Agnieszka Genowska

Change in Knowledge of Kindergarten Employees Participating in the Course “Diet full of life” in the Field of Children’s Nutrition, as Assessed by Generalized Estimating Equations

Abstract Nutrition is one of the most important environmental factors affecting the physical development and health of children. Education in this area and the development of proper eating habits are priorities. A prerequisite for the proper nutrition of preschool children is knowledge of proper nutrition of people working there. The aim of this study was an evaluation of the knowledge of kindergarten employees participating in the course “Diet full of life – courses in the field of children’s nutrition”. The study included 90 employees of nurseries and kindergartens, participants of the course in the field of children’s nutrition. The research tool was an original questionnaire. Study I (pre-test) was performed before the beginning of the course, while study II (post-test) was performed after its completion. Generalized Linear Models with a Generalized Estimating Equations extension was used to estimate the impact of the number of covariates on knowledge of course participants, taking into consideration the correlation between before- and after-course results. An increase in the knowledge of the participants of the investigated course on children’s nutritional standards was significant and reached 2.053 points on average. No relationship between age, job position, and knowledge level was determined. In the area of principles of proper nutrition for children, older participants had a lower level of knowledge compared to younger ones, and participants with higher education showed a significantly higher knowledge increase as compared to those with vocational education. A significant knowledge increase in the field of dietary behaviors of children was obtained during the course by all examined women, 1.6 points on average (p < 0.001). Younger participants obtained significantly more knowledge from the course than older ones (p < 0.001). Thus, it can be concluded that realization of the course entitled “Diet full of life” specifically relating to young children’s nutrition affected a significant increase in participant knowledge, particularly among the younger age groups and people with higher education. Kindergarten employees need constant supplemental education in the form of training courses, during which they acquire actual knowledge given in an accessible manner for use in practice. The proper assessment of the supplemental education course presented herein, as well as of the course participants, was performed using General Estimating Equations.

Changing 14-year trends in the epidemiology of hepatitis B virus infection in rural and urban Central-Eastern European areas.

In Poland, the prevalence of HBV infection constitutes an emerging public health concern. The aim of the study was to analyse changes in hepatitis B incidence rate by age, gender and place of residence in Poland between 1999 and 2012. The data were obtained from Polish state statistics institutions such as the National Institute of Public Health and State Sanitary Inspection. Relationships of hepatitis B incidence with age, gender and rural/urban areas were investigated using χ2 and tests for two proportions with Bonferroni adjustment. The incidence of hepatitis B in rural and urban populations was compared using Wilcoxons signed‐rank tests. Joinpoint regression was used to analyse trends in hepatitis B incidence rate. In Poland, a total of 26 660 cases of hepatitis B were reported in the studied period and 31.6% of these cases occurred in rural areas. There was significantly declining tendency in the hepatitis B incidence rate in the initial period of the study. However, there were periods of significant increase of HBV incidence rate in women from rural areas aged 15–24 years (9.4%/year) and in women from urban areas aged 15–24 years (10.9%/year) and 25–64 years (3.8%/year) in the final years of the observation. Despite the success in controlling this infection, a significant increase in the incidence of hepatitis B among young women living in rural and urban areas, as well as in adult women in urban areas, has been noted.

The Use of Joinpoint Regression Analysis in the Mortality Study of Developmental Age Population in the Podlaskie Voivodeship, 2003–2012

Abstract The youngest population in society is recognized as that at the healthiest stage of life but is burdened by the occurrence of premature death that should be avoidable. There is a need to use adequate statistical methods in assessing the health status of the population of developmental age. The aim of the study was to analyze trends of mortality in children and adolescents by age and gender in the Podlaskie Voivodeship in the years 2003-2012 by joinpoint regression and to identify the causes of mortality. The mortality rate was analysed according to gender and the age groups: 0, 1-4, 5-9, 10-14 and 15-19 years in the Podlaskie Voivodeship. The data were obtained from the Central Statistical Office for the period 2003-2012. Differences in mortality levels between age and gender subgroups were obtained by the Wilcoxon signed-rank test. Join- point regression was used to analyze the trends in mortality. The nomenclature of ICD-10 was used to assess the causes of mortality of children and adolescents. In the Podlaskie Voivodeship in the years 2003-2012 in the 0-19-year-old age group, the highest proportion of deaths (42.4%) occurred during the first year of life. There were differences in mortality rates between boys (8.0/104) and girls (3.1/104) in the 15-19-year-old age group (p < 0.01), and also between the 1-14-year-old and 15-19-year-old age groups (p < 0.01), both among boys (2.1/104 vs. 8.0/104) and girls (1.5/104 vs. 3.1/104). Monotonous trends were shown regarding total mortality rates in infants. There was a drop in the mortality rate of infant girls (AAPC = 5.3%, p < 0.05) and boys (AAPC = 4.7%, p < 0.05). Changes in the direction of the total mortality rate trend were visible in the population of boys aged 1-14 years, in which, between 2003 and 2010, a significant reduction in mortality (AAPC = 9.5%) was observed, while in the years 2010-2012 the trend was not significant. No statistical evidence was found that mortality changed among girls in the 1-14-year-old and 15-19-year-old age groups. Deaths in infancy were due to perinatal conditions and congenital mal- formations. The main causes of mortality in the 1-19-year-old age group were external causes, mainly traffic accidents and intentional self-harm. Joinpoint regression indicated a uniform decrease of mortality in the years 2003-2012 except for boys from 1-14 years old, for whom the decreasing trend was for the years 2003-2010 with subsequent stabilization. The main problems are still infant deaths due to perinatal conditions, traffic accidents and intentional self-harm in boys in the 15-19-year-old age group.

