The relationship between ambient air pollution and life expectancy - an ecological fallacy revisted.

INTRODUCTION: The results of multiple studies indicate the negative impact of exposure to air pollution on human life expectancy. Epidemiological evidence on this relation is in large proportion provided by ecological studies, what causes interpretation difficulties. Poland is a country characterized by large territorial differences in ambient air pollution and in life expectancy. This promotes analyses of the mentioned relationship based on ecological model. AIM: The aim of the study was to analyse the results of a simple ecological study concerning the relationship between life expectancy and air pollution with the focus on the difficulties in interpretation of the results. MATERIAL AND METHODS: The study used a simple ecological study approach. We used the official data on sex-specific life expectancy for year 2018 and annual average ambient air concentrations of PM2.5 in years 2010-2018 for 10 large metropolitan areas in Poland. The data was used as a marker of long-term air pollution levels in particular areas. Associations between life expectancy and air pollution levels were assessed using Spearman correlation analysis. RESULTS: The analysis concerning exposure to air pollution and life-expectancy in several Polish large agglomerations did not show statistically significant associations. CONCLUSIONS: Our ecological study did not show statistically significant associations between life expectancy and ambient air pollution levels measured by means of PM2.5 concentrations. Ecological nature of the population's exposure marker, without considering many important factors influencing length of life, may explain the negative results of the correlation analysis. This is an example of so called ecological fallacy, affecting the used model of epidemiological study.

Acute cardiorespiratory response to ambient air pollution exposure during short-term physical exercise in young males.

BACKGROUND: Physical exercise in the presence of ambient air pollution may increase the absorbed dose of air pollutants. The combined effect of such exposure on cardiorespiratory function in young adults remains unclear. AIM: To determine the acute cardiorespiratory responses in healthy young adults preforming submaximal physical exercise under exposure to high level winter-type ambient air pollution. METHODS: Healthy young males (n=30) performed two separate 15-minute submaximal exercise trials on a cycle ergometer - when air pollutants' concentrations were increased (exposure trial) and when air quality was good (control trial). Each time blood pressure, pulse oximetry, spirometry and fractional exhaled nitric oxide (FeNO) were measured at baseline, directly after exercise and after 15-min of rest. RESULTS: High air pollutants concentrations were observed during exposure trials (PM2.5 24.0-157.0 µg/m3, SO2 8.7-85.8 µg/m3). Group-based correlation analysis showed statistically significant negative correlations between post-exercise declines in FEV1/FVC and SO2, PM10 and PM2.5 concentrations. In individual cases the decrease was recorded only in subjects who exercised under particularly high exposure, and was not related to their BMI, physical activity pattern or allergy status. In multivariate analysis SO2 was a statistically significant predictor of both immediate (OR: 1.09, 95%CI: 1.01-1.17) and delayed decrease in airflow (OR: 1.08, 95%CI: 1.01-1.16), and PM2.5 was also a statistically significantly explanatory variable of post-exercise decline in FEV1/FVC (OR: 1.03, 95%CI: 1.00-1.06). CONCLUSION: In young and healthy males exposure to ambient air pollution during short-term submaximal exercise is associated with a decrease in airflow (FEV1/FVC) and the decrease is more apparent when the exercise takes place under particularly high exposure conditions.

Spatial variability of SARS-CoV-2 infection in the Silesian voivodeship, Poland.

INTRODUCTION: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and related to infection COVID-19 (coronavirus disease 2019) remain a new and global challenge for public health. Due to the location, specifics of employment, and the high density of population in the Silesia voivodeship it is appropriate to study the available epidemiological data in a region with a potentially higher risk of infection. MATERIAL AND METHODS: In the descriptive model of the study, data on the number of infected, hospitalized, and dead people due to SARS-CoV-2 infection were analyzed. The source of information was daily reports conducted by the Provincial Sanitary and Epidemiological Station in Katowice, in the period from March 5 to August 18, 2020. RESULTS: Results of antigenic molecular tests for SARS-CoV-2 infection in the Silesian voivodeship indicate that in the first half of 2020, the infection rate was approximately 5% and the symptomatic form of the disease was approximately 20%. CONCLUSIONS: The analysis of the frequency of infection and mortality in the poviats reveals a large variation in the occurrence of both phenomena, but the explanation of this difference is not possible due to the descriptive nature of the analysis and the secondary form of epidemiological data.

