Prenatal exposure to fine particles and polycyclic aromatic hydrocarbons and birth outcomes: a two-pollutant approach.

BACKGROUND: Previous epidemiologic studies have considered the effects of individual air pollutants on birth outcomes, whereas a multiple-pollutant approach is more relevant to public health policy. OBJECTIVES: The present study compared the observed effect sizes of prenatal fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH) (a component of PM2.5) exposures on birth outcome deficits, assessed by the single vs. two-pollutant approaches. METHODS: The study sample included 455 term infants born in Krakow to non-smoking mothers, among whom personal exposures to PM2.5 and PAH were monitored in the second trimester of pregnancy. The exposure effect estimates (unstandardized and standardized regression coefficients) on birth outcomes were determined using multivariable linear regression models, accounting for relevant covariates. RESULTS: In the single-pollutant approach, each pollutant was inversely associated with all birth outcomes. The effect size of prenatal PAH exposure on birth weight and length was twice that of PM2.5, in terms of standardized coefficients. In the two-pollutant approach, the negative effect of PM2.5 on birth weight and length, adjusted for PAH exposure, lost its significance. The standardized effect of PAH on birth weight was 10-fold stronger (ß = -0.20, p = 0.004) than that estimated for PM2.5 (ß = -0.02, p = 0.757). CONCLUSION: The results provide evidence that PAH had a greater impact on several measures of fetal development, especially birth weight, than PM2.5. Though in the single-pollutant models PM2.5 had a significant impact on birth outcomes, this effect appears to be mediated by PAH.

Maternal allergy as a potential source of variability of exhaled nitric oxide in children non-sensitized to common domestic allergens.

The goal of the study is to evaluate the importance of maternal atopy as a potential biological source of variability of exhaled FeNO values in healthy children who were non-asthmatic and non-sensitized to common domestic allergens. The study sample consisted of 61 seven-year old children. Fractional exhaled nitric oxide (FeNO) has been measured by NObreath (Bedfont portable device). Children with reported maternal atopy had significantly higher mean FeNO values (geometric mean =10.7 ppb; 95%CI: 6.7-17.1 ppb) than those who denied it (geometric mean =5.2 ppb 95%CI: 3.9-6.9 ppb) (p=0.010). Neither the correlation between FeNO values and gender, respiratory and eczema symptoms, nor ETS exposure in the prenatal and postnatal period or body mass of children were significant. We also found no significant association of FeNO values with the amount of common domestic allergens measured in the households. The results of the ROC analysis suggested 11 ppb as the cut-off point for FeNO to distinguish groups of healthy children with and without maternal atopy. In conclusion, our study provided some evidence suggesting that maternal atopy may affect FeNO level in children independently of asthma and sensitization status to common domestic allergens. The data should be considered in the interpretation of FeNO levels in clinical practice and setting up FeNO screening criteria for identification of eosinophilic airway inflammation.

Wheezing and asthma may be enhanced by broad spectrum antibiotics used in early childhood. Concept and results of a pharmacoepidemiology study.

UNLABELLED: One of the mechanisms supposed to explain the increasing prevalence of asthma, among children in particular, is the use of antibiotics because they may modify natural microbial exposure and development of the immune system in early childhood. The aim of this study is to investigate the association between the use of various classes of antibiotics (penicillin, cephalosporin and macrolide derivatives) in early childhood and the medical diagnosis of asthma or wheezing reported by mothers over the follow-up after adjustment for potential confounders and respiratory infections. In a population-based sample of 5-year-olds, a part of the ongoing birth cohort study, the standardized interviews on health outcomes, potential confounders (child's gender, maternal atopy, parity, prenatal and postnatal environmental tobacco smoke) and the use of antibiotics were gathered from mothers of 310 children. While the overall use of antibiotics during the early childhood was insignificantly associated with asthma (adjusted OR = 1.65, 95%CI: 0.93 - 2.93), the risk estimates were significant both for macrolide antibiotics (adjusted OR=2.14, 95%CI: 1.16-3.95) and cephalosporins (OR=1.98, 95%CI: 1.14-3.37). The significant excess in IRR (incident risk ratio) of wheezing episodes was related only to the use of macrolide antibiotics (adjusted IRR=1.91, 95%CI: 1.12-3.27). The use of other classes of antibiotics was found not to be associated with the medical diagnosis of asthma or wheezing episodes recorded in the study period. CONCLUSION: as early childhood use of broad spectrum antibiotics is associated with an increased risk of developing asthma in 5-year-olds, it may be hypothesized that the antibiotic- related suppression of allergic inflammatory responses in the course of treatment may later lead to greater than before atopic immune response in Th2 children or an impairment of Th1 immune responses in early childhood.