Study on changing patterns of reproductive behaviours due to maternal features and place of residence in Poland during 1995-2014.

INTRODUCTION The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland. MATERIAL AND METHODS Information about live births in Poland in the years 1995-2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used. RESULTS In 1995-2014, a shift in the age of highest fertility from 20-24 years to 25-29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15-29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30-49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5-29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005-2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped. CONCLUSIONS The postponement of births and reduction of fertility in women aged 15-29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas. ABBREVIATIONS APC - annual percentage change; AAPC - average annual percentage change; CSO - Central Statistical Office; TFR - total fertility rate.

Social costs of loss in productivity-related absenteeism in Poland

OBJECTIVES The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. MATERIAL AND METHODS Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych - ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. RESULTS Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30-39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium - 1.474 billion euro; respiratory diseases - 0.632 billion euro, injuries and poisonings - 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems. CONCLUSIONS Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the workplace are necessary. Policies aimed at reduction of sickness absence could potentially increase prosperity and the socioeconomic situation in Poland. Int J Occup Med Environ Health 2017;30(6):917-932.

Inequalities in mortality of infants under one year of age according to foetal causes and maternal age in rural and urban areas in Poland, 2004-2013.

INTRODUCTION European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence. OBJECTIVE Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004-2013. MATERIALS AND METHOD Data on mortality during the neonatal and infancy period in 2004-2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model. RESULTS In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20-34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly. CONCLUSIONS The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas.

The Use of Cluster Analysis for Non-Continuous Variables in the Assessment of Dietary Behaviours and Physical Activities in Primary School Children

Abstract Physical activity, along with proper nutrition, is a very important element in child development. Lack of everyday, regular physical activity among young people is a public health problem. The aim of the study was to use cluster analysis to assess the relationship between nutrition and physical activity levels of primary school children. The study included 682 students from randomly selected elementary schools and was performed using a proprietary questionnaire during the 2013/2014 school year. The questionnaire contained questions about eating habits and physical activity, as well as the socio-economic conditions of families. Clusters of students of similar dietary habits were identified using cluster analysis and subsequently compared in terms of physical activity level. We identified four clusters, characterized by relative internal homogeneity and at the same time variability between one another in terms of number of meals throughout the day and time of their consumption. The most important characteristic of Cluster 1 was eating four meals a day including breakfast, which is the most important meal of the day. The diets of children in Cluster 2 abounded with raw vegetables and fruits. Students in Cluster 3 were characterized by a regular and varied diet. The least appropriate behaviour in the field of nutrition was observed among students belonging to Cluster 4. Cluster analysis in the studied population allowed relationships between dietary habits and physical activity to be described. By using the UIAF indicator (Moderate to Intense Physical Activity), a statistically significant association between the eating habits of the children and their physical activity levels was observed. A sufficient level of physical activity was observed in most students belonging to Cluster 3, and high levels of physical activity were observed in a small percentage of children belonging Cluster 4. An average level of physical activity was observed in a high percentage of children belonging to Cluster 4. Low levels of physical activity were most frequently observed in Clusters 4 and 1 and least frequently observed in Cluster 3. All of the identified active forms of free-time activity were most commonly acknowledged in Cluster 3. The study supports a beneficial relationship between students’ eating behaviours and physical activity.

Application of Cluster Analysis in Assessment of Dietary Habits of Secondary School Students

Abstract Maintenance of proper health and prevention of diseases of civilization are now significant public health problems. Nutrition is an important factor in the development of youth, as well as the current and future state of health. The aim of the study was to show the benefits of the application of cluster analysis to assess the dietary habits of high school students. The survey was carried out on 1,631 eighteen-year-old students in seven randomly selected secondary schools in Bialystok using a self-prepared anonymous questionnaire. An evaluation of the time of day meals were eaten and the number of meals consumed was made for the surveyed students. The cluster analysis allowed distinguishing characteristic structures of dietary habits in the observed population. Four clusters were identified, which were characterized by relative internal homogeneity and substantial variation in terms of the number of meals during the day and the time of their consumption. The most important characteristics of cluster 1 were cumulated food ration in 2 or 3 meals and long intervals between meals. Cluster 2 was characterized by eating the recommended number of 4 or 5 meals a day. In the 3rd cluster, students ate 3 meals a day with large intervals between them, and in the 4th they had four meals a day while maintaining proper intervals between them. In all clusters dietary mistakes occurred, but most of them were related to clusters 1 and 3. Cluster analysis allowed for the identification of major flaws in nutrition, which may include irregular eating and skipping meals, and indicated possible connections between eating patterns and disturbances of body weight in the examined population.