Impact of changing GOLD guidelines (2007-2011-2017) on assignment of a COPD patient to disease severity category.

INTRODUCTION: The international standard for the recognition and treatment of chronic obstructive pulmonary disease (COPD) is guided by a regularly updated set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). AIM: To investigate the impact of updated COPD management guidelines from 2007 to 2017 (GOLD 2007, GOLD 2011 and GOLD 2017) on the assignment of patients into individual therapeutic groups, examining both individual and population dimensions. MATERIAL AND METHODS: Each of 500 randomly chosen primary care physicians in Poland provided information on 10 individual COPD patients (disease history, clinical status, treatment and pharmacotherapy). This data was used to simulate the consequences of the implementation of the GOLD 2007, 2011 and 2017 guidelines. RESULTS: A group of 298 physicians of 500 approached provided information on 2597 patients (64.2% males) aged 29-96 (61.6 ±11.1 years). Based on GOLD 2007 guidelines, most patients (56.7%) presented a severe stage of COPD. GOLD 2011 updates would significantly increase the proportion of patients with the most severe stage of disease, and this group would be predominantly classified as moderate or severe in GOLD 2007. The implementation of GOLD 2017 guidelines would result in a significant migration of patients towards the lightest (category A) form of the disease. CONCLUSIONS: Updates to the GOLD 2007 COPD guidelines for GOLD 2011 and 2017 would have a significant impact on the classification of patients for particular therapeutic groups. As a result of the migration of patients to particular therapeutic groups, the pharmacological treatment would also change.

Childhood asthma in Batumi, Georgia: Prevalence and environmental correlates.

OBJECTIVE: A relative lack of data for Eastern Europe and unknown epidemiology of childhood asthma in Batumi (Georgia) justified a study aimed at determining the prevalence of physician-diagnosed asthma and related respiratory conditions, a comparison of the prevalence of these conditions between urban and rural children, and identification of their environmental correlates. METHODS: Subjects of the cross-sectional population-based study were 3238 urban and 2081 rural children aged 5-17 years whose respiratory status was assessed using the ISAAC questionnaire. RESULTS: The overall prevalence of asthma was larger in rural children than in urban children (2.8% vs. 1.8%, respectively; p = 0.01). Spastic bronchitis occurred with similar frequency in urban (7.8%) and rural children (6.5%). Compared with urban children, rural subjects had dry cough at night (13.1 vs 8.2%, p < 0.001) and attacks of dyspnea (4.7 vs 2.4%, p < 0.001) more often. The prevalence of other symptoms did not differ significantly between urban and rural subjects. Results of multivariate analyses showed that both asthma and spastic bronchitis were associated (p < 0.05) with parental history of asthma, dampness in the house, and poor financial standing of the family. In addition, asthma was related to coal/wood-based heating whereas spastic bronchitis was associated with passive smoking and lower parental education. CONCLUSIONS: The findings show a low prevalence of ever-diagnosed asthma in the examined population. Nosological tradition and similar correlates of asthma and spastic bronchitis suggest that some cases of asthma might be included in the diagnostic category of spastic bronchitis.

Comparison of spirometric results obtained from the sitting and standing position in children participating in an epidemiological study.