Impact of excessive gestational weight gain in non-smoking mothers on body fatness in infancy and early childhood. Prospective prebirth cohort study in Cracow.

Gestational weight gain (GWG) is important for health policy as it may be associated with overweight epidemics in childhood and adolescence. The purpose of the study was to perform the risk assessment of joint effects of the excessive GWG and the pregravid maternal BMI on overweight in infancy and childhood. The observations were collected in the ongoing prospective birth cohort study of 482 non-smoking mothers and their newborns in Cracow inner city area. At 5 years of age the subsample of 312 infants were reexamined in order to assess their nutritional status. Body fatness was assessed by means of the weight/length ratio (WLR) in neonates and weight/height ratio (WHR) in 5-year-olds since they showed the strongest correlation with subcutaneous fat mass of young children. In the statistical analysis the binary regression models were applied to identify predictors of overweight. The excessive GWG (>18 kg) increased more than twofold the adjusted relative risk (RR) of neonatal fatness (R=2.7; 95% CI 2.0-3.7) and was also a significant independent risk factor for postnatal body fatness at 5 years of age (RR=2.0; 95% CI: 1.3-3.3). The results confirmed earlier findings that pregravid overweight increased not only the relative risk of neonatal fatness (RR=2.9; 95% CI: 2.2-3.9) but also overweight in early childhood (RR=2.7; 95% CI: 1.7-4.4). The conclusion is that excessive GWG may be a risk factor for overweight in early childhood and should be a focus of public health policy.

Case-control study of lifetime occupational and recreational physical activity and risks of colon and rectal cancer.

Important aspects of the inverse relation between physical activity and colon cancer risk are still under discussion. In 2000-2003, 239 incident cases of colorectal cancer confirmed by histopathology and 239 hospital-based controls, matched by age and gender, were enrolled. In standardized interviews, data on occupational and recreational physical activity for ages 20, 30, 40, 50 and 60 years were collected from 98 colon cancer cases, 141 rectal cancer cases, and from 193 controls. Besides lifestyle and sociodemographic characteristics, a detailed food frequency questionnaire was assessed. In multivariate logistic regression for colon cancer, significant risk reductions for the highest quartile of total physical activity were found for almost all ages. For lifetime mean physical activity, the multivariate odds ratio for the highest quartile was 0.37 [95% confidence interval (CI) 0.17, 0.83]. For lifelong constantly high-exercisers compared with lifelong non-exercisers an odds ratio of 0.26 (95% CI 0.08, 0.84) was estimated. For rectal cancer, no consistent association with physical activity was found. No confounding effects were observed but the authors found effect modification with total energy intake. These data support an inverse association of colon cancer risk and physical activity which is most expressed if activity is kept up throughout life.

Effect of indoor air quality in the postnatal period on lung function in pre-adolescent children: a retrospective cohort study in Poland.

