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Background: Vaccines are biologic medical products, the biological activity and characteristics of which are significantly different from common drugs and other medical products. The process of determining the dosing (vaccination) schedule for a particular vaccine is based on different principles and rules than other drugs. The dosing schedule for drugs is based on the essential pharmacological properties: pharmacokinetics and pharmacodynamics. When determining the schedule for vaccines, the pharmacokinetic and pharmacodynamic principles cannot be applied: sero-conversion and sero-protectivity of the biologically active component of the vaccine need to be applied. As opposed to drugs and medical products the dosing (vaccination) schedule in the Summary of Product Characteristics (SPC) is often provided in several versions, sometimes with a supplement referring to official (national) recommendations. In relation to the large variability vaccination schedules in the European Union (EU), it is not realistic to test each vaccination schedule in clinical studies. Requiring clinical trials for each vaccination schedule used only for the needs of regulators is more of an ethical issue than a scientific one. The European Centre for Disease Prevention and Control (ECDC), which is the Scientific Panel on Childhood Immunisation Schedule (SPACIS), accepts all the schedules used in EU countries as valid. Methods and Results: A review of the literature on immunisation schedules for primary series and booster doses choosing the following key words: immunisation, vaccination schedule, primary, booster, timing, vaccination delay.

Objective: The aim of the study was to determine the seroprevalence of three zoonotic infections among healthy blood donors/volunteers in Eastern Slovakia. Methods: Sera from 124 blood donors were investigated for the presence of antibodies against Borrelia burgdorferi, Francisella tularensis and Leptospira pomona. The participants also completed the questionnaire about demographic, exposure and epidemiological characteristics. Two serological methods were used for the diagnosis: the enzyme linked protein A/G assay (ELPAGA) and the Western blot (WB). First, sera were screened by ELPAGA (except for leptospirosis). Results: The observed seroprevalence was 15% for Lyme borreliosis (LB) and 4% for tularaemia (TUL). The results were confirmed by WB. Positive IgG antibodies (WB method) were detected only in 1.6% of examined for LB and 0.8% for TUL. Our results did not identify any antibodies against Leptospira pomona agent in the examined healthy blood donors group. Conclusions: ELPAGA seroprevalence for TUL was significantly higher in blood donors working in the agricultural area in the direct contact with hay, straw, manure, and agricultural land. Our outputs determine tick bite as a significant risk factor for LB. The study confirms the explosion of tick-borne diseases in the healthy population of people. The exposure risk for leptospirosis seems to be minimal.

Aim: Worldwide data indicate that antibiotics are frequently used inappropriately. The objective of this study was to investigate the extent of storage and wastage of antibacterial agents in households in Novi Sad, Serbia. Methods: The study was performed in 8 months period (December 2011-July 2012) in households in Novi Sad, Serbia. The households were randomly selected from the telephone directory. The interviewer performed the survey visiting each household. Results: The total number of antibacterial agents in the 383 surveyed households was 318, constituting 7.3% of the total stored medications. From 383 families included in the study antibiotics were found in 178 (46.5%). In 13 (7.3%) families were found more than one pack of the same antibiotics. The median number of antibacterial agents per household was 1 (range 1-5). The most common antibacterial agents that were not in current use were cephalexin (22.1%) and amoxicillin (16.6%), followed by doxycycline (11.4%), sulfamethoxazole/trimethoprim (11.4%) and amoxicillin/clavulanic acid (9.2%). The percentage of expired antibacterial agents was 20.8%, while 85.2% were not currently in use. Conclusion: Antibacterial agents were commonly encountered in Serbian households, and a relatively large percentage was wasted. Informational and educational activities aimed at improving the public knowledge about antimicrobials play the leading role in reducing imprudent use of antibiotics.

