Post-discharge surveillance of urinary tract infections in patients following hip and knee arthroplasty: Identifying targets for infection prevention and control

This population-based study aimed to evaluate the incidence of urinary tract infections following hip and knee arthroplasty (HPRO and KPRO) and identify urinary tract infection risk factors among Polish patients. The analysis included data from 83,525 patients, with incidence rates of 0.7% and 0.49% after HPRO and KPRO, respectively. We identified women, individuals over 65 years old, residents of long-term care facilities, patients with chronic circulatory, endocrine, or digestive diseases, and those operated on due to trauma as targets for infection prevention and control.

Gemtuzumab ozogamicin for relapsed or primary refractory acute myeloid leukemia in children-the Polish Pediatric Leukemia and Lymphoma Study Group experience

Background

Gemtuzumab ozogamicin (GO), one of the first targeted drugs used in oncology, consists of an anti-cluster of differentiation 33 (CD33) monoclonal antibody bound to a derivative of cytotoxic calicheamicin. After the drug withdrawn in 2010 due to a significantly higher rate of early deaths, GO regained approval in 2017 for the treatment of newly diagnosed, refractory, or relapsed acute myeloid leukemia (AML) in adults and children over 15 years of age. The objective of the study was a retrospective analysis of clinical characteristics, treatment outcomes, and GO toxicity profile in children with primary refractory or relapsed (R/R) AML treated in Poland from 2008 to 2022.

Methods

Data were collected through the Polish Registry of Acute Myeloid Leukemia. From January 2008 to December 2022, 35 children with R/R AML were treated with GO in seven centers of the Polish Pediatric Leukemia and Lymphoma Study Group.

Results

Most of the children (30 of 35) received only one GO cycle in combination with various chemotherapy cycles (IDA-FLA, DOXO-FLA, FLA, FLAG, and others). Eighteen children (51%) achieved complete remission (CR), 14 did not respond to treatment, and three progressed. GO therapy was followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 18 children in CR. The 5-year overall survival (OS) after GO therapy was 37.1% ± 8.7% for the total cohort. There was a trend toward a superior outcome in patients with strong expression of CD33 expression (over 50% positive cells) compared with that in patients with lower expression of CD33 (OS, 41.2% ± 11.9% versus 27.8% ± 13.2%; p = 0.5; 5-year event-free survival, 35.4% ± 11.6% versus 25.7% ± 12.3%; p = 0.5, respectively). Children under 15 years have better outcome (OS, 34.9% ± 10.4% versus 30% ± 14.5%, p = 0.3). The most common adverse events were bone marrow aplasia, fever of unknown origin, infections, and elevated liver enzyme elevation. Sinusoidal obstruction syndrome occurred in two children.

Conclusions

The use of GO in severely pretreated children, including those under 15 years of age, with previous failure of AML treatment is a feasible and effective bridging therapy to allo-HSCT with an acceptable toxicity profile.

Biomarkers for polycyclic aromatic hydrocarbons in human excreta: recent advances in analytical techniques-a review

Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental pollutants that are generated by the incomplete combustion of organic materials. The main anthropogenic sources of PAHs are the combustion of solid fuels for heating purposes, illegal waste incineration, road transport and industries based on fossil fuels. PAHs can easily enter the body because they are present in all elements of the environment, including water, soil, air, and food. Due to their ubiquitous presence, PAHs, may exert a harmful effect on human health. Assessing PAH exposure through biomonitoring mostly involve techniques to measure the concentration of 1-hydroxypyrene in human urine. Nevertheless, through recent progress in analytical techniques, other common metabolites of PAHs in human biospecimens can be detected. A scientific literature search was conducted to determine which hydroxy derivatives of PAHs are markers of PAHs exposure and to reveal the leading sources of these compounds. Techniques for analyzing biological samples to identify OH-PAHs are also discussed. The most frequently determined OH-PAH in human urine is 1-hydroxypyrene, the concentration of which reaches up to a dozen ng/L in urine. Apart from this compound, the most frequently determined biomarkers were naphthalene and fluorene metabolites. The highest concentrations of 1- and 2-hydroxynaphthalene, as well as 2-hydroxyfluorene, are associated with occupational exposure and reach approximately 30 ng/L in urine. High molecular weight PAH metabolites have been identified in only a few studies. To date, PAH metabolites in feces have been analyzed only in animal models for PAH exposure. The most frequently used analytical method is HPLC-FLD. However, compared to liquid chromatography, the LOD for gas chromatography methods is at least one order of magnitude lower. The hydroxy derivatives naphthalene and fluorene may also serve as indicators of PAH exposure.

Post-discharge occurrence of surgical site infections after hip or knee arthroplasty surgery in Poland, a population-based study

Arthroplasty is a common procedure improving functioning of patients and their quality of life. Infection is a serious complication that determines subsequent management of the prosthesis and the patient. The aim of the study was to investigate the incidence of post-discharge surgical site infections (SSI) and their risk factors. A retrospective analysis of an anonymized database from the National Health Found for 2017 of 56,068 adult patients undergoing hip replacement surgery (HPRO) and 27,457 patients undergoing knee replacement surgery (KPRO). The cumulative incidence of post-discharge SSI was 0.92% for HPRO and 0.95% for KPRO. The main risk factors for hip SSI were male gender, diseases of hematopoietic, musculoskeletal and nervous system. The risk factor for knee SSI was male gender. All comorbidities significantly increased the risk of SSI. The ICU stay and antibiotics administered at discharge in studied population increased the risk of detection of SSI after HPRO and KPRO by up to four and seven times, respectively. For both procedures rehabilitation after surgery and total endoprosthesis decreased incidence of SSIs. The lower experience of the center was related to higher SSI incidence in HPRO in primary (1.5% vs. 0.9%) and in revision surgeries (3.8% vs. 2.1%), but in KPRO, lower experience only in primary surgeries was significantly associated with SSI. The cumulative incidence of post-discharge SSI in Poland is higher than in other European countries. Special attention should be paid to patients with chronic diseases.

Prevalence of metabolic syndrome and improper nutritional status among adolescents

Prevalence of metabolic syndrome (MetS) and its components is a growing issue, including pediatric populations. However, because of many definitions used, it is difficult to assess the true frequency of these problems. The aim of this study was to assess the prevalence of MetS and its components as well as the frequency of problems with inadequate nutritional status among adolescents. One hundred ninety-six teenagers aged 15-18 years, living in Krakow and its vicinity were examined including measurement of blood pressure, anthropometric parameters and blood levels of cholesterol and glucose. The prevalence of MetS was low and varied from 0.5% to 2.0% depending on the definition. Based on Cook's definition of MetS, the most common components were hypertension (12.8%) and hypertriglyceridemia (12.8%). Improper body weight (based on BMI) was found in 23.5% of adolescents, including 5.1% underweight, and 18.4% overweight or obese. According to the body fat percentage (BF%), 45.8% of the boys were underfat and 6.3% had too much body fat, while only 4% of the girls were below the BF% reference values and 15% above. All girls and 86.5% of boys had too low total body water. In conclusion, the prevalence of metabolic syndrome in population of Krakow adolescents was relatively low, but more than 12% of the adolescents had a hypertension or hypertriglyceridemia. Based on BMI most of adolescents were found to have adequate body weight, but examination of fat content in the body high prevalence of underfat was observed, especially among boys.