The purpose of this study was to determine the association between level of lung function in pre-adolescence and indoor air quality in the postnatal period. The retrospective cohort study was carried out in a sample of 1036 pre-adolescent children (9 years of age) attending schools in two residential areas of Krakow, Poland. Measurement of health outcomes considered lung function together with height and weight. Indoor air quality was based on environmental tobacco smoke and type of household heating. In addition, the number of winter months that occurred during the first 6 months of life was included as a key independent variable. Multivariate linear regression of lung function measured by forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC), and postnatal exposure to indoor pollution in the heating season (PEIP score) was adjusted for potential confounders such as maternal smoking during pregnancy and parental education as a proxy of social class. In the total study sample, the adjusted beta coefficient for FEV1 per unit of the PEIP score was -0.06 (P=0.02), while that for FVC was -0.05 (P=0.04). The analysis carried out in the more polluted area found that children living in households heated with gas or coal had a PEIP score that was strongly inversely related to lung function (adjusted beta coefficient for FEV1=-0.13; P=0.03; for FVC=-0.15, P=0.01), whereas regression coefficients were not significant in the group of children living in households with central heating. This study suggests that a lower level of lung function in pre-adolescent children can be related to postnatal exposure to indoor emissions in the winter.

Helicobacter pylori, non-steroidal anti-inflammatory drugs and smoking in risk pattern of gastroduodenal ulcers.

BACKGROUND: Helicobacter pylori, NSAID and cigarette smoking are major risk factors for gastroduodenal ulcers. However, the results of studies on the interaction between these factors on ulcerogenesis are controversial. This study was designed to examine the association between gastroduodenal ulcers and H. pylori infection, NSAID use, smoking and age. METHODS: 5967 dyspeptic patients underwent 13C-urea breath test (UBT) and upper endoscopy, while age and dyspeptic symptoms were reported. RESULTS: Out of 5967 patients, 31.8% were ulcerated; 9.2% had gastric, 17.2% duodenal and 5.4% both gastric and duodenal ulcers. H. pylori was found in 72.5% of gastric ulcer patients, in 83.6% of duodenal ulcer patients, in 76.9% of gastroduodenal ulcer patients and in 64.8% of dyspeptic patients. The gastric, duodenal and gastroduodenal ulcers were related to H. pylori significantly and the respective ORs were: 1.44, 2.77 and 1.81. NSAID alone was used by 6.2%-12.7% of ulcer patients, tending to raise only the risk of gastric ulcer but reducing that of duodenal and gastroduodenal ulcers. The H. pylori prevalence was significantly higher in smokers (76%) than in non-smokers (67%) and the ulcer risk was also significantly higher in smokers than in non-smokers. About 20% of ulcers were 'idiopathic', i.e. without NSAID and H. pylori and the ratio of these ulcers to all ulcers significantly increased during the 5 years of the study. CONCLUSIONS: Based on multivariable logistic regression analysis we conclude that: 1) H. pylori infection, NSAID use, smoking and age play major roles in the pathogenesis of peptic ulcerations; 2) there is a negative interaction between H. pylori and NSAID on duodenal ulcers, suggesting that H. pylori reduces the development of these ulcers in NSAID users, and 3) about 20% of peptic ulcers in the Polish population are unrelated to H. pylori and NSAID use (idiopathic ulcers).

Contribution of epidemiology in Poland for better understanding of the natural history of diseases in gastrointestinal tract.

Descriptive epidemiologic studies on the geographical distribution of gastrointestinal diseases in Poland have been conducted in our country since several decades. One of the first descriptive analyses was cancer study in 1967, where age-standardized mortality rates in various regions of Poland by gender and area of residence (urban/rural) were presented. Since 1970 analytical epidemiologic studies aiming at explaining the natural course of various diseases within gastrointestinal tract started to produce interesting results. The first study in this field was the case-control study on the occurrence of peptic ulcer and tobacco smoking performed in 1974. The study provided one of the first epidemiologic evidence on the harmful effect of tobacco smoking in the etiology or peptic ulcers. Subsequent studies dealt with the importance of dietary habits and life style (tobacco smoking and vodka drinking) in the occurrence of gastric cancer. The studies confirmed previous findings that consumption of raw vegetables and fresh fruit is inversely related to risk for stomach cancer in Poland. In addition the results demonstrated, that dietary practices such as the modality of cooking the food, preparation of food products and storing conditions were connected with stomach cancer risk. These factors have also been found to influence the risk for stomach cancer in Poland. The main message of this latter study was that the family as a whole is affected by many risk factors for stomach cancer and families in which stomach cancer has occurred should be therefore targets for preventive measures. Interestingly, analysis of life style factors such as tobacco smoking or vodka drinking has showed that the risk for cardia cancer increased considerably for smokers of cigarettes without filters and in those who consumed large amounts of vodka. For the non-cardia region a uniform increase of risk could be observed for vodka drinking, regardless of cigarette smoking status. The findings of this study suggested the hypothesis that the effect of tobacco smoking and vodka drinking may be different for cardia cancer compared to the distal cancers. Our clinico-epidemiological study suggest that infection with Helicobacter pylori is not sufficient factor for inducing precancer changes in gastric mucosa. Besides, case-controls studies on dietary habits and physical activity level in the etiology of colorectal cancer are in progress. The preliminary results demonstrated the protective effect of higher physical activity in the occurrence of colorectal cancer after accounting for nutritional habits.

