Support for e-health services among elderly primary care patients.

BACKGROUND: E-health has a substantial potential to improve access to as well as support efficient and effective care for the elderly. Questions remain and must be addressed, however, regarding the challenges faced by the elderly in the use of this technology. The aim of the study was to assess the attitude (needs) and preferences of the elderly in a selected region of Poland regarding selected e-health services and the factors associated with them. MATERIALS AND METHODS: The study was conducted among 286 patients over 60 years of age being served by general practitioners in southwest Poland's Lower Silesia Province. The assessment pertaining to e-health was based on a specially designed questionnaire. RESULTS: Nearly one-third of the study respondents had a computer at home, and 61% of these (19% of all surveyed elderly) used it. Twenty-two percent of respondents used the Internet, at least occasionally, whereas 62% used mobile phones. Approximately 41% (n=116) of the elderly had a favorable attitude toward e-health services (labeled here as supporters) and were willing to use it if/when offered an opportunity to do so. A substantial majority (84%) of supporters expressed a desire to receive simple medical recommendations via mobile phone or a computer, although significant majorities (61% and 60%, respectively) would like to receive the results of tests by e-mail or short message service reminders for scheduled visits or prescribed medications. Slightly less than half (47%) of e-health supporters would request appointments online. Among the more important factors associated with support of e-health services were urban residence, higher education, and normal cognitive function, as well as having a computer, Internet access, or a mobile phone. CONCLUSIONS: The majority of elderly patients in this Polish community are not overly enthusiastic about using information and communications technology tools in their healthcare. Nevertheless, a substantial percentage (41%) among this group support selected e-health services.

Detection of Chlamydophila pneumoniae antigens in patients with chronic cough.

The aim of this study was to analyze the rate of Chlamydophila pneumoniae infection in adults with symptoms of chronic cough. The study was conducted in 83 hospitalized patients aged 18-67 suffering of chronic cough. The control group consisted of 20 healthy age-matched subjects without any respiratory symptoms. Bacteriological tests on the presence of Chlamydophila pneumoniae antigen were performed in throat swabs by indirect immunofluorescence technique using monoclonal antibodies labeled with fluorescein isothiocyanate. The rate of Chlamydophila infected patients was examined in relation to age and gender. The Chlamydophila pneumoniae antigen was detected in 15 (18 %) out of the 83 patients; about equally in both genders. Furthermore, we found that the patients aged 28-37 constituted the age group that most frequently tested positive for Chlamydophila pneumoniae. Unraveling the presence of Chlamydia infection in chronic cough patients enables to introduce a timely implementation of effective therapy and thus can prevent distant complications.

Incidence of Chlamydophila pneumoniae infection in children during 2007-2010.

Chlamydophila pneumoniae is the etiological agent of pharyngitis, bronchitis, and pneumonia. The aim of the study was to evaluate the frequency of chlamydial respiratory infections in children in the Lower Silesia Region in Poland in 2007-2010. There were 2,733 throat swabs examined, obtained from hospitalized patients aged from 20 months to 18 years with various clinical symptoms such as dry cough, productive cough, and from asymptomatic ambulatory patients. An indirect immunofluorescence technique, based on monoclonal antibodies labeled with fluorescein isothiocyanate, was used for detection of Chl. pneumoniae antigen. Overall, there were 1,114, 503, 641, and 475 patients studied in the consecutive 2007, 2008, 2009, and 2010 years. There clearly were fewer patients each next year submitted for Chl. pneumoniae detection procedure, which stemmed from the declining severity of respiratory infections noted in children and thus less demanding diagnostic workup commissioned by physicians. The percentage of results positive for Chl. pneumoniae antigen amounted to 53.3, 41.6, 43.1, and 36.4 % in the consecutive years, respectively. Detection of chlamydial infections had thus a decreasing tendency in the period studied. There also were decreases in Chl. pneumoniae detection rate in cases stratified due to the presenting symptom: dry cough, productive cough, or in asymptomatic cases. A milder course of respiratory infections resulting in a decreased number of children examined for Chl. pneumoniae antigen in consecutive years, makes it difficult to draw definite conclusions on the factual incidence rate. Nevertheless, we believe we have shown, from the clinical standpoint, a dropping rate of Chl. pneumoniae detection in children with respiratory infections.

Epidemiology of pertussis in an urban region of Poland: time for a booster for adolescents and adults.