Aim: An epidemiological cross-sectional study was conducted to evaluate the association between cutaneous melanoma, Hodgkin's lymphoma and non-Hodgkin's lymphoma in 40 European countries. Methods: Incidence rates were obtained from the database of the International Agency for Research of Cancer (IARC). We analyzed age-adjusted and gender-stratified incidence rates for cutaneous melanoma, Hodgkin's lymphoma and non-Hodgkin's lymphoma in 40 European countries. All European countries included had registration systems that fulfilled the quality criteria of IARC. Normal distribution of the variables was examined using Kolmorov-Smirnov test before calculating their correlations using Pearson's Correlation test. Results: In males, positive correlations were found between cutaneous melanoma, Hodgkin's lymphoma (r=0.14, p=0.38), and non-Hodgkin's lymphoma (r=0.64, p<0.001). In females, negative correlation was found between cutaneous melanoma and Hodgkin's lymphoma (r=0.28, p=0.08), however, positive correlation was found between cutaneous melanoma and non-Hodgkin's lymphoma (r=0.72, p<0.001). Conclusion: Our findings raise the hypothesis about common risk factors for cutaneous melanoma and non-Hodgkin's lymphoma. New epidemiological and genetic studies are needed to identify possible common risk factors.

Aim: The aim of the study was to estimate the possible risk of adverse birth outcomes of children born to mothers with rheumatoid arthritis (RA). Methods: The dataset of large population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities from 1980-1996 was evaluated including 22,843 cases with congenital abnormalities and 38,151 matched controls without any defect. Results: 36 cases (0.16%) had mothers with RA, while 68 controls (0.18%) were born to mothers without RA (OR=0.9, 95% CI=0.3-1.6). A higher risk for congenital abnormalities in the offspring of pregnant women with RA was not found. In fact there was a larger mean birth weight in the newborns without any defect of mothers with RA and it was associated with a somewhat lower rate of low birth weight. Conclusion: RA seems to have a beneficial effect not only for pregnant women but for their foetuses as well.

Aim: Traumatic brain injuries (TBI) are a major public health problem. Although they are well studied, information on some aspects, such as the place of occurrence, is limited. The aim of this study was to describe the patterns of severity, causes and outcomes of TBI occurring at different locations and to identify the primary populations at risk of suffering TBI at each of the analysed locations. Methods: 1,818 patients with TBI admitted to hospitals in Austria, Slovakia, Croatia, Bosnia, and Macedonia were analysed. Primary populations at risk, injury severity and extent along with short/long-term outcomes were analysed for TBI at each location. Results: The highest mean age (57.9 years, p<0.001) was observed in injuries at home. The distribution of injury causes across the group was significantly different (p<0.001), with falls (39%) and traffic accidents (30%) being predominant. TBI occurring on roads or highways were the most severe (mean ISS=32.5, p<0.001; mean GCS=7.8, p<0.001). Injuries at home had the worst outcome (50% mortality, p<0.001 and 70% unfavourable outcome, p<0.001) whereas TBI at sport facilities or outdoors had the best outcome (24% mortality, 44% unfavourable outcome). When adjusted for age and severity, TBI occurring at home had the highest odds of mortality (OR=3.12, 95% CI=1.86-5.25) and unfavourable outcome (OR=2.51, 95% CI=1.54-4.08), compared to sports facility and outdoors as a reference. Conclusions: TBI at different locations display distinctive patterns as to causes, severity, outcome and populations at risk. Location is therefore a relevant epidemiological aspect of TBI and we advocate its inclusion in future studies. Definitions of primary populations at risk at different locations could help in targeted public health actions.

The objective of this paper is an analysis of two main attributes of healthcare systems. First of the main attributes is the trend of ever growing expenditures of healthcare systems all across the world. Second attribute is the efficiency of chosen mixed healthcare systems, where mixed system is one which features involvement of both private and public sector. Countries chosen for analysis are USA as the country with high private sector influence on healthcare, France with its mediocre influence and Japan, where the private companies participate in health care but are very strictly regulated by a zero profit rule, and the Czech Republic, where public sector dominates the health care. The result is that the systems with higher influence of the private sector tend to have lesser occupancy, not significantly better performance and higher expenditures. This raise doubts whether the private sector brings anything of value for the patients within the healthcare system. However, more detailed analysis should be carried out to confirm or refuse this hypothesis.

