Health-related quality of life impairment and indirect cost of Crohn’s disease : a self-report study in Poland

Evidence on indirect cost of Crohn's disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity).A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients' characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient's version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients' productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients' productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders.The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care.Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland

Functional polymorphisms of the leptin and leptin receptor genes are associated with longevity and with the risk of myocardial infarction and of type 2 diabetes mellitus

Wstęp: Długowieczności często towarzyszy dobry stan zdrowia, opóźnione zachorowanie na „choroby związane z wiekiem”, których przebieg jest zwykle łagodny. Leptyna (LEP) znacząco wpływa na metabolizm oraz na inne funkcje organizmu. Aby sprawdzić, czy ekstremalna długowieczność i jej fenotyp są powiązane z odmianami genów leptyny i receptora leptyny (LEPR), przebadaliśmy częstość występowania polimorfizmów –2548 G/A i +19 G/A genu LEP oraz K109R, Q223R, i K656N genu LEPR u stulatków i w grupach kontrolnych.Materiał i metody: Częstość występowania polimorfizmów genów LEP i LEPR badano metodą analizy długości fragmentów restrykcyjnych u 128 stulatków, 414 młodych kontroli (Y), 226 pacjentów z zawałem serca (MI) i u 190 pacjentów z cukrzycą 2 typu (DM2).Wyniki: Genotyp GG polimorfizmu –2548 G/A genu LEP był znamiennie częstszy u stulatków niż w grupach Y, MI i DM2 (odpowiednio p = 0,048, p = 0,003 i p = 0,049). Genotyp AA polimorfizmu K109R genu LEPR był znamiennie rzadszy u stulatków niż w grupach Y, MI i DM2 (odpowiednio p = 0,026, p = 0,013 i p = 0,001).Wnioski: Sugerujemy, że szlak oddziaływań leptyny bierze udział w regulowaniu długości życia, być może poprzez modulowanie ryzyka zachorowania na MI i DM2. (Endokrynol Pol 2014; 65 (1): 11–16)Introduction: Longevity is commonly associated with good health and with delayed onset of age-related diseases with usually benign course. Leptin (LEP) significantly affects metabolism and numerous functions of the organism. To find out if extreme longevity and its phenotype are associated with genetic variants of leptin and leptin receptor (LEPR) genes, we analysed the frequencies of the –2548 G/A and +19 G/A LEP, as well as the K109R, Q223R, and K656N LEPR polymorphisms in centenarians and in control groups.Material and methods: The frequencies of the LEP and LEPR polymorphisms were tested by restriction fragment length polymorphism in 128 centenarians, 414 young controls (Y), 226 myocardial infarction (MI) patients, and 190 type 2 diabetes mellitus (DM2) patients.Results: The GG genotype of the –2548 G/A LEP polymorphism was significantly more common in centenarians than in the Y, MI and DM2 groups (p = 0.048, p = 0.003, p = 0.049, respectively). In addition, the AA genotype of the K109R LEPR polymorphism was significantly less frequent in centenarians than in the Y, MI, and DM2 groups (p = 0.026, p = 0.013, and p = 0.001, respectively).Conclusions: We suggest that the leptin pathway plays a role in the regulation of longevity, possibly by modulating the risk of development of MI and of DM2. (Endokrynol Pol 2014; 65 (1): 11–16

Geriatryczna Skala Oceny Depresji a sytuacja materialna i rodzinna osób starszych. Wstępne wyniki projektu PolSenior

