CHARACTERISTICS OF MORTALITY RATES FROM BREAST AND OVARIAN CANCER IN JAPAN

Objective: Breast and ovarian cancer is rare in Japan compared with other developed countries but their mortality rates are increasing. It is necessary to examine the experience of Japan as a guide to further prevent breast and ovarian cancer in our country. Methods: We conducted an epidemiological study of breast and ovarian cancer in the past 50 years to investigate the trends and characteristics of the mortality rates in Japan. The numbers of age-specific death from breast and ovarian cancer and the population of 5-year groups were obtained from the Vital Statistics of Japan. The truncated age specific mortality rates were calculated according to the patterns of age specific mortality rates from both cancers. Age adjustments were made to the standard world population. Results: In the past 50 years, mortality rates of breast and ovarian cancer increased about 2 or 6 fold, respectively. This increase was most marked over 50 years old. The death pattern of breast cancer was same as that of ovarian cancer, but that of ovarian cancer changed greatly with time. The birth cohort study had some interesting findings. Common to breast and ovarian cancer, the later the year of birth, the higher the mortality rates from both malignancies in later life. Conclusion: The increase of the yearly mortality rates from breast and ovarian cancer might be due to changes in lifestyle and environmental factors. We are very concerned about dietary practices. Further investigation is needed to clarify the possible causes of animal food.

National Breast Cancer Mortality and Incidence Rates According to the Human Development Index: An Ecological Study

Background: This study aimed to identify the role of human development index (HDI) in the incidence and mortality rates of breast cancer (BC) worldwide. Methods: Data on the age-standardized incidence and mortality rates of BC for 184 countries were obtained from the GLOBOCAN. Data about the HDI and other indices were obtained from the World Bank Report 2013. Linear regression model was used for assessment the effect of HDI on BC occurrence rates. Results: In 2012, BCs were estimated to have affected a total of 1,671,149 individuals (crude rate: 47.8 per 100,000 individuals), and caused 521,907 deaths worldwide (crude rate: 14.7 per 100,000 individuals). Nearly half of total female BC cases (46.3%) with the highest risk of incidence (age-standardized Rate (ASR): 128 per 100,000) had occurred in very high HDI regions. The most proportion of the mortality burden was in low HDI and medium HDI areas. Linear regression analyses showed a direct significant correlation between the incidence of BC and HDI at the global level (B = 104.5, P < 0.001). The mortality rate of BC was not significantly associated with HDI (B = 3.26, P = 0.160). Conclusion: Our study showed that the burden of female BC is enormous in very high HDI and low HID regions. Targeted interventions have the ability to reduce this number significantly through resource-dependent interventions. Moreover, further reductions in mortality could be brought about by increasing access to curative treatment for patients with BC.

Mortality rates of pathogen indicator microorganisms discharged from point and non-point sources in an urban area

This research measured the mortality rates of pathogen indicator microorganisms discharged from various point and non-point sources in an urban area. Water samples were collected from a domestic sewer, a combined sewer overflow, the effluent of a wastewater treatment plant, and an urban river. Mortality rates of indicator microorganisms in sediment of an urban fiver were also measured. Mortality rates of indicator microorganisms in domestic sewage, estimated by assuming first order kinetics at 20℃ were 0.197 day^-1, 0.234 day^-1, 0.258 day^-1 and 0.276 day^-1 for total coliform, fecal coliform, Escherichia coli, and fecal streptococci, respectively. Effects of temperature, sunlight irradiation and settlement on the mortality rate were measured. Results of this research can be used as input data for water quality modeling or can be used as design factors for treatment facilities.

Mortality in Cardiology in Sub-Saharan Africa: Case of the Cardiology Department of the Teaching Hospital Sylvanus Olympio of Lome

Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.

