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Objectives: The modern rise of vaccine rejection in society can alter the current progress that has been made towards the control and prevention of certain diseases, possibly even resulting in epidemics involving these preventable diseases. The aim of this study is to analyse the knowledge, attitude and behaviours of parents in Malatya city who rejected childhood vaccines. Methods: This descriptive, cross-sectional study was conducted between September-November 2019. The study includes parents who rejected vaccines and are registered in the family medicine clinics of Malatya city - total of 453 participants. The objective was to include all parents and avoid a sampling procedure. However, only 151 (33%) parents agreed to participate. These parents who rejected vaccines were individually contacted by phone. Descriptive data was represented by number (n) and percentage (%). The chi-square test was utilized in the statistical analysis of data and p < 0.05 was considered significant in all evaluations. Results: Mothers in the study group had a mean age of 26.07 ± 3.64, while the fathers were on average 30.03 ± 4.59 years of age; 98% of parents were aware of the health risks that vaccine rejection presented; 93% of parents were not satisfied with the explanation, insight, and advice that the healthcare personnel provided regarding vaccines. All parents of the study group stated the following: vaccines should not be administered because other children in their close environment acquired a disease as a result of vaccination, vaccines can harm the immune system of children - not yet fully developed, vaccines are unsafe and endanger the health of children. Conclusions: It can be said that parents who have obtained a lot of false information possess altered decisions and views on vaccinations, to the point where they accept the risks presented by preventable diseases. In addition, individuals lose trust following negative experiences with vaccination.

Objectives: Potential effect of three environmental variables (population density of rodents, global weather in the form of the North Atlantic Oscillation (NAO) index, and acorn crop) on human morbidity rate of three zoonoses: tick-borne encephalitis (TBE), leptospirosis and tularaemia were analysed in the Czech Republic for the period 1970-1990. Methods: The Pearson's correlation analysis was used. Results: The correlation analysis revealed that the significant factor for explaining annual morbidity rates of these zoonoses was the abundance of common voles (Microtus arvalis) in the current year (for leptospirosis) or in the previous calendar year (for TBE and tularaemia). Conclusions: The two other environmental variables tested (NAO index and acorn production) do not seem to play a significant role in these zoonoses in Central Europe.

Objectives: Virtually no previous research assessed physical activity (PA) of university students in Finland, and their associations with depressive symptoms, whilst simultaneously controlling for potential confounders. Methods: Students at the University of Turku (1,177) completed an online health and wellbeing questionnaire that assessed depressive symptoms (22 items), as well as their achievement of the guidelines of four forms of low, moderate, vigorous, and muscle strengthening PA (LPA, MPA, VPA, MSPA, respectively). We explored the associations of depressive symptoms with these PA forms, accounting for socio-demographic and health confounders (age, gender, year of study, marital status, accommodation during semesters, self-rated health). Results: Achievement of PA guidelines was generally low for these young adult Finnish undergraduates. Bivariate relationships (no controlling for confounders) between depressive symptoms and four forms of PA guidelines achievement showed that in males, good/very good/excellent self-rated health, and achievement of the MSPA guidelines were significantly negatively associated with depressive symptoms. Conversely, low PA was significantly positively associated with depressive symptoms. Multiple regression (controlling for confounders) showed that achievement of the MSPA guidelines was independently significantly negatively associated with depressive symptoms; and whilst achievement of the MPA and VPA guidelines was negatively associated with depressive symptoms, the relationships did not reach statistical significance. Likewise, low PA was positively associated with depressive symptoms, but the relationships were again not statistically significant. Conclusion: Universities would benefit from multipronged strategies and approaches employing effective interventions aimed at improving students' general awareness of their health and promoting more physically active lifestyles among students.

Objectives: Suicides of hospitalized patients present rare but very serious adverse events in healthcare settings. The aim of this article is to describe and analyse the facilities and material equipment of acute psychiatric settings in the Czech Republic and contrast these with recommendations for effective prevention of suicidal behaviour. Since there are currently no universally accepted protocols for risk assessment and prevention of suicides in hospital settings in the Czech Republic, these recommendations draw on international guidelines. Based on the outcomes of our study we provide recommendations for risk management and effective prevention of suicidal behaviour of patients hospitalized in acute care settings. Methods: In order to describe and analyse the environment of acute psychiatric wards in the Czech Republic we have developed a questionnaire based on international recommendations for risk management and prevention of suicidal behaviour. We also collected data on the prevalence of attempted and completed suicides and their respective methods in these hospitals. Results: We have established that acute psychiatric wards in the Czech Republic operate within insufficient safety regimes, especially with respect to the prevention of suicide by hanging and the accessibility of objects for cutting. Our findings demonstrate that only 75% of the wards are equipped with safety glass, and only 50% of the wards with safety mirrors. Only just over 40% of hospitals have safety door handles and shower heads. Conclusion: While it is impossible to entirely eliminate the risk of suicidal behaviour it is possible to manage it. The risk reduction is attainable by providing a safe-proofed environment and minimizing opportunities of suicide attempts by hanging and cutting. In order to effectively prevent suicides, it is essential to increase the awareness of the possibilities of safe proofing of the environment as well as standardization of risk assessment of potential suicidal behaviour of patients.

