Fulltext search in archive

Telemedicine, as a health service provided remotely, is increasingly becoming a common part of health care. Telemedicine is defined as "an umbrella term for health activities, services and systems operated remotely through information and communication technologies to promote global health, prevention and health care, as well as education, health management and health research". It also describes telemedicine as "the provision of services where distance is a critical factor, using information and communication technologies to exchange valid information for the diagnosis, treatment and prevention of disease and injury, for research and evaluation, and for the continuing education of healthcare providers to improve the health of individuals and communities". Both definitions imply that two of the hallmarks of telemedicine include the use of communication and information technologies to overcome distance as a critical factor, a factor that is well known to us, not least from the recent months of the COVID-19 pandemic. Distance medicine can thus act as a tool for improving access to health care and also complement health care itself in a very appropriate way.

Objectives: The participation of families in childhood vaccination decreases slightly every year around the world. Parents arrive at a decision that vaccines are not safe for their children due to many sources of misinformation. The aim of this study was to investigate the relationship between vaccine hesitancy, vaccine knowledge status and socio-demographic characteristics of the children's parents. Methods: In this cross-sectional study, 361 parents of children aged 5 years and under, who were admitted to our paediatric outpatient clinic, were included. The parents received scores between 0-20 points according to the correct answers they gave to the questions asked. Results: Although all parents had a positive attitude towards vaccination, some myths, e.g. that vaccination could weaken the child's immune system because it contains heavy metals which could cause infertility and that complementary and alternative medicine could replace vaccination, are thought to be real by 1.7% to 34.6% of the parents. Conclusions: Since the presence of misinformation may lead to vaccine hesitancy and incomplete vaccination, healthcare personnel have important duties and responsibilities for this group.

Objective: Group A beta-haemolytic streptococci (GAS), which are responsible for most cases of acute bacterial tonsillopharyngitis, are transmitted from person to person and may rarely cause foodborne outbreaks. This study aims to report the epidemic caused by GAS in our hospital and to draw attention to the explosive outbreaks of the bacteria. Methods: Acute tonsillopharyngitis was seen in 201 of 450 hospital employees who ate in the hospital cafeteria on 4-5 June 2015. Results: GAS was detected in 106 (68%) of 157 cases and in 40 (63.5%) of 62 throat culture samples. The attack rate was 44.7%. The most suspected source of the outbreak was a food handler who had been showing signs of streptococcal tonsillopharyngitis for six days, and perhaps the food prepared by these staff. Conclusion: It should not be forgotten that GAS can cause explosive outbreaks by infecting food through hand lesions or mouth secretions of food service personnel.

The case of spoilage of flavoured and sweetened soft drink occurred in the Czech Republic in 2019. After drinking it, the consumer was admitted to a hospital with sickness. The spoilage was caused by mould and an odorous substance, 1,3-pentadiene. The mechanism of food spoilage, with the formation of 1,3-pentadiene arising from the decarboxylation of sorbic acid and mould growth, is described. This could be the second case history reported worldwide of an allergic reaction to penicillin explaining how penicillin might get into the beverage. We hypothesise three possible causes of the health problem experienced with allergic reaction to penicillin or other mycotoxin produced by Penicillium mould as the most probable one.

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Objectives: Oral health can affect quality of life in all course of life, which is a key factor of general health. Dental caries, periodontitis and oral cancer are of the highest burden of oral diseases. Rising prevalence of soft drinks and alcoholic beverages consumption due to easy access and socio-demographic altering has increased the concerns on oral health. In this review our purpose was to show effects of the most consumed beverages on oral health in people older than 15 years. Methods: The review was based on papers published in last 10 years, searched with combined key words related to types of drinks and specific oral health problems. We included 4 older studies due to lack of newer studies on subjected topics. Results: Sugar-free soft drinks are found less cariogenic and erosive than regular versions in limited number of studies. Alcohol consumption is shown as one of the risk factors of prevalence and severity of periodontitis and is proven to have synergistic effects along with tobacco on oral cancer risk. Consumption of soft drinks and alcoholic beverages was related with tooth loss whether dental caries or periodontal diseases. Conclusion: There is good evidence for association between soft drinks and oral health problems, but still no clear answer exists about strength of association between sugar-free soft drinks and dental caries. Also the knowledge about influence of alcohol is inadequate. Since consuming style affects erosive potential of drinks manufacturers should be required to add some recommendations on labels about drinking style.