This article considers developing trends in self-perceptions of health among the Czech population. Its conclusions are based on data from the European Union Statistics on Income and Living Conditions (EU-SILC) conducted from 2005-2011. The data analysis suggests that the compression of morbidity is present, but the Czech Republic continues to lag behind Western Europe. In addition, among males the difference in health expectancies between the Czech Republic and the EU-15 is due to a change in mortality at higher ages, rather than in self-perceived health. Among females the opposite is true. Demographic categories, such as "attained education" and "age-group" proved to be significant factors in influencing self-perceived health in the Czech population for the year 2011. Gender and marital status seem to be less important.

Objective: Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic. Materials: Newly diagnosed HIV/AIDS cases (n=308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T. pallidum exposure. Results: HIV infection was transmitted through heterosexual (n=176) or homosexual (n=131) contact (266 male, 86.3%; age 38.3±11.7 years; CD4+ T lymphocyte count, 330.6±15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T. pallidum exposure. All patients with positive syphilis serology were male (p=0.0026). T. pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p=0.0003). Conclusion: Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

Background: Ambient air pollutants (PM2.5) are components of persistent haze in Beijing during the autumn and winter seasons. Materials: We collected hourly PM2.5 monitoring data for 35 days from 35 sites in Beijing during 2012. We also identified patients developing respiratory infections during the same time period in the same locale. A BME model was used to simulate environmental exposure concentrations over the course of each day. A medical accessibility analysis was performed to exclude the impact of medical availability on the analysis. A spatial analysis was included in the evaluation of the relationship between exposure duration and concentration of PM2.5 with the development of acute respiratory disease. Results: A low concentration of PM2.5 (greater than 35 µg/m3 and less than 115 µg/m3) for at least 3 days was associated with an increased risk of acute respiratory disease. A high concentration of PM2.5 (greater than 115 µg/m3) was associated with an increased risk of infection even after 1 day of exposure.

Objectives: Health status is represented by people's subjective assessment of their sense of well-being and ability to perform social roles and has been well accepted as a health indicator of different populations. The aim of this study was to determine health-related quality of life in Slovenian population. Methods: We performed a cross-sectional postal survey in a random stratified sample of 1,000 adult Slovenian inhabitants. The questionnaire consisted of the respondents' demographic data (sex, age, education level, employment status, living environment), self-reported chronic conditions, self-reported use of health services and EQ-5D instrument for measuring quality of life. Results: The response rate was 41% (53.1% men, mean age 51.5 years). Respondents reported most problems in the pain dimension of EQ-5D (59.3%), following by mobility (30.4%), anxiety/depression (30.3%), daily activities (29.8%) and self-care (9.0%). At least one moderate problem was reported by 272 (66.3%) respondents. Independent factors, associated with problems in any EQ-5D dimension were primary and vocational education, older age, high blood pressure, rheumatic diseases, back problems, anxiety/depression, a visit to the emergency department in the past year, and a house visit from a family doctor in the past year. Conclusions: The present study showed that the health-related quality of life of the Slovenian inhabitants is lower than the one found in some other European countries. This finding is surprising and also worrying. Because we cannot find any perceptible reason for this observation, larger and prospective studies are needed to confirm those results and to determine the reasons for that.

Background: The aim of this study was to compare socioeconomic characteristics of the Roma population living in Roma settlements with the majority population. Moreover, it was aimed to assess socioeconomic differences in health and health-related behaviour within the population living in Roma settlements. Methods: Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Roma in selected settlements were recruited by local Roma community workers. Respondents from the major population were randomly selected from a list of patients from general practitioners. Data were collected via questionnaire, anthropometric measures and analysed blood samples. Differences in socioeconomic characteristics between the population living in Roma settlements and the majority population were tested using the chi-square test. The contribution of selected socioeconomic characteristics on health and health-related behaviour of the population living in Roma settlements was assessed by logistic regression models adjusted for age and gender. Results: The population living in Roma settlements is characterised by significantly lower socioeconomic standards, and the living conditions are significantly worse compared with the majority. With few exceptions, the study did not confirm any significant association between socioeconomic indicators and health and health-related behaviour within the population living in Roma settlements. Conclusions: The deteriorating effect of living in Roma settlement on health and health-related behaviour seems to be immense regardless differences in socioeconomic characteristics or living condition within the settlement population.

