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.

[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.

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.

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.

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.

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.

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.

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.

New ideas, old problems? Heated tobacco products - a systematic review.

Heated tobacco products (HTPs) are a form of nicotine delivery intended to provide an alternative to traditional cigarettes. The aim of this systematic review was to present the current state of knowledge on HTPs with an emphasis on the potential impact of HTP use on human health. During the preparation of this systematic review, the literature on HTPs available within Medline/PubMed, EMBASE, CINAHL, ScienceDirect, and Google Scholar was retrieved and examined. In the final review, 97 research papers were included. The authors specifically assessed the construction and operation of HTPs, as well as the chemical composition of HTP tobacco sticks and the generated aerosol, based on evidence from experimental animal and cellular studies, and human-based studies.Heated tobacco products were found to generate lower concentrations of chemical compounds compared to traditional cigarettes, except for water, propylene glycol, glycerol, and acetol. The nicotine levels delivered to the aerosol by HTPs were 70-80% as those of conventional combustion. The results of in vitro and in vivo assessments of HTP aerosols revealed reduced toxicity, but these were mainly based on studies sponsored by the tobacco industry. Independent human-based studies indicated that there was a potentially harmful impact of the active and passive HTP smoking on human health. Currently, a large body of knowledge on HTP exposures and health effects is provided by the tobacco industry (52% of identified studies). Based on the available evidence, HTPs produce lower levels of toxic chemicals, compared to conventional cigarettes, but they are still not risk-free. Int J Occup Med Environ Health. 2019;32(5):595-634.

Acute respiratory responses to the use of e-cigarette: an intervention study.

The goal of our study was to assess acute respiratory responses to using e-cigarettes in exclusive e-cigarette users (E-Group) and dual users (T/E-Group) and to compare these effects with responses to smoking tobacco-cigarettes in tobacco smokers (T-Group). The study included 120 adults (age: 21.7 ± 2.1 years) divided into 4 groups (n = 30 each): Controls, T-, E-, T/E-Group. Spirometric status, O2 saturation, exhaled FeNO levels, exhaled CO levels, and airway temperature were assessed before the use of an e-cigarette (E-, T/E-Group) or tobacco cigarette as well as 'minute 1' and 'minute 30' after smoking. Controls used an e-cigarette without e-liquid. Lower (p < 0.05) baseline values of FeNO were found in T-Group (15.4 ppb) and in T/E-Group (15.0 ppb) than in Controls (19.6 ppb). Following exposure, and compared with Controls, T-, and T/E-Group had a significant decrease (p < 0.05) in PEF and MEF75. Mean FeNO values decreased on 'minute 1' in T-Group (by 2.1 ppb), E-Group (by 1.5 ppb) and in T/E-Group (by 2.2 ppb). Other effects included increase in temperature of exhaled air (p < 0.05). The use of e-cigarettes is associated with decreased FeNO and airflow indices (PEF, MEF75), but an increase in airway temperature. These changes are similar to those after exposure to tobacco cigarette smoke.

Costs of pharmacotherapy of chronic obstructive pulmonary disease in relation to changing Global Initiative for Chronic Obstructive Lung Disease guidelines (2007, 2011, and 2017 updates).

INTRODUCTION Chronic obstructive pulmonary disease (COPD) is one of the most common chronic noninfectious diseases. The clinical management is determined by patient assignment to the severity stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. OBJECTIVES Our aim was to determine the economic implications of changing GOLD guidelines (2007, 2011, and 2017 updates) and their impact on the direct costs of pharmacological treatment of patients diagnosed with COPD. PATIENTS AND METHODS This analysis was based on data provided by a group of 298 out of 500 randomly selected primary care physicians in Poland (response rate, 59.6%). Each primary care physician provided information on 10 consecutive patients with COPD. These data were used to simulate the economic consequences of the 2007, 2011, and 2017 GOLD guideline updates. RESULTS Regardless of the GOLD guidelines used, pharmacotherapy of patients with a very severe form of COPD was most expensive. Pharmacotherapy costs would be reduced with each subsequent guideline. In the same group of 2597 COPD patients, the average monthly cost of the first­line pharmacotherapy as well as the overall costs of pharmacotherapy (first- and second­line) per patient would be the lowest when applying the therapeutic regimen in accordance with the 2017 GOLD guidelines. CONCLUSIONS Implementation of 2011 and 2017 GOLD guidelines, as compared with the 2007 update, would result in a reduction of direct costs of COPD treatment.