Epidemiological data consistently show sustained upward trend in the incidence of cancer. The International Agency for Research on Cancer (IARC) estimated that in 2018 more than 18 million people were diagnosed with cancer, and in about 9.6 million cases cancer could be the cause of death. At the same time, an increasing percentage of overweight and obesity is observed in both adults and children. According to the World Health Organization (WHO), in 2016 over 1.9 billion (39% of the population) of adults were overweight, of which over 650 million (13%) were obese. Obesity is closely related to the risk of cancer development. Excessive body weight is considered as a second risk factor for the development of specific cancers after smoking. According to IARC data, high BMI index may be the cause of up to half a million cancer cases per year. In addition, overweight and obesity contribute to increased mortality due to malignancies - it is estimated that they are the cause of death in 20% of women and in 14% of men. Data from the American Cancer Society indicate increased mortality due to pancreatic cancer, liver cancer, multiple myeloma, and Hodgkin's lymphoma in connection with the occurrence of excessive body weight. The study tried to confirm the influence of obesity on the risk of cancer. To achieve this, risk factors such as excessive adipose tissue, chronic inflammation, hyperinsulinaemia and hyperglycaemia, sex steroids, and microbiome were taken into account. In addition, the study presents a simple method of estimating the risk quotient of chances of developing malignant tumors in people with excessive body mass and methods of cancer disease prevention. According to the current state of knowledge, the modification of factors significantly affecting the risk of falling ill may contribute to reducing the risk of cancer. In view of the above, the importance of the problem of overweight and obesity in society and their impact on the occurrence of some types of cancer should be emphasized. Thus, the understanding of excessive body weight as a serious health and social problem sets one of the priorities in the area of public health.

Objectives: This article investigates how the numbers of registered addict patients have changed in the last three decades in Hungary and whether the predicted HIV epidemic among intravenous drug users has occurred. Methods: Data were collected from the Annual Reports of the National Bureau of Statistics and National Epidemiological Centre as well as from the medical records of the author. Results: The total number of registered alcoholics decreased by about 75% during the investigated period. This decrease was more pronounced among males than females. After initial increase, the number of registered drug addicts showed stagnation with an about 50% drop-out rate. Fortunately, the anticipated HIV epidemic did not manifest. The negative effect of a poor political action upon the number of client visits could, however, be documented. Conclusion: In conclusion, negative trends are seen in the Hungarian addiction care. Numerous variables may be taken into consideration as affecting factors, but it is not yet clear to what extent these negative factors are responsible for trends. These data, however, warrant further investigations.

Objectives: The aim of the study was to investigate the variation in breast and cervical cancer screening attendance among Czech women by age and in regions in 2009-2017. Methods: The data from the health insurance company that covers around 50% of the Czech population were used to calculate age-specific attendance rates and standardized attendance rates by year and region. Results: In 2017, the attendance of all eligible women was 52% in breast cancer screening and 46% in cervical cancer screening. There were differences in attendance among groups of women. Women aged 45-49 had attendance rates in both screenings around 60%, while 39% of women aged 75-79 attended breast cancer screening, and 23% attended cervical cancer screening. In regions, attendance ranged from 38% to 70% in breast cancer screening and from 32% to 55% in cervical cancer screening. Conclusions: We identified the age-specific differences and regional variation in both breast and cervical cancer screening attendance among Czech women. Those with lower attendance may have a higher risk of dying from breast and cervical cancers. Mitigating this risk should be a priority of public health policies.