Since the last decades, an increase of reported incidence of pertussis has been observed in many countries, including Poland, despite high vaccination coverage among infants and children. Before the vaccinations era, pertussis was a major cause of morbidity and mortality among infants and young children. Currently, pertussis is increasingly reported in adolescents and adults. The objective of this paper was to present the epidemiology of pertussis in Mazovian region in Poland in years 2005-2009. In this report we analyzed retrospectively the epidemiological data collected by the Sanitary Station in Warsaw, Poland. A total of 1,455 cases of pertussis were reported in the Mazovian region of Poland in the years 2005-2009. The incidence of pertussis ranged from 2.4/100,000 (2006) to 7.9/100,000 (2008). The incidence was the highest in two groups: infants (>1 year of age; from 13.3/100,000 in 2005 to 32.7/100,000 in 2007) and teenagers (age of 10-14 years; from 11.8/100,000 in 2006 to 68.5/100,000 in 2008). The highest proportion of cases was also reported in the 10-14 years age-group (from 26.4% in 2009 to 46.0% in 2008). The number of hospitalizations due to pertussis ranged from 137 (2005) to 46 (2006), while the percentage of cases requiring hospitalization ranged from 37% (2005) to 25% (2007 and 2008). Three hundred ninety two (27%) cases of pertussis were reported among patients with negative or not confirmed history of pertussis vaccination. We conclude that there is an urgent need for booster vaccination against pertussis in adolescents and adults in Poland.

Influence of rapid influenza test on clinical management of children younger than five with febrile respiratory tract infections.

Children are an important vector for spreading influenza and they are at increased risk for complications. The appropriate diagnosis of influenza may help start early antiviral treatment and may optimize the use of antibiotics and additional laboratory tests. The objective of this study was to describe the influence of rapid influenza detection test (RIDT) on clinical management of children with acute febrile respiratory tract infections. The method consisted of a prospective, open, cohort study conducted in three primary care clinics in Warsaw, Poland, during the epidemic influenza seasons of 2009/2010 and 2010/2011. A total number of 256 children of the age 0-5 years with symptoms of febrile respiratory tract infection were enrolled into the study. A 115 of them were tested with RIDT (BD Directigen EZ FluA + B) and another 141 children, who were not tested, constituted a control group. We found that RIDT gave positive results in 35 (30%) out of the 115 tested children. Antibiotics, additional blood tests and urinalysis were administered more often in the control group compared with the rapid test group (16% vs. 7%; 14% vs. 5%, and 47% vs. 32%, respectively). Chest radiograms were made only in six cases of children from the control group. We conclude that in children with symptoms of acute febrile respiratory tract infection, the rapid influenza detection test provides a rational use of antivirals, reduces an inappropriate use of antibiotics, and decreases a number of additional tests conducted.

[Influence of tobacco smoking on newborn's birth weight--analisys of dates concerning births from Maternity Hospital named. Dr S. Mossor's in Opole City]. / Wplyw palenia tytoniu przez kobiety ciezarne na mase urodzeniowa noworodka--analiza danych z porodów w 2007 w Szpitalu Ginekologiczno-Polozniczym i Noworodków im. Dr S. Mossora w Opolu.

Despite wide education, tobacco smoking while being pregnant is very important issue in perinatology. It is important problem because of life style of polish society, including pregnant women. Clinical observation of this issue is pointing on risk of occurring pathology in pregnancy, unfavorable consequences for neonate also many distant pathological effects among children. Purpose of this was getting an answer for question: whether in current social and economic situation there is connection between low birth mass and smoking tobacco during pregnancy. Under analysis were found births between 38th and 40th one hundred successive births (according to book of birth-room from 2860 labors in hospital in Opol, 2007) of mothers are smoking up to 10 cigarettes a day (group I), mothers smoking 11-20 cigarettes a day (group II) and mothers that are not smoking. This works affirms that smoking has negative influence on child birth mass. It is also displayed that higher the number of smoked cigarettes the higher percent of newborns with low birth mass and higher number o fetus with intrauterine growth retardation. Among mothers that are smoking the biggest group were young women (mean. 24, years) and multipara female (58%).

[Influence of smoking cigarettes on the development of the child and its health condition]. / Wplyw palenia tytoniu na rozwój dziecka i jego stan zdrowotny.

