Impact of an influenza information pamphlet on vaccination uptake among Polish pupils in Edinburgh, Scotland and the role of social media in parental decision making.

BACKGROUND: In Edinburgh, Scotland, lower influenza vaccine uptake has been observed in primary school children in the Polish community. METHODS: To address this disparity, the Polish-language version of the NHS Health Scotland influenza information pamphlet was updated and distributed in 2018 to all identified Polish pupils attending three pilot schools. The impact of the revised pamphlet was evaluated by examining changes in vaccine uptake in these schools as compared to a control group of schools, and a questionnaire was issued to all Polish parents in the pilot schools to explore their opinions of the pamphlet and preferred sources of immunisation information. RESULTS: On average uptake was 7.4% (95% CI 1.0-13.8%, p < 0.05) higher in the three pilot schools in which the Polish-language pamphlet was distributed (28.7%) than control schools (21.3%). The questionnaire feedback was that 37.3% of respondents felt better-informed about the influenza vaccine following the pamphlet. The respondents reported that the most important information source in deciding whether to vaccinate is previous experience. Healthcare professionals were ranked lower in importance when making a decision. Parents, who refused consent (n = 65) were more likely to source information from social media, friends and family, and Polish websites compared with those who consented (n = 45). CONCLUSIONS: These findings suggest that issuing new Polish health literature was associated with a large increase in consent form return rate and a modest increase in uptake of the influenza vaccine by Polish pupils in the pilot schools. Social media and Polish websites were found to have a greater influence over Polish parents' decision to immunise than UK healthcare staff and health authority information. Intensive effort is required to encourage parents towards information sources where more accurate pro-vaccination messages can be promulgated by national health services and independent expert groups. The role of social media for migrant communities requires careful consideration, especially for vaccine programmes not delivered in their country of birth.

Comparing vaccination hesitancy in Polish migrant parents who accept or refuse nasal flu vaccination for their children.

This study investigates the background to low uptake of nasal influenza vaccination in Polish pupils in Edinburgh, Scotland. In autumn 2018, one week after their child's nasal flu vaccination sessions, 365 Polish parents were sent a questionnaire exploring influences on their vaccination choices. The questionnaire included a series of 10 vaccine hesitancy questions recommended by the WHO SAGE Working Group on Vaccine Hesitancy. 128 questionnaires were returned representing 43.4% of vaccinated, 41.9% of refusing and 23.8% of non-consent form returning parents. Responses highlighted concerns about side effects, new vaccines and the accuracy of professional advice and information sources. There was complacency expressed about vaccination against diseases that are not common any more. Vaccine refusers were consistently more negative about all aspects vaccination and more likely to answer 'don't know'. Almost half of refusers were uncertain about the quality of health information offered to them. Polish migrants in Scotland come with their beliefs about vaccination and modify these as they acculturate to the UK system. They also continue to be influenced by developments and opinions, norms and values from their home country, as well as diaspora media. We have highlighted issues of concern among Polish migrants as a group and gained additional insights by comparing responses of parents who have refused or accepted vaccination. These insights can inform and target messages and strategies to build confidence and encourage immunisation, which should lead to improved vaccine uptake among ethnic population groups.

A qualitative study of vaccination behaviour amongst female Polish migrants in Edinburgh, Scotland.

Vaccine hesitancy is increasing and failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. In Lothian and Scotland, low vaccine uptake has been seen in migrants - notably in the Polish group who have arrived since 2004. The recent Vaccine Confidence in European Union report highlights a concerning recent decline in vaccine confidence in Poland. We held three focus groups containing 13 Polish women about the childhood vaccination programme in Lothian, with specific focus on influenza and Human Papillomavirus vaccinations. Key emergent themes were: trust in the national vaccination policy, trust in the vaccination providers (health professionals), trust in the individual vaccines, balancing the risk of disease, and language and communication. Polish norms, beliefs and behaviours shape how Polish migrants navigate the UK health system and its vaccination programme. While not confident in the Scottish primary care model and its generalist practitioners, the participants liked the ethos of informed consent in Scotland and compared this favourably with the compulsory vaccination policy in Poland. There was a belief that vaccines in Scotland were of higher quality than Poland and with fewer adverse effects. Respondents reported returning to Poland for specialist clinical appointments and diagnostic testing. They regularly access Polish clinical expertise and their opinions about health are influenced by Polish friends and family. They say they have difficulty finding official UK Government and health authority vaccination material and often access Polish media, online resources and information. They are familiar with anti-vaccination activities in Poland. Consequently, there are important unmet information needs for this group of parents who may not be making truly informed choices about vaccination. This requires further investigation especially as migration continues and declining immunisation uptake is reported in many countries across Europe.

