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In this report the authors evaluate epidemiological evidence of thyroid cancer cases in a highly radiated territory in Poland - i.e. in the province of Opole after 1986. The analysis - based on logistic regression modelling of registered thyroid cancer and an ecological covariate (¹³⁷Cs concentration) - shows differences in incidence in six distinguished radiation zones and two equal periods. The results of this study indicate a significant increase in incidence of thyroid cancer in 1995-2002 in males and in females comparing to the years 1987-1994. Moreover, a considerable rise of incidences has been noticed in the elevated isotope's concentration zones in females across the province in the analyzed periods. The data comprises all the thyroid cancer cases registered in Opole province in the years 1987-2002. The data originated from the Provincial Cancer Registry in Opole. The information on ¹³⁷Cs concentrations was derived from the Polish Geological Institute in Warsaw. The computation was performed using WinBUGS software.

The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.

We analyzed the occurrence of healthcare-associated infections (HAI) at intensive care unit of the Department of Anesthesiology and Intensive Medicine of Martin Faculty Hospital in 2008. We performed a retrospective-prospective observation according the protocol of European HELICS (Hospital in Europe Link for Infection Control and Surveillance) system. We found 11 HAI (4.45%) which on average prolonged the length of hospitalization by 6 days. The most frequent localisation of HAI was the respiratory tract. By our own observation we found the same number of HAI cases as it had been reported officially but the observed and reported cases do not match. The surveillance system HELICS uses definitions slightly different from those used in Slovakia. The severity of health status of a patient at admission influences the risk of HAI. We suggest a continuing collaboration on HELICS system with further involvement of all departments of Martin Faculty Hospital and creation of a hospital infection control team. We also suggest an improvement in testing for etiologic agents of HAI and an introduction of methods of molecular epidemiology in diagnostics, as well as quantification of costs related to occurrence of HAI and to assess an implication of automated monitoring system in HAI surveillance.

Varicella is a mandatory reportable disease in Slovenia but it is not notifiable in most European countries. The aim of the study was to explore the completeness of mandatory varicella reporting in Slovenia. Data were extracted from three electronic datasets, including: mandatory notifiable communicable diseases dataset (SURVIVAL), health statistics dataset - consultations in primary care (ZUBSTAT), and health statistics dataset - hospitalizations (BOLOB). Age- and sex-specific reporting rates were compared during the period 1997-2006. During the ten-year period studied 168,089 cases were recorded via ZUBSTAT, and 128,222 cases by SURVIVAL. On average 76.2% (range: 62.9%-94.9%) were notified. In both datasets, the notified incidence of varicella was highest for preschool children, with a downward shift in age at contracting varicella. The percentage of notified cases decreased with increasing age. The number of hospitalized cases was low for BOLOB and SURVIVAL. On average 74% of hospitalized cases were reported. The mandatory notification system in Slovenia provides enough information to survey age/sex-specific varicella trends in the prevaccine era.

Hantaviruses are RNA viruses of the Bunyaviridae family, represented in the Czech Republic by three genospecies: Dobrava-Belgrade, Puumala and Tula. They persist in natural foci of infection. In 2004 to 2009, a local outbreak with 18 reported cases of nephropathia epidemica caused by Puumala hantavirus occurred in the Šumava mountains and foothills and was spacially associated with another outbreak in Lower Bavaria, Germany. In the Jelení locality in the Šumava mountains at 880 m above sea level, we identified a natural focus of infection suspected to be the source of hantavirus infection in forest workers. The focus was characterized geobotanically as a montane mixed forest with the predominance of beeches within the association Dentario enneaphylli-Fagetum, alliance Fagion, sub-alliance Eu-Fagenion, in a cold climate region with a podzolic soil. The biocenoses where hantaviruses are circulating typically show higher microclimate humidity. Their characteristization can be helpful in predicting where hantaviruses are likely to circulate.

