Epidemiologia astmy w Polsce z podziałem na regiony wiejskie i miejskie na podstawie danych dotyczących udzielanych świadczeń zdrowotnych

Introduction: Asthma is a serious health and social problem, also in Poland. The epidemiological data indicate that the problem of asthma concerns approximately 4 million people in Poland, whereas almost approximately 70% of them have no diagnosis and are not aware of their illness, and on the other hand in 39% of persons who declared the diagnosis of asthma in a survey the diagnosis was negatively verified (overdiagnosis of asthma). So far, no detailed comparative studies for asthma incidence rate in urban and rural areas were conducted in Poland. The aim of the study was to analyze patients with asthma in Poland in the years 2008−2012, with regard to province and type of commune (rural/urban). Material and methods: The study used data from National Health Fund (NFZ) — reported by health care providers regarding the patients diagnosed with asthma. Using structured query language (SQL) a set of patients was selected and created, for whom at the same time ICD-10 code: J45.X-bronchial asthma was reported. In order to estimate the number of patients with asthma we used the PESEL social security number as a unique identifier of the patient. Code of the patient’s commune of residence in conjunction with the Central Statistical Office data formed the basis for the division of municipalities into urban and rural areas. The analysis of asthma incidence trends in Poland was performed on the basis of health services provided to patients. The analysis was performed by using the Statistica 10 software using a negative binomial regression model. Results: In 2009 a significant increase in the number of patients with asthma was observed compared with the previous year, whereas after 2009 the number of patients diagnosed with asthma remained relatively constant. A significant increase of predominance of women among asthma patients in recent years can be noticed: from 107% in 2008 to almost 115% in 2012 (F:M ratio). Regardless of the analyzed year and the diagnosis the incidence rate remained constant: approximately 55−57% for urban areas and about 43−45% in rural areas. Conclusions: The average prevalence rate for rural areas is significantly lower than for urban areas. The use of adjusted incidence rate leads to the conclusion that the number of sufferers in urban areas is higher (about 10%) of the number of sufferers in the rural areas. The results of the analysis are consistent with information from previous studies in Poland and in the world.Wstęp: Astma jest ważnym problemem zdrowotnym i socjalnym na świecie oraz w Polsce. Dostępne dane epidemiologiczne wskazują, że problem astmy dotyczy prawie 4 mln osób w Polsce, podczas gdy około 70% z nich nie ma postawionej diagnozy i nie są świadomi swojej choroby. Jednocześnie około 39% chorych z postawioną diagnozą astmy jest następnie negatywnie weryfikowana (nadrozpoznawalność astmy). Do tej pory brakuje szczegółowych badań porównawczych astmy w regionach wiejskich i miejskich. Celem badania była analiza danych chorych na astmę w Polsce w latach w latach 2008−2012 w odniesieniu do województw oraz typu gminy (wiejskie/miejskie). Materiał i metody: W badaniu zastosowano analizę danych NFZ — sprawozdawanych przez świadczeniodawców — pacjentów ze zdiagnozowaną astmę. Przy zastosowaniu SQl (structured query language) wyodrębniono i utworzono zbiory pacjentów dla których sprawozdano kod ICD-10: J45.X- dychawica oskrzelowa. W celu oszacowania liczby pacjentów wykorzystano numer PESEL, jako unikalny identyfikator pacjenta. Kod gminy miejsca zamieszkania w połączeniu z danymi Głównego Urzędu Statystycznego był podstawą podziału gmin na regiony miejskie i wiejskie. Analizę trendu zachorowalności na astmę w Polsce wyliczono na podstawie udzielonych pacjentom świadczeń zdrowotnych. Analizę przeprowadzono za pomocą narzędzia Statistica 10, korzystając z modelu ujemnej regresji binominalnej. Wyniki: W 2009 roku obserwowano istotne zwiększenie liczby chorych na astmę w porównaniu z rokiem poprzednim, natomiast po 2009 roku liczba pacjentów z rozpoznaniem astmy pozostawała na względnie st ałym poziomie. Zwraca uwagę istotny wzrost w ostatnich latach przewagi kobiet wśród chorych na astmę: ze 107% w 2008 roku do prawie 115% w 2012 roku (stosunek K:M). Niezależnie od badanego roku i rozpoznania utrzymuje się stały współczynnik zachorowalności: około 55−57% dla regionów miejskich i około 43−45% dla regionów wiejskich. Wnioski: Średni wskaźnik chorobowości dla regionów wiejskich jest istotnie niższy niż dla regionów miejskich. Zastosowanie skorygowanego współczynnika zachorowalności pozwala na stwierdzenie, że liczba chorujących w regionach miejskich jest większa (o około 10%) od liczby chorujących w regionach wiejskich. Wyniki analizy są zbieżne z informacjami z wcześniejszych badań w Polsce i na świecie

