Jacek Jamiołkowski

Index of clinical consequences of untreated dental caries (pufa) in primary dentition of children from north-east Poland

PURPOSE The purpose of this study was to evaluate the prevalence and experience of clinical consequences of untreated dental caries in primary dentition in 5 and 7 year-old children from north-east Poland and to find whether there is a correlation between dmft and pufa indices. MATERIAL/METHODS Two hundred fifteen children aged 5 and 7 years living in the Podlaskie region were examined in the course of the Polish National Oral Health Survey 2011. Caries prevalence and experience in primary dentition was evaluated according to WHO criteria (dmft index). The clinical consequences of untreated dental caries were assessed by pufa index. RESULTS The dmft index was 5.56 ± 4.45 in 5-years-old children and 6.69 ± 3.14 in 7-years-olds. The prevalence/experience of pufa index was 43.4%/2.20 ± 3.43 and 72.4%/2.44 ± 2.22, respectively. Children living in rural areas presented a worse dental condition. A statistical analysis revealed a strong relation between dmft and pufa in both age groups. CONCLUSION The present study revealed negligence in the dental treatment of children from north-east Poland resulting in the high prevalence and experience of the pufa index in primary dentition. This index is a valuable measurement tool to record the clinical consequences of untreated dental caries.

The value of cardiac magnetic resonance and distribution of late gadolinium enhancement for risk stratification of sudden cardiac death in patients with hypertrophic cardiomyopathy

BACKGROUND The presence of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) is associated with worse clinical outcome and the extent of LGE predicts the increased risk of sudden cardiac death (SCD). Limited data exist regarding the distribution of LGE. We attempted to verify whether the presence of LGE outside the interventricular insertion points carries additional risk for patients with HCM. METHODS In this prospective study, 328 patients with HCM, who underwent cardiac magnetic resonance (CMR) were enrolled. Five major risk factors for SCD were assessed in all patients. The median follow-up was 37 months. RESULTS LGE was detected in 226 (68.9%) patients. In 70 (21.3%) patients it was present only at the interventricular insertion points - LGE (+) group, while in 156 (47.6%) it was noted in other locations - LGE (++) group. Primary endpoint defined as SCD or appropriate implantable cardioverter-defibrillator intervention occurred in 14 (4.3%) patients, one in LGE (+) and 13 in LGE (++). In multivariable analysis including five traditional risk factors and left ventricular ejection fraction <50%, only the presence of LGE outside the insertion points was a significant predictor of SCD/aborted SCD (HR 10.01, 95% CI 1.21-83.86, p=0.033). The performance of the multivariable sudden cardiac death risk model was improved by the addition of LGE (++) to the traditional risk factors (likelihood ratio p=0.005). The Kaplan-Meier curves showed better event-free survival in the LGE (-) and LGE (+) patient groups compared to the LGE (++) group. CONCLUSIONS In HCM patients, presence of LGE outside interventricular insertion points is associated with increased risk of sudden cardiac death or its equivalent as well as overall mortality. Cardiac fibrosis as a substrate for SCD in HCM may be identified on CMR and serve as an imaging biomarker of increased risk.

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.

Preferred health behaviors and quality of life of the elderly people in Poland.

Purpose The aim of this study was to assess possible differences between a group of residents of public nursing homes (PNH) and a group of members of Universities of the Third Age (UTA) measured using standard psychometric scales. Materials and methods The research was conducted between January 3, 2013 and February 15, 2014 on a group of 200 residents of PNH and 200 members of the UTA using five psychometric scales: Standardized Satisfaction with Life Scale (SWLS), Standardized Health Behavior Inventory (HBI), Standardized Social Support Scale (SSS), Standardized General Self-efficacy Scale (GSES), and Standardized Multiple Health Locus of Control Scale (MHLC). Results The average point total in the Standardized Satisfaction with Life Scale (SWLS) in the group of residents of PNH was 18.03 (Me =19) and was significantly higher (P=0.047) in comparison with the group of UTA members (17.08). Similar to residents of PNH, a vast majority of UTA members assessed the support received from the UTA as good, which significantly influenced their satisfaction from life (P=0.028) and their feeling of self-efficacy (P=0.048). An observed dependence states that the greater the level of satisfaction from life, the greater the level of various types of support from family. Conclusion This study indicates that biopsychosocial problems decrease quality of life in elderly people. The elderly people require a comprehensive, holistic approach to a variety of problems that occur with aging. In future, extended interdisciplinary research should be carried out on aspects of quality of life in order to optimize comprehensive geriatric assessment.

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.

Clinical and echocardiographic parameters as risk factors for atrial fibrillation in patients with hypertrophic cardiomyopathy

Atrial fibrillation (AF) is a common complication in patients with hypertrophic cardiomyopathy (HCM) and may contribute to high cardiovascular morbidity and mortality. Therefore, it is important to assess parameters associated with AF in HCM patients.