Objective: Despite advancing technology, national TB surveillance systems are still inadequate in terms of patient detection around the world. It was aimed to investigate suspicious cases detected by active surveillance method in pathology laboratories and to evaluate the effectiveness of this method in terms of finding new TB cases. Methods: This is a descriptive cross-sectional study. It was administrated in Samsun, Turkey, between January 2012-December 2017. Within the scope of active surveillance, pathology laboratories were regularly visited and reported cases with granulomatous inflammation were assessed. The obtained patient list was compared with the records of the Electronic Tuberculosis Management System (ETMS). Patients who were not included in these records were invited to the dispensary and evaluated for TB. They were also referred to the relevant hospitals for diagnosis if necessary. Frequency values and descriptive statistics were calculated using SPSS method. Results: It was found that 35.6% of 703 patients with the diagnosis of granulomatous inflammation were previously diagnosed, treated or currently undergoing treatment in the ETMS registry. As a result of the assessment of remaining 453 cases, 46 patients (10.1%) were newly diagnosed with TB. Newly diagnosed TB patients were reported, and their treatment started. Conclusion: As a result, active surveillance method conducted in pathology laboratories are used to detect unknown or late reported TB cases and allows to start treatment without further delay.

Objective: Hand hygiene (HH) compliance is associated with effective prevention of health care-associated infections (HAI), the topic being very important due to current COVID-19 pandemic. There is a growing debate about the role of educational institutions in the low HH compliance of health workers. This study aimed to assess HH knowledge, self-assessment and attitudes of medical students in relation to provided educational background. Methods: A cross-sectional survey (mixed methods-approach) combined with the curriculum analysis and questionnaires. Quantitative method: a questionnaire of knowledge of HH issues (QK), and a questionnaire of self-assessment and attitudes (SAQ) towards HH. Qualitative method focused on an analysis of content of the curriculum documents. Results: 250 (KQ) and 238 (SAQ) questionnaires were analysed from students of general medicine (n = 262; average age 22.5 years). Below-average knowledge of HH and a high self-assessment of knowledge and compliance with HH was reported by 72.2% and 76.0% of students, respectively. Significant differences in knowledge and self-assessment of HH were found among study years and gender. The content analysis has revealed gaps in HH-related information in general medicine educational programme. Conclusions: It is highly expected that there might be some association between low HH knowledge level, false self-assessment and educational programme in medical students.

Objectives: There has been insufficient evidence for a quantitative recommendation for dietary cholesterol, therefore, we aim to investigate the optimal cholesterol intake related to a lower all-cause mortality risk. Methods: The National Health and Nutrition Examination Survey (NHANES) is a large population survey to investigate public health in the United States. We analysed data from 1999-2002 linked with mortality data obtained through 2006. Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated to assess risks for all-cause mortality associated with cholesterol intake. Results: A total of 7,728 participants were analysed in the present study, and 519 assumed death events. Compared with the third quartile (216-373 mg/day) of cholesterol intake, the risks of mortality increased in both the first two and the last quartiles (quartile 1: HR 1.53, 95% CI 1.16-2.00; quartile 2: HR 1.22, 95% CI 0.94-1.60; quartile 4: HR 1.39, 95% CI 1.05-1.83). The association between cholesterol intake and the risk of all-cause mortality followed a U-shaped curve, with the cholesterol intake associated with the lowest mortality being 328 mg/day. Conclusions: The present study suggests an optimal cholesterol intake for lowering the all-cause mortality risk.

Objectives: The paper analyses real-world data on cost of treatment in patients after stroke hospitalized in early rehabilitation units within comprehensive stroke centres in the Czech Republic. This is the first study of the kind in the Czech Republic, while such information is extremely rare worldwide. Stroke treatment witnessed a dramatic development in the last years, when the main progress was due to establishment of specialized (comprehensive) stroke units incorporating also early rehabilitation. There is a general agreement among clinicians that early rehabilitation is beneficial for patients after stroke. Methods: Costs of early rehabilitation after stroke were calculated by the micro-costing method alongside a pragmatic study in three Czech hospitals. Patients were transferred to specialized early rehabilitation units usually on 7th to 14th day after stroke onset and received four hours of interprofessional rehabilitation per day. Results: The analysis of data collected during the prospective observational research of 87 patients proved significant differences between patients. The average costs of hospitalization were determined to be CZK 5,104 (EUR 194) per one day of intensive rehabilitation in seriously affected patients early after stroke. These costs differed significantly between hospitals (p-value < 0.001); the structure of direct costs was quite stable, though. About 60% of these costs were due to nursing and overhead, while no more than 15% were consumed by therapists. Conclusions: The treatment of patients after stroke in specialized stroke units proved to be beneficial for the patients increasing the number of those re-integrated in family and community life.

