Health Professionals' Perspectives on Commercially Available Intravenous Nutrient Therapies: A Preliminary Report.

BACKGROUND: Intravenous nutrient therapies (IVNTs) have gained popularity on the commercial market. Targeted at people with a variety of ailments and needs, the procedures allegedly offer numerous benefits and quick results, widely advertised on the websites of drip bars and health clinics as well as in the available literature. What is less often presented is the point of view of the customers of such services and the opinions of health personnel. Although the latter perspective seems to be crucial, little is known about it. Therefore, the purpose of this study was to present the opinions and experiences of health professionals (n = 188) on commercially available IVNTs dedicated to adults. METHODS: The study was conducted between April 2019 and March 2020 by means of a survey using an ad hoc questionnaire made available mainly to health professionals attending public health postgraduate courses at the Poznan University of Medical Sciences, Poland. RESULTS: As many as 91.5% of the respondents had heard of commercially available IVNTs (mostly from the media), and 47.3% knew of a facility offering such services. Among the possible situations where the use of IVNTs would be justified, the most commonly mentioned was a diagnosed nutrient deficiency (37.8%), while the least common ones were libido problems (1.1%) and the need to speed up metabolism (2.1%). For 25.5% of the respondents, there was no good rationale for using IVNTs. As many as 15.4% had no opinion on the subject. Health risks of IVNTs were recognised by 95.2% of professionals, with the biggest concerns being the lack of full information on patients' health status and medical contraindications (84%), the risk of overdose and interactions (77.1%), and hypersensitivity or allergic reactions (75.5%). Among the reasons for IVNTs' popularity, the respondents listed not only fads spread by celebrities and social media (89.4%) and the need for quick, effortless remedies (77.1%), but also reasons inherent in the Polish healthcare system. As many as 80.3% of the respondents stressed the need for public health institutions to take a stand on commercial IVNTs. Knowing of an IVNT facility was not significantly associated with the opinions of professionals in key areas. CONCLUSION: Postgraduate public health courses are a good opportunity to engage health professionals in discussions about the current challenges, trends, and needs in the area of health promotion and healthcare. This study's findings shed some light on the opinions about IVNTs held by health professionals, who are important stakeholders of the healthcare system. Thus, these findings may help to better understand the popularity of IVNTs and incorporate health professionals' perspectives in future efforts aiming to increase the awareness of IVNT-related health risks among both professionals and patients.

Development and Validation of a Health Behaviour Scale: Exploratory Factor Analysis on Data from a Multicentre Study in Female Primary Care Patients.

Health behaviours are the most important proximal determinants of health that can be either promoting or detrimental to the health of individuals. To assess and compare health behaviours in different socioeconomic groups within the population, a comprehensive, valid, reliable, and culturally appropriate measure is needed. This study aimed to develop a health behaviour questionnaire and validate it in a sample of female patients over 45 years of age with cardiovascular disease (CVD). The development procedure encompassed the following stages: literature search and item generation, content validity testing (focus group and expert evaluation), and field testing. A preliminary 38-item Health Behaviour Scale (HBS) was developed and tested in a group of 487 female primary care patients over 45 years of age. An exploratory factor analysis (EFA) yielded a four-factor structure. Factors jointly accounted for 47% of the variance observed. The results confirmed very good internal consistency of the questionnaire. The Cronbach's alpha and McDonald's omega coefficients for the entire scale were 0.82 and 0.84, respectively. The factor and item structure of the final 16-item HBS reflects the specificity of the studied sample. This measure can be a useful tool for primary care practitioners and public health researchers by helping them to develop interventions and strategies to reinforce health-promoting behaviours.

Nurses' Perspectives on Smoking Policies, Safety and Cessation Support in Psychiatric Wards: A Cross-Sectional Survey.

