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Aims The aim of the analysis was to assess the prevalence of diabetes and impaired fasting glucose in Poland. Methods A questionnaire survey on a representative sample of 2411 Polish adults, complemented by blood pressure, anthropometric and fasting plasma glucose measurements. The research was part of the national cross-sectional NATPOL 2011 Study. Diabetes was assessed as self-reported (diagnosed) or screened (fasting plasma glucose level ≥ 7 mmol/l, based on one blood draw). Results Total prevalence of diabetes in 2011 was 6.7% (95% CI 5.6-7.9); 6.4% (95% CI 5.0-8.0) in women and 7.0% (95% CI 5.4-8.8) in men and did not change from 2002 (6.8%, 95% CI 95% CI 5.8-7.9). Over one quarter of individuals with diabetes were not aware of having the condition. Obesity, arterial hypertension and male gender were strong predictors of screened diabetes. Total prevalence of impaired fasting glucose in the surveyed population was 15.6% (95% CI 14.0-17.2). Conclusions The prevalence of diabetes in Poland is similar to that observed in other European populations and has not changed over the last decade. The fact that every fourth person with diabetes is unaware of the disease creates important opportunities for screening and detection of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Chronic heart failure (CHF) is a growing medical and economic problem, especially in Central and Eastern Europe. However, only a few studies analyzed the prevalence of CHF in this region., Objectives: The aim of the study was to assess the prevalence of CHF in a representative sample of adult Poles., Patients and Methods: The NATPOL 2011 project was a cross‑sectional study of a representative sample of the adult Polish population that included 2413 individuals (1245 women, 1168 men) aged 18 to 79 years (mean [SD] age, 45.8 [16.7] years). All participants completed a detailed questionnaire and underwent laboratory tests. We evaluated the prevalence of CHF based on self‑reported symptoms, Pol-ish National Health Fund database, and the N-terminal pro-B-type natriuretic peptide (NT‑proBNP) level., Results: The proportion of patients that reported the diagnosis of CHF was 4.3% (95% CI, 3.6%-5.2%). Only 0.2% of people aged under 40 years reported CHF, compared with 3.2% of those aged 40 to 59 years and 13.2% of those aged 60 to 79 years. The distribution of NT‑proBNP levels in the patients with CHF was markedly skewed to the right, with the median value of 181 pg/ml (interquartile range, 90.8-531). Among the 104 individuals who declared having CHF, almost 56% had a record of at least 1 outpatient visit or hospitalization related to the ICD‑10 I50 code in the National Health Fund database, which translates to 2.4% of confirmed diagnoses of CHF in all Polish adults., Conclusions: The results of our study indicated that the proportion of inhabitants of Poland aged 18 to 79 years with heart failure was somewhere between 2.4% and 4.3%. This corresponds to 720 000 to 1 200 000 of diagnosed CHF cases in Poland.

Background: Measurements of glycated hemoglobin (HbA1c) in non-diabetics can identify subjects who are at increased risk for future cardiovascular (CV) events. There is no consensus agreement whether the addition of HbA1c improves the CV risk prediction., Objectives: The objective of this study was to assess mean values of HbA1c levels in a representative sample of general, diabetes mellitus (DM)-free Polish population, and its subgroups, and to identify important covariants., Material and Methods: HbA1c was measured in blood samples collected from 1,868 participants (males/ females (M/F) 901/967, age: range 18-74, mean 44.03 years) of NATPOLL 2011 study without previously and newly diagnosed DM. Univariate and multivariate analyses of HbA1c level in relationship to age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), lipids, creatinine, C-reactive protein (CRP), gender, and smoking status were performed., Results: Mean HbA1c level was 5.46 ±0.31% in the entire population and significantly higher levels were found in subjects with male gender, hypertension, fasting hyperglycemia, abdominal obesity, and higher BMI values but not in smokers. Univariate analysis revealed numerous significant correlations of HbA1c with the highest values correlation coefficient values for age (r = 0.55), FPG (r = 0.43), WC (r = 0.36), and BMI (r = 0.36). The best, final multivariate model explained 40% of HbA1c variance and the most important covariant was the age, explaining approx. 50% of R2, followed by FPG and BMI., Conclusions: HbA1c in non-diabetic level is associated with certain CV risk factors, mainly with age. Since known risk factors explain less than a half of HbA1c variance, the inclusion of HbA1c into the assessment may increase the performance of algorithms predicting CV risk.

