Realities of ambulatory multi-drug treatment of chronic diseases in rural areas of Lublin Province, eastern Poland - comparison of situations in 2010 and 2013.

INTRODUCTION: The economic stratification observed for many years among the population in Poland, increasing poverty rates, especially those being effects of the current economic crisis in the country, and the rising prices of medicines, are potential risk factors for medication non-adherence among patients in the poorest class of the Polish population. Materials an method. The subjects were 2 groups of inhabitants of rural areas of Lublin Province in eastern Poland. The first consisted of 209 people aged 52-80 years who were surveyed in 2010, the second - 210 people aged 51-88 years, surveyed in 2013. All patients were outpatients who attended the Endocrine Clinic in Poniatowa. The studies were conducted with the use of the standardized survey questionnaire. RESULTS: The problem of medication non-adherence among the surveyed was evident and has risen from 43.1% in 2010 to 54.8% in 2013. Both in 2010 and in 2013, the main reasons for this state of affairs were the financial problems of the surveyed people. During the period 2010-2013, both expenditure on medicine as well as the ratio "patients' expenditure on medicine/expenditure on food" had increased. In 2010, 25 respondents per 209 (12%) expressed the opinion that they had always had sufficient means to buy necessary medications, in 2013 - only 3 per 210 (1.5%). CONCLUSIONS: In 2013, most of surveyed patients (54.8%) did not follow prescribed treatment plans (in 2010-43.1%). In most cases, medication non-adherence were the result of financial problems. Current regulations governing refunding of the costs of medicines may make effective ambulatory treatment of chronic diseases impossible.

Lifestyle as an important factor in control of overweight and obesity among schoolchildren from the rural environment.

INTRODUCTION: Lifestyle of an individual is responsible for sixty percent of his/her state of health. Many studies of this problem indicate that in the style of life of schoolchildren, anti-health behaviours dominate over health promoting behaviours. OBJECTIVE: The objective of the presented study was recognition of the lifestyle of the rural adolescents with overweight and obesity. MATERIAL AND METHODS: The study covered adolescents aged 15-19, living in the rural environments of the West Pomeranian Region. Finally, the analysis covered 2,165 schoolchildren, and was performed with the use of a self-designed questionnaire form and the BMI was applied. RESULTS: The study showed that overweight occurred more often in the group of examined girls than boys, while obesity was twice as frequent among boys than among girls. Overweight schoolchildren (35.1%) had an adequate diet, while those obese--inadequate (78.3%). In the group of schoolchildren with overweight, passive leisure prevailed over active forms of leisure, 83.8% and 16.2%, respectively. Passive leisure was also dominant among obese respondents. Among as many as 81.8% of schoolchildren with overweight, physical activity was mediocre, while only 8.1% of them were active. The highest percentage of respondents with obesity were totally inactive physically. Obese schoolchildren relatively often experienced stressful situations. It is an alarming fact that both overweight and obese schoolchildren relatively often used psychoactive substances. CONCLUSIONS: A considerable number of respondents with overweight and obesity applied an adequate diet, preferred passive forms of leisure, experienced stressful situations, were characterized by low physical activity, and systematically used psychoactive substances.

The impact of economic factors on the realities of outpatient multi-drug treatment of chronic diseases in rural areas.

The reform of the health care system in Poland introduced in 1999 brought not ony a lot of disappointments arising from the failure in performing its basic assumptions, but also from the deterioration in access to medical care by patients coming from the poorest class of the Polish population. The subjects were 209 people at the age of 52-80 years including 149 women and 60 men - inhabitants of rural areas of Lublin province. These were outpatients who attended the Endocrine Clinic in Poniatowa. The studies were conducted with the use of the standardized survey questionnaire. Of all 209 respondents requiring long-term multidrug therapies for chronic diseases, 128 (61.2% of those surveyed) reported episodic or permanent noncompliance to treatment regimens, 90 people (43%) had applied medications in a way at variance with medical recommendations. Among the reasons, economic factors were most often mentioned. Ony 21 respondents (10%) expressed the opinion that they had always possessed sufficient means to buy necessary drugs. Current regulations concerning the refunding of costs of medicines may make effective outpatient treatment of chronic diseases impossible. Almost 61.2% of the polled treated themselves contrary to medical recommendations. In most cases, improper courses of treatment were caused by financial problems.

Eating habits of children and adolescents from rural regions depending on gender, education, and economic status of parents.