Background: Colorectal cancer (CRC) is the third most common cancer worldwide, after lung and breast cancer, and is associated with the population dietary and lifestyle factors. Aim: To determine the relation between dietary and lifestyle factors and development of CRC in patients attending Minia oncology centre and compare them with their control. Methods: Study included 150 CRC patients attending Minia oncology centre and 300 control subjects matched by age and sex. Subjects participating in the study filled in a questionnaire including questions about socio-demographic data, medical data concerning CRC and its treatment as well as dietary and lifestyle factors. Results: The most significant dietary and lifestyle CRC risk factors were higher consumption of red meat (OR=57.1), preserved food (OR=39.4), artificial sweeteners (OR=20.8), fast foods (OR=12.8), soft drinks (OR=4.6), spicy foods (OR=4.2), processed meat (OR=2.4), and smoking (OR=8.8). The most significant protective factors were physical activity (OR=0.001), calcium rich diet (OR=0.08), higher consumption of fruits and vegetable (OR=0.02), cruciferous vegetables (broccoli OR=0.11, cauliflower OR=0.30 and cabbage OR=0.30), high fiber bread (OR=0.15), fruit juice (OR=0.18), and sea foods (tuna OR=0.28 and fish OR=0.38). Conclusion: Sedentary lifestyle and unhealthy dietary choices were prevalent among CRC cases. This study provides strong evidence that lifestyle and dietary modification are important factors in the prevention of colorectal cancer.

Objective: We wanted to primarily examine the knowledge, attitudes and behaviour of parents and health workers (community nurses and paediatricians) regarding child injuries in order to understand the essence of the problem and to find out the most common misconceptions. Methods: Respondents were tested through an anonymous, self-administered questionnaire and all p values below 0.05 were considered significant. Results: Of all respondents, paediatricians answered accurately most of the questions considering knowledge than the other groups. More than 90% of respondents, in all groups, identified correct answers to 10 questions about attitudes towards child injury prevention and safety promotion. Conclusion: This study, which shows the current level of knowledge, attitudes and behaviour patterns of parents and health professionals in Croatia, could help in the preparation of appropriate prevention programmes.

Background: We aimed to evaluate the computer usage patterns of adolescents and to determine the effects of family life and parental attitude on these patterns. Methods: This was a descriptive, cross-sectional, population-based survey that included 935 children between 11 and 16 years of age who were students in the second level of primary school and their parents as well. The following instruments were used in the survey: student and parent questionnaires on computer usage patterns and the Parental Attitude Research Instrument (PARI) to assess parental attitudes towards child-rearing and family life. Results: Of the study population, the majority of the students had a computer in their homes and spent a lot of time on the Internet. Parental control over the amount of time spent on the Internet and the websites that were visited had sometimes limited and contradictory effects on computer usage among the students. A democratic parental attitude was the best approach. Using the computer as a reward or punishment had a negative impact on the children's computer usage patterns. Conclusions: Although parents are confused concerning the benefits and harms of the Internet for their children and not certain how to manage their children's use of the computer and safe navigation of the Internet, a democratic parental attitude appears to be the best approach for reaching the most beneficial computer usage patterns for students.