Corrigendum: SARS-CoV-2 antibody response after mRNA vaccination in healthcare workers with and without previous COVID-19, a follow-up study from the University Hospital in Krakow, Poland

[This corrects the article DOI: 10.3389/fimmu.2022.1071204.].

The intensity of empathy in adolescents treated in a day unit – preliminary reports

Cel pracy

Celem badania pilotażowego było porównanie poziomu empatii wśród młodzieży leczonej w oddziale dziennym psychiatrycznym w grupach zróżnicowanych pod względem wieku, płci i rodzaju zaburzenia (zaburzeń zachowania i emocji oraz depresyjno-lękowych).

Metoda

Badanie przeprowadzono w grupie 117 adolescentów (69 dziewcząt oraz 48 chłopców) w wieku 13-20 lat leczonych w Oddziale Dziennym Klinicznym Kliniki Psychiatrii Dorosłych, Dzieci i Młodzieży SU w Krakowie w latach 2016-2021. Do badań wykorzystano Skalę Empatii Davisa oraz Skalę Empatii Cohena.

Wyniki

Dziewczęta osiągnęły istotnie wyższe wyniki w skalach Empatii Cohena i Davisa oraz w podskali Davisa: Osobistej Przykrości w porównaniu do chłopców. Zaobserwowano istotne statystycznie interakcje dla czynników płci i wieku oraz wieku i rodzaju zaburzenia. Starsi chłopcy w porównaniu do młodszych cechowali się znamiennie statystycznie wyższymi wynikami w skali empatii Davisa, natomiast u dziewcząt zaobserwowano odwrotną prawidłowość, która jednak nie osiągnęła istotności statystycznej. Starsi pacjenci z zaburzeniami zachowania osiągali istotnie niższe wyniki w skali Empatii Cohena w porównaniu do młodszych, w grupie pacjentów z zaburzeniami depresyjno-lękowymi zaobserwowano odwrotną prawidłowość, która jednak nie osiągnęła znamienności statystycznej

Wnioski

Dziewczęta cechuje wyższy poziom empatii afektywnej i poznawczej niż chłopców. Nasilenie empatii zmienia się wraz z wiekiem w grupie chłopców (rośnie), dla dziewcząt otrzymane różnice nie są istotne statystycznie. Nasilenie empatii jest istotnie niższe w grupie starszych nastolatków z zaburzeniami zachowania i emocji w porównaniu do ich młodszych kolegów z tym samym rozpoznaniem. W grupie z zaburzeniami depresyjno-lękowymi odnotowano odwrotną, choć nieistotną prawidłowość. Otrzymane unikalne wyniki wskazują na różną trajektorię rozwoju empatii w grupie pacjentów z zaburzeniami zachowania oraz z zaburzeniami depresyjno-lękowymi.

Impact of Arterial Hypertension and Use of Antihypertensive Pharmacotherapy on Mortality in Patients Hospitalized due to COVID-19: The CRACoV-HHS Study

Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19.

Determinants of Quality of Life among Adolescents in the Małopolska Region, Poland

Knowledge about predictors associated with quality of life (QoL) in adolescents is important for public health. The aim of the study was to indicate determinants of the different dimensions of QoL in the fields of demographic, socio-economic factors, general health and lifestyle in a sample of Polish adolescents. The cross-sectional study was carried out in a southern region of Poland among 804 schoolchildren from junior high schools and upper secondary schools. The quality of life was measured using the Polish version of the KIDSCREEN-52 questionnaire. The author’s questionnaire concerning determinants of the adolescents’ quality of life was also used. In the analysis of the quality of life, standardized results on the European population (T-score) and categorization on the low, average and high quality of life were taken into account. Defining the possible determinants of the adolescents’ quality of life was made by the multivariate logistic regression models. The highest prevalence of low QoL was observed in the school environment (53.4%) and the psychological well-being (51.6%) dimensions of the KIDSCREEN-52. The factors that increased the risk of the low assessment of the quality of life were, inter alia, female sex for physical well-being, psychological well-being, self-perception, autonomy, parent relation and home life, and financial resources, higher school year for physical well-being, psychological well-being, moods and emotions (2nd grade of upper secondary school only), self-perception, social support and peers, and school environment, and dissatisfaction in appearance for physical well-being, psychological well-being, moods and emotions, self-perception, school environment, social acceptance and bullying.

Post-discharge pneumonia after hip arthroplasty. A population-based study of 55,842 patients in Poland

INTRODUCTION

Alloplasty is one of the most frequently performed procedures, due to its impact on the quality of life.

OBJECTIVES

The purpose of this study was to determine the incidence, risk factors, and clinical implications of post-discharge pneumonia (PNU) after hip endoprostheses in Polish adults.

PATIENTS AND METHODS

This retrospective study was conducted using the database of the National Health Fund containing data from 55,842 hip arthroplasties performed in 2017.

RESULTS

Post-discharge PNU was identified in 371 patients and accounted for 26.6% of all post-discharge infections, incidence rate of 0.7%. Multivariable analysis showed a significantly higher risk of PNU in patients aged 65 and older (OR 3.5, 95%CI 2.40-5.03), urgently admitted (OR 4.0, 95%CI 3.16-4.98), operated in winter (OR 1.7, 95%CI 1.37-2.11) and hospitalized in the intensive care unit (OR 5.9, 95%CI 3.65-9.46). Preventative factors were pre-surgery treatment in diseases of the musculoskeletal system (OR 0.7, 95%CI 0.59-0.91) and post-operative rehabilitation (both outpatient and inpatient OR 0.3, 95%CI 0.10-0.99, and OR 0.7, 95%CI 0.42-0.99, respectively). Seventy patients (18.9% of PNU cases) required inpatient PNU treatment. The in-hospital case fatality rate observed in post-discharge PNU was 21.4%.

CONCLUSIONS

PNU is one of the most common post-operative infections after hip endoprosthesis, especially in winter, requiring re-hospitalization. Efforts should be made to prepare patients in the perioperative period.