Improving colorectal cancer screening programs

In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology.They suggest policies for more effective colorectal screening.Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening.Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps.However,colonoscopy is an invasive process,and fecal tests such as the current hemoglobin immunodetection were developed,followed by endoscopy,as the general tool for population screening,avoiding logistical and economic problems.Even so,participation and adherence rates are low.Different screening options are being developed with the idea that if people could choose between the ones that best suit them,participation in population-based screening programs would increase.Blood tests,such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA,showed a similar accuracy rate to stool tests for cancer,but were less sensitive for advanced precancerous lesions.At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer,novel immune system-related biomarkers and information on patients’immune parameters,such as cell counts of different immune populations,were studied for the early detection of colorectal cancer,since they could be effective in asymptomatic people,appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood.sCD26,for example,detected 80.37%of advanced adenomas.To reach as many eligible people as possible,starting at an earlier age than current programs,the direction could be to apply tests based on blood,urine or salivary fluid to samples taken during routine visits to the primary health system.

Machine Learning Prediction of Fetal Health Status from Cardiotocography Examination in Developing Healthcare Contexts

Reducing neonatal mortality is a critical global health objective,especially in resource-constrained developing countries.This study employs machine learning(ML)techniques to predict fetal health status based on cardiotocography(CTG)examination findings,utilizing a dataset from the Kaggle repository due to the limited comprehensive healthcare data available in developing nations.Features such as baseline fetal heart rate,uterine contractions,and waveform characteristics were extracted using the RFE wrapper feature engineering technique and scaled with a standard scaler.Six ML models—Logistic Regression(LR),Decision Tree(DT),Random Forest(RF),Gradient Boosting(GB),Categorical Boosting(CB),and Extended Gradient Boosting(XGB)—are trained via cross-validation and evaluated using performance metrics.The developed models were trained via cross-validation and evaluated using ML performance metrics.Eight out of the 21 features selected by GB returned their maximum Matthews Correlation Coefficient(MCC)score of 0.6255,while CB,with 20 of the 21 features,returned the maximum and highest MCC score of 0.6321.The study demonstrated the ability of ML models to predict fetal health conditions from CTG exam results,facilitating early identification of high-risk pregnancies and enabling prompt treatment to prevent severe neonatal outcomes.

The Prognostic Value of Red Cell Distribution Width in Critically Ill Cerebral Infarction Patients:A Retrospective Cohort Study

Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background： Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods： Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group （0, 1-4, 5-9, 10-14...80＋）. Incidence and mortality rates were age-standardized to World Segi＇s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results： The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 （males, 42.18/100,000 and females, 24.31/100,000）. The age-standardized rate by world standard population （ASRW） was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 （males, 31.40/100,000 and females, 18.45/100,000）, ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 （ASRW =48.69/100,000） to 2004-2005 （ASRW =28.02/100,000）, with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes （APC） of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Conclusions： Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

Modified shock index and mortality rate of emergency patients

BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.

Subgroup comparison of COVID-19 case and mortality with associated factors in Mississippi: findings from analysis of the first four months of public data

We compared subgroup differences in COVID-19 case and mortality and investigated factors associated with case and mortality rate(MR)measured at the county level in Mississippi.Findings were based on data published by the Mississippi State Department of Health between March 11 and July 16,2020.The COVID-19 case rate and case fatality rate(CFR)differed by gender and race,while MR only differed by race.Residents aged 80 years or older and those who live in a non-metro area had a higher case rate,CFR,and MR.After controlling for selected factors,researchers found that the percent of residents who are obese,low income,or with certain chronic conditions were associated with the county COVID-19 case rate,CFR,and/or MR,though some were negatively related.The findings may help the state to identify counties with higher COVID-19 case rate,CFR,and MR based on county demographics and the degree of its chronic conditions.

Evaluation and Estimation of the Provincial Infant Mortality Rate in China's Sixth Census

Objective To assess the data quality and estimate the provincial infant mortality rate（1q0） from China＇s sixth census. Methods A log-quadratic model is applied to under-fifteen data. We analyze and compare the average relative errors（AREs） for 1q0 between the estimated and reported values using the leave-one-out cross-validation method. Results For the sixth census, the AREs are more than 100% for almost all provinces. The estimated average 1q0 level for 31 provinces is 12.3‰ for males and 10.7‰ for females. Conclusion The data for the provincial 1q0 from China＇s sixth census have a serious data quality problem. The actual levels of 1q0 for each province are significantly higher than the reported values.