A high prevalence of smoking and low rates of smoking cessation interventions can be observed in psychiatric wards. A questionnaire-based, cross-sectional study was performed in five hospitals among 107 psychiatric ward nurses. The aim was to investigate nurses' views on patients' smoking practices and their influence on the safety of both the patients and medical personnel. In addition, we asked about the availability of smoking cessation support. Most of the respondents noticed the negative impacts of smoking on patients and medical personnel. Nearly a third of our respondents (29.0%) recalled smoking-related accidents in their facilities. In 45.2% of these accidents, a patient set someone else on fire. Around one fifth of nurses had rather permissive attitudes towards tobacco use in hospital wards. Significant associations were identified between respondents' smoking status and their opinions on amending smoking policies and on unsupervised smoking. Regarding professional help available to smoking patients, 88.8% of participants reported that interventions to address smoking were available in their wards. Psychiatric hospitalisation can be an opportunity to offer tobacco treatment to patients with mental health conditions. To make use of this opportunity, smoke-free policies need to be put in place and hospital personnel, particularly nurses, should be trained and equipped with the knowledge and skills needed to assist in the smoking care of psychiatric ward patients.

Cohen's Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model.

The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen's Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa's reclassification were compared with the results obtained using NRI. The random variables' distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program.

[Risk factors for smoking in persons over 45]. / Czynniki warunkujace palenie tytoniu w grupie osób po 45 roku zycia.

Tobacco smoking has long been one of the most important risk factors contributing to the development of many health problems e.g. cardiovascular diseases respiratory diseases and cancers. Smoking is a modifiable factor, which means that every smoker who quit smoking has a great chance to lower the risk of developing these diseases. The aim of the study was to identify the factors influencing smoking among people over 45 and to estimate the extent of the phenomenon of smoking in 2 Polish provinces: Wielkopolskie and Dolnoslaskie. The sample was 867 persons over 45. The number of study subjects was proportional to the sex and age structure of Polish population. The sampling was random and the research tool was a self-made survey questionnaire. In order to identify factors contributing to smoking a logistic regression analysis was applied. Tobacco was smoked by 16.7% of the research subjects (15.1% of women and 19.1% of men). In Wielkopolskie province smokers constituted 19% of the sample (17.7% of women and 22% of men), in Dolnoslaskie province 14.1% of the respondents were smokers (12.5% of women and 16.2% of men). Smoking is more prevalent among men aged 55-65 years (OR=4.34; 95% CI: 2.0-9.41). The lowest prevalence of smoking without statistical significance was in rural areas (OR=0.63; 95% CI: 3.6-1.10) and among persons with low educational levels (OR=0.74; 95% Cl: 0.36-1.56). Significantly higher prevalence of smoking was found among the unemployed (OR=2.90; 95% CI: 1.07-7.84) and people performing partly physical work (OR=2.82; 95% Cl: 1.37-5.79). The prevalence of smoking was higher among people being in a relationship (OR=1.63; 95% Cl: 1.0-2.66) and declaring income below PLN 1,000 per month (OR=2.82; 95% CI: 0.81-3.55). Statistically significantly lower risk of smoking was among obese subjects (OR-0.42; 95% CI: 0.24-0.74). It was found that the number of years of smoking significantly correlated with high systolic blood pressure and the number of smoked cigarettes was associated with hinh level of LDL cholesterol. The smokers aged over 45 can be generally characterized as strongly addicted and have been smoking for many years. Anti-tobacco activities targeted at this group should be intensified in order to reduce the number of cigarettes smoked daily. These interventions should take into account group characteristics and its needs.

[Health behaviours among men age > 50 years with reference to risk factors cardiovascular diseases]. / Charakterystyka zachowan zdrowotnych mezczyzn po 50 roku zycia w Poznaniu w odniesieniu do czynników ryzyka wystapienia chorób sercowo-naczyniowych.