Objectives: The eating habits of most Lithuanian people do not adhere to the recommendations for a healthy diet. If children and adolescents were provided with the relevant information, it would not only improve their nutritional knowledge, but also their eating habits in adulthood and the subsequent health of their children. The objective of this study was to determine the need for information on nutrition among Lithuanian adolescents, the current knowledge of adults regarding recommendations for the consumption of various food groups, and the factors that influence both the need for information and the current knowledge. Methods: Two cross-sectional studies were conducted, consisting of 3,574 adolescents aged 14-18 years and 1,007 adults aged 18-75 years. Logistic regression models with confidence intervals of 95% were used to determine the influence of various socio-demographic factors on the adolescent need for information on nutrition and the adult knowledge of nutrition. Results: A total of 66.7% of adolescents stated that they need information regarding nutrition, whereas 29.8% indicated that they lack such information. Significantly more girls than boys, and more students from schools in urban areas than students from schools in rural areas, expressed their need for information on nutrition. Lithuanian adults lacked knowledge of recommendations for the consumption of various food groups. Women and respondents with higher education degrees were found to have more knowledge on recommendations of the consumption of various food groups compared to men and respondents of other levels of education respectively. Conclusions: The results of this study demonstrate that the required information on nutrition must be continuously provided via various channels to both adolescents and adults, and socio-demographic factors must be taken into account when planning public health intervention measures.

The dramatic progress in tumour biology and immunology in the past several years has opened new avenues for the treatment and prevention of cancer. One of the great contributions of the immunotherapeutic approaches is an increasing understanding of the immunology of cancer, which is, gradually creating conditions for the development of prophylactic anti-cancer vaccines. Efficient vaccines have been developed and employed for the prophylaxis of two frequent cancers of viral origin, namely cervical cancer and liver cancer. The new knowledge on the interactions between the immune system and the malignant tumors seems to provide means for the development of prophylactic vaccines against cancers developing due to the mutations in the proto-oncogenes converting their products into oncoproteins. According to the present estimates, these cancers form a great majority of human malignancies. Recent evidence has indicated that the immune system recognizes such mutated proteins, and that the development of cancer is due to the failure of the immune system to eliminate neoplastic cells. Followingly, it can be expected that inducing immunity against the mutated epitopes will increase the capacity of the body to deal with the initiated precancerous cells. In the present paper this hypothesis is primarily discussed in the relationship with colorectal cancer (CRC), which seems to be a well-fitting candidate for prophylactic vaccination. CRC is the third most frequent malignancy and the fourth most common cause of cancer mortality. Mutations of two proto-oncogenes, namely RAS and RAF, are involved in the majority of CRC cases and, in addition, they are shared with other human malignancies. Therefore, the strategy to be used for prophylaxis of CRC is discussed together with several other frequent human cancers, namely lung cancer, pancreatic duct cancer and melanoma. The prophylactic vaccines proposed are aimed at the reduction of the incidence of these and, to a lesser extent, some other cancers.

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 aim of the study was to determine the trend and methods of violent deaths (suicide and homicide) in adolescents aged 15-19 years in Serbia. Methods: Mortality database was drawn from the Statistical Office of Serbia from the 1997-2019 period. To calculate the annual percentage change (APC) of mortality rate (MR) with corresponding 95% confidence interval we used join point regression analysis. Statistical analyses were also performed using the chi-square test and Spearman's rho correlation. Results: The average suicide rate was 3.65 per 100,000 and homicide rate was 1.36 per 100,000 adolescents. The boys to girls ratio was 4.2 for suicides and 2.7 for homicides. Among girls, suicide rate significantly decreased (APC -20.7%; 95% CI -32.5 to -6.8) and homicide rate insignificantly decreased (APC -19.3%; 95% CI -37.8 to 5.1). Among boys, suicide rate significantly decreased (APC -4.6%; 95% CI -7.0 to -2.0) as well as homicide rate (APC -7.7%; 95% CI -11.5 to -4.3). The most common method of suicide was hanging (195, 44.3%) and nearly one third (198, 32.6%) of violent deaths were caused by firearms. Significantly negative correlation was observed between the Human Development Index (HDI), gross domestic product (GDP) per capita and MR due to suicides and homicides among both genders (p < 0.05). Conclusions: Increase of GDP and HDI, national preventive intervention and strict application of the provisions of the law regarding the possession and storage of weapons must be implemented in order to continue reducing violent deaths among adolescents.