Objectives: The aim of the study was to determine the probable places of coronavirus transmission in association with the work. Methods: The work analysed data from the Information System of Infectious Diseases managed by the Institute of Health Information and Statistics of the Czech Republic in the period March-December 2020. Results: 732,202 COVID-19 cases were officially confirmed, from them 64,587 (9%) represented work-related disease, 184,384 cases (25%) work-related contact, and 483,231 cases (66%) out-of-work contact. There were identified 13 occupations with the highest incidence of COVID-19 in the observed period (42,072 cases), in descending order nurse, paramedic, teacher, machinist, clerk, social worker, physician, worker/agency worker, craftsman, policeman, manager, food worker, and miner; 150 cases of COVID-19 were recognized as an occupational disease in 2020, from them 148 cases in the health and social care economic activity sector. Conclusion: The available data show probable exposures to an infectious agent (without proof of specific contact with the source of the infection), of which at least one third are related to work, so different relevant anti-epidemic measures in the workplace have considerable practical importance for epidemic control.

Objectives: Influenza is a widespread respiratory disease with a potentially risky course. Vaccination is considered the most effective method of prevention. However, only a small portion of the population is vaccinated. Teachers work in a high-risk environment and they have a significant impact on the population through student education. Therefore, the aim of this study was to find out the knowledge and attitudes of pre-service teachers about influenza and vaccination. Methods: A questionnaire survey was conducted to find out what knowledge, attitudes and behaviour pre-service teachers (N = 373) show in relation to influenza and influenza vaccination. It was statistically tested whether there were differences between students with respect to their field of study. Results: The majority of pre-service teachers have a good knowledge of influenza symptoms, however, they often mistaken it for other respiratory diseases. The field of study plays only a partial role in the knowledge. The respondents perceive influenza as an easily spread disease, but they have negative attitudes towards vaccination, and most pre-service teachers think that its disadvantages outweigh the advantages. This was stated primarily by pre-services science teachers. These attitudes are also reflected in the low vaccination rate of the sample (6%). Conclusions: Relatively good knowledge of teachers is not reflected in their attitudes and behaviour. Negative attitudes towards vaccination are most held by pre-service teachers, whose field primarily includes teaching this topic. It can have a significant effect on students' attitudes not only toward influenza vaccines but also to other vaccinations.

Objective: Allergic contact dermatitis (ACD) in the healthcare sector is a major occupational health hazard. There are many reasons for a higher frequency of ACD in healthcare personnel compared to other populations: among others, simultaneous exposure to multiple substances, use of aggressive detergents and wet work. However, studies that systematically correlate skin symptoms with the presence of sensitization investigated through patch tests in specific categories of health workers are very rare and conflicting. Although some studies have reported a correlation between skin disease and night shift, the strength of the evidence is rather limited. The purpose of our study was to investigate by means of patch testing the skin sensitization (SS) to common allergens in the hospital setting in a group of healthcare workers (HCW) reporting symptoms related to dermatitis, according to their job activity and their shift status. Methods: 132 HCWs visiting a health surveillance centre were investigated by means of specific questionnaire for dermatitis, followed by patch test evaluation including 40 haptens of the SIDAPA 2016 series. Results: Skin sensitization was observed in 1/3 of the subjects investigated by patch tests. The nursing job was strongly associated with cutaneous reactivity after controlling for the confounding of gender, age and other factors. Shift work was related to the prevalence of SS. Conclusions: In our study, the nurse's role and shift work were significantly associated with the risk of cutaneous sensitization, in particular for common antigens.

Objectives: Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults. Methods: This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used. Results: The sample's perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables. Conclusions: Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

