Active Case Finding among Homeless People as a Means of Reducing the Incidence of Pulmonary Tuberculosis in General Population

The incidence of tuberculosis (TB) declined more than two-fold, compared with the national average, in the northeastern region of Poland in the period of 2003-2012. During that time, four programs of active case finding of TB were conducted as part of which a total of 944 homeless individuals were examined and 21 cases of active TB were detected. 

The objective of the present study was to find out whether the observed beneficial epidemiological trend could be a result of those programs. We addressed the issue of how the active case finding programs in the homeless community affected the TB incidence in the general population using a modified crisscross SIS-type (Susceptible - Infected - Susceptible) model which describes the dynamics of TB spread between the homeless and non-homeless populations. The values calculated from our model proved highly congruent with the actual epidemiological data. 

Our analysis showed a significant decline in TB incidence within 1 year of completion of each active case finding program. The model shows that each identified and cured case in the homeless community reduced the number of new cases in the general population by 3-4 within 1 year and by up to 20 within 5 years.

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By:  Romaszko J1, Siemaszko A2, Bodzioch M2, Buciński A3, Doboszyńska A4.

• 1Family Medicine Unit, University of Warmia and Mazury in Olsztyn, 30 Warszawska St, 10-082, Olsztyn, Poland. jerzy.romaszko@uwm.edu.pl.
• 2Faculty of Mathematics and Computer Science, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
• 3Department of Biopharmacy, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
• 4Pulmonary Department, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland. 
• Adv Exp Med Biol. 2016 Mar 19. 

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The Mediating Role of Romantic Desolation and Dating Anxiety in the Association Between Interpersonal Competence and Life Satisfaction among Polish Young Adults

This study investigates the role of romantic desolation on life satisfaction in young adulthood. 

Using data from a Polish sample of 330 (205 females and 125 males) young adults aged 20–30, who completed Polish versions of the Satisfaction With Life Scale, Dating Anxiety Scale, Interpersonal Competence Questionnaire-Revised, and Social and Emotional Loneliness Scale for Adults-Short Form, romantic desolation (romantic loneliness and lack of a romantic partner) and dating anxiety were tested as mediators of the association between interpersonal competence and life satisfaction. 

Results revealed that single individuals reported lower life satisfaction and higher romantic loneliness than did partnered individuals. At the same time, no differences emerged between single and partnered individuals in dating anxiety or interpersonal competence. Structural equation modeling results showed that low interpersonal competence has an indirect effect on romantic desolation through higher levels of dating anxiety. Also, dating anxiety had an indirect effect on lower life satisfaction through increased romantic desolation. 

These results highlight the important role of dating anxiety and romantic desolation for explaining why low interpersonal competence is associated with diminished life satisfaction in young adults.

Below:  Structural model of interpersonal competence, dating anxiety, romantic desolation, and life satisfication. Note For ease of presentation, error terms have omitted from the model. *p < .05; **p < .01; ***p < .001

Full article at:   http://goo.gl/1VcHhg

By:  Katarzyna Adamczyk and Chris Segrin

Institute of Psychology, Adam Mickiewicz University, ul. A. Szamarzewskiego 89/AB, 60-568 Poznan, Poland

Department of Communication, University of Arizona, Tucson, AZ 85721 USA

Katarzyna Adamczyk, Phone: 48 61 829 23 11, Email: lp.ude.uma@kyzcmadA.anyzrataK.

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Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus

Background. 

The aim of the study was to explore the prevalence of illicit drug use in a group of Polish adolescents with type 1 diabetes (DM1) in comparison with a national cohort of their healthy peers. 

Methods. 

Two hundred and nine adolescents with DM1, aged 15-18 years, were studied in 2013 with an anonymous questionnaire prepared for the European School Survey Project on Alcohol and Other Drugs (ESPAD). The control group was a representative sample of 12114 students at the same age who took part in ESPAD in 2011. Metabolic control was regarded as good if self-reported HbA1c was <8% or poor if HbA1c was ≥8%. 

Results. 

Lifetime prevalence of illicit drug use was lower among adolescents with DM1 than in the control group [58 (28%) versus 5524 (46%), p = 10(-5)]. Cannabis preparations were the most frequently used substances [38 (18.3%) versus 3976 (33.1%), p = 10(-5)], followed by tranquilizers, sedatives, and amphetamine. Lifetime and last 12-month use of cannabis were associated with poorer glycemic control (HbA1c ≥ 8%), p < 0.01 and 0.02, respectively. 

