Witold Lukas

Association between anthropometric obesity measures and coronary artery disease: a cross-sectional survey of 16 657 subjects from 444 Polish cities

Background: Excessive body weight is known to cluster with cardiovascular (CV) risk factors, but it is not clear which anthropometric obesity measure provides best independent predictive value of coronary artery disease (CAD). Methods and results: We explored associations between CAD and four different obesity measures (body mass index (BMI), waist circumference, waist/height and waist/height2) in a cohort of 16 657 subjects (40.4% men; 20.8% CAD patients), recruited by 700 primary care physicians in 444 Polish cities. 42.8% of subjects were classified as overweight, 31.7% as obese and 39.8% had abdominal obesity. In univariate analyses all obesity measures correlated with CAD (p>0.001), but waist/height2 was the strongest discriminator between CAD patients and controls. Age-adjusted and sex-adjusted analyses confirmed a graded increase in CAD risk across distributions of all four obesity measures—1 standard deviation (SD) increase in BMI, waist, waist/height and waist/height2 increased the odds of CAD by 1.23, 1.24, 1.26 and 1.27, respectively (all p<0.001). In models fully adjusted for CV risk factors, waist/height2 remained the strongest obesity correlate of CAD, being the only independent associate of CAD in men. In a fully adjusted BMI—waist circumference stratified model, sarcopenic obesity (waist > median, BMI < median) and simple obesity (waist and BMI > median) were the strongest independent associates of CAD in men (p = 0.008) and women (p>0.001), respectively. Conclusion: This cross-sectional study showed that waist/height2 may potentially offer a slightly higher predictive value of CAD than BMI or waist circumference and revealed an apparent sexual dimorphism in correlations between obesity measures and CAD.

Antibiotics in the treatment of upper respiratory tract infections in Poland. Is there any improvement

What is known:  Acute upper respiratory tract infections are among the most frequent reasons for encounters in primary health care. Relevant data about antibiotics use in respiratory tract infections in Poland are scarce.

Prevention of coronary heart disease in primary medical care in Poland: results from the LIPIDOGRAM study:

Aims: To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals. Design: Cross-sectional study in randomly selected Polish primary care practices. Method: 5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level. Results: 18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively. Conclusion: There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.

How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: a study in polish primary care

BackgroundStudies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women.MethodsA total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual’s CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects’ self-care behavior was examined.ResultsWe found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important.ConclusionsDifferent predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.

The attractiveness of family medicine among Polish medical students.

Abstract Background: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. Objectives: To investigate the career choices of Polish students in different stages of their medical education. Methods: Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. Results: A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. Conclusion: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.

The relation of rapid changes in obesity measures to lipid profile - insights from a nationwide metabolic health survey in 444 Polish cities

Objective The impact of fast changes in obesity indices on other measures of metabolic health is poorly defined in the general population. Using the Polish accession to the European Union as a model of political and social transformation we examined how an expected rapid increase in body mass index (BMI) and waist circumference relates to changes in lipid profile, both at the population and personal level. Methods Through primary care centres in 444 Polish cities, two cross-sectional nationwide population-based surveys (LIPIDOGRAM 2004 and LIPIDOGRAM 2006) examined 15,404 and 15,453 adult individuals in 2004 and 2006, respectively. A separate prospective sample of 1,840 individuals recruited in 2004 had a follow-up in 2006 (LIPIDOGRAM PLUS). Results Two years after Polish accession to European Union, mean population BMI and waist circumference increased by 0.6% and 0.9%, respectively. This tracked with a 7.6% drop in HDL-cholesterol and a 2.1% increase in triglycerides (all p<0.001) nationwide. The direction and magnitude of the population changes were replicated at the personal level in LIPIDOGRAM PLUS (0.7%, 0.3%, 8.6% and 1.8%, respectively). However, increases in BMI and waist circumference were both only weakly associated with HDL-cholesterol and triglycerides changes prospectively. The relation of BMI to the magnitude of change in both lipid fractions was comparable to that of waist circumference. Conclusions Moderate changes in obesity measures tracked with a significant deterioration in measures of pro-atherogenic dyslipidaemia at both personal and population level. These associations were predominantly driven by factors not measureable directly through either BMI or waist circumference.

Prevention of cardiovascular disease in a rural general practice

INTRODUCTION Cardiovascular disease (CVD) prophylaxis in general practice, especially in rural areas, is a major organizational challenge. OBJECTIVE The aim of this study was to determine the prevalence of CVD risk factors in the studied population, and to identify the effect of the number of planned prophylactic consultations on selected clinical parameters, risk factors, and total cardiovascular risk on the SCORE scale (Systemic Coronary Risk Evaluation). MATERIALS AND METHOD The study included patients of a rural general practice, aged 35-55 years, with at least one modifiable CVD risk factor. Medical history was obtained, a physical examination performed, blood glucose levels, lipid profile, BMI, waist circumference and blood pressure measured and the SCORE cardiovascular risk at baseline and at the end of the study calculated. All participants were provided with targeted specific education. Analysis was performed in two groups of patients (1 and 2), where group 1 had one more prophylactic consultation than Group 2. RESULTS The results at baseline and a year later were compared in pharmacologically untreated patients, 26 in Group 1 and 34 in Group 2. In Group 1, which had had more prophylactic consultations, a statistically significant decrease was found in the mean systolic blood pressure: 131.000-124.782 (p= 0.02721), mean diastolic blood pressure: 86.846-83.462 (p=0.01111), and a statistically significant decrease in total cardiovascular risk on the SCORE scale (p=0.0478). CONCLUSIONS The higher number of preventive consultations had an impact on a statistically significant decrease in mean blood pressure and mean SCORE value. The year-long cardiovascular disease prophylaxis programme proved less effective than expected, and neither a decrease in body weight nor an improvement in lipid metabolism was achieved in any of the groups.

Aktualne zasady stosowania pediatrycznych szczepionek wysoce skojarzonych zawierających komponentę bezkomórkową przeciw krztuścowi (DTPa) u niemowląt i dzieci do 3. roku życia

Streszczenie W dniach 24 lutego i 24 marca 2011 roku w Warszawie odbyly sie dwa spotkania robocze polskiej Grupy Ekspertow * pod wspolnym tytulem „Nowe mozliwości stosowania pediatrycznych szczepionek zawierających DTPa”. Podczas obu konferencji dyskutowano nad dotychczasowymi wynikami badan klinicznych i praktycznych doświadczen opublikowanych w piśmiennictwie, poświeconych szczepionkom skojarzonym zawierającym komponenty DTPa, ze szczegolnym uwzglednieniem szczepionek piecio- i sześciowalentnych. W tematycznych prezentacjach czlonkow Grupy Ekspertow przedstawiono szereg zagadnien: aspekty immunogenności i bezpieczenstwa szczepionek wysoce skojarzonych, ich stosowanie w pediatrycznych grupach ryzyka oraz aktualną praktyke i schematy stosowania w programach szczepien ochronnych krajow Unii Europejskiej. Dyskutowano takze nad zagadnieniami stosowania szczepionek wysoce skojarzonych w kontekście danych tworzących medycyne opartą na faktach, związanych z krytycznym spojrzeniem na przedstawione dotychczas wyniki stosowania szczepionek skojarzonych zawierających DTPa. Przedstawiony ponizej tekst stanowiska czlonkow Grupy Ekspertow powstal w wyniku uzyskania konsensusu, po uwzglednieniu uwag, propozycji i akceptacji ostatecznego tekstu przez uczestnikow obu spotkan.