Pulmonary prevention program in the Proszowice county: description and results

  INTRODUCTION: In the Proszowice county, both lung cancer and chronic obstructive pulmonary disease (COPD) are more common in comparison with other regions of Poland. The purpose of this study was to provide a report on a prevention program carried out in the area to reduce the burden of COPD and lung cancer in the region. MATERIAL AND METHODS: The program consisted of the following: active prevention ― questionnaire survey offered to every county inhabitant aged at least 40 and chest X-ray and spirometry performed in selected subjects; and passive prevention ― covering multiple educational activities promoting healthy lifestyle. Data obtained from questionnaire survey and spirometry were further analyzed. RESULTS: Education program covered all local children aged 13–15, a majority of adolescents and a significant proportion of adult inhabitants of the county. Questionnaire data were obtained from 14,455 subjects (about 70% of county inhabitants). On the basis of the questionnaire results, the participants were selected to undergo spirometry (5,816 subjects) and chest X-ray (5,514 subjects). Current smokers constituted 24.2% of the total number of participants (33.3% of men and 16.8% of women). Electronic cigarettes were currently used by 0.65% of the subjects. Negative impact of occupational exposures (including farming) on lung function and the presence of respiratory symptoms was observed. Basing on post-bronchodilator spirometry, COPD was diagnosed in 13.2% of the subjects. Physician’s diagnosis of asthma was reported by 7.2%. CONCLUSION: Educational activities and questionnaire-based study were targeted at and reached the majority of the county inhabitants. The study provided data on the prevalence and risk factors of COPD, asthma and respiratory symptoms in the Proszowice region.

Correspondence Analysis of the Global Epidemiology of Cutaneous and Visceral Leishmaniasis

Cutaneous leishmaniasis is mostly prevalent in the western and central Asia, North Africa, Southeastern Europe, Central and South America while visceral leishmaniasis is most prevalent in Central, South and Western Asia, the Mediterranean countries, East Africa, Southeastern Europe and South America. Result from the correspondence analysis showed that the number of reported cases of cutaneous leishmaniasis is increasing moderately while visceral leishmaniasis is increasing slightly. The plots showed that countries that are clustered together have similar trend while isolated countries have irregular trend.Correspondence analysis has helped to reveal many hidden patterns of the data and the models are significant even with though the model was able to explain small amount of variation of the data. The research concluded with some suggested policy statements and recommendatio

Association between Nine Types of TCM Constitution and Five Chronic Diseases: A Correspondence Analysis Based on a Sample of 2,660 Participants

Objective. The purpose of this study was to explore the association of nine types of Traditional Chinese Medicine (TCM) constitution with the five chronic diseases: hypertension, hyperlipidemia, diabetes mellitus, heart disease, and obesity. Methods. Chi-squared test was performed to investigate the distribution characteristics of TCM constitutions in the participants with the five chronic diseases in questionnaire. Correspondence analysis was used to explore the correlation between them. Results. A total of 2,660 participants (1,400 males; 1,260 females) were included in this study. The mean age was 52.54 ± 13.92. Of them, 600 were of gentleness type accounting for 22.56%. Proportions of gentleness type in the chronic diseases (16.00%~23.70%) were less than that in general population (32.14%). The gentleness type and yin-deficiency type were significantly correlated with hypertension and diabetes mellitus, qi-deficiency type was correlated with heart disease, phlegm-dampness type was associated with obesity, and dampness-heat type was correlated with hyperlipidemia. Conclusions. The correlations between TCM constitution types and the five chronic diseases were different. This may have a significant implication for TCM practice, and even the people with gentleness type should not be ignored in health management

Evaluating the long-term effect of respiratory syncytial virus (RSV) infection on children: a prospective longitudinal birth cohort study in Bangladesh

