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The objective of this paper was to assess the frequency and trends of hospitalization of patients with diabetes in Poland between 1980 and 1999. The analysis of data from 10% annual systematic random samples of all hospitalised cases revealed that patients hospitalized because of diabetes make 1.5% of all hospitalized cases. The respective hospitalization rates per 10,000 population for males were 7.9-16.4 for males and 10.9-20.4 for females in the years under study. Frequency of hospitalization of patients with diabetes for males and females was steadily increasing between 1984 and 1993 whereas certain decline was observed from 1994 onwards. In all analysed years the diabetes hospitalization rates were higher among females than males and among urban inhabitants than those living outside cities. The hospital fatality rate from diabetes (around 3% in last years) is higher than overall hospital fatality rate (1%) which may indicate that patients with diabetes admitted to hospital are in the greater risk of serious vascular complications and coexisting diseases. Over 50% of hospitalized cases were diagnosed with insulin-dependent diabetes.
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PMID:[Diabetes mellitus as a cause of hospitalization in Poland, 1980-1999]. 1266 89

The authors discuss epidemics of diabetes in the world and in Poland. In the Lublin region (eastern Poland), for instance, they found type 2 diabetes (DM 2) in 15.6% of the examined aged over 35 (according to the WHO criteria of 1985). The health care system reform in Poland has made more difficult the access of the diabetic to a specialist that treats this disease. Therefore doctors and nurses of primary health care have become more responsible for diabcare than before. The authors believe that the systematic education of primary health care doctors by specialists so that they can treat patients according to the modern standards of practical diabetology as well as sharing of tasks and responsibilities between primary and specialist diabetologic care, are very important. Primary health care would be in charge of prevention and early diagnosis of DM 2 as well as prevention and early diagnosis of concomitant complications of the disease. Specialists would have consultation on the patients at the moment of diagnosis and then at least once a year. They would also take care of search for and diagnosis of remote diabetes complications. Primary health care doctors would still treat most of diabetics with DM 2; specialist centres doctors would treat most of diabetics with DM type 1, patients with complications and from special risk groups (e.g. women with gestational diabetes).
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PMID:Primary and specialist diabetes care three years after introduction of health care system reform in Poland. 1289 74

Diabetes mellitus is the most common endocrinologic disease all over the world. 150 million people suffer from this disease, in Poland about 2 million. The disease on the basis of the onset and pathophysiology may be divided into type I and type II. Pathophysiologic changes include diabetic microangiopathy, macroangiopathy and neuropathy. The most common presentations in head and neck are otitis externa, hypoacusis, vertigo, disequilibrium, xerostomia, dysphagia, fungal and recurrent infections. The changes in nasal mucosa are not very well known. Only few papers concerned the problem. The main complaints of patients regarding the nose are xeromycteria, hyposmia and various degree of decreased patency of the nose. Chronic atrophic rhinitis, septal perforation, ulceration of nasal mucosa, alar necrosis, symptoms of staphylococcal or fungal infection can be found during otolaryngologic examination. The treatment in this group of patients should consist of systemic therapy of diabetes mellitus and on the other hand focal therapy with the use of a solution to moisten the nasal mucosa.
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PMID:[Nasal mucosa in patients with diabetes mellitus]. 1452 78

Ischaemic Heart Disease (IHD) is still an essential health problem in many countries. In Poland it is one of the leading causes of cardiac deaths, while in western countries and in the USA mortality rate due to heart diseases decreases. The prevention of coronary vessels diseases is a long and a hard process. There is a need to start an early prophylactic action. The programs of primary and secondary prevention should be directed to as many people as possible. In individual strategy any action should be based on the assessment of the degree of complete risk with regard to every single person. Directives and standards elaborated by the Committee of Prophylaxis are helpful. In this research the group of 105 health service female workers were prepared to carry out further preventive searches towards the IHD danger. The following factors were taken into account: the level of total cholesterol (LDL, HDL and triglycerides level), hypertension, cigarette smoking, overweight and obesity, diabetes. The factors mentioned above defined as global risk elements were examined among three age groups: 35-39 years, 40-45 years, 46-50 years. Coronary hazard was established in accordance with the Card of Prophylaxis IHD of Polish Cardiological Society. The main purpose of this research was to identify the IHD risk factors as well as to evaluate its danger among women.
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PMID:[Occurrence of risk factors for ischemic heart disease among women--health service workers]. 1452 77

