Proton Shell Gaps in N=28 Nuclei from the First Complete Spectroscopy Study with FRIB Decay Station Initiator

The first complete measurement of the β-decay strength distribution of _{17}^{45}Cl_{28} was performed at the Facility for Rare Isotope Beams (FRIB) with the FRIB Decay Station Initiator during the second FRIB experiment. The measurement involved the detection of neutrons and γ rays in two focal planes of the FRIB Decay Station Initiator in a single experiment for the first time. This enabled an analytical consistency in extracting the β-decay strength distribution over the large range of excitation energies, including neutron unbound states. We observe a rapid increase in the β-decay strength distribution above the neutron separation energy in _{18}^{45}Ar_{27}. This was interpreted to be caused by the transitioning of neutrons into protons excited across the Z=20 shell gap. The SDPF-MU interaction with reduced shell gap best reproduced the data. The measurement demonstrates a new approach that is sensitive to the proton shell gap in neutron rich nuclei according to SDPF-MU calculations.

Rare ^{40}K Decay with Implications for Fundamental Physics and Geochronology

Potassium-40 is a widespread, naturally occurring isotope whose radioactivity impacts subatomic rare-event searches, nuclear structure theory, and estimated geological ages. A predicted electron-capture decay directly to the ground state of argon-40 has never been observed. The KDK (potassium decay) collaboration reports strong evidence of this rare decay mode. A blinded analysis reveals a nonzero ratio of intensities of ground-state electron-captures (I_{EC^{0}}) over excited-state ones (I_{EC^{*}}) of I_{EC^{0}}/I_{EC^{*}}=0.0095±[over stat]0.0022±[over sys]0.0010 (68% C.L.), with the null hypothesis rejected at 4σ. In terms of branching ratio, this signal yields I_{EC^{0}}=0.098%±[over stat]0.023%±[over sys]0.010%, roughly half of the commonly used prediction, with consequences for various fields [27L. Hariasz et al., companion paper, Phys. Rev. C 108, 014327 (2023)PRVCAN2469-998510.1103/PhysRevC.108.014327].

S02-2 Socioeconomic determinants of physical activity, sleep and screen time among children aged 6-9 years of age in Europe

Background

Physical activity is key for preventing obesity and development of noncommunicable diseases later in life. Previous research suggests that socioeconomic factors, such as parental education or income, may influence a child’s risk of obesity. However, previous research on this has provided heterogeneity in results. Our aim was to investigate the socioeconomic disparities between physical activity, sedentary behaviour and sleep patterns in school-aged children aged 6 to 9 years in 24 European countries, using a large nationally-representative sample of children from 24 countries (Albania, Bulgaria, Croatia, Czechia, Denmark, France, Georgia, Ireland, Italy, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Malta, Montenegro, Poland, Portugal, Romania, Russian Federation – only Moscow, San Marino Republic, Spain, Tajikistan, Türkiye and Turkmenistan).

Methods

COSI collected information on physical activity patterns of children, sedentary behaviour and sleep duration through a questionnaire filled by parents. Among these, the paper focused on the following behaviours: Transportation to and from schools, Time spent on practising sports, Time spent on actively/vigorously playing, Time spent watching TV or using electronic devices and Hours of sleep per night. For the paper purpose, countries were grouped in 4 macro-regions according to United Nations “Standard Country or Area Codes for Statistical Use”.

Results

Findings indicated that a high prevalence of motorized school transport among children of employed parents in Southern Europe. The highest prevalence of insufficient sports and active play was among families from West-Central Asia who meet the end of the month with troubles, the highest prevalence of excessive screen time is among families from Eastern Europe, where both parents have a low level of education and the highest prevalence of insufficient sleep is among families from West-Central Asia where both parents have a high level of education.

Conclusions

There are important differences in the socioeconomic determinants of PA, sleep and screen related behaviours both between countries and sub-regions across the WHO European Region. This analysis of results from the COSI survey provides important insights that can help guide policy makers to take action to address the childhood obesity epidemic.

Gestational weight gain and blood pressure control in physiological pregnancy and pregnancy complicated by hypertension

BACKGROUND

Obesity is a widely recognised risk factor for chronic and gestational hypertension. Influence of gestational weight gain on blood pressure control throughout the pregnancy is not well characterised.

MATERIAL AND METHODS

Women in the third trimester of a singleton pregnancy were recruited to the study. Medical records were analysed and a special survey was conducted to obtain history on hypertensive disorders in pregnancy and weight changes during pregnancy. Blood pressure measurements were taken during the office visit in line with international guidelines. Relationships between gestational weight gain and maximal and office values of systolic and diastolic blood pressure values were analysed.

RESULTS

Data of 90 women in normal pregnancy, 40 with gestational hypertension and 21 with chronic hypertension were analysed. Gestational weight gain was 11.9 ± 4.6 kg in the normal pregnancy group, 13.0 ± 5 kg in the gestational hypertension group and 10.6 ± 3.4 kg in the chronic hypertension group. Gestational weight gain positively correlated with both office (r = 0.48; p < 0.001) and maximal blood pressure values (r = 0.34; p = 0.004) in normal pregnancy and with maximal blood pressure values (r = 0.57; p = 0.02) in women with chronic hypertension. No correlation was observed between gestational weight gain and blood pressure values among women with gestational hypertension.

CONCLUSION

In normal pregnancy and in women with chronic hypertension greater gestational weight gain is related to higher blood pressure values in the third trimester.

Everyday challenges faced by Polish teenagers during the COVID-19 pandemic in the context of selected demographic factors

BACKGROUND

The enforced restrictions, including physical isolation and school lockdowns after the outbreak of the COVID-19 pandemic, have brought about anxiety and uncertainty the younger generation.

OBJECTIVE

The main objective is to analyse the everyday challenges faced by adolescents in Poland during the time of social isolation in the COVID-19 pandemic.

MATERIAL AND METHODS

A nationwide, online survey of adolescents aged 11-18 (N=2408) was conducted in April 2020. Quantitative and qualitative analyses were undertaken. Differences in the everyday challenges experienced during the COVID-19 pandemic connected with gender, age and place of residence were analysed.