Evidence of decreased HPV vaccine acceptance in Polish communities within Scotland.

Human papillomavirus (HPV) vaccines are currently utilised globally in national immunisation programmes. Many new European migrants have settled in the United Kingdom (UK) since the 2004 European Union expansion with approximately 91,000 Polish people resident in Scotland. Following anecdotal reports from several NHS Boards within Scotland of lower HPV vaccine uptake in Polish communities compared with other ethnic minorities, an extract containing both forename and surname, was taken from the Scottish Immunisation Recall System (SIRS) for all girls in S2 and S3 in school years 2014/15 to 2016/17. We then used the OnoMap algorithm software to derive ethnicity. OnoMap identified between 289 and 321 age-eligible girls as Polish with significant disparity noted for completed HPV vaccine uptake between UK (87.2-89.8%) and Polish ethnicities (69.7-77.2%) (P < 0.01). Preliminary discussions with Polish families suggest that vaccine programme differences, trust in medical/healthcare practitioners, and cultural influences may be important drivers of acceptance.

Low uptake of nasal influenza vaccine in Polish and other ethnic minority children in Edinburgh, Scotland.

Failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. Low immunisation rates are often associated with religious, social and ethnic minorities, including refugees or migrant groups. Polish people form Scotland's newest and largest migrant group. They have moved to Scotland since 2004, joining established ethnic minorities from China, the Indian subcontinent and Africa. Scotland has had a seasonal influenza nasal vaccination programme for all primary school children since 2013. We investigated three primary schools in Edinburgh, which had reported low influenza vaccination uptake rates in 2016 and 2017 and found that these schools contained many pupils from ethnic minorities, the majority of whom were Polish. Pupils were categorized as one of three ethnic groupings: White British, Polish and Other Identified Ethnic Minority (OIEM). We ascertained ethnicity using NHS and Education Department information sources and name recognition. We examined vaccine acceptance, declination and non-return of consent forms. In 2017, nasal influenza vaccine uptake was 70.7% (65.2-75.6%, p < 0.001) in White British, 60.9% (53.9-67.6%%, p < 0.001) in other identified ethnic minorities and 25.0% (20.9-29.6%, p > 0.001) in Polish children. White British children were more likely to return completed forms (78.9%) than other groups (OIEM 68.2% and Polish 61.8%). 36.8% of Polish families completed a consent form declining vaccination compared to 6.2% of White British families. These findings demonstrate that significant differences exist in nasal influenza vaccination uptake rates, which have important implications for the trans-national study of vaccine hesitancy. Further qualitative work and an investigation of uptake rates of other childhood immunisations in Polish and other migrant groups is required to assess differences in uptake and behaviours.

Ultrasonographic evaluation of anal endometriosis: report of four cases.

BACKGROUND: The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination. We report our experience with preoperative ultrasound evaluation of four cases of anal endometriosis. METHODS: Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography. RESULTS: In 3 of 4 women, the lesions involved old episiotomy scars. Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized. The lesions either involved the anal sphincter (n = 2, one within the rectovaginal septum) or were localized superficially in the ischiorectal space (n = 2). Surgery and pathologic exam confirmed the ultrasonographic findings. CONCLUSIONS: Ultrasonographic findings of anal endometriosis are characteristics and may allow accurate preoperative staging of the disease.

Does different approach during pancreatoduodenectomy influence intestinal migrating myoelectrical complex recovery? Study in experimental pig model.

