Upper respiratory tract infection (URTIs), caused by a variety of viruses and sometimes by bacteria, represents the most common acute illness in primary health care. The aim of the study was to ...explore the registered incidence of URTIs in Poland in the period between 2015-2019, and its burden on the health care system.
A retrospective analysis was carried out of all medical encounters in Poland registered within the national billing database of public healthcare services. Medical services provided due to acute URTIs were classified according to the ICD-10 codes. Registered Incidence Rate (RIR) was calculated yearly, in a 100,000 population. A generalised additive model was used to calculate the Incidence Rate Ratio (IRR).
In the analysed 5-year period, acute URTI was diagnosed in 24.3 million patients (61.7% of the whole population registered in PHC). The RIR of all acute URTIs in PHC was 50,762/100,000/year. Nearly 99% of consultations in this group of patients were provided by PHC physicians. Only 0.8% were referred to an OSC consultation and 0.4% were hospitalised. In PHC, indeterminate URTIs were most frequently diagnosed. The estimated IRR for children aged 1-4 years was 1.65 (95% CI: 1.64; 1.66, p<0.01) and for men 0.79 (95% CI: 0.79; 0.79; p<0.01). In the studied period, the number of patients consulted for acute URTI decreased slightly in PHC, but significantly in specialist services.
The registered incidence of URTIs in Poland burdens mainly PHC physicians. Women and children aged 1-4 years are more frequent users of medical services related to URTIs. It appears that strategies for increasing patient empowerment to provide efficient self-care reducing the utilisation of PHC services are needed.
Comorbidities in primary care do not occur in isolation but tend to cluster together causing various clinically complex phenotypes. This study aimed to distinguish phenotype clusters and identify the ...risks of all-cause mortality in primary care.BACKGROUNDComorbidities in primary care do not occur in isolation but tend to cluster together causing various clinically complex phenotypes. This study aimed to distinguish phenotype clusters and identify the risks of all-cause mortality in primary care.The baseline cohort of the LIPIDOGEN2015 sub-study involved 1779 patients recruited by 438 primary care physicians. To identify different phenotype clusters, we used hierarchical clustering and investigated differences between clinical characteristics and mortality between clusters. We then performed causal analyses using causal mediation analysis to explore potential mediators between different clusters and all-cause mortality.METHODSThe baseline cohort of the LIPIDOGEN2015 sub-study involved 1779 patients recruited by 438 primary care physicians. To identify different phenotype clusters, we used hierarchical clustering and investigated differences between clinical characteristics and mortality between clusters. We then performed causal analyses using causal mediation analysis to explore potential mediators between different clusters and all-cause mortality.A total of 1756 patients were included (mean age 51.2, SD 13.0; 60.3% female), with a median follow-up of 5.7 years. Three clusters were identified: Cluster 1 (n = 543) was characterised by overweight/obesity (body mass index ≥ 25 kg/m2), older (age ≥ 65 years), more comorbidities; Cluster 2 (n = 459) was characterised by non-overweight/obesity, younger, fewer comorbidities; Cluster 3 (n = 754) was characterised by overweight/obesity, younger, fewer comorbidities. Adjusted Cox regression showed that compared with Cluster 2, Cluster 1 had a significantly higher risk of all-cause mortality (HR 3.87, 95% CI: 1.24-15.91), whereas this was insignificantly different for Cluster 3. Causal mediation analyses showed that decreased protein thiol groups mediated the hazard effect of all-cause mortality in Cluster 1 compared with Cluster 2, but not between Clusters 1 and 3.RESULTSA total of 1756 patients were included (mean age 51.2, SD 13.0; 60.3% female), with a median follow-up of 5.7 years. Three clusters were identified: Cluster 1 (n = 543) was characterised by overweight/obesity (body mass index ≥ 25 kg/m2), older (age ≥ 65 years), more comorbidities; Cluster 2 (n = 459) was characterised by non-overweight/obesity, younger, fewer comorbidities; Cluster 3 (n = 754) was characterised by overweight/obesity, younger, fewer comorbidities. Adjusted Cox regression showed that compared with Cluster 2, Cluster 1 had a significantly higher risk of all-cause mortality (HR 3.87, 95% CI: 1.24-15.91), whereas this was insignificantly different for Cluster 3. Causal mediation analyses showed that decreased protein thiol groups mediated the hazard effect of all-cause mortality in Cluster 1 compared with Cluster 2, but not between Clusters 1 and 3.Overweight/obesity older patients with more comorbidities had the highest risk of long-term all-cause mortality, and in the young group population overweight/obesity insignificantly increased the risk in the long-term follow-up, providing a basis for stratified phenotypic risk management.CONCLUSIONOverweight/obesity older patients with more comorbidities had the highest risk of long-term all-cause mortality, and in the young group population overweight/obesity insignificantly increased the risk in the long-term follow-up, providing a basis for stratified phenotypic risk management.
