Inequalities in mortality of infants under one year of age according to foetal causes and maternal age in rural and urban areas in Poland, 2004-2013

Introduction. European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence. Objective. Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004–2013. Materials and method. Data on mortality during the neonatal and infancy period in 2004–2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model. Results. In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20–34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly. Conclusions. The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas

Inequalities in mortality of infants under one year of age according to foetal causes and maternal age in rural and urban areas in Poland, 2004–2013

Introduction European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence. Objective Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004–2013. Material and Methods Data on mortality during the neonatal and infancy period in 2004–2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model. Results In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20–34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly. Conclusions The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas

Evaluation of CD40 and CD80 receptors in the colonic mucosal membrane of children with inflammatory bowel disease

[b][/b][b]Introduction. [/b]The most prevalent inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD). Immune processes play a vital role in the etiopathogenesis of these conditions, involving both cellular and humoral response mechanisms. The aim of this study was to quantify CD40- and CD80-positive cells in the biopsy specimens of large intestinal mucosa from children with IBD. [b]Materials and method. [/b]The study comprised 38 children aged between 3–17 years (mean 11.5±3.7 years) – 20 boys (52.6 %) and 18 girls (47.4%). Eighteen patients were diagnosed with UC on the basis of clinical manifestation, endoscopic and histopathological findings. Mean age of this subgroup was 11.55±4.07 years. A group of 10 children (mean age 12.30±2.83) diagnosed with CD was also included. The control group comprised 10 IBD-free children (mean age 10.28±4.07 years). The surface expressions of CD40 and CD80 were analyzed in large intestine mucosa biopsy specimens, fixed in formaldehyde, embedded in paraffin, and cut with a microtome into 4 µm slices. [b]Results. [/b]The number of CD40- and CD80-positive cells in the large intestinal mucosa of children with Crohn’s disease and ulcerative colitis was significantly higher than in the controls. The highest number of CD40+ and CD80+ cells was observed in the caecal mucosal membrane of Crohn’s disease patients and in the rectal mucosa of individuals with ulcerative colitis. [b]Conclusion.[/b] IBD is characterized by elevated, segment-specific, expression of CD40 and CD80

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

Expressions of Matrix Metalloproteinases (MMP-2, MMP-7, and MMP-9) and Their Inhibitors (TIMP-1, TIMP-2) in Inflammatory Bowel Diseases

Crohn’s disease (CD) and ulcerative colitis (UC) belong to a group of inflammatory bowel diseases (IBD). The aim of our study was to evaluate the expression of MMP-2, MMP-7, MMP-9, TIMP-1, and TIMP-2 in ulcerative colitis and Crohn’s disease. The study group comprised 34 patients with UC and 10 patients with CD. Evaluation of MMP-2, MMP-7, MMP-9, TIMP-1, and TIMP-2 expression in tissue samples was performed using immunohistochemistry. The overexpression of MMP-9 and TIMP-1 was dominant in both the glandular epithelium and inflammatory infiltration in UC patients. In contrast, in CD subjects the positive expression of MMP-2 and TIMP-1 was in glandular tubes while mainly MMP-7 and TIMP-2 expression was in inflammatory infiltration. Metalloproteinases’ expression was associated with the presence of erosions, architectural tissue changes, and inflammatory infiltration in the lamina propria of UC patients. The expression of metalloproteinase inhibitors correlated with the presence of eosinophils and neutrophils in UC and granulomas in CD patients. Our studies indicate that the overexpression of metalloproteinases and weaker expression of their inhibitors may determine the development of IBD. It appears that MMP-2, MMP-7, and MMP-9 may be a potential therapeutic target and the use of their inhibitors may significantly reduce UC progression

Volumetric Magnetic Resonance Imaging Study of Brain and Cerebellum in Children with Cerebral Palsy

Introduction. Quantitative magnetic resonance imaging (MRI) studies are rarely used in the diagnosis of patients with cerebral palsy. The aim of present study was to assess the relationships between the volumetric MRI and clinical findings in children with cerebral palsy compared to control subjects. Materials and Methods. Eighty-two children with cerebral palsy and 90 age- and sex-matched healthy controls were collected. Results. The dominant changes identified on MRI scans in children with cerebral palsy were periventricular leukomalacia (42%) and posthemorrhagic hydrocephalus (21%). The total brain and cerebellum volumes in children with cerebral palsy were significantly reduced in comparison to controls. Significant grey matter volume reduction was found in the total brain in children with cerebral palsy compared with the control subjects. Positive correlations between the age of the children of both groups and the grey matter volumes in the total brain were found. Negative relationship between width of third ventricle and speech development was found in the patients. Positive correlations were noted between the ventricles enlargement and motor dysfunction and mental retardation in children with cerebral palsy. Conclusions. By using the voxel-based morphometry, the total brain, cerebellum, and grey matter volumes were significantly reduced in children with cerebral palsy

Selected nutritional habits of teenagers associated with overweight and obesity

Introduction A balanced diet is at the heart of healthy growth and development of children and youth, whereas inappropriate eating habits considerably influence the incidence of disorders connected with nutrition, including overweight and obesity. This paper aims at studying nutritional factors of 18-year-old secondary school youth in the urban environment and their effect on the incidence of overweight and obesity. Materials and methods The survey was conducted among 1,999 secondary school students chosen at random. The research tool consisted an original survey questionnaire. The measurements of respondents’ height and body mass provided data for calculating the body mass index. Results and conclusion The percentage of youth with deficient body mass was estimated at 8.4%. The percentage of normal weight students in the surveyed group was estimated at 77.6%. Overweight and obesity characterized 14.0% of the total number. As many as 21.8% of overweight and obese respondents would eat one or two meals as opposed to 16.8% of normal weight students. Three-fourths of the surveyed students would eat breakfast regardless of their nutritional habits. Lunch is eaten by 52.9% of normal weight 18-year-olds and 46.1% of overweight and obese students. The analysis of mealtimes suggests that overweight and obese students would have their breakfast and dinner at later hours than the rest of the surveyed. More than half of the participating students failed to eat lunch (53.9%), and one in four students within this group resigned from supper. Girls would eat fruit and vegetables more frequently than boys several times a day. The percentage of persons in the surveyed groups who would eat fast foods on a daily basis was similar regardless of their nutritional status. Sweetened carbonated beverages would be drunk more often by overweight and obese boys (81.2%) as compared with boys with proper body mass (75.8%). The same type of beverages would be popular with two-thirds of girls, and this result was similar regardless of their nutritional status. About 44.2% of overweight and obese girls and 20% of girls with proper body mass attempted to lose weight, and 5.7% of boys tried to go on a diet. Eating limitations were declared by 16.5% of overweight and obese boys and ca. 3% of normal weight boys. Conclusion Within the surveyed group of youth, it was possible to indicate eating errors primarily consisting in irregular eating, too low a number of meals during the day, particularly skipping breakfast, which took place more frequently among overweight and obese students rather than normal weight ones. The survey points to the insufficient intake of vegetables and fruit as opposed to salty and sweet meals. It is essential to convey the knowledge on the causes of overweight and obesity as well as rules of a healthy diet as factors preventing civilization diseases

Wiedza rodziców dzieci z autyzmem z Polski, Białorusi i Francji na temat choroby dziecka

Background. Autism is not only a problem for p eople with autism, but also for their entire families. Material and methods. 83 families were analysed, including 30 families from Poland, 25 families from Belarus and 28 families from France, an author’s questionnaire was used. Results. The majority of respondents were aware of the fact that autism can also be diagnosed in an adult person. Likewise, the notion of the autistic spectrum was known. While parents from Poland and France realised that a one-time diagnosis of the condition is insufficient, parents from Belarus more often chose the incorrect answer, and therefore they express the tendency to immediately start a therapy without additional consultations. All respondents from France chose the statement that treatment of autism should be started before the age of 3, which was confirmed by the majority of respondents from the other two countries. Polish parents barely considered the importance of preparation required to understand their child’s behaviour, whereas this aspect of the therapy was indicated by almost 90% of the respondents from the other two countries. Parents from Poland (69%) and Belarus (76%) were mostly convinced that autism cannot be cured completely. A different opinion was expressed by 42.9% of parents from France, who were convinced about it. The Poles most willingly used the Internet as a source of knowledge, while the French and Belarusians - a psychologist. A paediatrician was a preferred educator in Poland, in Belarus and France - a psychologist. Conclusions. The parents of autistic children, regardless of the country, showed a low level of knowledge about autism. The vast majority of respondents declared a desire to deepen their knowledge on autism, expressing their preference to have an individual conversation with an educator.Wprowadzenie. Autyzm nie jest problemem jedynie osób z autyzmem, ale również całych ich rodzin. Materiał i metody. Analizie poddano 83 rodziny, w tym 30 rodzin z Polski, 25 rodzin z Białorusi oraz 28 rodzin z Francji i wykorzystano kwestionariusz autorski. Wyniki. Większość ankietowanych wiedziała, że autyzm można zdiagnozować także u osoby dorosłej, znane było także pojęcie spektrum autystycznego. O ile rodzice z Polski i Francji zdawali sobie sprawę, że jednorazowa diagnoza choroby jest niewystarczająca, to rodzice z Białorusi częściej wybierali błędną odpowiedź, a więc natychmiastowe rozpoczęcie terapii bez dodatkowych konsultacji. Wszyscy ankietowani z Francji wybierali stwierdzenie, iż leczenie autyzmu należy zacząć przed 3 rokiem życia, co potwierdziło większość ankietowanych z pozostałych dwóch krajów. Rodzice z Polski ledwie w połowie za ważne uznali przygotowanie rodziców do zrozumienia zachowań dziecka, podczas gdy ten aspekt terapii wskazało niemal 90% ankietowanych z dwóch pozostałych krajów. Rodzice z Polski (69%) i Białorusi (76%) byli w większości przekonani, iż autyzmu nie można wyleczyć całkowicie. Odmienną opinię wyraziło 42,9% przekonanych o tym rodziców z Francji. Polacy najchętniej jako źródło wiedzy wykorzystywali Internet, Francuzi i Białorusini - psychologa. Za edukatora w Polsce preferowano pediatrę, na Białorusi i we Francji - psychologa. Wnioski. Rodzice dzieci autystycznych, niezależnie od kraju, wykazywali niski poziom wiedzy na temat autyzmu. Zdecydowana większość respondentów deklarowała chęć pogłębienia wiedzy na temat autyzmu preferując w tym celu rozmowę indywidualną z edukatorem