BACKGROUND: Respiratory Syncytial Virus (RSV) is a leading cause of illness among neonates and young infants. In 2019, an estimated 33 million [95% CI: 21·6-50·3) RSV-associated acute lower respiratory infected (RSV-ALRI) episodes occurred worldwide in children younger than five years, and 101,400 of them died [1]. Children from all parts of the world suffer from RSV-associated illnesses. Nevertheless, those who are from the developing part of the world are disproportionately affected, as 93% of all RSV-associated acute lower respiratory infections (RSV-ALRI) and 99% of RSV-ALRI mortality occurs among children living in developing world countries. Evidence also suggests that children with RSV infection during early infancy are at increased risk for asthma and recurrent wheezing in subsequent years. Nevertheless, few studies have assessed the long-term impact of RSV infection in developing healthcare settings, and none of the previous studies focussed on neonates. This PhD thesis aimed to evaluate the long-term effects of RSV infection within 0-59 days of life in a resource-poor setting. RESEARCH PLAN: In this thesis study, I assessed the respiratory health of a cohort of children aged 6-8 years with known RSV infection exposure during 0-59 days of life to evaluate the association between RSV infection and recurrent wheezing and asthma. I evaluated whether RSV infection during the young infant period (0-59 days) affects lung functions and physical growth of the children. Finally, I evaluated the diagnostic value of the peripheral blood eosinophil level for the diagnosis of childhood asthma. METHODS: I enrolled study participants from a rural community in Bangladesh, a country in South Asia. Children of 6-8 years old with known RSV infection information during 0-59 days of life (RSV+'ve cohort) were enrolled at their household and followed for 12 months. In this study, I leveraged the findings of population-based surveillance on the aetiology of neonatal infection in South Asia (ANISA study), which identified the RSV infection cases in young infants in a rural community with an annual birth cohort of 10,000 neonates. The RSV infection cases were identified in the ANISA study through prospective community-based disease surveillance. Control children (RSV-'ve cohort) had no illness signs (i.e., asymptomatic) during 0-59 days of life. I followed the study participants for 12 months to collect health-related information. During the follow-up period, research assistants (RAs) visited the study participants three times; each visit was scheduled within six months intervals. RAs collected health-related data of the study participants from their respective caregivers using structured questionnaires. The lung function of the participants was assessed using spirometry at the outreach clinics. An open-air 6-minute running exercise test was performed to assess the exercise-related airway hyper-reactivity. The height and weight of the children were collected to monitor the growth of the participants. Capillary blood was collected to determine the blood eosinophil level. The primary outcome measure was "current asthma", which I defined as ≥3 episodes of wheezing in the past 12 months or ≥1 episode of wheezing with repeated cough during the night when the child did not have a cold or chest infection. Additional outcome measures included "asthma ever", "doctor-diagnosed asthma", "wheezing ever", "current wheezing", different lung function parameters (i.e., FVC, FEV1, FEV1/FVC ratio), stunting, and underweight. RESULTS: I enrolled 534 children in this study; of these, 179 children had RSV infection within 0-59 days of life (RSV+'ve cohort), and the other 355 children were controls (RSV-'ve cohort) who were healthy during the same period of life without known RSV infection episode. The primary outcome of this study was “current asthma” at follow-up age (asthma at age 6-8 years) was 4.4%, [95% CI: (-)1.8-10.5] higher among the children in the RSV+'ve cohort [15.1%, 95% CI: 10.5-21.1] compared to those in the RSV-'ve cohort [10.7%, 95% CI: 7.8-14.3], but the difference was not statistically significant. Even though the "current asthma" prevalence was not statistically significantly higher among the children in the RSV+'ve cohort, all other asthma phenotypes that I investigated were significantly higher in this group compared to the controls. The prevalence of "asthma ever" was (significantly) 14% higher [95% CI: 5.8-22.3] among the RSV+'ve cohort children [36%, 95%: 29.0-43.1] compared to the RSV-'ve cohort [22%, 95% CI: 9.7-15.2]. There was also a significantly higher prevalence of "current wheezing" [10%, 95% CI: 2.5-17.3] among the children in RSV+'ve cohort [25.1%, 95% CI: 19.3-32.0] compared to those in the RSV-'ve cohort [15.2%, 95% CI: 11.8-19.4]. Parental asthma [Odds Ratio [OR) 2.15; 95% CI: 1.22-3.79] and household crowding index ≥3 [OR 1.83; 95% CI: 1.04-3.21] were found as the risk factors for "current asthma" among the study participants. In general, the different lung function parameters of the participants that were measured in this study were significantly lower than the expected values, but no significant differences were found between the children in RSV+'ve and RSV-'ve cohorts. Children in the RSV+'ve cohort had a mean Forced Vital Capacity (FVC) of 1.41 litres, 92% of the predicted mean, which was 1.29 litres for the children in the RSV-'ve cohort, 91% of the predicted mean. The mean Forced Expiratory Volume in one second (FEV1) of the children in RSV+'ve cohort was 1.31 litres, 96% of the predicted mean, compared to 1.21 litres, 95% of the predicted mean for the children in the RSV-'ve. There was a high burden of stunting (29.2%) and underweight (40.3%) among the study population, but the differences were not statistically significant between the children in the RSV+'ve and RSV-'ve cohorts. About 71% of the participants had >300 eosinophils cells/µl blood without any notable difference between the RSV+'ve and RSV-'ve cohorts. Also, there was no significant difference in the blood eosinophil level among children with and without current asthma. DISCUSSION: This study demonstrates the association of RSV infection during 0-59 days of life with an increased risk of subsequent asthma in childhood in rural Bangladesh. However, the strength of the association between RSV infection and asthma was not significant after 6-8 years of infection. Thus, RSV intervention would likely have little impact in controlling asthma in children, but the high prevalence of current wheezing, doctor-diagnosed asthma, asthma ever and wheezing ever, suggest that RSV-specific interventions may have a broader impact and should be evaluated using all these definitions to ensure that potential benefit can be captured. Additionally, understanding the possible interaction between RSV infection and genetic and environmental risk factors may help intervene in childhood asthma development. CONCLUSIONS: The burden of RSV-associated illness and asthma among children substantiates the continued research on the association between these two conditions. Future studies on the interactions between host, environment, and RSV infections in developing asthma phenotypes and establishing their causality could contribute to articulating a single intervention to control both RSV-associated illness and asthma, which has greater public health importance