World Health Organization includes the eight main risk factors, which causes about 61% of cardiovascular deaths. These factors are: tobacco and alcohol use, high blood pressure, high body mass index, abnormal blood lipid levels, high blood glucose, a diet high in saturated fat and low in fruit and vegetable intake and physical inactivity. Thanks to them it's possible to expect probability of illness and its complication. Particularly exposed to cardiovascular morbidity are those patients who have multiple risk factors. The investigated group consisted of 114 male patients, who lived in Poznan. The authors analyzed lifestyle factors (smoking, prophylactic examination, exercise and leisure activities and diet), which were compared with laboratory and diagnostic tests plus selected individual characteristics of respondents. Answers distribution within the group are presented as percentages. The aim of the study was to analyze health behaviors among men age > 50 years related to risk factors cardiovascular diseases. Results shows that most of the study group had overweight or obesity and their daily physical activity was confined only to the work in the garden or walking. There were 33% of men with BMI>30, which increases their risk of heart attack twice. Incidence of hypertension was related to obesity, high blood cholesterol and high triglyceride levels. Vascular interventions occurs more frequently among daily smokers and former smokers. More than half of study group with hypertension stopped smoking because of their diseases. Men who declared healthy lifestyle more frequently perform prophylactic control tests and examination. Mostly three or four risk factors were found among study group. For the men after 50 there should be implemented more prophylactic programs, to encourage lifestyle changes and eliminate risk factors.

[Do antismoking campaigns fulfil their function?]. / Czy kampanie antynikotynowe spelniaja swoja funkcje?

Smoking is a commonly recognized risk factor of civilization diseases. The number of damaging compounds, including carcinogenetic, inhaled by a smoker and exhaled, is directly proportional to a number of smoked cigarettes. Currently 32% of the Polish adult population smoke tobacco (38% males and 26% females), which is a serious social and healthy issue. The aim of study was to recognition opinions about an antismoking campaign as a motivation to quit smoking. Altogether 384 adults participated in the survey. 207 were smokers and 177 people who had quit. The results of the research show that antismoking campaigns must be organized and should rather inform about unhealthy effect than motivate to quit smoking. Only few of respondents change their attitudes and stop smoking thanks to conducted antismoking campaign.

[Smokers' motivation to quit smoking]. / Motywacje osób uzaleznionych od nikotyny do zaprzestania palenia.

Smoking is a commonly recognized risk factor of civilization diseases. The number of damaging compounds, including carcinogenetic, inhaled by a smoker and exhaled, is directly proportional to a number of smoked cigarettes. Currently 32% of the Polish adult population smoke tobacco (38% males and 26% females), which is a serious social and healthy issue. The aim of study was to recognition opinions about smoking and motivations to quit. Altogether 384 adults participated in the survey. 207 were smokers and 177 people who had quit. Author contrasted two groups of the respondents to find out the differences. For the both groups the most important motivations to smoking cessatiom were healthy reasons independent of sex, age and education.

[Opinions about smoking bans and e-cigarettes among inhabitants of Poznan--the results of a pilot study]. / Opinie na temat zakazu palenia oraz e-papierosów wsród mieszkanców Poznania--wyniki badania pilotazowego.

The aim of the pilot study was to assess the opinions about smoking bans and e-cigarettes among inhabitants of Poznan. In this research we used inquiry-sheet public opinion tool verifying acquaintance of problem. Opinions in that survey were different among men and women. Most women declared support for smoke-free policies. The highest level of support was for smoke-free public transport. Majority of respondents believed that polish smokers do not respect smoke-free regulations. E-cigarettes have not a big chance to be popular in Poland.

Hepatitis B virus genotypes in children with chronic hepatitis B in Poland.

OBJECTIVES: To analyse the distribution of HBV genotypes in Polish children with chronic hepatitis B, and to assess the relation between the viral genotype and the severity of liver damage. METHODS: Serum samples from children with chronic hepatitis B were used for biochemical and serological testing, and for determination of HBV genotypes by a nested-multiplex-polymerase chain reaction. Liver biopsies were obtained for histological assessment, which was performed according to the Batts and Ludwig scoring system of chronic hepatitis. RESULTS: Of 78 children with chronic hepatitis B, 74 had an identifiable HBV genotype: 86.5% were infected with genotype A, and 13.5% were carriers of genotype D. The frequency of HBeAg clearance and the levels of alanine aminotransferase and serum aspartate transaminase were comparable in both genotype groups. There was no correlation between the HBV genotype and either activity of liver inflammation or liver fibrosis. CONCLUSIONS: This study shows that the distribution of HBV genotypes in Polish children with chronic HBV infection reflects the general prevalence of HBV genotypes in Europe. The course of chronic hepatitis B in children is not significantly influenced by viral genotypes A or D.