It is said that leaving intact the functional motor unit of the pylorus leads to better gastric emptying and reduces postoperative upper gut motility disturbances. However, despite obvious different surgical approach, both major pancreatoduodenectomies lead to substantial myoelectrical dysfunctions. The latter are not efficiently recognized. We compared Whipple and Longmire-Traverso procedures in terms of electromyography patterns of the upper jejunum musculature and the density of Cajal cells network. Twelve male weaned pigs underwent surgery first to implant bipolar electrodes and telemetry transmitters for continuous electromyography recordings and then, after 1 week recovery, to create Whipple (n=6) and Longmire-Traverso (n=6) pancreatoduodenectomies. The first myoelectric activity was already registered 1-2 hours after both operations. Time to first regular patterns of migrating myoelectrical complex activity was significantly longer in the Whipple than in the Longmire-Traverso group (68.2±12.9 versus 27.8±51 hours, p=0.002). However, the restored patterns were substantially disturbed in both groups. Namely, after Longmire-Traverso operation, migrating myoelectrical complex cycles were very often and significantly shorter versus control ones, with reverse migration in the area of anastomosis while after Whipple procedure migrating myoelectrical complex cycles were less frequent and of short duration, significantly shorter in comparison even with Longmire-Traverso group. Cajal cells network in the vicinity of anastomosis, and distally from it, presented greater destruction after the Whipple operation. In conclusion, the advantage of one of two major pancreatoduodenectomies in terms of myoelectrical activity correctness in upper gut has not been proved in the study.

Professor Ludwik Rydygier father and legend of Polish surgery.

Ludwik Rydygier is undoubtedly the father of Polish gastrointestinal surgery. He performed two pioneering stomach operations: on 16 November 1880, first in Poland and second in the world after Jules Pean, the surgical removal of the pylorus in a 64-year-old patient suffering from stomach cancer; the operation took about four hours, unfortunately the patient died 12 hours later, and on 21 November 1881 he performed the world's first pylorectomy due to gastric ulcer, applying his own method of pylorectomy followed by the restoration by end-to-end anastomosis of the duodenal stump with the stomach stump; the patient survived the operation and recovered. Three years later, Rydygier introduced a new method of surgical treatment of peptic ulcer disease by means of gastroenterostomy. This review was designed to commemorate the outstanding achievements of Professor Rydygier, who worked at two universities: at the Jagiellonian University in Cracow, and at the Lemberg (Lviv) University. He was one of the founders of the Association of Polish Surgeons and an organizer of the first Meeting of Polish Surgeons in 1889. He was the author of over 200 published papers and several text-books on surgical infections, surgical techniques, orthopaedics and traumatology, urology, neurosurgery, and gynaecology. Professor Ludwik Rydygier possessed comprehensive knowledge of surgery and other medical disciplines, he was a courageous surgeon and skilled operator, being at the same time an extremely gifted organizer. His promotion to the rank of General of Polish Army crowned his credits for country's defence. At the anniversary of 90 years after his death, Polish surgeons pay the tribute to their mentor.

Do low-molecular-weight heparins influence the healing process in colon anastomosis?

Anastomosis leakage is one of the most serious complications of colorectal surgery. A role for extracellular matrix remodelling in the healing process of the colon wall has been recently postulated. Changes in matrix metalloproteinase (MMP) activity in the intestinal wall occurring prior to elective resection and primary anastomosis appear to be responsible for dehiscence leading to anastomosis. Thrombophylaxis using low-molecular-weight heparins is routinely administered to all patients during the perioperative period. However, adverse antiproliferative and proapoptotic effects such as limitation of bioavailability of growth factors and angiogenesis inhibition have been characterized in various cell types as a result of heparin administration. It is also likely that relationships exist between extracellular matrix homeostasis and the coagulation/fibrinolysis system. We hypothesize that subcutaneous administration of LMWHs (low-molecular-weight heparins) may influence matrix metalloproteinase activity in the colon wall and increase the risk of postoperative leakage.

A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure.

OBJECTIVE: The aim of this study was to compare prospectively diltiazem with GTN ointment in the treatment of anal fissure. PATIENTS AND METHODS: Of 43 outpatients with chronic anal fissure, 22 patients were randomized to topical diltiazem (2%) ointment and 21 patients to glyceryltrinitrate (GTN) (0.5%) ointment twice daily for 8 weeks. During the course of treatment each patient was seen three times. Side-effects and healing were recorded. RESULTS: Healing occurred in 19 of 22 patients treated with diltiazem and 18 of 21 patients were cured with GTN (P = 0.95). Those who were treated with nitroglycerin ointment developed headache and dizziness developed after GTN in 33.3% of cases while no patient had any side-effects after diltiazem. CONCLUSIONS: Diltiazem and glyceryltrinitrate (GTN) were equally effective in healing anal fissure but the former resulted in fewer side-effects.