Background: Maternal cervical incompetence in pregnancy (CIP) showed an association with a higher rate of preterm births. The objective of this study was to determine the prevalence of CIP in Hungarian pregnant women, to determine the rate of preterm birth, and to check the preventive efficacy of preterm births due to CIP by therapeutic cerclage or bed rest alone. Methods: Analysis of the population-based large data set of 38,151 newborns (without any defects) of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), born during 1980-1996, i.e. 1.8% of Hungarian newborns. Prospective cohort analysis based on medically recorded variables of CIP, birth weight and gestational age. Results: A total of 2,795 (7.33%) newborns born to mothers with CIP. The newborns of mothers with CIP had a shorter gestational age at delivery (39.0 wk) and higher rate of preterm birth (11.1%) than the Hungarian reference sample without CIP (39.4 wk and 9.0%). Of 2,795 pregnant women with CIP 1,112 were treated by cerclage, while 1,683 with bed rest alone. The mean gestational age was shorter both after therapeutic cerclage (39.2 wk) and particularly bed rest alone (38.9 wk). The rate of preterm births was 9.1% and 12.7% after therapeutic cerclage and bed rest alone. Conclusions: CIP is very frequent in Hungary probably due the extremely high number of previous induced abortion performed by dilatation and curettage method. CIP associates with an increased risk for preterm births; however, this increased risk was reduced by bed rest alone and mainly by therapeutic cerclage.

Introduction: Lead (Pb) poisoning at both low and high concentrations adversely affects haematopoietic, vascular, nervous, renal, and reproductive systems. Recent research has indicated that even blood Pb concentrations below 10 μg/dl (0.48 μmol/l) may be associated with negative health outcomes especially in children. Determination of lead in blood, serum/plasma, urine, hair, bone, teeth, nail, milk etc., is used in epidemiological studies. However, not all mentioned indicators equally reflect exposure/dose and internal dose/effects relationship.
Objective: The aim of our research was to review recent literature related with studies of δ-aminolevulinic acid dehydrathase, and to evaluate whether it could be used as a biomarker of low-level lead exposure.
Materials and methods: We searched PubMed/MEDLINE and Google Scholar for relevant publications using the headings "aminolevulinic acid dehydrathase", "ALAD AND lead". The headings matched 5330 hits for "ALAD", and 2270 hits "ALAD AND lead", dated from the year 1986. We selected 70 articles based on the selection criterions and keywords presented below.
Results and discussion: One of the primary detectable parameters of lead exposure is inhibition of haeme synthesis and the decrease of the δ-aminolevulinic acid dehydrathase (ALAD) activity in erythrocytes. Lead inhibits three enzymes in the haeme biosynthesis pathway - ALAD, coproporphyrinogen oxidase, and ferrochelatase - but its effects on ALAD are most profound. At the molecular level, lead displaces a zinc ion at the metal binding site, producing inhibition through a change in the enzyme's quaternary structure. The ALAD inhibition results at blood lead levels less than 10 μg/dl while there are indications that ALAD activity is not proper measure of lead exposure at high (>50 μg/dl) blood lead levels. The differences in susceptibility to lead toxicity could be explained by ALAD G177C polymorphism, which yields two co-dominant alleles, ALAD-1 and ALAD-2. The rarer ALAD-2 allele, predominant among Caucasians, has been associated with high blood lead levels and has been thought to increase the risk of lead toxicity by generating a protein that binds lead more tightly than the ALAD-1 protein. Studies also imply that carriers of the ALAD-2 allele who are exposed to lead might then retain it in their blood and tissues longer, increasing the chance of an adverse effect due to inhibition of ALAD and consequent build-up of δ-aminolevulinic acid (ALA) or perhaps due to lead itself. Conclusions: It is suggested that the critical dose of blood lead, causing the increased levels of ALA in plasma and urine is below 10 μg/dl. The degree of erythrocyte ALAD inhibition has been used clinically to gauge the degree of lead poisoning. Thus, the ALAD activity may be used as one of the earliest and sensitive diagnostic biomarkers of low-level lead exposure. Moreover, it is essential to take into account an ALAD genotype when studying lead kinetics and adverse health effects.

The aim of this study is to provide an easy tool to identify patients with a high cardiovascular risk, especially those qualifying for lipid-lowering treatment. The decision to treat with lipid-lowering drugs was assessed with five new risk algorithms. The Five Risk algorithm (5R) takes into account male gender, high systolic blood pressure, high total cholesterol, smoking and high blood sugar as independent risk factors. Patients with three independent risk factors qualify for lipid-lowering treatment. Compared to the Framingham Risk Score, the 5R has a Kappa coefficient of 0.62. Compared to the SCORE, the Six Risk algorithm (6RDF) has a Kappa coefficient of 0.70. The 6RDF uses only four independent risk factors (male gender, high systolic blood pressure, high total cholesterol and smoking) but having diabetes or a family history of premature coronary heart disease are exclusion criteria for which treatment with lipid-lowering drugs is always indicated.