Post-Discharge Clostridioides difficile Infection after Arthroplasties in Poland, Infection Prevention and Control as the Key Element of Prevention of C. difficile Infections

Clostridioides difficile is still one of the most common causes of hospital-acquired infectious diarrhea (CDI), and the incidence of CDI is one of the indicators that allows conclusions to be derived on the correctness of antibiotic administration. The objective of this observational study was the analysis of post-discharge CDI incidence in patients undergoing hip or knee arthroplasty, in order to specify optimum conditions for the surgical procedures and outpatient postoperative care. One-year observational study. Public Polish hospitals. Retrospective records for 83,525 surgery patients having undergone hip or knee arthroplasty were extracted from the Polish National Health Fund databases. CDI and/or antibiotic prescriptions in the 30 day post-surgery period were expressed per 1000 surgeries with antibiotic prescription on discharge or in ambulatory care, respectively. The CDI incidence rate was 34.4 per 10,000 patients, and 7.7 cases per 100,000 post-surgery patient-days. Patients who were prescribed at least one antibiotic were diagnosed with CDI more often than patients who had no antibiotic treatment (55.0/1000 patients vs. 1.8/1000 patients). In the multifactorial analysis, the following factors were significant: being at least 65 years of age, trauma as the cause of surgery, length of stay over 7 days, HAIs other than CDI and taking beta-lactams and/or quinolones but not macrolides in the post-discharge period. Postoperative antibiotic prescription in patients undergoing joint replacement surgery is the main risk factor for CDI. These observations indicate the necessity of improvement of infection control programs as the key factor for CDI prevention.

SARS-CoV-2 antibody response after mRNA vaccination in healthcare workers with and without previous COVID-19, a follow-up study from a university hospital in Poland during 6 months 2021

Introduction

Healthcare workers (HCWs) from the beginning of the pandemic have been at risk of exposure to SARS-CoV-2, so they were vaccinated as first.

Objectives

The purpose of the study was to determine the level of antibodies against SARS-CoV-2 in HCWs before and after vaccination with mRNA preparations according to previous COVID- 19.

Patients and methods

The HCWs from the University Hospital in Krakow completed two surveys: the baseline survey before receiving the first dose of vaccine (in January 2021) and the follow-up survey in June 2021. In parallel, two blood samples were collected from each participant at baseline and at follow-up. Total anti-SARS-CoV-2 antibody levels were measured using the ECLIA technique.

Results

At baseline, 41.1% of HCWs had positive antibody test results, and at follow-up, the vaccinated HCWs had almost 100 times higher antibody levels than the unvaccinated HCWs. Participants under 30 years of age had significantly higher antibody levels in June than older HCWs. Among participants with positive antibody test results in January, HCWs who had experienced asymptomatic COVID-19 had more than five times higher antibody levels in June than HCWs self-reported severe COVID-19. In total, 86.9% of HCWs received Comirnaty or Spikevax. The incidence rate of COVID-19 in the unvaccinated vs. vaccinated group was 13 times higher, 20.5% and 1.9% respectively.

Conclusions

These results confirm the effectiveness of vaccination in the prevention of COVID-19 in HCWs. It is worth getting vaccinated regardless of previous infection. Furthermore, vaccination among HCWs under 30 years of age induced more effective antibody production compared to older individuals.

Patterns of multimorbidity in 4588 older adults. Implications for non-geriatrician specialist

INTRODUCTION

Multimorbidity has been recognized as an important factor in the geriatric medicine. However, its importance for other specialists is still to be fully appreciated.

OBJECTIVES

To assess the prevalence and patterns of multimorbidity in older subjects drawn from general population.

PATIENTS AND METHODS

PolSenior was a nationwide, multicenter, cross-sectional survey of aged population in Poland. Questionnaire, physical examination and laboratory data were gathered. Multimorbidity was defined as a coexistence of two and more chronic diseases or medical problems out of 17 identified. Factor analysis was employed to identify clusters of conditions.

RESULTS

Of 4588 subjects 51.9% were men, 640 were aged 55-59, 3948 were aged ≥ 65 years, and 1757 ≥ 80 years. Multimorbidity depended on age and sex, and was diagnosed in 70.9% of those aged 55-59, 88.4% of 65-79, and 93.9% of those aged ≥80 years. Only 8.5% participants aged 55-59, 2.2% aged 65-79 years, and 0.9%  aged ≥ 80 years had no diagnosis of chronic disease. Hypertension, metabolic diseases and obesity predominated in 55-59 and 65-79 years age-groups, whereas hypertension, eye disorders, and cognitive impairment prevailed in the oldest group. The highest likelihood of multimorbidity was found in the youngest subjects who had stroke, kidney disease, cancer, or a composite of Parkinson's/epilepsy; in 65-79 years old with history of stroke, and in ≥80 years old with history of stroke or heart failure.

CONCLUSIONS

The age-specific analysis of clustering revealed differences in prevalence and patterns of comorbidities, which stresses the importance of individual approach to older patients.

Patients Undergoing Hip or Knee Arthroplasty in Poland Based on National Data-Challenge for Healthcare in Aging Society

Arthroplasty procedures are more frequently performed due to their impact on the quality of life. The aim of this study was to evaluate and analyze the Polish national datasets and registries for hip and knee arthroplasty across Poland in order to describe and understand the challenges for healthcare in an aging society. The study included national data on 83,525 hip or knee arthroplasties performed in 2017. Of those, 78,388 (93.8%, 63.0% females) were primary operations: 66.6% underwent hip replacement surgery (HPRO, mean age 68.43 years, SD 11.9), and 5137 were secondary operations (females: 62.9%), with 75.2% of those being HPRO (mean age 69.0 years, SD 12.0). The mean age of the patients undergoing knee surgery (KPRO) was 68.50 years (SD 8.2). The majority (79.9%) were scheduled. The main reason for hospitalization was arthrosis (84.2% in total, HPRO-76.5%, and KPRO-99.5%), then trauma (15.1%; p < 0.001). In 5137 cases (6.2%, 62.9% females) in revision surgery group, 75.2% underwent HPRO (mean age 69.0 years; SD12.0), and 24.8% KPRO (mean age 68.0 years; SD 10.5). Similarly, 71.1% were scheduled. The main reason for hospitalization was complications (total-90.9%, HPRO-91.4%, and KPRO-89.4%) (p < 0.001). Comorbidities were present (over 80%) with the level of influenza, hepatitis B vaccination, and pre-hospital rehabilitation not exceeding 8% each in both groups. Due to the increasing age of patients, implicating comorbidities, there is a need for better preparation prior to surgery.

Infection-associated hospitalizations of women in labour

BACKGROUND

The article analyzes hospitalizations of women in the postpartum period in the Małopolska Province. Re-hospitalization of women as a result of puerperal complications may be used as an infection control quality measure in this patient population.

METHODS

It was a population-based, retrospective analysis using data obtained from the Polish National Health Fund (paying for medical services, financed by all Polish employees contributing 9% of their salaries), collected routinely in 2013-14. The analysis encompassed 29 hospitals and 68 894 childbirths.