Cardiovascular diseases (CVD) are the leading cause of lost productivity, morbidity, disability and mortality in Poland.The aim of this article is to present feasible in primary health care (PHC) ...actions to prevent or delay the onset of CVD. The role of the family doctor in these activities is discusses.Both in the Polish and European publications special attention is paid to health promotion and disease prevention as an important task of family doctors. Preventive measures should be implemented in all age groups (children, adults, elderly), and regardless of gender. This article highlights the need to assess the total CVD risk, which is the basis for selection of the best treatment decisions; discusses the risk factors for CVD; presents their occurrence in the Polish population and the methods used in PHC for their early diagnosis. It also describes the method of "brief interventions", which is a technique that allows altering the lifestyle of patients.CVD prevention should include the correction of all modifiable risk factors. In our country, there are still areas in which there is much room for improvement of the quality of preventive care. In addition to the activities conducted in PHC, it is advisable to take action at other levels of health care system.
Purpose
Lung ultrasound (LUS) at the point‐of‐care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the ...interhospital transport of neonates with respiratory failure.
Methods
LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X‐ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport.
Results
LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5‐98.5%), and specificity was 92.6% (95%CI: 74.2‐98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0‐85.9%) and 81.5% (95%CI: 61.2‐92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5‐99.1%) and a specificity of 100% (95%CI: 89.9‐100%). For CXR, sensitivity was 16.7% (95%CI: 0.01‐63.5%) and specificity was 97.7% (95%CI: 86.4‐99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 95%CI: 0.40‐0.74) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 95%CI: 0.74‐0.98). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression.
Conclusion
LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.
Arterial hypertension is the most important modifiable risk factor for cardiovascular morbidity and mortality. In some countries, pharmacists' patient-centered approach has become a common practice, ...and their role in supporting the management of cardiovascular disease has been successfully developed for years. In particular, recent findings have confirmed benefits of pharmacist-provided hypertension care. Current guidelines emphasize the need for regular BP measurements in subjects age 40 years and older, who are at increased risk of hypertension. A panel of experts in cardiology, hypertensiology, family medicine, and pharmacy presented a narrative review of implementing community pharmacy blood pressure (CPBP) measurements into Polish pharmacy practice to assist pharmacists in CPBP readings. The paper focuses on basic aspects of management of untreated patients with elevated blood pressure levels, as well as management of individuals diagnosed with hypertension, who should follow their primary care physicians' recommendations for anti-hypertensive therapy. The article also includes a few important aspects related to CPBP measurement, such as equipment and techniques. Development of ready-made schemes of procedures for patients with different results of blood pressure measurement could ensure a uniform standard of services provided by pharmacists. This gives an opportunity to provide such patients with medical care and initiate treatment, and facilitates effective maintenance of BP in hypertensive subjects. This article reviews the role of pharmacists in Poland in screening for hypertension by taking blood pressure measurements.Arterial hypertension is the most important modifiable risk factor for cardiovascular morbidity and mortality. In some countries, pharmacists' patient-centered approach has become a common practice, and their role in supporting the management of cardiovascular disease has been successfully developed for years. In particular, recent findings have confirmed benefits of pharmacist-provided hypertension care. Current guidelines emphasize the need for regular BP measurements in subjects age 40 years and older, who are at increased risk of hypertension. A panel of experts in cardiology, hypertensiology, family medicine, and pharmacy presented a narrative review of implementing community pharmacy blood pressure (CPBP) measurements into Polish pharmacy practice to assist pharmacists in CPBP readings. The paper focuses on basic aspects of management of untreated patients with elevated blood pressure levels, as well as management of individuals diagnosed with hypertension, who should follow their primary care physicians' recommendations for anti-hypertensive therapy. The article also includes a few important aspects related to CPBP measurement, such as equipment and techniques. Development of ready-made schemes of procedures for patients with different results of blood pressure measurement could ensure a uniform standard of services provided by pharmacists. This gives an opportunity to provide such patients with medical care and initiate treatment, and facilitates effective maintenance of BP in hypertensive subjects. This article reviews the role of pharmacists in Poland in screening for hypertension by taking blood pressure measurements.