RESULTS

Girls were significantly more likely than boys to perceive the limitations in contacts with others (friends and family) and the concerns about the health of relatives as a big difficulty. Among the youngest students (11-12 years of age), the lack of contact with friends and family and worries about their health and the fear of infection ranked higher than for other students. For the oldest (17-18) the lack of private time and space and not being able to meet one's boyfriend/ girlfriend were the most troublesome. The necessity to stay at home and the inconvenience resulting from the lack of outdoor exercise were ranked higher by urban students than by students living in rural areas.

CONCLUSIONS

When planning campaigns in the near future to support the mental health of adolescents in the context of the pandemic it is recommended to include especially the youngest adolescents and those living in small and medium-sized cities.

Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017

INTRODUCTION

Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions.

METHODS

We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1.

RESULTS

Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries.

DISCUSSION/CONCLUSION

Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.

Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI)

Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI) has resulted in a surveillance system which provides regular, reliable, timely, and accurate data on children's weight status-through standardized measurement of bodyweight and height-in the WHO European Region. Additional data on dietary intake, physical activity, sedentary behavior, family background, and school environments are collected in several countries. In total, 45 countries in the European Region have participated in COSI. The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI, data are collected according to a common protocol, using standardized instruments and procedures. The systematic collection and analysis of these data enables intercountry comparisons and reveals differences in the prevalence of childhood thinness, overweight, normal weight, and obesity between and within populations. Furthermore, it facilitates investigation of the relationship between overweight, obesity, and potential risk or protective factors and improves the understanding of the development of overweight and obesity in European primary-school children in order to support appropriate and effective policy responses.

Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region

Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.

Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017

In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.

Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6-9-year-old children from 19 countries from the WHO European region

In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6-9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30-80% and 30-90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1-2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.

Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)

BACKGROUND

Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits.

METHODS

The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status.

RESULTS

Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet.

CONCLUSION

Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.

Insight into the Key Points of Preeclampsia Pathophysiology: Uterine Artery Remodeling and the Role of MicroRNAs

Preeclampsia affects about 3-8% of all pregnancies. It represents a complex and multifaceted syndrome with at least several potential pathways leading to the development of disease. The main dogma in preeclampsia is the two-stage model of disease. Stage 1 (placental stage) takes place in early pregnancy and is thought to be impaired placentation due to inadequate trophoblastic invasion of the maternal spiral arteries that leads to reduced placental perfusion and release of numerous biological factors causing endothelial damage and development of acute maternal syndrome with systemic multiorgan failure (stage 2-the onset of maternal clinical symptoms, maternal stage). Recently, in the light of the vast body of evidence, two-stage model of preeclampsia has been updated with a few novel pathways leading to clinical manifestation in the second part of pregnancy. This paper reviews current state of knowledge about pathophysiology of preeclampsia and places particular focus on the recent advances in understanding of uterine artery remodeling alterations, as well as the role of microRNAs in preeclampsia.

Demographic analysis of difficulties related to remote education in Poland from the perspective of adolescents during the COVID-19 pandemic

INTRODUCTION AND OBJECTIVE

Due to the COVID-19 pandemic all schools in Poland were closed and obliged to conduct lessons remotely. The aim of the study is to present the demographic analysis of difficulties with remote learning, as perceived by students during coronavirus pandemic in Poland.

MATERIAL AND METHODS

In April 2020, a nationwide online survey was conducted among adolescents aged 11-18 (N=2408). Quantitative and qualitative data were used. Teenagers were asked about the problems connected with remote learning. In order to examine the overall level of remote learning difficulties, a scale of remote learning difficulties (RLD) was devised (range 0-23 points). Differences connected with gender, age and place of residence were analysed.

RESULTS

More than a half of the teenagers surveyed rated the increased demands from teachers as a major problem. This answer appeared statistically more often among girls than boys (59.6% v. 53.2%). Almost every third adolescent saw the lack of consultation (31.6%) as a significant problem. Difficulties related to learning in the remote system were most often described as considerable by the oldest students (17-18-years-old) and those living in rural areas. The big problem for them was usually much higher requirements of teachers and poor organization of distance learning. The mean level on the scale of remote learning burden was M=11.9 (SD=7.1). Technical difficulties and insufficient skills in using software constituted additional problems most frequently mentioned by students.

CONCLUSIONS

There is a need to pay particular attention to organizing appropriate technical conditions for remote learning, especially in rural areas, where students have complained more often than in cities about equipment and problems with access to the Internet during the pandemic.

The potential association between a new angiogenic marker fractalkine and a placental vascularization in preeclampsia

Purpose

Impaired angiogenesis is one of the most common findings in preeclamptic placentas. A new angiogenetic role of fractalkine (CX3CL1) is recently recognized apart from inflammatory activity. In this study, a link between CX3CL1 and the development of placental vasculature in preeclampsia was examined.

Methods

The study comprised 52 women allocated to Group 1 (normotensive, n = 23) and Group 2 (preeclampsia, n = 29). In each group Doppler parameters, serum levels of CX3CL1, soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF) were assessed between 30 and 32 week of pregnancy. After the delivery, placental samples were taken and the vascularization and expression of CX3CR1 receptor were assessed after immunostaining.

Results

CX3CL1 and sFlt-1 serum levels were significantly higher levels in Group 2 vs Group 1, while PlGF serum levels was significantly lower in Group 2. Lower cerebroplacental ratio (CPR) was observed in Group 2. The vascular/extravascular tissue index (V/EVTI) was significantly lower in Group 2, while compared to Group 1, with the lowest value in the fetus growth restriction (FGR) subgroup (0.18 ± 0.02; 0.24 ± 0.03; 0.16 ± 0.02, respectively). The expression of examined CX3CR1 was higher in Group 2, while compared to Group 1, reaching the highest values in FGR subgroup. There was a moderate negative correlation between birth weight, V/EVTI and CX3CL1 serum level and CX3CR1 placental expression in the group of pregnancies complicated with preeclampsia.

Conclusion

The significant underdevelopment of placental vascular network in preeclampsia is associated with the change in the CX3CL1/CX3CR1 system, especially in FGR complicated pregnancies.

