Psychiatric Comorbidities in Pediatric Monogenic Diabetes due to GCK Mutation: Impact on Diabetes-Related Quality of Life.

BACKGROUND: Monogenic diabetes caused by mutation in the glucokinase gene (GCK-MD) is a rare disorder manifesting in childhood as mild, prevalent hyperglycemia. By consensus, it is managed by dietary supervision and infrequent consultations. However, its impact on the mental health of the affected children is largely unknown. OBJECTIVE: To estimate the prevalence of psychiatric comorbidities in children with monogenic glucokinase-related diabetes (GCK-MD) and evaluate their association with quality of life (QoL). METHODS: The study invited children with GCK-MD aged 5-18 years identified in the Central National Registry and treated in 3 pediatric diabetes centers in Poland. The control group comprised children with type 1 diabetes (T1D, the most common diabetes type in youth) matched for age and family history of diabetes. Participants underwent a semistructured clinical interview diagnostic for psychiatric comorbidities, questionnaires assessing behavioral problems, depressive symptoms, parental stress, and measuring general and diabetes-related QoL (PedsQl). RESULTS: We included 35 patients with GCK-MDMD and 199 with T1D. Eight (22.9%) GCK-MD patients were diagnosed with psychiatric disorder in their lifetime, compared with 16 (8.1%) in the T1D group (odds ratio 3.4 [95% confidence interval: 1.3-8.7]). Patients with GCK-MD showed better parent-reported general QoL (87.1 ± 11.9 vs 82.0 ± 14.0, P = 0.0060) and higher diabetes-related QoL in both parental (84.5 ± 13.8 vs 74.1 ± 15.2, P < 0.0001) and child's perspective (87.6 ± 10.9 vs 77.3 ± 13.9, P < 0.0001). Psychiatric disorders (+P) were associated with worse child-reported diabetes QoL (T1D+P 66.6 ± 16.7, T1D-P 78.2 ± 13.3, GCK-MD+P 79.6 ± 16.3, GCK-MD-P 90.1 ± 7.5, P = 0.0002). CONCLUSIONS: High prevalence of psychiatric disorders in children with GCK-MD and lower QoL emphasizes the need for psychologic surveillance in those otherwise mildly-treated patients.

The Impact of Selected Risk Factors on The Occurrence of Highly Pathogenic Avian Influenza in Commercial Poultry Flocks in Poland.

INTRODUCTION: Introduction of highly pathogenic avian influenza virus (HPAIV) into a country and its further spread may have a devastating impact on the poultry industry and lead to serious economic consequences. Various risk factors may increase the probability of HPAI outbreak occurrence but their relative influence is often difficult to determine. The study evaluates how the densities of selected poultry species and proximity to the areas inhabited by wild birds impacted HPAI outbreak occurrence during the recently reported epidemics in Poland. MATERIAL AND METHODS: The analysis was developed using these risk factors in the locations of affected and randomly chosen unaffected commercial farms. Generalised linear and non-linear models, specifically logistic regression, classification tree and random forest, were used to indicate the most relevant risk factors, to quantify their association with HPAI outbreak occurrence, and to develop a map depicting spatial risk distribution. RESULTS: The most important risk factors comprised the densities of turkeys, geese and ducks. The abundance of these species of poultry in an area increased the probability of HPAI occurrence, and their farming intensity in several areas of central, western, eastern and northern Poland put these areas at the highest risk. CONCLUSION: The results may improve the targeting of active surveillance, strengthen biosecurity in the areas at risk and contribute to early detection of HPAI in outbreak reoccurrences.

Quantitative risk assessment of the introduction of low pathogenic avian influenza H5 and H7 strains into Poland via legal import of live poultry.

Low pathogenic avian influenza (LPAI) caused by H5 and H7 viruses is considered a threatening disease for poultry production due to the possibility of prolonged undetected virus circulation in a poultry flock and its potential to mutate to highly pathogenic avian influenza (HPAI). The occurrence of HPAI may have devastating impact on the poultry industry and has serious economic consequences. The possibility of LPAI virus (LPAIV) being introduced into Poland via import of live poultry from EU countries was considered. The main aim of the study was to quantitatively assess the probability of LPAIV H5 and H7 introduction into Poland (PLPAI) via this pathway, to evaluate the relative contribution of exporting countries and species of poultry to this probability and to present the spatial distribution of the introduction probability in Poland. To this end, a stochastic multilevel binomial risk model, taking into account uncertainty and variability of input parameter values, was developed. The results of this model indicate that the mean annual probability of LPAIV H5 or H7 introduction into Poland is 0.088 [95 % uncertainty interval: 0.0575, 0.128], which corresponds to, on average, one outbreak every 11 years. The countries contributing most to this probability are Germany, Czech Republic and Denmark. Importations of ducks, chickens and turkeys contribute most to PLPAI, whereas importations of geese and guinea fowl represent a minor risk. The probability of LPAIV introduction is not equally distributed across Poland with the majority of counties having a high probability of LPAIV introduction being located in the Western part of the country. The results of this study can be used to support decision makers on targeted prevention or risk-based surveillance strategies for LPAI.

