Correlates of Blood Pressure and Cholesterol Level Testing Among a Socially-Disadvantaged Population in Poland

As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among a socially-disadvantaged population in Poland. This cross-sectional study was performed between 2015 and 2016 among 1710 beneficiaries of government welfare assistance. Face-to-face interviews conducted by trained staff at each participant’s place of residence allowed for completion of questionnaires that covered socio-demographic, health and lifestyle-related information. Sixty-five percent of the participants declared a blood pressure and 27% of them cholesterol level testing at least once within the year proceeding the study. A higher chance of having blood pressure testing was observed among the women (OR = 1.5; p = 0.002) and people with high blood pressure (OR = 3.9; p < 0.001). The women (OR = 1.4; p = 0.04) and older people (OR = 1.9; p = 0.02; OR = 2.6; p < 0.001, OR = 2.7; p = 0.002, for the following age groups: 30-39, 40-49, 50-59 years respectively), the respondents who declared health problems such as heart attack (OR = 3.0; p = 0.04), high blood pressure (OR = 2.3; p < 0.001) and type 2 diabetes (OR = 3.3; p = 0.004) and those with a family history of chronic diseases (OR = 1.5; p = 0.03) had a higher chance of cholesterol level checking. Higher healthy lifestyle index, indicating that the study participants have followed almost all of the studied lifestyle-related recommendations, was a significant correlate of cholesterol level testing (OR = 1.7; p = 0.006). Actions that promote lifestyle changes, blood pressure, and cholesterol level testing should take into account the needs of the disadvantaged population and should especially target men, people with existing chronic diseases, and those with unfavorable lifestyle characteristics. With respect to the socially-disadvantaged population, the social assistance institutions and outpatient clinics are the best places to conduct activities promoting a healthy lifestyle. The most commonly applied strategies to promote lifestyle changes can cover risk assessment, increasing awareness, emotional support and encouragement, as well as a referral to specialists.

Predictors of Counselling Related to a Healthy Lifestyle Carried Out by a General Practitioner

The aim of the study was to assess whether general practitioners (GPs) monitor and evaluate the health behavior of their patients in the field of a diet, physical activity, and weight control, and whether they provide appropriate counselling as part of this evaluation. Predictors of those activities among physicians were also determined. The cross-sectional study was conducted in the Piotrkowski district among 200 GPs. The questionnaire covered socio-demographic data and lifestyle characteristics of the physicians, their role as healthy lifestyle providers, and whether they assess lifestyle characteristics of their patients and perform healthy lifestyle counselling. More than 60% of the GPs did not evaluate lifestyle features during their patients’ examination. In total, 56% of the GPs provided healthy lifestyle recommendations among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations, and 73% of GPs provided recommendations to patients with chronic diseases related to lifestyle. The study showed that the chance to assess lifestyle characteristics of the patients was significantly higher for the GPs who believed that they were obliged to do so (OR = 6.5; p = 0.002). The chance to recommend a healthy lifestyle among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations was 5.9 times higher among the GPs working in the public sector (p < 0.001) and 16.3 times higher for these who believed that they had sufficient knowledge to provide the advice (p = 0.02). The following predictors of providing a healthy lifestyle counselling among patients with diagnosed chronic lifestyle-related diseases were identified: conviction that a GPs is obligated to provide it (OR = 4.4; p = 0.02), sufficient knowledge (OR = 8.7; p = 0.01), and following health recommendations by themselves (OR = 3.9; p = 0.04). Conclusions: The identified predictors are crucial for the development of appropriate strategies aiming at increasing GPs’ involvement in preventive measures and consequently at improving the population’s health.

