Multimorbidity Patterns in the Urban Population in Poland

A number of studies have been conducted on multimorbidity; however, there are different patterns in various countries, ethnicities and social groups. The aim of this study is to estimate the prevalence of multimorbidity (physical diseases) in the urban population in Poland. In this population-based study, we examined multimorbidity stratified by sex, age, educational attainment and professional activity. Sixty-seven conditions were identified based on self-reported history (known conditions) and completed examinations (unknown conditions). Among the overall individuals aged 20-80 years, 1422 (88.2%) of the total 1612 individuals, 787 (88.9%) of 885 women and 635 (87.3%) of 727 men were diagnosed with at least two chronic conditions. On average, 5.25 ± 3.5 conditions occurred in the study population. The number of diagnosed conditions per individual increased with age and decreased with higher educational levels, with differing pathways in women and men. Women showed a higher number of conditions than men in the same age groups and educational levels. Only among students, the level of multimorbidity was lower in women than in men. In the other occupational activity categories, it was already higher in women. The level of multimorbidity in employed and unemployed individuals in a particular sex cluster was similar. We identified a high prevalence of multimorbidity in the urban population in Poland varying by age, sex, education attainment and professional activity. Our work may help in the selection of appropriate screening tests based on age, sex and educational attainment in order to recognise multimorbidity based on both known and unknown conditions. Ultimately, it may impact clinical practice, service delivery and study design.

Reference Values for Birth Weight in Relation to Gestational Age in Poland and Comparison with the Global Percentile Standards

INTRODUCTION

Percentiles of birth weight by gestational age (GA) are an essential tool for clinical assessment and initiating interventions to reduce health risks. Unfortunately, Poland lacks a reference chart for assessing newborn growth based on the national population. This study aimed to establish a national reference range for birth weight percentiles among newborns from singleton deliveries in Poland. Additionally, we sought to compare these percentile charts with the currently used international standards, INTERGROWTH-21 and WHO.

MATERIALS AND METHODS

All singleton live births (n = 3,745,239) reported in Poland between 2010 and 2019 were analyzed. Using the Lambda Mu Sigma (LMS) method, the Generalized Additive Models for Location Scale, and Shape (GAMLSS) package, smoothed percentile charts (3-97) covering GA from 23 to 42 weeks were constructed.

RESULTS

The mean birth weight of boys was 3453 ± 540 g, and this was higher compared with that of girls (3317 ± 509 g). At each gestational age, boys exhibited higher birth weights than girls. The weight range between the 10th and 90th percentiles was 1061 g for boys and 1016 g for girls. Notably, the birth weight of Polish newborns was higher compared to previously published international growth standards.

CONCLUSION

The reference values for birth weight percentiles established in this study for Polish newborns differ from the global standards and are therefore useful for evaluating the growth of newborns within the national population. These findings hold clinical importance in identifying neonates requiring postbirth monitoring.

Disparities in the Prevalence and Risk Factors for Carotid and Lower Extremities Atherosclerosis in a General Population—Bialystok PLUS Study

This study was conducted in a representative sample of area residents aged 20–80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60.

The prevalence of diabetes and prediabetes: a population-based study

INTRODUCTION

Diabetes remains one of the top public health care priorities. Over 6% of the world's population is affected by type 2 diabetes; however, a similar number of individuals may be unaware of this diagnosis.

OBJECTIVES

Our population‑basedstudy aimed to investigate the true prevalence of diabetes and prediabetes in the general population of a medium‑sized city in Poland.

PATIENTS AND METHODS

The analysis included 1051 participants of the Bialystok PLUS population‑based cohort study. In those who did not report a history of diabetes, the oral glucose tolerance test (OGTT) was performed. Medical history data were gathered using standardized questionnaires, and anthropometric as well as body composition measurements were performed.

RESULTS

According to the medical history data, a total of 75 participants had diabetes (7.14%). Prediabetes (impaired fasting glycemia [IFG] or impaired glucose tolerance [IGT]) was identified in 410 individuals, including 241 participants with IFG (22.9%) and 169 patients with IGT (16.1%). Moreover, there were 71 individuals (6.75%) who were newly diagnosed with diabetes based on OGTT results. Overall, 146 patients with diabetes (13.8%) were identified. The ratio of lean mass to fat mass differed significantly between the patients with newly diagnosed diabetes and those without impaired glucose metabolism.

CONCLUSIONS

Our cohort study demonstrated a high prevalence of undiagnosed diabetes in the Białystok population. In addition, we showed that a large group of patients still remains undiagnosed for other hyperglycemic disorders. Abdominal obesity as well as imbalance between the fat and lean mass may predispose to diabetes.

Emission of Industrial Air Pollution and Mortality Due to Respiratory Diseases: A Birth Cohort Study in Poland

BACKGROUND

Air pollution is a major risk factor for public health worldwide, but evidence linking this environmental problem with the mortality of children in Central Europe is limited.

OBJECTIVE

To investigate the relationship between air pollution due to the emission of industry-related particulate matter and mortality due to respiratory diseases under one year of age.