Nutrition and physical activity environments in primary schools in Poland - COSI study

INTRODUCTION

Schools are important settings for the promotion of healthy diet and sufficient physical activity to prevent civilisation diseases related to lifestyle.

OBJECTIVE

To describe school physical activity and nutrition environment in elementary schools in Poland, and to asses differences in school physical activity and nutrition environments, depending on school location and size.

MATERIAL AND METHODS

Data was used from the World Health Organisation European Childhood Obesity Surveillance Initiative (COSI) conducted in 2016 in 135 Polish schools. Logistic regression was used to asses association between the location and individual school environment indicator. On the basis of answers to 20 questions about school physical activity and nutrition environment, a positive school environmental assessment index was compiled.

RESULTS

Large, urban schools were characterised by a significantly greater availability of sweet snacks, whereas flavoured milk with added sugar was more often available in small and rural schools. The univariate logistics analysis parameters showed that an urban-rural location had a significant association for the availability of an indoor gym and existence of a canteen and a shop. Analysing the positive schools environmental assessment index, there were no statistically significant differences in mean values due to location, but statistically significant differences were found depending on the school size, with the highest level in large schools and the lowest in small schools.

CONCLUSIONS

The factor which adversely differentiates the school environment in terms of healthy nutrition and physical activity is primarily the school size, and then the school location. Systemic and social solutions should aim at reducing the small school "exclusion syndrome", both in rural and in urban areas, also with regard to infrastructure and availability of conditions conducive to healthy nutrition and physical activity.

Downregulated expression of microRNAs associated with cardiac hypertrophy and fibrosis in physiological pregnancy and the association with echocardiographically-evaluated myocardial function

The aim of the present study was to analyze the profiles of cardiac microRNAs (miRNAs/miRs) in healthy pregnant women and non-pregnant controls. A total of 61 healthy women >18 years of age with singleton pregnancies in the third trimester were compared with 19 non-pregnant controls. Specifically, expression of miRNAs associated with cardiac hypertrophy (miR-1, miR-17-5, miR-22, miR-34a, miR-124, miR-133a, miR-195, miR-199a-3p, miR-199b, miR-210, miR-222 and miR-1249) and miRNAs associated with cardiac hypertrophy and fibrosis (miR-15b, miR-21, miR-26a, miR-29-a, miR-29c, miR-30c, miR-101, miR-146a, miR-191, miR-208a-5p and miR-328) were analyzed and compared with echocardiographic examination results. Both groups had similar cardiac miRNA expression profiles, but differed in quantitative evaluation. Women in the third trimester of physiological pregnancy exhibited downregulation of certain profibrotic miRNAs (miR-21, miR-30c and miR-328), decreased expression of a hypertrophic and antimetabolic miRNAs (miR-146a), downregulation of an antifibrotic miRNA (miR-222), and downregulation of a hypertrophic miRNA (miR-195). In pregnant women, the indices of systolic function were associated with miR-195 expression, and an interplay between miR-17-5p and diastolic function was observed. While the profiles of cardiac miRNAs expressed in healthy pregnant women and healthy non-pregnant controls were similar, these two groups differed in terms of expression of specific miRNAs. In the third trimester of physiological pregnancy, a downregulation of miR-17-5p, miR-21, miR-30c, miR-146a, miR-195, miR-222 and miR-328 was observed. The differences in the association between echocardiographic indices with miRNAs in pregnant and non-pregnant women suggest that miRNAs regulate both the structure and function of the pregnant heart, influencing cardiac muscle thickness as well as systolic and diastolic function.

A Snapshot of European Children's Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI)

Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.

Childhood Obesity Surveillance Initiative (COSI) in Poland: Implementation of Two Rounds of the Study in the Context of International Methodological Assumptions

Nowadays, childhood obesity is one of the key health problems in European countries. This article presents a study that is part of the World Health Organization (WHO) Childhood Obesity Surveillance Initiative (COSI) implemented in the WHO European Region since 2007. The main goal of the study is to monitor obesity in early school-aged children. The methodology of the study, the thematic scope of research tools, the organisational principles and the development of research carried out in Poland in the context of existing international assumptions are presented. In Poland, two rounds of the study were financed by the National Health Program, in cooperation with the WHO Office in Poland. The first study was carried out from November to December 2016 on a group of 3,408 children aged 8 years from 135 schools and 2,298 parents, in 9 voivodeships in Poland. The second round was carried out in the last quarter of 2018 in 12 voivodeships. A group of 2691 pupils aged 8 years from the 2nd grade of 140 primary schools in Poland and 2450 parents were examined. Data on body mass index distribution and lifestyle-related behaviours of children and their families were collected. Poland is the first country where blood pressure was measured in all participants of the COSI study. Considering the growing obesity epidemic, reliable monitoring of overweight and obesity in early childhood and the study of determinants of this phenomenon should be a priority for public health. The results obtained from this type of research are a reference point for the design and implementation of accurate prevention initiatives in this age group.

Changes in physical activity of adolescent girls in the context of their perception of the Healthy Me programme

BACKGROUND

An assumption was made that results of programme evaluation lead to better understanding for whom this intervention may work. The aim of the article is to compare the changes in physical activity of the intervention programme participants depending on subjective assessment of its impact.

METHODS

The data were obtained from 14- to15-year-old Polish girls (N = 1120) from 48 random selected secondary schools participating in the 1-year Healthy Me programme in the 2017/2018. Schools were randomly assigned to one of two types of intervention or to a control (null) group. Satisfaction with the programme according to 21 criteria was measured retrospectively just after the intervention. Change in MVPA (moderate-to-vigorous physical activity) during the programme implementation was assessed in relation to satisfaction level, and adjusted for initial MVPA.

RESULTS

In total, the MVPA did not change significantly comparing pre- and post-intervention surveys (3.94 ± 1.94 vs. 3.87 ± 1.93)-P = 0.093. However, the perceived notable improvement of functioning in 10 out of 21 areas was related to the unquestionable increase in MVPA (P ≤ 0.001). With respect to the four impact areas, an interaction was demonstrated between an intervention group and an improvement in the domain-specific functioning. The beneficial impact of the programme on these areas was associated with the improvement of physical activity only in case of full and null intervention.

