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Fish and other aquatic organisms are important source of dietary proteins for the human population. Fish meat, however, is contaminated with methyl mercury (MeHg), a potent neurotoxin. The well known Minamata and Niigata epidemic outcomes in Japan have raised the awareness of the health risk resulting from consumption of fish (and shellfish) from water basins polluted with industrial wastes containing mercury. In the present study, pregnant rat dams were exposed to environmental toxic elements - methyl mercury, 1000-1200 h, daily from the fifth gestation day (GD5) till parturition. Three groups of animals were given, by gavages, MeHg (0.5, 1.0 and 2.0 mg/kg/day) and control group received 0.9% saline at the same time. All animals were allowed to deliver and wean their offspring. Pups were evaluated for early development effects. There was a significant effect of treatment on somatic growth such as reduction in percentage of maternal weight gain (20.62%) at higher dose level whereas there was no change in percentage of live birth (100.00%) with 0.5 and 1.0 mg/kg dose treatment groups. There was a significant increase in the percentage of resorption (100.00%) per litter with 2.0 mg/kg/day MeHg dose. Average gestation length (days) and percentage resorption per litter or percentage foetuses/malformations per litter were not affected at 0.5 and 1.0 mg/kg/day dose level. The results of the study confirmed the high-teratogenic potential of MeHg and the need of payng increased attention to MeHg concerning its exogenous use during pregnancy.

Background: Dental caries as an infectious disease is still a major oral public health issue. As documented in some recent studies, it has been recognized as the most common chronic childhood disease. Aim: The aim of this study was to evaluate caries prevalence, DMFT and dmft scores, as opposed to caries free children at the age of 6 years from a well developed western region of Primorsko-Goranska county. The purpose was also to evaluate a Significant Caries Index (SiC) and a Restoration Index (RI) in the same study sample of 6 year olds. Methods: Data for a sample of 1,825 (868 girls and 957 boys) children was collected and analyzed by using Chi-square and Mann-Whitney U Tests. Results: Results showed that the mean dmft was 4.68±4.19, and the mean DMFT was 0.22±0.69. D/d component constituted a major part of caries score (DMFT/dmft) in both primary and permanent dentitions in the population of 6 years old children. Caries prevalence was 74.5 in primary dentition and 11.9 in permanent dentition. Significant Caries Index value (SiC) was 0.66 for permanent and 9.6 for primary teeth, respectively. The Restoration Index (RI) was 20.1 for primary and 39.5 for permanent dentition. Conclusion: The results obtained in this study revealed that dental caries still appears to be quite a significant problem among 6 year olds. However, collected data, particularly considering the SiC Index, can be used for further planning of preventive and restorative dental treatments as well as setting up future goals for the prevention of dental caries in Croatian school children of Primorsko-Goranska county.

Background: There has been limited investigation of the sexuality and sexual dysfunction in homosexuals by the sexual medicine community. The purpose of this article is to describe the methodology of the online GAy MEn Sex StudieS (GAMESSS) on the sexual behaviour and sexual dysfunctions of Belgian men who have sex with men (MSM). Aim: To describe the methodology of an online study that investigate sexual behaviour and sexual function and dysfunction in a sample of Belgian MSM. Methods: An internet-based survey on sexual behaviour and sexual dysfunctions was administered to MSM between April and December 2008. The questionnaire was a compilation of the Kinsey Scale for Sexual Orientation, the Index of Premature Ejaculation (IPE), the Erection Quality Scale (EQS), the Female Sexual Function Index (FSFI), the Brief (Male) Sexual Function Inventory (BSFI) and the Gay Men Sexual Addiction Screening Test (G-SAST). The analytic sample comprised 1,830 Belgian men aged 18 years or older, who reported having sex with men. Conclusion: The use of an online questionnaire is a convenient way to gather information from a hidden population such as MSM. The anonymity of the participants is guaranteed. The collected data can be easily analyzed. With this online study, we aim to detect variables in sexual behaviour (SB) and sexual dysfunction (SD) that can help to improve care for MSM. Belgian MSM have a very active and varied sex life. They are rather promiscuous and do not always practice safe sex. This behaviour poses a high risk of spreading sexually transmitted diseases. Additional research in this MSM population is needed.