METHODS

A retrospective birth cohort analysis of the dataset including 2,277,585 children from all Polish counties was conducted, and the dataset was matched with 248 deaths from respiratory diseases under one year of age. Time to death during the first 365 days of life was used as a dependent variable. Harmful emission was described as total particle pollution (TPP) from industries. The survival analysis was performed using the Cox proportional hazards model for the emission of TPP at the place of residence of the mother and child, adjusted individual characteristics, demographic factors, and socioeconomic status related to the contextual level.

RESULTS

Infants born in areas with extremely high emission of TPP had a significantly higher risk of mortality due to respiratory diseases: hazard ratio (HR) = 1.781 [95% confidence interval (CI): 1.175, 2.697], p = 0.006, compared with those born in areas with the lowest emission levels. This effect was persistent when significant factors were adjusted at individual and contextual levels (HR = 1.959 [95% CI: 1.058, 3.628], p = 0.032). The increased risk of mortality was marked between the 50th and 150th days of life, coinciding with the highest exposure to TPP.

CONCLUSIONS

The emission of TPP from industries is associated with mortality due to respiratory diseases under one year of age. A considerable proportion of children's deaths could be prevented in Poland, especially in urban areas, if air pollution due to the emission of particle pollution is reduced.

Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland?

BACKGROUND

Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland.

METHODS

The 2010-2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations.

RESULTS

Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010-2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index).

CONCLUSIONS

Significant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.

A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.

Effectiveness of Lifestyle Modification vs. Therapeutic, Preventative Strategies for Reducing Cardiovascular Risk in Primary Prevention-A Cohort Study

BACKGROUND

Cardiovascular diseases (CVD) are still the leading cause of death in developed countries. The aim of this study was to calculate the potential for CV risk reduction when using three different prevention strategies to evaluate the effect of primary prevention.

METHODS

A total of 931 individuals aged 20-79 years old from the Bialystok PLUS Study were analyzed. The study population was divided into CV risk classes. The Systematic Coronary Risk Estimation (SCORE), Framingham Risk Score (FRS), and LIFE-CVD were used to assess CV risk. The optimal prevention strategy assumed the attainment of therapeutic goals according to the European guidelines. The moderate strategy assumed therapeutic goals in participants with increased risk factors: a reduction in systolic blood pressure by 10 mmHg when it was above 140 mmHg, a reduction in total cholesterol by 25% when it was above 190 mg/dL, and a reduction in body mass index below 30. The minimal prevention strategy assumed that CV risk would be lowered by lifestyle modifications. The greatest CV risk reduction was achieved in the optimal model and then in the minimal model, and the lowest risk reduction was achieved in the moderate model, e.g., using the optimal model of prevention (Model 1). In the total population, we achieved a reduction of -1.74% in the 10-year risk of CVD death (SCORE) in relation to the baseline model, a -0.85% reduction when using the moderate prevention model (Model 2), and a -1.11% reduction when using the minimal prevention model (Model 3). However, in the low CV risk class, the best model was the minimal one (risk reduction of -0.72%), which showed even better results than the optimal one (reduction of -0.69%) using the FRS.

CONCLUSION

A strategy based on lifestyle modifications in a population without established CVD could be more effective than the moderate strategy used in the present study. Moreover, applying a minimal strategy to the low CV risk class population may even be beneficial for an optimal model.

Perception of smell of a perfume applied to the women skin in course of menstrual cycle

INTRODUCTION

Perfumes are the cosmetics applied to the skin. Body odor has been shown to be attractive in the fertile days in non-user of contraception. However, contraception pill intake destroy cyclic attractiveness of odors.

AIM

The aim was to test attractiveness and intensiveness of perfume applied to the female skin in course of menstrual cycle.

MATERIAL AND METHODS

Diluted vanilla extract was applied on forearm of 18 women (9 women users of contraception and 9 non-users of contraception). Thirty minutes occlusion samples were collected and judged for its attractiveness and intensity by 25 men. Samples were collected at 1st, 8th, 14th, and 22nd day of cyclus.

RESULTS

Attractiveness of smell of perfume in women, which use contraceptive was statistically significantly higher than in non-user. Furthermore, attractiveness of smell at 15th day of menstrual cycle was second best when perfume was applied in women, which use contraceptive.

CONCLUSIONS

Perfume on the skin of women, which apply contraceptive, smell better than on non-contraceptive-user skin. Moreover, women body odor together with perfume is highly attractive in contraceptive-user in the middle of the cyclus.

Effects of cardiac rehabilitation on risk factor management and quality of life in patients with ischemic heart disease: a multicenter cross‑sectional study

INTRODUCTION

While cardiac rehabilitation (CR) improves survival outcomes in patients with ischemic heart disease (IHD), the long‑ term benefits of short term programs are still discussed.

OBJECTIVES

The aim of the study was to assess the impact of CR on risk factor management in a multicenter real‑ life registry of patients with IHD.

