Neonatal hypothyroid screening in monitoring of iodine deficiency and iodine supplementation in Poland.

UNLABELLED: Neonatal hypothyroid screening in Poland is standardised and all newborns screening data are registered in central data base in the National Institute of Mother and Child. About 400,000 newborns are screened per year for hypothyroidism (TSH) and phenylketonuria (PKU). Unfortunately, obstetric clinics still use antiseptics that contain iodine. According to our data 71% of clinics used iodine in 1998 (58% iodine tincture and 13% povidone iodine) and 58.2% (35.4 iodine tincture and 13% povidone iodine) in the year 2000. Presence of iodine resulted in over 3 times increase of a percentage of TSH levels over cut off, increasing the number of false positives in the hypothyroid screening. Analysis of TSH distribution for iodine containing and iodine free hospitals gave totally different estimation of iodine deficiency according to WHO criteria. In the group of iodine free hospitals 24 regions were classified as not deficient, 9 regions were borderline with a fraction of TSH levels over 5 mlU/l of 3-5%. 10 regions could not be analysed because all hospitals declared use of iodine. In the second group all regions were iodine deficient. TSH distribution since 1994 shows significant decrease of percentage of TSH levels over cut off from 2.23% in 1994 to 0.16 in 1997 and to 0.12 in 2000. These changes are most probably connected with successive introduction of iodine supplementation which became obligatory in 1997 and suggest that iodine supplementation covers iodine requirements during pregnancy. CONCLUSIONS: Iodine deficiency and iodine supplementation in Poland can be studied using TSH blood spot newborn screening results in correlation with data on interfering factors and in reference to modified criteria for the analytical test and the population. To reduce false positive rate in neonatal hypothyroid screening iodine containing antiseptics, particularly iodine tincture, should be withdrawn from all obstetrics clinics in Poland.

[Level of retinol and beta-carotene in plasma of smoking and non-smoking women]. / Poziom retinolu i beta-karotenu w osoczu krwi palacych i niepalacych kobiet ciezarnych.

Cigarette smoking during pregnancy generates many oxidants and free radicals and it has been implicated in cellular damage. Retinol and its provitamin beta-carotene are natural factors protecting cells from damaging influence of free oxygen species. The aim of our study was the assessment of vitamin A and beta-carotene levels in plasma of smoking and non-smoking pregnant women. Assignment the groups was based on the concentration of serum cotinine. In the presented studies the mean level of serum cotinine in smoking pregnant women was 1326 +/- 790 micrograms/l (range 350-1930 micrograms/l). In the group of tobacco abstinents the level of cotinine was in a range of 0-60 micrograms/l. Plasma concentrations of retinol and beta-carotene were measured by high pressure liquid chromatography (HPLC). Plasma level of vitamin A was lowered by 20% and was 1.64 +/- 0.42 mumol/l and 2.06 +/- 0.58 mumol/l in smoking and abstinent groups respectively. Women who smoke during pregnancy also have significantly lower levels of beta-carotene in plasma (1.9 +/- 0.5 mumol/l) than non-smokers (2.4 +/- 0.6 mumol/l; p < 0.001). We have observed that plasma concentration of beta-carotene has decreased since 21 gestation week in smokers while in abstinent group increased during pregnancy. The increase of plasma level of beta-carotene indicates that their physiological requirement is satisfied by standard vitamins supplementation. The reduced concentrations of plasma retinol and beta-carotene suggest that consumption of these antioxidants for neutralization of free radicals present in cigarette smoking is enhanced. The observed changes indicate that vitamins intake in smoking pregnant women should be carefully controlled.

Epidemiological studies on Trichinellosis among swine, wild boars and humans in Poland.

The introduction of the digestion method (the magnetic stirrer type) resulted directly in the reduction of Trichinella sp. infection among people in Poland. Pork and its products are still the main cause of human trichinellosis in Poland. However, epidemics caused by eating wild boar meat suggested that this way of the transmission of Trichinella sp. larvae to humans might be of considerable importance.

Project of the countrywide data collecting system for neonatal hearing screening programme in Poland.

Neonatal hearing screening is becoming a standard of care in increasing number of hospitals and outpatient departments in Poland. A project of central data collecting system applicable to a neonatal hearing screening programme has been elaborated as a preparation to introducing a countrywide screening programme. The data collecting system will be based on the currently existing central system for the registration of neonatal screening tests for metabolic diseases. Data on risk factors for hearing loss and hearing screening test results will be collected. A central data collecting system for a neonatal hearing screening programme will increase the efficiency of the screening programme and facilitate epidemiological studies.