Conclusions. 

Adolescents with DM1 report using illicit drugs to a lesser extent than their healthy peers. The use of cannabis is associated with a poorer metabolic control in teens with DM1.

Below:  The proportion of patients who tried or did not try marijuana, according to HbA1c levels, p = 0.03; response rate to that question was 189/209.

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By:  Hogendorf AM1, Fendler W1, Sieroslawski J2, Bobeff K3, Wegrewicz K3, Malewska KI3, Przudzik MW3, Szmigiero-Kawko M4, Sztangierska B4, Mysliwiec M4,Szadkowska A1, Mlynarski W1.

• 1Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 2Department of Studies on Alcoholism and Other Dependencies, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland.
• 3Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 4Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland.
• J Diabetes Res. 2016;2016:4153278. doi: 10.1155/2016/4153278. Epub 2015 Dec 29. 

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The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases

The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland.

A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test.

Results: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm³ (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. 

The most frequent malignancies were: NHL (26.39%), KS (17.01%), ICC (11.81%), HD (7.99%), lung cancer (6.25%) and HCC (4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender, advanced age: 50–60 years and ≥ 60 years, longer duration of HIV-infection and successful HAART were independent predictors of NADMs overall, respectively.

Conclusions

In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

Below:  Estimated prevalence of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs). The latter are divided into virus related (NADMs-VR) and virus unrelated (NADMs-VUR) over the presented periods of time

Full article at: http://goo.gl/unAlxb

By:  Jacek Kowalski,1 Grażyna Cholewińska,1 Karolina Pyziak-Kowalska,1 Elżbieta Jabłonowska,2 Grażyna Barałkiewicz,3Anna Grzeszczuk,4 Magdalena Leszczyszyn-Pynka,5 Anita Olczak,6 Maria Jankowska,7 Tomasz Mikuła,8 Monika Bociąga-Jasik,9 Ewa Firląg-Burkacka,8 and Andrzej Horban8

¹Hospital for Infectious Diseases in Warsaw, Warsaw, Poland

²University of Lodz, Lodz, Poland

³Poznan University of Medical Sciences, Poznan, Poland

⁴Medical University of Bialystok, Bialystok, Poland

⁵Pomeranian Medical University, Szczecin, Poland

⁶Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland

⁷Medical University of Gdansk, Gdansk, Poland

⁸Medical University of Warsaw, Warsaw, Poland

⁹Jagiellonian University Medical College, Krakow, Poland

Corresponding author.

Address for correspondence: Jacek Kowalski, Hospital for Infectious Diseases in Warsaw, Wolska 37, 01-201 Warsaw, Poland. e-mail:moc.liamg@2891ikslawokkecaj

 

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Relating HIV Testing Patterns in Poland to Risky & Protective Behavior

The aim of the study was to understand HIV testing patterns needed to improve access to early HIV diagnosis, and to investigate the spread of the virus in different populations. We examined prior testing history of individuals presenting for an HIV test across all 30 voluntary testing and counselling sites in Poland, 2008-2010 to determine factors associated with the testing rate using zero-truncated Poisson regression. 

Of 2397 persons presenting for an HIV test, 25 (1%) were HIV positive and 470 (19.6%) were repeat testers. The proportion of repeat testers was higher among men who have sex with men (MSM) at 37% (90/246), and people who inject drugs (PWID) at 32% (21/65). Higher testing rate was independently associated with exposure category (testing rate ratio, RR for MSM = 2.0, 95% CI 1.6-2.6, and 1.6, 0.9-2.6 for PWID), >5 sex partners (1.9, 1.4-2.7), high-risk partner (1.3, 1.1-1.6), urban residence (2.1, 1.3-3.5) and higher education attainment (1.1, 1.0-1.5). Inconsistent condom use with casual partners and sex under the influence of alcohol were associated with lower testing rates. 

There is a need to increase HIV testing uptake in Poland, especially among the rural population. Despite testing rates being higher among populations with higher risk of exposure to HIV (MSM and PWID), they still remain low, indicating the existence of barriers to testing.

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By:  Rosińska M1, Simmons R2, Marzec-Bogusławska A3, Janiec J1, Porter K2.

• 1 Department of Epidemiology , National Institute of Public Health - National Institute of Hygiene , Chocimska 24, Warsaw , Poland.
• 2 MRC Clinical Trials Unit at University College London , Aviation House 125 Kingsway, London , UK.
• 3 National AIDS Centre , ul. Samsonowska 1, Warsaw , Poland. 