RESULTS

In total, 1.7% of women were re-hospitalized and 563 of these re-hospitalizations (0.8%) were due to infection. Re-hospitalizations due to infections were significantly more often recorded among women who lived in villages compared with inhabitants of towns (OR 1.6, 95% CI 1.23-1.98; P < 0.001) and in women giving birth in primary referral hospitals in comparison with the second referral or clinical hospitals (OR 2.8, 95% CI 1.69-4.65; P < 0.001). On the one hand, the results of the study indicate that, in patients giving birth, the infection control system is not sensitive enough, and on the other hand, more detailed studies need to cover primary referral hospitals, specifically.

CONCLUSIONS

The problem of the infection-associated hospitalizations in the postpartum period is not reliably assessed by infection control professionals and constitutes a challenge for surveillance, including prevention and control. Complications associated with childbirth should be an indication of the quality of healthcare provision and knowledge of the scale of the problem should be the basis for its evaluation and prevention. This is especially true for infections in puerperas.

Chronic bacterial pulmonary infections in advanced cystic fibrosis differently affect the level of sputum neutrophil elastase, IL-8 and IL-6

Advanced cystic fibrosis (CF) lung disease is commonly characterized by a chronic Pseudomonas aeruginosa infection and destructive inflammation caused by neutrophils. However, the lack of convincing evidence from most informative biomarkers of severe lung dysfunction (SLD-CF) has hampered the formulation of a conclusive, targeted diagnosis of CF. The aim of this study was to determine whether SLD-CF is related to the high concentration of sputum inflammatory mediators and the presence of biofilm-forming bacterial strains. Forty-one patients with advanced CF lung disease were studied. The severity of pulmonary dysfunction was defined by forced expiratory volume in 1 second (FEV1) < 40%. C-reactive protein (CRP) and NLR (neutrophil-lymphocyte ratio) were examined as representative blood-based markers of inflammation. Expectorated sputum was collected and analysed for cytokines and neutrophil-derived defence proteins. Isolated sputum bacteria were identified and their biofilm-forming capacity was determined. There was no association between FEV1% and total number of sputum bacteria. However, in the high biofilm-forming group the median FEV1 was < 40%. Importantly, high density of sputum bacteria was associated with increased concentrations of neutrophil elastase and interleukin (IL)-8 and low concentrations of IL-6 and IL-10. The low concentration of sputum IL-6 is unique for CF and distinct from that observed in other chronic pulmonary inflammatory diseases. These findings strongly suggest that expectorated sputum is an informative source of pulmonary biomarkers representative for advanced CF and may replace more invasive bronchoalveolar lavage analysis to monitor the disease. We recommend to use of the following inflammatory biomarkers: blood CRP, NLR and sputum elastase, IL-6, IL-8 and IL-10.

Is treated hypertension associated with a lower 1-year mortality among older multimorbid residents of long-term care facilities?

INTRODUCTION

Long-term care facility (LTCF) residents are typically excluded from clinical trials due to multimorbidity, dementia, and frailty, so there are no clear evidence-based rules for treating arterial hypertension in this population. Moreover, the role of hypertension as mortality risk factor in LTCFs has not yet been clearly established.

OBJECTIVES

The study aimed to investigate whether treated hypertension is associated with lower mortality among older LTCF residents with multimorbidity.

PATIENTS AND METHODS

The study was performed in a group of 168 residents aged ≥ 65 years in three LTCFs. Initial assessment included blood pressure (BP) measurements and selected geriatric scales: MNA-SF, AMTS and ADL. Hypertension, comorbidities, pharmacotherapy, antihypertensive drugs and mortality during one-year follow-up were extracted from the medical records. The data was compared in groups: Survivors and Deceased.

RESULTS

Survivors and Deceased revealed similar age, DBP, number of diseases, medications, and antihypertensive drugs. However, Deceased had significantly lower SBP (P <0.05) and presented significantly worse functional, nutritional and cognitive status than Survivors (P <0.001). Hypertension (P <0.001) and antihypertensive therapy (P <0.05) were significantly more frequent among Survivors. Significantly more of the hypertensive-treated than other multimorbid residents survived the follow-up (P <0.001). Logistic regression analysis showed that treated hypertension had a protective effect on mortality [OR = 0.11 (95% CI, 0.03-0.39); P <0.001].

CONCLUSIONS

One-year survival of LTCF residents with treated hypertension was significantly higher than the others. Appropriate antihypertensive therapy may be a protective factor against death in frail nursing home residents, even in short period of time.

Evaluation of a Polish Version of the Dundee Ready Education Environment Measure

INTRODUCTION

The Dundee Ready Education Environment Measure (DREEM) is an instrument that assesses the educational environment.

AIM

The aim of this study was to psychometrically evaluate a Polish version of the DREEM instrument.

MATERIAL AND METHODS

203 medical students who fully completed the DREEM questionnaire were included in the study. Validity was evaluated through the analysis of construct validity and reliability.

RESULTS

After language validation the internal consistency was assessed. Cronbach's alpha for the overall score was 0.93 and the five subscales were: perceptions of learning 0.86, perceptions of teachers 0.82, perceptions of atmosphere 0.75, academic self-perceptions 0.61, and social-self perceptions 0.61. The exploratory factor analyses, however, yielded dimensions that did not fully correspond to the original DREEM subscales.

CONCLUSIONS

Internal consistency of the Polish version of the DREEM scale as a whole was excellent, however for each of five originally developed subscales it was lower and vary a lot; construct validity of Polish version was not compatible with the original structure of the DREEM scale but was reasonable. A new five-factor solution obtained in this study could be a reliable tool for assessing the medical education environment in the Polish circumstances, but it will require confirmation in future study.

Frequency of occurrence of the pain form of the temporomandibular disorders and gender distribution

Temporomandibular disorders includes abnormalities of the masticatory muscles, temporomandibular joints and the surrounding structures. The aim of the study was to carry out a retrospective assessment of the frequency of the pain form of TMD based on the analysis of medical records of patients treated at the Prosthodontic Department at Jagiellonian University in Kraków.

MATERIAL AND METHODS

The study included the results of a medical history and a clinical examination of patients, who came for consultation at the Prosthodontics Department at Jagiellonian University in Krakow, due to pain of the masticatory muscles or/and TMJ and painless symptom of TMD like limitation of the jaw movements and joints' sounds. Out of all the analyzed results of the examination of treated patients, a group of patients with a painless and painful TMD was selected.

RESULTS

The study involved the results of a detailed specialized functional examination of 334 patients (210 women and 124 men), ranging in age from 41 to 68 years. Analysis of the results of clinical examinations conducted in all patients revealed that 161 had the painless form - SG (99 women and 62 men) and 173 patients had the pain form of the TMD - CG (111 women and 62 men). In the CG 104 patients reported mostly pain in the masticatory muscles, while the remaining (69 patients) had a history of pain in one or simultaneously two TMJs.