Background: The purpose of the current study was to describe tuberculosis (TB) knowledge, beliefs, and experience with TB services among injecting drug users. Methods: Participants for this anonymous, cross-sectional study were recruited from a community based syringe exchange programme in Tallinn, Estonia. A structured questionnaire was completed and included information on socio-demographics, health history, drug use, and knowledge about TB and HIV. Results: The study included 407 people (79% male, mean age 27.9 years, mean injection drug use 9.4 years). 32.9% of participants reported HIV infection and 1.7% lifetime history of TB. 26.4% participants (n=106) reported symptoms suggestive of TB. 93% of participants recognized correctly that TB is air-borne infection and 91% that HIV is a risk factor for TB. Only 40% of the participants knew that TB diagnostics and treatment in Estonia are free of charge for everybody and 58% reported they knew where to get health care services in case they suspected that they had TB. TB transmission and treatment adherence knowledge was better among those in contact with either health care or harm reduction services, e.g the community based syringe exchange programme. Conclusion: Similar to HIV services, TB prevention and education should be integrated into harm reduction and drug treatment programmes to facilitate early diagnosis and treatment of TB among injecting drug users.

Objectives: Organizations engaged in drug addiction treatment started their activities only recently in Hungary. This paper examines the organisational environment in drug outpatient treatment using the example of Blue Point Foundation (BPF), a non-governmental organization (NGO). The authors describe BPF's organizational structure and functioning related to its effectiveness. Methods: BPF staff members anonymously completed a 59-item questionnaire about its organizational characteristics and functioning. The questionnaire covered demographic data, 50 items of the Quality Control questionnaire and a SWOT (Strengths, Weakness, Opportunities, Threats) analysis. Results: Policy and strategy were considered BPF's best feature, while the management of funds received the lowest rating. The assessment of the staff and that of the organization as a whole was closer to the midpoint of the scale. Discussion: High risk of staff burnout and unstable organizational environment are the most important threats on the NGOs working in addictology in Hungary.

Objective: To examine the association of age and other factors with Self-rated Health (SRH) in the population aged 65 years or more in the context of action for health promotion in older adults. Material and Methods: The data used come from the household and adults questionnaires of the National Health Survey of Spain for 2006. SRH was categorized as positive (very positive or positive) and negative (fair, poor or very poor). Odds ratios for positive SRH compared to negative SRH were calculated using logistic regression models for complex samples. The determinants of the Positive SRH were obtained for the elderly population. Results: Among the population aged 65 years and older 39.7% report positive SRH. In this age group, those of 83 or more years have a better SRH. Other factors specific to this age group that improve the SRH are living alone, not having any functional dependence and high monthly family income. Conclusions: The association between several factors (particularly age) and positive SRH in people aged 65 and older differs from the one found in the rest of the population. Understanding the factors positively associated with the positive SRH in this population is of great importance for the design of specific programmes aimed at improving the health of older people.

Objectives: The objective of this paper is to provide information on indoor air quality and on the quality of the broader indoor environment of the houses in Roma villages in Slovakia and Romania and to discuss possible implications for health. Methods: Indoor air was sampled in 11 houses in a Romanian Roma village and in 19 houses in a Slovakian Roma village. Levels of Carbon Monoxide (CO), Carbon Dioxide (CO²), total particulate matter (PM), temperature and humidity were measured. A questionnaire and a checklist were used to obtain additional information on the indoor environment and behavioural factors. We have sampled the same houses in winter and in summer. Results: Levels of CO and CO² were higher in winter in both countries as compared to summer. The limit value of 10 mg/m³ CO was exceeded in a few cases in both countries. In general, levels of CO, CO² and PM were higher in Romania. Further environmental and behavioural hazards such as indoor smoking, pets inside or lack of ventilation were found. The reported self-perceived quality of the indoor environment was poor in many aspects. Conclusions: Our findings of CO, CO² and PM levels suggest that indoor air pollution in Roma settlements has the potential to be a health threat. The fact that the inhabitants spend a relatively long time inside the houses and that a number of additional environmental and behavioural hazards were identified by our study emphasizes the importance of the indoor air quality for health and thus priority attention should be paid to these issues by health authorities and researchers. Further research is essential and study designs must consider cultural background and specific characteristics of the community, especially in order to obtain valid data on health outcomes.