Models To Assess the Risk of Introduction of Selected Animal Viral Diseases Through the Importation of Live Animals As a Key Part of Risk Analysis.

Introduction of an animal viral disease, especially a notifiable disease, into an importing country or region free from the disease may lead to serious epidemiological consequences and economic losses. Trade in live animals is historically considered one of the most important risk pathways. To estimate the magnitude of such risk, the likelihood of a virus' entry into a country and the consequences of this event should be jointly evaluated. Depending on data availability, the urgency of the problem and the detail level of the objectives, a risk assessment may be conducted in a qualitative, semi-quantitative or quantitative way. The purpose of this review was firstly to provide a brief description of each step of the risk analysis process, with particular emphasis on the risk assessment component, and subsequently to supply examples of different approaches to the assessment of the risk of the introduction of selected animal viral diseases. Based on the reviewed models, the overall likelihood of introduction of particular diseases was generally estimated as low. The output risk value was strongly dependent on the duration of the silent phase of the epidemic in the country of origin. Other parameters with some bearing upon the risk derived from the epidemiological situation in the country of origin and the biosecurity or mitigation measures implemented in the country of destination. The investigated models are universal tools for conducting assessment of the risk of introduction of various animal diseases to any country. Their application may lead to timely implementation of appropriate measures for the prevention of the spread of a disease to another country or region.

Identification of Areas at Increased Risk of Highly Pathogenic Avian Influenza Occurrence in Commercial Poultry in Poland.

The objective of the study was to identify the areas at increased risk of highly pathogenic avian influenza (HPAI) occurrence in commercial poultry in Poland. To identify the risk factors related to the occurrence of HPAI outbreaks, the opinions of Polish experts were combined with literature-driven knowledge. The relative impact of each risk factor was determined using a multicriteria decision analysis approach. The applied model suggests that the greatest risk of HPAI occurrence is concentrated in several counties in the eastern, western, and central parts of the country. The most influential risk actors responsible for HPAI occurrence in Poland included waterfowl density and proximity to waterbodies. The model had a high predictive value (area under the curve = 0.78). The developed spatial risk assessment of HPAI occurrence provides a valuable source of information for risk managers and can contribute to early detection of potential outbreaks of HPAI in poultry.

Nota de investigación- Identificación de áreas con mayor riesgo de aparición de influenza aviar altamente patógena en aves comerciales en Polonia El objetivo del estudio fue identificar las áreas con mayor riesgo para la aparición de influenza aviar altamente patógena en la avicultura comercial de Polonia. Para identificar los factores de riesgo relacionados con la aparición de brotes de influenza aviar altamente patógena, las opiniones de los expertos polacos se analizaron en conjunto con el conocimiento derivado de la literatura sobre este tema. El impacto relativo de cada factor de riesgo se determinó utilizando un enfoque de análisis de decisión con criterios múltiples. El modelo aplicado sugiere que el mayor riesgo para la presentación de influenza aviar altamente patógena se concentra en varios condados del este, oeste y centro del país. Los factores de riesgo responsables para la presentación de influenza aviar altamente patógena en Polonia que mostraron mayor influencia incluyeron la densidad de aves acuáticas y la proximidad a cuerpos de agua. El modelo mostró un alto valor predictivo (área bajo la curva = 0.78). La evaluación de riesgo espacial desarrollada para la presentación de la influenza aviar altamente patógena proporciona una valiosa fuente de información para administradores de riesgos y puede contribuir a la detección temprana de brotes potenciales de influenza aviar altamente patógena en avicultura.

Risk Assessment of High Pathogenicity Avian Influenza Virus Introduction into Poland via Legal Importation of Live Poultry.

The risk of highly pathogenic avian influenza (HPAI) virus introduction via import of live poultry results from the probability that infected birds are exported from apparently HPAI-free areas during the silent phase of the epidemic, i.e., the period between an incursion of the virus into a susceptible population and a report on the outbreak by an exporting country. In our study we adapted a stochastic model, previously published in 2010 by Sánchez-Vizcaíno et al., with our own modifications in which the probability of HPAI introduction was assessed as the sum of the probabilities of entry of at least one infected bird from each susceptible species exported from each country into each Polish region (county). The mean annual probability of HPAI introduction into Poland via legal trade of live poultry was very low (3.07 × 10(-3), which corresponds to 1 outbreak every 326 yr). The highest risk was associated with the import of turkeys (62%) and chickens (33%). The exporting countries that contributed the most to the overall risk were Italy (31%), the Netherlands (24%), and the Czech Republic (17%). The risk was not evenly distributed across the country and it seemed higher in western, north-central, and eastern Poland while several counties of the north-west, central, or south-east parts of the country were at negligible risk. The applied model provides quantitative evidence that the risk of HPAI introduction through legal trade of poultry does not play a major role and that other paths, such as wild birds migrations or illegal trade, should be considered as the most-likely routes along which the virus can be introduced.