Objectives: In July 2018, vaccine against meningococcal B infection in Lithuania was added to the national vaccination calendar. However, vaccination rates were low. The aim of the study was to identify parents' attitudes towards meningococcal disease and vaccination. Methods: In the period from February to March 2019, a questionnaire survey was conducted; 483 parents of children aged up to 2 years participated. In the validated questionnaire respondents provided data on their gender, education, age and answered questions that helped to estimate knowledge and attitudes towards meningococcal disease and vaccination. Results: Parents with higher education are more likely to believe that meningococcal infection can be prevented; 316 (65.4%) parents are concerned that their child is at high risk of infection and evaluated the level of anxiety M = 7.39, SD = 2.29 out of 10 points; 309 (64.0%) believe that the vaccine is effective (M = 8.41; SD = 1.15 out of 10 points). One third of parents will not vaccinate their children because they believe that the MenB vaccine is not safe (71.2%); 370 (76.6%) have heard negative information about this vaccine, the majority (83.2%) from the Internet. The negative information received is positively correlated with the belief that the vaccine is not effective (r = 0.18, p = 0.031) and not safe (r = 0.35, p < 0.001); 49.3% of parents report side effects after vaccination; 326 (67.5%) parents believe that they need more evidence-based information on MenB vaccination and 90.8% would like to get it from a healthcare professional. Conclusions: Due to high level of mistrust of vaccines and the lack of evidence-based information, parents decide not to vaccinate their children against meningococcal B infection. There is a great need for parents' education and the dissemination of evidence-based information among them.

Objectives: The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. Methods: Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. Results: The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. Conclusion: 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.

Objectives: Smoking has been extensively investigated as a risk factor for periodontal disease and many studies have confirmed it. The aim of this study was to show data from Croatia on periodontal health among high school students, with the focus on association of tobacco use and oral hygiene habits, and the periodontal parameters. Methods: Pocket probing depth (PPD), bleeding on probing, supragingival calculus, and oral hygiene habits were recorded for each examinee out of 517 high school students. PPD was measured at 4 interproximal sites on all first molars and central incisors (index teeth). Results: There were 34.6% smokers among subjects, who started smoking on average at the age of 14. More than half of the smokers (55.3%) smoked 1-10 cigarettes per day and intensity of smoking increased with age. PPD was significantly greater (p = 0.012) in smokers (1.69 mm) than in non-smokers (1.59 mm). In non-smoking subjects, increased values of PPD were in direct proportion to the reduced frequency of brushing, while there was no difference in smokers. The number of cigarettes smoked and duration of smoking had a great influence on PPD. Smokers had on average more teeth with supragingival calculus than non-smokers, while non-smokers had more bleeding on probing, and the difference was statistically significant (p < 0.001). Conclusions: This study indicated that cigarette smoking was associated with decreased periodontal health even in this young population. Irregular oral hygiene was associated with decreased periodontal health only in non-smokers. Therefore, it should be important to inform young smokers about the negative effects of cigarette smoking on periodontal health, to provide consultations and reinforce smoking prevention measures.

This publication analyses current literary knowledge on selected topics in the fields of oral health and pathology, with a particular emphasis on the potential roles of the oral microbiome and preventative approaches to oral afflictions. An important association with floral dysbiosis has been documented in important oral conditions, sometimes as a predisposing factor and at other times as a result thereof. However, much remains to be elucidated regarding the specific mechanisms at play, as well as their meaning in clinical practice. Continued research into the pathophysiology of certain oral diseases is of particular importance considering how widespread they are. A specific emphasis should be placed on understanding the exact mechanisms through which the microbiota facilitates health, and when disturbed, sickness. And perhaps of most importance is the implementation of knowledge already acquired on disease prevention if the burden of oral diseases worldwide is to decline in the future.

Objective: The main effort of this work was to evaluate the situation of the atmosphere in selected regions of Brno during the years 2009-2013 and to estimate health risks which might come up due to the increased concentrations of airborne particulate matter. Methods: PM₁₀ samples were collected in four areas varying in degree of automobile traffic using automatic and gravimetric sampling methods. PM₁₀ concentrations were assessed using Spearman's rank correlation coefficient. Health risks were estimated based on calculation of relative risks and population for four health endpoints. The selected health outcomes were premature mortality, cardiovascular disease, respiratory disease, and chronic bronchitis. Results: The highest PM₁₀ concentrations were measured in two regions with high traffic loads T1, T2 and background region B2. The values were 34.33 ± 11.52 µg.m^-3 in 2010, 34.87 ± 12.03 µg.m^-3 in 2013 and 34.52 ± 8.81 µg.m^-3 in 2009, respectively. The highest correlation was between T1 and T2 having Spearman's correlation coefficient 0.888 followed by T1-B1 pair with coefficient 0.886. For all health outcomes, the highest health effect of PM (E) was determined for T2 site in 2010 which was 48 ± 14, 49 ± 21, 44 ± 19 and 24 ± 10 for premature mortality, cardiovascular disease, respiratory disease, and chronic bronchitis, respectively. Conclusion: The concentrations are highly correlated, especially in traffic regions. The annual concentrations did not exceed the legislation limit but 24-hours limit was exceeded more than two times in several cases. The highest number of cases with a given health outcome was estimated in traffic regions especially for cardiovascular disease and premature mortality.