CONCLUSIONS

Indicators related to the implementation process and the results obtained during the Healthy Me programme evaluation could represent a change in motivational and environmental factors that indirectly affects adolescent girl's physical activity.

Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study

Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.

Behavioural factors as predictors of self-rated health among polish adolescent girls

OBJECTIVE

Introduction: Self-rated health (SRH), an indicator which is extensively used in population studies, constitutes a measure of health closely linked to morbidity, mortality and overall health status and enjoys popularity in surveys monitoring adolescents. Most studies show that at puberty girls assess their health as worse than boys do, and the difference widens with age. Moreover, puberty is a crucial period for health, since it is the time when health risk behaviours are often initiated or become established. Aim: To analyse the associations between high scores on self-rated health among 15-year-old girls, participants of the Healthy Me programme, and their selected health behaviours.

PATIENTS AND METHODS

Material and methods: The study covered a group of 1173 second-grade female students from 48 lower secondary schools located in rural and urban areas of 16 voivodeships all over Poland. The participants answered questions about chronic diseases or disability, self-rated health, diet, leisure activities, physical activity and health risk behaviours. In the statistical analysis, the association between self-rated health and individual indicators of health behaviour was examined using logistic regression.

RESULTS

Results: Two thirds of the girls assessed their health as excellent or good. Only approximately 5% of the respondents made the "extreme negative" assessment. In the final multivariate analysis, five factors remained important predictors of high self-rated health scores: regular participation in physical education classes, vigorous physical activity, daily breakfast consumption, consumption of fruit at least once a day and sleep for at least 8 hours a day.

CONCLUSION

Conclusions: Regular participation in physical education classes, vigorous physical activity, consumption of breakfast and fruit every day, as well as sleep for at least 8 hours a day are powerful predictors of high scores on self-rated health of 15-year-old adolescent girls. Public health activities aimed at adolescents should focus on the positive aspects of health and a lifestyle paying special attention on pro health behaviours.

Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity-WHO European Childhood Obesity Surveillance Initiative (COSI 2015⁻2017)

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.

Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017

BACKGROUND

In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity.

OBJECTIVES

It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children.

METHOD

Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed.

RESULTS

The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies.

CONCLUSION

The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.

Rise in antifibrotic and decrease in profibrotic microRNA protect the heart against fibrosis during pregnancy: A preliminary study

BACKGROUND

Physiological pregnancy is associated with volume overload. Unlike cardiac pathologies linked with volume overload, such as mitral or aortic regurgitation, pregnancy is thought to be unrelated to fibrosis of the heart. However, changes in the cardiac extracellular matrix during pregnancy remain poorly understood.

OBJECTIVES

The aim of the study was to examine the expression of 11 microRNAs associated with cardiac fibrosis (miR-21, miR-26a, miR-26b-5p, miR-29b-3p, miR-29c-3p, miR-101a, miR-146a, miR-208a, miR-223 and miR-328) during pregnancy and to compare them with a healthy control group.

MATERIAL AND METHODS

Six women in singleton pregnancy (30-36 weeks) and 6 non-pregnant women as a control group were included in the study. Each woman underwent an echocardiographic examination, and had blood pressure on both arms measured and a blood sample taken. MicroRNAs expression was analyzed using Custom TaqMan® Array MicroRNA Cards (Applied Biosystems, Foster City, USA).

RESULTS

Median age of the pregnant women was 34 years (range 25-39 years) and of the control group 32 years (range 29-43 years). Median week of pregnancy was 34 years (range 31-36 years). Most of the examined microRNAs had a lower expression in the pregnancy group (fold change 1.0).

CONCLUSIONS

In the 3rd trimester of physiological pregnancy, there is a 244% increase in expression of miR-101a and a decrease by 73% in expression of miR-328. Both of these changes can protect against fibrosis during volume overload occurring in physiological pregnancy.

Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data

INTRODUCTION

Pulmonary embolism (PE) is a leading cause of mortality in pregnancy and a great diagnostic challenge. Deviations from the recommended diagnostic pathway in suspected PE contribute to greater mortality in the general population. The deviations from the guidelines of the European Society of Cardiology (ESC) for diagnosis of PE were analyzed, with particular emphasis on pregnant women with suspected PE.

MATERIAL AND METHODS

ZATPOL is a prospective national registry including data of all patients with suspected PE admitted to 86 Polish cardiology departments between January 2007 and September 2008. We analyzed diagnostic pathways used in all 2015 patients (mean age: 67 ±15 years, 60% women) with suspected PE. Detailed analysis included diagnostic pathways used in 12 pregnant patients and 85 non-pregnant women in childbearing age.

RESULTS

Pregnancy was the strongest predictor of deviations from the recommended diagnostic pathway in the whole study group (HR = 4.0, 95% CI: 1.28-12.5, p = 0.02). Pregnant patients did not differ significantly from non-pregnant women in most risk factors and symptoms of PE, and diagnostic tests used in this condition. Deviations from the recommended diagnostic pathway were found in 7 (58%) and 36 (42%) pregnant and non-pregnant women, respectively (p = 0.297), and the preliminary diagnosis of PE was eventually confirmed in 42% and 67% of the patients, respectively (p = 0.086).

CONCLUSIONS

Despite the lack of significant differences in PE symptomatology in pregnant and non-pregnant women, pregnancy seems to be the strongest predictor of deviations from the diagnostic pathway recommended in PE by the ESC. Further studies are required to evaluate the adherence to current guidelines in pregnant women.