INTRODUCTION: It is recommended that spirometric testing in children be completed while sitting. Our experience indicates that children prefer standing during spirometry. AIM: We sought to compare spirometric results obtained from the sitting (SIP) and standing (STP) positions. MATERIAL AND METHODS: Two testing sessions were performed in random order (SIP vs. STP: 30-45 min apart) in 118 children (7-13 years), attending one, randomly selected, primary school (response rate: 92%). RESULTS: Acceptable quality was found in 77.9% of STP and 77.1% of SIP maneuvers. Higher values of spirometric variables on STP, compared to SIP, were obtained for forced vital capacity (FVC) (2.12 ±0.41 l vs. 2.11 ±0.39 l) and forced expiratory volume in 1 s (FEV1) (1.78 ±0.36 l vs. 1.77 ±0.35 l) but the differences were not statistically significant. Relative between-position differences (RBPD) ≤ 5% were found with the following frequencies: FVC: 56.4%, FEV1: 69.2%, PEF: 21.7%, and FEF25-75: 24.3%. Similar patterns were found for FEF25, FEF50, and FEF75. Relative between-position differences were related to age in the case of FEV1 (p = 0.005), FEF25 (p = 0.02), and FEF25-75 (p = 0.01) where older children had smaller RBPD. Forced vital capacity RBPD was lower (p = 0.01) in subjects with current wheeze; PEF RBPD were lower (p = 0.02) in children with asthma. CONCLUSIONS: In epidemiological studies, the position of spirometric testing does not affect the results of lung function assessment.

[Profile of adults suffering from COPD in Poland].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in adults. It is estimated, that in Poland around two million people suffer from COPD. THE AIM: The aim of this study, was to characterize population of patients with COPD in Poland. MATERIAL AND METHODS: The study, established and coordinated by the Polish Respiratory Society, included a representative sample of 500 GPs where were asked to fill questionnaires on diagnosis and treatment of their COPD patients. The questions dealt with disease history and clinical presentation, COPD severity stage, diagnostic and therapeutic procedures. RESULTS: Altogether 298 physicians (59.6% of invited) provided information about 2756 COPD patients aged 61.6 ± 11.1 years (36.3% were women). According to GOLD recommendations 16.6% of patients had mild, 57.0% moderate, 18.6% severe and 2.1% very severe COPD. Smoking history was declared by 97.8% of respondents. 51.4% of COPD patients had continued smoking. Over the last year Ambulance Service intervened in 19.7% of patients and 29.1% of respondents required hospital treatment of COPD. Among more than 80% of patients, doctor diagnosed limitation in exercise tolerance, and shortness of breath at rest, and in approximately 60% of the respondents were presented productive cough, weakened vesicular murmur and prolonged phase of exhalation. CONCLUSIONS: Despite the diagnosis, more than half of men and women had continued smoking. The number of hospitalizations and emergency intervention positively correlated with the severity of the disease. The survey results emphasize the urgent need for health education in patients with COPD.

[Comorbidity diseases in adults with diagnosed interstitial lung diseases among inhabitants of the Silesian voivodeship, Poland]. / Choroby wspólistniejace w przypadku sródmiazszowych chorób pluc u doroslych mieszkanców województwa slaskiego.

BACKGROUND: Interstitial lung diseases form a group of chronic diseases associated with a significant worsening of the quality of life. Proper management of these diseases involves the recognition and treatment of comorbidities, so it implies high direct and indirect costs of therapy. The lack of epidemiological data on the total incidence of interstitial diseases in Poland, as well as of information on their increasing incidence in other European countries justify investigations into epidemiological situation in the Silesian voivodeship (the southern region of Poland). MATERIAL AND METHODS: In a descriptive study registered data provided by the National Health Found in 2006-2010 were used to assess the temporal variability of standardized incidence rates. A data set included interstitial lung diseases and comorbidities in adults aged ≥ 19 years, residents of the Silesian voivodeship. RESULTS: In the period under study standardized incidence ratios for interstitial lung disease declined from 9.7/100 000 adult population to 7.8/100 000 adult population. The most prevalent comorbidities included cardio-vascular diseases, chronic and infectious respiratory diseases, metabolic diseases and musculoskeletal and connective tissue diseases. Comorbidities were found more frequently in older people ≥ 65 years, except for sarcoidosis, which was four times more prevalent in younger people (19-64 years) compared to older patients. The estimated costs of treatment of the analysed diseases reached more than 50 mln zlotys (12 mln dollars) per year. CONCLUSIONS: A small but systematic decrease in the value of the standardized incidence rate for interstitial lung disease has been shown within the range of 9.7-7.8/100 000 adult inhabitants. The most frequent comorbidities included cardiovascular or chronic and infectious respiratory diseases. The high cost of therapy of interstitial lung diseases was largely related to simultaneous treatment of comorbidities. Med Pr 2016;67(6):751-763.

