The nationwide program of allergic disease prevention as an implementation of GARD guidelines in Poland

Background

In 2006, the Global Alliance against Chronic Respiratory Diseases (GARD) was established. The GARD strategy is based mainly on activities aimed at implementing preventive tasks at a local and global level. In Poland, the National Health Program (NHP) is the strategic document describing the tasks of governmental and local administration in the field of public health. One of the activities under the NHP is a project to carry out mass allergy screening (of children and adolescents at school age) and to organize an information and education campaign.

Methods

In 2017-2018, the screening will cover a group of at least 10,000 children and adolescents at school age (6-18 years of age) in 10 of 16 voivodships in Poland. In the study, the e-health tool for early pre-medical risk assessment of allergic diseases was used. The algorithm determines the risk of bronchial asthma (BA) and allergic rhinitis (AR) based on a series of 38 questions on the symptoms of allergic diseases. In order to assess the effectiveness of the screening test (algorithm) a validation study was carried out before screening. Moreover, the algorithm was calibrated on the basis of the obtained results. The screening is accompanied by a nationwide information and education campaign carried out by means of new media.

Results

A total of 1,008 children and adolescents participated in the validation study. In outpatient examination AR was diagnosed in 46.4% and BA in 11.2%. In the case of AR, the sensitivity of the calibrated version of the algorithm was 0.852 and the specificity was 0.840. In the case of BA, it was 0.841 and 0.912, respectively. In 2017, 1,512 people used the screening tool, of which 1,472 respondents went through all stages of the assessment. BA positive AR result (probably sick) was found in 19.5% of respondents and BA in 8.4%.

Conclusions

The use of e-health tools in mass screening and new media to conduct information and education campaigns allows for the reduction of costs and for efficient implementation of activities. It is important to popularize the use of this type of solutions both at national and local level.

[Polyneuropathy in non-Hodgkin lymphoma]

In a group of patients with non-Hodgkin lymphoma axonal sensorimotor polyneuropathy was found in 15%. It appeared in the treated patients, those receiving doses of oncovin. Polyneuropathy was not correlated with the type of malignancy. Treatment seems to be the important factor which can cause polyneuropathy.

[Visual and somatosensory evoked potentials in the patients with non-Hodgkin lymphoma]

Visual (VEPs) and somatosensory (SEPs) evoked potentials in a group of 33 patients (mean age 49 years) with non-Hodgkin lymphoma (n-HL) without CNS involvement were recorded. There were 24% of patients with pathological VEPs and 30% of patients with pathological SEPs. Pathological VEPs and SEPs were both recorded in 42% of patients. In comparison to the controls the statistically significant prolongation of mean latencies of VEPs, SEPs and transit time to cortex were found in the group of n-HL patients. These abnormalities were noted much more often in patients with long duration of the disease and with intermediate type of malignancy. In the untreated patients evoked potentials were normal. In 6 patients despite normal neurological status and normal eeg the evoked potentials were abnormal. The evoked potentials examination seems to be very sensitive method of afferent pathways involvement estimation and can be used for diagnosis and prognosis in n-HL patients. This method reveals CNS lesions more often than physical examination or eeg.

[Multiple sclerosis coexisting with myasthenia]

In a male patient multiple sclerosis was found to coexist with myasthenia. The symptoms of muscle fatiguability and of central nervous system damage developed at the same time. Multiple sclerosis was the predominating disease, especially in later stage of the disease. The authors discuss the possibility of a common immunological substrate for both conditions.

[Visual and somatosensory evoked potentials in workers exposed to metallic mercury vapors]

Thirty-seven workers occupationally exposed to metallic mercury vapours were subjected to neurological examination and determination of visual (WPW) and somatosensory (SSPW) evoked potentials. In 6 cases slight sings of damage to the central nervous system was demonstrated. Prolonged WPW latency was noted in 15 cases. SSPW abnormalities were observed most frequently in the cortical components (13 cases), less frequently in the brainstem components (4 cases). Simultaneous WPW and SSPW changes were present in 10 cases. In the group of workers with changes of evoked potentials the mean urinary mercury levels were higher and the duration of exposure was longer than in the remaining workers. The use of multimodal electrophysiological methods increases the effectiveness of the diagnosis of subclinical damage to the nervous system in chronic mercury intoxication.

[Cortical and spinal evoked potentials in parkinsonism. Part I. Visual potentials evoked with a checkerboard pattern]

In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).

[Cortical and spinal evoked potentials in parkinsonism. Part II. Somatosensory potentials evoked form the posterior tibial nerve]

In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.