[Concept of evidence-based medicine: a new challenge to epidemiology and preventive medicine]. / Koncepcja medycyny opartej na dowodach nowym wyzwaniem dla epidemiologii i medycyny zapobiegawczej.

In the last decade evidence-based medicine (EBM) has become popular between clinicians and epidemiologists as a tool to facilitate the translation of scientific research into clinical practice. The concept applicable to public health follows the same principles, but some additional aspects have to be considered. For example, in preventive medicine, there is the strong need to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease both at the population and at the individual level, since it is crucial for setting preventive priorities and health policy making. Traditionally, systematic reviews and meta-analyses quantify the effects of treatments on selected endpoints (health outcomes). However, in setting preventive priorities the reverse perspective is important. Moreover, the judgement about preventive action cannot be done without an adequate consideration of ethical and social context. In view of emerging evidence-based approach in preventive medicine the teaching of evidence-based medicine to health professionals became a new challenge.

On the need to teach evidence-based preventive medicine to health professionals.

In the last decade evidence-based medicine (EBM) has become popular between clinicians and epidemiologists as a tool to facilitate the translation of scientific research into clinical practice. In public health, this approach is important for health protection, different levels of disease prevention, and health promotion practice. EBM concept applicable to public health follows the same principles, but some additional aspects have to be considered. For example, in preventive medicine, there is the strong need to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease, as it is crucial for setting preventive priorities. Usually, systematic reviews and meta-analyses quantify the effects of treatments on selected endpoints (health outcomes). However, in setting preventive priorities the reverse perspective is important. The judgement about preventive action cannot be done without an adequate consideration of ethical and social context. In view of emerging evidence-based medicine to health professionals became of paramount importance. In the paper, this course of action has been discussed as an aftermath of the EB training workshop organized in Pavia (Italy) by the International Center for Studies and Research in Biomedicine.

Cohort study on low physical activity level and recurrent acute respiratory infections in schoolchildren.

The purpose of the study was to explain childhood respiratory infections in terms of life-style factors like being overweight or physically inactive. In the course of the cohort study we gathered data on respiratory health of 1028 preadolescent children in Krakow. Recurrent acute respiratory infections (RARI) in children have been defined as frequent spells (10 or more infections) over the two-year follow-up. In scoring the physical activity level, the data on regularly exercising sport and the number of hours spent daily TV watching or doing homework have been used. Excessive weight was based on the BMI index. In the total sample, the RR estimates of RARI adjusted to BMI and other potential confounders were consistently higher in children with low physical exercise (RR = 2.96; 95% CI: 1.78-4.93) or with moderate exercise (RR = 1.87; 95% CI: 1.33-2.65). Than among the highly active group. In the subgroups of allergic and non-allergic or overweight and not-overweight children the adjusted RR estimates were consistent with those found in the total sample. We concluded that physical exercise in preadolescent children may lessen the risk of acute respiratory infections and that the low physical activity is an independent predictor of increased risk of RARI besides excessive weight and other potential risk factors.

Transient or persistent asthma-like symptoms and lung growth over 2-year follow-up in pre-adolescent children.