PATIENTS AND METHODS

We included patients aged 80 years or younger who had been hospitalized due to acute coronary syndrome or for a myocardial revascularization procedure and interviewed 6 to 18 months later. Control of risk factors was compared between patients who participated in CR and those who did not. Propensity score matching was used to account for differences in patient characteristics between the groups.

RESULTS

Of 1012 interviewed patients (28.6% women), 35.6% were referred for CR and 76.1% of them completed the program. Those referred were younger (P <0.001), employed (P <0.001), have presented with ST‑ segment elevation myocardial infarction (P <0.001), had hypertension (P <0.001), and were current smokers (P <0.001). Logistics regression revealed that patients who participated in CR were more likely to stop smoking (odds ratio [OR], 2.42; 95% CI, 1.33-4.14), achieve acceptable glucose control (OR, 1.70; 95% CI, 1.02-2.83), and better quality of life (β = 0.12; 95% CI, 0.00-0.24) compared with those who did not participate in CR.

CONCLUSIONS

Cardiac rehabilitation is moderately effective if performed only once and without a continuous support program. Further efforts to increase referrals for CR in patients with IHD must be accompanied by a long‑ term strategy to sustain the beneficial effects.

Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland

Background: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. Methods: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. Results: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45–1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11–1.42 and IRR = 1.19, 95% CI 1.02–1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. Conclusions: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.

Undiagnosed Diabetes and Prediabetes in Patients with Chronic Coronary Syndromes-An Alarming Public Health Issue

Dysglycemia is a public health challenge for the coming decades, especially in patients with chronic coronary syndromes (CCS). We want to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes, as well as identify factors associated with the development of dysglycaemia in patients with CCS. In total, 1233 study participants (mean age 69 ± 9 years), who, between 6 and 18 months earlier were hospitalized for acute coronary syndrome or elective revascularization, were examined (71.4% men). The diagnosis of DM, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) have been made according to World Health Organization (WHO) criteria. Based on the oral glucose tolerance test (OGTT) results, DM has been newly diagnosed in 28 (5.1%, mean age 69.9 ± 8.4 years) patients, 75% were male (n = 21). Prediabetes has been observed in 395 (72.3%) cases. IFG was found in 234 (42.9%) subjects, 161 (29.5%) individuals had IGT. According to multinomial logistic regression, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) should be considered when assessing risk of development of dysglycaemia after discharge from the hospital. Among people with previously diagnosed DM, a significantly higher percentage were willing to change their lifestyles after the index event compared to other patients. Patients with chronic coronary syndromes suffer a very high frequency of dysglycaemia. Most patients with chronic coronary syndromes, especially those with high BMI or low HDL-C, should be considered for screening for dysglycemia using OGTT within the first year after hospitalization. A higher percentage of patients who were aware of their diabetic status changed their lifestyles, which added the benefit of timely diagnosis and treatment of diabetes.

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals With Low Cardiovascular Risk

Background: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events. The electrocardiography (ECG) has poor sensitivity, but it is commonly used to detect LVH. Aim: To evaluate the diagnostic efficacy of known ECG indicators to recognize LVH in subgroups with different cardiovascular risk levels. Methods: 676 volunteers were included. Results: We found that 10.2% of the analyzed population had LVH based on echocardiography. Individuals with LVH were older, had a higher body mass index, higher systolic blood pressure, lower heart rate, higher parameters of insulin resistance, higher cardiovascular risk, and android-type obesity. Variables that remained independently associated with LVH were QRS duration, left atrial volume index, troponin T, and hemoglobin A1c. The receiver operating characteristics (ROC) curve analysis of the Sokolow–Lyon index did not show a significant predictive ability to diagnose LVH in the whole study population including all cardiovascular risk classes. The ROC curves analysis of Cornell and Lewis indices showed a modest predictive ability to diagnose LVH in the general population and in a low cardiovascular class. Conclusions: There is a need for new, simple methods to diagnose LVH in the general population in order to properly evaluate cardiovascular risk and introduce optimal medical treatment of concomitant disease.

Independent Impact of Gynoid Fat Distribution and Free Testosterone on Circulating Levels of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) in Humans

Background: Natriuretic peptides (NPs), including brain natriuretic peptide (BNP), are neurohormones involved in the regulation of water-sodium balance and the maintenance of cardiovascular homeostasis. A higher concentration of NPs is observed in females, but the mechanism behind this difference has not been fully elucidated. Methods: Randomly chosen 255 volunteers from the general population were examined. Overall, 196 people without severe cardiovascular disease were included (mean age 48 years, 35.7% male). A comprehensive assessment was performed, including anthropometric measurements, N-terminal pro-brain natriuretic peptide (NT-proBNP), total testosterone (TT) and sex hormone-binding globulin (SHBG) concentration, transthoracic echocardiography (ECHO), and body composition analysis by direct dual-energy X-ray absorptiometry (DEXA). The univariate analysis adjusted by the known affecting factors determined which measurements were independently associated with NT-proBNP concentration. Results: NT-proBNP concentration was positively associated with gynoid fat mass, gynoid/total fat (G/TF) mass index, SHBG and negatively with android/gynoid (A/G) fat mass index, TT and calculated free testosterone (CFT) concentrations. Furthermore, body composition parameters remained independently associated with NT-proBNP levels even after adjusting for CFT and SHBG. Conclusion: In the population without severe cardiovascular disease, the NT-proBNP concentration is independently associated with lower availability of testosterone and higher gynoid fat distribution, which may explain higher NPs levels in females.