[Levels of lipid peroxides and of some antioxidants in placenta and cord blood of newborns whose mothers smoked during pregnancy].

Cigarette smoking during pregnancy increases the risk of oxidative damage and induces not only intrauterine foetal growth retardation, but also causes disturbances in postnatal growth and development. In the presented studies oxidative damage was estimated through the measurement of lipid peroxides concentration and the level of some antioxidants in placenta and in cord blood of newborns whose mothers smoked during pregnancy. We observed that the concentration of lipid peroxides was higher in cord blood and in placenta tissue (8%) than in the newborns of non-smoking mothers, but the activity of superoxide dismutase and glutathione peroxidase were lower by 20% and 16% respectively. Plasma level of vitamin A (p<0.005), vitamin E (p<0.05), fS-carotene (p< 0.0001) and total plasma antioxidant capacity (p<0.05) were significantly lower in the newborn of smoking than the non-smoking mother group. It is suggested that placental tissue protected the foetus against oxidative stress, but not sufficiently. Antioxidant activities of cord blood may also be insufficient in dismutation of free radicals and their detoxication in order to protect newborns against smoking dependent metabolic disturbances.

Trichinellosis in swine and wild boars in Poland from 1993 to 1998.

The prevalence of Trichinella sp. among 97, 193, 480 swine and 309,040 wild boars was determined by artificial digestion method. Pork meat was about 6 times less infected with Trichinella sp. in the years 1997-1998 than in the years 1993-1994. In the years 1993-1994 894 positive Trichinella sp. cases (prevalence--0.0029%) in pork meat were established. The prevalence of Trichinella larvae infection in pork meat in the years 1997-1998 was 0.00030%--larvae were found in 141 cases, only.

[Evaluation of iron status in women with pregnancy complicated by tobacco smoking]. / Ocena statusu zelaza u kobiet w ciazy powiklanej paleniem tytoniu.

Relatively common iron deficiency in pregnant women is assumed to be enhanced by cigarette smoking. In the presented studies we determined cotinine in serum and urine of 75 pregnant women in order to select groups of smoking women and tobacco abstinence. In the smoking group, a mean concentration of cotinine 1039 +/- 560 mg/L in serum and 1025 +/- 540 mg/L in urine were observed. For assessment of iron status we determined in serum: iron, iron-binding capacity (TIBC), transferrin, transferrin saturation, soluble transferrin receptor and ferritin. In serum of smoking woman in comparison to non smoking, the level of ferritin and transferrin was higher but non significantly. Significant increase of TIBC (p < 0.05) and decrease of transferrin saturation (p < 0.05) was observed. Therefore iron deficiency in transport compartment can not be excluded. The concentration of soluble transferrin receptor was the same in both groups studied. However, in late pregnancy (above 27 week of gestation) ferritin concentration less than 20 mg/L of serum was observed in 70% of smoking and only in 39% of non smoking women (p < 0.05). We concluded that cigarette smoking during pregnancy did not have any effect on the entry of iron-bearing transferrin to cells mediated by soluble transferrin receptor, but affected the level of iron-storage ferritin, which leads to iron deficiency in the storage compartment (ID I).

[Evaluation in school anti-tobacco programmes]. / Ewaluacja w szkolnych programach antytytoniowych.

The National Research Institute of Mother and Child (NRIMC) school anti-tobacco programmes are presented. They are discussed with reference to the Centres for Disease Control and Prevention (CDC) guidelines and other effective school programmes to prevent tobacco use among children and young people. The general objectives of the programmes at different educational levels and the elaborated strategic recommendations are presented. The own conceptualised evaluation model of school anti-tobacco programmes is analysed, including process and outcome evaluation. The presented model clarifies concepts and procedures of planning the design and evaluation of the programme in its different stages. In our opinion, the NRIMC evaluation model can be applied in other heath promotion programmes.

[Anti-tobacco education programs for children and youth at different stages of schooling]. / Edukacyjne programy antytytoniowe dla dzieci i mlodziezy na róznych poziomach nauczania.