Proposed legislative changes would return the country to the flawed communist model, says Tomasz Tomasik, with paediatricians and internists offering primary healthcare
B a c k g r o u n d: Due to current increased life expectancy, the quality of life (QoL) of senior patients is gaining in importance. The aims of this study were: to estimate QoL in a group of ...patients, aged above 64 years, that is cared for by general practitioners (GPs) in Krakow, Poland, and to find relation- ships between elements of QoL and the results of comprehensive geriatric assessment (CGA) and other important medical and social factors. M e t h o d s: We designed a cross-sectional, questionnaire study among patients who attended GPs' surgeries from April 2018 to April 2019. To examine the patients, we used the Euro-Quality of Life Questionnaire (EQ-5D-5L) and eight scales forming CGA: the Activities of Daily Living, the Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment, Clinical Frailty Scale and Athens Insomnia Scale. R e s u l t s: The lowest QoL was observed in dimensions of pain/discomfort and mobility, where 70% and 52% of patients, respectively, reported problems in these areas. Only 91 (21%) respondents had highest results in all five dimensions of QoL. The average score in the Visual Analogue Scale (VAS) of the EQ-5D-5L (representing self-rated health on a given day) was 62.36 ± 18.98 points. Statistically significant relationships were observed between QoL and age, physical activity and multimorbidity (in all cases p <0.001). The results of QoL were correlated with every aspect of CGA, while the strongest relationship was noticed between scores in the EQ-5D-5L VAS scale and scales assessing depression and frailty (p <0.001; r = -0.57 both).
the aim of this study was to assess the reliability and validity of the Delphi method in preparing hypertension guidelines for family physicians in Poland.
a two-round Delphi method was used to ...develop guidelines for management of hypertension by the College of Family Physicians in Poland. The respondent group consisted of 36 family physicians and 19 specialists. To assess reliability, the internal correlation coefficient (Cronbach's alpha) was calculated for both rounds. Criterion validity was examined by comparing recommendations in the guidelines with scientific evidence from a study in the Medline database. The content validity was estimated by measurement of extent to which recommendations were related to the competences of family physicians in Poland. To calculate construct validity, a comparison between the results obtained by the Delphi method with those of other methods was performed (Holley and Guilford (G) index).
reliability (Cronbach's alpha) was 0.944 for round one and 0.850 for round two. The five missing recommendations and contrary evidence for one recommendation indicated that criterion validity was fulfilled only in part. Among 28 routine tasks related to hypertension carried out by family physicians, the guidelines contained no recommendations for five (17.9%) of them. This indicated that content validity was only satisfactory, whereas construct validity was good (Holley and Guilford (G) index 0.39-0.65).
the Delphi method in the form used in Poland for preparing hypertension guidelines showed good reliability and satisfactory validity. The method should be used judiciously and only after careful preparation.
We will not find many erotic poems in Zbigniew Herbert’s literary output, but that does not mean that the poet ignores such anthropological themes as corporeality, sexuality and eroticism. The body ...in the Herbert’s poetry is used as the vehicle for the senses and mediates between the spiritual and the material. The most important senses are the sense of touch and sight, so the motif of hands and eyes often occurs in this poetry. Herbert’s male protagonist distances himself from the hard hegemonic masculinity. Taking the concept of Jung into account we can say that the animus is balanced by the anima. Zbigniew Herbert’s eroticism is expressed primarily by the language of sensitivity. The attitude, in which the mind is in agreement with the feelings, eros with logos, cogito with caritas, seems to be the most compatible with the personal philosophy of the poet.
Inflammation is a marker of arterial disease stemming from cholesterol-dependent to -independent molecular mechanisms. In recent years, the role of inflammation in atherogenesis has been underpinned ...by pharmacological approaches targeting systemic inflammation that have led to a significant reduction in cardiovascular disease (CVD) risk. Although the use of nutraceuticals to prevent CVD has largely focused on lipid-lowering (e.g, red-yeast rice and omega-3 fatty acids), there is growing interest and need, especially now in the time of coronavirus pandemic, in the use of nutraceuticals to reduce inflammatory markers, and potentially the inflammatory CVD burden, however, there is still not enough evidence to confirm this. Indeed, diet is an important lifestyle determinant of health and can influence both systemic and vascular inflammation, to varying extents, according to the individual nutraceutical constituents. Thus, the aim of this Position Paper is to provide the first attempt at recommendations on the use of nutraceuticals with effective anti-inflammatory properties.
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