Age,growth,and mortality rate of the yellow goosefish Lophius litulon(Jordan,1902)in the Yellow Sea

With the decline in the most fisheries resources in the Yellow Sea,the yellow goosefish Lophius litulon has increased in commercial and ecological importance in recent years.We studied the length distribution,length-weight relationship,age composition,growth pattern,mortality,and exploitation rates of the yellow goosefish in the Yellow Sea.Total length(TL)of females and males ranged from 173 to 582 mm and 178 to 500 mm,respectively.The length-weight relationships were also estimated for females and males.Age classes from 2 to 4 years predominated in the samples.The von Bertalanffy growth function(VBGF),estimated based on non-linear least-squares methodology,showed significant differences between sexes.Females attained a greater estimated asymptotic total length(765 mm TL)compared to males(579 mm TL).The VBGF did not differ significantly between stocks of the northern Yellow Sea and the southern Yellow Sea.Estimated natural instantaneous mortality rate(M)ranged from 0.25/a to 0.33/a based on four age-and length-based methods.Total instantaneous mortality rate(Z)of total samples calculated by the age-based catch curve method was 0.591/a and the average fishing mortality(F)was 0.30/a.Estimated exploitation rate(E)was approximately 0.5,indicating that the population of L.litulon in the Yellow Sea may be sustainable.These results provide a reference for the present status of L.litulon and information for the management.

SutteARIMA:A Novel Method for Forecasting the Infant Mortality Rate in Indonesia

This study focuses on the novel forecasting method(SutteARIMA)and its application in predicting Infant Mortality Rate data in Indonesia.It undertakes a comparison of the most popular andwidely used four forecasting methods:ARIMA,Neural Networks Time Series(NNAR),Holt-Winters,and SutteARIMA.The data used were obtained from the website of the World Bank.The data consisted of the annual infant mortality rate(per 1000 live births)from 1991 to 2019.To determine a suitable and best method for predicting InfantMortality rate,the forecasting results of these four methods were compared based on the mean absolute percentage error(MAPE)and mean squared error(MSE).The results of the study showed that the accuracy level of SutteARIMA method(MAPE:0.83%andMSE:0.046)in predicting InfantMortality rate in Indonesia was smaller than the other three forecasting methods,specifically the ARIMA(0.2.2)with a MAPE of 1.21%and a MSE of 0.146;the NNAR with a MAPE of 7.95%and a MSE of 3.90;and the Holt-Winters with aMAPE of 1.03%and aMSE:of 0.083.

Underlying disease may increase mortality risk in users of atypical antipsychotics

Schizophrenia is a group of the most common types of mental illness.Commonly used antischizophrenia drugs all increase mortality to some extent.The increased risk of death in older individuals and patients with dementia using atypical antips-ychotics may be due to myocardial damage,increased mobility and increased risk of stroke.

An Assessment of Association between Neighborhood Socioeconomic Status and Infant Mortality in High Focus States in India

Neighbourhood characteristics influence infant mortality above and beyond individual/household factors. In India, there are very few studies discussing the effects of neighbourhood characteristics on infant mortality. This study examined the effect of neighbourhood socioeconomic characteristics on infant mortality using data from the India’s Third District Level Household Survey conducted in 2007-2008. Multilevel analyses applied on the representative sample of 168,625 nested within 14,193 communities using MCMC procedure. Results established that place of residence, neighbourhood socio-economic factors as important determinants of infant mortality. Overall, being born in affluent (OR: 0.79, p < 0.01), more educated (OR: 0.86, p < 0.01) and socially disadvantaged caste (OR: 0.83, p < 0.01) neighbourhood was associated with the significant reduction in hazards of infant death. The finding of this study suggests that effort should be made to reduce infant mortality in these high focus states by including policies which aim at improving infant survival in the neighbourhood that is economically and socially deprived.