Regional and temporal variability of GP concultations due to asthma in children aged 0-18 years in Silesian voivodeship.

UNLABELLED: The aim of this study was to analyze the spatial and temporal variability of the ratio describing outpatient medical visits due to asthma in children aged 0-18 years, living in Silesian voivodeship. MATERIAL AND METHODS: Descriptive study was conducted, in which secondary epidemiological data concerning number of medical outpatient visits due to asthma of children in the age of 0-18 years, were analyzed. The required data from the period 2007-2010 were reported on the MZ-11 form. To assess the temporal or spatial variability in Silesian voivodeship the ArcGIS 9.2 Software was used. RESULTS: Significant spatial and temporal variability of outpatient medical visits due to asthma in children have been discovered. The systematical increase of outpatient visits rate was observed (respectively 20.8 and 26.9% compared to the starting year). The largest values of the ratio concern the central region of the Silesian voivodeship. Most frequently outpatient medical visits due to asthma were related to children aged 5-14 years. CONCLUSIONS: Systematic and detailed analysis of the data collected in the health care system can replace the routine reporting and may be used to identify needs for public health.

[Treatment of asthma in Poland by primary care physicians--results of PulmoScreen study]. / Leczenie chorych na astme bedacych pod opieka lekarzy POZ--wyniki ogólnopolskiego badania PulmoScreen.

INTRODUCTION: Proper treatment of asthma patients is crucial for long-term control of the disease. OBJECTIVE: The aim of the study was to evaluate the treatment of adult asthma patients by primary care physicians in the light of international GINA guidelines. MATERIAL AND METHOD: The cross-sectional study included a representative sample of 1852 general practitioners (GPs) who were asked to complete questionnaires on the diagnosis and treatment often consecutive patients with asthma who are under their care. RESULTS: Altogether 1250 GPs provided information about 10,981patients. During the entire duration of the disease 50.9% were ever treated by systemic corticosteroids. In the current treatment of asthma inhaled steroids were used in 78.8% of cases, oral steroids in 5.8%, intravenous steroids in 1.3% and intramuscular steroids in 0.7% of patients. SABA were used in 63.1% of patients, LABA in 57.1%, methylxanthine in 25.1%, leukotriene modifiers in 21.1%, anticholinergics drugs in 15.5%, cromones in 1,9%, and antihistamines in 23.1% of adult patients with asthma. In 88.8% cases LABA treatment was combined with inhaled corticosteroids. In 83.8% of cases therapeutic regimens were in line with the GINA guidelines. CONCLUSIONS: There is a need for systematic educational activities addressed to primary care physicians.

Impact of early kidney resistance index on kidney graft and patient survival during a 5-year follow-up.

