[Relationship between healthy lifestyle behaviours and subjective wellbeing: an european observational study.] / Relación entre los estilos de vida saludables y el bienestar subjetivo: estudio observacional europeo.

OBJECTIVE: A healthy lifestyle is related to physical and mental health. The aim of this study was to assess whether different healthy lifestyle behaviours are associated with experiential and evaluative well-being. METHODS: A total of 10,800 participants from Finland, Poland and Spain were interviewed in 2011-2012. Physical activity, fruit and vegetable consumption, smoking, alcohol use, and sleep quality were self-reported. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using an abbreviated version of the Day Reconstruction Method. Multivariate regression analyses were performed. RESULTS: Healthy lifestyle behaviours (consumption of five or more servings of fruit and vegetables per day, moderate or high physical activity, being a non-daily smoker, and having a good sleep quality) were positively associated with evaluative well-being (ß=0.23 p<0.001; ß=0.16, p<0.001; ß=0.26, p<0.001; ß=0.23, p<0.001, respectively), after controlling for confounding variables such as health and depression. Good sleep quality was related with higher positive affect (ß=0.29, p<0.001), lower negative affect (ß=-0.15, p<0.001) and higher life satisfaction (ß=0.23, p<0.001), after adjusting for those confounding variables. CONCLUSIONS: A healthy lifestyle is an important correlate of well-being independently of its effects on health. Healthy lifestyles could be considered when developing strategies to improve not only the physical health, but also the well-being of the population.

OBJETIVO: Un estilo de vida saludable está relacionado con la salud física y mental. El objetivo de este trabajo fue evaluar si diferentes comportamientos de estilo de vida saludable estaban asociados con el bienestar subjetivo. METODOS: Se entrevistó a un total de 10.800 participantes de Finlandia, Polonia y España en 2011-2012. La actividad física, el consumo de frutas y verduras, el tabaco, el alcohol y la calidad del sueño fueron autoinformados. La satisfacción con la vida se midió con la Cantril Self-Anchoring Striving Scale. El afecto positivo y negativo se evaluaron utilizando una versión abreviada del Método de Reconstrucción del Día. Se llevaron a cabo análisis de regresión múltiple. RESULTADOS: Las conductas de estilo de vida saludable (consumo de cinco o más frutas y verduras al día, actividad física moderada o alta, no fumar a diario y tener una buena calidad del sueño) se asociaron positivamente con el bienestar evaluativo (ß=0,23, p<0,001; ß=0,16, p<0,001; ß=0,26, p<0,001; ß=0,23, p<0,001, respectivamente), después de controlar por variables de confusión como la salud y la depresión. La buena calidad del sueño se relacionó con mayor afecto positivo (ß=0,29, p<0,001), menor afecto negativo (ß=-0,15, p<0,001) y mayor satisfacción con la vida (ß=0,23, p<0,001), después de ajustar por dichas variables de confusión. CONCLUSIONES: Un estilo de vida saludable se correlaciona de manera importante con el bienestar, independientemente de sus efectos en la salud. Los estilos de vida saludables podrían ser considerados a la hora de desarrollar estrategias que mejoren no solo la salud física, sino también el bienestar de la población.

Non-alcoholic fatty liver disease in Poland: how and at what stage is diagnosed, and how is treated. A survey study.

INTRODUCTION: Epidemiological studies show an increasing incidence of overweight and obesity all over the world, leading to an increase in the number of patients consulted due to liver damage. AIM: Assesement to which doctors (general practitioners or specialist) refer patients with elevated liver enzymes in Poland, how they are diagnosed and treated. MATERIAL AND METHODS: We conducted questionnaire surveys among 1322 doctors of various specialties to find the most common causes of liver disease, at which stage of the disease patients reported to doctors, and what schemes of management are followed. RESULTS: Non-alcoholic fatty liver disease (NAFLD) was the most common cause of abnormal liver enzymes (59.7%). Patients with liver damage most often reported to internal medicine specialists (59%) and gastroenterologists (27.5%). The diagnosis was based on abnormal aminotransferases (80.8%) and abdominal ultrasound examination (89.9%). Computed tomography/magnetic resonance imaging (50.2%) and liver biopsy (22.4%) were used to assess fibrosis. Almost all respondents recommended reduction of body mass and lifestyle changes, and less than half (46.4%) recommended pharmacological treatment. CONCLUSIONS: NAFLD was the most common liver disease that was the reason for medical consultations, but its incidence seems to be underestimated due to referral for further diagnostics only in patients with abnormal aminotransferases. The diagnostic methods used to assess the severity of the liver fibrosis and the recommended pharmacological treatment varied depending on the physician's specialisation and the centre's reference level.