Introduction: Egypt adopted a comprehensive strategy to eliminate measles and rubella by conducting a catch up campaign (in 2008) targeting children and young adults in the age group 10-19 years. This study aimed to explore the seroprevalence of rubella among females aged 20 to 30 years in order to provide the Ministry of Health with information to develop future strategies for rubella supplemental immunization activities among women of childbearing age before marriage and conception. Methods: A total of 339 females in the age group 20 to 30 were selected. The study group comprised women who attended the central laboratory of the Ministry of Health for checking up before travelling abroad as pre-travel requirements for visa application. The collected serum samples were tested for rubella-specific IgG antibodies. Results: The overall prevalence of rubella antibodies in the study group was 88.2%. Around 5.0% of females, who reported that they had been vaccinated, were susceptible to rubella. Age, history of measles, mumps and rubella (MMR) vaccination and past history of rubella infection were considered factors associated with seropositivity for rubella. Conclusion: The seroprevalence rate of rubella antibodies among our female study group was considered low.

Aims: The current study assessed, by university and sex, the association between nutritional behaviour (twelve independent variables), and stress and depressive symptoms (dependent variables) in a sample from three UK countries. Methods: A cross-sectional survey was undertaken among undergraduates enrolled across seven universities in England, Wales and Northern Ireland (N=3,706). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale and modified Beck Depression Inventory. Sex and university comparisons were undertaken. Univariable and multivariable regression analyses were computed for each of the two outcomes - perceived stress and depressive symptoms. Results: The frequencies of consuming of the various food groups differed by university and sex, as did depressive symptoms and perceived stress. Multivariable regression analyses indicated that consuming 'unhealthy' foods (e.g. sweets, cookies, snacks, fast food) was significantly positively associated with perceived stress (females only) and depressive symptoms (both males and females). Conversely, consuming 'healthy' foods (e.g. fresh fruits, salads, cooked vegetables) was significantly negatively associated with perceived stress and depressive symptoms scores for both sexes. There was significant negative association between consuming fish/sea food and depressive symptoms among males only. For males and for females, consuming lemonade/soft drinks, meat/sausage products, dairy/dairy products, and cereal/cereal products were not associated with either perceived stress or depressive symptoms. Conclusions: The associations between consuming 'unhealthy' foods and higher depressive symptoms and perceived stress among male and female students as well as the associations between consuming 'healthy' foods and lower depressive symptoms and perceived stress among male and female students in three UK countries suggest that interventions to reduce depressive symptoms and stress among students could also result in the consumption of healthier foods and/or vice versa.

Aims: This cross-sectional study aimed to determine the socio-demographic, lifestyle and well-being variables that are associated with body image concerns (BIC) and whether these associations differed between female and male students. Methods: A cross-sectional survey; 3,706 undergraduate students (2,699 females, 765 males) from seven universities in the UK completed a self-administered questionnaire that assessed socio-demographic, lifestyle, well-being and BIC based on the Body Shape Questionnaire developed by Cooper et al. Multifactorial logistic regression analysis examined the odds ratios for the association between four increasing levels of BIC as the dependent variables (no BIC, mild BIC, moderate BIC and marked BIC) on the one hand, and the socio-demographic (gender, age, year at university), lifestyle (physical activity, nutrition) and mental well-being variables (quality of life, perceived stress, perceived health, depressive symptoms) on the other. Results: More females (35%) than males (8%) reported being moderately or markedly concerned with their body image. For both genders, BIC was associated with a higher level of depressive symptoms and to variable extents, with nutrition and year at university. Females' BICs were exclusively associated with low perceived health, higher perceived stress, studies in general as a stressor, and low physical activity. In contrast, males' BIC were found to be exclusively associated with low quality of life and with older age. Conclusions: Health promoting strategies and activities should address the co-occurrence of depressive symptoms and BIC and should moreover pay attention to the gender-specific correlates of BIC for tailoring evidence based interventions for females and for males.