Depresja to obok otępienia najczęstsze zaburzenie psychiczne występujące u osób w podeszłym wieku. Objawy kliniczne depresji są często niecharakterystyczne, co powoduje zbyt rzadkie rozpoznawanie zespołów depresyjnych u osób starszych. Celem niniejszej pracy była ocena częstości występowania nasilenia objawów depresji oraz określenie środowiskowych czynników towarzyszących tym objawom. W ogólnopolskim projekcie PolSenior, dedykowanym populacji w podeszłym wieku, zastosowano 15-punktową Geriatryczną Skalę Oceny Depresji (GDS). Grupę badaną stanowiły osoby w wieku 55-59 lat (kohorta przedpola starości) oraz 65 i więcej lat z dziewięciu województw. Badanie za pomocą GDS wykonano u 1718 respondentów (852 M, 866 K) bez istotnych zaburzeń funkcji poznawczych, którzy uzyskali w Krótkiej Skali Oceny Stanu Psychicznego (MMSE) co najmniej 70% punktacji maksymalnej. Wyniki GDS zestawiono z danymi, dotyczącymi sytuacji rodzinnej i materialnej respondentów. Z przeprowadzonych analiz wynika, że objawy depresyjne występują częściej u kobiet niż u mężczyzn, a częstość ich występowania zwiększa się wraz z wiekiem. Czynnikami ryzyka depresji są ponadto zła sytuacja materialna oraz samotne zamieszkiwanie

Total and high molecular weight adiponectin and level-modifying polymorphisms of ADIPOQ in centenarians

Wstęp: Adiponektyna odgrywa ochronną rolę w patogenezie otyłości, cukrzycy typu 2 i chorób układu krążenia. Polimorfizmy &#8211;11377C > G, &#8211;11391G > A, i &#8211;11426A > G promotora ADIPOQ wpływają na stężenie adiponektyny. Autorzy zbadali stężenie całkowitej i wysokocząsteczkowej adiponektyny u stulatków i powiązali je z parametrami biochemicznymi. Sprawdzili, czy modyfikujące stężenie adiponektyny polimorfizmy ADIPOQ korelują z długowiecznością. Materiał i metody: Stężenia całkowitej i wielkocząsteczkowej adiponektyny oznaczono metodą ELISA u 40 stulatków. Częstość występowania polimorfizmów ADIPOQ zbadano metodą analizy długości fragmentów restrykcyjnych u 148 stulatków, 414 młodych, zdrowych ochotników, 207 chorych po przebytym zawale serca i u 190 chorych z cukrzycą typu 2. Wyniki: Średnie stężenie całkowitej adiponektyny u stulatków wynosiło 13,19 &#177; 1,37 &#956;g/ml, a adiponektyny wielkocząsteczkowej 9,17 &#177; 1,15 &#956;g/ml. Stężenia te pozytywnie korelowały ze stężeniem HDL (odpowiednio r = 0,4696, p = 0,0025 i r = 0,3912, p = 0,015), a negatywnie z BMI (r = &#8211;0,3702, p = 0,034 i r = &#8211;0,3963, p = 0,025) i stężeniem triglicerydów (r = &#8211;0,346, p = 0,028 i r = &#8211;0,3227, p = 0,045). Bardzo rzadki genotyp AA polimorfizmu -11391G > A występował znamiennie częściej u stulatków niż u młodych kontroli (p = 0,026) i, w porównaniu z genotypem GG, był związany z 2,4-krotnie wyższym stężeniem całkowitej adiponektyny (26,53 &#177; 13,29 &#956;g/ml v. 10,97 &#177; 4,28 &#956;g/ml) i prawie 3-krotnie wyższym stężeniem adiponektyny wielkocząsteczkowej (20,65 &#177; 12,72 &#956;g/ml v. 7,36 &#177; 3,35 &#956;g/ml). Wnioski: Korelacja pomiędzy stężeniami całkowitej i wielkocząsteczkowej adiponektyny u stulatków a korzystnymi z punktu widzenia ryzyka sercowo-naczyniowego parametrami biochemicznymi może świadczyć o udziale adiponektyny w promowaniu długowieczności. (Endokrynol Pol 2012; 63 (6): 439&#8211;446)Introduction: Adiponectin demonstrates a protective role against the development of obesity, type 2 diabetes mellitus, and cardiovascular disease. The &#8211;11377C > G, &#8211;11391G > A, and &#8211;11426A > G promoter polymorphisms of ADIPOQ gene influence the level of circulating adiponectin. We examined the level of total and high molecular weight (HMW) adiponectin in centenarians and associated it with biochemical parameters. We checked if the expression and concentration-modifying polymorphisms of ADIPOQ are associated with extreme longevity. Material and methods: Total and HMW adiponectin were examined using ELISA in 40 female centenarians. The frequencies of the ADIPOQ polymorphisms were tested by restriction fragment length polymorphism in 148 centenarians, 414 young controls, in 207 myocardial infarction patients, and in 190 type 2 diabetes mellitus patients. Results: The mean concentration of total adiponectin in centenarians was 13.19 &#177; 1.37 mg/mL and of HMW adiponectin it was 9.17 &#177; 1.15 mg/mL. They were positively correlated with HDL (r = 0.4696, p = 0.0025 and r = 0.3912, p = 0.015, respectively), and negatively with BMI (r = &#8211;0.3702, p = 0.034 and r = &#8211;0.3963, p = 0.025) and triglycerides (r = &#8211;0.346, p = 0.028 and r = &#8211;0.3227, p = 0.045). A very rare AA genotype of the &#8211;11391G > A polymorphism was significantly more common in centenarians than in young controls (p = 0.026) and, while compared to the GG genotype, it was associated with a 2.4-fold higher mean concentration of total adiponectin (26.53 &#177; 13.29 mg/ mL v. 10.97 &#177; 4.28 mg/mL) and with an almost 3-fold higher mean HMW adiponectin (20.65 &#177; 12.72 mg/mL v. 7.36 &#177; 3.35 mg/mL). Conclusions: Serum adiponectin concentration in female centenarians is associated with biochemical parameters that are favourable for cardiovascular risk. We suggest that adiponectin might be of importance for extreme longevity. (Endokrynol Pol 2012; 63 (6): 439&#8211;446

Use of renal risk drugs in a nation-wide Polish older adult population : an analysis of PolSenior database

Abstract Background Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population. Methods We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC). Results There were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m2, and 1734 (38%) with CC <  60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as ‘appropriate’ or ‘inappropriate’ was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%. Subgroups with sMDRD < 60 ml/min/1.73m2 and with CC <  60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively). There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m2 and 18.0% with CC <  60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs. Conclusions Use of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance. Trial registration Not applicable

Sprawność funkcjonalna polskich stulatków

The functional status of Polish centenarians For elderly subjects their independence in activities of daily living is the most important. The aim of the study was to characterize the functional status of Polish centenarians based on their independence in the basic activities of daily living according to ADL scale and their cognitive functions estimated by MMSE. The study included centenarians of PolStu 2001 program. ADL was estimated in 340 subjects (292 females and 48 males) but MMSE only in 293 mainly due to severe hearing impairment (251 females and 42 males). Only 4.8% of studied centenarians (14 subjects) had no dementia according to MMSE and was independent in ADL (ADL 0). Their was 9 females and 5 males (3.6% vs. 11,9%; p=0,016).The strong positive correlation was found between the results obtained in ADL and MMSE (p=0,000). It seems possible that cognitive impairment is a very important component of ADL. Further studied are necessary to prove this hypothesis

Pharmacological stroke prevention in the elderly with atrial fibrillation in Poland : results of PolSenior study

Introduction: Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. Objectives: The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors. Patients and methods: The analysis included elderly (≥65 years) participants of the PolSenior study performed in years 2008-2012. Results: The study group consisted of 4979 people (mean age: 79.3 8.7 years). Among them, there were 875 patients (18.7%) with documented history of AF. Pharmacological prevention with the use of vitamin K antagonists (VKA) was applied by 117 (13.4%) of the elderly with AF, including 15 (1.7%) on dual therapy. Additionally, 386 (45.3%) subjects with AF were using oral antiplatelet therapy (OAPs), mostly aspirin. Acenocoumarol was much more often used than warfarin. New oral anticoagulant drugs (NOACs) were not used at all. Only personal income was associated with the use of VKA. No significant correlation was found for the age, sex, place of residence and level of education