Impact of Modular Total Absorption Spectrometer measurements of β decay of fission products on the decay heat and reactor ν[over ¯]_{e} flux calculation

We report the results of a β-decay study of fission products ^{86}Br, ^{89}Kr, ^{89}Rb, ^{90gs}Rb, ^{90m}Rb, ^{90}Kr, ^{92}Rb, ^{139}Xe, and ^{142}Cs performed with the Modular Total Absorption Spectrometer (MTAS) and on-line mass-separated ion beams. These radioactivities were assessed by the Nuclear Energy Agency as having high priority for decay heat analysis during a nuclear fuel cycle. We observe a substantial increase in β feeding to high excited states in all daughter isotopes in comparison to earlier data. This increases the average γ-ray energy emitted by the decay of fission fragments during the first 10 000 s after fission of ^{235}U and ^{239}Pu by approximately 2% and 1%, respectively, improving agreement between results of calculations and direct observations. New MTAS results reduce the reference reactor ν[over ¯]_{e} flux used to analyze reactor ν[over ¯]_{e} interaction with detector matter. The reduction determined by the ab initio method for the four nuclear fuel components, ^{235}U, ^{238}U, ^{239}Pu, and ^{241}Pu, amounts to 0.976, 0.986, 0.983, and 0.984, respectively.

Low DLCO in idiopathic pulmonary arterial hypertension - clinical correlates and prognostic significance

INTRODUCTION

Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients.

MATERIAL AND METHODS

In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value.

RESULTS

Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective.

CONCLUSIONS

Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.

The value of the new scoring system for predicting neoplastic pericarditis in the patients with large pericardial effusion

PURPOSE

Early recognition of neoplastic pericarditis (npe) is crucial for the planning of subsequent therapy. The aim of the present study was to construct the scoring system assessing the probability of npe, in the patients requiring pericardial fluid (pf) drainage due to large pericardial effusion.

METHODS

One hundred forty-six patients, 74 males and 72 females, entered the study. Npe based on positive pf cytology and/or pericardial biopsy specimen was recognised in 66 patients, non-npe in 80. Original scoring system was constructed based on parameters with the highest diagnostic value: mediastinal lymphadenopathy on chest CT scan, increased concentration of tumour markers (cytokeratin 19 fragments-Cyfra 21-1 and carcinoembryonic antigen-CEA) in pf, bloody character of pf, signs of imminent cardiac tamponade on echocardiography and tachycardia exceeding 90 beats/min on ECG. Each parameter was scored with positive or negative points depending on the positive and negative predictive values (PPV, NPV).

RESULTS

The area under curve (AUC) for the scoring system was 0.926 (95%CI 0.852-0.963) and it was higher than AUC for Cyfra 21-1 0.789 (95%CI 0.684-0.893) or CEA 0.758 (95%CI 0.652-0.864). The score optimally discriminating between npe and non-npe was 0 points (sensitivity 0.84, specificity 0.91, PPV 0.9, NPV 0.85).

CONCLUSION

Despite chest CT and tumour marker evaluation in pericardial fluid were good discriminators between npe and non-npe, the applied scoring system further improved the predicting of neoplastic disease in the studied population.

Maternal serum vitamin D and parathormone concentrations during gestation and in umbilical cord blood - pilot study

OBJECTIVE

We wanted to define levels of vitamin D (25(OH)D), parathormone (PTH), calcium (Ca), phosphorus (P) and the correlations between them during gestation as well as in umbilical cord blood.

METHODS

The study included 37 healthy singleton pregnant women in the course of gestation with no medical history concerning systemic diseases, nor with negative obstetrics and gynecological history. Biochemical parameters were determined using commercially available kits.

RESULTS

In the studied group, there were no significant differences in serum vitamin D, PTH, Ca and P concentrations in each trimester and during delivery. The negative significant association between serum 25(OH)D and PTH level was observed (r=-0.25; p< 0.05). Vitamin D levels during the summer season were significantly higher than observed in winter time in I (p< 0.01) and II trimester (p< 0.05), but not in III trimester. There was positive correlation between maternal serum and cord blood 25(OH)D (r= 0.74; p < 0.01). It was noted that 38-48% mothers had severe deficiency of vitamin D.

CONCLUSION

The study showed that regardless of the supplementation only 11-21% of studied pregnant women had optimal levels of vitamin D. The association between maternal and cord blood 25(OH)D suggested that inadequate vitamin D stores- during pregnancy may lead to a deficiency of this vitamin in newborns.

Non-tuberculous mycobacterial lung disease (NT MLD ) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension

INTRODUCTION

Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH).

MATERIAL AND METHODS

Thirteen patients (10 - CTEPH, 3 - IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007).

RESULTS

M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted.

CONCLUSIONS

NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.

Guzki środkowej części zrazika w tomografii komputerowej płuc o wysokiej rozdzielczości u chorych na IPAH—Wstępne korelacje kliniczno-radiologiczne

Wstęp: Zmiany miąższowe w tomografii komputerowej płuc o wysokiej rozdzielczości (TKWR) obserwowane są u niektórych chorych na idiopatyczne tętnicze nadciśnienie płucne (IPAH), pomimo że nie mają oni śródmiąższowej choroby płuc. Najczęściej opisuje się: słabo odgraniczone guzki środkowej części zrazika (CN, centrilobular nodules) albo ogniskowe zacienienia typu matowej szyby (FGGO, focal ground glass opacities). Nie wiadomo czy obecność tych zmian wskazuje na odmienny typ IPAH czy też na zarostową chorobę żył płucnych (PVOD, pulmonary venoocclusive disease). Celem pracy była ocena częstości występowania i znaczenia klinicznego zmian miąższowych w płucach stwierdzanych w TKWR u chorych na IPAH. Materiał i metody: Do badania zakwalifikowano 52 chorych na IPAH (38 kobiet, 14 mężczyzn, średni wiek 41 ± 15 lat). Wszystkie dostępne badania TKWR zostały poddane retrospektywnej analizie doświadczonego radiologa, nieposiadającego wiedzy na temat danych klinicznych. Wyniki: U 10 chorych (19%) stwierdzono CN, u 12(23%) FGGO. U badanych chorych nie występowały cechy PVOD, takie jak powiększenie węzłów chłonnych czy też pogrubienie przegród międzyzrazikowych. Wykazano, że chorzy z CN w porównaniu z pozostałymi byli istotnie młodsi (średnie wieku wynosiły 31 lat oraz 43.5 roku, p = 0.02), nie posiadali drożnego otworu owalnego (0% oraz 43%, p = 0.03), mieli istotnie wyższe średnie ciśnienie w prawym przedsionku (12.5 mm Hg oraz 7.94 mm Hg, p = 0.01). Nie wykazano jednak istotnych różnic dotyczących rokowania. Wnioski: Chorzy na IPAH, u których stwierdzono w TKWR guzki środkowej części zrazika, charakteryzowali się nieobecnością PFO, młodszym wiekiem i wyższym ciśnieniem w prawym przedsionku w porównaniu z pozostałymi chorymi.

