Changes in body proportions and body fat content in GH-deficient and non-GH-deficient children during the first year of growth hormone treatment.

Introduction: The growth hormone/insulin-like growth factor-1 axis (GH/IGF-1) is crucial for longitudinal bone growth and exerts several metabolic effects. It is debatable whether and how the recombinant human growth hormone (rhGH) treatment affects the trunk-limb proportions. Aim of the study: We aim to evaluate the changes in body proportions and body fat content in short children with growth hormone deficiency (GHD), children born small for gestational age (SGA), and girls with Turner syndrome (TS) during the first year of rhGH therapy. Material and methods: The data of 70 children with GHD, 40 children born SGA, and 36 girls with TS from 1998 to 2019 were analyzed. The following parameters were measured: height, body weight, sitting height, and two skinfolds on the arm above the triceps brachii and below the scapula at the beginning of rhGH therapy and after the first year of treatment. Sitting height and lower limb length were presented as percentages (%) of body height. Fat mass percentage (%FAT) was calculated using the Slaughter formula. Results: At the beginning of rhGH, TS girls had the greatest height deficit (-2.7 SDS), the highest sitting height (%), and the lowest lower limb length (%) compared to children with GHD and children born SGA. Moreover, TS girls had higher body weight SDS, BMI SDS compared to SGA children (p < 0.001), and higher %FAT compared to both GHD and SGA children (p < 0.001 for both). After the first year of rhGH therapy, a significant increase in lower limb share (%) and a decrease in %FAT were observed in all the study groups. TS girls still had significantly higher sitting height (%), shorter lower limbs (%), and higher %FAT, body weight SDS, and BMI SDS compared to children with GHD and children born SGA (p < 0.05 for all variables). Conclusions: Our results show that rhGH treatment could increase lower limb length in relation to height and reduce fat mass in treated children. Girls with TS had the largest baseline body disproportions and the highest body fat content. Despite a satisfactory reduction in height deficit, after the first year of rhGH therapy, these girls had still higher body weight SDS, BMI SDS, %FAT, the highest sitting height (%), and the lowest lower limb length (%) compared to children with GHD and born SGA.

Analysis of the sense of occupational stress and burnout syndrome among physiotherapists during the COVID-19 pandemic.

The nature of physiotherapists' work involves an increased risk of occupational stress and burnout, particularly during the COVID-19 pandemic. Therefore, the aim of the study was to analyse the level of perceived generalised stress, the occupational stress and the occupational burnout syndrome among physiotherapists during the COVID-19 pandemic. One hundred seventy professionally active physiotherapists participated in the study: 100-during the pandemic and 70 before the COVID-19 pandemic. The study was carried out using the authors' survey, the Subjective Work Assessment Questionnaire (SWAQ), the Oldenburg Burnout Inventory (OLBI), the Perceived Stress Scale (PSS-10), and the Brief Coping Orientation to Problems Experienced (Mini-COPE) inventory. The physiotherapists examined prior to the pandemic exhibited a higher level of generalised stress and higher level of occupational stress and occupational burnout (p = 0.0342; p < 0.00001; p < 0.00001, respectively). The key factors which caused intensified occupational stress in both groups included the lack of rewards at work, social interaction, and the lack of support. The results suggest that healthcare professionals including physiotherapists are exposed to occupational stress and a high risk of occupational burnout, not only during the COVID-19 pandemic. Occupational stress prevention programmes should be based on the identification and elimination of all occupational risks.

Assessment of the Emotional State of Parents of Children Starting the Vojta Therapy in the Context of the Physical Activity-A Pilot Study.