BACKGROUND: Resistance index (RI) measured by Doppler sonography during the early post-transplant period reflects interstitial oedema within the transplanted kidney. We have prospectively analysed the relationship between RI measured shortly after kidney transplantation (KTx), patient and graft survival, as well as kidney graft function during a 5-year follow-up. METHODS: RI was measured at the second to fourth day after KTx in 364 consecutive patients, who were divided into tertiles, according to baseline RI value (Group 1: RI < 0.73, Group 2: RI between 0.73 and 0.85 and Group 3: RI > 0.85). The kidney graft function [estimated glomerular filtration rate (eGFR)] during the follow-up period was calculated according to the Modification of Diet in Renal Disease formula. RESULTS: During the 5-year follow-up period, 23 patients died (2.6 versus 6.5 versus 9.6% in RI tertiles, respectively) and 59 lost their kidney graft (12.1 versus 17.7 versus 18.4%, respectively). Survival analyses showed that the effect of RI was significant for a combined outcome [graft loss or death; hazard ratio (HR) = 10.88] and in relation to death, it was of borderline significance (HR = 45.3, P = 0.09). The effect of delayed graft function (DGF) was only significant on graft loss (HR = 1.73). eGFR in the highest tertile was lower than in the lowest tertile during the entire follow-up period. CONCLUSIONS: High RI values measured in segmental arteries in the very early post-transplant period predict worse kidney graft function and increased risk of all-cause graft loss, including patient death in the 5-year follow-up period. (ii) The predictive value of RI is not completely independent from the adverse influence of DGF on the premature graft loss.

[Profile of adults suffering from asthma in Poland--results of PulmoScreen study]. / Profil doroslych chorujacych na astme w Polsce--wyniki badania PulmoScreen.

INTRODUCTION: Adult patients with diagnosis of asthma remain largely under the care of primary care physicians (general practitioners). Thus, they play an important role in diagnosing and treating this population. The aim of the study was to characterize of adults with asthma remaining under the care of Polish general practitioners (GP) as well as to evaluate the use of diagnostic tools and treatment in light of GINA recommendations. MATERIAL AND METHODS: This questionnaire study included a representative sample of 1852 general practitioners (GPs) who were asked to complete questionnaires on the diagnosis and treatment of their patients with asthma. RESULTS: Altogether 1250 GPs provided information about 10 981patients. Controlled asthma had 21.2% patients, 46.9% partly controlled, and 31.9% uncontrolled asthma. Allergy skin prick tests were performed in 64.8%, bronchial reversibility tests in 58.1% and bronchial provocation tests in 9.8% of patients. Spirometry results were obtained for 41.9% of patients. In the last year 16.6% of patients underwent emergency intervention due to asthma exacerbation and 18.1% required hospitalization. CONCLUSIONS: In Polish asthma patients the frequency of allergological and pulmonological visits as well as the frequency of spirometric assessment are poorly associated with asthma control level. The diagnostic tests recommended by international and national guidelines for the management of asthma are performed too seldom. Hospitalizations and emergency interventions related to asthma exacerbations are found in a large portion of patients and depend on their gender and asthma control level. Asthma has a negative impact on everyday activity in more than half of patients. Proper assessment of the level of causes asthma control according to GINA guidelines poses problems to Polish general practitioners.

[Eye symptoms in office employees working at computer stations]. / Dolegliwosci ze strony narzadu wzroku u pracowników biurowych zatrudnionych na komputerowych stanowiskach pracy.

BACKGROUND: The aim of the study was to measure the prevalence and intensity of eye symptoms in office workers who use computers on a regular basis, and to find out if the symptoms depend on the duration of computer use and other work-related factors. MATERIAL AND METHODS: Office workers employed at large social services companies in two cities (Warszawa and Katowice) were invited to fill in a questionnaire (cross-sectional study). The questions included work history and history of last-week eye symptoms and eye-related complains. Altogether 477 men and women returned the completed questionnaires. Between-group symptom differences were tested by the chi-square test and verified by the results of multivariate logistic analysis. The examined effects included the role of daily computer use and lighting conditions at work stations. RESULTS: The examined persons complained of such eye symptoms as eye strain, visual acuity impairment and mucosal dryness or eye burning. The following values of symptom prevalence were found in women and men, respectively: eye strain 50.7% and 32.6%, disturbed visual acuity 38.3% and 21.2%, mucosal dryness and eye burning 46.5% and 24.2%. The results of multivariate analysis confirmed the statistically significant effects of lighting intensity and screen flickering on the occurrence of symptoms. CONCLUSIONS: Frequent occurrence of eye symptoms and their associatation with some characteristics of the work environment point to the need of observing ergonomic standards of work stations and of the usage of computers at work.