Lack of an association between Helicobacter infection and autoimmune hepatitis in children.

An association between Helicobacter infection and autoimmune hepatitis (AIH) in children was investigated. The prevalence of antibodies to H. pylori did not differ between the AIH and the control group, (22% versus 14%), and antibodies to non-gastric Helicobacter were not detected in either group. H. pylori DNA was found in two AIH liver tissues, but Helicobacter was not cultured from any sample.

Antimicrobial resistance of Helicobacter pylori in Poland: a multicentre study.

The resistance of Helicobacter pylori to antimicrobials, known to be increasing in many countries, is an important factor compromising the efficacy of eradication therapy. Therefore, our study aimed at analysing the current susceptibility status of H. pylori in Poland. A total of 337 H. pylori isolates were cultured from children (N=179) and adults (N=158) from various regions of the country from January 2001 to December 2004. All strains were susceptible to amoxicillin and tetracycline. The overall resistance to clarithromycin (CL) was 28%, but there were significant differences between the centres (ranging from 0% to 33%) and between child and adult isolates (28% versus 15%, respectively; P=0.01) for primary a resistance. Altogether, 46% of H. pylori isolates were resistant to metronidazole (MTZ) and 20% of isolates were simultaneously resistant to CL and MTZ.

Prevalence of potential virulence markers in Polish Campylobacter jejuni and Campylobacter coli isolates obtained from hospitalized children and from chicken carcasses.

The pathogenicity of thermotolerant Campylobacter species, common food-borne pathogens, depends on certain factors unevenly distributed among strains of different origin. The prevalence of such markers has never been examined in a population of Polish Campylobacter strains of human and poultry origin. Therefore, we analysed the presence of the cadF, cdtA, cdtB and cdtC genes and the iam sequence in Campylobacter jejuni (n = 115) and Campylobacter coli (n = 57) isolates from children with diarrhoea and from chicken carcasses. The cadF gene was present in nearly 100% of Campylobacter isolates tested, regardless of their origin or species. In contrast, the iam region was found in 83.3% and 100% of C. coli isolates from children and chickens, respectively, but in only 1.6% and 54.7%, respectively, of C. jejuni isolates. Similarly, the detection rates of cdt genes varied between human and chicken isolates. All three cdt genes were found in nearly all C. jejuni isolates from both children and chickens, but in only 5.6% of human C. coli isolates as compared to 87.2% of chicken C. coli isolates. This different distribution of genetic markers between human and chicken isolates indicates that some Campylobacter infections in children may have additional sources other than contaminated chicken meat.

Persistence of HBV-DNA in children with chronic hepatitis B who seroconverted to anti-HBs antibodies after interferon-alpha therapy: correlation with specific IgG subclass responses to HBsAg.

BACKGROUND/AIMS: We examined the persistence of HBV-DNA in sera collected 4-10 years after IFN-alpha therapy from patients with chronic hepatitis B who had seroconverted to anti-HBs antibodies. We also wanted to assess whether any association exists between HBV-DNA status and the IgG anti-HBs subclass responses. METHODS: Sera were obtained from 38 patients and the following parameters were determined in each of them: (1) serological markers of HBV; (2) concentrations of IgM, IgG, IgA; (3) total IgG subclasses. HBV-DNA and IgG anti-HBs subclasses were determined in anti-HBs positive sera. RESULTS: Four to 10 years after therapy, anti-HBs were found in 37 of 38 patients (GMT: 775IU/L). In 13 of them (35.1%) free and/or bound HBV-DNA was present in sera. Significant differences in the profiles of IgG anti-HBs were observed when the HBV-DNA status was considered. Patients with undetectable HBV-DNA responded mainly with IgG1 and/or IgG3, while in the HBV-DNA-positive group, a high contribution of IgG4 was found. CONCLUSIONS: Our study showed that HBV-DNA may persist for a long time after IFN-alpha therapy despite the appearance of anti-HBs antibodies. The monitoring of specific IgG subclasses may be of predictive value for HBV-DNA persistence.

