Cohort fertility of Polish women, 1945–2015: the context of postponement and recuperation

The article is a follow-up and an extension to previously published papers by Holzer-Żelażewska & Holzer (1997) and Holzer-Żelażewska & Tymicki (2009). Fristly, we have added new cohorts to the cohort analysis based on the individual data from births registration for the years 2009–2015. Secondly, we have extended the scope of the study by taking into account the context of postponement and recuperation to analyses of cohort fertility of Polish women. The approach applied to the fertility postponement and recuperation on the cohort data refers to the method which was originally proposed by Frejka (2011) and Lesthaeghe (2001) and further developed by Sobotka et al. (Sobotka et al., 2011). This method allows for calculation of fertility postponement and recuperation measures with respect to a benchmark cohort chosen as the one that first experiences an onset of the increase in the mean age of motherhood at first birth. The results show the remarkable changes in the fertility patterns in Poland. The main driving forces behind the change in fertility patterns in Poland are related to the postponement of first births along with a relatively good recuperation. The magnitude of recuperation for Polish cohorts dropped significantly for second births and was almost non-existent for third and higher births. Therefore, the pattern of fertility in Poland observed till 2015 could be characterized by postponement and recuperation of first births along with a significant decrease in second births with perpetual postponement of third and higher births

Porównanie stężeń IL-6 i IL-10 w osoczu dzieci poddanych zabiegowi kardiochirurgicznemu z krążeniem pozaustrojowym i bez niego

Wstęp: Zabieg kardiochirurgiczny z krążeniem pozaustrojowym (CPB) wiąże się z występowaniem odpowiedzi zapalnej. Czynnikiem sprawczym jest ekspozycja ustroju na działanie silnych bodźców prozapalnych. Przedmiotem badań była ocena zmian stężeń IL-6 i IL-10 podczas zabiegu na otwartym sercu i po nim. Materiał i metody: Badaniami objęto 14 dzieci poddanych zabiegowi operacyjnemu z użyciem CPB i 7 dzieci bez CPB. Stężenia IL-6 i IL-10 badano kolejno: przed znieczuleniem, na początku zabiegu (z CPB i bez CPB), 30 min po rozpoczęciu CPB, po zakończeniu zabiegu (z CPB i bez CPB), po 24 i po 72 godzinach od zakończenia zabiegu (z CPB i bez CPB). Wyniki: Wykazano istotny wzrost stężenia IL-6 w obu grupach 24 godziny po zabiegu. W grupie pacjentów z CPB stężenie IL-6 po zabiegu było istotnie wyższe niż w grupie dzieci bez CPB. W grupie dzieci, u których zabieg przeprowadzono z zastosowaniem CPB, stwierdzono wzrost stężenia IL-10 obserwowany w momencie zakończenia zabiegu, który powracał do wartości rejestrowanej przed zabiegiem po 72 godzinach. Natomiast, w grupie dzieci, u których nie zastosowano CPB, stężenie IL-10 wzrastało, osiągając najwyższą wartość 24 godziny po zakończeniu zabiegu. Wnioski: Wyniki badania potwierdziły, że zabieg kardiochirurgiczny u dzieci wiąże się z istotnymi zmianami stężeń cytokin w osoczu krwi obwodowej. Zastosowanie CPB w trakcie zabiegu pogłębia zaburzenia równowagi cytokin i istotnie wpływa na rozwój reakcji zapalnej. (Folia Cardiol. 2005; 12: 57–63

Porównanie stężeń IL-6 i IL-10 w osoczu dzieci poddanych zabiegowi kardiochirurgicznemu z krążeniem pozaustrojowym i bez niego

Wstęp: Zabieg kardiochirurgiczny z krążeniem pozaustrojowym (CPB) wiąże się z występowaniem odpowiedzi zapalnej. Czynnikiem sprawczym jest ekspozycja ustroju na działanie silnych bodźców prozapalnych. Przedmiotem badań była ocena zmian stężeń IL-6 i IL-10 podczas zabiegu na otwartym sercu i po nim. Materiał i metody: Badaniami objęto 14 dzieci poddanych zabiegowi operacyjnemu z użyciem CPB i 7 dzieci bez CPB. Stężenia IL-6 i IL-10 badano kolejno: przed znieczuleniem, na początku zabiegu (z CPB i bez CPB), 30 min po rozpoczęciu CPB, po zakończeniu zabiegu (z CPB i bez CPB), po 24 i po 72 godzinach od zakończenia zabiegu (z CPB i bez CPB). Wyniki: Wykazano istotny wzrost stężenia IL-6 w obu grupach 24 godziny po zabiegu. W grupie pacjentów z CPB stężenie IL-6 po zabiegu było istotnie wyższe niż w grupie dzieci bez CPB. W grupie dzieci, u których zabieg przeprowadzono z zastosowaniem CPB, stwierdzono wzrost stężenia IL-10 obserwowany w momencie zakończenia zabiegu, który powracał do wartości rejestrowanej przed zabiegiem po 72 godzinach. Natomiast, w grupie dzieci, u których nie zastosowano CPB, stężenie IL-10 wzrastało, osiągając najwyższą wartość 24 godziny po zakończeniu zabiegu. Wnioski: Wyniki badania potwierdziły, że zabieg kardiochirurgiczny u dzieci wiąże się z istotnymi zmianami stężeń cytokin w osoczu krwi obwodowej. Zastosowanie CPB w trakcie zabiegu pogłębia zaburzenia równowagi cytokin i istotnie wpływa na rozwój reakcji zapalnej. (Folia Cardiol. 2005; 12: 57–63