The aim of the study was to assess the emotional state of parents at the moment of starting therapy for their children using the Vojta method in the context of the physical activity undertaken by the parents. The study involved 68 parents (37 mothers and 31 fathers) of children with central coordination disorders (CCD) presenting for consultation and therapy using the Vojta method. The authors' questionnaires, the Perceived Stress Scale (PSS-10), the State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire (PHQ-9), the Satisfaction With Life Scale (SWLS), and the Inventory to Measure Coping Strategies with Stress (Mini-COPE) were used. As many as 84% of mothers and 77% of fathers presented high level of perceived stress. Comparative analysis showed a statistically significant difference in anxiety and life satisfaction between the groups of mothers and fathers studied. Taking declared physical activity into account, there was a statistically significant difference in stress and anxiety in the mothers' group and a statistically significant difference in mood and life satisfaction in the fathers' group. Promoting physical activity among parents of children with CCD can be helpful in maintaining better psycho-physical conditions and can also be a good tool in combating stress in difficult situations, such as the illness and therapy of a child.

The Incidence of Body Posture Abnormalities in Relation to the Segmental Body Composition in Early School-Aged Children.

Children are exposed to multiple factors that contribute to an increase in body mass and the development of posture defects. The aim of the study is to assess the relationship between the segmental distribution of fat mass and muscle mass and the incidence of body posture abnormalities in early school-aged children. A total of 190 children aged 7-9 were included in the research project. The examined children were divided according to age (class level) into three groups. Height, weight and body composition, BMI, and body posture were determined. Thoracic and lumbar spine abnormalities occurred most frequently in the examined children (7-95%, 8-92%, 9-89.5%). During the assessment of the segmental body composition, the lowest fat-fat-free index was found in the trunk. The number of abnormalities of the cervical spine, pelvis, and lower extremities increases with age. The number of abnormalities of the thoracic and lumbar spine, as well as of upper extremities and the pectoral girdle decreases with age. Body posture abnormalities are correlated with body composition and in particular with the fat mass percentage. The segmental body com-position analyzer can be used to screen for posture defects.

Changes of Peripheral Th17 Cells Subset in Overweight and Obese Children After Body Weight Reduction.

Background: Obesity has been a growing problem in young patients leading to serious metabolic complications. There are many studies supporting the idea, that obesity should be considered as a chronic inflammation closely associated with immune system alterations. Th17 subpopulation is strongly involved in this process. The aim of our study was to evaluate circulating Th17 cells in overweight and obese children and explore the relationships between Th17 subset and metabolic parameters. Methods: We evaluated peripheral Th17 cells in fresh peripheral blood samples from 27 overweight and obese and 15 normal-weight children. Th17 cells were identified by flow cytometry using monoclonal antibody and intracellular IL-17A staining. Th17 cells were defined as CD3+CD4+CD196+IL-17Aic+. The analysis involved anthropometric and metabolic parameters measured at baseline and three months after the change of lifestyle and diet. We evaluated the relationship between metabolic parameters and Th17 cells. Results: In overweight and obese children we found significantly higher Th17 cells percentage compared to normal weight controls (median 0.097% (0.044 - 0.289) vs 0.041% (0.023 - 0.099), p = 0.048). The percentage of Th17 cells decreased statistically significantly in children who reduced weight after the intervention (0.210% (0.143 - 0.315) vs 0.039% (0.028 - 0.106), p = 0.004). In this group we also noticed statistically significant reduction of TC and LDL-C concentration (p = 0.01, p = 0.04, respectively). Conclusions: Obesity in children is associated with increased percentage of peripheral Th17 cells. Weight reduction leads to significant decrease of circulating Th17 cells and improvement of lipid parameters. This significant reduction of proinflammatory Th17 cells is a promising finding suggesting that obesity-induced inflammation in children could be relatively easily reversible.

Analysis of the Sense of Occupational Stress and Burnout Syndrome among Working Physiotherapists-A Pilot Study.