CONCLUSION

The analysis of the patients forms allows to conclude that more than half of patients seeking help are patients with the painful form of the TMD and these abnormalities occur more frequently in women than in men.

Electrocardiography and cardiac magnetic resonance imaging in the detection of left ventricular hypertrophy: the impact of indexing methods

BACKGROUND

Discrepancies between increased left ventricular mass (LVM) and electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) are described in the literature.

AIMS

This study aimed to evaluate the usefulness of ECG criteria in the diagnosis of LVH, as determined by cardiac magnetic resonance (CMR) imaging, using various LVM indexing methods.

METHODS

We included 53 patients who underwent CMR imaging and had electrocardiograms of appropriate quality available in their medical records. The majority of the study patients had cardiovascular diseases. We defined CMR‑LVH as increased LVM, also assessed after LVM indexing to body surface area (LVM/BSA), height1.7, height2.7, or as the percentage of predicted LVM (%pLVM). To determine ECG‑LVH, 10 different ECG-LVH criteria were used.

RESULTS

The prevalence of CMR‑LVH ranged from 11% (for %pLVM) to 72% (for LVM/BSA). At the same time, for a single criterion, the prevalence of ECG‑LVH ranged between 1.9% (for R wave amplitude in lead V5 / V6 greater than 2.6 mV, Sokolow-Lyon product, and Gubner-Ungerleider criterion) and 45.3% (for Peguero-Lo Presti criterion), showing high sensitivity, from 55.3% (95% CI, 38.3-71.4) to 100% (95% CI, 54.1-100). The sensitivity of ECG‑LVH criteria when all criteria were applied together ranged from 57.9% (95% CI, 40.8-73.7) to 100% (95% CI, 63.1-100). The best performance regarding the endpoint of CMR‑LVH diagnosis after LVM indexing was achieved by the Peguero-Lo Presti and Cornell criteria (area under the curve, 0.621-0.876; P, 0.001-0.17).

CONCLUSIONS

Thediagnosis of LVH strongly depends on ECG- and CMR‑based definitions. ThePeguero-Lo Presti criterion and the Cornell criteria, which are sex‑specific, may provide the highest level of diagnostic accuracy and should be considered when screening patients with cardiovascular diseases for LVH.

The relationship between malnutrition risk and inflammatory biomarkers in outpatient geriatric population

PURPOSE

Malnutrition is an underestimated, but significant problem among older persons. It is described as a consequence of genetic and environmental factors, lack of physical activity, and co-morbidities. However, a key role of a geriatrician is to further explore the multidimensional complexity of this issue. The aim of this study was to identify the relationship between nutritional status and different factors, particularly focusing on inflammatory biomarkers.

METHODS

Nutritional status was assessed using Mini-Nutritional-Assessment with a score below 24 (out of 30) defined as malnutrition. Different serum biomarkers of inflammation were measured, such as High-Sensitivity-C-Reactive-Protein (hsCRP), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-18(IL-18), osteoprotegerin(OPG), and Soluble-Receptor-For-TNF-alfa(sTNFRII). Medical history, mental status (Mini-Mental-State-Examination, Geriatric-Depression-Scale) and activities of daily living (using Instrumental-Activities-of-Daily-Living-Scale) were used in the evaluation. The relationship between nutritional status and the factors listed was assessed.

RESULTS

The mean age of 76 examined persons (40.8% female) from the outpatient clinic was 71 years. Malnutrition risk was recognized in 29%. The following factors significant in univariate regression were used in stepwise regression analysis: age, sex, mental status (MMSE, GDS), valve disease, number of diseases, IADL. Stepwise regression revealed that the risk of malnutrition was increased by the presence of valve disease, number of diseases, and female sex. Factors that increased the risk of malnutrition were: logsTNFRII (OR = 3.09; 95% CI 1.07-8.96), IL-8 (OR = 1.09; 95% CI 1.00-1.18), and OPG (OR = 1.27; 95% CI 1.02-1.57). Risk of malnutrition was negatively associated with Il-18(OR = 0.995; 95% CI 0.991-0.999).

CONCLUSIONS

Chronic inflammation and immunologic process are likely contributors to the complex etiopathogenesis of malnutrition in older persons.

Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE)

BACKGROUND

While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed.

AIM

To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care.

DESIGN

Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses.

SETTING/PARTICIPANTS

Nurses or care assistants who are most involved in care for the resident.

RESULTS

We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%-Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%-the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life.

CONCLUSION

The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

Depressive symptoms among adolescents in non-clinical Krakow's population - thirty years' follow-up

OBJECTIVES

Assessment of predictive value of the occurrence of depressive symptoms during adolescence. For this purpose,the life history of untreated adolescents screened for the presence of depressive symptoms was assessed twice, at intervals of fifteen years, including an assessment of their health history, their family-related, occupational, material and social situation. The comparison of the fate of depressive adolescents with the fate of their non-depressive peers was aimed at answering the question about the influence of adolescent depression on health in adulthood.

METHODS

In 1985, a random sample of 1,035 people - students aged 15 and 17 - was examined for a screening diagnosis of adolescent depression. The Krakow Depression Inventory (KID) questionnaires version for 15-year-olds ("IOB1") and for 17-year-olds ("IOC1") were used. After 15 years, data on 238 people (23%) were obtained. In 2015, responses were obtained from 101 people (9.8% of those surveyed in 1985).

RESULTS

An analysis of the results of a 30-year prospective study of the relationship between depressiveness in adolescence, in untreated adolescents, and the health and functioning in adulthood indicates that, contrary to predictions, the appearance of depression in this phase of development cannot be treated as a predictor of mental disorders later in life.

CONCLUSIONS

Long-term observation in our prospective study supports the hypothesis of a developmental character of adolescent depression.

Validation of a modified Oral Health Impact Profile scale (OHIP-14) in patients with oral mucosa lesions or periodontal disease

BACKGROUND

Now that healthcare systems have helped successfully extend the human lifespan, the next challenge is to improve the patient's quality of life (QOL), in particular health-related quality of life (HRQOL). A proper HRQOL assessment requires using reliable instruments that are well-adapted to the population.

OBJECTIVES

The objective of this study was to validate a modified Polish version of the Oral Health Impact Profile scale (OHIP-14) for patients with oral mucosa lesions or periodontal disease.

MATERIAL AND METHODS

The sample consisted of 180 adults seeking highly specialized treatment at the Periodontology Department of the University Dental Clinic in Kraków, Poland. The main modification made to OHIP-14 was the inclusion of subquestions regarding the teeth (subscale 1), oral mucosa and other soft tissues (subscale 2), and dentures (subscale 3).