Aim: The present study is aimed to examine whether recent changes in population total cholesterol (TC) levels in Poland might be attributed to increased use statins., Methods: Two independent, nationally representative cross-sectional studies were conducted in adults aged 18-79 years in 2002 (n=2993, mean age 46.2 years) and 2011 (n=2413, mean age 45.8 years), including measurements of TC in venous blood samples. The mean change of TC between 2002 and 2011 was assessed. Then the expected therapeutic reduction in TC level in 2011 attributable to statins only was calculated based on already published statin effectiveness data. Uncertainty was quantified using probabilistic sensitivity analysis., Results: Statin uptake in Poland rose to 11.2% in 2011 (95% Confidence Intervals (CI): 10% to 12.5%) and approximately 32% (95% CI: 28.4 to 36.0%) in subjects aged 60-79 years. Mean TC in Poland in 2002 was 5.35 mmol/l, and fell by 0.21 mmol/l (95% CI: 0.14 to 0.28) by 2011. This fall would have been only 0.03 mmol/l (95% CI: -0.04 to 0.10) for the total adult population and 0.06 mmol/l (95% CI: -0.09 to 0.22) in people aged 60-79 years if statins had not been used. Statin use thus apparently explained approximately 85% (95% CI: 49% to 120%) of the observed decrease., Conclusion: Between 2002 and 2011, statin medications apparently explained a large part of the observed fall in population cholesterol level, suggesting very little changes in population TC attributed to dietary changes., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of this study was to assess the diagnostic value of hepatocyte growth factor (HGF) as a new predictor of severity in patients with acute pancreatitis (AP) at early phase of disease., Materials and Method: The studied group involved 40 patients (16 women and 24 men) with AP admitted to Ist Dept. of Surgery Jagiellonian University Medical College in Krakow. Twenty-four patients had mild and twelve severe form of AP. Glasgow and Imrie scores were calculated to evaluate severity of AP. HGF concentrations were measured by ELISA (R&D Systems) on days 1, 3 and 5 after admission within 48 hours after onset of symptoms., Results: Serum median concentrations of HGF was significantly higher in patients with severe versus mild clinical course of AP on each of the study days (7.61 vs 3.30 ng/mL, p = 0.05 on day 1; 7.19 vs 3.43, p = 0.04 on day 3 and 5.76 vs 2.42, p = 0.02 on day 5). HGF positively correlated with Glasgow and Imrie scores (R = 0.57 and R = 0.51). HGF negatively correlated with fetuin A, a negative acute phase protein (R = -0.60 on day 3 and R = -0.45 on day 5) and positively with CRP (R = 0.93; R = 0.80), SAA (R = 0.78; R = 0.82), IL-6 (R = 0.61; R = 0.77; R = 0.85 on day 1, 3 and 5, respectively) and PMN-elastase (R = 0.58; R = 0.64; R = 0.77). On day 1 of the study, HGF reached the diagnostic sensitivity of 100% and specificity of 50% for the detection of severe and moderate AP., Conclusions: Serum HGF correlates with several inflammatory markers and clinical scores (Glasgow, Imrie) in patients with AP and may be considered a new promising tool in assessing the severity of acute pancreatitis.

Background: Cardiovascular diseases (CVD) have been the main cause of death in Poland for the last five decades. In 2010, CVD caused 46.0% of all deaths in Poland. An analysis performed using the IMPACT model, have shown that the reduction in mortality due to ischaemic heart disease, which took place in Poland, was primarily a result of lifestyle changes and of changes affecting risk factors in the population of adults. From the perspective of health policy planning it is very important to know the prevalence of CVD risk factors and to be aware of trends in the population., Aim: The NATPOL 2011 Survey was a cross-sectional observational study aimed to assess the prevalence and control of CVD risk factors in Poland. The aim of this paper is to describe the objectives and methodology of the NATPOL 2011 project., Methods: The survey was designed as a representative observational study and was carried out on a representative sample of Polish residents aged 18-79 years. The planned size of the research sample was 2,400 subjects. Participants were randomly selected in bundles, in a stratified, proportional draw performed in three stages. The study was composed of a questionnaire interview, blood pressure and anthropometric measurements as well as a blood and urine sample collection. The examination consisted of two visits at subjects' homes and was performed by well-trained nurses., Results and Conclusions: Letters of invitation were sent to 4,420 potential participants. Of those, 786 persons could not be contacted because the addresses were wrong, the respondents resided at an address other than their registered place of residence or, in some cases, the respondents died prior to the survey. Among 3,634 addresses of the persons sampled for the study there were 661 (M: 328, F: 333) "closed doors" (the nurse was unable to contact the respondent during three consecutive attempts) and 560 (M: 295, F: 265) direct refusals. Finally, 2,413 subjects participated in the study and 2,401 of them completed all the procedures in the survey. The data mentioned above give the response rate of 66.4%.The structure of the study sample, including age groups and gender is almost identical to the structure of the adult population of Poland in 2010, according to the Central Statistical Office data. The sample reflected the structure of the adult population quite well, therefore the weights' adjustments calculated for epidemiological analyses were in range from 0.36 to 4.11.

