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Poor health status of general population in Poland together with existing trends were discussed on the basis of health indices and in comparison with other European countries. Examples of health effects related to environmental pollution in Poland were presented, and some vital preventive activities for improving the situation were proposed.
The authors present the results of analysis of data on occupational diseases in Poland during the years 1984-1992. The statistical material covers 86,871 cases of various diseases. Among them hearing lesions, vocal organ diseases, contagious and invasive diseases, pneumoconioses, dermatoses, vibration syndrome, poisonings and chronic bronchitis proved to be most common. In Poland, among the etiological factors, noise, industrial dusts, hepatitis virus, chromium and its compounds, lead and its inorganic compounds, carbon disulphide and carbon monoxide pose the highest risk. Apart from the statistics concerning the number of cases of occupational diseases according to sex, age, exposure duration, national economy branches and regions (voivodeships), the article presents, for the first time, some consequences of occupational diseases, such as granting disability pensions and/or indemnity depending on the per cent of health impairment.
The author discussed current data on sources of the environmental exposure to lead, health effects of exposure in adults and children as well as recommended admissible concentrations of lead in blood. The review of studies on biological monitoring of exposure to lead in Poland permits to state that the results of measurements of Pb-B concentrations performed by laboratories which did not participate in the inter-laboratory programme of quality assurance were often overestimated evoking public concern. The outcome of investigations carried out by the Nofer Institute of Occupational Medicine in Lodz and other institutions which are provided with appropriate analytical equipment, tested under the inter-laboratory programme of quality assurance gives the ground for a hypothesis that an excessive environmental exposure to lead in Poland may result only from industrial emission. The mean geometric lead blood concentrations in persons living in areas free from industrial emissions of lead range from 40 to 70 micrograms/l and they do not prove any potential hazard for adults. Exposure of children and pregnant women living in areas polluted with lead due to industrial emissions and where mean geometric Pb-B concentrations reach 100-170 micrograms/l may create a significant problem. The results obtained emphasize the need for targetted surveillance aimed at identifying areas of excessive lead contamination, measurements of Pb-B concentrations in populations living in those areas and necessary preventive measurements. Collection of blood samples and measurements of lead levels should be performed only by those laboratories which satisfy necessary requirements.
Following the determination of blood lead levels in children of 8-10 age group, living in selected clean regions of Poland, a statistical analysis of results was carried out. On the basis of this analysis reference values were proposed. The values are characteristic for the whole area of Poland and they should be applied in all studies pertaining to the assessment of exposure to lead among children. A border concentration of lead in blood equal to 14 micrograms/dl was proposed as a reference one for individual examinations. For group examinations reference concentrations of 50 and 90 percentiles should not exceed 8 micrograms/dl and 12 micrograms/dl, respectively.
The present study was aimed at assessment of a degree of regional differences in hospitalized morbidity in Poland for some of diseases considered to be related to environmental contamination and its relationship with general environmental characteristic of the regions. The performed analysis has shown that however in recent years there have been substantial differences in the discharge rates between provinces of Poland, these differences are not well explained by differences in general environmental factors. The possible reasons of these results have been discussed.
Seven out of twenty-seven areas of ecological hazard are located in South Poland, close to the Silesia-Cracow region. This region is most affected by several factors of both industrial and non-industrial origin. Air pollutants are of prime importance for the whole area. Mining of coal, zinc and lead ores cause a great additional threat to the natural environment and human population. A considerable set of data is available on the air pollution in the city of Cracow and the whole area of Katowice voivodship. In the center of the industrial area the concentrations of SO2 and dust exceed the country average by 7 to 13 times. In the Katowice district alone about 40% of the total amount of solid waste for Poland is located. The air concentrations of manganese, zinc, iron, ammonia, carbon monoxide, lead, cadmium, sulphur and nitrogen oxides, ozone, PAH, phenol, heterocyclic and chlorinated hydrocarbons exceed the allowed limits. Many of the above mentioned contaminants create an appreciable threat to human health. Poor infrastructure, nervous stresses, ugly environments and other factors are potential additional threats to human health, causing civilizational diseases. The ecological awareness of most people is rather poor, and extremely weak within some social groups (coke-plant workers, mine workers).
A group of 26 holocaust survivors was interviewed. The aim of the project was to find answers to the following questions: 1) What are the differences between Jewish survivors of the holocaust and Polish ex-prisoners of concentration camps imprisoned for political reasons; 2) What are the differences between survivors in Poland and survivors described in western literature. Generally the interviewed survivors had similar PTSD symptoms to concentration camp prisoners and survivors described in western literature. They did not differ in their suspiciousness and the long period of maintaining silence about the holocaust and experiences connected with it. They did not differ in setting up families quickly, in wanting home and children, in creating their own world to feel safe and supported by the family. They did not differ in an excessively fearful, often overprotective attitude to their own children. Higher educational level and keeping not only holocaust but their origin secret are differences we have found. Differences. The research was conducted within the "Judaica" programme of the Department of History and Jewish Culture in Poland, the Jagiellonian University, Kraków, under the direction of Prof. Józef Gierowski.