Frailty and health status of older individuals in three European countries: The COURAGE cross-sectional study.

BACKGROUND AND AIM: Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged ≥50 years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants. METHODS: Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain (n = 7987 individuals aged ≥50 years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted. RESULTS: The factor analysis on the components of the index extracted three main dimensions for frailty (disability and daily functioning, cognitive function, chronic health conditions), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits. CONCLUSIONS: These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty.

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.

Health determinants and survival in nursing home residents in Europe: Results from the SHELTER study.

OBJECTIVE: The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. DESIGN: Multicentre longitudinal cohort-study. SETTING: 57 nursing homes (NH) in 7EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). PARTICIPANTS: 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. MEASUREMENTS: We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. RESULTS: During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. CONCLUSIONS: Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

Determinants of Quality of Life in Ageing Populations: Results from a Cross-Sectional Study in Finland, Poland and Spain.

PURPOSE: To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18-50 and 50+. METHODS: In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately. RESULTS: Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics. CONCLUSIONS: Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study.

BACKGROUND: The aim of this study was to evaluate the factors associated with low skeletal muscle mass (SMM), sarcopenia, and sarcopenic obesity using nationally representative samples of people aged ≥65 years from diverse geographical regions of the world. METHODS: Data were available for 18 363 people aged ≥65 years who participated in the Collaborative Research on Ageing in Europe survey conducted in Finland, Poland, and Spain, and the World Health Organization Study on global AGEing and adult health survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. A skeletal muscle mass index (SMI) was created to reflect SMM. SMM, SMI, and percent body fat (%BF) were calculated with specific indirect population formulas. These estimates were based on age, sex, weight, height, and race. Sarcopenia and sarcopenic obesity were defined with specific cut-offs. RESULTS: The prevalence of sarcopenia ranged from 12.6% (Poland) to 17.5% (India), and that of sarcopenic obesity ranged from 1.3% (India) to 11.0% (Spain). Higher %BF was associated with lower SMM in all countries, and with sarcopenia in five countries (p < 0.001). Compared to high levels of physical activity, low levels were related with higher odds for sarcopenia [OR 1.36 (95%CI 1.11-1.67)] and sarcopenic obesity [OR 1.80 (95%CI 1.23-2.64)] in the overall sample. Also, a dose-dependent association between higher numbers of chronic diseases and sarcopenic obesity was observed. CONCLUSIONS: Physical activity and body composition changes such as high %BF are key factors for the prevention of sarcopenia syndrome.

Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective.

The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of >0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability.

[Preoperative quality of life in women with pathological alteration in breast]. / Jakosc ycia kobiet ze zmianami patologicznymi piersi w okresie przygotowawczym do zabiegu chirurgicznego.

The aim of the study was to assess the similarities or differences in the psychosocial response to primary diagnosis of malicious or benign tumor in breast significantly influenced the quality of life in women in preoperative period. Health-related quality of life has been studied in the preoperative period in the group of 59 patients with malicious tumor and in the group of 130 women with benign tumor in comparison to 126 healthy women. Study was performed using self-administered questionnaire consists of The Rand Mental Health Inventory (three distress scores include depression, anxiety and loss of behavioral or emotional control; two well-being scores include general positive affect and emotional ties), COOP Charts (measuring nine dimensions of QOL), subscale focus on social support was used for the presented analysis; additionally questions concerning demographic and social characteristics of women as well as questions on illness behaviors have been involved. Statistical analysis was performed using multidimensional models of logistic regression. Results based on multidimensional logistic regression models showed higher risk of anxiety (OR=4,0; 95% CI=(1,8; 8,6)), depression(OR=3,0; 95% CI=(1,4; 6,2)) and distress (OR=2,5; 95% CI=(1,2; 5,3)) in women with malicious tumor in comparison to healthy women. Comparatively, higher risk of anxiety (OR=1,8; 95% CI=(1,0; 3,2)) and depression (OR=2,0; 95% CI=(1,2; 3,5)) among women with benign tumor in regard to healthy ones. Further examination of determinants of components of mental health among three analyzed group of women showed that among women with benign tumor higher risk of anxiety (OR=3,5; 95% CL=(1,2; 10,5)), depression (OR=3,2; 95% CI=(1,2;9,1)) and loss of behavioral or emotional control ((OR=4.3; 95% CI=(1,5;12,0)) as well as distress (OR=4,3; 95% CI=(1,5;13,0)) was related with considerable reduction of receiving support. Women with malicious tumor also indicated that slightly reduction of the received support was associated with higher risk of the loss of behavioral or emotional control (Isz=6,6; 95% PU=(1,4; 30,8)). Results confirmed that also diagnosis of benign tumor in breast is perceived as an event which significantly decreased quality of life in preoperative period. Interactions between medical staff - and patients with any change in breast should based on good verbal communication, giving information which help understanding by patients all aspects of diagnosis and expected treatment.