Background and Objectives: As medical service employees, physiotherapists are prone to suffer from job-related stress and are at great risk of experiencing occupational burnout. Therefore, the aim of this pilot study was to evaluate the level of generalized stress, occupational burnout syndrome and occupational stress in a group of professionally active physiotherapists and to answer the question: which psychosocial and physical factors (work characteristics) present at the given workplace were perceived as the most stress-inducing in the study group and in various subgroups? Materials and Methods: This study included 70 physiotherapists, mean age 40.1 ± 11.6, employed in sanatoria and outpatient clinics. An authorial survey, the Subjective Assessment Work Questionnaire, the Oldenburg Burnout Inventory, the Perceived Stress Scale, and the Inventory to Measure Coping Strategies with Stress Mini-COPE were used. Results: The study group of physiotherapists was characterized by a moderate level of stress, a high level of occupational stress and a moderate level of occupational burnout. The most common stressors reported by the participants included the lack of rewards at work, the sense of uncertainty resulting from workplace organization, the sense of threat, social interaction, and the lack of control. Conclusions: The knowledge of the level of occupational stress among health care professionals (including physiotherapists) and, most importantly, the assessment of stress-inducing psychosocial and physical factors present at the given workplace may prove useful while designing a prevention and health protection strategy.

Physical Activity and the Emotional State of Physiotherapy Students Who Finish Their Education.

This study aimed to evaluate the emotional state and the level of the sense of coherence in the context of physical activity among physiotherapy students and investigate how the participating students' emotional state changed after two years of studying and what factors were associated with the mood disorders. The study group consisted of 110 students-79 female and 31 male. The Back Depression Inventory (BDI), the Sense of Coherence Questionnaire (SOC-29) and the Perceived Stress Questionnaire (PSQ) were used. The results presented an increase in depressive symptoms during the studies of a group of physiotherapy students. Physical activity can play a protective role in the prevention and treatment of mood disorders. The students who regularly engaged in physical activity exhibited better mood, a lower perceived stress level and a higher level of the sense of coherence as compared to the physically inactive students.

Evaluation of mood, stress levels and sense of coherence in future physiotherapists.

BACKGROUND: Researchers suggest that physiotherapists are highly exposed to both the physical and the mental strains. OBJECTIVE: The aim of this study was to assess mood and the level of stress as well as a sense of coherence among future physiotherapists studying at the Department of Physiotherapy. METHODS: The study included 249 students, 181 women and 68 men. The Beck Depression Inventory (BDI), the Sense of Coherence Questionnaire (SOC-29) and the Perceived Stress Questionnaire (PSQ) were used. RESULTS: The examined group had an average level of sense of coherence and a low level of stress. One out of four students exhibited mood disorders. The factors associated with the prevalence of mood disorders among studied students were as follows: female (gender), lack of regular physical activity, poor financial situation, lack of friend to talk to in case of problems, dissatisfaction with the chosen field of study, and being inadequately prepared to work as a physiotherapist. CONCLUSIONS: The results of the study indicate an increased prevalence of mood disorders among students of physiotherapy. It is suggested that this situation may require the implementation of effective psychoprophylactic activities during the course of studies and broadly understood education about the psychophysical wellbeing of students, especially as they will work in an environment that requires high resistance to stress and support for other people in a crisis situation.

Obesity and chronic inflammation crosslinking.

The adipose tissue has been recognized as an active organ involved in numerous metabolic, hormonal and immunological processes. Obesity and associated chronic inflammation leads to many metabolic and autoimmune disorders. The number of cells, their phenotype and distribution in adipose tissue depends on the degree of obesity. Polarization of macrophages towards M1, neutrophils influx to adipose tissue, activation of Th1 and Th17 cells and increased level of proinflammatory cytokines are characteristic for obesity-induced inflammation. Several mechanisms, such as adipocytes' hypoxia, oxidative stress, endoplasmic reticulum stress, impairment of PPAR receptors, inflammasomes' activation and activation of TLR are involved into development of chronic obesity-induced inflammation. A better understanding of this processes can provide new treatments for obesity and related disorders.

Changes in leukocyte profile and C-reactive protein concentration in overweight and obese adolescents after reduction of body weight.