The article describes bio-monitoring study concerning recent and long-term exposure of Czech women to toxic metals. Blood cadmium, mercury and lead levels were measured in groups of women with various life styles, etc., to have comparable results in the course of a long study period; a strong emphasis was laid on the quality control of the whole process during the study. Higher cadmium level was found in smokers compared to non-smokers, lower mercury level was found in the group of women who never eat fish. A slight increase of blood lead level with age was observed. No significant differences were found between localities in a given period. Our results do not differ from those gained in other European countries.

This paper seeks to outline the challenges of tobacco consumption control in the transitional economy of Bulgaria. It focuses on issues of taxation, high unemployment, and smuggling while attempting to meet European Union (EU) requirements for tobacco control legislation that reduces smoking consumption. The issue of tobacco control is not a simple one and requires a multi-pronged approach. While Bulgaria has made some progress in adopting legislation, it needs to strengthen its efforts in terms of enforcement, stronger legislation and increased taxation of cigarettes.

Objective: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Turkey in 2003 and 2009 to examine changes in tobacco use and important tobacco control measures. Methods: The GYTS were conducted in grades 7-9 in 2003 and 7-10 in 2009 in Turkey. Data in this paper are limited to 13 to 15 year old students. A total of 15,957 students from 202 schools participated in 2003 and 5,054 students from 69 schools participated in 2009. The overall response rate was 92.1% in 2003 and 87.5% in 2009. Results: Between 2003 and 2009 current cigarette smoking did not change significantly for either boys (9.4% to 10.2%) or girls (3.5% to 5.3%). Current cigarette smoking was higher among boys than girls in 2003 and in 2009. In 2009, half of students reported they had been exposed to second hand smoking (SHS) at home and 80% reported they had been exposed to SHS in public places. Three in ten students reported they had been exposed to pro-tobacco advertising in newspapers or magazines; one in ten had an object with a cigarette brand logo on it; and 7% had been offered free cigarettes by a cigarette company representative. Two-thirds of current cigarette smokers reported that they wanted to stop smoking; and almost two-thirds had been taught in school in the past year about the dangers of smoking. Conclusion: Passing and implementing the Law No. 4207 on Prevention of Hazards of Tobacco Products, ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), raising tax on tobacco, and requiring pictorial warning labels were important steps forward for tobacco control in Turkey. However, as to the tobacco control much work yet to be accomplished including developing an effective enforcement plan for all tobacco control efforts.

Tajikistan has the large stocks of poly-metal ores, which basic deposits are concentrated on Pamir, in Central and Northern Tajikistan. In case rich ore deposits are located in places of a mass settlement of the people, the enterprises of a mining industry represent in the certain sense "a bomb of the slowed down action" as at normal work of ore dressing enterprise the huge amounts of industrial wastes with high content of heavy metals in ores are formed, the part of which together with waste water regularly contaminates sources of drinking water. Such metals according to an industrial structure of ore dressing combines are mercury, lead, cadmium, zinc, copper and other metals. In our presentation the results of the carried out monitoring of quality of waters of rivers being a source of drinking water for the population settled along them (rivers Varzob, Siama, Zimchurud, Zeravshan) are submitted. These rivers are presumably polluted with waste water of the ore dressing enterprises. Besides the content of heavy metals, the hydrogen parameter and electro conductivity, content of nitrites, nitrates, ammonium nitrogen, fluoric were defined. In most cases quality of waters corresponded to the requirements of the State Department of Standards. However, close to Takob ore dressing combine an appreciable excess of extreme allowable concentration on such indicators as the content of copper 25.0-7.3х10-4 (3.0х10-4) mg/l (in brackets the extreme allowable concentration), fluoric anions 4.16 (1.5) mg/l, ammonium nitrogen 0.06 (0.02) were revealed. The greatest concentration of ions cadmium was found out in dumps of waters of Takob combine 2.2х10-4 mg/l and on the river Zimchurud 3.7х10-4 mg/l, however, these parameters fall below the extreme allowable concentration (1.0х10-2 mg/l). The parameters on mercury in all cases have appeared to be below the extreme allowable concentration. The analytical data on quality of water were used for correlation with prevalence of most common diseases in places of detection of pollution. In the report the wide spectrum of diseases is presented with a probable explanations for found out anomalies.