Anti-tobacco education programmes for children and youth, developed at the National Research Institute of Mother and Child, are presented. The targets and goals of elaboration and implementation of these programmes are discussed. The four programmes contribute to a continuum of anti-tobacco education from preschool to secondary school. For each programme, the elaborated educational objectives, curriculum structure and methodology are presented. Problems related to evaluation of health promotion programmes are discussed in relation to the requirements of evidence-based medicine. Results of pilot programme implementation are presented. The programmes have been accepted by teachers, pupils and parents and can be implemented in the reformed education system in Poland.

[Compensatory antioxidant activity in blood of women whose pregnancy is complicated by cigarette smoking]. / Kompensacyjna aktywnosc przeciwutleniajaca krwi kobiet w ciazy powiklanej paleniem tytoniu.

In pregnancy complicated by the cigarette smoking the risk of oxidative damage depends not only on the amount of physiologically enhanced free oxygen species but may be affected by intoxication with tobacco smoke radicals. In the presented studies oxidative damage was estimated through measurement of lipid peroxidation, level of total antioxidant activity and selected antioxidants in plasma and erythrocytes of non-smoking and smoking pregnant women. No differences were found between those two groups in the level of lipid peroxidation and antioxidant activity. Plasma concentration of vitamin A was lower by 15% in smoking than in non-smoking women but vitamin E level did not change. In erythrocytes of the smoking group, concentration of reduced glutathione was 35% higher than in the non-smoking group but activity of glutathione peroxidase and concentration of vitamin E were the same. The observed changes indicate that protection of erythrocytes against free radicals may be sufficient to prevent lipid peroxidation and may manifest local and adaptive response of metabolism for tobacco smoking by pregnant women.

[Evaluation of the possibility of using the National Cancer Registry for survival analysis of children and youth with selected malignancies--leukemias and lymphomas during 1990-1995 in Poland]. / Ocena mozliwosci wykorzystania Krajowego Rejestru Nowotworów do analizy uwarunkowan czasu przezycia dzieci i mlodziezy chorych na wybrane nowotwory zlosliwe--bialaczki i chloniaki w latach 1990-1995 w Polsce.

There are about 1400 new cases of cancer and almost 600 deaths from cancer a year in children and youth aged between 0-19 in Poland. Leukaemias and lymphomas comprise 37.8% of the total number of cases and 43.3% of the total number of deaths from cancer. The National Cancer Registry is the unique data source of the incidence of cancer as well as further health information in particular the fact of death. In this research, pioneer attempt of using Registry data to conduct survival analysis in children and youth with leukaemias and lymphomas has been undertaken. Cox regression and Kaplan-Meier survival curves methods were used. Organizational and clinical conclusions have been formulated. Organizational conclusions concern mainly the principles of conducting the Registry namely introducing of International Classification of Diseases for Oncology (ICD-O) and extending the period of observation from 2 to 5 years. The leading clinical conclusions are: lack of improvement in prognosis in the 6 years period from 1990 to 1995 and crucial importance of early diagnosis of oncological disease for survival time. Further clinical conclusions concerning the impact of treatment cannot be made on the basis of the Registry data.

[Evaluation of the possible use of the National Cancer Registry for survival analysis of children and youth with selected malignant neoplasms--tumors in 1990-1995 in Poland]. / Ocena mozliwosci wykorzystania Krajowego Rejestru Nowotworów do analizy uwarunkowan czasu przezycia dzieci i mlodziezy chorych na wybrane nowotwory zlosliwe--guzy lite w latach 1990-1995 w Polsce.

This paper is the continuation of previous research described in the article "Evaluation of the possibility of using the National Cancer Registry in survival analysis of children and youth with selected malignancies-leukaemias and lymphomas in 1990-1995 year in Poland" on the basis of the National Cancer Registry data concerning tumours. Tumours comprise 62.0% of total number of cases and 56.6% of total number of deaths from cancer in children and youth. Modern methods of statistical analysis such as Cox regression and Kaplan-Meier survival curves method have been used. The conclusion formulated in the previous paper is still valid. Despite the fact that the Registry is not designed for survival analysis, they are possible and are the basis of many important findings. The crucial factor for the value of the Register in the time of advanced statistical analysis and computer methods is organisation of the Registry and data quality. Organizational and clinical conclusions have been formulated. Organizational conclusions concern mainly the principles of conducting the Registry namely introducing of International Classification of Diseases for Oncology (ICD-O) and extending it from 2 to 5 years the period of observation. The leading clinical conclusions are: lack of improvement in prognosis in the 6 years period 1990-1995 and crucial importance of early diagnosis of oncological disease for survival time. Further clinical conclusions concerning the impact of treatment cannot be stated on the basis of the Registry data.