BACKGROUND: The main purpose of this study was to assess the effect of transient and continued asthma-like symptoms on lung function growth in preadolescent children. METHODS: The follow-up respiratory health survey has been conducted on the sample of 1,129 children aged 9 years over 2 years follow-up. The basic health end-points were the occurrence of asthma-like symptoms and slower lung function growth (SLFG), which was defined as the lung function gain over 2 years within the lowest quintile of the distribution of a given spirometric test. RESULTS: Adjusted odds ratios (OR) for SLFG [forced vital capacity (FVC)] were significantly higher only in the children having continued symptoms [OR = 3.39: 95% confidence interval (CI) = 1.39-8.27]. There was a consistent trend of adjusted ORs for SLFG [forced expiratory volume (FEV,) with the category of symptoms, where OR was 2.00 (95% Cl = 1.17-3.42) in children with transient symptoms: while 4.10 (95% Cl = 1.71-9.86) in children who had persistent symptoms. The corresponding ORs for SLFG [maximal mid-expiratory flow (FEF25_75c)] were 2.27 (95% Cl = 1.37-3.76); and 5.43 (95% Cl = 2.38-12.40). DISCUSSION: The association between asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

Biomarkers of polycyclic aromatic hydrocarbon-DNA damage and cigarette smoke exposures in paired maternal and newborn blood samples as a measure of differential susceptibility.

Human and experimental evidence indicates that the developing fetus may be more susceptible than the adult to the effects of certain carcinogens, including some polycyclic aromatic hydrocarbons (PAHs). Factors that can modulate susceptibility include proliferation rates, detoxification capabilities, and DNA repair capacity. Biomarkers can facilitate quantification of age-related susceptibility among human populations. In this study, we report on three biomarkers measured in paired blood samples collected at birth from 160 Polish mothers and newborns: 70 pairs from Krakow (a city with high air pollution including PAHs) and 90 pairs from Limanowa (an area with lower ambient pollution but greater indoor coal use). Biomarkers were: WBC aromatic-DNA adducts by (32)P-postlabeling and PAH-DNA adducts by ELISA (as indicators of DNA damage from PAHs and other aromatics) and plasma cotinine (as an internal dosimeter of cigarette smoke). Correlations were assessed by Spearman's rank test, and differences in biomarker levels were assessed by the Wilcoxon signed-ranks test. A significant correlation between paired newborn/maternal samples was seen for aromatic-DNA adduct levels (r = 0.3; P < 0.001) and plasma cotinine (r = 0.8; P < 0.001) but not PAH-DNA adduct levels (r = 0.14; P = 0.13). Among the total cohort, levels of the three biomarkers were higher in newborn samples compared with paired maternal samples. The difference was significant for aromatic-DNA adduct levels (16.6 +/- 12.5 versus 14.21 +/- 15.4/10(8) nucleotides; P = 0.002) and plasma cotinine (14.2 +/- 35.5 versus 8.3 +/- 24.5 ng/ml; P < 0.001) but not for PAH-DNA adduct levels (7.9 +/- 9.9 versus 5.9 +/- 8.2/10(8) nucleotides; P = 0.13). When analyses were restricted to the 80 mother/newborn pairs from whom the blood sample was drawn concurrently (within 1 h of each other), levels of all of the three biomarkers were significantly higher in the newborn compared with paired maternal blood samples (P < 0.05). Results suggest reduced detoxification capabilities and increased susceptibility of the fetus to DNA damage, especially in light of experimental evidence that transplacental exposures to PAHs are 10-fold lower than paired maternal exposures. The results have implications for risk assessment, which currently does not adequately account for sensitive subsets of the population.

Reversibility of asthma-like symptoms and lung function growth over two-year follow-up in preadolescent children.

BACKGROUND: The interesting feature of childhood asthma is the great reversibility of symptoms. The main purpose of this study was to assess the effect of persistent and reversed asthma-like symptoms on lung function growth in preadolescent children. MATERIAL AND METHODS: The follow-up respiratory health survey has been conducted in the sample of 1129 children aged 9 yrs over two years follow-up. The basic health end-points was the occurrence of asthma-like symptoms and the slower lung function growth (SLFG). RESULTS: Adjusted OR for SLFG(FVC) was significantly higher only in the children having the continued symptoms(OR = 3.40; 95% CI: 1.32-8.77). There was a consistent trend of adjusted ORs for SLFG(FEV1) with the category of symptoms, where OR was 1.46 (95% CI: 1.02-2.10) in children with recent new symptoms; 2.06; (95% CI: 0.93-4.58) in those with symptoms remitted, while 3.46; (95% CI: 1.43-8.40) in children who had persistent symptoms. The corresponding ORs for SLFG(FEF25-75%) were 2.03; (95% CI: 0.97-4.28), 2.63; (95% CI: 1.38-4.99), and 5.84; (95% CI: 2.53-13.50). CONCLUSIONS: The consistent association between reversibility of asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

[Prevalence of type II diabetes mellitus in population of Krakow]. / Chorobowosc z powodu cukrzycy typu 2 w populacji Krakowa.

UNLABELLED: The study was carried out within a framework of the Polish Multicenter Study on Diabetes Epidemiology in 1998-2000. The aim of the study was to define the prevalence of type 2 diabetes, especially unknown diabetes, and prevalence of impaired glucose tolerance in a demographically well-defined urban population using the comparable epidemiological methods which were applied in the previous study in Wroclaw in 1985-1986. The study was carried out in 200,000 subjects inhabiting the town quarter. Out of those who were 35 or more 6000 subjects were randomised using a table of random numbers. All randomized subjects received a letter of invitation explaining the sense of study, its objectives and methods. If necessary the invitations were renewed, and then the subjects were contacted by phone. Each responding person received a questionnaire to complete. Then anthropometric and blood pressure measurements were taken. Blood was sampled for plasma glucose, insulin, total cholesterol, HDL cholesterol and triglycerides in the fasting state. Those who declared being non-diabetic and in whom screening test using a glucometer (Glucotrend) revealed fasting glycemia below 8 mmol/l underwent an oral glucose tolerance test (75 g) to determine glycemia and insulinemia at 120 min. Plasma glucose, total cholesterol, HDL cholesterol and triglycerides concentrations were measured with an enzymatic method, whereas insulinemia was defined with the IRMA technique, using ready kits Swierk-Poland. Diabetes mellitus and impaired glucose tolerance were recognised according to the 1985 WHO criteria. Chi square test, Fisher's test and Mann-Whitney test were used for statistical analysis. Statistical analysis was carried out using the statistical package BMDP. During 3 years of the study out of 6000 randomly selected subjects 3060 (1731 women and 1329 men) responded. In the study population 192 patients were with known diabetes, including 150 subjects receiving oral antidiabetic agents or insulin at the time of the study or some with high fasting glycemia not receiving any treatment except a diet. The 42 subjects who prior to the study had not been receiving hypoglycemic agents or in whom fasting glycemia had been below 8 mmol/l underwent an oral glucose tolerance test. Of them diabetes was confirmed in 11 patients, impaired glucose tolerance was observed in 9, and glucose intolerance was excluded in 22 subjects. Thus, in the study group 161 subjects (75 women and 86 men) with a mean age 61.5 +/- 8.95 years had already diabetes. Their mean BMI was 31.5 +/- 4.6 kg/m2 and did not differ significantly between both sexes. Only HDL cholesterol was significantly higher in men (women 1.1 +/- 0.3 vs. men 1.3 +/- 0.3, p < 0.001) in this group. Among those who declared being non-diabetic 160 subjects (77 men and 83 women), mean age 58.0 +/- 9.7 years and mean BMI 31.4 +/- 4.9 kg/m2 had diabetes identified according to the 1985 WHO criteria. Fasting insulinemia was 16.6 +/- 12.0 uj/ml in this group. At 120 min OGTT insulinemia in women was higher than in men (152.6 +/- 90.5 vs. 112.0 +/- 83.4, p < 0.01). In the whole study population diabetes was found in 321 subjects, including 161 with known and 160 with newly diagnosed diabetes. Based upon these data a standardized prevalence rate due to type 2 diabetes was calculated being 5.37% for the whole population (2.82% for known and 2.55% for unknown diabetes, respectively). When only part of the population over 35 years of age was taken into consideration, the rate was 10.77% (5.66% for known and 5.11% for unknown diabetes). When only fasting glycemia according to ADA recommendation was analysed, diabetes was recognised in 160 subjects (107 men and 53 women). In 78 subjects (49 men and 29 women) diabetes was diagnosed according to the WHO and ADA criteria. When oral glucose tolerance test and glycemia at 120 min exceeding 11.1 mmo/l is considered a gold standard for the diagnosis of diabetes, the diagnostic accuracy of the ADA criteria is 48.7%. In the study population 449 (14.55%) subjects (201 men and 248 women), mean age 56.6 +/- 9.6 years and mean BMI 29.7 +/- 4.6 (men 29.0 +/- 3.7 vs. women 30.2 +/- 5.2, p < 0.01) had impaired glucose tolerance. In our study population there were 572 subjects (329 men and 243 women) with impaired fasting glucose. Of them 359 subjects (212 men and 147 women) had normal glucose tolerance in OGTT, 161 (99 men and 62 women) had impaired glucose tolerance, and 52 (18 men and 62 women) type 2 diabetes. Thus, of the 572 subjects 9% (5.4% of men and 13% of women) had diabetes type 2, and 28% (30% of men and 25% of women) had impaired glucose tolerance. As the frequency of impaired glucose tolerance in this subgroup is higher than in the whole study population it seems justified to identify a group of subjects with increased fasting glycemia and to administer OGTT. CONCLUSIONS: 1. A significant rise in the prevalence of type 2 diabetes was observed between 1986 and 2000 (from 3.7% to 10.77%). 2. Prevalence of unknown diabetes increased considerably (reaching 5.11%). 3. The similar rise in the prevalence of impaired glucose tolerance was observed between 1986 and 2000 (from 2.9% to 14.5%) 4. Early detection of type 2 diabetes should be based upon oral glucose tolerance test according to the WHO.