Changes in Dietary Patterns and the Nutritional Status in Men in the Metallurgical Industry in Poland Over A 21-Year Period

BACKGROUND/AIMS

The study was carried out to evaluate the changes in the eating habits and lipid parameters in a 21-year follow-up on a group of 435 men living in Poland.

METHODS

The studied population was composed of the same subjects: a group of men who were first studied in the years 1987-1989 and in 2008-2010. The following data was gathered: body mass, body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentration in blood serum.

RESULTS

The changes in the eating habits among the studied men registered throughout the 21-year period were positive since they showed a reduction in the caloric content of their diet (p < 0.001), lower total fat content (p < 0.001), total amount of carbohydrates (p < 0.001), sucrose (p < 0.001), iron (p < 0.001), and featured more vitamins: A (p < 0.002), B1 (p < 0.001), and C (p < 0.001). An adverse trend was observed in terms of constant calcium shortages in their food portions (ns). A 21-year follow-up of the studied group showed significant differences in terms of weight (p < 0.001), BMI (p < 0.001), and all cholesterol fractions (p < 0.001) in their blood serum, except cholesterol alone (ns).

CONCLUSION

It is important to continue observing the dietary trends in the studied group, with the focus on the occurrence of potential changes in their bodies.

The effect of omeprazole treatment on the gut microflora and neutrophil function

BACKGROUND AND AIM

Proton pump inhibitors (PPIs) may increase the risk of Clostridium difficile infections. There are interactions between gut microbiota and innate immune cells including neutrophils. We evaluated the effect of treatment with omeprazole on the gut microflora and neutrophil function.

METHODS

In 50 patients, we evaluated the effect of 4-week omeprazole treatment (n=25 with 20mg per day and n=25 with 20mg twice daily) on intragastric pH, results of stool culture and lactulose hydrogen breath test (LHBT) and neutrophil function.

RESULTS

The treatment caused significant increase of the mean intragastric pH, especially in the group with 20mg omeprazole twice daily (from 2.05±0.59 to 5.06±1.6, P<0.001). In LHBT, the increase of hydrogen concentration was observed in higher percentage of patients with 20mg of omeprazole twice daily, compared to patients with the lower dose (42.1% vs 29.4%; ns). Four weeks of omeprazole treatment have caused considerable changes in stool culture results. Patients treated with higher dose of omeprazole have had some tendency to decrease diversity of colonic microflora in comparison with patients treated with the lower dose of omeprazole. Treatment with omeprazole did not result in C. difficile positive stool culture and had no significant effect on neutrophil function.

CONCLUSIONS

Omeprazole treatment have caused considerable changes in stool culture results. Patients treated with the higher dose had some tendency to decreased diversity of colonic microflora and towards changes in fermenting bacteria of the gut. The potential effect of omeprazole on gut microflora does not depend on neutrophil function deterioration.

The effect of short-term oral treatment with omeprazole or pantoprazole on the function of polymorphonuclear neutrophils

Recent studies report an increased risk of enteric infections in patients treated with proton pump inhibitors (PPIs). Polymorphonuclear neutrophils (PMNs) play a key role in host response to bacterial infection. We evaluated the effect of omeprazole and pantoprazole treatment on the PMN function. Fifteen patients were treated with omeprazole 20 mg daily and 15 patients with pantoprazole 40 mg daily for 7 days. Treatment with omeprazole or pantoprazole had no effect on spontaneous nitroblue tetrazolium (NBT) test results. Significant increase in the percentage of phagocytes in the omeprazole group in stimulated NBT test (by 69%) was found. Treatment with omeprazole or pantoprazole had no effect on nitric oxide (NO) concentration in the PMN culture supernatant and serum, cyclic guanosine monophosphate concentration in the PMN culture supernatant and serum, as well as inducible nitric oxide synthase (iNOS) protein expression and p38 mitogen-activated protein kinase activity in PMNs. In conclusion, treatment with PPI has no effect on NO production and p38 mitogen-activated protein kinase activity in PMNs. Interestingly, short-term treatment with omeprazole but not with pantoprazole enhances PMN reactive oxygen species production.

Social costs of loss in productivity-related absenteeism in Poland

OBJECTIVES

The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland.

MATERIAL AND METHODS

Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych - ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added.

RESULTS

Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30-39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium - 1.474 billion euro; respiratory diseases - 0.632 billion euro, injuries and poisonings - 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems.

CONCLUSIONS

Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the workplace are necessary. Policies aimed at reduction of sickness absence could potentially increase prosperity and the socioeconomic situation in Poland. Int J Occup Med Environ Health 2017;30(6):917-932.