Polish statement on food allergy in children and adolescents

An adverse food reaction is defined as clinical symptoms occurring in children, adolescents or adults after ingestion of a food or chemical food additives. This reaction does not occur in healthy subjects. In certain individuals is a manifestation of the body hypersensitivity, i.e. qualitatively altered response to the consumed food. The disease symptoms observed after ingestion of the food can be triggered by two pathogenetic mechanisms; this allows adverse food reactions to be divided into allergic and non-allergic food hypersensitivity (food intolerance). Food allergy is defined as an abnormal immune response to ingested food (humoral, cellular or mixed). Non-immunological mechanisms (metabolic, pharmacological, microbiological or other) are responsible for clinical symptoms after food ingestion which occur in non-allergic hypersensitivity (food intolerance). Food allergy is considered a serious health problem in modern society. The prevalence of this disorder is varied and depends, among other factors, on the study population, its age, dietary habits, ethnic differences, and the degree of economic development of a given country. It is estimated that food allergy occurs most often among the youngest children (about 6-8% in infancy); the prevalence is lower among adolescents (approximately 3-4%) and adults (about 1-3%). The most common, age-dependent cause of hypersensitivity, expressed as sensitization or allergic disease (food allergy), are food allergens (trophoallergens). These are glycoproteins of animal or plant origine contained in: cow's milk, chicken egg, soybean, cereals, meat and fish, nuts, fruits, vegetables, molluscs, shellfish and other food products. Some of these allergens can cause cross-reactions, occurring as a result of concurrent hypersensitivity to food, inhaled or contact allergens. The development of an allergic process is a consequence of adverse health effects on the human body of different factors: genetic, environmental and supportive. In people predisposed (genetically) to atopy or allergy, the development of food allergy is determined by four allergic-immunological mechanisms, which were classified and described by Gell-Coombs. It is estimated that in approximately 48-50% of patients, allergic symptoms are caused only by type I reaction, the IgEmediated (immediate) mechanism. In the remaining patients, symptoms of food hypersensitivity are the result of other pathogenetic mechanisms, non-IgE mediated (delayed, late) or mixed (IgE mediated, non-IgE mediated). Clinical symptomatology of food allergy varies individually and depends on the type of food induced pathogenetic mechanism responsible for their occurrence. They relate to the organ or system in which the allergic reaction has occurred (the effector organ). Most commonly the symptoms involve many systems (gastrointestinal tract, skin, respiratory system, other organs), and approximately 10% of patients have isolated symptoms. The time of symptoms onset after eating the causative food is varied and determined by the pathogenetic mechanism of the allergic immune reaction (immediate, delayed or late symptoms). In the youngest patients, the main cause of food reactions is allergy to cow’s milk. In developmental age, the clinical picture of food allergy can change, as reflected in the so-called allergic march, which is the result of anatomical and functional maturation of the effector organs, affected by various harmful allergens (ingested, inhaled, contact allergens and allergic cross-reactions). The diagnosis of food allergy is a complex, long-term and time-consuming process, involving analysis of the allergic history (personal and in the family), a thorough evaluation of clinical signs, as well as correctly planned allergic and immune tests. The underlying cause of diagnostic difficulties in food allergy is the lack of a single universal laboratory test to identify both IgE-mediated and non-IgE mediated as well as mixed pathogenetic mechanisms of allergic reactions triggered by harmful food allergens. In food allergy diagnostics is only possible to identify an IgE-mediated allergic process (skin prick tests with food allergens, levels of specific IgE antibodies to food allergens). This allows one to confirm the diagnosis in patients whose symptoms are triggered in this pathogenetic mechanism (about 50% of patients). The method allowing one to conclude on the presence or absence of food hypersensitivity and its cause is a food challenge test (open, blinded, placebo-controlled). The occurrence of clinical symptoms after the administration of food allergen confirms the cause of food allergy (positive test) whereas the time elapsing between the triggering dose ingestion and the occurrence of clinical symptoms indicate the pathogenetic mechanisms of food allergy (immediate, delayed, late). The mainstay of causal treatment is temporary removal of harmful food from the patient’s diet, with the introduction of substitute ingredients with the nutritional value equivalent to the eliminated food. The duration of dietary treatment should be determined individually, and the measures of the effectiveness of the therapeutic elimination diet should include the absence or relief of allergic symptoms as well as normal physical and psychomotor development of the treated child. A variant alternative for dietary treatment of food allergy is specific induction of food tolerance by intended contact of the patient with the native or thermally processed harmful allergen (oral immunotherapy). This method has been used in the treatment of IgE-mediated allergy (to cow's milk protein, egg protein, peanut allergens). The obtained effect of tolerance is usually temporary. In order to avoid unnecessary prolongation of treatment in a child treated with an elimination diet, it is recommended to perform a food challenge test at least once a year. This test allows one to assess the body's current ability to acquire immune or clinical tolerance. A negative result of the test makes it possible to return to a normal diet, whereas a positive test is an indication for continued dietary treatment (persistent food allergy). Approximately 80% of children diagnosed with food allergy in infancy "grow out" of the disease before the age of 4-5 years. In children with non-IgE mediated food allergy the acquisition of food tolerance is faster and occurs in a higher percentage of treated patients compared to children with IgE-mediated food allergy. Pharmacological treatment is a necessary adjunct to dietary treatment in food allergy. It is used to control the rapidly increasing allergic symptoms (temporarily) or to achieve remission and to prevent relapses (long-term treatment). Preventive measures (primary prevention of allergies) are recommended for children born in a "high risk" group for the disease. These are comprehensive measures aimed at preventing sensitization of the body (an appropriate way of feeding the child, avoiding exposure to some allergens and adverse environmental factors). First of all, the infants should be breast-fed during the first 4-6 months of life, and solid foods (non milk products, including those containing gluten) should be introduced no earlier than 4 months of age, but no later than 6 months of age. An elimination diet is not recommended for pregnant women (prevention of intrauterine sensitization of the fetus and unborn child). The merits of introducing an elimination diet in mothers of exclusively breast-fed infants, when the child responds with allergic symptoms to the specific diet of the mother, are disputable. Secondary prevention focuses on preventing the recurrence of already diagnosed allergic disease; tertiary prevention is the fight against organ disability resulting from the chronicity and recurrences of an allergic disease process. Food allergy can adversely affect the physical development and the psycho-emotional condition of a sick child, and significantly interfere with his social contacts with peers. A long-term disease process, recurrence of clinical symptoms, and difficult course of elimination diet therapy are factors that impair the quality of life of a sick child and his family. The economic costs generated by food allergies affect both the patient's family budget (in the household), and the overall financial resources allocated to health care (at the state level). The adverse socio-economic effects of food allergy can be reduced by educational activities in the patient’s environment and dissemination of knowledge about the disease in the society

