 for asthma and COPD, respectively). CONCLUSION: Seasonality of AES visits for asthma and COPD are similar and seems to be related to specific weather conditions and to influenza outbreaks.

Association of house dust allergen concentrations with residential conditions in city and in rural houses.

BACKGROUND: The aim of the study was to evaluate the relationship between house dust mite, cat and dog allergen levels with household characteristics in the houses of children living in urban and rural areas in central Poland. METHODS: Dust samples were collected from 141 urban and 191 rural houses. Der f1 + Der p1, Can f 1, and Fel d1 levels were measured and associated with residential conditions and atopy-related health outcomes assessed by clinical examination and skin prick testing. RESULTS: Concentrations of mite allergens were lower, and cat and dog allergen levels were higher in urban houses. Fel d1 and Can f1 levels depended on the presence of a respective animal in the house. In urban houses, Der p1 + Der f1 concentration was lower in households with central heating, whereas Can f1 concentration was related to building age. Multivariate analyses revealed that the concentrations of house dust mite and dog allergens were associated with relative humidity, number of people in the household, and the presence of a dog at home. There was no significant association between allergen level and sensitization or atopic diseases. CONCLUSIONS: Concentrations of indoor allergens in urban and rural houses differ significantly, and residential conditions associated with allergen levels seem to be different in both environments.

Associations of allergic sensitization and clinical phenotypes with innate immune response genes polymorphisms are modified by house dust mite allergen exposure.

INTRODUCTION: Polymorphisms within innate immunity genes are associated with allergic phenotypes but results are variable. These associations were not analyzed with respect to allergen exposure. We investigated associations of TLR and CD14 polymorphisms with allergy phenotypes in the context of house dust mite (HDM) exposure. MATERIAL AND METHODS: Children, aged 12-16 years (n=326), were recruited from downtown and rural locations and assessed by allergist. Skin prick tests, total and HDM-specific sIgE measurements were done. HDM allergen concentrations in dust were measured. Genetic polymorphisms were identified using restriction fragment length polymorphism (RFLP). RESULTS: Allergic rhinitis, asthma and atopy were more prevalent in urban area. Although HDM allergen concentrations were higher in rural households, sIgE were present more frequently in urban children. In the whole population no association was found between HDM exposure and sensitization. In children with CD14/-159CC, CD14/-159TT and TLR9/2848GA genotypes increased exposure to HDM was associated with reduced incidence of allergic rhinitis. Significant associations of increased HDM exposure with reduced incidence of atopy were found for the whole population and subjects with CD14/-159CC, CD14/-1359GT, TLR4/896AA and TLR9/2848GA genotypes. Among children with CD14/-159CC and CD14/-1359GG significant positive correlation between HDM allergen concentrations in household and sensitization to HDM was observed. In contrast, protective effect of high HDM allergen exposure against specific sensitization was seen in subjects with TLR4/896 AG. CONCLUSIONS: Development of specific sensitization and allergy may be associated with innate immune response genes polymorphisms and is modified by allergen exposure.

How to improve cooperation with political leaders and other decision-makers to improve prevention of cardiovascular disease: lessons from Poland.

BACKGROUND: Cardiovascular diseases (CVD) are the main health problem in Poland. We decided to use modern social marketing methods to present the current epidemiological situation to political and key opinion leaders in Poland. MATERIALS AND METHODS: The surveys were carried out in the following groups: members of the Polish parliament, members of the executive bodies of the two largest trades unions in Poland, participants at the Polish Hygiene Society Congress, representatives of the health insurance board in the district of Pomerania, and press and radio journalists. The study consisted of a questionnaire, anthropometric measurements, blood pressure measurements, and cholesterol and glucose level tests. The results were presented to examined subjects individually and in the form of an educational conference held on the same day. RESULTS: In the examined groups of political and opinion leaders awareness of one's own blood pressure was declared by 40.6-86% of the subjects, increased blood pressure was found in 36-43.5%, overweight or obesity (body mass index 25 kg/m) in 40.6-67.3%, smoking was declared by 16.5-30%. The results were compared with those obtained in corresponding age groups in the general population. CONCLUSION: The idea of presenting the current epidemiological burden caused by CVD in Poland by means of an assessment of individual and collective CVD risk among political and opinion leaders appeared to be an effective method of education and constructive lobbying for the fight against an epidemic of myocardial infarctions and strokes in Poland.

Production and characterization of amphiploids of Aegilops kotschyi and Ae. biuncialis with Secale cereale, and of backcross hybrids of Ae. biuncialis x S. cereale amphiploids with 2x and 4x S. cereale.

Amphiploids (2n = 6x = 42) of Ae. kotschyi and Ae. biuncialis with self-compatible S. cereale were produced from F1 sterile hybrids (2n = 3x = 21) through colchicine treatment and callus tissue regeneration. The amphiploids resembled the F1 plants in overall morphology, but were larger in all respects and self-fertile. The spikelets consisted mostly of 3 well-developed florets. Selfed seeds were obtained from some colchicine-doubled sectors and callus regenerates. Most of the produced seeds were well developed. Backcrosses between amphiploids and rye (2x and 4x) resulted in obtaining (Ae. biuncialis x S. cereale amphiploid) x S. cereale hybrids via embryo culture. The BC1 plants (2n = 4x = 28 and 2n = 5x = 35, respectively) were phenotypically intermediate between the parents and vigorous in vegetative growth. Some seeds were obtained only from the 35-chromosome BC1 hybrids.

[The role of medical university in modern prevention of cardiovascular diseases. Examples from Medical University of Gdansk]. / Rola uczelni w nowoczesnej prewencji chorób ukladu krazenia na przykladzie programów Akademii Medycznej w Gdansku.

Constant worsening of epidemiological situation in cardiovascular diseases in Poland in the 70's and 80's called for intensive measures in the field of preventive cardiology. Thus in 90's, in order to change this situation, among others, team from Department of Hypertension and Diabetology from Medical University of Gdansk started, in cooperation with other medical universities, important regional and national research programs and preventive interventions. The aim of the educational program carried out in years 1999-2001 for Members of the Polish Parliament, opinion leaders and decision makers was to increase knowledge of the Polish elites about epidemic of cardiovascular diseases in our country. These actions made possible receiving greater support from the government for new epidemiological and preventive programs in this field. Thanks to NATPOL PLUS project, carried out on the representative sample of adults in 2002, we determined for the first time the prevalence and control of main cardiovascular risk factors in Poland. Results of this program helped planning preventive tasks in the National Cardiovascular Diseases Prevention and Treatment Program POLKARD 2003-2005. The aim of the preventive programmes: SOPKARD and Polish Four-Cities Project was to work out standards of modern, comprehensive interventions. They permitted planning and introduction of the largest preventive program: the Polish 400 Cities Project (PP400M). The PP400M is addressed to citizens of all small towns (to 8000 citizens) and surrounding villages in the whole country. All these accomplishments in the field of quickly expanded clinical epidemiology and cardiovascular prevention are directed mainly to Pomeranian and Polish citizens, especially those who are not aware of high risk of myocardial infarction or stroke. The main principle of our strategy is the role of university as an expert in preparation and supervision of the programs, which were carried out by the specialized organizations and firms such as PBS in Sopot. The second important component of our strategy was an intensive cooperation with other leading research centres in Poland that allowed taking advantage of the joint achievements.

Physical activity and angiotensin-converting enzyme gene polymorphism in mild hypertensives.

It has been suggested that the insertion(I) allele of the I/deletion(D) polymorphism of the angiotensin converting enzyme (ACE) gene is associated with endurance exercise and increased physical conditioning in response to this type of exercise. To investigate the association between the ACE I/D polymorphism and physical activity status in 355 never treated, stage I hypertensives (265 men, 90 women, mean age: 33 +/- 9 years), in whom power exercise is contraindicated, participants of the HARVEST study. Physical activity was assessed using a standardized questionnaire. BMI and age did not vary among genotypes. None of active subjects performed power oriented exercises. ACE I/D frequencies (II-18%, ID-55%, DD-27%) were in Hardy-Weinberg equilibrium. Sedentary lifestyle was more common among DD than II hypertensives (76% in DD, and 48% in II, Chi(2) = 13.9, P = 0.001). In stepwise MANOVA using age, marital status, profession, sex, and ACE genotype as predictors of physical activity, marital status (F = 24.4, P < 0.0001) and ACE genotype (F = 16.03, P < 0.0001) contributed to more than 50% of the variance in physical activity status of the population. Our results suggest that the ACE I/D polymorphism may be a specific genetic factor associated with physical activity levels in free-living borderline and mild hypertensive subjects.

Effects of social intervention on detection and efficacy of treatment for arterial hypertension. Main results of the Polish Four Cities Programme.

BACKGROUND: Cardiovascular diseases are the main cause of death in the adult Polish population. Beside lipid disorders and cigarette smoking, hypertension represents the most important risk factor leading to cardiovascular complications. Representative studies conducted in Poland in 1994-2002 showed that in 2002 the number of respondents in the survey who stated they knew their own blood pressure values dropped by 3.5 million, compared with 1994. This decrease was predominantly seen in small towns and in the countryside. Preventive programmes should therefore be addressed mainly to the most vulnerable communities. Modern methods of social marketing may play a substantial role in the creation of a healthy lifestyle. AIM: The aim of the Polish Four Cities Programme (PP4M), conducted in 2000-2001, was to develop the most effective methods of detection of and improvement in treatment for hypertension among the residents of small towns and rural areas. One of the programme tasks was to compare the effectiveness of a standard medical screening intervention with a similar approach combined with the use of social marketing methods.Methods. The programme was conducted by an interdisciplinary team in three small Polish towns -- Kartuzy, Oborniki Wlkp. and Braniewo, as well as in one of the districts of a large city Lódz -- Olechów. Medical intervention combined with social marketing (community intervention) took place in Oborniki Wlkp. whereas the residents of Kartuzy and Lódz were subjected only to the traditional medical intervention. Braniewo served as a control location -- neither medical nor community intervention was implemented. Community intervention with elements of social marketing consisted of a three-month, intensive education and information campaign, initiated four weeks prior to the start of medical intervention. Epidemiological situation was assessed in all the four cities before and after the completion of the preventive interventions (screening), using representative surveys, with the objective to assess the changes in the awareness of one's own blood pressure values, detection of hypertension and knowledge concerning cardiovascular risk factors.Results. In two survey locations -- Kartuzy and Lódz - awareness of one's own blood pressure values after the medical intervention did not significantly change (61% and 67.6% at baseline versus 62.1% and 71.6% after the intervention, respectively). In contrast, social marketing activities conducted in Oborniki significantly increased this parameter from 61.5% to 79.8% (p<0.01). While medical intervention did not change the proportion of non-diagnosed hypertension in a small town (a non-significant decrease from 49% to 45% in Kartuzy), its effect in a large city was clearly visible (a decrease from 46% to 28% in Lódz). In Oborniki Wlkp. (medical intervention combined with social marketing) the effects were the most noticeable -- a reduction from 50% to 27% was achieved. The efficacy of hypertension treatment at baseline was low (4.7% in Kartuzy, 6.6% in Oborniki, and 6.5% in Lódz), but it then improved significantly (a twofold increase in Kartuzy and Oborniki, and more than twofold increase in Lódz). When the target value of blood pressure was set at 160/95 mmHg, the highest efficacy of hypotensive therapy was observed directly after the completion of medical and community intervention in Oborniki (an almost twofold increase in treatment efficacy). CONCLUSIONS: 1. Medical intervention combined with a community intervention and marketing campaign leads to a statistically significant improvement in self-awareness of blood pressure values among residents of small towns. 2. Medical intervention combined with community intervention brings the detection rate of hypertension in small towns up to the level observed in large cities. 3. Medical intervention, especially when combined with community intervention, improves the efficacy of the treatment of hypertension, regardless of the size of agglomeration.