Agnieszka Kiełtyka

Prenatal, perinatal and neonatal risk factors for autism - study in Poland

The results of conducted research studies suggest that heredity and early fetal and neonatal development play a causal role in autism. The objective was to determine a relationship between pre-, peri-, and neonatal factors and autism. The relationship between genders and individual risk factors for autism was also examined. A case-control study was conducted among 288 children (96 cases with childhood or atypical autism and 192 controls individually matched to cases by the year of birth, sex, and general practitioners). Data on autism diagnosis and other medical conditions were acquired from physicians. All other information on potential autism risk factors were collected from mothers. Autism risk was significantly higher when mothers were taking medications (OR=2.72, 95%CI: 1.47-5.04) and smoked during pregnancy (OR=3.32, 95%CI: 1.12-9.82). It was also significantly associated with neonatal dyspnea (OR=3.20, 95%CI: 1.29-8.01) and congenital anomalies (OR=7.17, 95%CI: 2.23-23.1). In gender analysis only congenital anomalies were significantly associated with autism for girls but all of mentioned factors stayed independent risk factors for boys.

Epidemiologia nowotworów neuroendokrynnych układu pokarmowego w Krakowie i powiecie krakowskim w latach 2007-2011.

INTRODUCTION Gastroenteropancreatic neuroendocrine neoplasms (GEPNEN) are rare and heterogeneous tumours with variable biology. The aim of this study was to evaluate the epidemiology of GEPNEN in the population of Krakow and Krakow district in 2007-2011. MATERIAL AND METHODS The Database of the Chair and Department of Endocrinology, Jagiellonian University Medical College, comprising the data on NEN cases collected from the Endocrinology Department, University Hospital in Krakow and from independent sources: surgery, pathology, and endocrinology departments located in the Krakow area, was searched for cases of GEPNEN patients living in Krakow and Krakow district, diagnosed between 2007 and 2011. Eighty-eight such patients (39 males, 49 females, median age at diagnosis 59 ± 17 years) were identified and characterised. RESULTS The mean follow-up time was 2.67 ± 1.6 years. The most frequent primary location of GEPNEN was small intestine (20%), followed by the appendix (18%), stomach (16%), pancreas (16%), rectum (15%), and colon (15%). NENG1 predominated (64%) in the analysed group. Most well-differentiated GEPNEN (63%) were diagnosed at stage I; however, 18% of them were diagnosed at stage IV. Metastases at diagnosis were found in 31% of patients. The GEPNEN incidence rate in 2007-2011 was 2.1/100000 inhabitants/year, without significant increase during the studied period. CONCLUSIONS GEPNEN incidence and epidemiology in the population of Krakow and Krakow district is similar to the incidence observed in most European countries. Registers are important tools to evaluate GEPNEN epidemiology. (Endokrynol Pol 2017; 68 (1): 42-46).

Rubella outbreak in Poland in 2013 – an analysis of surveillance data at the national and province level

Abstract Introduction. Poland is a member of the WHO European Region where a complete eradication of measles and rubella is planned to be finished by 2015. Poland accounted for 99% of all reported rubella cases in 27 EU/EEA countries in 2013. It is a good time to evaluate whether the established Polish vaccination strategy was sufficient to reach the goal of rubella elimination in the near future. Aim. The aim of this study was to analyze the epidemiology of rubella in Poland when the disease outbreak took place in 2013, to determine the reasons of that situation and to find the solution for future rubella elimination strategies. Material and methods. To analyze the epidemiology of rubella in Poland during the disease outbreak in 2013 the authors used rubella surveillance data collected by the Provincial and National Notifiable Disease Reporting System in 2004-2013. The information at the provincial level derived from one of the 16 provinces (Malopolska). The data on MMR vaccination coverage in 2003-2012 derived from the National Surveillance System. The percentages of rubella cases and vaccine coverage between Poland with Malopolska province were compared. Results. The outbreak started in late 2012 and continued through 2013, when 38548 rubella cases (incidence rate 100.1/ 100 000) were notified. Geographically, rubella cases were reported from the entire country, with the highest incidence rate in Malopolska province (254.9/100 000). Only 5 cases from Malopolska and 120 in whole country were laboratory confirmed, the remaining 99.7% were reported solely on the basis of clinical signs. The vaccination coverage was not sufficient to protect the population against rubella outbreak in Poland, especially among adolescents and young adult males. Conclusions. The strengthening of routine immunization program and implementation of some additional vaccination campaigns in young adults as well as laboratory confirmation of all suspected cases are the challenges that will have to be met to eliminate rubella in Poland

Reply to correspondence letter “Krakow’s children cohort and long term follow-up of Thimerosal exposure - design and statistics”

Dear Editor J.P.K. Rooney and J. Dorea raised some important issues related to the design and statistics of our last study on thimerosal-containing vaccines and children cognitive development, which we feel should be explained. They are right that we did not discuss our previous results published inNeurotoxicol Teratol [5] in our last paper [6]. The last paper was focused only on children’s cognitive development and the results did not differ in that issue with the previous study, when follow-up was limited to 3-year-old infants. We found no relationship between neonatal thimerosalcontaining vaccine (TCV) exposure and mental developmental delays in children up to 3 years of age [5], which was confirmed in the last paper related to longer exposure to TCVs (both neonatal and up to the sixth month of life) and longer follow-up of children’s cognitive development (up to 9 years of age) [6]. On the other hand, our previous results have shown that ethylmercury is not completely harmless for the first stage of life and may be responsible for poorer outcomes of psychomotor development in children. The lower psychomotor scores associated with TCV neonatal exposure were observed only during the first 2 years of life. That negative association disappeared by 36 months [5]. We did not discuss it because in older children, we did not perform the psychomotor tests and we could not assess the potential influence of TCVon psychomotor development in later age. Differences in size of analyzed population between papers [5, 6] were associated with different attitudes as during the first 3 years of life, the same test was conducted [5], and repeated analysis was in our opinion the best way of analysis. The period analyzed in our last paper [6] was much longer and represented by different tests (and different scales) of children’s cognitive development. It was hardly possible to compare them in repeated analysis techniques. Furthermore, as we noted [6], there was substantial dropout from the basic number of children (at the first year of life) to 45 % at the age of 8. So each analysis was made for a particular age category and differed in number of children as a result of lack of some test performances. The full enrolled cohort was indeed 505 children; however, due to drop out, the lack of the possibility to check vaccination history, and missing cord blood results of heavy metals, the biggest possible number available for analysis was 318 [6]. It was smaller in a 2012 paper [5] as only children with Bayley (BSID-II) tests who performed repeated measures during all 3 years with a score result were analyzed. Furthermore, analyzing a period of 9 years in a rather small cohort, we needed to choose which cord blood metal, lead or mercury, introduces in final models for adjustments, as adjusting for both makes the group too small. Finally, we decided to present models adjusted for mercury level as more important as thimerosal issue was considered. During the analysis process, adjustments to lead level instead of mercury one were also performed; however, they were not changing the inference of thimerosal. They were not present in the manuscript, similarly as full models, due to the interest of simplicity. We do not This is a reply to the correspondence found at http://dx.doi.org/10.1007/ s00431-015-2568-7