[Organization of school health care during health reform implementation in Poland]. / Organizacja opieki zdrowotnej nad uczniami w okresie wprowadzania reformy ochrony zdrowia w Polsce.

School children and adolescents needs particularly good medical health care because of the specific character of this developmental period and the danger due to risky behaviours among pupils. The aim of this study was to assess the quality prophylactic health care for pupils in the early stage of initiating health care reforms. The initiation of the health reform on January 1st 1999 caused a deterioration of prophylactic medical health care in pupils. It may also produce more health problems among school children and adolescents in the future.

[Use of phototherapy for in newborns with pathologic jaundice]. / Zastosowanie fototerapii u noworodków z zóltaczka patologiczna.

An analysis was done of 596 newborns with intermediate hyperbilirubinaemia treated with phototherapy. The causes of hyperbilirubinaemia were determined. The effectiveness of phototherapy was compared in three groups of newborns: in 300 newborns irradiated by continuous method, in 178 newborns irradiated by intermittent method, and in 118 newborns treated with exchange transfusion and phototherapy. It was found that the effectiveness of phototherapy depended on the initial bilirubinaemia and was similar both after continuous irradiation and intermittent phototherapy. In one-third of the newborns subjected to phototherapy side effects were observed mainly in the form of loose stools.

[RH and ABO incompatibility in newborns treated in a pediatric hospital]. / Konflikt serologiczny Rh i w ukladzie AB0 u noworodków leczonych w szpitalu dzieciecym.

A clinical analysis is presented of 85 cases of serological incompatibility in newborns hospitalized in neonatal diseases department within 7 years. In 35 newborns Rh incompatibility was diagnosed including 24 with the presence of anti-D antibodies, and in eight newborns antibodies were found against other Rh antigens. In 53 newborns AB0 incompatibility was diagnosed, and the overwhelming majority of mothers had 0 blood group and almost 70% of the newborns has A blood group. In all newborns pathological jaundice occurred. Among newborns with Rh incompatibility prematurity, birth weight below 2500 g, perinatal complications and low Apgar score were more frequently found. Almost 80% of the newborns with Rh incompatibility and over 60% of the newborns with AB0 incompatibility showed signs of infection, and bacterial sepsis was most frequently diagnosed.

[The course of sexual development in girls with diabetes type I in view of ultrasonographic examinations]. / Przebieg pokwitania u dziewczat chorych na cukrzyce typu i w swietle badan ultrasonograficznych.

The gynecologic a ultrasonographic examinations in 34 insulin--dependent diabetic girls aged from 1-9 y, were performed. Diabetes duration oscillated between 1-9 y. The obtained results showed that the dynamics of sexual maturation of this girls was independent of theirs calendar age, but was conditioned by the time of obtained sexual development. The right metabolic balance of diabetes stipulates regular course of sexual maturation.

[Clinical analysis of 53 cases of septicemia caused by Streptococcus viridans in children]. / Analiza kliniczna 53 przypadków posocznicy Streptococcus viridans u dzieci.

The clinical analysis has been performed in 53 cases of sepsis induced by Streptococcus viridans. Among children with diagnosis of sepsis majority of cases in group of older infant and children up to 2 year age was due to above infection. The S. viridans strain isolated form the blood were in 90% percentage resistant to cloxacillin , the resistance to penicillin, ampicillin and gentamicin was equal to 70%, 50% and 34% respectively. The main symptoms of the S. viridans sepsis was most frequently localized in lung. Laboratory findings most frequently revealed anemia and toxic granulation in neutrophils . Four children died due to the infection (mortality index to 7.5%).

[Clinical analysis of Streptococcus faecalis septicemia in children]. / Analiza kliniczna posocznicy Streptococcus faecalis u dzieci.

The clinical analysis of 59 cases of Streptococcus faecalis sepsis in infants aged 1 to 5 months has been presented. Streptococcus faecalis strains isolated from the blood were characterized by drug resistance especially against penicillin or its derivatives. The clinical picture of the Streptococcus faecalis sepsis in a majority of cases is similar to that of other Gram-positive sepsis. Meningitis, first of all purulent, was noted in twenty percent of infected children. About one third of neonates with the Streptococcus faecalis sepsis showed intrauterine infection. The mortality index in children with the Streptococcus faecalis sepsis was equal to 10.2%.