Objective: Patients with type 2 diabetes (T2DM) are at increased risk of fractures. The aim of this study is to analyze the prevalence and risk factors of osteoporosis and osteoporosis related fractures in postmenopausal women with T2DM. Methods: A total of 112 postmenopausal women with T2DM and 171 control nondiabetic women received a standardized questionnaire on osteoporosis risk factors, and were evaluated for bone mineral density (BMD, by using a dual energy X-ray absorptiometry), biochemical markers of bone and glucose metabolism, soluble receptor for advanced glycation end products (sRAGE) and its gene polymorphisms (rs1800625 or rs2070600). Results: In T2DM patients the prevalence of osteoporosis was 25% and low trauma vertebral (Vfx) and non-vertebral fractures were found in 8% and 19% women, respectively. When compared between subjects with and without fractures, there were no significant differences in BMD at any site between the groups, except for distal radius, which was significantly lower in T2DM women with Vfx (p<0.05 vs.non-fractured without osteoporosis). We found no associations between bone and glucose metabolism variables, sRAGE and BMD. No significant differences were observed in sRAGE levels according to their rs1800625, rs 2070600 genotype or fracture prevalence. Serum osteocalcin was significantly lower in T2DM women (p<0.01 vs. controls) and in T2DM women with Vfx (p<0.05) vs. non-fractured without osteoporosis. T2DM women with low daily walking activity (< 2 h daily) had significantly higher serum sclerostin levels (p<0.05 vs. those who were walking > 2 h daily). Conclusion: Diabetes-specific parameters as well as RAGE polymorphisms did not associate with BMD or fractures in T2DM postmenopausal women. Lower levels of osteocalcin, namely in those with Vfx and higher sclerostin levels in those with low daily walking activity suggest lower bone remodeling and/or decreased bone quality in T2DM.

Objective: There is recent evidence that poor health literacy (HL) could be implicated in the aetiology of obesity and could be an important reason behind obese people's inability to encounter difficulties in overcoming obesity issues. The current study reviews the recent scientific evidence investigating the possible link between poor HL levels and excess body weight in adults and children. Methods: The authors performed a thorough systematic computer-assisted literature search from 1 January 2005 up to 31 May 2017. Only English original studies in healthy people, investigating the relationship between HL and excess body weight, were included. Results: Twenty-two studies in total were included in this literature review, 17 studies were conducted in adults and 5 in children. In 17 out of 22 studies reviewed, low HL was significantly associated with increased body mass index, overweight and obesity. In case of children and adolescents, the above association seems to be more consistent compared to adults. Conclusion: There is good evidence that low levels of HL are associated with excess body weight, particularly in children. Initiatives to improve health literacy levels could be a useful tool in the management of the obesity epidemic.

Objective: The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions. Methods: A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed. Results: During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%). Conclusions: Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.

The main objective of this study is to describe the most common childhood diseases occurring in the Theresienstadt ghetto during the Second World War as well as applied anti-epidemic measures. A partial objective is to describe medical and nursing care of sick child prisoners. The data was obtained by the method of synthesis of primary and secondary data with the highest importance after adequate external source criticism using selected monographs, memoirs, survivor diaries, Orders of the day by the Council of the Elders and Reports of the Jewish self-government of the Theresienstadt ghetto from 1941 to 1945, the Archives of the Jewish Museum in Prague, the Ghetto Museum, the Museum of the History of Polish Jews in Warsaw, Post Bellum online electronic collection of oral historical interviews, and witness accounts. The validity of the presented conclusions is ensured by comparing data from several sources. The most common infections in Theresienstadt children were enteritis, scarlet fever, infectious jaundice, measles, mumps, rubella, varicella, black cough, pneumonia, otitis media, and typhoid fever. Most of these infections had entirely atypical symptomatology or complications. Children were hospitalized in children's hospitals, in children's rooms of hospitals for adults and infirmaries in children's homes. Albeit diagnostic methods had a high standard, options of treatment were very limited. The most common treatments included bed rest, diet and cold compress. Occasionally, chemotherapeutic agents (e.g. a sulphonamide drug Prontosil) and Aspirin were available. The anti-epidemic measures in the ghetto focused on hygiene, enhancing children's immunity, vaccination and pest control.