[Infection fatality rate (IFR) during the course of COVID-19 pandemic in Upper Silesia Metropolitan Area (Poland) in 2020]. / Wskaznik smiertelnosci infekcji (IFR) w przebiegu pandemii COVID-19 w Aglomeracji Górnoslaskiej w 2020 r.

BACKGROUND: During the course of COVID-19 pandemic, a wide range of scientific projects was implemented worldwide, including studies focusing on infection fatality rate (IFR). The value of IFR depends on the number of COVID-19 deaths in a population in a given period and the number of infected people in this population, usually provided by seropepidemiological studies (anti-SARS-CoV-2 IgG in the case of COVID-19). The objective of our study was to estimate IFR in the course of COVID-19 pandemic in 2020, in the general population of Upper Silesia Metropolitan Area (USMA). MATERIAL AND METHODS: The seroepidemiological study was conducted in October-November 2020. Among randomly selected inhabitants of Katowice, Gliwice, and Sosnowiec (N = 1167), the presence of SARS-CoV-2 virus infection was assessed based on a positive IgG test result performed with the ELISA method. Data on deaths due to COVID-19 were obtained from the Registry Offices of each city. The infection fatality rate was calculated using the formula IFR (%) = [number of deaths/number of infected] × 100. RESULTS: Results of our study showed the prevalence of infection at 11.4% (95% CI: 9.5-13.2). In three examined towns, in the period January-November 2020, there was a total of 516 COVID-19 deaths. The resulting crude IFR was 0.65% (95% CI: 0.56-0.78). The IgG test had 88% sensitivity and 99% specificity and these figures were used to adjust IFR. The adjusted IFR value was similar to the crude value: IFR = 0.62% (95% CI: 0.53-0.74). CONCLUSIONS: The value of IFR estimated for the USMA population was similar to average values obtained in other countries and can be used as the background for monitoring the course and impact of COVID-19 pandemic in the Upper Silesian Industrial Area. Med Pr. 2021;72(6):671-6.

COVID-19-related risk of in-hospital death in Silesia, Poland.

INTRODUCTION: The situation regarding COVID­19 in Poland is rapidly evolving. Because of this, it is important to investigate COVID­19 mortality and its predictors in one of the most densely populated regions of the country, Silesia Province. OBJECTIVES: The goals of this study were to assess in­hospital mortality due to COVID­19 and the impact of sex, age, and coexisting diseases on the risk of death. PATIENTS AND METHODS: The data analysis was based on discharge reports of patients with COVID­19 hospitalized between March and June 2020 in all hospitals in the region. Age, sex, hospital discharge status, and the presence of coexisting diseases were abstracted from the charts. RESULTS: In a group of 2830 in­patients with COVID­19, 325 died during hospitalization. COVID­19 deaths were associated with male sex (odds ratio [OR], 1.52; 95% CI, 1.17-1.96), older age (OR, 6.11; 95% CI, 4.5-8.31), and the presence of 3 or more coexisting diseases (OR, 4.78; 95% CI, 3.52-6.49). The most prevalent comorbidities were chronic cardiovascular and respiratory diseases. CONCLUSIONS: The estimated in­hospital fatality rate for COVID­19 was 11.5%, which is lower than the average COVID­19 fatality rate in other European countries. The risk of in­hospital death was associated with sex, age, and the number of coexisting diseases, such as chronic cardiovascular and respiratory diseases.

Seroprevalence of Anti-SARS-CoV-2 Antibodies in a Random Sample of Inhabitants of the Katowice Region, Poland.