The aim of this study was to assess the risk factors in the origin of lethal or surgically corrected isolated atrial septal defect secundum. The population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (conducted between 1980 and 1996) comprised 472 atrial septal defect secundum cases, 678 matched controls and 38,151 available controls without any defects; in addition, 21,022 malformed controls with other isolated defects. Medically recorded chronic disorders in the prenatal maternity logbook were evaluated, while acute maternal diseases, drug treatments and pregnancy supplements were analyzed on the basis of both prospective medically recorded data and retrospective maternal information. Acute pelvic inflammatory disease, paroxysmal supraventricular tachycardia and phenolphthalein treatment due to severe constipation of mothers were shown to contribute to the development of atrial septal defect secundum of their children. High doses of folic acid in early pregnancy had positively influenced a minor part of isolated atrial septal defect secundum in foetuses. In conclusion, the obvious genetic predisposition for atrial septal defect secundum is connected with maternal paroxysmal supraventricular tachycardia and triggered by acute pelvic inflammatory diseases and phenolphthalein treatment, while the manifestation of atrial septal defect secundum can be reduced by high doses of folic acid supplementation in early pregnancy.

Q fever, which is caused by Coxiella burnetii, is a worldwide zoonotic infectious disease and ruminants are the main reservoir for human infec-tions. Humans become infected primarily by inhaling aerosols that are contaminated with C. burnetii. Ingestion (particularly drinking raw milk) and person-to-person transmission are minor routes. Animals shed the bacterium in urine and faeces, and in very high concentrations in birth by-products. The bacterium persists in the environment in a resistant spore-like form which may become airborne and transported long distances by the wind. Q fever is considered primarily an occupational disease of workers in close contact with farm animals or processing their products, however, it may occur also in persons without direct contact. To prevent the introduction and spread of Q fever infection, preventive measures should be implemented including immunisation with currently available vaccines of domestic animals and humans at risk.

A neighborhood environment allows defining typical features for physically active or inactive lifestyle. An accelerated pace of life and higher availability of an unhealthy lifestyle increase obesity rates. An analysis of body composition can be used as a predictor for assessment of current somatic conditions. The aim of the study was to determine the dependence of selected body composition parameters on neighborhood walkability in 167 women aged 20-60 years attending weight-loss programme called STOB-courses. A multifrequency bioimpedance analysis InBody 720 was used to determine the body composition of respondents. Further, ANEWS questionnaire was used to determine the level of neighborhood walkability. We divided the sample into two age groups (<40 years; ≥40 years) and into partial subgroups according to the neighborhood "level of walkability" (lower and higher level). Based on the assessment of body composition, it can be assumed more walkable neighborhood opportunities positively affect body composition. Body composition in older women is positively influenced if they lived in high walkable areas. In younger women we found only one indicator of body composition (body fat mass) influenced by neighborhood walkability. The relationship between health indicators of body composition and residential infrastructure might be useful in strategies aimed at maintaining and developing a healthy lifestyle within the community.

In many countries the incidence of melanoma has been doubling in every 10 years. Since 1930, the rate of melanoma has increased over 1,800% and researchers are expecting this trend to continue and increase for the next 10 to 20 years. Primary prevention and early detection of skin cancer in childhood is important to reduce the risk of developing skin cancer later in life. Primary prevention programmes are more beneficial and effective in children, not only due to the particular importance of sunlight exposure during this period, but because this is when individuals are more open to changes and adopt new attitudes and behaviour. The purpose of this manuscript is to review the results of intervention studies designed to modify sun exposure behaviour among children in the United States of America, Australia and Europe. An additional purpose is to summarize the recommendations obtained from the reviewed studies. The strongest recommendation to emerge from this review is that the skin cancer primary prevention programme should be carried out over several school years, not just one time, to produce changes in the sun safety behaviour. Moreover, it recommends that parents should be targeted to educate their children about sun protective skills and promote skin cancer prevention behaviour.

Background: Throughout Europe, differences in satisfaction with HIV-care of people living with HIV (PLHIV) persist, despite a tendency towards harmonisation of policy and management. Methods: A European sample of 1,549 PLHIV responded to an anonymous questionnaire assessing demographic background, general health, mental health, sexual health, and HIV-service provision. We compared the results across 3 regions: Western, Southern and Central/Eastern Europe. Results: PLHIV differed in several socio-demographic variables (gender, migrant status, sexual orientation, and financial situation) as well as specific psychosocial aspects (HIV-related discrimination, satisfaction with sexual and reproductive health (SRH) services in HIV-care settings, and complaints about service provision). Using multivariate analysis, a predictive model for satisfaction with SRH services in HIV clinics was developed, resulting into region of residence, and participants' satisfaction with their own health status as significant predictors. Conclusions: Better integration of SRH services in HIV-care should be encouraged. Service providers should be trained and encouraged to discuss SRH issues with their patients to create a supportive environment, free of discrimination. More time should be allocated to discuss SRH issues with individual patients.