Background: The Invader® HPV HR Molecular Assay is an isothermal signal amplification technology designed to detect highrisk (HR) HPV types in cervical cytology samples. This assay also utilizes an internal control, the human histone 2 gene (HIST2H2BE) to assure sample sufficiency. Studies were undertaken to determine the analytical sensitivity, specificity, and accuracy of this assay in detecting 14 HR HPV types associated with cervical cancer. Methods: DNA extraction was performed using the Agencourt® GENfind™ v.1 kit. Analytical sensitivity was determined by testing dilutions of purified HPV DNAs of known copy number. Cross-reactivity was evaluated by testing low-risk HPV types and a panel of microorganisms. Accuracy for clinical specimens was established by testing 192 PreservCyt® cervical cytology samples with results compared to those obtained with PCR/sequencing. Reproducibility was determined in a multi-center study using a panel of 16 PreservCyt® samples containing cervical cells or cultured cells. This testing was performed at 3 external laboratories on 5 non-consecutive days. Results: Established sensitivities varied depending on each of the 14 HR HPV types tested, with sensitivities ranging from 1,250-5,000 copies of HPV DNA/reaction. Of 192 clinical samples tested, clear Invader® and sequencing results were available for 188/192. An overall 91.5% agreement (172/188; 95% CI=86.6-95.1) was observed between methods, with a positive and negative agreement of 94.4% and 87.5%, respectively (95% CI=88.3-97.9 and 78.2-93.8). No cross-reactivity was observed to common low-risk HPV types or the tested microorganisms. The reproducibility study demonstrated that between-day (within site) percent agreement across all 3 sites was 99.3% (1-sided 95% confidence lower limit=97.6%). Betweensite percent agreement was 99.3% (1-sided 95% confidence lower limit=98.7%).
Conclusions: The Invader® HPV HR Molecular Assay is a sensitive, specific, highly accurate, and consistently reproducible method for identifying HR HPV in PreservCyt® liquid cytology specimens. These characteristics make it suitable for use for cervical cancer screening programs.

Aims: The purpose of this paper is to highlight some of the benefits and challenges when undertaking research across several countries comprising diverse ethnic, lingual and historically different communities.
Methods: Literature review and experiences of the researchers who participated in the Students' Health Inquiry, as regards the benefits and the challenges that can emerge when conducting collaborative research. The Delphi technique was employed to reach consensus on and prioritise the emerging challenges and suggested solutions.
Results: Challenges of research consortia include the preparatory work before the study, the ownership of the data and dissemination of results, as well as methodological, financial, operational, and structural challenges. These are described, each challenge is further broken down in its subcomponents, examples are given, and potential solutions are suggested.
Conclusions: If challenges can be prevented or solved, the benefits of research consortia include greater generalisability of findings, and more comprehensive understanding of the issues than would be possible with a single-site study. There is also an increased probability to bring about policy changes and programmatic adjustments. Cross-national research consortia can contribute to reduction in the inequality of resources and research opportunities in the collaborating countries. Research consortia deserve the attention of funding agencies. They are capable of bringing about synergies that result from working collaboratively together of large multi-disciplinary team of investigators who share their strengths, disciplines and expertise in order to bear on the same research issue in multiple countries and diverse populations.