35.5% of Polish society is active smokers and as many as 20% of pregnant women. Influence of passive smoking on fetuses and children is bigger than active smoking on adults. The aim of this scrutiny was to develop relationship between preschool children passive smoking and their health condition. Research was made with the use of 100 anonymous questionnaires among parents of children from nursery schools in Opole. We received the following results: active smokers lived in almost half of examined families (44%), the most numerous group of smokers was parents (80.5%). The most often (43.3%) children were exposed on 20 cigarettes per day. 40.9% parents smoked outside, on the balcony, however the rest of them inside, in various rooms of the house. Most of parents thought that the health condition of their children was good, but more smokers than non-smokers estimated it as bad (11.4% vs. 1.8%). To the question how often are their children sick the most parents in both groups answered that 1-3 times per year. Most frequent illnesses concerned children of smokers and it was mainly respiratory tract diseases. Antibiotics intake was more often among children of smokers than non-smokers. Relationship between their children health condition and cigarette smoking confirmed 90% of parents. Denied it 10% and all of them were smokers. It indicates the need of better education of both, parents and children, in the field of harmful effects of passive smoking on health.

[The influence of smoking during pregnancy on decresed vitamin C concentration in blood serum]. / Wplyw palenia tytoniu w ciazy na obnizenie stezenia witaminy C w surowicy krwi.

UNLABELLED: There are reports about decreased vitamin C concentration in blood serum of smokers. In pregnancy decreased vitamin C concentration in blood serum is observed as well. The aim of this study was to analise vitamin C concentration in blood serum of pregnant women in two periods of pregnancy (20-22 and 38-41 week), in smokers and non-smokers and its comparision to our own results from researches made 25 years ago. Vitamin C concentration was determined by using Roe and Kuether method, in groups of 20 prgnant women being in 20-22 and 38-41 pregnancy weeks, smoking over 10 cigarettes per day and non-smoking. Because most of pregnant were using recommended vitamins, only these were qualified for research, who were taking multivitamin supplements including vitamin C in daily dose from 100 to 180 mg. Statistical analysis of the results was made by using t-Student test with changeability for p < 0.05. RESULTS: average vitamin C concentration in pregnant woman blood serum smoking over 10 cigarettes per day in 20-22 week of pregnancy was 1.43 mg% and in 38-41 week was 1.35 mg%. This concentration is much higher than that compatible from 25 years (0.51 mg% in both 20-22 and 38-41 week of pregnancy). Vitamin C concentration in non-smoking pregnant woman blood serum are higher now as well. These diffrences should be explained by taking multivitamin supplements widely recommended during pregnancy, by education and promotion of healthy living, by improvement of socioeconomic and environmental conditions. However the fact of harmful influence of cigarette smoking on vitamin C concentration in pregnant woman blood serum is still clear.

[Cigarette smoking in medical personnel and evaluation of this problem by smoking and non-smoking patients]. / Palenie papierosów przez personel medyczny i ocena tego problemu przez palacych i niepalacych pacjentów.

Cigarette smoking is a problem in all environments, including health service workers. It increases the number of ill people and accelerates death. The aim of this study was to diagnose the problem of smoking in medical staff and evaluation of this problem by patients. Research was made in hospitals and out-patient clinics in Opole by using an anonimous questionnaire. Along years there has been a decrease of smoking initiation age: 60-years-old-women had their first cigarette in 70% after them finished 18 years old, while most 30-year-old-women had it before. Every year the level of education in medical staff grows up, but the number of smokers in them does not fall down. It is still common to smoke in non-smokers and pregnant woman presence in spite of knowledge about passive smoking. Also pregnancy is not always strong argument to complete quit smoking, among medical staff as well. Smoking medical personnel has definitely negative evaluation by non-smoking patients (70%), a bit less negative it is seen by smoking patients. As the research showed, promotion of nonsmoking workers by employers could be a motivation to quit smoking.

[Asthma bronchial among children and youth exposed to tobacco smoke]. / Astma oskrzelowa u dzieci i mlodziezy a narazenie na dym tytoniowy.

Purpose of this work was to judge progress of diagnosed bronchial asthma among children and youth that are exposed on tobacco smoke in aspect of number of exacerbation of disease, therapy (doses of corticosteroids) and number of hospitalizations. There were two groups of patients with bronchial asthma under examination, first one were children and youth that are exposed on tobacco smoke, and the other group of children and youth that are not exposed on tobacco smoke. We discovered statistically significant difference in number of exacerbation of disease among those two groups, also bigger therapeutic and prophylactic doses of inhaled steroids during treatment, and much more often hospitalizations among children and youth that are exposed on tobacco smoke.

[Cigarette smoking and immunity disorder]. / Palenie papierosów a zaburzenia odpornosci.

Cigarette smoking addiction is one of the cardinal factors the diseases of respiratory system, cardio-vascular system and neoplasms. A part of them is the effect of immunosupression. It includes both morphologic changes (atrophia of lymphoid tissue) and cell functional disorder of the immune system. Cell-mediated response Th1-type, which is responsible for pathogens invasion, is depleted, whereas Th2-type is increased and has its effect on higher frequency of allergic diseases. Susceptibility to neoplasmatic changes is also augmented.

