Ewa Niewiadomska

Impact of road traffic noise on sleep disturbances and attention disorders amongst school children living in Upper Silesian Industrial Zone, Poland

OBJECTIVES Published reports suggest that some adverse health impact may be related to noise exposure, and motor vehicle traffic is considered to be the main source of environmental hazard of noise. The aim of this study has been to assess an association between occurrence of sleep and attention disorders with exposure to the noise generated by motor vehicle traffic in the case of a large group of children living in an urban environment. MATERIAL AND METHODS The data was obtained using a cross sectional study design in Bytom (Silesia, Poland) from 2003-2007 for a selected group of 7-14 year olds (N = 5136). The geographic information system was used for assessing the exposure to noise generated by the motor vehicle traffic. The association between occurrences of sleep disturbances or attention disorders and exposure to the traffic noise was examined by means of multivariable logistic regression. RESULTS Sleep disturbances and attention disorders were found to be statistically significantly associated with exposure to the traffic noise. The multivariable logistic regression results suggest that sleep disturbances and attention disorders were more likely to occur in the case of children living in the area with higher traffic density, the odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.05-1.97) and 1.38 (95% CI: 1.03-1.86), respectively. CONCLUSIONS The results of the study have confirmed that the exposure to the traffic noise could be a significant risk factor for sleep disturbances and attention disorders among children. Int J Occup Med Environ Health 2017;30(3):511-520.

Searching for factors associated with resistance to acetylsalicylic acid used for secondary prevention of stroke

Introduction The aim of the study was to evaluate the prevalence of resistance to acetylsalicylic acid (ASA), used for secondary prevention of stroke, including the assessment of risk factors associated with the lack of ASA anti-aggregatory action. Material and methods Patients after a transient ischaemic attack (TIA) or ischaemic stroke in the acute (n = 111) and chronic phase (n = 87) were enrolled in the study. The assessment of platelet function was performed by whole blood impedance aggregometry using a multi-channel platelet function analyser (Multiplate). Results A proper response to ASA was found in 121 patients (61.1%) (ASA responders), a partial response to ASA in 59 patients (29.8%) (ASA partial responders), and ASA resistance in 18 patients (9.1%) (ASA non-responders). Acetylsalicylic acid resistance was observed more frequently in the chronic phase. The mean low-density lipoprotein (LDL) concentration was higher in ASA non-responders (p = 0.02). The mean heart rate (p = 0.03) and the mean haematocrit (p = 0.03) were higher in the group of ASA partial responders and ASA non-responders. Angiotensin II receptor antagonists were more often used in the group of ASA partial responders and ASA non-responders (p = 0.04). Diuretics were more rarely used by ASA non-responders, whereas fibrates were more rarely used by ASA partial responders. Conclusions The method enabled the detection of ASA resistance in some patients with cerebrovascular disease. The study revealed some possible risk factors of ASA resistance: long ASA therapy, increased heart rate, higher LDL concentration, and higher haematocrit value. The relationship between the effect of ASA and other medications (angiotensin II receptor blockers, fibrates, diuretics) requires further study. Platelet function monitoring should be considered in patients at a greater risk of ASA resistance.

Comorbidity diseases in adults with diagnosed interstitial lung diseases among inhabitants of the Silesian voivodeship, Poland

BACKGROUND Interstitial lung diseases form a group of chronic diseases associated with a significant worsening of the quality of life. Proper management of these diseases involves the recognition and treatment of comorbidities, so it implies high direct and indirect costs of therapy. The lack of epidemiological data on the total incidence of interstitial diseases in Poland, as well as of information on their increasing incidence in other European countries justify investigations into epidemiological situation in the Silesian voivodeship (the southern region of Poland). MATERIAL AND METHODS In a descriptive study registered data provided by the National Health Found in 2006-2010 were used to assess the temporal variability of standardized incidence rates. A data set included interstitial lung diseases and comorbidities in adults aged ≥ 19 years, residents of the Silesian voivodeship. RESULTS In the period under study standardized incidence ratios for interstitial lung disease declined from 9.7/100 000 adult population to 7.8/100 000 adult population. The most prevalent comorbidities included cardio-vascular diseases, chronic and infectious respiratory diseases, metabolic diseases and musculoskeletal and connective tissue diseases. Comorbidities were found more frequently in older people ≥ 65 years, except for sarcoidosis, which was four times more prevalent in younger people (19-64 years) compared to older patients. The estimated costs of treatment of the analysed diseases reached more than 50 mln zlotys (12 mln dollars) per year. CONCLUSIONS A small but systematic decrease in the value of the standardized incidence rate for interstitial lung disease has been shown within the range of 9.7-7.8/100 000 adult inhabitants. The most frequent comorbidities included cardiovascular or chronic and infectious respiratory diseases. The high cost of therapy of interstitial lung diseases was largely related to simultaneous treatment of comorbidities. Med Pr 2016;67(6):751-763.