Large bowel perforation: morbidity and mortality.

Perforations of large bowel are rare but severe complications, mainly of colorectal cancer and colonic diverticulitis. The choice of the surgical procedure is still debated. We retrospectively studied peritonitis caused by large bowel perforation to assess predictors of mortality and safety of primary resection and anastomosis. We investigated 59 patients with large bowel perforation treated surgically as emergency cases: 18 patients underwent primary resection and anastomosis, 36 had primary resection of the diseased part of bowel without anastomosis, and 5 patients had non-resective procedures. The severity of peritonitis was assessed using Hinchey's classification and the Mannheim peritonitis index (MPI). Overall mortality was 16.9%. MPI score was significantly lower for survivors vs. non-survivors, and for patients with resection and anastomosis vs. those who underwent resection without anastomosis (p<0.001). The mortality rate was 11.1% for primary resection with anastomosis, and 22.2% for primary resection without anastomosis. No patient with MPI less than 25 died, while 10 (38.5%) of the patients with MPI of 26-36 died. In conclusion, a radical aggressive approach is recommended for most patients with large bowel perforation. Mortality and morbidity are closely related to the extent of intraperitoneal infection and the incidence of postoperative complications is higher in patients with perforation due to non-malignant causes.

The membrane-disrupting activity of alpha-aminoalkanephosphonic acids and their derivatives.

The influence of a series of acyclic and cyclic aminophosphonates on the physicochemical properties of model (planar lipid membranes-BLM) and biological (erythrocytes-RBC) membranes was studied. The results obtained were compared with the results of physiological tests performed on the aquatic plant Spirodela oligorrhiza. It was found that the inhibition of plant growth by the compounds studied correlated, although not very highly, with the observed changes in the properties of membranes used. It was also found that both the biological activity of aminophosphonates and their efficiency at modifying the physicochemical parameters of membranes depended on their structural features.

[Surgical treatment of colonic diverticulitis--personal observations]. / Leczenie chirurgiczne zapalenia uchylków okreznicy--doswiadczenie wlasne.

The aim of paper is presentation of our experience in surgical treatment of diverticular disease. In the period of 11 years we operated on 22 patients aged from 38 to 85 years because of complicated diverticulitis. We admitted to hospital 11 patients as emergency cases; operation was performed urgently in 9 of them due to symptoms and signs of acute peritonitis. The other patients were admitted to hospital because of stenosing inflammatory pericolic mass, pericolic abscess or at least two episodes of acute diverticulitis in the past. Resection of affected part of colon was performed in all patients. Primary anastomosis was performed in 13 patients, Hartmann's operation was performed in 8 patients and suture of caecum in site of resected diverticulum was performed in one patient. There was no mortality. Perioperative complications occurred in 31.8% of patients; anastomotic leak occurred in 1 (7.7%) of 13 patients with primary bowel anastomosis. Results were discussed on the base of recent literature.

Aminophosphonate-induced changes of betacyanine and ionic efflux.

Betacyanine and ionic leakage from red beet (Beta vulgaris ssp. L. rapacea) roots and lilac (Syringa vulgaris L.) leaves under the influence of new aminophosphonates were studied by spectroscopic and conductometric methods. It was found that the leakage of dye or electrolytes depended both on the concentration of the compounds used and their structural features. The results compared to those obtained for the well known herbicide Buminafos (dibutyl 1-butylamino-1-cyclohexanephosphonate) enabled to conclude that some of the compounds studied exhibited comparable or better activity than this herbicide. That makes them potentially good herbicides. It is possible that the effects observed are the result of action on cell membranes of the tissues used. The possible role of the structural features of aminophosphonates in this action is discussed.

Physiological activity of some aminophosphonates.

Influence of some new aminophosphonates on electrolyte leakage from cucumber (Cucumis sativus cv "Wisconsin") cotyledons as well as on the content of chlorophyll and activity of guaiacol and pyrogallol peroxidase were studied. Concentration of malondialdehyde (MDA), one of the end-products of lipid peroxidation, was also measured. It was found that aminophosphates influenced the parameters observed to various extents, depending on their structural features and the concentration used. Most active modifiers were those possessing sufficiently long hydrocarbon substituents at the nitrogen atom and/ or iso-propyl chain at the phosphorus atom.