Introduction: The GRADE working group has recently suggested a rigorous framework for clinical practice guidelines (CPG) addressing diagnostic tests and test strategies based on the impact of alternative approaches on patient-important outcomes. The framework mandates explicit evidence summaries, ratings of the quality of evidence, and specifying recommendations as strong or weak., Objectives: To test the feasibility and performance of the GRADE approach, we applied this framework to well-researched issues in the diagnoses of deep venous thrombosis (DVT)., Methods: A 16-member panel with interest in thromboembolism and CPG development identified pertinent clinical questions. Our search for relevant studies included existing CPG and systematic reviews. We summarized the data in form of evidence tables and developed recommendations including, when needed, a formal consensus process., Results and Conclusions: We provide three groups of recommendations for clinicians practicing in settings with access to different types of D-dimer tests -- highly sensitive, moderately sensitive, and no availability of D-dimer. We consider the use of clinical prediction rules in guiding the diagnostic process, the potential for negative D-dimer or venous ultrasound (US) to rule out disease, and the role of follow-up testing (US following positive D-dimer result, D-dimer following negative US, and serial US) depending on the probability of DVT at the start of diagnostic process. We recommend the following: that clinicians without access to a highly or moderately sensitive D-dimer test rely on US to guide DVT diagnosis; that those with access use the highly sensitive D-dimer to determine, in patients with low or moderate probability of DVT (by the Wells rule) whether US is needed; that in patients with low pre-test probability (pre-TP) and a negative D-dimer (either highly or moderately sensitive) they follow patients without further testing; that in patients with high pre-test probability they perform a compression ultrasound without D-dimer testing.

The environmental iodine deficiency has been a serious problem in the Polish health care system for many years. In many European countries the prevention of iodine deficiency-related health deficits in population scale is based on edible salt supplementation with KI. In the decade of the 80-ties the iodine supplementation program in Poland was stopped, which has caused a subsequent increase in prevalence of goiter and iodine deficiency-related hypothyreosis. These diseases were observed in many regions of Poland, including the areas beyond regions of formerly known iodine deficiency endemias. In order to control the whole Polish population, iodine consumption deficit in1991 the "Polish Program of Iodine Deficiency Control and Prevention of Iodine Deficiency-related Disorders" has been established in the year 1991. In 1992--1996 a common iodine supplementation of salt used for general consumption was 20 mg KI/kg of NaCl, and in 1997 the mandatory supplementation of salt was 30 (+10) per kg of salt which has been introduced for the whole country. This paper reports the results of iodine excretion assays in school children 6-12 years old, in the years 1993--94, 1996--97 and 1999--2002 respectively. The obtained collections of iodine urine concentrations have shown distributions with a remarkable rightward skewness. Normalization of distributions required logarythmic transformation. The quartile values obtained for data collections from years 1992--94, 1996--97 and 1999--2002 have shown that in 5-7 years of iodine deficiency prevention program yielded increase in iodine excretion in morning urine samples by about 37.8 microg, while the iodine excretion median values increased from 63.5 mg/L in years 1992--1994 to 94.0 mg/L in years 1999--2001, respectively. The lower limits of iodine excretion ranges calculated as the mean value minus 2SD of transformed data for the years 1992--1994 amounted to: 7.74 mg/L and for the years 1999--2001 amounted to 14.1 microg/l, respectively. Assessing percent of children obtaining low iodine suplementation then recommended (below 50 mg/L in urine sample) amounted to 35.8% in years 1992--1994 and 15.4% in years 1999--2001 respectively.

Unlabelled: In the last few years much attention is being given to the problem of diabetes mellitus, to it's development, prevalence and progression of chronic complications. The aim of the study was to 1. evaluate correction of metabolic disturbances in patients with long-term type 1 diabetes mellitus; 2. evaluate occurrence of diabetic nephropathy and excretion function in patients with long-term type 1 diabetes mellitus; 3. evaluate function of the cardiovascular autonomic nervous system in patients with long-term type 1 diabetes mellitus; 4. search for connections between the type and change dynamics in the cardiovascular system and degree of diabetic nephropathy advancement. The study was performed in a group consisting of 31 patients with type 1 diabetes mellitus (20 women, 11 males). Mean age of the study group equaled 37.6 +/- 10.75 years, duration of diabetes mellitus 21.3 +/- 9.55 years. Concentration of cystatin C in the study group was 0.98 +/- 0.23 ng/ml, in the group of patients with diabetic retinopathy 1.13 +/- 0.30 ng/ml, while in the group without diabetic retinopathy 0.89 +/- 0.13 ng/ml. Concentration of cystatin C (p <0.05) and calculated GFR according to equations proposed by F.J. Hoeck [GFR/1.73 m2 = -4.32 + 80.3/plasma cystatin] (p < 0.01) also G.D. Tan [GFR -10 = (87.1/plasma cystine) - 6.87] (p < 0.01) significantly differentiated the discussed groups., Conclusions: despite normal levels of blood creatinine in the studied patients, decreased glomerular filtration was calculated for plasma cystatin C. Plasma cystatin C concentrations and calculated glomerular clearance significantly differentiated the group with retinopathy from the group without diabetic retinopathy. Determining cystatin C concentrations as a protein which probably does not undergo glycation in plasma, may play a role in the detection of early diabetic nephropathy, when as well as plasma creatinine levels and albumin/creatinine index calculated from a sample of morning urine do not differentiate the studied group of patients.