The Prevalence of Asthma and Declared Asthma in Poland on the Basis of ECAP Survey Using Correspondence Analysis

Results of epidemiological and public health surveys are often presented in the form of cross-classification tables. It is sometimes difficult to analyze data described in this way and to understand relations between variables. Graphical methods such as correspondence analysis are more convenient and useful. Our paper describes an application of correspondence analysis to epidemiological research. We apply the basic concepts of correspondence analysis like profiles, chi-square distance to medical data concerning prevalence of asthma. We aim at describing the relationship between asthma, region, and age. The data presented in this paper come from Epidemiology of Allergy in Poland (ECAP) survey in years 2006–2008. Correspondence analysis shows that there is a fundamental difference in the structure of age groups for people with symptoms compared to those who have declared asthma (regardless of the level of symptoms of asthma and the level of declaration). The variable which best differentiates declared asthma in all regions is “wheezing and whistling.” Correspondence analysis also shows significant differences between locations. Our analyses are performed in the R package “ca”

Stakeholder engagement in European health policy : a network analysis of the development of the European Council Recommendation on smoke-free environments

Background: With almost 80,000 Europeans estimated to die annually from the consequences of exposure to second-hand smoke (SHS) and over a quarter of all Europeans being exposed to the toxins of cigarette smoke at work on a daily basis, SHS is a major European public health problem. Smoke-free policies, i.e. policies which ban smoking in public places and workplaces, are an effective way to reduce exposure. Policy options to reduce public exposure to SHS were negotiated by European Union (EU) decision makers between 2006 and 2009, resulting in the European Council Recommendation on smoke-free environments. A variety of stakeholders communicated their interests prior to the adoption of the policy. This thesis aims to analyse the engagement and collaboration of organisational stakeholders in the development of the Council Recommendation on smoke-free environments. Methods: The case study employs a mixed method approach to analyse data from policy documents, consultation submissions and qualitative interviews. Data from 176 consultation submissions serve as a basis to analyse the structure of the policy network using quantitative network analysis. In addition, data from these submissions, selected documents of relevance to the policy process and 35 in-depth interviews with European decision makers and stakeholders are thematically analysed to explore the content of the network and the engagement of and interaction between political actors. Results: The analysis identified a sharply polarised network which was largely divided into two adversarial advocacy coalitions. The two coalitions took clearly opposing positions on the policy initiative, with one coalition supporting and the other opposing comprehensive European smoke-free policy. The Supporters’ Alliance, although consisting of diverse stakeholders, including public health advocacy organisations, professional organisations, scientific institutions and pharmaceutical companies, was largely united by its members’ desire to protect Europeans from the harms caused by SHS and campaign for comprehensive European tobacco control policy. Seemingly coordinated and guided by an informal group of key individuals, alliance members made strategic decisions to collaborate and build a strong, cohesive force against the tobacco industry. The Opponents’ Alliance consisted almost exclusively of tobacco manufacturers’ organisations which employed a strategy of damage limitation and other tactics, including challenging the scientific evidence, critiquing the policy process and advancing discussions on harm reduction, to counter the development of effective tobacco control measures. The data show that the extent of tobacco company engagement was narrowed by the limited importance that industry representatives attached to opposing non-binding EU policy and by the companies’ struggle to overcome low credibility and isolation. Discussion: This study is the first that applies social network analysis to the investigation of EU public health policy and systematically analyses and graphically depicts a policy network in European tobacco control. The analysis corroborates literature which highlights the polarised nature of tobacco control policy and draws attention to the complex processes of information exchange, consensus-seeking and decision making which are integral to the development of European public health policy. The study identifies the European Union’s limited competence as a key factor shaping stakeholder engagement at the European level and presents the Council Recommendation on smoke-free environments as an example of the European Commission’s successful management of the policy process. An increased understanding of the policy network and the factors influencing the successful development of comprehensive European smoke-free policy can help to guide policymaking and public health advocacy in current European tobacco control debates and other areas of public health