Flock Dynamics and Approaches for Reducing Mortality Rate among Mubende Goats at BuZARDI Semi-Intensive Farm, Hoima, Uganda

Goats are globally very important domestic small ruminants being kept for meat, milk, skin, byproducts and several socio-cultural purposes. Goat farmers in the Lake Albert Crescent Zone (LACZ) of Uganda identified dry-season feed scarcity, poor breeds, diseases, informal marketing and theft as major constraints which underscore the scarcity of information on improved management technologies and the need for targeted decisions. At BuZARDI goat farm, a semi-intensive farm that is also experiencing similar challenges, we documented management practices and collected production related data for 2 years. We computed flock dynamics and mortality rates purposely to influence decisions aimed at increasing the farm’s productivity. Data were collected using pens and books, validated and analyzed using MS office 2013 and SPSS version 22. The flock size increased from 37 goats in July 2020 to 175 goats in June 2022. One hundred twenty-five goats were introduced into the farm as breeding stock, 89 kids were born on the farm and 61 goats died due to various causes. The average number of goats in the farm per month was 109.2 (SEM = 13.7), female 79.8 (SEM = 10.8) and male 29.4, (SEM = 9.9). Average population of goats at risk of death was 95 and the Mortality rate was 27 goats per 1000 goat months. The disaggregated mortality rate of 5 goats per 1000 goat months and 39 goats per 1000 goat months were obtained for the period FY 2020-2021 and FY2021-2022 respectively. The main contributors to the mortality of goats were worm infestation (33%), fracture and injuries arising from stampedes (18%), Ticks and tick borne diseases (18%), respiratory tract infections (11%) and malnutrition (10%). We recommend strict adherence to the flock health program;improved parasite management, separation & improved care for kids, vaccinations, safer feeding, and evidence based disease management, adoption of digital data collection tools and development of an appropriate app for more accurate determination of mortality rates.

Maternal and Neonatal Factors Associated with Mortality of Preterm Babies Admitted in Newborn Unit of Kenyatta National Hospital, Kenya

Background: Preterm birth is a primary cause of neonatal morbidity and mortality especially in low-income countries. Although understanding the preventable factors of neonatal deaths in preterm infants is required for timely interventions, data on those factors is lacking in Kenya. We attempted to determine mortality and its associated factors in preterm babies in Kenya. Methods and Materials: A hospital-based, prospective study was implemented from July 2019 to October 2019 involving 163 preterm neonates and their mothers admitted at Kenyatta National Hospital. A systematic random sampling method was used to recruit the study participants. Data on mortality and the associated factors in preterm neonates were collected using a pretested questionnaire for mothers and neonatal medical records. Data was analyzed using descriptive and inferential statistics. Results: The mortality rate was 18.4%. Of the neonates who died, respiratory distress syndrome (63.3%) and neonatal sepsis (20.0%) were documented as the primary causes. Neonates born of single mother (AOR = 8.006, 95% CI 2.267 to 28.272, p = 0.001), unemployed (6.960, 1.059 - 45.757, p = 0.043), self-employed (4.040, 1.067 - 15.302, p = 0.040), anemic (7.465, 2.530 - 22.023, p < 0.001) and with history of bleeding during pregnancy were more likely to have died. The neonates born before 28 weeks of gestation (126.188, 14.554 - 1094.060, p < 0.001), those who did not cry immediately at birth (54.271, 5.970 - 493.395, p < 0.001) and the resuscitated at birth (54.406, 6.807 - 434.851, p < 0.001) were likely to die. Conclusion: High mortality rates of preterm neonates are attributed to both maternal and neonatal factors. Focused antenatal care should aim at early identification of high-risk mothers for early management of bleeding during pregnancy, close monitoring of nutritional status for mothers and health education.