RESULTS

The Cronbach's alpha values were excellent for all 3 subscales (subscale 1: α = 0.924; subscale 2: α = 0.937; subscale 3: α = 0.936). In the case of subscale 1, the Kaiser criterion showed a model with 3 factors ("psychological and social limitations"; "physical limitations"; "functional limitations"), which together explained 67.1% of the variance, in the case of subscale 2 - a model with 1 factor, and in the case of subscale 3 - a 2-factor model ("social interactions limitations"; "basic activities disorder and personal discomfort").

CONCLUSIONS

Statistical testing demonstrated that a modified OHIP-14 questionnaire is a reliable tool for evaluating QOL in patients with periodontal or oral mucosa diseases.

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

Importance

Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.

Objectives

To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.

Design, Setting, and Participants

Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.

Exposures

Gestational weight gain.

Main Outcomes and Measures

The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.

Results

Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).

Conclusions and Relevance

In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts

OBJECTIVE

To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact.

DESIGN

Individual participant data meta-analysis of 39 cohorts.

SETTING

Europe, North America, and Oceania.

POPULATION

265 270 births.

METHODS

Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used.

MAIN OUTCOME MEASURES

Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth.

RESULTS

Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain.

CONCLUSIONS

Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity.

TWEETABLE ABSTRACT

Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.

Influence of Sociodemographic, Behavioral and Other Health-Related Factors on Healthy Ageing Based on Three Operative Definitions

OBJECTIVES

Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA.

DESIGN, SETTING, PARTICIPANTS

The study used cross-sectional data of the PolSenior Project - nationwide research evaluating different aspects of ageing in Poland - which included 4'653 respondents aged 65 years and over.

MEASUREMENTS

Data were collected by trained interviewers in respondents' homes. Three definitions of HA including or not the participants' chronic conditions were analyzed.

RESULTS

The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively).

CONCLUSIONS

The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.

Is Vaginal Birth without an Episiotomy a Rarity in the 21st Century? Cross-Sectional Studies in Southern Poland

Purpose: The objective of this study was to analyze the birth methods (vaginal, with medical intervention, or by Cesarean Section, CS) predominant in the Malopolska province, to describe the risk factors for non-physiologically normal births, and to characterize the demographics of women who give birth and selected parameters of maternity care. Methods: The retrospective analysis was conducted on data collected in 2013⁻2014 in the framework of the current activity of the Polish National Health Fund and encompassed 68,894 childbirths from 29 hospitals in 21 towns in the south of Poland. Results: In the study period, 38,366 (56.5%) of the births in Malopolska were vaginal, and only 22,839 (22.9%) of births were considered 'normal', without an episiotomy. The remaining were births by CS (29,551; 43.5%). Factors increasing the chances of having a normal childbirth in comparison with birth by CS were as follows: days free from work, living in a village, woman's age > 35 years, and the hospital's referral level (primary or secondary). Women aged 18⁻34 years and those living in a village/town were more frequently admitted directly into the birth room without a stay in the maternity units. There was a high level of medicalization of births in Malopolska: natural labour and childbirth were rare. It seems that efforts to increase natural birth rates should be directed toward both reducing the CS rate as well as increasing vaginal birth without an episiotomy.

Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

BACKGROUND

Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies.

METHODS

We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape.

RESULTS

We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications.

CONCLUSIONS

Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.

Lung function growth trajectories in non-asthmatic children aged 4-9 in relation to prenatal exposure to airborne particulate matter and polycyclic aromatic hydrocarbons - Krakow birth cohort study

BACKGROUND

Patterns of lung function development during childhood can be helpful in understanding the pathogenesis of respiratory diseases. A variety of environmental and lifestyle factors, present from the prenatal period to adulthood, may affect or modulate lung function growth. The aim of this study was to investigate, the associations between individual growth trajectories of children's lung function during childhood and prenatal exposure to airborne fine particulate matter (PM_2.5) and polycyclic aromatic hydrocarbons (PAH), which were hypothesized to adversely affect spirometry parameters.

MATERIAL AND METHODS

The study group comprised 294 non-asthmatic, full term children from the Krakow birth cohort, who underwent annual spirometry testing at the ages of 4-9 years. Individual personal air monitoring of PM_2.5 and PAH were performed over 48 h in the second trimester of pregnancy. Possible confounders or modifiers such as child's gender, height, atopic status and exposure to environmental tobacco smoke (ETS) were considered. Polynomial multilevel mixed models were used to assess the growth rates of children's lung functions.

RESULTS

Lung function trajectories differed significantly for boys and girls for FVC, FEV1 and FEF25-75. Girls had lower rates of increase than boys: - 20.5 (95%CI: - 32.4; - 8.6) ml/year (FVC); - 19.9 (95%CI: -30.7;-9.0) ml/year (FEV1); and - 32.5 (95%CI: - 56.9; - 8.2) ml/year (FEF25-75). Spirometry functions increased with age; however the growth rate decelerated over time. Significant lung function impairment (lower FVC and FEV1 levels) was observed from 4 to 9 years among subjects prenatally exposed to higher levels of PM_2.5 as well as PAH, but not in the case of FEF25-75. No significant differences were observed in the rates of increase over time in relation to prenatal PM_2.5 and PAH exposure.

CONCLUSION

Our results indicate that in non-asthmatic children high prenatal exposure to airborne PM_2.5 and PAH is associated with lower trajectories of FVC and FEV1, but not the rate of increase over time, suggesting that the initial effect is not diminishing in time.

The "Wholesome Contact" non-pharmacological, volunteer-delivered multidisciplinary programme to prevent hospital delirium in elderly patients: study protocol for a randomised controlled trial

Background

In hospital settings, delirium affects as many as 50% of older patients, aggravating their symptoms and worsening their condition, and therefore increasing the risk of in-hospital complications and death. The aim of this study is to assess the efficacy of structured, non-pharmacological care, delivered to older hospitalised patients by trained volunteers (students of medical fields), on the reduction of incidence of adverse health-related outcomes.

Methods/design

This trial will be a randomised, investigator-blind, controlled trial conducted in an internal medicine and geriatric ward in Poland. We aim to include 416 patients who are 70 years of age and have been hospitalised for medical reasons. Eligible patients will be randomised 1:1 to receive structured, non-pharmacological care delivered by students of medicine, psychology and nursing, together with standard medical treatment or standard medical care alone. The protocol of interventions has been designed to cover nine main risk factors for delirium, with the scope of multidisciplinary interventions being individualised and tailored. The protocol will be aimed at immobilisation, vision and hearing impairment, cognitive impairment and disorientation, stress and anxiety, sleep–wake cycle disturbances, dehydration and malnutrition, and pain. A structured evaluation of patients’ cognition, mood, anxiety and functional performance is planned to be carried out twice, on the day of group allocation and at discharge; structured screening assessment for delirium will be conducted daily using the Confusion Assessment Method. The primary outcome will be the incidence of delirium in hospital; secondary outcomes will be in-hospital changes in cognition, mood and anxiety, and functional status, occurrence of falls and death.