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.

Evaluation of the First Polish Web-Based Intervention Aimed at Improving Cancer Prevention (the PORINA Study).

The appropriate level of the society's health-oriented knowledge is essential for improving the effectiveness of actions to reduce the number of new cases and deaths caused by cancer. The aim of this study was to identify the role of web-based educational campaigns in the field of cancer prevention in Poland. From 14.05.2015 to 13.11.2016 readers of Polish scientific websites were invited to participate in the "PORINA" prospective interventional study. A total of 1118 volunteers (unrepresentative sample) were recruited and randomized (interventional and control groups). After applying the inclusion and exclusion criteria, 463 participants (41.4% of the recruited) qualified for the final analysis; 207 were allocated to the interventional and 256 to the control group. A specially designed internet platform, a self-reported questionnaire (validated during the study) and educational materials which were prepared by a physician specialized in clinical oncology were used. Assessments of participants' knowledge were based on the authors Cancer Knowledge Index (CKI). The number of subjects with an increase in CKI score was significantly higher for the interventional group with minor changes in the control (p < 0.001). The highest increase in CKI scores was obtained in the following demographic groups: females, younger participants, those living in smaller villages and also among the less educated. An overall impact of presented web-based educational intervention was moderate. However, the results obtained confirmed that well-organized intervention supported by oncologists may be useful in cancer prevention.

Parental Opinions and Attitudes about Children's Vaccination Safety in Silesian Voivodeship, Poland.

Despite mandatory vaccinations in Poland, the final decision on vaccination in children is taken by their parents or legal guardians. Understanding parents' attitudes and opinions regarding vaccinations is essential for planning and undertaking extensive and properly targeted educational actions aimed at preventing their hesitancy. In 2016, a cross-sectional study was conducted in the Silesian Voivodeship (Poland) in 11 randomly selected educational institutions. The authors' self-administered questionnaire contained 24 mixed-type questions. It was distributed among 3000 parents or legal guardians of children aged 6-13 years; prior consent of the relevant bioethics committee had been obtained. The response rate was 41.3% (N = 1239). Data were analysed using descriptive and analytical statistics, and focused on parental opinions regarding the safety of vaccines. Results of simple and multivariable analyses showed that perceived risk of adverse vaccine reaction (AVR), contraindications and perception of the qualification procedure for vaccination as substandard were significant factors associated with the rating of children's vaccination as unsafe (p < 0.001). Respondents with a lower level of education, compared with those with higher, more often declared vaccinations to be safe (p = 0.03); however, results of multivariable analysis did not confirm that effect. AVR occurrence, finding of contraindication to vaccinations and perception of qualification procedure for vaccination were found to be the most important factors responsible for influencing general public opinions in the field of vaccination safety.

Between-occasion repeatability of fractional exhaled nitric oxide measurements in children.

The aim of the study was to assess short-term repeatability of measurements of fractional exhaled nitric oxide (FENO) and its correlates in children in the 6- to 9-year age bracket participating in a respiratory epidemiological survey. FENO was measured in two sessions one week apart in 101 children. Participants were divided into three groups: asymptomatic (n = 76); symptomatic (n = 14); and asthma (n = 11). Absolute and relative differences between the measurements, as well as concordance correlation coefficients, were used in order to assess repeatability. The two FENO measurements were strongly correlated (0.98). Although intragroup comparisons of the two measurements were not significantly different (p = 0.2), intergroup comparisons were. FENO measurements are reproducible in children in epidemiological settings.

Between-occasion repeatability of fractional exhaled nitric oxide measurements in children / Repetibilidade de medidas da fração de óxido nítrico exalado em crianças em duas ocasiões

ABSTRACT The aim of the study was to assess short-term repeatability of measurements of fractional exhaled nitric oxide (FENO) and its correlates in children in the 6- to 9-year age bracket participating in a respiratory epidemiological survey. FENO was measured in two sessions one week apart in 101 children. Participants were divided into three groups: asymptomatic (n = 76); symptomatic (n = 14); and asthma (n = 11). Absolute and relative differences between the measurements, as well as concordance correlation coefficients, were used in order to assess repeatability. The two FENO measurements were strongly correlated (0.98). Although intragroup comparisons of the two measurements were not significantly different (p = 0.2), intergroup comparisons were. FENO measurements are reproducible in children in epidemiological settings.