Lack of knowledge around seroprevalence levels of COVID-19 in Poland was the reason for the implementation of a seroepidemiological study in the Katowice Region (2,100,000 inhabitants). In October-November 2020, a questionnaire examination and measurement of anti-SARS-CoV-2 IgG and IgM antibodies were performed in a random sample of the general population (n = 1167). The objectives of the study were to estimate the prevalence of IgG and IgM antibodies and to assess their host-related correlates. The prevalence of IgG seropositivity was 11.4% (95% CI: 9.5-13.2%) and IgM seropositivity was 4.6% (95% CI: 3.5-5.8%). Diagnosis of COVID-19 was found in 4.8% of subjects. A positive IgG test was statistically significantly associated with age (inverse relationship), a person's contact with a COVID-19 patient, quarantine, and two symptoms in the past: fever and loss of smell/taste. Positive IgG tests were less prevalent in subjects who had diagnoses of arterial hypertension, diabetes, or rheumatologic disorders. IgM test positivity was associated with quarantine and loss of smell/taste only with no effect of chronic diseases found. In Poland, in the period October-November 2020, the prevalence of SARS-CoV-2 infection was larger than earlier estimates obtained in other European countries, probably reflecting the measurements obtained during the "second wave" of the epidemic.

Long­term outcomes of transcatheter self-expanding aortic valve implantations in inoperable and high surgical-risk patients with severe aortic stenosis: a single-center single-valve registry.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is being increasingly used in patients with longer life expectancy. Data on long­term outcomes are still limited. AIMS: The aim of the study was to assess the clinical outcomes of patients treated with TAVI and identify baseline and procedure­related factors influencing long­term survival. METHODS: Symptomatic patients with critical aortic stenosis who were inoperable or had high surgical risk were qualified for TAVI. Between August 2012 and December 2017, 248 consecutive patients treated with self ­expanding Medtronic valve implantation at American Heart of Poland in Bielsko­Biala were prospectively enrolled. Patients were followed for 30 days after the procedure and subsequently annually. All events were classified according to the Valve Academic Research Consortium­2 (VARC­2) criteria and assessed. Survival was compared between the subgroups defined by the EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and with matched representatives from the general population. RESULTS: The median (interquartile range) follow­up was 3.4 (2.5-4.6) years, and the longest follow­up lasted 7.8 years. A total of 92 patients (37.1%) died during the follow­up. The Kaplan-Meier estimates for cumulative mortality at 1, 3, 5, and 7 years were: 11.3%, 26.8%, 42.1%, and 60.6%. Patients with EuroSCORE II greater than 6% experienced worse survival compared with those with EuroSCORE II 6% or less (P = 0.008). Patients with EuroSCORE II 6% or less had similar survival to the general population. Male sex, baseline eGFR of less than 50 ml/min/1.73 m2, chronic obstructive pulmonary disease, moderate / severe paravalvular leak, absence of postdilatation, major vascular complication, and stroke at 30 days were independently associated with long­term mortality. CONCLUSIONS: TAVI with a self­expanding Medtronic valve implantation according to a consistent protocol was associated with favorable outcomes. Patients with lower EuroSCORE II scores had the same prognosis as the actuarial survival of the general population.

Development, evaluation and validation of a new instrument for measurement quality of life in the parents of children with chronic disease.