Aim: The aim of the study was to estimate the awareness of healthy lifestyle behaviours in cardiovascular diseases (CVD) prevention and to find out possible determinants of this knowledge among adult residents of Polish provinces with the highest CVD mortality rates. Material and Methods: A cross-sectional analysis of randomly selected representative sample of 2,211 (51.9% women) aged 20-74 years from Łódź and Lublin voivodeships participating in the National Polish Health Survey WOBASZ. Knowledge on CVD prevention, sociodemographic and lifestyle characteristics were collected by an interviewer-administered questionnaire. Blood pressure, anthropometrics, plasma lipids and glucose were measured according to the WHO MONICA protocol. Results: Approximately 68% of participants, had poor awareness of preventive methods and majority of them were not able to name any specific approach. Most often mentioned method of CVD prevention was relaxing/avoiding stress (51.2%). The least known healthy behaviour was a reduction of salt intake and adequate fruit/vegetables consumption, mentioned by 18.2% and 23%, respectively. About 16.4% of women and 23% of men with risk factors of CVD were not aware of any non-pharmacological preventive method. Poor knowledge of CVD prevention was significantly more prevalent among persons aged ≥65 years, with elementary education level, lower income, living in the rural settings, declaring poor self-rated health. Dietary and physical activity advice given by a primary care physician was significantly related to better knowledge among men with CVD risk factors. Conclusions: There is a need to focus on increasing educational level in this regions, especially in rural settings. Due to important role of primary care physicians in health education, more attention should be paid to individuals with CVD risk factors as their preventive knowledge level is very low and comparable to the level of low-risk individuals.

The aim of this study was to evaluate the cardiovascular risk (CVR) factors and morbidity in a sample of the population that received a brief intervention on cardiovascular prevention seven years ago. All family physicians who participated in the Cardiovascular Prevention Campaign in five Belgian towns in 2002-2003 received a follow-up questionnaire for each participating patient. The questionnaire included questions about new cardiovascular diagnoses, parameters of the latest physical examination and blood tests. Analyses were based on the 318 questionnaires that included essential information such as the date of the latest contact and the new diagnosis or mortality. The proportion of patients with a low CVR decreased from 75% in 2002-2003 to 40% in 2010. Participants showed a significant increase of the abdominal circumference, triglycerides and fasting glycaemia. Only LDL-cholesterol levels decreased significantly (p=0.002). Four percent of the patients died, more male (7%) than female (2%) (p=0.03). One in ten patients presented with a cardiovascular event. Most of the changes are probably attributable to age. It is clear that the long-term effect of a brief intervention only followed by usual care is not sufficient to attain optimal level of cardiovascular prevention.

Aims: University students' wellbeing and health promoting and damaging behaviours are important and comprise many parameters. The purpose of this study was to assess a range of health behaviours and lifestyle characteristics of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these parameters between males and females, and across the participating universities. Methods: A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), nutrition, dietary intake and food consumption patterns, as well as the importance of healthy eating, three levels of physical activity, restful sleep, tobacco smoking, use of illicit substance (recreational drugs), frequency of binge drinking and problem drinking. The data was collected in 2007-2008. Results: While females generally reported lower use of tobacco, illicit substances and alcohol (binge drinking/problem drinking) and consumed more fruits and vegetables, male students had a higher level of physical activity, consumed less sweets and had more restful sleep. When lifestyle characteristics of students were compared between the different universities we observed some clustering of the parameters under study, whereby favourable health practices would be exhibited at some universities; and conversely, the clustering of less favourable practices exhibited at other participating sites. Conclusions: We conclude that only a minority of students exhibited positive health practices above recommended levels and the level of binge drinking and problem drinking was high. This calls for increased awareness of university administrators, leaders and policy makers to the risky health habits of their students. The observed clustering effects also indicate the need for local (university-specific) health profiles as basis and guidance for relevant health promotion programmes at universities.

Flies of the genus Sarcophaga are known to cause myiasis in necrotic wounds and in anatomical cavities where fluids have collected. We present here the first case of external cutaneous myiasis by Sarcophaga larvae in the absence of skin ulcerations or necrosis. The host in this case was a geriatric patient with limited motor and neurological capacity who lives in a nursing home. Of particular importance is that Sarcophaga is capable of causing myiasis even in the absence of cutaneous infections or significant stasis of fluids or secretions and that the larvae can cause damage in otherwise healthy tissue.