Mannose-binding lectin (MBL) in adult patients with inflammatory bowel disease

Inflammatory bowel disease (IBD) refers to disorders associated with progressive inflammatory processes in the gastrointestinal system. IBD consists of two major forms, Crohn's disease (CD), and ulcerative colitis (UC). IBD became a global disease in the 21^st century. Its pathogenesis is still not fully understood. Mannose-binding lectin (MBL) is a pattern-recognising molecule, involved in anti-microbial and anti-cancer immunity. It is able to opsonize microorganisms and abnormal host cells, and to initiate complement activation. The aim of this study was to investigate possible involvement of MBL in inflammatory bowel disease in adults. Forty persons diagnosed with CD and 28 with ulcerative colitis were recruited. The control group consisted of 136 healthy persons. Single nucleotide polymorphisms of the MBL2 gene (localised to both promoter and exon 1) were determined as were serum MBL concentrations. The exon 1 variant alleles and MBL deficiency-associated genotypes were more frequent among patients compared with controls, although this difference was not statistically significant. No differences of MBL levels were found between the major groups. However in MBL2 A/A homozygous IBD patients, the median was significantly higher than in corresponding healthy subjects. That was particularly evident in the case of active Crohn's disease (1493 ng/ml vs. 800 ng/ml, p = 0.021). It may suggest that MBL and MBL-dependent complement activation contributes to excessive inflammation and its adverse effects in the course of CD. It cannot also be excluded that high MBL activity constitutes in some cases part of a multifactorial network conducing to development of CD.

Perceived cessation treatment effectiveness among socially disadvantaged light and heavy smokers

OBJECTIVES

The aim of the current study was to assess the perceived treatment effectiveness and beliefs with respect to the best advisor who could conduct smoking cessation treatment or counseling among socially disadvantaged light and heavy smokers. This could be crucial for implementation of a successful smoking cessation intervention among this vulnerable population.

MATERIAL AND METHODS

The current assessments were based on the data collected during the second wave of a cross-sectional study performed in the Piotrkowski District among 1668 adults aged 18-59, entitled to social aid from welfare institutions. Face-to-face interviews were conducted to collect the relevant data.

RESULTS

The current daily smoking status was declared by 31% of the participants. About 23% of the study sample (74% of daily smokers) admitted to being heavy smokers with a meaningful difference between men and women (p < 0.05). About 29% of the daily smokers indicated that medications/pharmacotherapy could be a good method for giving up the habit. Fifteen percent of the participants shared the opinion that a smoking cessation specialist is the best advisor for counseling, and only about 7% would choose a general practitioner or pharmacist, and even fewer a nurse, as a person who could provide help to smokers. There were no statistically significant differences in any of the evaluated perceptions between the light and heavy smokers (p > 0.05).

CONCLUSIONS

A high share of heavy smokers among socially disadvantaged people, and their perception that medications/pharmacotherapy would be a good solution to quit smoking, underline the need for stronger support for this method, including relevant financing resources and training. However, this method should be applied along with behavioral counseling. Int J Occup Med Environ Health. 2019;32(4):527-36.

Perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland

OBJECTIVES

This study aimed at assessment of the perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland. It is hypothesized that different factors can be considered depending on the level of smoking addiction. Therefore, a comparison between light and heavy smokers was performed.

MATERIAL AND METHODS

Data collected during the second wave of a cross-sectional study carried out in the Piotrkowski District in October 2016 - February 2017 among 1668 socio-economically disadvantaged persons constituted the source of information for the present study. Barriers and motivators to smoking cessation among daily smokers were identified via face-to face interviews.

RESULTS

About one-third of the studied population admitted to being current daily smokers, almost 75% of whom were heavy smokers. The most common barriers to quitting smoking were related to difficulties in quitting (62%), the lack of willingness to quit (56%), as well as addiction and withdrawal symptoms (craving cigarettes [65%], habit [56%], stress and mood swings [55%]). A significantly higher proportion of such barriers was noted among heavy smokers compared to light smokers (p < 0.05). The following motivations to quit were pointed out by the respondents: available pharmacotherapy (47%), access to a free-of-charge cessation clinic (40%), and encouragement and support provided by their doctor (30%), with no differences between various levels of smoking addiction (p > 0.05).

CONCLUSIONS

Developing effective interventions targeted at unique deprived populations requires understanding the barriers and motivators to quitting smoking. Social support and financial issues, including free-of-charge pharmacotherapy and cessation clinics, as well as doctor's encouragement and support, are crucial for successful smoking cessation in this vulnerable population. Int J Occup Med Environ Health. 2019;32(3):363-77.