Spatial variability and trends in ambient air concentrations of metals in Cracow, Poland.

Even though the air quality has been improving since the beginning of the 1980s, Cracow still belongs to the most polluted cities in Poland. The air pollution originates mainly from industry, small-size emission sources and transport. Metals in ambient air have been monitored since 1992 by 4 stations located within the city. The aim of the study was to determine the city areas where the national limits of heavy metals in suspended particles are exceeded and to assess the trends for the years 1992-1999. The monthly mean and maximum values of lead, zinc, chromium, copper, cadmium, nickel and iron were used in the analysis. Between 1992 and 1999, the level of most monitored metals in suspended particles was much below the national standards. Only the concentration of lead exceeded the limits by 50% in the area with the station monitoring traffic air pollution. However, the substantial variability in concentrations of monitored metals observed within the city was most pronounced around the metallurgical plant. Nowadays a new factor prevails: heavy traffic has resulted in a substantially enhanced concentration of lead across the city.

[Validity study on the certification and coding of underlying causes of death for the mortality statistic]. / Trafnosc wyboru przez lekarza wyjsciowej przyczyny zgonu i kodowania danych z kart zgonów.

The study was designed to assess the differences in the quality of certification and coding practices of underlying causes of death, which the mortality statistics is based upon. The mains focus of the study was the problem of proper selection of the underlying cause of death in various diseases. In the analysis the potential impact of medical experience of the physicians and the hospitalization of patients before the death have been taken in consideration. There were 479 death certificates chosen randomly out of all certificates filled in by 240 medical doctors in 1999 in Krakow. For each death certificate the available clinical case histories for deceased persons have been collected in order that a team of medical experts could formulate their independent opinion about the underlying cause of death. From comparisons of the underlying causes of death from the death certificates with those of experts, the indices of agreement have been calculated. The best overall agreement has been found for the neoplasmatic diseases (83.1%) and the lowest for the chest diseases (30.7%). For cardiovascular diseases the overall agreement was 65.5%, however in coronary heart disease it reached 74.0% and in cerebrovascular diseases 78.7%. Generally, the better agreement has been demonstrated if the additional information about the coexistent diseases or direct causes of the death has been mentioned in the death certificates as well. The longer period of hospitalization of subjects before death was related significantly with the higher agreement indices.