The aim of the study was to analyse the self-reported use of health services among the older Estonian population, to explain the predictors of health care utilisation and to study access to health services in comparison with other population groups. In November 2005, a randomly sampled Estonian residents aged 15-64 (n=1264) and 65-74 (n=182) was personally interviewed using structured questionnaires. Of the respondents aged 65-74, 81% reported having visited a general practitioner (GP) or specialist during the previous 12 months. Compared to younger people they used health services more often, except dental care. No significant differences were found in comparison with the waiting times to see the general practitioner or specialist between the younger and older population groups. Compared to the rest of the population people aged 65-74 were more satisfied with their access to health services. The probability of visiting a GP was higher for those respondents who had health problems and lived in rural areas. The presence of chronic illness also had an effect on the use of specialist services and ambulance services. Higher education, living in an urban area and having a family member with a chronic illness predicted the use of ambulance services as well. Younger age, higher income and higher education were predictors of the use of dental services. The availability of and access to health services for older people in Estonia are comparable with other groups of the population.

Background: Ukraine has the highest rate of HIV infection in Europe, with an estimated adult prevalence of 1.6 percent. The epidemic in Ukraine remains largely driven by injection drug use, and women of reproductive age are being increasingly affected. Prior research has highlighted the need to improve the quality of services for prevention of mother-to-child transmission (PMTCT) and to address other issues related to HIV counseling, testing, and care, especially in the context of antenatal and obstetric services.
Methods: From 2004 to 2007, PATH led a collaborative effort to improve the quality of PMTCT services in Ukraine. Initial assessments included focus groups with Ukrainian women and review of existing educational materials. Interventions focused on training providers to improve skills in communication and referral to community-based support; they also addressed the underlying issue of stigma.
Results: Observational data demonstrated that providers who participated in the training intervention delivered PMTCT counseling of a consistently higher quality than did providers who did not undergo training. Exit interviews with clients confirmed these findings.
Conclusions: An intervention focused on strengthening voluntary counseling and testing for HIV, forging partnerships with local organizations, and undoing HIV-related stigma can help to improve access to and quality of PMTCT services in antenatal care clinics.

Introduction: HIV infection is the major public health, social and economic problem in Georgia. Although the HIV epidemic is in its nascent phase in the country, the potential risk for development of a wide spread HIV epidemic is very high.
The aim of this study is to evaluate the effectiveness of ARV treatment principles in Georgia, including treatment and monitoring methods. Materials and Methods: The study included 985 people living with HIV/AIDS in Georgia registered at Infectious Disease, AIDS and Clinical Immunology Research Center since 2004. To ensure universal access to ARV therapy all HIV/AIDS individuals included in the study were investigated by special algorithm, all identified patients requiring ARV therapy were offered treatment and monitored during therapy on treatment effectiveness and side effects.
HIV-1 RNA in plasma was measured by quantitative Polymerase Chain Reaction. For determination of percentages and absolute count of Tlymphocyte subpopulations single-platform immunophenotyping technique using the Becton-Dickinson FACSCalibur flow cytometer was applied. For resistance testing TRUGENE HIV-1 Genotyping Kit with the OpenGene DNA Sequencing System (Siemens) was used. Reasons of treatment failure and mortality rate among ARV treated patients were analyzed.
Results and Conclusions: Treatment was offered to 398 HIV/AIDS patients. 397 patients started treatment, 1 patient refused. Out of 397 HIV/AIDS patients treated 21 patients discontinued, 54 patients died and 322 patients are currently on ARV treatment. Out of the treated patients 281 adults and 11 children are receiving first-line treatment, 27 adults and 2 children are on second-line treatment and 1 adult is receiving salvage regimen. Treatment failure was defined in 52 cases. Among them immunological failure was observed in 7 cases, clinical failure in 1 case and virologic failure in 44 cases. Prevalence of drug resistance among virologic failure cases accounted for 73% and inadequate adherence for 27% cases. Out of drug resistance cases 3% has three-class drug resistance, 84% - two-class drug resistance and 13% found to be resistant to one class. In ARV naive patients the prevalence of drug resistance to any class was 4.33%. The majority of death cases among ARV treated patients was due to non-AIDS related or incurable conditions, while deaths due to AIDS related conditions were mainly associated with delayed referral of patients in already advanced stage of disease. It's worth to mention that the highest number of death cases was due to liver failure in HIV/HCV and/or HBV co-infected patients.