13910C>T and 22018G>A LCT gene polymorphisms in diagnosing hypolactasia in children

Background

Primary lactose intolerance (PLI) is a gradual decrease of lactase activity that usually manifests at the age of 1-5 years. It has been proved that PLI is related to a single-nucleotide polymorphism of the lactase (LCT) gene.

Objective

An evaluation was performed on the usefulness of genetic tests in detecting LCT 13910C>T and 22018G>A polymorphisms in diagnosing lactose intolerance in children.

Methods

The study group included 99 children aged from 2 months to 16.5 years with different digestive tract symptoms. In all patients a hydrogen breath test (HBT) was conducted and blood samples were collected to determine LCT polymorphisms. PLI was defined as the presence of the 13910CC and/or 22018GG polymorphism in patients with a positive HBT result.

Results

In the group younger than 6 years, no statistically significant correlation was observed between the 13910CC and/or 22018GG LCT polymorphisms and HBT result. In the group of children older than 6, a statistically significant correlation between the 13910CC (p = 0.0011) and 22018GG (p = 0.003) LCT polymorphisms and HBT result was detected.

Conclusions

In children older than 6, the result of genetic testing based on LCT 13910C>T and 22018G>A polymorphisms may diagnose lactose intolerance.

Lectin pathway factors in patients suffering from juvenile idiopathic arthritis

Both complement activation and certain infections (including those with Yersinia sp.) may contribute to the pathogenesis of juvenile idiopathic arthritis (JIA). We investigated factors specific for the lectin pathway of complement: mannose-binding lectin (MBL), ficolins and MBL-associated serine protease-2 (MASP-2), in 144 patients and 98 controls. One hundred and six patients had oligoarticular disease and 38 had polyarticular disease. In 51 patients (out of 133 tested), Yersinia-reactive antibodies were found (JIA Ye+ group). MBL deficiency was significantly more frequent in the JIA Ye+ group than in patients without Yersinia-reactive antibodies or in controls. Median serum ficolin-2 level was significantly lower (and proportion of values deemed ficolin-2 insufficient greater) in JIA patients irrespective of their Yersinia antibody status. The minority (C) allele at -64 of the FCN2 gene was less frequent among JIA patients than among control subjects. No differences were found in the frequency of FCN3 gene +1637delC or MASP2 +359 A>G mutations nor for median values of serum ficolin-1, ficolin-3 or MASP-2. However, high levels of serum ficolin-3 were under-represented in patients, in contrast to MBL. MBL, ficolin-1, ficolin-2, ficolin-3 and MASP-2 were also readily detectable in synovial fluid samples but at a considerably lower level than in serum. Our findings suggest a possible role for the lectin pathway in the pathogenesis of JIA, perhaps secondary to a role in host defence, and indicate that investigations on the specificity of lectin pathway recognition molecules towards specific infectious agents in JIA might be fruitful.

Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland

Background

To prevent adolescents from becoming smokers, it is essential to understand factors that cause them to become susceptible to smoking (SS). The aim of this study was to examine association between individual and school characteristics and susceptibility to smoking initiation and experimentation in the youth.

Methods

We collected cross-sectional survey data from students aged 13–19 years attending 21 schools from Piotrkowski district. Of 4050 students, 3552 respondents, including 2508 non-smokers, filled in an anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey. The univariate and multivariate logistic regression analyses were applied to the study factors linked to SS among the never and ever smoking youth.

Results

About 22 % of the never smoking and 57 % of the ever smoking students were found to be vulnerable to smoking. The youth who were males (OR = 1.4; p = 0.001), who were older (OR = 1.1; p = 0.002) and those, whose mothers had medium (OR = 1.8; p < 0.001) and lower (OR = 4.1; p < 0.001) educational levels were more prone regarding future smoking compared to the females, younger ones and those whose mothers were highly educated. The students who lived in households with no smoking ban (OR = 1.4; p = 0.001) and those who had ever tried cigarettes (OR = 3.5; p < 0.001) were more susceptible to smoking comparing to those who indicated smoke-free home and who had never smoked. In addition, having smoking friends (OR = 2.3; p < 0.001), seeing school personnel smoking on the premises of the school (OR = 1.8; p < 0.001) and perceiving smoking girls more attractive than the non-smokers (OR = 3.8; p < 0.001) were the correlates of smoking susceptibility. Finally, the separate analysis among the never smokers indicated that no school training on tobacco harm (OR = 1.3; p = 0.04) is the additional significant factor for susceptibility to smoking initiation.