[Smoking of the tobacco by the parents of hospitalized children at the Pediatric Department of the Provincional Hospital in Opole]. / Palenie tytoniu przez rodziców dzieci hospitalizowanych w Oddziale Pediatrycznym Szpitala Wojewódzkiego w Opolu.

Nonsmoking children who live with smoking parents are exposed to many harmful chemicals of cigarette smoke. This situation is called "passive smoking". Unfortunately this situation is very often because 25% women and 40% men smoke. Cigarette smoke has bad effect on respiratory mucous membrane because it destroys its histological structure. Result of epidemiological studies provides that 45% parents and 54% children in pulmonological departments of pediatric hospitals are passive smokers. This indicates the necessity of pro-health education as well as the necessity of banning smoking from hospital area.

[Selected respiratory, digestive and urinary system diseases as causes of hospital treatment in the lower Silesia region in aspect smoking-related diseases]. / Wybrane choroby ukladu oddechowego, pokarmowego i wydalniczego jako przyczyny leczenia w szpitalach Dolnego Slaska w aspekcie chorób odtytoniowych.

UNLABELLED: Extensive smoking is impairing function of respiratory, digestive and urinary system. MATERIALS AND METHODS: Analysis was made using data describing hospitalizations in years 2003-2005 caused by respiratory, digestive and urinary system diseases, especially malignant neoplasmas. In analyzed period the count of Lower Silesia region citizens treated in hospitals because of respiratory, digestive and urinary system diseases connected with smoking has dropped. Outside the positive trend stay malignant neoplasms of pancreas, renal pelvis and ureter, lip, oral cavity and pharynx, and bronchiectases. Positive changes in hospitalization because of respiratory, digestive and urinary system diseases could to some extent be assigned as a success of health promotion activities, including anti-smoking actions.

[Analysis of changes in most common circulatory system diseases related hospitalizations in the Lower Silesia region in aspect smoking-related diseases]. / Analiza zmiennosci hospitalizacji z powodu najczestszych chorób ukladu krazenia w województwie dolnoslaskim w aspekcie chorób odtytoniowych.

Cigarette smoking is a risk factor of circulatory system diseases and causes many hospital admissions. Existing data describing hospitalizations because of cardiovascular system diseases in years 2003-2005 were analyzed using statistical methods. In the analyzed years the count of hospitalizations caused by angina pectoris, heart failure, hypertension, atherosclerosis and strokes has dropped, minor changes were visible in frequency of hospital admissions because of acute myocardial infarction and the count of cerebral infarction cases slightly increased. ln the analyzed years in the Lower Silesia region there was visible slight improvement in the area of most main circulatory system diseases. Their hospital treatment is in much extent concentrated in bigger hospitals, because it needs specialized stuff and equipment.

[Epidemiology of tobacco-related diseases in province of Lower Silesia]. / Epidemiologia chorób odtytoniowych w województwie dolnoslaskim.

The aim of the study is to present the epidemiology of tobacco-related diseases in province of Lower Silesia and to determine needs and tasks of medical service at this area. Tobacco use is the leading preventable cause of death in the world, resulting in approximately 4000000 deaths each year (in Poland probably 70.000 deaths). Results of the study can be a ground for planning of health education and health promotion programs. The aim of the education should be to reduce an incidence of tobacco-related diseases. The target groups should be young people and teenagers. It's necessary to create "no smoking" trend. There is an important role of doctor and nurses. They should set a good example.

[Attitude of high school youth among tobacco smoking habit. Why they do? Why they do not?]. / Postawa mlodziezy licealnej wobec nalogu palenia tytoniu. Dlaczego tak? Dlaczego nie?

Issue of smoking is a big problem among youth. In connection with this statement, very helpful is knowledge about motivation and attitude toward tobacco smoking habit. This is the issue of our research, which we carried out among 289 high school students. In questionnaire we tried to reveal flounce smokers in family and nearest environment. Obtained results showed that almost 20% of respondents are active smokers, and half of them are smoking longer than two years. We also learned that 4% of non-smokers obey parents' prohibition of smoking and only 2% of smokers are taking into account parents opinion.

[Active and passive exposure to tobacco smoke of pregnant women: two-center study]. / Czynne i bierne narazenie kobiet ciezarnych na dym tytoniowy--badanie dwuosrodkowe.