This paper seeks to outline the challenges of tobacco consumption control in the transitional economy of Croatia. It focuses on issues of taxation, high unemployment, and smuggling while attempting to meet European Union (EU) accession 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 Croatia has made good progress in adopting legislation, it needs to strengthen its efforts both in terms of enforcement and increased taxation of cigarettes.

The aging of our population represents a most significant demographic change. It represents important challenges and consequences for the nation's economic, social, and health institutions and for the health and well-being of older persons and their families.
Old people over 60 are now the most rapidly growing segment of the population and represent 20% of all Slovak inhabitants. Because of the high prevalence of morbidity and disability among the elderly they are the most important consumers of health care and social care services, both extramural and intramural.
Long-term care is a relatively closed system of health care and social care services. Initially, long-term care policies were formulated as a response to ageing of the population, which brought about growing needs of elderly people for social care and health care, and was associated with relatively rapid increases of necessary costs.
All industrial countries are facing similar problems when it comes to the integration of long-term care. In developed countries, current long-term care focuses on all age groups in need of assistance and support from others due to the limitations caused by their state of health. Long-term care within the public services system does not exist in Slovakia.

The article will briefly explain the processes of organized screening in the NHS Cervical Screening Programme (NHSCP). Quality control is well established and monitored by regional quality assurance reference centres. The final outcome of screening is also monitored by national cervical cancer mortality and incidence rates: data will be presented for rates of in situ and invasive cervical carcinoma before and after the introduction of organized screening. The NHSCSP is using the introduction of liquid-based cytology as a platform for modernization, which is planned to include high-risk human papillomavirus (HR HPV) testing for low-grade cytology triage as well as a test of cure after treatment. Trials of computer-assisted screening are also in progress. High standards of quality control will be needed in the era of vaccination, when prevalence of preinvasive and invasive cervical cancer will decline. The NHSCSP is well placed to take on these challenges, if necessary by introducing primary HR HPV testing so that cytology screening can be concentrated on women who are genuinely at risk.

The Albania SimSmoke simulation model is used to examine the effects of tobacco control policies. The model is used to consider the projected trends in smoking prevalence and associated smoking-attributable deaths in the absence of new policies, and then to examine the effect of new policies that are consistent with the Framework Convention for Tobacco Control (FCTC) on these outcomes.
The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases. A comprehensive strategy to further reduce smoking rates should include a media campaign complete with programs to publicize and enforce clean air laws, a comprehensive cessation treatment program, strong health warnings, advertising bans, and youth access laws.
Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps to identify important information needed for both modeling and policymaking. The effectiveness of future tobacco control policy will require proper surveillance and evaluation schemes for Albania.

EuroSIDA is a pan-European observational study that follows 14,265 HIV-infected patients from 31 European countries, Israel and Argentina, of which 2,560 are patients from eastern Europe (EE). The study group has performed several analyses addressing regional differences in the HIV-epidemic across Europe, where all countries were divided into five regions: south, west central, north, east central Europe and EE. Significant regional differences in patients' characteristics and pattern of AIDS diagnoses were documented. More patients from EE were diagnosed with tuberculosis compared to other regions. Significantly fewer HIV-infected patients in EE, who fulfilled the criteria for starting combination antiretroviral therapy (cART), actually received cART as compared with other regions of Europe. Those, receiving cART in EE had a lower initial virologic response rate irrespectively of the regimen used, although it has improved within years. Besides, treatment failure was more common in this region. Thus, improvements in the clinical management of HIV patients in EE are urgently needed. Strategies include creating scientific collaborations for HIV clinicians as well as teaching clinicians about the most advanced HIV management at clinically oriented courses held in eastern Europe.

Background: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay.
Aims: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. Design: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child's parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification.
Results: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value=0.015) which was due to lower dental caries levels in children with non-deprived social background.
Conclusions: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.

The authors present a retrospective analysis of community-acquired and hospital-acquired rotaviral gastroenteritis (RVGE) cases in a 5 years period 2001-2005 and prospective analysis in 2006 in the referral area in a population of 7,000 children under 5 years of age.
Out of 228 patients with RVGE, nosocomial RVGE accounted for 27.75% of the cases. Children with nosocomial RVGE were in average 9.8 months younger compared to patients with community-acquired RVGE. Nosocomial cases were also characterised by the need for longer stay in intensive care, overall longer hospital stay, longer duration of the illness and by lower age of the patients.
The wider implementation of vaccination in the youngest members of the population would be likely to have a significant influence on the occurrence of not only community-acquired but also hospital-acquired RVGE.