Spatial and temporal variability of bronchiectasis cases in Silesian voivodeship in 2006–2010

OBJECTIVES Reports on an increasing number of hospitalizations in other European countries and the lack of epidemiological data on the prevalence of bronchiectasis in Poland constituted motivation for the authors to investigate temporal changes of the registered incidence and hospitalization due to bronchiectasis in Silesian voivodeship, and to evaluate spatial variability of the disease in the study region. MATERIAL AND METHODS The study is a descriptive epidemiological project. Temporal and spatial variability of coefficients describing numbers of newly diagnosed cases and first time hospitalizations due to bronchiectasis (code J47 according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)) were evaluated based on the registered data available from the National Health Found (2006-2010) and the data from MZ/Szp-11 reports (2000-2011). The data concerned adults aged ≥ 19 years, inhabitants of Silesian voivodeship. Maps of incidence or hospitalization rates due to bronchiectasis were constructed by the use of a geographical information system ArcGIS. RESULTS The obtained results show a stable trend of reported new diseases, whereas the number of first time hospitalizations is increasing. Values of the standardized incidence were 19.9-25.1/100 000 inhabitants, and values of the standardized first-time hospitalization were 1.2-2.9/100 000 inhabitants. The reported rates of bronchiectasis indicate significant spatial differences in epidemiological situation in the study region. CONCLUSIONS The findings showed territorial variability of the incidence and hospitalization of bronchiectasis recorded in Silesian voivodeship. The observed variability might result from regional differences in the availability of specialized medical services.

Prevalence of high on-treatment platelet reactivity in patients with chronic kidney disease treated with acetylsalicylic acid for stroke prevention

Introduction Chronic kidney disease (CKD) is one of risk factors for stroke and may be associated with impaired platelet reactivity. Objectives The aim of the study was to evaluate platelet reactivity in patients with CKD treated with acetylsalicylic acid (ASA), using 2 different laboratory methods. Moreover, we searched for factors responsible for the phenomenon of high on-treatment platelet reactivity (HOPR). Patients and methods A total of 108 patients with CKD and 41 controls without CKD using ASA were enrolled in the study. Platelet function was assessed by impedance aggregometry in whole blood, using a multi-channel platelet function analyzer (Multiplate®; ASPItest). Urinary 11-dehydrotromboxane levels were measured by the AspirinWorks® test. Results No significant differences were observed in the prevalence of HOPR between patients with and without CKD. Patients with CKD and HOPR measured by ASPItest had higher creatinine levels (P = 0.05) and were younger (P <0.01) than patients with CKD without HOPR, while patients with CKD and HOPR measured by AspirinWorks® had lower red blood cell count (P = 0.05), hemoglobin (P = 0.05), hematocrit (P = 0.05), and high-density lipoprotein levels (P = 0.05). All patients with HOPR had higher C-reactive protein levels (P <0.05) (AspirinWorks®) and white blood cells (P <0.05) (ASPItest). Conclusions The applied methods allowed to detect HOPR in more than one third of CKD patients taking ASA for stroke prevention. The compatibility of both methods for HOPR assessment was confirmed. The study revealed several potential risk factors for HOPR in CKD, including younger age, higher levels of inflammatory markers, dyslipidemia, and lower hematocrit and hemoglobin levels.

Cardiovascular effects of H3 histamine receptor inverse agonist/ H4 histamine receptor agonist, clobenpropit, in hemorrhage-shocked rats