Opinions of Old Age According to Residents of Polish Public Nursing Homes and Members of the Universities of the Third Age

BACKGROUND

Statistical data from the turn of the 21st century shows a significant increase in the average human life span and, what follows, an extension of old age.

OBJECTIVES

The aim of this study was to become familiar with the opinions submitted by respondents regarding aging and old age, health problems connected with aging and preferred health behaviors.

MATERIAL AND METHODS

The research was conducted between January 3rd 2013 and February 15th 2014 on a group of 200 residents of public nursing homes and 200 members of the University of the Third Age using a questionnaire created by the authors.

RESULTS

Forty-two point five per cent of the residents of PNHs and 58.0% of the members of UTAs were of the opinion that old age can be a successful period of life. Sixty-one percent of all participants stated that the elderly are needed in society. According to respondents, the factor which was most important in delaying aging was an active lifestyle (80.0% of residents of PNH vs. 90.0% of UTA members).

CONCLUSIONS

Perceptions of elderly people by the seniors are different, complex and multidimensional. The perception of elderly people to society can variously affect (positively or negatively) quality of life in this age group. The results of the study showed small differences between the residents of public nursing homes and students of Universities of the Third Age in the perception of old age. There is a need to integrate seniors with younger generations in order to eliminate the stereotypes prevailing in society about older people.

Inequalities in mortality of infants under one year of age according to foetal causes and maternal age in rural and urban areas in Poland, 2004-2013

INTRODUCTION

European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence.

OBJECTIVE

Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004-2013.

MATERIALS AND METHOD

Data on mortality during the neonatal and infancy period in 2004-2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model.

RESULTS

In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20-34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly.

CONCLUSIONS

The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas.

Self-reported Oral Health Behaviour among Scandinavian and Polish Medical Students Studying in Poland

AIM

The aim of the study was to assess the self-reported oral health behaviour of Scandinavian and Polish medical students studying in Poland.

METHODS

Three hundred and fifty subjects took part in the questionnaire survey. They were the 4th to 6th year Scandinavian and Polish medical students attending the same medical school. Test-retest reliability demonstrated an accepted level of kappa > 0.50. The questionnaire comprised issues dealing with demographics, dental health behaviour, fluoride tablet recommendation, self-rated oral health, and smoking habit. Statistical analyses were performed using the Fisher-Freeman-Halton test, Fisher's exact test and the multiple logistic regression. A p value<0.05 was considered significant.

RESULTS

Gender and nationality statistical differences were observed regarding the frequency of visiting a dentist: more Polish females visited a dentist less than a year ago (p=0.011), the reasons for visiting a dentist - check up, filling (p=0.002; p=0.040); the frequency of tooth brushing was higher among Polish females compared to Polish males and Scandinavian females (p<0.001; p<0.001). Polish males ate sweet snacks significantly more often than Polish females and Scandinavian males (p=0.018; p=0.004). In the logistic regression analysis factors were independently associated with visiting a dentist at least once a year: female gender (OR=2.310; 95% CI 1.381-3.865), Polish nationality (OR=3.833; 95% CI 2.293-6.408). Associations with the female gender were significant for the following dependent variables: visiting a dentist more than a year ago (OR=1.913; 95% CI 1.192-3.070), brushing teeth at least once a day (OR=3.759; 95% CI 1.567-9.017), and use of dental floss (OR=2.249; 95% CI 1.445-3.503). Polish nationality was associated with an increasing rate of brushing teeth for at least 3 minutes (OR=2.435; 95% CI 1.526-3.885), and smoking cigarettes (OR=2.340; 95% CI 1.336-4.098).

CONCLUSIONS

Better prognosis for maintaining good oral health was established in the Scandinavian group of students. Polish females took greater care of their teeth than Polish males and the majority of their Scandinavian counterparts.

Changing 14-year trends in the epidemiology of hepatitis B virus infection in rural and urban Central-Eastern European areas

In Poland, the prevalence of HBV infection constitutes an emerging public health concern. The aim of the study was to analyse changes in hepatitis B incidence rate by age, gender and place of residence in Poland between 1999 and 2012. The data were obtained from Polish state statistics institutions such as the National Institute of Public Health and State Sanitary Inspection. Relationships of hepatitis B incidence with age, gender and rural/urban areas were investigated using χ(2) and tests for two proportions with Bonferroni adjustment. The incidence of hepatitis B in rural and urban populations was compared using Wilcoxon's signed-rank tests. Joinpoint regression was used to analyse trends in hepatitis B incidence rate. In Poland, a total of 26 660 cases of hepatitis B were reported in the studied period and 31.6% of these cases occurred in rural areas. There was significantly declining tendency in the hepatitis B incidence rate in the initial period of the study. However, there were periods of significant increase of HBV incidence rate in women from rural areas aged 15-24 years (9.4%/year) and in women from urban areas aged 15-24 years (10.9%/year) and 25-64 years (3.8%/year) in the final years of the observation. Despite the success in controlling this infection, a significant increase in the incidence of hepatitis B among young women living in rural and urban areas, as well as in adult women in urban areas, has been noted.