Objectives: Analysis of participation in drug costs by seniors in the Czech Republic in connection with seniors' access to pharmacotherapy. Materials and methods: Quota-sampled guided interview with 450 respondents visiting pharmacy; ratio of men and women approximately 1:2; age over 60 years; 3 regions of the Czech Republic.
Results: Respondent's income was retirement pension in 80 %. More than 55% of respondents did not reach the official state average. Respondents used altogether 1,650 medicines on physician's prescription in the last four weeks. Overall co-payment for medicines was 38,778 CZK, i.e. 86 CZK per patient. Only 27% of respondents used fully reimbursed products. Respondents used together 273 OTC drugs (over-the-counter drugs, e.g. non prescription drugs) in value of 16,540 CZK, i.e. 37 CZK per patient. Average respondent spent on medicines 123 CZK in the last four weeks, i.e. 1.5% of the official state average income. There were respondents, about 10%, searching for the level of co-payment in several pharmacies and more than 8% of respondents had to refuse dispensation of medicines due to co-payment.
Conclusions: Our study demonstrates that there are patients who may fail to gain access to medication due to co-payment in the Czech Republic. The financial participation in health care costs is generally low in the Czech Republic (8.8% of total health expenditures) but there were differences in co-payment levels in patients ranging from 1 CZK to thousands CZK.
In our opinion problem might be in the absence of any instrument limiting the highest individual participation as it is for example in 12-month period in Sweden. In our study co-payments were lower in smaller communities that may be due to better communication between physicians and patients or physicians and pharmacists. We found a critical ethical problem in different levels of co-payment of concrete product.

Background: The reliability of retrospective maternal self-reported information regarding smoking and alcohol drinking during pregnancy seemed necessary to be checked.
Methods: Two groups of congenital abnormalities were selected for the study from the population based Hungarian Congenital Abnormality Registry. The prevalence of smoking and drinking during the study pregnancy was measured in the mothers of 81 cases affected with isolated orofacial cleft and 537 cases with congenital limb deficiencies, and in their matched control pairs without any defect by maternal self-reported retrospective information through a mailed structured questionnaire. In the second step the latter data were checked by an independent personal interview of fathers and other family members at the home visit or in our department using the same structured questionnaire.
Results: The family consensus indicated the low reliability of retrospective maternal self-reported information concerning smoking in the mothers of cases but not in mothers of controls. However, the comparison of retrospective maternal self-reported data and information of close relatives indicated a reported bias concerning the drinking of alcohol beverages during pregnancy in both controls and cases.
Conclusions: Since retrospective maternal self-reported data had low reliability, therefore, data of smoking and alcohol drinking were not collected for the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996.

Although attracting rapidly increasing attention from the public, the health impact of environmental exposures related to the operation of waste dumping sites is a relatively new issue in Poland. However, the problem cannot be neglected in light of the fact that environmental impact assessment in selected sites revealed the lack of sufficient documentation concerning quantity and quality of dumped materials and poor technological management of the sites. The paper describes the results of health survey performed in a vicinity of a country's largest municipal waste site. Although the study came across methodological obstacles involving low participation and difficult to estimate representativeness of the examined group its findings obtained in 393 adults and 188 children and the results of internal comparisons revealed some interesting observations. Three "exposure-classification" variables were used in data analysis (geographical location, distance, "waste traffic" intensity) and health status was examined by means of self- and physician-administered questionnaire, physical examination and routine laboratory analyses. Relationship, although weak, of subjective symptoms and objective findings with the place of residence vis-a-vis the waste site location suggests that potential health effects of waste site-related environmental exposures might include psychological problems, digestive tract disorders and respiratory disorders as well as allergic symptoms. An intriguing observation concerning pregnancy-related health outcomes was made. The exact role of environmental determinants in this respect remains unclear and should be addressed by specific environmental epidemiological and toxicological studies. The findings as well as subjects' concern about health consequences of exposures to waste-related pollution (paralleled by subjective perception of impaired health) justify further investigations and public health initiatives including environmental impact assessment and health monitoring activities targeting populations living in a vicinity of waste sites in Poland.