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Tuberculosis in Homeless Persons in Poland

Comparison of TB features in homeless persons and in non-homeless patients.

TB cases reported to National TB Register in Poland in whom information about the social status was available (the data about the social status were collected obligatorily in the years 2004-2013 only) were analysed. The results of DSTs were obtained from laboratory records and were available for the cases reported since 2010. Treatment outcome after 12 months was analysed for the cases registered between 2004-2012. The significance (Si) of the differences in proportions was assessed with chi-square test. P< 0.05 was regarded as statistically significant. Test F was used to evaluate the significance of differences of the means of age. The multivariate logistic regression models were applied to find out the independently operating determinants of not achieving of success of treatment.

2,349 homeless persons (HP) and 72,989 other patients (OP) with TB were included. In the group of HP, there was a greater proportion of males in comparison with OP (90.5% vs. 66.3%) (Si). The mean age of HP was 49.8 years (SD ± 10.9); of OP - 52.9 years (SD ± 17.5) (Si). 16.6% of HP and 10.4% of OP were previously treated for TB (Si). The previous treatment was adequate in 62.2% of HP and in 85.8% of OP (Si). Pulmonary TB was in 98.0%, extrapulmonary TB in 2.0% of HP and, respectively, in 92.5% and 7.5% of OP (Si). Pulmonary TB was confirmed by culture in 76.3% of HP and in 64.5% of OP (Si). Sputum smears were positive in 70.7% of HP and in 62.5% of OP (Si). Caseous pneumonia occurred in 2.7% of homeless subjects and in 1.1% of OP (Si); infiltrative TB in 95.5% of HP and in 97.5% of OP (Si). Resistance to isoniazid was observed in 2.9% of HP and in 3.1% of OP; to rifampicin in 0.0% of HP and in 0.2% of OP; to isoniazid and rifampicin in 0.4% of HP and in 0.8% of OP. These differences were not Si. Treatment success rate among HP was 44.1%; default rate 24.8%; 4.0% of HP died from tuberculosis; 3.2% died from other causes; 5.2% were transferred and their outcomes were unknown; 0.4% were still on treatment; 0.4% had treatment failure; in 17.9% of HP results of treatment were not available. Among other TB patients the rate of success was 66.8%; of default - 8.8%; 1.9% died from TB; 3.1% died from other causes; 2.6% were transferred; 0.5% were still treated; 0.2% had treatment failure; in 16.1% the results were not reported. Differences between both groups were Si, except for the category "died from other causes", "still on treatment" and "treatment failure".

In the group of homeless persons with tuberculosis phenomena which indicate a delay in diagnosis of disease and in some cases the possibility of a recent infection and also unfavorable treatment outcomes occur in a greater proportion than among other patients. Targeted screening for TB and directly observed treatment could likely improve the epidemiological situation of tuberculosis in the population of homeless. 

Full PDF article at: http://goo.gl/uAk9sX

By: Korzeniewska-Koseła M1, Kuś J2, Lewandowska K2, Siemion-Szcześniak I2.

• 1National Tuberculosis and Lung Diseases Research Institute, Department of Tuberculosis Epidemiology and Surveillance.
• 2National Tuberculosis and Lung Diseases Research Institute, I Department of Lung Diseases.  

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Sexual Aggression Victimization & Perpetration among Female & Male University Students in Poland

This study examined the prevalence of victimization and perpetration of sexual aggression since age 15 in a convenience sample of 565 Polish university students (356 females). 

The prevalence of sexual aggression was investigated for both males and females from the perspectives of both victims and perpetrators in relation to three coercive strategies, three different victim-perpetrator relationships, and four types of sexual acts. 

We also examined the extent to which alcohol was consumed in the context of sexually aggressive incidents. The overall self-reported victimization rate was 34.3% for females and 28.4% for males. The overall perpetration rate was 11.7% for males and 6.5% for females. The gender difference was significant only for perpetration. 

Prevalence rates of both victimization and perpetration were higher for people known to each other than for strangers. In the majority of victimization and perpetration incidents, alcohol was consumed by one or both parties involved. 

The findings are discussed in relation to the international evidence and the need for tailored risk prevention and reduction programs.

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By: Tomaszewska P1, Krahé B2.

• 1University of Potsdam, Germany ptomasze@uni-potsdam.de.
• 2University of Potsdam, Germany.  

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