The control of gynaecological cancers in Poland has developed from three factors: 1) the organization of the Committee for Cancer Research and Control in 1906, which considered these activities as extremely important; 2) the personal commitment of Maria Skłodowska-Curie, and 3) the opportunity to train Polish physicians at the Foundation Curie in Paris after 1921, enhanced by the support of Head of the Fondation Professor Claude Regaud in introducing the "Paris Method" as a therapy against cervical cancer, to be provided for patients at the Radium Institute in Warsaw. The separation of gynaecological oncology as an independent branch of oncology occurred in Poland in 1951 when the Gynaecological Oncology Departments were opened first at the Institute of Oncology and later in other oncological clinics. The establishment of the Polish Gynaecological Society in 1992 was the next milestone.
Despite the growing number of PAP tests performed in Poland every year, (approximately 3 million per year in 1992) the mortality rates of cervical cancer are stable or increasing. With the intention of changing this unfavourable situation, a team of specialists in 1988 has developed a model for cervical cancer screening in Poland. Six experimental centres were chosen for the implementation of this model. The principles of the screening system were as follows: 1) population-based; 2) individual invitations; 3) computer assisted; 4) reproducible; 5) cytotechnicians' participation; 6) target population 30-60 years; 7) frequency of PAP tests: every 3 years. Preliminary data from the population of 25,841 which was covered by the screening campaign in Warsaw showed a 70.1% attendance rate and detectability of 3 cases per 1,000 screened women.
This paper presents systems how chemical substances, those in use and new ones, are evaluated in the EEC countries and in Poland prior to their admission to trade turnover. The Polish hygienic monitoring of chemical substances in comparison with systems operating in the Western countries requires a very thorough verification. New organizational concepts of evaluation of chemical substances before their admission to trade turnover in Poland are generally outlined. It is stressed that issues related to production and entering the market with chemical substances require new legal regulations. It also is necessary to set up a national centre responsible for implementing provisions of the Chemical Substances Act which is now being drafted.
Deaths from cancer in Poland are expected to increase by over 60% during the next 20 years due to aging of the population and increasing age-standardized male cancer mortality. Five-year survivals are much lower than in developed Western countries. Improvement of statistics of cancer incidence and survival in different regions of Poland is essential for operational planning of interventions and resources. Reduction of tobacco smoking must remain a priority in prevention. Legislation enforcing protection from carcinogenic workplace exposures and development of monitoring is necessary. Poor performance of primary health care physicians is the major cause of delays in diagnosis. Interventions in this field should focus on professional training and development of units of rapid diagnosis of cancer. Implementation of state-of-the-art treatment through multicenter programs is recommended. Access to specialized treatment, in particular radiotherapy, should be improved through further development of the oncological networks.
Sponsored by the U.S. Agency for International Development (AID), Albany Medical College and the Marie Skłodowska-Curie Memorial Cancer Center and Institute of Oncology formed a Partnership in 1992 aimed at enhancing cancer control and care in Poland by providing technical assistance and education to foster existing programs and develop new oncologic programs. The initial focus of the partnership is on breast cancer. Three demonstration screening/early disease programs are being developed, as well as a clinical and clinical research program and a Polish Breast Cancer Trials Group. A program to foster accreditation of oncologic facilities and programs throughout Poland is being considered.
Two hundred and twenty strains of Streptococcus faecalis (103 isolated in Poland and 117 in Federal Republic of Germany), were tested for antibiotic-susceptibility to 32 antimicrobial agents by agar dilution technique. Most effective in vitro appeared ampicillin, penicillin G, and a combination (1:1) of penicillin and streptomycin. Partly effective were also macrolide antibiotics, trimethoprim + sulfamethoxazole and five tetracyclines. Other antibiotics, including five cephalosporin derivatives, five aminoglycoside antibiotics, two lincomycins, two polymyxins, chloramphenicol and fucidin, appeared practically ineffective in vitro. Effectiveness of antimicrobials in vitro was considered on the basis of standard bioavailability of antimicrobial agents. No differences in antibiotic-susceptibility patterns of any practical significance were found, when strains isolated in Poland and Federal Republic of Germany were compared.