BACKGROUND: Childhood chronic disease may affect patients' and their family's functioning. Particularly parents, who play an important role in cooperation between patient and health care professionals, report impaired health-related quality of life (HRQOL). The aim of this study was development, evaluation and validation of a new instrument: Quality of Life in a Child's Chronic Disease Questionnaire (QLCCDQ). The questionnaire is addressed to parents of children with a chronic disease. METHODS: Study design included semi structured interview and qualitative study, which allowed to identify most troublesome problems. Following the results the questionnaire was developed, which consists of 15 questions and covers domains--emotions, patients -perceived symptoms, roles limitations. An observational study involving parents of asthma and diabetes children was conducted to assess the psychometric characteristics of the measure. Psychometric testing was based on the reliability of defined subscales, construct validity, reproducibility assessment, as well as comparison between stable/unstable disease stages and parents of healthy children. RESULTS: Most troublesome concerns for parents of child with chronic disease included emotional distress and feeling depressed due to child's disease, avoiding social interactions due to child's disease or symptoms. 98 parents of children with asthma or insulin - depended diabetes participated in the psychometric testing of QLCCDQ. Internal consistency reliability for the defined subscales ranged between 0.77 and 0.93. Reproducibility based on the weighted kappa coefficients showed expected level of agreement and was almost perfect in case of 8 questions, substantial for 5 questions and moderate for 2 questions. QLCCDQ demonstrated very good construct validity--all subscales showed statistically significant correlations ranging from 0.4 to 0.9. QLCCDQ scores differed significantly by clinical status--parents of children qualified as stable presented higher scores in most subscales in comparison to parents of children with unstable disease. CONCLUSIONS: The QLCCDQ shows good internal consistency, test-retest reliability, and construct validity. The questionnaire may be useful in helping to understand the impact of chronic child's disease on parental perception of health outcomes.

[Children environmental health--Polish epidemiological publications in the global literature on the topic]. / Srodowiskowe zagrozenia stanu zdrowia dzieci--polskie doniesienia epidemiologiczne na tle swiatowej literatury przedmiotu.

Environmental hazards in children are subject to many research programs and public health priority, also in Poland. Assessment of the publication output in this field can be used to evaluate the level of general scientific activity in epidemiology. "Medline"-based review (topic: environmental exposure) showed that in the examined period the percentage of Polish publications concerning children aged 0-18 years reached 1,67%, and a half of the articles was published in English. Following the period of a visible increase in annual numbers of Polish publications two recent years revealed a marked decrease of the output. Review of the contents showed a number of broad thematic categories: occurrence and risk factors of allergic diseases including asthma, effects of passive smoking, impact of exposure to lead and other metals including biomonitoring, waste site-related exposures, environmental correlates of physical development, risk related to ionizing radiation and electromagnetic fields. Results suggest an average status of Polish activity in the light of global scientific publications, within the analyzed topic. Moreover, Polish publications cover a narrow spectrum of environmental health issues. The review helped to identify a number of problems that could be addressed to improve scientific activity of Polish environmental epidemiology centers. Those are universal and reflect well recognized problems of the current status of the Polish science, in general.

[Occupational exposure to HIV in health care workers, Silesia voivodeship]. / Zawodowa ekspozycja pracowników sluzb medycznych na wirus HIV w województwie slaskim.

BACKGROUND: Occupational exposure to HIV is defined as a contact of health care workers with potentially infectious material. The risk of occupational transmission is not high (0.09-0.3%), but it increases in case of percutaneous injuries caused by tools contaminated with infected blood, deep needle stick or direct contact of an infected needle with artery or vein. MATERIAL AND METHODS: The aim of the study was to determine the epidemiology of HIV infections among health care workers in the Silesian voivodeship, in the years 1999-2006 and the conditions of occupational exposure. Data on occupational exposure, collected by the Center for AIDS Diagnosis and Therapy in Chorzów, were analyzed. RESULTS: During the study period, 789 cases of occupational exposure to HIV in the medical staff were documented. In the exposed group women predominated (78.9%). In the occupational group under study, nurses made 65% and physicians 17.5%. Needles were the most frequent (75.2%) source of exposure during injections and left hand fingers (thumb and index finger) were the major targets. Post-exposure prophylaxis with antiretroviral medications was introduced in about 60% of cases (499/789). No HIV transmission was registered. CONCLUSIONS: Nurses run the highest risk of occupational exposure to HIV, usually related with injections. There is a need to continue education in postexposure prophylaxis addressed to medical staff. The development of a standard questionnaire and its practical use could be very useful in monitoring occupational exposure.