Nutrient intake patterns in gastric and colorectal cancers.

The purpose of the study was to present the dietary risk pattern in gastric and colorectal cancers, using the same methodological approach in a parallel hospital-based case-control study. In all, 180 cases of colorectal cancer and 80 cases of stomach cancer, confirmed histopathologically, were enrolled from the University Hospital in Cracow. A high intake of carbohydrates was associated with an increased risk of colorectal cancer (OR = 2.45). For stomach cancer, a moderate consumption of carbohydrates markedly increased relative risk (OR = 4.29), while a high intake of carbohydrates increased the risk by 8.73. The patterns of dietary risk factors related to intake of fats were definitively different in both cancer sites. The higher fat consumption was not associated with the higher risk of stomach cancer. A medium intake of fats increased the risk of colorectal cancer by 1.96 and that above 83 g/day by 2.20. In colorectal cancer, the significant protective effect of retinol, carotene and vitamin C has been evidenced, however, only carotene and vitamin E were inversely correlated with stomach cancer.

Risk of colorectal cancer from alcohol consumption at lower vitamin intakes. A hospital-based case-control study in Poland.

The purpose of the study was to assess the relation between the simultaneous exposure to alcohol and consumption of micronutrients that have protective properties against colorectal cancer. A hospital-based case-control study of colorectal cancer was carried out between January 1998 and November 1999 at the University Hospital in Krakow, Poland. In total, 180 incident cases of colorectal cancer, confirmed by histopathology, were recruited and an equal number of controls, individually matched by gender and age (+/-5 y), were chosen amongst patients with no history of cancer. A food-frequency questionnaire for 148 food items, combined with the quantity of foods eaten, was used to assess the normal dietary pattern. The data confirmed the reported inverse association between the intake of retinol, thiamine, or antioxidant micronutrients (vitamins C, E) and the occurrence of colorectal cancer. Alcohol intake was found to be an important risk factor for this cancer site, and the risk escalated in parallel with increased intake of retinol, carotene, vitamins C and E, but with high consumption of alcohol ran a noticeably high risk of colorectal cancer (OR= 6.79; 95% CI: 2.08-22.18). The risk was markedly lower, however, among alcohol drinkers who reported a high intake of micronutrients (OR = 1.35; 95% CI: 0.39-4.67). The data suggest that a combination of high consumption of alcohol and low intake of retinol and antioxidant vitamins may considerably increase the risk of colorectal cancer.

Combined risk assessment of physical activity and dietary habits on the development of colorectal cancer. A hospital-based case-control study in Poland.

The purpose of the study was to assess the importance of physical activity performed both in occupational settings and in leisure time on the risk of colorectal cancer, considering the possible confounding effects of dietary habits. The hospital-based case-control study was carried out in Poland. In total, 180 incident cases of colorectal cancer were recruited. An equal number of controls, individually matched by gender and age, were chosen from patients with no history of cancer. A food frequency questionnaire combined with quantity of foods eaten was used to assess the usual dietary pattern for 148 food items. The average physical load of the interviewed patients before the occurrence of disease was ascertained by self-assessment. The degree to which patients' recreational time was sedentary was measured by the number of hours spent watching TV. The adjusted risk of colorectal cancer was reduced by half in those active in leisure time (OR 0.45, 95% CI 0.24-0.84). The effect of occupational physical activity was of about the same order of magnitude in terms of risk reduction (OR 0.61, 95% CI 0.29-1.29) and both activities combined acted as independent protective factors. The protective effect of healthy nutrition appeared to be independent from that attributed to physical effort.