Objectives: The aim of the study is to describe attitudes which underlie Pole's declarations of support for a smoking ban in public places. Methods: The qualitative study using semi-structured individual in-depth interviews was conducted. The 30 IDI-s (in depth interviews) being a part of a larger research project entitled 'Lay meanings of health and life orientation of Polish society versus prevention and health promotion attitudes' were realized between 2007-2009. People belonging to all key socio-demographic categories identified by variables such as sex, age, education, and place of domicile were interviewed. The resulting material was subjected to content analysis. In the study the structural concept of 'attitude' was adopted. In order to identify the attitudes towards smoking bans in public places statements related to all three components of attitudes were analysed, but the typology of attitudes was constructed mainly on the basis of the emotional-evaluative component. Results: The study identified as many as four attitudes behind the declared support for a smoking ban in public places. Those attitudes were labelled 'supportive', 'accepting', 'conditionally accepting', and 'ambivalent'. They differ as regards degree of acceptance for the ban, conviction about harmfulness of passive smoking, setting great store by other regulators of smoking like cultural norms or healthy consciousness, and propensity to observe and execute the smoking ban. The 'supportive' attitude can be characterized not only by total support for the smoking ban in public places but also by insistence on the need for its extension. The 'accepting' attitude means approval for the smoking ban, and the 'conditionally accepting' attitude is distinguished from the others by the stress put on the right of smokers to have an access to places where smoking is permitted. The 'ambivalent' attitude can be typified by underlining other than legal ways of influencing smoking in public places. Conclusions: The study suggests that the attitudes underlying the Pole's declarations of support for a smoking ban in public places can be differentiated. However, because of the low number of participants in the study the results should be verified thus the further research is needed. Therefore, there is a need not only to study people's declaration of support or objection for the smoking ban in public places but also to examine their attitudes including cognitive and behavioural components using both qualitative and quantitative methods of social research.

Occupational hazardous exposure in healthcare workers is any contact with a material that carries the risk of acquiring an infection during their working activities. Among the most frequent viral occupational infections are those transmitted by blood such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Therefore, they represent a significant public health problem related to the majority of documented cases of professionally acquired infections. Reporting of occupational exposures in University Hospital Dubrava has been implemented in connection with the activity of the Committee for Hospital Infections since January 2002. During the period of occupational exposures' monitoring (from January 2002 to December 2011) 451 cases were reported. The majority of occupational exposures were reported by nurses and medical technicians (55.4%). The most common type of exposure was the needlestick injury (77.6%). 27.9% of the accidents occurred during the blood sampling and 23.5% during the surgical procedure. In 59.4% of the exposed workers aHBs-titer status was assessed as satisfactory. Positive serology with respect to HBV was confirmed in 1.6% of patients, HCV in 2.2% of patients and none for HIV. Cases of professionally acquired infections were not recorded in the registry. Consequences of the occupational exposure could include the development of professional infection, ban or inability to work further in health care services and last but not least a threat to healthcare workers life. It is therefore deemed necessary to prevent occupational exposure to blood-borne infections. The most important preventive action in respect to HBV, HCV and HIV infections is nonspecific pre-exposure prophylaxis.