Health-related quality of life in women after cancer treatment.

Cancer survivorship is the term used to represent the state or process of living with cancer or living after diagnosis of cancer. Living with cancer or living after cancer--are conditions characteristic to an increasing number of long-term survivors ("society of remission"); health-related quality of life in these individuals is an important indicator of successful treatment and patient's satisfaction. Health-related quality of life in oncological patients has remained one of the main topic of research. The present paper reviews psychosocial outcomes in breast cancer (female disease) and gender-related differences in health-related quality of life in colon cancer survivors. Breast cancer diagnosis is usually associated with several expected psychosocial consequences like psychosocial distress. Specific psychological variables like body image, fear, satisfaction with treatment and cosmetic evaluation may improve general will to live. Women who perceive support from family and friends have better coping and psychological adjustment, while lack of social support is a risk factor for anxiety and depression. Colon cancer remains an important medical and social problem in Poland; polish data showed the following gender-related differences: in patients with stoma, women reported lower level of psychological well-being than men, reported increasing level of stress and loss of control over emotions and behaviours.

Adaptation of quality of life module EORTC QLQ-CR29 for Polish patients with rectal cancer: initial assessment of validity and reliability.

Heath related quality of life has been an important object of interest in the clinical practice, focused on assessment of treatment effects from patient's point of view, with particular emphasis placed on effect of treatment on daily patient functioning. Concept of health-related quality of life needs valid and reliable instruments.The aim of the study was to present the process of validation of a new version of EORTC QLQ-CR29 module in Polish patients suffering from rectal cancer.Material and methods. EORTC QLQ-CR29 module comprises 29 questions, and was adapted to Polish cultural conditions based on EORTC procedure. Data collected from 20 patients were analyzed, their agreement with theoretical and empirical structure was assessed. Convergent and discriminant validity were analyzed with multi trait scaling.Reliability was assessed with Cronbach alpha coefficient. Known group validity was assessed in terms of differences between men and women, and between stoma and non-stoma patients. Exact Mann-Whitney test was used. P values lower than 0.05 were considered significant.Results. Scales built on bases of empirical model of module had higher validity and reliability than those based on theoretical model.There were no significant differences between men and women in health-related quality of life. Significantly higher values were observed in non-stoma patients on body image scale and for leakage of stool item. Reversed relationship was observed in case of abdominal and buttocks pain, as well as embarrassment because of bowel movements.Conclusions. Module CR29 is a valid and reliable tool, which enables standardized measurement of treatment effects, suggested for use as main tool measuring impact of disease itself and applied treatment on health-related quality of life of rectal cancer patients.

[Validity and reliability of the quality of life questionnaire (EORTC QLQ C30) and its breast cancer module (EORTC QLQ BR23)]. / Trafnosc i rzetelnosc kwestionariusza oceny jakosci zycia EORTC QLQ C30 oraz jego modulu dotyczacego pacjentek z nowotworami piersi (EORTC QLQ BR23).