Objectives: Mediterranean spotted fever (MSF) is a tick-borne endemic disease caused by Rickettsia conorii conorii and transmitted to humans by the brown dog tick Rhipicephalus sanguineus. It is characterized by fever, maculopapular rash and a tick bite skin lesion "tache noire". The disease affects all age groups and usually has mild to moderate course. It has long been considered a benign infection. However, very severe "malignant" forms with fatal outcome strongly influenced by the patients' age were also observed. We aimed to reveal the features of MSF in children by comparing them with some of the disease patterns in adults. Methods: Our prospective study data are based on the monitoring of all inpatients of the Clinic of Infectious Diseases in Plovdiv City and environs, the largest MSF endemic region in Bulgaria. The total number of patients admitted and treated for MSF over a study period of 10 years is 549, the incidence reaching 9.44/100,000. MSF is confirmed by antibody response to a specific antigen measured by indirect immunofluorescence assay (IFA). IgG ≥ 128 and/or IgM > 64 were considered to be indicative of acute infection. Results: Eighty-five (15.48%) patients were children up to 14 years of age and 464 (84.52%) were aged 15-85 years. The skin lesion "tache noire" was present in 73.68% of children, and in 76.93% of the older age groups; symptoms as anorexia, nausea, vomiting, abdominal pain, and diarrhoea were more frequent in children, till general weakness and malaise was prevalent in adults. Children accounted approximately for 70% of the disease mild forms. No lethality was registered in this age group. Even though there were isolated cases of severe and malignant forms, children did not undergo the fatal complications seen in adults. Conclusion: Knowledge of the peculiarities of MSF in children will contribute to children's health protection, timely diagnose and disease prevention.

Objectives: Acrylamide is a toxic compound that can be found it both occupational and non-occupational environments. This study focuses on its sources and health effects of its exposure. Methods: Adverse effects of acrylamide, especially carcinogenic, genotoxic, and teratogenic were reported in many studies conducted on animals. Neurotoxicity was reported in workers exposed to acrylamide in the occupational environment. Another important source of populations' exposure to acrylamide is their nutrition. Results: This study focuses on humans' exposure to acrylamide from various sources and its harmful effects on their health. Conclusions: Dietary intake of acrylamide, as well as occupational exposure, cigarette smoking, cosmetics usage and other environmental sources could have a significant effect on human health.

Objective: Acrylamide is a toxic compound found in occupational and non-occupational environment. It originates from industrial use, technological processes in construction as well as food production, water purification, and laboratory use. Adverse effects including neurotoxicity, probably carcinogenicity, genotoxicity, teratogenicity, and reproductive toxicity were reported in many studies. Our study is focused on acrylamide content in selected food products in the Czech Republic. Method: In this study, we determined acrylamide content in selected samples of commonly consumed food products (potato chips, biscuits, popcorn, corn flakes, breakfast cereals, and baked muesli). Results: The concentration of acrylamide in most samples of potato chips, biscuits and popcorn exceeded the benchmark limits. The acrylamide content in samples of potato chips from one manufacturer in 4 cases out of 5 analysed samples exceeded benchmark limit. On the other hand, no corn flakes sample acrylamide content from the same manufacture exceeded the benchmark limit. With 20 of all analysed samples exceeding the benchmark levels for acrylamide, it can be concluded that 47.6% of samples did not comply with the benchmark level. Conclusion: Dietary intake of frequently consumed food products with the acrylamide content exceeding the recommended comparative value could have adverse effects on the human health. Our study confirmed high amount of acrylamide in some selected food samples. The reduction of dietary burden with acrylamide is possible by complying with the correct technological principles in food preparation.

Objective: Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre. Methods: This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded. Results: 34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05). Conclusions: The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.