Titanium dioxide nanofibres (TiO₂) were intratracheally instilled in dose of 4 mg/0.2 mL saline solution per animal (Wistar rats). After 48 hours and 14 days the animals were exsanguinated (under i.p. thiopental narcosis), bronchoalveolar lavage (BAL) was perfomed and cells from BAL fluid were isolated. Following inflammatory, cytotoxic and oxidative stress BAL parameters were examined: differential cell count (% of alveolar macrophages (AM), polymorphonuclears and lymphocytes); the viability and phagocytic activity of AM; the proportion of immature cells; the proportion of multinucleated cells; count of AM/mL lavage; count of BAL cells/ mL lavage; the level of ascorbic acid and activity of superoxide dismutase, both in tissue homogenate and in bronchoalveolar lavage fluid. The majority of examined BAL parameters in the acute and subacute phase in our study suggest serious inflammatory and cytotoxic processes in lung after exposure to TiO₂.

Child survival is the focus of the fourth Millenium Developmental Goal (MDG4). This paper describes levels, trends, and differentials in Under-Five Mortality Rate (U5MR) and also summarizes state programmes in Turkey between 1988 and 2010. Turkey is among only a few countries that have already surpassed MDG4 and have reduced their under-five mortality rate by more than two-thirds. In 2010, 13 out of every 1,000 children died before their fifth birthday. Low birth weight, high-birth order, short birth intervals, rural residence, low level of maternal education and lowest wealth quintile have affected negatively children's chances of survival. Expanding the scope of free vaccination programmes for children, improving screening and disease prevention schemes aimed at children, encouraging breastfeeding, implementing an emergency obstetric care programme, improving the services provided to newborns (a newborn intensive care programme) have brought about a significant decrease in the rate of infant and under-five mortality. The implementation of state and region specific action plans should be necessary to increase the chance of an access to the Continuum of Care for each mother and infant and to surpass MDG4.

This article investigates elements of tobacco control issues in Romania. Using European Union requirements for tobacco control legislation as a backdrop, it examines the key issues of smuggling, taxation, and unemployment in a transitional economy. Romania has made some progress by adding text and pictorial warnings to cigarette packages and offering comprehensive help to quit smoking. Using empirical examples, it is argued that more progress in tobacco control is needed in the area of increased taxation, enforcement of non-smoking bans, and new legislation requiring advertising bans at point of sale, kiosks, and billboards. This article draws wider public attention to the problems that smuggling and taxation present for tobacco control, helps identify other countries confronting similar issues, and stimulates effective interventions.

Objective: We examined the effect of a 6-month combined aerobic and resistance training programme on cardiometabolic risk factors in non-diabetic subjects and compared its effectiveness when executed under strict professional supervision or without direct supervision. Methods: Eighty-five sedentary, non-diabetic subjects (27 men and 58 women), mean age 47.5±0.6 years, mean body mass index (BMI, 33.8±0.6 kg/m²) participated in a combined exercise programme assigned to supervised (S, n=31), non-supervised (NS, n=24) or control group (C, n=30). Cardiometabolic risk parameters were assessed at baseline and after the 6-month training. Results: In both the S and NS group there was a significant decrease in BMI (-1.6±0.3, p<0.001 and -1.0±0.3 kg/m², p=0.004), waist circumference (-10.1±1.1 cm, p<0.001 and -7.8±0.8 cm, p<0.001), fat mass (-1.8±0.4%, p<0.001 and -2.1±0.6%, p=0.003), and a significant increase in fat-free mass (+1.7±0.4%, p<0.001 and +2.0±0.7%, p=0.008), and aerobic capacity (+6.9±1.1, p<0.001 and +6.9±0.8 ml/kg per min, p=0.008). Fasting glucose did not change in S and NS, but increased in C (p=0.048). In the S group a significant decrease in fasting insulin (p<0.001), homeostasis model assessment of insulin resistance (p<0.001), highly sensitive C-reactive protein (p=0.004), leucocytes count (p=0.04), systolic high (p<0.001) and diastolic (p=0.009) blood pressure was found. Comparable significant decreases in total and low-density lipoprotein cholesterol were observed in all study groups. Conclusions: A 6-month combined exercise programme led to substantial improvement of various cardiometabolic risk factors. This programme was effective even when executed without direct supervision, although the effects were more pronounced in the supervised group. Our findings suggest that non-supervised exercise programmes may be a valuable, cost-effective tool to translate the current physical activity guidelines in a real-life setting.