The objective of the study was to estimate the possible association of maternal diseases with the risk of isolated ear congenital abnormalities (IECA) including mainly microtia and anotia in their children. Incidence of acute and prevalence of chronic maternal diseases in the mothers with IECA and in the mothers of their matched controls and all controls without any defects, in addition in the mothers of malformed controls with other isolated defects was compared in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Of 354 cases with IECA, 32 had mothers with high fever related influenza-common cold during the critical period of IECA and it resulted in a higher risk of IECA in their live-born infants (adjusted OR with 95% CI: 4.3, 1.9-7.4) compared with their matched controls. However, the early and effective antifever treatment in these pregnant women prevented them from the IECA. In addition there was an association of maternal otitis media with higher risk of complex defects of middle and external ears (OR with 95% CI: 5.2, 1.6-28.3), however, this association was based on 4 cases only. In conclusion high fever related influenza-common cold with secondary complications may play a role in the origin of IECA, but is preventable with the early and effective antifever treatment of these pregnant women.

The aim of the study was to evaluate clinical, epidemiological and demographic data of patients with syphilis hospitalized at the Department of Dermatovenereology of the General Teaching Hospital in 2009 and to identify the groups at high risk of sexually transmitted diseases. The results were compared with the previous surveys carried out between 1999 and 2005 and also with the data of the National Registry of Venereal Diseases for 2008. A total of 232 patients were hospitalized in 2009 (including 26 women admitted for compulsory retreatment in pregnancy). We noticed a 25% increase in the number of patients in comparison with the year 2008. Of the total number of patients, 206 were patients with newly diagnosed syphilis, of which 153 (74.3%) were men and 53 (25.7%) women. There was 22.3% of patients with primary and 31.6% with secondary syphilis. As in the previous years, heterosexual contact remained the most frequent route of syphilis transmission. However, the number of homosexual and bisexual men increased, amounting to 64.7% of all hospitalized men. Four men were HIV positive. The age distribution did not change; majority of the patients were aged between 30 and 40. The proportion of foreigners also remained unchanged (19.9%); they came mainly from the Slovak Republic (31.1%) and Ukraine (26.7%). The absolute number of reported syphilis cases has been increasing in the Czech Republic since 2006. From the epidemiologic point of view, the increasing incidence of early stages of the disease is alarming. Men prevail over women among the infected persons; the men having sex with men (MSM) has been increasing in the last three years.

Objective: As HIV/AIDS prevalence rises in Eastern Europe, assessment of local epidemics in the bordering Central European region, especially South Eastern Europe, is vital in order to meet treatment and prevention needs. Understanding current medical and social needs and barriers to care experienced by HIV-positive patients in these regions may provide insight into how to best respond to the local epidemics, increase patients' access to treatment, and reduce loss to follow-up. Design: This study assesses the patient characteristics, barriers to care, and current medical and social needs of HIV-positive patients in Albania. Semi-structured interviews were used in this cross-sectional study. Methods: We interviewed 79 of 85 patients (93% response rate) followed at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic, which represented the majority of patients under HIV care in Albania during 2009. Results: The local HIV epidemic seems to be comprised mainly of heterosexual men who have spent an average of 3.6 years abroad. The vast majority of patients under care at UHCT HIV/AIDS Ambulatory Clinic had experienced barriers to care associated with social stigma (97.4%), lack of knowledge of HIV medical care (76.6%), and medical provider's lack of knowledge of HIV (70.9%). Social needs of the patients were also overwhelmingly unmet (90.0-95.7%). Conclusions: In addressing HIV/AIDS in Albania, it will be crucial to educate the healthcare sector in ways to identify and address barriers to care and current medical and social needs of HIV-positive patients.

402 subjects with diabetes mellitus have been vaccinated of the total of 34,000 vaccinees immunized during the study period of 9 and half months. Altogether 229 diabetic patients (56.97%) have been vaccinated against tick-borne encephalitis (TBE) and 74 (18.4%) against viral hepatitis (41 types A+B, 30 type A, 3 type B). The average age in four most commonly administered vaccines (FSME IMMUN 0.5 ML, Twinrix Adult, Typhim Vi, and Havrix 1440) was 65, 52, 56, and 54 years, respectively. Live attenuated vaccines have been given to 6 patients with diabetes (1.49%) - 5 travellers to endemic countries received the yellow fever vaccine Stamaril (1 female, 4 male) and one male patient varicella vaccine Varilrix. Among the least common vaccines in diabetic patients were those against invasive pneumococcal and meningococcal infections. Not a single unexpected side effect has been observed following the vaccination procedure in any diabetic patient. Based on the results of this retrospective study we can conclude that vaccination in diabetic patients is free of any risk - provided that there are no other contraindications, e.g. allergy to vaccine components or severe acute febrile illness. In the case of unstable glycaemia and significantly impaired immune system due to diabetes mellitus, vaccination with live attenuated vaccines should be carefully considered and measured against the risks of exposure to each and every specific infectious agent. There is no reason to be afraid of vaccination in diabetic patients provided that general contraindications are respected. On the contrary, this risk group can benefit from vaccination more remarkably since it may have some life-saving potential.

Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system. The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level.

The improper management of large quantity of chemical waste of a chemical plant caused considerable soil contamination on a temporary hazardous waste disposal site. Initial and action-oriented exposure and health risk assessment was carried out in early 90's. The dominant contaminants were tetrachlorobenzenes (TeCBs), pentachlorobenzene and hexachlorobenzene (HCB). Concentration of TeCBs in top soil layer and vadoze zone exceeded several g/kg. After taking appropriate technical measures quantitative health risk assessment was performed for the target population living in the surrounding settlements. Health risk estimates to HCB ingested or inhaled with suspended dust and soil particulates showed that carcinogenic risk values lower than 10^-6 i.e. below the acceptable risk. For other chlorobenzenes that cause non-cancer toxic effects risk quotients showed marked health hazard inside the dump and small potential risk in vicinity. However, this assessment is based on limited monitoring data, additional information is needed to substantiate this conclusion.

Background: Therapeutic DNA vaccines against oncogenic infection with human papillomavirus type 16 (HPV-16) are mostly targeted against viral oncoproteins E7 and E6. To adapt the E7 oncoprotein for DNA immunization, we have previously reduced its oncogenicity by modification of the Rb-binding site and enhanced immunogenicity of the modified E7GGG gene by its fusion with the 5' terminus of the gene encoding E. coli ß-glucuronidase (GUS) generating E7GGG. GUS. In this study, we attempted to improve immunogenicity of the GUS-based anti-E7 vaccines by increasing the steady-state level of fusion proteins.
Materials and Methods: We fused deletion mutants of E7GGG and codon-optimized E7GGG with the 5' terminus of GUS and unaltered E7GGG with the 3' terminus of GUS. Furthermore, we mutated the initiation codon of the GUS gene in the E7GGG.GUS construct, as GUS alone was produced from this fusion gene.
Results: We have found that only the fusion of E7GGG with the 3' terminus of GUS (GUS.E7GGG) and deletion mutants of E7GGG with the 5' terminus of GUS increased the steady-state level of fusion proteins in transfected human 293T cells. Analysis of immune reactions induced in mice by vaccination via a gene gun showed that the increased steady-state level of fusion proteins resulted in augmented production of E7-specific antibodies, but did not enhance cell-mediated anti-tumor immunity. Finally, we joined the signal sequence of the adenoviral E3 protein with GUS.E7GGG. This modification led to the predominant localization of the fusion protein in the endoplasmic reticulum and enhancement of CD8+ T-cell response while antibody production was reduced.
Conclusions: To conclude, we have found modifications of the E7GGG.GUS fusion gene that augmented either humoral or cellmediated immune responses.