[Persistence of hepatitis B virus in children after interferon-alpha therapy despite the seroconversion in HBsAg/anti-HBs system]. / Przetrwanie HBV DNA u dzieci leczonych interferonem alfa mimo serokonwersji do przeciwcial anty-HBs.

OBJECTIVE: The aim of our study was to assess: (1) whether seroconversion to IgG anti-HBs, induced by IFN-alpha therapy in children with chronic active hepatitis B, is maintained 4-10 years after treatment; and (2) whether HBV-DNA is present in circulation despite the synthesis of anti-HBs. METHODS: Serum samples were collected from 38 patients and serological markers of HBV were determined in each of them. HBV-DNA was determined by PCR in anti-HBs positive sera. Serum samples obtained from 19 subjects with a complete spontaneous seroconversion after acute HBV served as controls. RESULTS: Four to 10 years after therapy, anti-HBs were present in ca. 97.4% patients with GMT value of 775 IU/L vs 127 IU/L found in controls. HBsAg was found in 2/38 subjects. In 13 out of 37 patients (35.1%) free and/or bound HBV-DNA was present. CONCLUSIONS: This study showed that seroconversion induced by IFN-alpha may not be a sustained phenomenon. HBV-DNA may persist for a long time after therapy despite the anti-HBs synthesis.

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from children with community-acquired respiratory tract infections in Central Poland.

Resistance to commonly used antimicrobial agents among the key respiratory pathogens is increasing worldwide and therefore a rational choice of an empirical treatment requires knowledge of both global and local resistance patterns. The susceptibility of 185 Streptococcus pneumoniae and 169 Haemophilus influenzae isolates collected from January 1999 to May 2002 at the Children's Memorial Health Institute, Warsaw, Poland, from 351 children with community-acquired respiratory tract infections (RTIs) has been determined. Of S. pneumoniae isolates, 84% were susceptible to penicillin, 91% to cefaclor, 95% to cefuroxime, 98% to cefotaxime, 79% to erythromycin, 46% to co-trimoxazole, 82% to clindamycin and 59% to tetracycline. The majority (83%) of erythromycin-resistant isolates tested carried the erm(B) gene, conferring the MLS(B) phenotype. All tetracycline-resistant S. pneumoniae strains analysed were tet(M) positive and tet(O) negative. A total of 24% of H. influenzae isolates were beta-lactamase-positive. H. influenzae susceptibility to amoxicillin/clavulanate, cefaclor, cefuroxime, azithromycin, tetracycline and co-trimoxazole was 100, 89, 94, 96, 96 and 43%, respectively.

Primary resistance of Helicobacter pylori to antimicrobial agents in Polish children.

Helicobacter pylori resistance to antimicrobial agents is an important factor compromising the efficacy of treatment. Therefore the aims of our study were: to determine the prevalence of H. pylori resistance to clarithromycin, metronidazole, amoxycillin and tetracycline in children prior to eradication therapy, to compare different methods of susceptibility testing and to detect mutations responsible for clarithromycin resistance. During 1996-2000, 259 H. pylori strains were isolated from antral gastric biopsies. Susceptibility to antimicrobials was determined by the agar dilution method and the Etest. Mutations in the 23S rRNA gene associated with clarithromycin resistance were analysed by PCR-RFLP and direct sequencing. Overall, ninety-six strains (37%) were resistant to metronidazole, 50 strains (19.3%) were resistant to clarithromycin, and 20 strains (7.7%) were simultaneously resistant to both drugs. All cultured isolates were sensitive to amoxycillin and only one isolate (0.4%) was resistant to tetracycline. The agar dilution method and the Etest showed a perfect category correlation for clarithromycin and 4% discrepancies for metronidazole. Primary resistance to clarithromycin was mainly associated with an A2143G mutation in the 23S rRNA gene of H. pylori. The study highlights the high prevalence of H. pylori primary resistance to clarithromycin in Polish children, which implies a need for pretreatment susceptibility testing.