Discussion

Delirium prevention programmes are being introduced worldwide. A particular novelty of our project, however, is that invitations for voluntary work with older patients at risk for delirium will be addressed to medical students. With the use of the service learning method, the students will shape their attitudes, increase their knowledge and understanding of hospital care, and master competencies to work within interdisciplinary teams, which establishes the originality and practicality of the project.

Trial registration

Polish Science Database, 317484. Registered on 23 October 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2781-6) contains supplementary material, which is available to authorized users.

Urinary polycyclic aromatic hydrocarbon metabolites among 3-year-old children from Krakow, Poland

Polycyclic aromatic hydrocarbons (PAHs) are widespread in the environment and can adversely affect human health. The aim of the present study is to describe the level of PAHs exposure in children living in Kraków, one of the most polluted cities in Poland, and to determine the relationship of urinary biomarkers with environmental PAHsexposure. Urinary monohydroxy metabolites (OH-PAHs) of 20 PAHs were assessed in 218 three-year old children, of which only 10 were present in nearly all the samples: monohydroxy metabolites of naphthalene, fluorene, phenantrene and pyrene. Of the metabolites analyzed, hydroxynaphthalenes were predominant and constituted almost 73% of total excreted OH-PAHs, while 1-OH-PYRene was the least abundant (2.3% of total OH-PAHs). All measured urinary OH-PAHs were statistically significantly correlated with each other (R = 0.165-0.880) but the highest correlation coefficients with other individual OH-PAHs and with total OH-PAHs were observed for 2-OH-FLUOR. Children exposed at home to environmental tobacco smoke (ETS) had higher concentrations of fluorene and pyrene urinary metabolites compared to those without ETS exposure; and those exposed to gas-based appliances used for cooking or heating water had higher levels of fluorene and phenanthrene metabolites than children not exposed. The use of coal, wood or oil for heating was associated with elevated levels of 1-OH-PYRene. Urinary PAHs metabolites only modestly reflect high molecular weight carcinogenic PAHs exposures such as those monitored in air in the present study. None of the measured PAHs metabolites was correlated with airborne PM_2.5 and only two were slightly correlated with measured higher molecular mass airborne PAHs. The average concentrations of these specific metabolites in Polish children were much higher than observed in other pediatric populations living in developed countries. Our findings suggest that to capture various sources of PAHs, in addition to 1-OH-PYRene, biomonitoring of PAHs exposure should include 2-OH-NAP and 2-OH-FLUOR.

Body weight and quality of life among adolescents in Krakow

AIM

The aim of this study was to assess the relationship between body weight and the quality of life among adolescents in Krakow, Poland.

MATERIAL AND METHODS

The study comprised 1291 pupils - 632 girls and 659 boys from 17 Krakow middle schools. Their quality of life (QoL) was assessed by means of the Polish version of the KIDSCREEN-27 questionnaire. Five dimensions of QoL were analyzed as low, average and high QoL according to Polish cut-off points. The body mass index (BMI) of the adolescents was classified as underweight, normal weight, or excessive weight according to Polish growth charts.

RESULTS

Low QoL was observed significantly more often in girls than in boys. Excessive weight among both girls and boys was found to be a risk factor for low QoL in the "Physical Well-being" dimension as compared to normal weight adolescents. Additionally, boys with excessive weight had a two-fold higher risk of low QoL in the "Social Support % Peers" dimension (OR=2.00; 95%CI:1.14-3.50). Underweight was associated with higher risk of low QoL in the "Physical Well-being", "Autonomy & Parents", and "Social Support % Peers" dimensions, but only among boys.

CONCLUSIONS

Both, underweight and excessive weight were associated with low QoL. Excessive weight in youth was linked mainly with lower physical well-being. Underweight was a predictor of low QoL only among boys in the dimensions related to physical health, as well as relations with family and peers.

Health status of older cancer survivors-results of the PolSenior study

PURPOSE

The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study.

METHODS

We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors.

RESULTS

There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4 ± 8.2 years and the median time since cancer diagnosis was 8.5 years (Q1-Q3: 4-16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR = 1.38; 95% CI: 1.04-1.83), and to report poor health (OR = 1.49; 95%CI: 1.83-2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p < 0.001).

CONCLUSIONS

Cancer survivors over the age of 65 years have a higher prevalence of falls, are more likely to report poor health status, and have a higher number of chronic conditions than the non-cancer population, but they maintain independence in IADLs. Advanced age and elementary education are associated with increased occurrence of functional impairments in older cancer survivors IMPLICATIONS FOR CANCER SURVIVORS: Older cancer survivors may require preventive services to reduce the risk of functional decline.

Preferring fried dishes increases risk of benign breast disease, but not breast cancer

BACKGROUND

Unhealthy diet and cooking method used may influence the risk of breast cancer (BC), but there is only limited evidence with regard to benign breast disease (BBD). The aim of this study was to assess a relationship between cooking technique, especially fried to boiled meals ratio in the diet, and the risk of BC and BBD in a group of Polish women.

MATERIAL AND METHODS

A case-control study involving 34 BC cases, 81 BBD cases and 122 healthy controls was conducted between July 2007 and November 2011. All the women were asked about their nutritional habits, especially the way of preparing meat and fish dishes. Then the ratio of fried to boiled meals was calculated.

RESULTS

High fried to boiled ratio was associated with increasing risk of BBD, but not BC. Women consuming fried dishes more often than boiled dishes had elevated risk of BBD: OR = 3.04 and OR = 3.65 for the second and the third tertile, respectively. Adjustment for the other confounders only slightly altered this relationship.

CONCLUSION

Women who preferred frying as a cooking technique had increased risk of benign breast disease, but not breast cancer. There is a need of more precise investigation to confirm this association.

Clustering of geriatric deficits emerges to be an essential feature of ageing - results of a cross-sectional study in Poland

The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI: 4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.

The quality of life among middle-school adolescents in Krakow

AIM

The aim of the study was to describe the quality of life of Polish adolescents living in a big city and to investigate whether there are differences in this respect between girls and boys. Moreover, we would like to compare the results concerning the quality of life of the screened adolescents from Krakow with those of their European peers.

MATERIAL AND METHODS

The survey was carried out in 2013-2015 in 17 middle schools in Krakow based on anonymous auditorium questionnaires. The analysis included the responses of 1387 pupils - 686 girls and 701 boys. In order to assess the quality of life, the Polish version of the international KIDSCREEN-27 questionnaire was used. Five dimensions of the quality of life (Qol) were analyzed. The specific dimensions of Qol were analyzed using 0-100 point scales, as well as T-scores standardized for the European population.