Objective: Through series of multinational collaborative projects WHO has developed a methodology for indicator-based assessment and reporting on environmental health situation and relevant policies in Europe. A significant outcome is the baseline assessment of the children's health and the environment with regards to four regional priority goals of CEHAPE (Children's Environment and Health Action Plan for Europe).
Methods: A set of 26 indicators encompasses children's health and most relevant environmental risks of water-borne diseases and unsafe sanitation, injuries, respiratory health and air quality, hazardous chemicals and radiation. They were selected on the basis of policy relevance and scientific reliability, and the availability and accessibility of necessary data. Analyzed were time and space patterns for each indicator and potential health benefits of interventions. The information provided by each of the indicators, along with its scientific basis and policy context, was presented in the form of standardized "fact sheets", accessible on the web site http://www. enhis.org. The "baseline assessment" integrates the information providing a first evaluation of the status and trends in the first half of the current decade of the priority environmental health (EH) issues specified by the CEHAPE.
Results: Health-related water problems, fatalities from road traffic accidents, unintentional injuries and infant respiratory disease mortality showed a clear West-East European regional gradient. The lack of harmonized water-borne diseases surveillance hampered the assessment of children's health related to water quality indicators. Outdoor air pollution remains a problem and asthma and allergic symptoms tend to increase throughout the WHO European Region. Environmental tobacco smoke continues to be the most significant indoor air health problem and smoking bans in bars and restaurants is still insufficient. Among the current chemical risks in food, heavy metals and persistent organic compounds cause presently concern in Europe. Excessive UV radiation is an important risk factor for severe diseases which is largely preventable by simple measure. For several indicators, in particular those related to hazardous chemicals, only surveys limited to selected parts of country population were available restricting possibility for country-wide assessments. Conclusions: The information on health effects related to the environment, environmental issues affecting children's health, and actions aiming at reduction, or prevention of the health risks enables policy-makers to monitor situation and trends in the countries and evaluate relevant policy effectiveness. Systematic approach to regular indicator reporting can help resolving information and knowledge gaps. Opportunities and challenges, and actions needed to advance the environmental health information system in Central and Eastern Europe will be highlighted. Setting a participatory process involving all relevant parties is essential for system development, strengthening country capacity and information sharing.

Objectives: To determine the proportion of high risk patients followed at a tertiary care lipid clinic who met recommended lipid targets and to identify predictors of reaching goal lipid levels.
Research design and methods: A retrospective cohort study of 502 high risk patients followed between 1983 and 2003. Clinical and demographic data and fasting lipid profiles were extracted from each patient's first two clinic visits as well as the most recent visit.
Results: All patients in this study were at high risk of cardiovascular events due to dyslipidemia. At "Visit 1", only 55 (11.0%) of patients were at target TC/HDL-C < 4.0, and 97 (19.3%) of patients met target LDL-C < 2.5 mmol/l. At "Visit 3", 229 (45.8%) patients reached TC/HDL-C target, and 216 (43.2%) patients were at LDL-C target. The mean change in lipid values between Visit 1 and Visit 3 was significant (p = 0.0002) for LDL-C and (p < 0.0001) for TC/HDL-C. The use of statins, niacin, or salmon oil were all significantly associated with reaching TC/HDL-C target and LDL-C target, as well male gender, diabetes mellitus and peripheral vascular disease were also associated with reaching LDL-C target. Increasing age and lower body mass index were associated with reaching goal TC/HDL-C.
Conclusions: The mean absolute changes in lipid values were significant and median lipid levels approached target levels in patients followed at specialized clinic, however the majority of high risk patients are not meeting goal lipid levels.

The activities of the kraft pulp-mill in Ružomberok have great impact on ambient air quality in the town and the neighboring villages. The malodorous sulfur compounds adversely contribute to the overall emission profile. The reduced sulfur proportion forms the inorganic and organic compounds containing sulfur atoms in their lowest oxidation condition (S^2-). The total sulfur proportion reduced includes hydrogen sulfide, mercaptans, dimethyl sulfide, dimethyl disulfide and other sulfur compounds. Hydrogen sulfide (H₂S) - as mentioned above - is of prime importance. The kraft pulp-mill has measured of hydrogen sulfide contained in ambient air since 2002. The environmental samples were collected in 7 localities in all their selection based on the geographic, climatic and demographic factors. Four exposure localities in the Ružomberok neighborhood, have been defined by the specified criteria. Exposure assessment was made for each exposure locality by determination of the average daily inhalation dose. The average concentration of H₂S reached 5.8 µg.m^-3 in the most polluted locality (Černová, 2003). To complete the health risk assessment, the standard risk characterization procedure was made by the Hazard Quotient (HQ) calculation for hydrogen sulfide exposure. The highest level of HQ, almost 7, was identified in the event of a worst case exposure scenario (using the 95% concentrations), as for exposure group C. Statistically significant decrease of reported H₂S levels was noted during the entire measurement period (-0.25/year, p<0.001).