RESUMO O objetivo do estudo foi avaliar a repetibilidade em curto prazo de medidas da fração de óxido nítrico exalado (FENO) e seus correlatos em crianças de 6-9 anos participantes de uma pesquisa epidemiológica respiratória. A FENO foi medida em duas sessões, com uma semana de intervalo, em 101 crianças. Os participantes foram divididos em três grupos: assintomático (n = 76), sintomático (n = 14) e asma (n = 11). A repetibilidade foi avaliada por meio de diferenças absolutas e relativas entre as medidas, bem como por coeficientes de correlação de concordância. As duas medidas da FENO correlacionaram-se fortemente (0,98). Embora as comparações entre as duas medidas em um mesmo grupo não tenham sido significativamente diferentes (p = 0,2), as comparações entre os grupos o foram. Medidas da FENO são reprodutíveis em crianças em cenários epidemiológicos.

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.

Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland.

Introduction. The presented study of 4,535 children aged 7-17 years in the Upper Silesian region of Poland yielded 186 cases of previously known asthma, and 44 children with newly diagnosed asthma. The aim of the presented study was to identify non-medical factors that could explain why children with a newly established diagnosis ('undiagnosed asthma') had not been diagnosed in the past. Materials and method. The study was performed according to a case-control design. Parents of the children answered questionnaires on socio-economic status and family-related factors. Statistical determinants of undiagnosed asthma were explored using raw (OR) and logistic odds ratios with their 95% confidence intervals (logOR, 95%CI). Results. Children with undiagnosed asthma were younger compared to the group with previously known asthma (11.3±2.1 vs. 12.6±2.5 years; p=0.0008). Newly diagnosed cases were more frequent in children who had less parental attention (less than 1 hour/day spent by parent with child - OR=4.36; 95%CI: 1.76-10.81) and who were not registered with specialized health care (OR=2.20; 95%CI: 0.95-5.06). Results of logistic regression analysis suggest that under-diagnosis of asthma is related to age below 12 years - logOR = 3.59 (95%CI: 1.28-10.36), distance to a health centre > 5 km - logOR = 3.45 (95%CI: 1.05-11.36), time spent with child < 1 hour/day - logOR = 6.28 (95%CI: 1.98-19.91). Conclusion. Among non-medical determinants of undiagnosed asthma the age of a child plays a major role. Another factors of importance is the large distance between residence and health centre, and low parental attention at home.

Spatial and temporal variability of idiopathic pulmonary fibrosis cases in Silesian Voivodeship in years 2006-2010.

OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) (J84.1 by the International Statistical Classification of Diseases and Related Health Problems, 10th revision - ICD-10) is a rare disease of unknown cause. Among many risk factors, occupational exposure to metal dust is enumerated. Because of metal industry concentration in the Silesian Voivodeship, Poland, an attempt of spatial and temporal variability of the idiopathic pulmonary fibrosis occurrence evaluation in 2006-2010 is made. MATERIAL AND METHODS: The research is a descriptive analysis. Data of the number of new treated cases and firsttime hospitalization due to idiopathic pulmonary fibrosis in the years 2006-2010 was obtained from the National Health Found (Narodowy Fundusz Zdrowia - NFZ). We also assessed spatial and temporal variability of both rates. Data concerned adults aged ≥ 19 years old inhabited the Silesian Voivodeship. RESULTS: The standardized incidence rate due to idiopathic pulmonary fibrosis increased in the study period and was in the range of 2.9-3.8/100 000 population. The highest values of incidence were observed in districts localized in the centre of the Silesian Voivodeship. CONCLUSIONS: Incidence of idiopathic pulmonary fibrosis is not so high in the Silesian Voivodeship but the number of newly treated cases slightly increased in 2006-2010. Spatial and temporal variability of incidence rates for treated registered cases of idiopathic pulmonary fibrosis in the Silesian Voivodeship was observed. It could be an effect of occupational exposure to metal dust, however, final conclusions need more precise studies to the extent of analytical epidemiology. Int J Occup Med Environ Health 2017;30(4):593-601.