The proper lifestyle of a child, including proper eating habits, should be monitored to ensure proper physical and psychological development. This applies particularly to rural areas which are economically, socially and educationally backward. The study included 1,341 rural schoolchildren and adolescents aged 9-13 years (734 females, 607 males). The representative survey research was conducted in 2008, making use of an original survey questionnaire. The results showed that the majority of respondents eat improperly. 83.2% of them have regular breakfast, and 62.6% have regular light lunch. Most respondents do not eat more than 4 meals a day (usually 3-4). It is worrying that the consumption of sweets is high (34.9% of the surveyed group eat them regularly), whereas fruit and vegetable consumption is low. In this study, relationships between types of diet and such descriptive variables as gender, parents' educational status, and economic situation of the households are described. In families where the parents have a higher education and the household situation is good, the eating habits are much better. The list of poor dietary habits of pupils from rural schools includes skipping breakfast and/or light lunch, high consumption of sweets and low consumption of fruit and vegetables. There are correlations between improper dietary habits and gender of the children and adolescents, educational status of parents, economic situation of households, and housing conditions.

[Congenital and genetic related causes of end-stage renal disease--data from Polish Registry of Renal Rreplacement Therapy in Children 2000-2004]. / Genetycznie uwarunkowane i wrodzone choroby nerek prowadzace do schylkowej niewydolnosci nerek--dane z polskiego rejestru dzieci leczonych nerkozastepczo (2000-2004).

UNLABELLED: One of the objectives of Polish Registry of Renal Replacement Therapy in Children established on 31st Dec. 2000 was to collect complete data on etiology of end stage renal disease (ESRD) in polish children. MATERIAL AND METHODS: Data on 469 patients (251 boys, 218 girls) aged 0-22 years treated with renal replacement therapy (RRT) at 13 pediatric dialysis units in Poland from 2000 to 2004 were analyzed. The mean age at start of dialysis was 10 years and 3 months. Renal diseases were defined according to EDTA coding system. Data is presented for the whole group, in 5-year age groups and separately for both sexes. RESULTS: Congenital and genetic renal diseases were the cause of ESRF in 56% of the polish population of children and adolescents on RRT. 39% of causes were acquired diseases, 5% remained unidentified. Congenital and genetic causes dominated in children < 5 years of age (71%). They accounted for 49%, 61% and 45% of causes in the consecutive 5-year age groups. The most numerous group of congenital diseases leading to ESRF were uropathies 37% and 25% of causes in the consecutive age groups. In boys the most frequent uropathy was obstructive uropathy (25%), the majority caused by posterior urethral valves. In girls the most frequent uropathies were reflux nephropathy (10%) and nephropathy secondary to neurogenic bladder (9%). Uropathies were followed by renal hypo-dysplasia without urinary tract anomalies (11%) and cystic diseases (10%). CONCLUSIONS: Congenital kidney anomalies and genetic diseases are the leading cause of end-stage renal disease in children up to 15 years of age.

[Acquired Fanconi-de Toni-Debre syndrome due to therapy for Ewing's sarcoma in 5-years old boy]. / Nabyty zespól Fanconi-de Toni-Debre w przebiegu terapii miesaka Ewinga u piecioletniego chlopca.

We present a 5-years old boy with acquired Fanconi-de Toni-Debre syndrome being a effect of therapy for Ewing's sarcoma. At the age of 3 years, this boy was diagnosed as suffering from Ewing sarcoma of his right femur. The boy received a course of 8-month pre-surgery (6 VIDE--Vincristine, Ifosfamide, Doxorubicin, Etoposide cycles and 2 VAI--Vincristine, Actinomycin, Ifosfamide cycles) and 6-month post-surgery (6 VAI--Vincristine, Actinomycin, Ifosfamide cycles) cytostatic therapies according to EWING, EURO 99 protocol. In forth month of post-surgery cytostatic therapy, progressive malaise, polyuria, polydypsia, and recurrent vomiting occurred. The association between those symptoms and malignancy was excluded. Laboratory studies revealed hypokaliemia, hypophosphatemia, proximal tubular acidosis, proteinuria, glucosuria, aminoaciduria, hyperkaliuria and hyperphosphaturia. Acquired Fanconi-de Toni-Debre syndrome due to toxic effect of cytostatic therapy on renal proximal tubules was diagnosed. At present, two years after the time the diagnosis was made, despite constant substitution of potassium, phosphates and bicarbonates, deficit of body mass and height, and bone mineral density abnormalities are observed.

[The diagnosis of familial hypomagnesemia with hypercalciuria and nephrocalcinosis in a girl with acute lymphoblastic leukemia--case report]. / Rozpoznanie rodzinnej hipomagnezemii z hiperkalciuria i nefrokalcynoza u dziewczynki chorej na ostra bialaczke limfoblastyczna--opis przypadku.

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) is a rare autosomal recessive tubulopathy resulting from mutation in the gene encoding paracelin 1. The main symptoms of FHHNC include excessive urinary calcium and magnesium excretion, nephrocalcinosis, and chronic renal failure. We present 16-year old girl in whom symptoms of FHHNC were accidentally recognized during therapy of acute lymphoblastic leukemia. In our patient, some symptoms of FHHNC were initially taken for the adverse effects of cytostatic therapy that delayed an adequate diagnosis. To the best of our knowledge, this is the first report of FHHNC associated with acute lymphoblastic leukemia. However, in our opinion this association is accidental.