Aims: To use the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) for the evaluation of birth outcomes beyond congenital abnormalities and to show as example the study of 49 antimicrobial drugs used in Hungary for the reduction of preterm births.
Methods: The population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996, included 38,151 newborn infants without birth defects and this sample represented 1.8% of Hungarian births. Medically recorded gestational age at delivery and birthweight, in addition the rate of preterm births and low birthweight newborns born to mothers with or without different antimicrobial drugs used at least by ten pregnant women were analysed.
Results: Of 49 antimicrobial drugs, two: ampicillin (adjusted POR with 95% CI: 0.8, 0.7-0.9) and clotrimazole (0.8, 0.7-0.9) showed a preterm birth preventive effect. This preterm preventive effect was found mainly after the use of ampicillin and clotrimazole during the first trimester of pregnancy.
Conclusions: Ampicillin and clotrimazole may be effective for the reduction of preterm births due to infectious diseases of pregnant women in general but particularly caused by genital infections. However, the limitation of the data set did not allow the appropriate evaluation of some antimicrobial drugs (e.g. clindamycin).

Various foreign bodies (FB) may be ingested. Most of them harmlessly pass through the anus but sharp or pointed ones are likely to cause complications. Although FB's ingestion is commonly seen by the emergency room personnel, a case of an ingested tongue-ring in the stomach of a female adolescent has not been reported. A 16-year-old female was referred to us for swallowing a tongue-ring while eating, a day after she had swallowed its clip. After finishing her meal, she had replaced the ingested tongue-ring with a similar one! She had a history of accidental swollowing the clip during breakfast a day before as well. She had no history of mental illness, alcohol or drug abuse. An abdominal X-ray confirmed their presence in the gastrointestinal tract. On endoscopy, an intact esophagus' mucosa, a stomach filled with food, her tongue-ring in its greater curvature and a patulous pyloric channel were observed. She was turned in the right lateral position and small amounts of water were carefully used in order to shift the food residues to the antrum. The slippery object was grasped by a biopsy forceps and it was pulled out gently. The procedure was uneventful and she was discharged home on the same day. Our case of a tongue-ring ingested by an adolescent demonstrates a troublesome and possibly dangerous consequence of certain fashion accessories' easy adoption especially by younger subjects. It does not only send a social message, but it also might represent the first example of a potentially emerging medical condition.

This review article describes different forms of tobacco usage and its direct relationship with the prevalence of dental caries. Smoking along with co-existing factors like old age, bad oral hygiene habits, food habits, limited preventive dental visits and over all health standards, can be associated with high caries incidence. However, a direct etiological relationship is lacking. Environmental tobacco smoke (ETS) causes dental caries in children but no studies have been reported in adults. Existing findings are not sufficient and conclusive enough to confirm that ETS causes dental caries. Oral use of smokeless tobacco (ST), predominantly tobacco chewing, is presumably a positive contributing factor to higher incidence of dental caries. Unfortunately, published studies are not converging towards one single factor through which tobacco usage can have direct relationship to dental caries.

Objectives: The main objective of ERFORT Study is to investigate cardiovascular risk factors, life-style related factors and psychosocial factors with regard to total and cause-specific mortality and morbidity. This paper describes the study design, frequency data on cardiovascular and psychosocial factors at baseline survey, and findings of three 5 year follow-up medical examinations. Life status was followed for 30 years. Methods: The Erfurt Male Cohort Study (ERFORT Study) is a population-based prospective cohort study and has its origin in the WHO initiated feasibility study to acquire experience in multi-factorial intervention programs. The baseline survey in 1973-75 examined a random populationbased sample of 1,160 males aged 35-61 years (brutto response rate 74.6 %) from the city of Erfurt, East Germany.
Results: Standardized and mostly validated methods were applied for a collection of data on cardiovascular risk factors, lifestyle-related and psychosocial factors, blood tests and ECG. Three consecutive follow-up examinations yielded datasets of 907, 740 and 609 subjects' re-examination in 1978-79, 1983-85 and 1988-90. Cardiovascular diseases such as myocardial infarction, angina pectoris, and claudication intermittent approximately doubled within a 15-year follow-up. Prevalence of diabetes strongly increases from 2.8 % at baseline to 12.0 % at the 15-years follow up. High blood pressure (≥160/95 mm Hg) only slightly increased, whereas the antihypertensive treatment increased from 8.7% to 33.6%. Conclusions: This data set of a German cohort followed for several decades is an outstanding database to answer questions about long-term associations between biological and psychosocial factors and mortality in men.