Hemorrhagic shock has a potential to be life-threatening when it is not treated. The main causes of hemorrhagic shock involve: (1) forces causing injury; and (2) diseases that can cause hemorrhage., Therefore, due to the causes of hemorrhagic shock and the life-threatening potential, the search for new methods of shock treatment is extremely valuable to the modern medicine. The aim of this study was to investigate the influence of clobenpropit in the model of hemorrhagic shock. The experiments were conducted in 110 adult male Wistar rats weighing between 205 and 470g. 1, 2 and 5 μmol/kg of intravenous H3 receptors reverse agonists, clobentropit, and/or 1, 5 and 10 μmol/kg H3 receptor agonist, imetit, were used as general anesthetics. Irreversible hemorrhagic shock was induced by the paused bleeding until the mean arterial pressure (MAP) lowered to the level of 20–25 mmHg. It was proved that, in cases of critical hypotension, clobenpropit triggered a dose-dependent increase of: systolic blood pressure (SBP), diastolic blood pressure (DBP), MPA and heart rate (HR) of rats with critical hypotension. The most significant changes in hemodynamic parameters were achieved by administrating dosages of 2 mmol/kg. This resulted in the survival rate increase to up to 100%. However, imetit did not trigger any hemodynamic changes nor an increase in SBP, DBP, MAP or HR. Furthermore, it was found that the premedication with prazosin, yohimbine, 6-hydroxydopamine and the vasopressin V1a receptor antagonist blocked the effects of clobenpropit. Additionally, premedication with propranolol, captopril and ZD 7155 did not cause any significant changes in the measured hemodynamic parameters. In conclusion, after an intravenous injection clobenpropit, the inverse agonist of H3 histamine receptors/agonist of histamine receptors H4, causes a resuscitating effect on rats in hemorrhagic shock. Moreover, such effect is based on the effector mechanisms of sympathetic nervous system and vasopressin.

Epidemiologia astmy oskrzeloweju osób dorosłych w województwie śląskimna podstawie wtórnych danych epidemiologicznych

BACKGROUND Asthma is a serious public health challenge because of the increasing number of people with a new diagnosis and consequently the increasing costs of medical treatment (direct and indirect). The aim of this study is to analyze available epidemiological data with respect to their spatial and temporal variability in the Silesian voivodeship. In addition, the costs incurred by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ) in treating asthmaic patients are analyzed. MATERIAL AND METHODS The epidemiological descriptive study concerns adult inhabitants of the Silesian voivodeship with asthma diagnosed under the health service delivery system, financed by NFZ, as well as diagnossis and/or hospitalization registed in the routine register run by the NFZ in Katowice. Crude and standardized incidence and prevalence rates are calculated and their changes are evaluated. Spatial variability in districts is evaluated as well and costs incurred by NFZ are revealed. RESULTS In the years 2006-2010 the standardized rate of asthma remained at a high level of 392.3-469.6/100 000 inhabitants. Greater values were related to women than to men, as well as to inhabitants of districts located in the central and southern parts of the Silesian voivodeship. A slight decrease in the values of crude prevalence rates, from 52/100 000 inhabitants to 42/100 000, is reported. The annual cost of new cases treatment is 17 million PLN while the annual cost of all hospitalizations is at the level of 10 million PLN. CONCLUSIONS Variability of incidence and prevalence due to asthma in the Silesian voivodeship is observed. An attempt at explaining this diversity requires in-depth research. A slight decrease in the values of both rates over time indicates less significant reduction in expenditure devoted to hospital treatment of asthmatic patients. Med Pr 2017;68(4):479-489.

Authors’ response (July 6, 2017)to the letter to the Editor concerningthe paper “Impact of road traffic noiseon sleep disturbances and attentiondisorders amongst school children livingin Upper Silesian Industrial Zone, Poland”

OBJECTIVES: Published reports suggest that some adverse health impact may be related to noise exposure, and motor vehicle traffic is considered to be the main source of environmental hazard of noise. The aim of this study has been to assess an association between occurrence of sleep and attention disorders with exposure to the noise generated by motor vehicle traffic in the case of a large group of children living in an urban environment. MATERIAL AND METHODS: The data was obtained using a cross sectional study design in Bytom (Silesia, Poland) from 2003-2007 for a selected group of 7-14 year olds (N = 5136). The geographic information system was used for assessing the exposure to noise generated by the motor vehicle traffic. The association between occurrences of sleep disturbances or attention disorders and exposure to the traffic noise was examined by means of multivariable logistic regression. RESULTS: Sleep disturbances and attention disorders were found to be statistically significantly associated with exposure to the traffic noise. The multivariable logistic regression results suggest that sleep disturbances and attention disorders were more likely to occur in the case of children living in the area with higher traffic density, the odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.05-1.97) and 1.38 (95% CI: 1.03-1.86), respectively. CONCLUSIONS: The results of the study have confirmed that the exposure to the traffic noise could be a significant risk factor for sleep disturbances and attention disorders among children.

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.