Changes in Dietary Patterns and the Nutritional Status in Men in the Metallurgical Industry in Poland Over A 21-Year Period

Background/Aims: The study was carried out to evaluate the changes in the eating habits and lipid parameters in a 21-year follow-up on a group of 435 men living in Poland. Methods: The studied population was composed of the same subjects: a group of men who were first studied in the years 1987–1989 and in 2008–2010. The following data was gathered: body mass, body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentration in blood serum. Results: The changes in the eating habits among the studied men registered throughout the 21-year period were positive since they showed a reduction in the caloric content of their diet (p < 0.001), lower total fat content (p < 0.001), total amount of carbohydrates (p < 0.001), sucrose (p < 0.001), iron (p < 0.001), and featured more vitamins: A (p < 0.002), B1 (p < 0.001), and C (p < 0.001). An adverse trend was observed in terms of constant calcium shortages in their food portions (ns). A 21-year follow-up of the studied group showed significant differences in terms of weight (p < 0.001), BMI (p < 0.001), and all cholesterol fractions (p < 0.001) in their blood serum, except cholesterol alone (ns). Conclusion: It is important to continue observing the dietary trends in the studied group, with the focus on the occurrence of potential changes in their bodies.

Platelet aggregation and the risk of stent thrombosis or bleeding in elective percutaneous coronary intervention patients.

&NA; Platelet aggregation monitoring in patients after stent implantation is a promising way of preventing stent thrombosis and bleeding. The aim of the study was to verify whether clopidogrel (ADPtest) and aspirin (ASPItest) response measured by Multiplate (Dynabyte, Munich, Germany) analyzer in elective percutaneous coronary implantation patients predict the risk of stent thrombosis or other ischemic adverse events and bleeding. In this prospective, observational study 697 elective percutaneous coronary implantation patients were analyzed. The median ASPItest was 86 AU min. In 69 patients (9.9%), an ASPI result of more than 203 AU min was observed. The median ADP-dependent platelet aggregation was 212 AU min. In 36 (5.2%) patients, the result was at least 468 AU min. Cox regression analysis showed the prognostic factors of definite or probable stent thrombosis and cardiac death at 1 year were higher ASPItest result [odds ratio (OR) 1.006, 95% confidence interval (CI) 1.004–1.008, P < 0.001], ASPItest more than 203 AU min (OR 7.61, 95% CI 2.83–20.43, P < 0.001), higher ADPtest result (OR 1.005, 95% CI 1.003–1.007, P < 0.001) and ADPtest at least 468 AU min (OR 12.54, 95% CI 4.56–35.53, P < 0.001). In turn, ADPtest 188 AU min or less predicted GUSTO scale major and moderate bleeding (OR 4.15, 95% CI 1.12–15.32, P = 0.033). There was also a strong trend toward higher rate of major and moderate bleeding for the ASPItest less than 35 AU min (lowest quintile) – (OR 3.04, 95% CI 0.96–9.58, P = 0.058). Lower creatinine clearance and lower hemoglobin level were associated with both ischemic and bleeding complications. The results of this study show that impaired platelet response to clopidogrel and aspirin measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death. Furthermore, the study showed that increased response to clopidogrel is related to major and moderate bleeding events.

Factors related to on-treatment platelet aggregation assessed by multiple electrode aggregometry in percutaneous coronary intervention patients on clopidogrel and aspirin

Introduction There is ongoing controversy concerning the clinical value of platelet function monitoring in patients undergoing percutaneous coronary interventions (PCI). Patients at risk of high on-treatment platelet aggregation (HPR) may benefit most from such monitoring. Aim To define the factors related to HPR on aspirin and clopidogrel, looking at a wider spectrum of variables than those assessed in some previous studies. Material and methods We assessed platelet function in 908 patients on clopidogrel and aspirin after PCI using the multielectrode aggregometry system Multiplate to define which clinical, procedural and laboratory factors are related to on-treatment platelet aggregation in response to aspirin and clopidogrel either as linear values or using established cutoff values for HPR. Results We found that in PCI patients on clopidogrel and aspirin, age (OR per year 1.06; 95% CI: 1.024–1.097; p = 0.001), gender (OR = 0.319; 95% CI: 0.139–0.731; p = 0.007), active smoking (OR = 2.57; 95% CI: 1.29–5.15; p = 0.008), diabetes (β = 37.6; 95% CI: 16.5–58.8; p = 0.001) and hypertension (β = 26.9; 95% CI: 6.73–47.1; p = 0.009) are independently linked to platelet aggregation values treated as linear values and as dichotomous variables at the accepted cutoffs. The same is true for stented segment length (OR per mm 1.033; 95% CI: 1.010–1.057; p = 0.009) and stent inflation pressure (OR per atmosphere 0.862; 95% CI: 0.772–0.963; p = 0.002). Conclusions The study shows that, contrary to some earlier data, in the tested cohort women are better clopidogrel responders, but more often aspirin low-responders. Older age, active smoking, diabetes and hypertension all predispose to HPR. A novel finding is that stented segment length is an independent predictor of lower response both to aspirin and clopidogrel, possibly as a marker of more diffuse atherosclerosis.