Three hundred and sixty strains of Gram-negative bacilli (Escherichia coli, Salmonella enteritidis, Enterobacter cloacae, Providencia, indole-positive and indole-negative Proteus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Serratia marcescens), were isolated by random in Poland and Germany, and tested by agar dilution method for susceptibility to 15 antimicrobial agents, including six cephalosporin derivatives, colistin, gentamycin and tobramycin, three newer tetracyclines, ampicillin and carbenicillin, and a combination of trimethoprim and sulfamethoxazole. This investigation revealed existence of growing antibiotic-resistance of Gram-negative bacilli to all antimicrobial agents. A detailed analysis of this problem is described and a list of agents effective in vitro is presented. Some evidence has been found concerning possible existence of geographical differences in antibiotic-susceptibility patterns of strains of Gram-negative bacilli, isolated in Poland and Federal Republic of Germany.
A case of Poland's syndrome--the association of congenital thoracic abnormalities with ipsilateral syndactyly--in a newborn infant is described. The infant demonstrated unusual manifestations of the syndrome: there was extension of the liver through the chest, and there was absence of a whole arm rather than hypoplasia and syndactyly. The authors describe the investigation and treatment of this infant, and they discuss the diversity of findings in Poland's syndrome.
Long-term oxygen therapy (LTOT) is known since the second half of the present century. In Poland it was introduced in 1986. By the end of 1991, 37 regional LTOT centers, using almost 1000 oxygen concentrators as oxygen source, were organized all over the country. To LTOT are classified two groups of patients with the advanced chronic pulmonary disease complicated with fixed respiratory failure and frequently with cor pulmonale. One group consist of patients with severe hypoxemia (PaO2 < or = 7.3 kPa, i.e. < or = 55 mm Hg) accompanied by the signs of cor pulmonale or tissue hypoxia whereas another consists of patients with moderate hypoxemia (PaO2 7.4-7.8 kPa, i.e. 55-65 mm Hg). A 5-year history of the regional LTOT centres in Poland was assessed. According to questionnaires received from 27 centres, 971 patients (662 males and 309 females), aged 59.3 years on the average, were classified to the long-term oxygen therapy between August 1, 1986 and December 31, 1991. Six hundred fifty seven patients (67.6%) has COPD, 229 (23.6%) had non-COPD pulmonary disease, and 85 patients (8.8%)-other diseases. Six hundred forty four patients (66.3%) were given oxygen concentrators for severe hypoxemia and 327 patients (33.7%) for moderate hypoxemia wit co-existing signs of the cor pulmonale and tissue hypoxia. Mean time of oxygen use in 839 patients was 13.8 hours a day. Long-term oxygen therapy was ceased in 31 patients (3.2%).(ABSTRACT TRUNCATED AT 250 WORDS)
Mortality study was carried out on the cohort of 11,224 men with coal workers' pneumoconiosis or silicosis diagnosed during the period 1970-1985. The cohort was selected from the register of occupational diseases and was traced up to the end of 1991. The general male population of Poland was a reference group. The study showed small but significant excess of total mortality (SMR = 115; p < 0.01). The analysis of death causes revealed an elevated mortality from infectious diseases, among which tuberculosis was most prevalent (SMR = 212; p < 0.01) and from pneumoconioses predominant in diseases of the respiratory system, (SMR = 426; p < 0.01) and lung cancer (SMR = 116; p < 0.01). The comparison of the prevalence of smoking in the population under study with that in the reference general male population of Poland indicated that this habit is mostly responsible for the excess of lung cancer deaths. This finding contradicts the hypothesis that there is a causal relationship between exposure to dusts containing crystalline silica, pneumoconiosis and lung cancer.
Multicentre study was carried out in three regions of Poland aimed to assess cholecystolithiasis incidence in urban population and some potential risk factors of the disease. 10133 persons in five age groups, from 16 to 70 (6071 women and 4062 men) were examined. The examination consisted of questionnaire considered sex, age, weight, dietary habits, complaints, chronic drugs use, family history and in women number of pregnancies and deliveries as well as hormone therapy. The results obtained were analysed statistically with Chi 2 test. Cholecystolithiasis was found in 1411 persons (10.7%), among them 18% women (1083 women) and 8.2% men (328 men). Incidence rate was 180.5/1000 women and 82.0/1000 men. The obtained increase in percentage of cholecystolithiasis cases with age was statistically significant. No relation were found between the number of stones and sex of the examined persons. In 1480 persons (43.5%0 the disease was asymptotic. The studies did not prove the correlation between cholecystolithiasis in women and sex of the first child or oral contraception. Positive correlation was found between cholecystolithiasis in women, obesity, number of pregnancies and family history. In men age was most significant risk factor. Incidence of cholecystolithiasis in Poland, Western Europe and USA is similar.