Environmental and socio-economic determinants of infant mortality in Poland: an ecological study

BACKGROUND

Health status of infants is related to the general state of health of women of child-bearing age; however, women's occupational environment and socio-economic conditions also seem to play an important role. The aim of the present ecological study was to assess the relationship between occupational environment, industrial pollution, socio-economic status and infant mortality in Poland.

METHODS

Data on infant mortality and environmental and socio-economic characteristics for the 66 sub-regions of Poland for the years 2005-2011 were used in the analysis. Factor analysis was used to extract the most important factors explaining total variance among the 23 studied exposures. Generalized Estimating Equations model was used to evaluate the link between infant mortality and the studied extracted factors.

RESULTS

Marked variation for infant mortality and the characteristics of industrialization was observed among the 66 sub-regions of Poland. Four extracted factors: "poor working environment", "urbanization and employment in the service sector", "industrial pollution", "economic wealth" accounted for 77.3% of cumulative variance between the studied exposures. In the multivariate regression analysis, an increase in factor "poor working environment" of 1 SD was related to an increase in infant mortality of 40 (95% CI: 28-53) per 100,000 live births. Additionally, an increase in factor "industrial pollution" of 1 SD was associated with an increase in infant mortality of 16 (95% CI: 2-30) per 100,000 live births. The factors "urbanization and employment in the service sector" and "economic wealth" were not significantly related to infant mortality.

CONCLUSION

The study findings suggested that, at the population level, infant mortality was associated with an industrial environment. Strategies to improve working conditions and reduce industrial pollution might contribute to a reduction in infant mortality in Poland.

Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland

Background

The Oral Health Impact Profile-14 (OHIP-14) and the Geriatric/General Oral Health Assessment Index (GOHAI) have never been compared for a group of the same subjects in the Polish population. The aim of the study was to compare the OHIP-14 and GOHAI measures.

Methods

178 independently living people over the age of 55 were included in the study. The GOHAI and OHIP-14 measures were used. Other variables included age, gender, self-ratings of oral general health, education, number of missing teeth, chewing problems and dry mouth.

Results

The mean age of respondents was 70.8 years. The internal reliability (Cronbach’s alpha) showed a high internal consistency for both measures. Spearman’s rank correlation coefficient between the GOHAI and OHIP-14 scores was 0.81. Using the additive method of creating scores, 1.1% of respondents had the GOHAI score of zero, indicating no impact from oral conditions, while 13.5% of them had an OHIP-14 score of zero. Dental status, partial dentures, chewing problems, dry mouth and self-rated oral health were significantly associated with the results of the GOHAI and the OHIP-14 (Kruskal–Wallis test, Mann–Whitney U test). The numbers of preserved and missing teeth significantly correlated with the GOHAI and the OHIP-14, while DMF was significantly associated with the GOHAI only. 6 individuals with discrepant results were revealed. After the exclusion of the abovementioned patients, the internal reliability (Cronbach’s alpha) still showed a high internal consistency, and the correlation between the GOHAI and OHIP-14 scores using Spearman’s rank-correlation coefficient increased to 0.87. This phenomenon was identified as a “fatigue effect”.

Conclusions

There was a strong correlation between the GOHAI and the OHIP-14. Both instruments demonstrated good discriminant properties and helped capture the respondents’ oral health problems. The questionnaires should be randomly distributed to avoid the influence of “fatigue effect” on the results of a comparison of different measures.

Determinants of all cause mortality in Poland

AIM

The study objective was to evaluate quantitatively the relationship between demographic characteristics, socio-economic status and medical care resources with all cause mortality in Poland.

MATERIALS AND METHOD

Ecological study was performed using data for the population of 66 subregions of Poland, obtained from the Central Statistical Office of Poland. The information on the determinants of health and all cause mortality covered the period from 1st January 2005 to 31st December 2010. Results for the repeated measures were analyzed using Generalized Estimating Equations GEE model. In the model 16 independent variables describing health determinants were used, including 6 demographic variables, 6 socio-economic variables, 4 medical care variables. The dependent variable, was age standardized all cause mortality rate.

RESULTS

There was a large variation in all cause mortality, demographic features, socio-economic characteristics, and medical care resources by subregion. All cause mortality showed weak associations with demographic features, among which only the increased divorce rate was associated with higher mortality rate. Increased education level, salaries, gross domestic product (GDP) per capita, local government expenditures per capita and the number of non-governmental organizations per 10 thousand population was associated with decrease in all cause mortality. The increase of unemployment rate was related with a decrease of all cause mortality. Beneficial relationship between employment of medical staff and mortality was observed.

CONCLUSIONS

Variation in mortality from all causes in Poland was explained partly by variation in socio-economic determinants and health care resources.

[Selected eating habits and caries occurrence in adolescents]

INTRODUCTION

Normal nutrition is an important element of caries prophylaxis. The aim of the study was to evaluate the influence of chosen bad eating habits on caries occurrence in adolescents.