RESULTS

The mean values for five dimensions of quality of life assessed by the KIDSCREEN-27 questionnaire ranged from 54 pts. to 65 pts. (maximum score 100 pts.). However, the results for the Polish adolescents were lower when compared to their European peers. The greatest differences in the level of Qol between Polish adolescents and their European peers involved the following dimensions: Psychological Well-being and School Environment. On average, girls scored their Qol lower than boys in three out of five dimensions (Physical Well-being, Psychological Well-being, Autonomy & Parents; p<0.001). Additionally, using the norm data for the Polish population (sex and age specific), more girls than boys were classified as having low Qol regarding the School Environment (23.5%vs 14.8%; p<0.001).

CONCLUSIONS

Polish adolescents scored their Qol lower than their European peers. The quality of life for girls was significantly lower than of boys, except for the relation with their friends and peers (Social Support & Peers).

The diurnal profile of melatonin during delirium in elderly patients--preliminary results

Delirium is an acute-onset syndrome that exacerbates patients' condition and significantly increases consequential morbidity and mortality. There is no comprehensive, cellular and tissue-level, pathophysiological theory. The melatonin hormone imbalance has been shown to be linked to circadian rhythms, sleep-wake cycle disturbances, and delirium incidence. There has been relatively little research about melatonin in delirium, and there has been no such study done in the group of elderly patients of a general medicine ward yet. The aim of our study was to compare melatonin hormone concentration in relation to the presence of delirium in elderly patients hospitalized in the general medicine ward. Blood samples were collected four times a day for two days (at 12:00, 18:00, 00:00 and 6:00), on the day when delirium was diagnosed and 72 h after the delirium resolution. Delirium was diagnosed with the Confusion Assessment Method and the criteria of the Diagnostic and Statistic Manual of Mental Disorders, 4th Revision. The mean age of 30 patients (73.3% women) was 86.5 ± 5.2 years. Delirium was diagnosed most often on the second and third day of hospitalization. A lot of predisposing and precipitating factors for delirium were identified. There was a significant difference in the melatonin hormone concentration measurement at 12:00 when patients had acute delirium and after its resolution [18.5 (13.8, 27.5) vs 12.9 (9.8, 17.8), p<0.01]. Different patterns of the melatonin hormone concentration were shown in analyses in the subgroups defined according to the patients' diagnosis of dementia. We found that the delirium recovery was, in fact, associated with the alteration of the daily profile of melatonin.

The significance of motivation in periodontal treatment: the influence of adult patients' motivation on the clinical periodontal status

Motivation plays an important role in the treatment process of chronic diseases, as treatment requires behavioural change and lifelong adherence to medical recommendations. Periodontitis is a good example of such health condition as to maintain good periodontal health patients have to adhere to a strict oral hygiene regimen.

OBJECTIVE

To examine whether the motivation of patients suffering from chronic periodontitis influences their clinical periodontal condition.

BASIC RESEARCH DESIGN

Cross sectional study.

CLINICAL SETTING

Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland.

PARTICIPANTS

199 adult periodontal patients, aged 20-78 years.

INTERVENTIONS

Questionnaire concerning patients' medical and dental history, modified Zychlińscy motivation assessment questionnaire, clinical periodontal examination.

MAIN OUTCOME MEASURES

The extent of motivation. Periodontal status evaluated with the use of periodontal indices (API, BOP, CPITN).

RESULTS

The mean motivation score was 57.4. The mean API and BOP values were 55.7% and 46.4%, respectively. For most of the patients the recorded CPITN value was 3. Correlations were observed between motivation and both API and BOP, and between API and BOP.

CONCLUSION

Periodontal patients with greater motivation having better oral health (lower API and BOP) suggests an influence on the quality of their self-management of the disease (i.e. adherence to their oral hygiene regimen).

Relative validity of a semi-quantitative FFQ in 3-year-old Polish children

OBJECTIVES

The aim of the study was to assess the relative validity of a semi-quantitative FFQ (SFFQ) which measures the usual dietary intake of 3-year-old children.

DESIGN

The children's daily dietary intake was measured using the SFFQ. The average intake of three 24 h dietary recalls (24hDR) was calculated as a reference method. Wilcoxon's rank test and Spearman's rank-correlation coefficient were used to compare nutrient intakes assessed by both methods. The level of agreement between the SFFQ and the repeated 24hDR was determined by the Bland-Altman method. To assess the agreement in quartile distribution, the weighted kappa coefficient (κ w) was used.

SETTING

Krakow, Poland.

SUBJECTS

One hundred and forty-three 3-year-old children and their mothers, participants of a prospective cohort study.

RESULTS

Overall, the SFFQ overestimated energy and nutrient intakes compared with the repeated 24hDR. The median correlation coefficient for energy and nutrient intakes was 0·456, with higher results for Ca, P and riboflavin. Although the κ w value showed only slight to fair agreement between the two methods, about 75 % of the children were classified into the same or adjacent quartile and the level of agreement assessed by the Bland-Altman method for most of the nutrients investigated was good.

CONCLUSIONS

The study indicated that the SFFQ might be a useful tool to assess dietary intakes of nutrients by small children, especially for ranking them according their nutrient intake.

The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment

OBJECTIVE

The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlińscy motivation scale adjusted to the needs of periodontology.

BASIC RESEARCH DESIGN

Cross sectional study.

CLINICAL SETTING

Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland.

PARTICIPANTS

199 adult periodontal patients, aged 20-78.

INTERVENTIONS

14-item questionnaire. The items were adopted from the original Zychlińscy motivation assessment scale.

MAIN OUTCOME MEASURES

Validity and reliability of the proposed motivation assessment instrument.

RESULTS

The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment.

CONCLUSION

The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

Pre-pregnancy Dietary Vitamin A Intake May Alleviate the Adverse Birth Outcomes Associated with Prenatal Pollutant Exposure: Epidemiologic Cohort Study in Poland

A cohort study assessed the relationship between dietary intake of vitamin A in 493 healthy mothers before and around conception and adverse birth outcomes associated with environmental toxicant exposures. The cohort, non-smoking women with singleton pregnancies, aged 18-35 years, gave birth at 34-43 weeks of gestation. The women were asked about their diets over one year preceding pregnancy. Measurements of PM2.5 were carried out during the second trimester. Birth outcomes were adjusted for potential confounding factors, including gestational age. Standardized beta regression coefficients confirmed an inverse association between PM2.5 and birth weight (beta = -172.4, p = 0.02), but the effect of vitamin A on birth weight was positive (beta = 176.05, p = 0.05), when the two were adjusted for each other. The negative effect of higher prenatal PM2.5 exposures (above third tertile) on birth weight was significant in women below the third tertile of vitamin A intakes (beta = -185.1, p = 0.00), but not in women with higher intakes (beta = 38.6, p = 0.61). The negative effect of higher PM2.5 exposure on length at birth was significant with lower vitamin A intakes (beta = -1.1, p = 0.00) but not with higher intakes (beta = -0.3, p = 0.56). Prepregnancy nutrition of mothers may modulate the harmful effects of prenatal exposures to pollutants on birth outcomes.