Acquired perforating dermatosis (APD) is characterized by umbilicated 1- to 10-mm-measuring papulonodules with a central adherent oystershell-like keratotic plug, typically on the dorsa of the hands, forearms and over the knees. APD is associated with systemic diseases, especially diabetes mellitus and/or renal failure. Histologically the lesions show transepidermal elimination of altered dermal components into a cup-shaped epidermal depression. We present a 69-year-old man with coexisting APD and Poland syndrome (PS), an association not yet described. PS (OMIM 173800) is a rare congenital anomaly consisting of unilateral partial or total absence of the greater pectoralis muscle and ipsilateral symbrachydactyly. Most cases of PS are sporadic as it was in our case. Our patient had, in addition, an untreated diabetic condition, hyperuricaemia, dilated cardiomyopathy and a very recent pulmonary embolism. He responded to therapy with allopurinol.
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PMID:Acquired perforating dermatosis in a patient with Poland syndrome. 1465 33

The authors evaluated the prevalence of TPO Ab and thyroid disorders in 219 children and adolescents (119/54% girls) with type 1 diabetes from southeast Poland aged 3.2-22.3 years (mean age-13.7 +/- 3.9 years). Their age upon diagnosis ranged from 1.6 to 17.2 years (mean age--8.1 +/- 3.6 years), while diabetes duration was between 1 and 18.7 years (mean, 6.4 +/- 3.7 years). In addition to clinical assessment of all patients, determinations were made of serum TPO Ab, FT4 and TSH; thyroid ultrasound was performed in each patient with abnormal thyroid morphology and/or positive TPO Ab titer. Positive TPO Ab titer was demonstrated in 76 (34.7%) patients with type 1 diabetes; in this group 49 showed no other overt thyroid pathological symptoms. Hashimoto's disease was detected in 26 children, Graves's disease in 1 girl. Twenty children (9.1%) with negative TPO Ab titter were shown to have euthyrotic goiter. Thus, thyroid abnormalities were demonstrated in 43.8% of the patients and were seen twice as often in girls than in boys (+ n = 69 > n = 27). Thyroid dysfunction was detected in 11 (5.05%) patients. These 11 patients with thyroid dysfunction constituted 14.5% of the entire group of children with both type 1 diabetes and positive TPO Ab titer (n = 76). Ten patients were hypothyroid (including 8 with previously undiagnosed disease) and 1 girls had hyperthyroidism. The present results indicate that in each child with type 1 diabetes--apart from diabetes control--thyreologic assessment should be done, and the frequency and type of examinations should depend on the comprehensive preliminary evaluation.
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PMID:[Thyroid peroxidase antibodies and thyroid diseases in children and adolescents with type 1 diabetes mellitus from Southeast Poland]. 1497 77

The cost of management of diabetes mellitus in Poland, which has become a very common disease recently, is estimated at over 1 milliard zloty a year. Therefore, it is necessary to increase the effectiveness of prevention and treatment of DM and its complications both by using improved methods and the promotion of positive health behaviours such as physical activity, rational diet, and reduction of harmful ones such as smoking, in diabetic patients. The aim of the study was to assess positive and negative health behaviours and the presence of diabetes mellitus complications in type 1 and 2 DM patients of provincial diabetic outpatient department. The study included 53 DM patients who reported to diabetic outpatient department in Biala Podlaska. The participants filled in a questionnaire consisting of some questions applying to the type of DM and a way of treatment, frequency of plasma glucose measurement, medical check-ups, DM complications, coexistent diseases, family history of DM and health behaviours (physical activity, appropriate diet, smoking etc.). The results allowed to draw the following conclusions: 1. the majority of diabetic patients of the studied population lead a fairly healthy life-style: they are physically active, use a suitable diabetic diet, do not smoke, regularly control weight, plasma glucose concentration and blood pressure, declare systematical ophthalmologist control and they take special care about their feet; 2. type 1 diabetic patients are more careful about DM management than type 2 diabetic subjects.
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PMID:Health behavior among patients with type 1 and 2 diabetes mellitus as reported from a regional diabetic outpatient department. 1532 68

Elevated levels of total and low density lipoprotein (LDL) cholesterol and low levels of high density lipoprotein (HDL) cholesterol are important risk factors for coronary heart disease. Another established predictor of cardiovascular disease is obesity. Obesity and overweight are widespread phenomena and they have reached epidemic proportions in the developed countries, including Poland. Only 30% of people in the Lublin region have normal weight (BMI<25). The aim of this study was to asses the relationship between BMI (body mass index) and blood lipids in the population of 83 people from Aleksandrow commune (64 women and 19 men aged 28-81) who spontaneously applied for medical examination performed as student research. Mean total cholesterol and triglycerides concentrations were higher in obese persons in comparison to normal weight subjects and HDL cholesterol concentration was lower in obese subjects as compared to normal and overweight individuals. Differences in mean concentrations of LDL cholesterol were not significant. A linear correlation between the degree of obesity and plasma level of LDL cholesterol and triglycerides was shown. In conclusion, obesity and overweight are accompanied by unfavourable blood lipids patterns and in a considerable proportion of overweight or obese patients other risk factors for coronary heart disease, such as hypertension, smoking, diabetes or family history of cardiovascular diseases coexist.
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PMID:Blood lipids profile in obese or overweight patients. 1532 17

There are scare data concerning the prevalence of diabetes mellitus in rural population in Poland. Our study, performed in 1806 subjects from rural areas, showed that prevalence of diabetes mellitus in rural population is unexpectedly high (17.2%) and is higher than in urban population. The fact that 3/4 of the cases turned out to be the cases of previously undiagnosed diabetes mellitus is especially distressing. Thus, main efforts should be concentrated on the necessity of screening tests in the group which is not subjected to periodical medical examinations, the more so that the prevalence of obesity in women reached 40%. The family physician and an appropriate organisation of educational prophylaxis can play a major role in fighting this problem.
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PMID:Diabetes mellitus type-2 is unknown in 75% of cases--results of a population study in rural areas of the Lublin Region (Eastern Poland). 1532 38

The purpose of this study was to estimate exposure of pregnant women in Poland to fine particulate matter [less than or equal to 2.5 microm in diameter (PM 2.5)] and to assess its effect on the birth outcomes. The cohort consisted of 362 pregnant women who gave birth between 34 and 43 weeks of gestation. The enrollment included only nonsmoking women with singleton pregnancies, 18-35 years of age, who were free from chronic diseases such as diabetes and hypertension. PM 2.5 was measured by personal air monitoring over 48 hr during the second trimester of pregnancy. All assessed birth effects were adjusted in multiple linear regression models for potential confounding factors such as the size of mother (maternal height, prepregnancy weight), parity, sex of child, gestational age, season of birth, and self-reported environmental tobacco smoke (ETS). The regression model explained 35% of the variability in birth weight (beta = -200.8, p = 0.03), and both regression coefficients for PM 2.5 and birth length (beta = -1.44, p = 0.01) and head circumference (HC; beta = -0.73, p = 0.02) were significant as well. In all regression models, the effect of ETS was insignificant. Predicted reduction in birth weight at an increase of exposure from 10 to 50 microg/m3 was 140.3 g. The corresponding predicted reduction of birth length would be 1.0 cm, and of HC, 0.5 cm. The study provides new and convincing epidemiologic evidence that high personal exposure to fine particles is associated with adverse effects on the developing fetus. These results indicate the need to reduce ambient fine particulate concentrations. However, further research should establish possible biologic mechanisms explaining the observed relationship.
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PMID:Estimated risk for altered fetal growth resulting from exposure to fine particles during pregnancy: an epidemiologic prospective cohort study in Poland. 1547 32


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