MATERIAL AND METHODS

The examination was carried out in the group of 367 (68.5% girls and 31.5% boys) pupils of the 3rd year of high schools in Białystok in 2011. Own questionnaire was used for the evaluation of eating habits. Caries intensity (PUW) was assessed by dental examination. To verify statistic hypotheses, the level of significance was estimated at p < 0.05. All calculation was performed with the use of the Statistic programme Statistica 7.0 (StatSoft).

RESULTS

It was stated that 5 meals a day were consumed by 29.4% of examined pupils, 4 meals were eaten by 33.2%, 3 meals--by 31.3%, 2 meals--by 5.4%, and one meal was consumed by 0.5% of pupils. There were 55.3% of pupils who had irregular meals while 24.3% did not eat breakfast and 62.9%--did not have elevenses. Eating between meals was stated in 96.7% of pupils. Sweets consumption was revealed as follows: 16.8% several times a day, 19%--once a day, 40.5%--several times a week, 18.5%--several times a month, 5.2%--rarely or never. "Fast food" was not consumed by 34% of examined pupils while 54.6% consumed such meals several times a month, 10.9%--several times a week, and 0.5%--once a day. Higher level of caries intensity was observed in girls (mean coefficient PUW = 11.3) than in boys (mean coefficient PUW = 10.8). Mean coefficient PUW = 11.5 concerned pupils with consumption of fast food several times a month while PUW = 11.0 in those who consumed it several times a week, and PUW = 10.7 in pupils who eat rarely or never such food. As far as eating sweets, PUW was higher than mean (12.4) in pupils who eat sweets several times a day. Persons who eat between meals were characterized by higher coefficient (PUW = 13.0) as compared to those who eat between meals rarely (PUW = 11.3) and those who do not eat between meals (PUW = 8.9).

CONCLUSIONS

(1) Bad eating habits (irregular meals, skipping breakfast, eating between meals as well as overeating sweets) in the developmental age can be a significant caries coefficient in adolescents. 2. High mean coefficient PUW in the examined group of 18-year-old pupils, in relation to abnormal eating habits in the significant percentage of those pupils, indicates the necessity of health education as far as caries prophylaxis is concerned.

[Prognosis of the IVF ICSI/ET procedure efficiency with the use of artificial neural networks among patients of the Department of Reproduction and Gynecological Endocrinology]

OBJECTIVES

Prognosis of pregnancy for patients treated with IVF ICSI/ET methods, using artificial neural networks.

MATERIAL AND METHODS

Retrospective study of 1007 cycles of infertility treatment of 899 patients of Department of Reproduction and Gynecological Endocrinology in Bialystok. The subjects were treated with IVF ICSI/ET method from August 2005 to September 2008.

RESULTS

Classifying artificial neural network is described in the paper Architecture of the network is three-layered perceptron consisting of 45 neurons in the input layer 14 neurons in the hidden layer and a single output neuron. The source data for the network are 36 variables. 24 of them are nominal variables and the rest are quantitative variables. Among non-pregnancy cases only 59 prognosis of the network were incorrect. The results of treatment were correctly forecast in 68.5% of cases. The pregnancy was accurately confirmed in 49.1% of cases and lack of pregnancy in 86.5% of cases.

CONCLUSIONS

Treatment of infertility with the use of in vitro fertilization methods continues to have too low efficiency per one treatment cycle. To improve this indicator it is necessary to find dependencies, which describe the model of IVF treatment. The application of advanced methods of bioinformatics allows to predict the result of the treatment more effectively With the help of artificial neural networks, we are able to forecast the failure of the treatment using IFV ICSI/ET procedure with almost 90% probability of certainty These possibilities can be used to predict negative cases.

[Comparison of test with antigen VlsE (C6) with tests with recombinant antigens in patients with Lyme borreliosis]

In diagnosis of Lyme borreliosis classic, recombinant antigens are used. Introduced recombinant antigen VlsE increases hope to improve sensibility of the tests.

AIM OF THE STUDY

Serological results detecting antibodies against Borrelia burgdorferi, recombinant antigens in both classes and test with VlsE were compared.

MATERIAL AND METHODS

Quick ELISA C6 Borrelia Assay Kit (U.S.A.) for both classes simultaneusly were compared with two tests composed of recombinant antigens Borrelia IgG recombinant, Borrelia IgM recombinant (Biomedica, Austria)separate for IgM i IgG antibodies. Patients with borreliosis as eryhtema migrans were evaluated (n=36) and group with chronic Lyme arthritis (n=68).

RESULTS

Statistical coincidence between results of test ELISA C6 and presence of antibodies IgM (p < 0.0001) and IgG (p < 0.0001) obtained in tests based on recombinant antigens in group erytema migrans. In group Lyme arthritis coincidence (p < 0.0002), with IgM antibodies was stated.