Fertility and family policies in Central and Eastern Europe after 1990

This paper examines fertility and family policies in 15 Central and East European (CEE) countries to establish firstly, likely directions of cohort fertility trends for the coming decade; and secondly, to provide an overview and analysis of family policies in CEE countries, and to assess their impact on cohort fertility trends. Demographic analysis suggests that the cohort fertility decline of the 1960s cohorts is likely to continue at least among the 1970s birth cohorts; stagnation cannot be ruled out. Births that were postponed by women born in the 1970s were not being replaced in sufficient numbers for cohort fertility to increase in the foreseeable future, and shares of low parity women (childless and one child) were larger than shares of high parity women among the late 1960s cohorts than in older cohorts. Also, childbearing postponement which started in the 1990s is reflected in dramatic changes of childbearing age patterns. As period fertility rates have been increasing in the late 2000s throughout the region an impression of a fertility recovery has been created, however the findings of this project indicate that no such widespread childbearing recovery is underway. For the first time ever an overview and analysis of CEE family policies is conceptualized in this paper. It demonstrates that fertility trends and family policies are a matter of serious concern throughout the region. The following family policy types have been identified: comprehensive family policy model; pro-natalist policies model; temporary male bread-winner model; and conventional family policies model. The majority of family policies in CEE countries suffer from a variety of shortcomings that impede them from generating enhanced family welfare and from providing conditions for cohort fertility to increase. The likely further decline of cohort fertility, or its stagnation, may entail long-term demographic as well as other societal consequences, such as continuous declines in total population numbers, changes in age structures, as well as implications for health and social security costs.Publisher PDFPeer reviewe

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation