Tomasz Zdrojewski

Polish Cardiac Society recommends to use SCORE tables to estimate the risk of cardiovascular disease (CVD) in clinical practice.
The aim of the study was (1) to compare the estimates of the risk of death from cardiovascular disease (CVD) obtained by using a SCORE function calibrated for the Polish population in 2007 with the risk calculated from the observed number of CVD deaths in the last decade, and (2) to compare the estimates of the risk of death from CVD obtained by using a SCORE function calibrated for the Polish population in 2015 with the CVD risk estimated from the observed number of deaths in 2012, using data on the prevalence of risk factors from the two studies of the representative samples of Polish adult population (WOBASZ and WOBASZ 2).
The risk identified by the SCORE 2007 function was higher than the observed risk by 20–40% in men and 18–33% in women. This indicated that the SCORE 2007 function overestimated cardiovascular risk. The risk calculated by using the SCORE 2015 function was more similar to the CVD risk estimated by using the current mortality data. However, SCORE 2015 function may overestimate CVD risk in future if the decreasing mortality trend would persist in Poland.

Cardiovascular diseases (CVD) represent the principal cause of death in Poland. The main reasons are high prevalence and low detectability of main risk factors: arterial hypertension, diabetes and hyprelipidaemia.
Also smoking is one of the main CVD risk factor. Polish 400 Cities Project consists of the following modules:
1. social marketing preceding screening tests and education,
2. medical intervention – screening tests,
3. education for local leaders regarding health promotion and CVD prevention,
4. antitobacco intervention,
5. educational intervention for children: training program for teachershealth promotion among pupils,
6. training programs for doctors and nurses,
7. education for patients with newly-detected diseases.
Antitobacco module contains the following interventions:
1) social marketing via mass media,
2) education among children in schools,
3) education for smoking patients with newly-detected diseases,
4) training program for doctors: treatment of nicotinism,
5) training program for local representatives: elaboration of local antitobacco program,
6) in 2006 new module – antitobacco intervention for pregnant women.
In years 2003–2006 screening tests were performer among 92378 adults. Tobacco smoking was reported by 12.3% of woman and 21.9% of men, mainly in the age group 25–45 (W 21.1%; M 28.5%). Data from intervention among children show that among 24,005 ten years old boys and girls, 5.7% girls and 12.8% boys say “yes” for the question “have you ever smoke” in the questionnaire interview. In years 2006–2008 the main antitobacco module was antitobacco intervention for pregnant women. The purpose of the research was to measure phenomenon of active and passive smoking among pregnant women in the smallest cities with surrounding villages. The aim was also to trace social features associated with smoking and develop the strategy for future antitabacco interventions. The research was conducted along with intervention based on American College of Obstetricians and Gynecologists 5 A’s model tailored for pregnant women adjusted to Polish organizational limitations. The model include 1) asking about tobacco smoking during every contact with pregnant women, 2) advising not to smoke or avoid passive exposure, 3) assessing the determination to make a quit attempt, 4) assist with the trial, 5) arrange next meeting with the focus on the problem. During the research 919 pregnant women were questioned and examined with micro Co device. Among that number were 22% of active smokers and 31% exposed on passive smoking in their home or work. The prevalence of smoking were higher among lower educated – 46% of women with only primary school compared with 7% of women with university diploma. Smoking was more frequent among women with lower per capita personal income. 80% of smoking pregnant women were motivated to make a quit attempt.

About 40% of men and 25% of women in Poland are smokers and smoking causes approximately 50 000 premature deaths annually. According to the WHO experts, a tobacco cessation short intervention program provided by primary care physicians is one of the most important prevention measures. In 2004 National  Cardiovascular Disease Prevention Program was launched as a procedure funded by National Health Funds (NFZ), which included the identification of smokers, assessment and treatment of smoking habit. In 2007, the Polish Forum of Prevention issued guidelines that can serve as an effective framework for tobacco cessation intervention in primary care clinics.
The aim of this paper is: 1) evaluation the effectiveness of primary care in professional assistance for smoking patients, 2) evaluation of the impact of the NFZ program on frequency of professional consultations on smoking cessation and evaluation of the impact of the NFZ program on smoking prevalence. There were 66 primary care clinics which were recruited to participate the project; 33 clinics participated in NFZ program, the remaining 33 constituted a control group.
Random sample of persons at age 35–55 years was selected from all persons registered in each clinic. Eligible for the study were patients free of cvd for whom medical records were available from January 1st 2005 at least. Finally 3940 patients in NFZ clinics, 3162 patients in control clinics were included. For each eligible patient medical records were reviewed and information was collected using a standard questionnaire.
All patients were invited for a visit in the clinic. Finally, 2314 persons from the NFZ clinics and 2107 persons from the control clinics participated were examined.
That effectiveness of the routine management of smoking cessation in primary care practices was very low. Equally in the NFZ clinics and the control group about 45% of participants were current smokers. Only 15% of patients had recorded information on smoking status in medical documentation and no significant difference between the NFZ clinics and the control group was observed. The NFZ program increased identification of smoking patients (up to about 80%). Physicians and nurses provided advising to 80% and 30% patients, respectively and the other measures to facilitate smoking cessation were used in small proportion of patients. For instance nicotine replacement therapy, including bupropion, was advised to less than 10% of smokers.
With the exception to distribution of leaflets which were distributed more frequently in patients of clinics which participated in the NFZ program (22.5%) as compared to control clinics (12.8%), there were no statistical differences in proportion of patients getting professional assistance or other intervention measures between the studied groups. The NFZ program appeared to play important role in identification of smokers. However, the program was not effective enough in treatment of patients addicted to smoking. There is a need to supply the NFZ program by more effective procedure, a kind of structured intervention, which would allow to lower smoking prevalence in primary care patients.

Public health community worldwide encouraged by successes of former campaigns have always accepted vaccination as the most effective way to handle infectious diseases pandemics. Even before the outburst of SARS-CoV-2 pandemic in many countries mandatory vaccination against many diseases, especially child related had been implemented. From among 193 countries under study in as many as 105 (54%) such obligation existed and in 62 of them (59%) at least one form of punishment or harm for those opposing was involved. Following this sort of available solutions and facing COVID-19 pandemic disaster the authors on behalf of the Public Health Committee of the Polish Academy of Science recommend to the government implementation od mandatory vaccination against COVID-19 for all workers in sectors of health care, education and welfare.