Conclusions

SS is prevalent in secondary and high school students in Poland. Personal, social and environmental factors are strongly correlated with SS. When addressing the youth, efforts should be focused on the groups at risk, with a comprehensive approach including multiple factors and involving school personnel, parents and the group leaders in tobacco control activities. Projects aimed at changing social norms around smoking and providing the youth with knowledge and skills to resist smoking are also needed. This may help to implement an effective approach to prevent smoking susceptibility and initiation of tobacco use among the youth.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-016-0092-9) contains supplementary material, which is available to authorized users.

Components of the lectin pathway of complement activation in paediatric patients of intensive care units

Infections are a major cause of childhood mortality. We investigated components of the lectin pathway of complement activation in the context of sepsis at both genetic and protein levels in neonates, infants and older children. Major components of the lectin pathway and two genes for Toll-like receptors were studied in 87 neonates with confirmed sepsis and compared with 40 babies with infections who did not develop sepsis (disease controls) and 273 infection-free neonatal controls. A second cohort comprised 47 older children with sepsis and 87 controls. Low MBL-conferring genotypes (LXA/O+O/O) were more frequent in sepsis patients than in healthy controls but no significant differences in the frequency of SNPs of other lectin pathway genes (FCN1, FCN2, FCN3, MASP1/3, MASP2) or TLR receptor genes (TLR2, TLR4) were found. One case of primary MASP-2 deficiency was found among healthy pre-terms and one neonate suffering from SIRS was heterozygous for the rare FCN1 gene mutation, +6658 G>A. Generally, sepsis was associated with low serum MBL and low ficolin-2 concentrations on admission. Among neonates, ficolin-1 and MASP-2 levels were elevated in sepsis relative to healthy, but not disease, controls. Unlike neonates, ficolin-3 and MASP-2 levels were lower in older patients than in healthy controls while no difference was found for ficolin-1. With the possible exception of MBL, inherited lectin pathway insufficiencies do not seem to predispose to sepsis, rather changes in protein concentrations reflect alterations in disease course.

Patterns of nicotine dependence in four Eastern European countries

BACKGROUND

Evidence of patterns of nicotine dependence, although crucial for developing and implementing effective tobacco control strategies, is limited in the Eastern European countries. The purpose of this study was to evaluate the correlates of high nicotine dependence among adults in Poland, Romania, the Russian Federation and Ukraine.

METHODS

The data used in the current analysis is available from the Global Adult Tobacco Survey (2009-2011). Nicotine dependence was assessed using the Heaviness of Smoking Index (HSI), which covers two measures: reported cigarettes smoked per day and time to the first cigarette upon waking. Based on a six-point scale of HSI, nicotine dependence was categorized into low to moderate (score 0-3), and high dependence (score 4-6). Out of 31,936 completed interviews, we used data from 8229 daily smokers.

RESULTS

The study results indicate that more than 25 % of daily smokers were highly dependent on nicotine. Higher odds of high nicotine dependence were identified for males (OR = 1.5 in Poland and Romania, OR = 2.7 in Russia; p ≤ 0.001), people between 50-59 years of age (the highest odds in Romania; OR = 4.8; p ≤ 0.001) and those who had started smoking at a young age (the highest odds in Romania, OR = 5.0; p ≤ 0.001). Having fewer restrictions on smoking at home was significantly associated with a high level of nicotine dependence (the highest odds in Romania, OR = 3.0; p ≤ 0.001). A high proportion of the participants had no interest in quitting smoking, with a statistically significantly higher percentage observed among smokers highly dependent on nicotine compared to the less addicted (p ≤ 0.01).