Evidence for Gamow-Teller Decay of ^{78}Ni Core from Beta-Delayed Neutron Emission Studies

The β-delayed neutron emission of ^{83,84}Ga isotopes was studied using the neutron time-of-flight technique. The measured neutron energy spectra showed emission from states at excitation energies high above the neutron separation energy and previously not observed in the β decay of midmass nuclei. The large decay strength deduced from the observed intense neutron emission is a signature of Gamow-Teller transformation. This observation was interpreted as evidence for allowed β decay to ^{78}Ni core-excited states in ^{83,84}Ge favored by shell effects. We developed shell model calculations in the proton fpg_{9/2} and neutron extended fpg_{9/2}+d_{5/2} valence space using realistic interactions that were used to understand measured β-decay lifetimes. We conclude that enhanced, concentrated β-decay strength for neutron-unbound states may be common for very neutron-rich nuclei. This leads to intense β-delayed high-energy neutron and strong multineutron emission probabilities that in turn affect astrophysical nucleosynthesis models.

Decays of the Three Top Contributors to the Reactor ν[over ¯]_{e} High-Energy Spectrum, ^{92}Rb, ^{96gs}Y, and ^{142}Cs, Studied with Total Absorption Spectroscopy

We report total absorption spectroscopy measurements of ^{92}Rb, ^{96gs}Y, and ^{142}Cs β decays, which are the most important contributors to the high energy ν[over ¯]_{e} spectral shape in nuclear reactors. These three β decays contribute 43% of the ν[over ¯]_{e} flux near 5.5 MeV emitted by nuclear reactors. This ν[over ¯]_{e} energy is particularly interesting due to spectral features recently observed in several experiments including the Daya Bay, Double Chooz, and RENO Collaborations. Measurements were conducted at Oak Ridge National Laboratory by means of proton-induced fission of ^{238}U with on-line mass separation of fission fragments and the Modular Total Absorption Spectrometer. We observe a β-decay pattern that is similar to recent measurements of ^{92}Rb, with a ground-state to ground-state β feeding of 91(3)%. We verify the ^{96gs}Y ground-state to ground-state β feeding of 95.5(20)%. Our measurements substantially modify the β-decay feedings of ^{142}Cs, reducing the β feeding to ^{142}Ba states below 2 MeV by 32% when compared with the latest evaluations. Our results increase the discrepancy between the observed and the expected reactor ν[over ¯]_{e} flux between 5 and 7 MeV, the maximum excess increases from ∼10% to ∼12%.

Low DLCO in Idiopathic Pulmonary Arterial Hypertension—Clinical Correlates and Prognostic Significance

Introduction: Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. Material and methods: In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as <55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. Results: Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. Conclusions: Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.

Current trends in tobacco smoking among 15-year-old adolescents in Poland in the background of 30 countries

The international HBSC (Health Behaviour in School-aged Children) survey has enabled the comparison of the patterns of changes with respect to a number of health indicators in adolescence. The aim of the study was to show international trends and how the position of Poland in international rankings of smoking prevalence has changed since 2002.

MATERIAL AND METHODS

The study comprised 30 countries for which data was available from four rounds of HBSC survey (2002-2014). In total, 218 759 15-year-olds were surveyed, including 7289 in Poland. For each country a linear trend was estimated, separately for boys and girls, to describe changes in regular smoking (daily or at least once a week).

RESULTS

In the investigated period, the percentage of 15-year-old boys who smoke every week fell in Poland from 26.2% to 15.5%, and the respective percentage in girls decreased from 17.2% to 14.7%. This means annual decrease of 0.88% in boys and 0.24% in girls. In a combined international sample, exactly the same as in Poland rate of change was noted in boys; however, a definitely faster in girls (0.95% a year). The highest rate of change was observed in Ukraine, Germany and Norway, while the lowest in Greece, Croatia and Israel. Poland’s position in the international ranking moved from 8th to 24th, providing that the countries are listed according to the growing percentage of 15-year-olds of both genders who smoke regularly.

CONCLUSIONS

Decrease in the prevalence of smoking among Polish adolescents, observed from the beginning of this century, has been undoubtedly a success related to the implemented preventive measures. However, attention should be drawn to the strategies launched in countries which achieved better results than Poland, as well as to the reasons of less positive trends among Polish girls.

Use of dexmedetomidine in the adult intensive care unit

Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.

Intraoperative awareness--comparison of its incidence in women undergoing general anaesthesia for caesarean section and for gynaecological procedures

BACKGROUND

Intraoperative awareness (IA) is diagnosed when patients can recall their surroundings or an event related to the surgery that occurred while they were under general anaesthesia. The female gender and Caesarean section are considered to be contributing factors. The aim of the present study was to analyse the frequency of IA in patients undergoing general anaesthesia either for Caesarean section or gynaecological procedures.

METHODS

ASA I and II women were included into the study. Patients were randomly allocated to 4 groups: A, B and C included patients qualified for elective gynaecological surgery, and group D comprised Caesarean section patients. Premedication was not given. Group A received total intravenous anaesthesia with TCI, and groups B, C and D received balanced anaesthesia. The depth of anaesthesia was monitored with an AEP monitor. Blinded structured interviews were conducted 2 hours after anaesthesia and on postoperative days 7 and 30.

RESULTS

337 patients were enrolled into the study. 45 patients reported diverse sensations connected to the anaesthesia (Group A - 7 patients, B - 9 patients, C - 2 patients, D - 28 patients). There were mainly dream sensations, but IA was present in 3 cases. In all of the cases, IA was recognised during the first interview. One episode of awareness appeared in group B, and the other two appeared in group D. One Caesarean section was complicated by intraoperative haemorrhage. The patient from group B had similar sensations during previous anaesthesia. Two women enrolled in the study reported awareness in the past, which did not occur this time.