CONCLUSIONS

Test ELISA C6 (with protein VlsE-C6) in group of patients with Lyme borreliosis had statistically essential predictive values of presence antibodies in IgM i IgG class, stated in tests performed separately for IgM and IgG classes with recombinant antigens. Tests based on conservative part of protein VlsE (C6), detecting antibodies in both classes are very promising in diagnosis of early stages Lyme borreliosis.

[Concentrations of soluble forms of adhesive particles: sVCAM-1, sPECAM-1, sVAP in early localized and late disseminated borreliosis]

OBJECTIVE

Serum concentration of sVCAM-1, sPECAM- i sVAP in Lyme borreliosis patients with early localized-erythema migrans (EM) and disseminated Lyme arthritis (LA), before and after treatment were estimated.

MATERIAL AND METHODS

Twenty subjects with EM, and 20 persons with LA were enrolled to examinations. Control group consisted of 10 healthy blood donors. Concentrations of sVCAM-1, sPECAM- and sVAP were performed with ELISA kits (Bender Med. System) Statistic analysis were performer with ANSTAT i Statistica PI, programs as well ROC curves.

RESULTS

In group of early localized Lyme borreliosis essentially increase of serum concentrations of sVCAM and sPECAM were stated, in late, disseminated (LA), essentially increase of sVAP concentration was stated.

CONCLUSION

Measurement of serum concentrations of soluble forms some adhesion molecules In liquid compartments can be a potential marker of disease activity, and differentiation among Early localized and late disseminated stages of Lyme borreliosis.

Comparative analysis of the effect of preparations used in professional fluoride prophylaxis on the chosen parameters of human saliva

Regular supply of fluoride ions to the oral environment is one of the prophylactic actions against dental caries. Fluorides, whose exogenous action combines with saliva properties, condition the anticariogenic effect. Fluoride ions exhibit high chemical activity, can alter the oral environment parameters and inhibit the activity of enzymes.

PURPOSE

In the current study, the effect of fluoride preparations used in professional caries prophylaxis on chosen saliva parameters was studied. The levels of pH and fluoride ions, and the activity of cathepsin D in human saliva were determined.

MATERIAL AND METHODS

Material for analysis contained resting mixed saliva collected before and 1, 4 and 24 hours after the application of Duraphat, Elmex Gel, Fluor Protector, Fluormex Gel and Fluoro-Gel.

RESULTS

The fluoride-containing preparations inhibited the activity of cathepsin D in the way depending on the time that had passed since the application and altered the pH level of human saliva.

Overweight and obesity and their determinants among men from Podlasie region in the years 1987-1998

The goal of the study was to determine the frequencies of occurrence of obesity and overweight among men from Podlasie region of Poland, as well as nutritional and environmental factors related to these conditions. During 9-year period (1987-1998), dietary habit of each of 556 men was evaluated three times using 24-hour consumption questionnaire. At the same time body mass index (BMI) was also calculated. BMI increased significantly from 26.2 kg/m2 to 27.6 kg/m2 during discussed period, while percentage of overweight grew up from 62.7% to 73.2% and percentage of obesity rose from 14.5% to 22.5%. Executed multiple regression analysis revealed a variety of predictors of obesity and overweight. Among nutritional factors, the increase of energy and carbohydrates (especially saccharose) in diet were the reasons of increasing BMI. Considering psychological, sociological and economical features, multi-shift work provoked increase of BMI, while decrease of BMI was induced by smoking. Observed increase of spread of overweight and obesity among men, had its nutritional and environmental reasons.

Effect of fluoride preparations on the activity of human salivary cathepsin C

Preparations containing organic and inorganic fluorine compounds are used for oral hygiene. Fluoride ions contained in these preparations display high bioactivity and can alter the environment of the mouth. The aim of the study was to determine the effect of preparations containing aminofluorides, commonly used in oral hygiene, on the activity of salivary cathepsin C (EC 3.4.14.1). The research material included mixed saliva, collected at rest before and after the application of the following preparations: Elmex gelee, Elmex red fluid, Elmex green fluid, Fluormex rinse. The salivary pH, concentration of fluoride ions and activity of cathepsin C were determined. Fluoride preparations inhibit the activity of cathepsin C and cause changes in human salivary pH. Saliva can serve as a diagnostic material in the examination of the environmental exposure to fluorides.

Dietary habits of men from Podlasie region of Poland in the years 1987-1998 analysed with self-organizing neural networks

The study was conducted on a group of 556 men. Their dietary habits were evaluated 3 times in the years 1987-1998 by the frequency of consumption of 41 food items during last three months. Obtained frequencies were processed by self-organizing Kohonen neural network, allowing to group persons of similar dietary habits into 3 clusters. After analysing frequencies of consumption of each food item in each cluster, in view of health value, one model was described as appropriate, while remaining were described as two different inappropriate models. In three studies during 11 years, statistically significant increase in frequency of appropriate model was observed. That increase was linked with decrease of occurrence of inappropriate models. Additional verification of described models revealed significant differences between them in nutritive ingredients intake, and also in concentrations of HDL cholesterol in the blood serum of men assigned to those dietary patterns.