Evolution of Mortality Due to Parkinson’s Disease in the Capitals of the Brazilian States in the Period from 2010 to 2019

After Alzheimer’s disease, Parkinson’s disease (PD) is the most common neurodegenerative disease. According to WHO data, about 1% of the world’s population over 60 years of age is affected by PD, and its incidence increases with age. Information about mortality plays a relevant role in the planning and distribution of financial resources in the areas of public health, social assistance and the like. Thus, this article aims to describe the evolution of PD mortality in the Brazilian state capitals, in the period from 2010 to 2019. A descriptive and retrospective study was conducted, based on data collection (number of deaths and estimated resident population), by sex and age group, available in the DATASUS SIM. Mortality rates were calculated per 100 thousand inhabitants;and statistical tests of linear regression, the t-test, ANOVA and the Tukey test, using the R program, were performed to evaluate the significance of the data. The number of deaths and mortality rates were higher in males compared to females and the incidence of mortality was higher in the over 80s. Notably, the southeastern region presented the highest mortality rates, which is to be expected because it concentrates the highest proportion of elderly people. It is hoped that such data will aid the implementation of public health policies and adequate social assistance for those affected by PD, in order to improve their quality of life.

Influencing Factors and Mortality Prediction of Covid-19 Contact Infection Rate in China

Taking the COVID-19 data from 2020-1-23 to 3-21 days released by the China Health Protection Committee as the sample,the hospital remaining rate,mortality rate and cure rate are selected as covariates,and the contact infection rate is used as response variable to establish a high precision ADL model,results of return substitution show that the predicted value of contact infection rate almost coincides with the sample value,and shows three stages of change characteristics.After March 1,2020,the overall trend is downward,stable below 12%.Main influencing factors of contact infection rate are analyzed quantitatively.Based on this,the ARIMA(1,2,2)model is established to analyze and predict the mortality change trend.The results showed that the domestic COVID-19 mortality rate is stable near 4%after 2020-3-27.

Healthcare Quality According to ICU Level of Care

Introduction: Little is known about the quality of healthcare in intensive care units (ICUs) in Poland. Data on patients hospitalized in ICUs in Warsaw and the results of their treatment are scarce. This information, crucial for improving the quality of ICU healthcare services, is not collected routinely. Quality indicators are essential in the concept of holistic quality management. Implementation of these indicators in ICUs is a complex and time-consuming process. Systematic increase in demand for quality assessment tools that can reflect real conditions of the practices of ICUs, prompts the search for effective solutions. Methods: The study included 12,155 patients hospitalized in 16 ICUs of Warsaw hospitals (8 ICUs, n = 3293 of the first level of care, and 8 ICUs, n = 8862 of the second level) between 1st January 2017 and 31st December 2018. ICUs in pediatric and oncological hospitals were excluded from the study. Characteristics and demography of patients as well as the structure, treatment and human resources of the ICUs in Warsaw were analyzed. Length of stay, unexpected extubations, nosocomial infections, ICU readmissions and standardized mortality ratios (SMR) were retrieved from National Health Fund, Ministry of Health, and other public databases. Results: In primary level ICUs patients’ age (66.42 vs. 64.43 years;p = 0.005) and comorbidity rate (30.56% vs. 22.78%, p = 0.037) were higher when compared to ICUs of the second level of care. The crude mortality rate in ICUs in Warsaw was significantly higher than in other EU countries and differed between ICUs of the first and the second level (34.77% vs. 24.53%, respectively;p = 0.004). SMRs were however very low: 0.71 and 0.64 (ns), respectively. ICU readmission rate, unexpected extubations, central catheter related infections, and length of stay were identical in both groups. More patients were admitted to ICU form emergency department and/or discharged home in Level 1 ICUs (18.9% vs 12.9%, p Conclusions: There are no major differences in quality of care provided by Level 1 and Level 2 ICUs in Poland, although more rigorous adhesion to admission and discharge policies is needed. Implementation of the instruments for assessing quality of ICUs including benchmarking, self-assessment of departments and evaluation of changes resulting from audits according to the Deming cycle is of utmost importance. Standardization of quality measures and markers, communication, and cooperation in reporting and creation of ICU medical registers is necessary to improve the quality of healthcare.