CONCLUSIONS

Smokers highly dependent on nicotine constitute a quarter of the Romanian group of daily smokers and even more in the remaining three analyzed countries. Similar patterns of nicotine dependence were observed in all of the investigated countries showing that male gender, younger age at the smoking onset, and fewer restrictions on smoking at home were significantly associated with higher nicotine dependence. The study highlighted the fact that a high proportion of the participants had no interest in quitting smoking. These results underscore importance of policy measures as well as prevention and cessation interventions for smokers who are highly dependent on nicotine, which need to take into account the social gradient in smoking patterns.

Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009-2010)

Background

Expanding the information on determinants of smoking cessation is crucial for developing and implementing more effective tobacco control measures at the national as well as European levels. Data on smoking cessation and its social correlates among adults from middle-income countries of Central and Eastern Europe are still poorly reported in the literature. The aim of the study was to analyze the association of socio-demographic indicators with long term tobacco smoking cessation (quit smoking for at least one year prior to interview) among adults. Moreover, we evaluated motives for giving up smoking from former smokers.

Methods

Data on former as well as current smokers’ socio-demographic and smoking-related characteristics were derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Poland between 2009 and 2010. GATS collected data on a representative sample of 7,840 individuals including 1,206 individuals who met the criteria of long-term smoking cessation and 2,233 current smokers. Smoking cessation rate was calculated as the number of former smokers divided by the number of ever smokers. Logistic regression analyses were used to obtain odds ratios (ORs) and 95% confidence interval (CI) of the broad number of variables on successful cessation of smoking.

Results

Among females the quit rate was 30.4% compared to 37.9% in males (p < 0.01). Former smokers declared concerns about the health hazard of smoking (60.8%) and the high price of cigarettes (11.6%) as primary reasons for smoking cessation. Older age, high education attainment, awareness of smoking health consequences was associated with long-term quitting among both genders. Also employed males had over twice the probability of giving up smoking compared with unemployed, and being religious did not contribute to successful smoking cessation.

Conclusion

Results indicated that smoking cessation policies focused on younger age groups are vital for curbing tobacco epidemic in Poland and should become a public health main concern. There is also the need for interventions to raise awareness on smoking health risks and quitting benefits are crucial to increase cessation potential among adult smokers. Nevertheless further effort needs to be done to prevent smoking uptake.

Changes in smoking prevalence and exposure to environmental tobacco smoke among adults in Łódź, Poland

Comprehensive monitoring informs the stakeholders about the level of tobacco epidemic and helps to allocate tobacco control resources where they are most needed and will be most effective. The aim of the paper was to evaluate the prevalence of daily cigarette smoking and environmental tobacco smoke (ETS) exposure among adult citizens of Łódz area in Poland between year 2001 and 2010 by selected characteristics.

MATERIAL AND METHODS

For the purpose of the presented analysis, data were used from 3 cross-sectional studies on randomly-selected 3,874 adults from the Łódź area, conducted in 2001, 2005 and 2010. Changes in the rates between the surveys were assessed by odds ratio.

RESULTS

Smoking prevalence remained stable but high between 2001-2010. There was an inverse relationship between smoking prevalence and educational level for both genders (p for trend ≤0.01) in each survey. For men in all surveys, the prevalence of current daily tobacco smoking decreased with increased income (p for trend ≤0.01), and also for women in the 2009-2010 survey (p for trend =0.03). The statistically significant changes for the comparison of 2001 and 2005 surveys were observed for exposure to ETS (p<0.001). Percentages of men and women who declared exposure to environmental tobacco smoke at least one hour per day decreased significantly. Furthermore, the proportion of people who declared exposure to ETS decreased with the increasing age of participants (p for trend ≤0.005), level of education for men in both surveys, and for women in the 2001 survey (p for trend ≤0.003), and income for both men and women in the 2001 survey (p for trend <0.001).

CONCLUSION

Established, long-term tobacco surveillance systems of smoking and ETS exposure, based on nationally and locally representative samples, are necessary in Poland.