According to the current data over 12 million Polish citizens smoke tobacco, 40% of them are women. Maternal smoking in pregnancy significantly increases the rate of having a low-birthweight baby, the rate of perinatal mortality and several other adverse pregnancy outcomes. The aim of the study was to estimate the rate of smoking women during pregnancy and those who are exposed to secondhand smoke. 219 women hospitalized at Gynecology and Obstetrics Department of Wroclaw Medical University and Gynecology and Obstetrics Department in Opole have undergone the examination. The pregnant women have been interviewed and the results of questionnaire have been checked by the exhaled carbon monoxide (ExhCO) measurement. CO expresses the percentage of carboxyhemoglobin (HbCO) and is used for objective monitoring tobacco smoking. The results of the study suggest that regular exposure to secondhand smoke becomes a serious problem. 25.5% patients from Wroclaw and 16.4% patients from Opole have declared passive smoking. The mean value of ExhCO in this group of women obtained the level of 3.3 ppm vs 1.95 ppm in the group of patients who have denied both active and passive exposure.

[Comparative study of pregnant women exposure to tobacco smoke: POLAND-MEXICO]. / Badanie porównawcze narazenia kobiet ciezarnych na dym tytoniowy: POLSKA-MEKSYK.

The aim of the study was to estimate both active and passive pregnant women exposure to tobacco smoke. 154 women hospitalized at the Gynaecology and Obstetrics Department in Opole, Poland and at the Gynaecology and Obstetrics Department of Hospital Universitario Monterey in Mexico have undergone the examination. The patients have been surveyed in order to obtain a subjective evaluation of their exposure. Then the exhaled carbon monoxide (ExhCO) measurement used for objective monitoring tobacco smoking has been performed. According to the results of the questionnaire 40 women (26% of the examined patients) confirmed smoking in pregnancy. 24 women (60% of smoking ones) have been smoking for the whole period of pregnancy. Though the rate of smoking among Polish and Mexican women was comparable, Polish mothers were less likely to quit after confirmation of pregnancy. Both Polish and Mexican smoking mothers were much younger than their non-smoking counterparts. The babies of the smoking mothers have been noticed to obtain the lower count in Apgar scale. The exhaled carbon monoxide (ExhCO) measurement has revealed that 14 Polish and 10 Mexican patients have been exposed to tobacco smoke. The results of their questionnaires have been thoroughly examined. 71% of them confirmed active smoking in pregnancy, 8.3% pointed to second-hand smoke exposure, 20.7% lied by denying the exposure. Thus the need to verify the questionnaires results has been confirmed. The mean value of ExhCO of both non-smoking women and those, who quit smoking after confirmation of pregnancy was equal. This may suggest that quitting smoking in the early stages of pregnancy reduce the risk of the harmful smoke impact on the unborn baby. Nearly doubled average concentration of ExhCO among passive smoking mothers in comparison to the non-smoking ones arises a serious concern.

[Effect of passive cigarette smoking on the frequency of respiratory tract infections, allergy and bronchial asthma in children]. / Wplyw biernego palenia papierosów na czestosc infekcji dróg oddechowych, alergii i astmy oskrzelowej u dzieci.

Passive cigarette smoking is an important medical problem; it concerns first of all children as an injurious environmental factor affecting their health. Results of the conducted questionnaire and evaluation of the CO concentration in exhaled air proved the injurious exposure to be the cigarette smoke. The study showed more often allergy, bronchial asthma and respiratory tract infections in the group of children exposed to passive smoking cigarettes at home in comparison with the group of children without this exposure. The study was conducted among 75 families belonging to Model Family Practice so it has also important educational aspects.

[Tobacco smoking among high school adolescents]. / Palenie tytoniu wsród mlodziezy gimnazjalnej.

According to the American data each day more than 4000 kids in the United States try their first cigarette and more than 2000 kids become new regular, daily smokers. Roughly one-third of all youth smokers will die prematurely from smoking-caused disease. The aim of the study was to estimate the frequency of nicotine addiction among high school adolescents. The special attention has been paid to the problem of passive smoking. 60 high school students from Opole and Zielona Góra have undergone the examination. The exhaled carbon monoxide (ExhCO) measurement has been performed. Moreover the students have been interviewed about the frequency of smoking and smoking habits in their surroundings. In 17 cases (28% of students) the values of the exhaled carbon monoxide (ExhCO) concentration were out of range for non-smoking people. The exhaled carbon monoxide (ExhCO) measurement has revealed that 65% of smoking children should be regarded as heavy smokers, proving their strong nicotine addiction. 21 children (35% of examined population) have confirmed exposure to secondhand smoke. In the families of 36 students (60%) at least one of the parents has been smoking cigarettes.