CONCLUSION

Awareness during general anaesthesia occurs occasionally. The frequency of occurrence in a group of patients undergoing general anaesthesia for uncomplicated Caesarean section is not higher than for other procedures. The anaesthesia for Caesarean section, as well as for other procedures, may be accompanied by pleasant dreams.

Management of myasthenic crisis in a child

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.

Severity of arterial and chronic thromboembolic pulmonary hypertension is associated with impairment of heart rate turbulence

BACKGROUND

Heart rate turbulence (HRT) impairment is a validated and an independent indicator of cardiovascular death. There are limited data on HRT in pulmonary hypertension (PH), so we assessed potential HRT alterations in PH, especially in relation to its severity.

METHODS

Thirty-three out of 41 patients were enrolled in the study aged 49.7 ± 15.9 years (22 with arterial, 11 with chronic thromboembolic PH). Routine evaluations, right heart catheterization, and 24-hour Holter monitoring with heart rate variability and HRT assessment were performed.

RESULTS

HRT was significantly impaired in PH patients, as compared to 25 healthy controls: mean turbulence onset (TO) was -0.27% versus -2.60% (P < 0.0001), and median turbulence slope (TS) was 3.13 versus 13.5 msRR (P < 0.0001). Abnormal HRT (TO ≥ 0.0% and/or TS ≤ 2.5 ms/RR) was found in 63.3% of PH patients. Patients with PH and abnormal HRT presented more compromised functional, biochemical, and hemodynamic status than PH patients with normal TO and TS values. Multivariate stepwise regression analysis showed that TO value was related to oxygen desaturation <90% in 6-minute walking test (6-MWT; OR 0.41, P < 0.001) and was related to N-Terminal pro-B type Natriuretic Peptide concentration (OR 0.40, P < 0.001); TS was related to 6-MWT distance (OR 0.53, P < 0.0001).

CONCLUSIONS

Patients with arterial or chronic thromboembolic PH are characterized by significant impairment of HRT which is related to the disease severity. We hypothesize that patients with abnormal HRT could be considered as subjects with an increased risk of cardiovascular death, however, it needs further investigation.

Outcome of Medically Versus Surgically Treated Patients With Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is an ominous disease leading to progressive right heart failure. Selected patients can be treated by pulmonary endarterectomy (PEA). We assessed long-term clinical outcome of patients with CTEPH who underwent PEA and patients who remained on medical treatment alone. A total of 112 consecutive patients with CTEPH referred between 1998 and 2008 to one center were followed for a mean of 35 (range 0-128) months after diagnosis. All the patients had advanced pulmonary hypertension at baseline. The operated group had higher World Health Organization functional class compared to the nonoperated group. No other differences in hemodynamic, echocardiographic, or biochemical parameters were observed at baseline. Despite the perioperative mortality rate of 9.1%, patients who underwent PEA had significantly lower long-term mortality compared to nonoperated patients (12.7% vs 34.8%; P = .003), and PEA survivors showed sustained clinical improvement. All efforts should be undertaken to perform PEA in all patients with operable CTEPH.

New generation pulse oximetry in the assessment of peripheral perfusion during general anaesthesia - a comparison between propofol and desflurane

BACKGROUND

A pulse oximeter is a standard device for perioperative monitoring. It is well known that the early detection of tissue hypoxia is of great importance. It has been made easier due to a new generation pulse oximetry device from Masimo. This enables measurements of the peripheral perfusion index (PI) in real time. It has been found that volatile anaesthetics such as sevoflurane and desflurane increase the perfusion index. As we know, no data is available about perfusion index during propofol/remifentanil total intravenous anaesthesia.

METHODS

ASA I and II class women scheduled for elective gynaecological surgery were eligible for the study. Patients were divided into two groups: group P receiving propofol/remifentanil intravenous anaesthesia and group D receiving desflurane/fentanyl general anaesthesia. PI was noted before anaesthesia, after remifentanil/fentanyl injection, after endotracheal intubation, at the beginning of surgery, during the procedure at ten minute intervals, at the end of the procedure, after awakening, after extubation and before discharge to the ward.

RESULTS

Eighty-three patients were enrolled to the study. In both groups, PI increased significantly from the start to the end of surgery. There was a significant correlation between PI and end-tidal desflurane concentration (r = 0.807; P = 0.001). No correlation was found between propofol or remifentanil concentrations and PI.

CONCLUSION

Both intravenous propofol/remifentanil and desflurane/fentanyl general anaesthesia increase peripheral perfusion. An increase in end-tidal desflurane concentration raises peripheral perfusion.

Emotional sequelae among survivors of critical illness: a long-term retrospective study

CONTEXT

Treatment in an ICU can be stressful and traumatic for patients, and can lead to various physical, psychological and cognitive sequelae.

OBJECTIVES

The aim of the study was to assess the influence of the social, economic and working status of individuals in regard to long-term anxiety and depression among ICU convalescents.

DESIGN

Retrospective, cross-sectional, 5-year survey between 2005 and 2009.

SETTING

The general ICUs of two hospitals in Lublin (Poland): the Teaching Hospital, Medical University of Lublin and the District Hospital.

PATIENTS

All adults surviving an ICU stay of more than 24 h were eligible. In December 2010, 533 questionnaires were sent to discharged ICU survivors, and 195 (36.6%) were returned. One hundred and eighty-six patients were enrolled in the study. Patients with brain injuries were excluded.

MAIN OUTCOME MEASURES

The questionnaire consisted of the Hospital Anxiety and Depression Scale (HADS); questions defining social, economic and working status before and after intensive care stay, health status before intensive care stay, as well as questions about memories and readmissions to intensive care were included.

RESULTS

According to HADS, 34.4% patients had an anxiety disorder and 27.4% were depressed. There was a strong positive correlation between anxiety and depression (r = +0.726, P<0.001). Better material and housing conditions correlated with lower anxiety and depression rates. Acute Physiology and Chronic Health Evaluation II scores on admission positively correlated with both anxiety (r =+0.187; P=0.011) and depression (r = +0.239; P=0.001). A negative correlation between health status before intensive care admission and HADS scores was observed (anxiety rs = -0.193; P=0.008; depression rs = -0.227; P=0.002); better health resulted in less anxiety and depression disorders.