AIM OF THE STUDY: To assess the changes in the leukocyte profile and C-reactive protein (CRP) concentration in adolescents with excess fat mass after 6-12 months of dietary intervention. MATERIAL AND METHODS: The retrospective study included 99 overweight and obese adolescents, aged from 10.0 to 17.5 years, 82 of whom were re-hospitalized 6 to 12 months after dietary counseling. The control group consisted of 42 normal weight peers. Anthropometric measurements and laboratory tests were performed, homeostasis model assessment - insulin resistance (HOMA-IR) and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio were calculated. RESULTS: Obese and overweight adolescents had higher white blood cells (WBC), neutrophil, monocyte counts and CRP concentration. In the backward stepwise regression analysis, body mass index standard deviation score (BMI SDS) and fasting insulin concentration were independent predictors of WBC and neutrophil counts at the baseline. At the follow-up visit in 45 (54.8%) children, who had lost weight, decreases in WBC, neutrophil and monocyte counts and CRP, fasting insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) concentrations were observed. Changes in WBC and neutrophil counts were dependent on changes in HOMA-IR and TG/HDL ratio. Changes in HOMA-IR had a significant impact on changes in the monocyte count. CONCLUSIONS: Adipose tissue promotes systemic inflammation and its intensity depends on the degree of obesity and insulin resistance. This state is reversible. Changes in HOMA-IR were independent predictors of changes in WBC, neutrophil and monocyte counts after reduction of body weight.

Peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves' disease at baseline and after the initiation of antithyroid drug therapy.

AIM OF THE STUDY: Assessment of the peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves' disease (GD) at baseline and 4-6 weeks after the initiation of antithyroid drug (ATD) therapy. MATERIAL AND METHODS: Data of 59 children were assessed retrospectively. Baseline analysis included concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), TSH receptor antibodies (TSH-R Ab), complete blood cell count (CBC), aspartate (AST) and alanine aminotransferase (ALT) activity. Reassessment of CBC and aminotransferase activity was performed 4-6 weeks after the initiation of ATD therapy. RESULTS: Significant decreases in the neutrophil count, MCV, haemoglobin (Hgb), red blood cell (RBC) count, white blood cell (WBC) count and platelet (PLT) count were found in 37.3%, 32.2%, 22%, 13.6%, 8.5% and 5% of untreated patients, respectively. Increased baseline ALT and AST activity was observed in 44% and 32.2% of children, respectively. Initiation of ATD therapy led to significant changes in Hgb, RBC and PLT count, RDW and ALT activity. Negative associations between TSH-R Ab, TSH and MCV were found. ALT and AST activity were negatively related to baseline TSH levels. ALT activity was also associated with baseline fT4 and fT3. CONCLUSIONS: The incidence of haematopoiesis and liver abnormalities in GD children seems to be similar to that reported in adult patients. The most common alterations are changes in neutrophil count, RBC parameters and ALT activity. The initiation of ATD therapy usually leads to significant improvement in those parameters.

The Comparison of the Body Composition of Children at the Early School Age from Urban and Rural Area in Southwestern Poland.

The aim of the study was to compare the segmental body composition with the use of fat-fat-free (FFF) index in children at early school age, depending on sex and place of residence, with particular emphasis on urban and rural areas. The study consisted of 329 children aged 7.78 (SD = 0.88; mean age in years). The study group was divided according to the place of residence and sex. The height and body mass, Body Mass Index (BMI), segmental body composition (Tanita BC-418MA), and FFF were calculated. A more frequent occurrence of excessive body weight was observed in children from rural areas (over 20%) compared to their peers from the urban area (10%). Statistically significant lower values of FFF index as well as in the lower limbs and torso were observed in the case of the examined children from the urban area as compared with their peers from the rural areas. The body composition of children living in metropolitan and rural areas is diverse. Lower values of FFF indexes were found in children from the city than in children living in villages. There are more children in the city with signs of being underweight and of normative body mass and paradoxically more overweight ones in the village.