OBJECTIVES: The aim of this study was to assess validity and reliability of the EORTC QLQ C30 and BR23 questionnaires among patients with breast neoplasm in Poland. MATERIAL AND METHODS: Analysis was done on the basis of research conducted at the First Department of General Surgery JUMC, Kraków, among 105 women. Two aspects of questionnaire validity have been analyzed: construct validity using principal component analysis and criterion validity evaluated by comparison of two clinical subgroups of patients. Reliability analysis was done by estimating internal consistency using Cronbach's alpha coefficient and correlations between items and hypothesized scales. In addition, test-retest reliability was evaluated by calculating the correlation coefficient between two assessments, done 6 and 12 months after treatment. RESULTS: All scales met Nunnally's criterion except for the scale of nausea and vomiting. Almost all variables met Kline's criterion, except for two variables: one from the scale of physical functioning and the other a part of the scale of systemic therapy side effects. High correlations obtained by the test-retest method confirmed the reliability of all scales. Analysis showed some fault in the theoretical validity of the scale of systemic therapy side effects. Nonetheless, criterion validity was confirmed for all scales. CONCLUSIONS: Results have confirmed the validity and reliability of the EORTC QLQ C30 and BR23 tests as instruments for quality of life evaluation in Polish patients.

[Psychosocial consequences of genetic susceptibility on development of disease]. / Psychospoleczne konsekwencje genetycznej podatnosci na choroby.

The development of predictive genetic DNA- tests gives people the choice "to know" or "not to know" a decision with tremendous short-mid- and long-term consequences. Family history of disease can provide information about the increased risk of susceptibility, and these knowledge may have psychosocial implication. The results of studies using genetic testing and their psychological impact are discussed with regard to hereditary cancer (breast, colorectal, prostate) as well as particular neurogenetic disease (e.g. Huntington' disease). Psychological studies on genetic risk concentrating on psychological adjustment, transfer of information within the family and perception of genetic risk in families showed that genetic disease had a considerable impact on family life (e.g. reproductive decisions). Findings showed that people with a family history of cancer (without genetic testing) vary in their illness behaviour, but little is known about the effect of inheredited predisposition to disease (e.g. cancer) on such health related behaviour as smoking, diet, activity level. Genetic information could both increase (strengthening the belief that current behaviour combined with genetic predisposition is putting person at increasing risk of disease) and decrease motivation to change behaviour (weakening belief that changing behaviour will reduce risk of disease because genetic is immutable).

[Protective effects of physical activity in the occurrence of colon cancer]. / Rola aktywnosci fizycznej w zapobieganiu zachorowaniom na raka jelita grubego.

The purpose of the study was to assess the role of occupational and leisure physical activity on the risk pattern of colon cancer considering the possible confounding effects of dietary habits. Case-control study has been carried out in 180 incident cases of colon cancer hospitalized in Chair of Surgery CMUJ in Kraków. The equal number of controls individually matched by gender and age were chosen amongst patients with no history of cancer from the university hospital. Food frequency questionnaire combined with quantity of foods eaten was used to assess the usual dietary patterns for 148 food items. The occupational physical activity of the interviewed subjects before the occurrence of the disease was assessed by self-rating. Leisure time activity was measured by the number of hours watching TV. The adjusted risk of colon cancer was reduced by half in those being active in leisure time (OR = 0.56, 95% CI: 0.32-0.98). The effect of occupational physical activity had the same order of magnitude in terms of risk reduction (OR = 0.56; 95% CI: 0.28-1.10). The protective effect of healthy nutrition appeared to be independent from that attributed to physical effort.

Alcohol consumption and the risk of colorectal cancer at low levels of micronutrient intake.

BACKGROUND: The purpose of our study was to assess the relationship between simultaneous exposure to alcohol and consumption of micronutrients that may have protective properties against colorectal cancer. MATERIAL/METHODS: This hospital-based case-control study of colorectal cancer was carried out between January 1998 and November 1999 in Cracow, Poland. A total of 180 cases of colorectal cancer confirmed by histopathology were recruited from the University Hospital in Cracow. An equal number of controls, individually matched by gender and age (+/- 5 years) were chosen from among patients from the same hospital with no history of cancer. An interviewer-administered food frequency questionnaire covering 148 food items, including the quantity consumed, was used to assess the typical dietary pattern. RESULTS: When the analysis was carried out on quartile intake data, a consistent inverse association was confirmed between the intake of retinol, thiamine or antioxidant micronutrients (carotene, vitamin C and E) and the occurrence of colorectal cancer. Alcohol intake appeared to be an important risk factor for this cancer site, and the risk increased with the amount of pure alcohol intake. The group with deficient intake of retinol, carotene, and vitamins C and E, but with higher consumption of alcohol, incur a noticeably high risk of colorectal cancer (OR=6.79; 95%CI: 2.08-22.18). CONCLUSIONS: The data support the hypothesis that higher consumption of alcohol, when combined with low micronutrient intake, may considerably increase the risk of colorectal cancer.