CONCLUSION

Adverse social and economic status is associated with higher rates of anxiety and depression following ICU stay.

Independent lung ventilation for treatment of post-traumatic ARDS

BACKGROUND

Independent lung ventilation (ILV) has been recommended for unilateral pulmonary pathology. We describe a case of a multiple trauma patient treated with ILV for unilateral lung injury.

CASE REPORT

Following a road accident, an 18 year-old male patient was referred to the university hospital with multiple organ failure, a ruptured liver and spleen, a fractured spine at the Th1-2 level, and left lung contusion. Splenectomy and liver repair had been performed in a regional hospital. On admission, a left sided pneumothorax and haemothorax were diagnosed and an emergency thoracotomy was performed, with partial resection of the left lower lobe. Because of the failure of recruitment of the left upper lobe, the patient was intubated with a double lumen tube and ILV was started using a single ventilator and a prototype flow separator, allowing separation of volume and PEEP settings. The left lung was ventilated with larger volumes and a higher PEEP than the right side, resulting in rapid improvement of gas exchange, reduction of air leak, and a return to conventional ventilation within two days. The patient underwent spinal stabilisation, and was extubated a few days later and transferred to a rehabilitation unit.

CONCLUSIONS

ILV with a larger tidal volume and high PEEP may be indicated in unilateral lung injury with a significant air leak from the injured tissue.

Normal D-Dimer Concentration in Hospitalized Patients with Lung Diseases

Introduction: D-dimer testing is an established method in diagnostics of suspected pulmonary embolism (PE). However, in hospitalized patients, increased D-dimer concentration may be caused by comorbidities, which limits the applicability of this test in PE diagnostics. According to published data, calculating the index D-dimer/fibrinogen ratio can increase specificity of D-dimer testing in diagnostics of venous thromboembolism (VTE). The aim of the present study was: (1) to determine the frequency of normal D-dimer concentration in hospitalized patients with lung diseases in whom the differential diagnostics of PE can be particularly difficult; and (2) to evaluate the utility of D-dimer/fibrinogen ratio in subgroups of patients with acute VTE or with lung cancer. Materials and methods: The study group included 619 consecutive patients aged 54.9 (±15.4) years, hospitalized in a pulmonology reference centre. Among them there were 96 (15%) patients with acute VTE, 65 (10%) with exacerbation of COPD, and 172 (27%) with lung cancer. Results: Mean D-dimer concentration (Vidas D-dimer New) was 1956 ± 3691 ng/mL and median value was 842 (45–35,678) ng//mL. Normal D-dimer concentration (<500 ng/mL) was found in 225/523 (43%) patients without acute VTE. In 49% (32/65) patients with COPD and in 25% (43/172) patients with lung cancer, D-dimer concentration was below 500 ng/ml. Ddimer/ fibrinogen ratio was significantly higher in acute VTE patients compared to lung cancer patients (808 ± 688 and 289 ± 260, respectively; p < 0.001). Conclusions: Normal D-dimer concentration was found in more than 40% of patients with lung diseases hospitalized in the reference pulmonology centre. This observation can suggest a better utility of D-dimer measurement for PE exclusion in such a population than that seen in previously published reports. D-dimer/fibrinogen ratio is significantly higher in acute VTE than in lung cancer, but the clinical value of this test requires further evaluation.

[Normal D-dimer concentration in hospitalized patients with lung diseases]

INTRODUCTION

The use of D-dimer testing is an established part of the diagnosis of suspected pulmonary embolism (PE). However, in hospitalized patients many various factors might be responsible for increased D-dimer concentration and they could lower utility of D-dimer in exclusion of PE in such population. According to some published data, calculating the index D-dimer/fibrinogen could increase the specificity of D-dimer in the recognition of venous thromboembolism (VTE). The aim of the present study was to determine the frequency of normal D-dimer concentration in hospitalized patients with lung diseases in whom the differential diagnosis of PE is particularly difficult and to evaluate the utility of the index D-dimer/fibrinogen in subgroups of patients: with acute VTE and with lung cancer.

MATERIAL AND METHODS

619 consecutive patients aged 54.9 (± 15.4) hospitalized in reference pulmonary center were enrolled into observation. Among them, there were 96 (15%) patients with acute VTE, 65 (10%) with exacerbation of COPD and 172 (27%) with lung cancer.

RESULTS

Mean D-dimer concentration (Vidas D-dimer New) was 1956 ± 3691 ng/ml and median value 842 (45-35 678) ng/ml. Normal D-dimer concentration (〈 500 ng/ml) was found in 225/523 (43%) without acute VTE. In 49% (32/65) patients with COPD and in 25% (43/172) patients with lung cancer D-dimer concentration was below 500 ng/ml as well. The index D-dimer/fibrinogen was significantly higher in acute VTE patients compared to lung cancer patients - 808 ± 688 and 289 ± 260 respectively, p 〈 0.001.

CONCLUSIONS

Normal D-dimer concentration was found in more than 40% of patients with lung diseases hospitalized in reference pulmonary center. This observation could suggest higher than described in the literature utility of D-dimer measurement in exclusion of PE in such a population. The value of the index D-dimer/fibrinogen, which is significantly higher in acute VTE than in lung cancer requires further evaluation to establish its clinical utility.

Recurrent Exudative Pericarditis in the Course of Adult-Onset Still’s Disease—Two Case Reports

Exudative pericarditis is a disease of varied aetiology requiring inclusion of both infectious and non-infectious causes in its differential diagnosis. The possible diagnoses include adult-onset Still’s disease (AOSD), a rare systemic inflammatory disease of unknown aetiology. AOSD typically develops in patients between 16 and 35 years of age and is characterised by fever, arthralgia, transient salmon-coloured rash and other abnormalities including pharyngitis, serositis (particularly pleuritis and pericarditis) and laboratory abnormalities, such as elevated white blood cell count and elevated markers of inflammation. We report two cases of AOSD with recurrent exudative pericarditis.