Graves' disease in children in the two decades following implementation of an iodine prophylaxis programme.

Grave's disease (GD) is a form of thyroid autoimmune disease characterised by hyperthyroidism. It is a rare clinical problem in paediatrics. Development of disease is the result of genetic susceptibility and some environmental factors. One of the best-documented environmental factors involved in thyroid autoimmunity is iodine excess. The aim of our study was to analyse the clinical course and response to pharmacological treatment in children diagnosed with Graves' disease in first two decades after mandatory salt iodination. Records of 94 children diagnosed with GD in the years 1998-2017 were analysed. Medical data of patients was compared between two decades following implementation of iodine prophylaxis: 1998-2007 (first-decade group - FDG) and 2008-2017 (second-decade group - SDG); 34 and 60 patients, respectively. Medical data of FDG was obtained from archival records and previous analysis performed in 2006. Data of 60 patients from SDG were obtained from currently available medical records. Results were statistically analysed using Microsoft Excel and Statistica 11 software. Results: In our study, after mandatory salt iodination, the tendency of an increase in newly diagnosed GD in children without family susceptibility was observed. The antibody profile indicates the significant contribution of the autoimmune process involving all thyroid antigens; therefore, the term "autoimmune hyperthyroidism" seems to be more appropriate than classical GD in this group of patients. The first-choice treatment with methimazole rarely causes adverse events during the therapy, and they have benign character.

Postural stability in young adults with Down syndrome in challenging conditions.

To evaluate postural control and performance in subjects with Down syndrome (SwDS), we measured postural sway (COP) in quiet stance in four 20-second tests: with eyes open or closed and on hard or foam surface. Ten SwDS and eleven healthy subjects participated, aged 29.8 (4.8) and 28.4 (3.9), respectively. The time-series recorded with the sampling rate of 100 Hz were used to evaluate postural performance (COP amplitude and mean velocity) and strategies (COP frequency, fractal dimension and entropy). There were no intergroup differences in the amplitude except the stance on foam pad with eyes open when SwDS had larger sway. The COP velocity and frequency were larger in SwDS than controls in all trials on foam pad. During stances on the foam pad SwDS increased fractal dimension showing higher complexity of their equilibrium system, while controls decreased sample entropy exhibiting more conscious control of posture in comparison to the stances on hard support surface. This indicated that each group used entirely different adjustments of postural strategies to the somatosensory challenge. It is proposed that the inferior postural control of SwDS results mainly from insufficient experience in dealing with unpredictable postural stimuli and deficit in motor learning.

Assessing postural asymmetry with a podoscope in infants with Central Coordination Disturbance.

The aim of this study was to digitally evaluate the incidence and severity of postural asymmetry in infants with Central Coordination Disturbance (CCD) by using a computer-aided podoscope (PodoBaby) from CQ Elektronik System. A sample of 120 infants aged from 3 months (± 1 week) to 6 months (± 1 week) took part in the study, of which 60 were diagnosed with CCD by a neurologist using Vojta's method and the remaining half healthy, non-afflicted infants. The relationships between Vojta's method, as a subjective clinical diagnostic tool for assessing the functional performance of infants with CCD, and the postural asymmetry results recorded with the podoscope, were also defined. Each infant was placed on the podoscope and photographed underneath in two positions: first lying on their back and then on their stomach. A symmetry index was used to calculate body asymmetry, i.e., the percent difference of abnormal body posture by favoring one side of the body to the other. The results confirmed that postural asymmetry assessed by the PodoBaby was in line with the earlier clinical diagnosis using Vojta's method. Statistically significant differences in postural asymmetry were also found between the healthy infants and infants with CCD. In addition, significant relationships were demonstrated in the magnitude and direction of asymmetry in the stomach and back positions.