Objectives: We examined the association between exclusive breastfeeding, early introduction of feeding formula, early weaning, and asthma in children aged six months to five years in a sample of non-institutionalized US children using a propensity score approach. Methods: Our study used data from the National Survey of Children's Health (2012-2018) of 3,820 children with physician-diagnosed asthma aged 6 months to 5 years. Propensity score matching (PSM) was applied to control selection bias with age, sex, race, birth weight, Federal Poverty Level, parent's education, and parent smoking history used as covariates in PSM. The total number in the matched sample was 6,904 (3,452 non-asthmatics; 3,452 asthmatics). Matched and unmatched samples were analysed using the χ² test and multiple logistic regression. Results: Exclusive breastfeeding was protective against asthma in the pre-matching (AOR 0.72; 95% CI: 0.54-0.97; p = 0.03) and post-matching (AOR 0.66; 95% CI: 0.55-0.81; p < 0.001) samples. Formula feeding before 6 months was associated with asthma in unmatched (AOR 1.38; 95% CI: 1.15-1.66; p < 0.001) and matched (AOR 1.31; 95% CI: 1.16-1.47; p < 0.001) sample. Early weaning before 6 months was associated with asthma in unmatched (AOR 1.62; 95% CI: 1.35-1.54; p < 0.001) and matched sample (AOR 1.37; 95% CI: 1.23-1.54; p < 0.001). Conclusion: Public health systems should continue to recommend the implementation of the World Health Organization exclusive breastfeeding guideline in developed countries. Asthma interventions in children under two years should continue to emphasize exclusive breastfeeding to reduce the incidence of infant asthma.

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.

Background and Aim: According to the World Health Organization (WHO) more than 2 million premature deaths and 7 million of total deaths each year can be attributed to the effects of air pollution. The contribution of air pollution to the health status of population is estimated to be about 20%. Health is largely determined by factors outside the reach of healthcare sector, including low income, unemployment, poor environment, poor education, and substandard housing. The aim of the paper was to review a current knowledge of relationships among air pollution, socioeconomic health inequalities, socio-spatial differentiation, and environmental inequity. The relationships were demonstrated on an example of the Ostrava region. Also basic approaches to health valuation were reviewed. Results: Social differences are reasons both for health inequalities and spatial patterns of unprivileged area housing. In urban environments with poor air quality there is also a large concentration of low income residents. Less affluent population groups are more often affected by inadequate housing conditions including second-hand smoking and higher environmental burden in their residential neighbourhoods. Environmental injustice is highly correlated with other factors that link poverty with poor health, including inadequate access to medical and preventive care, lack of availability of healthful food, lack of safe play spaces for children, absence of good jobs, crime, and violence. Conclusions: The theoretical background and also results of the studies brought evidence that population health is affected by both socioeconomic and environmental inequalities. Air pollution is unevenly distributed in Ostrava and is related to distribution of socially disadvantaged environment and social exclusion as well.

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

Aim: Poverty and social exclusion is measured through different criteria and one of them is the health sector. The relationship between Roma population and the health sector is on the edge of researchers' interest in the Slovak Republic. The purpose of this paper is a quantification of the regional disparities in the development of mortality which is causally linked with selected infrastructural determinants - namely access to water and sewerage. These determinants differently participate in the structure of mortality in marginalised and segregated communities and they deepen regional disparities in health. Methods: It is a spatial analysis of the districts of the Slovak Republic. The data from the Atlas of Roma communities in Slovakia 2013 is applied. Through the multiple linear regression model the relationship between mortality of the Roma population and water and sewerage availability in the Roma settlements is examined. Similarity between the districts is measured by the Euclidean metric system. Results: The most appropriate district for representing the Slovak Republic average is the Dunajská Streda district in a field of arithmetic mean and the Veľký Krtíš district in a field of median value. The outermost district is represented by the Košice-okolie district, conversely, the Trnava district is the closest to the rest of the Slovak Republic. The highest statistically significant impacts on mortality are explored in public water supply extension plan and public sewerage supply extension plan. It seems that water play a greater role in determining health of Roma population. The highest number of inhabitants with supplied public water and public sewerage is kept by the Kežmarok district, the Košice district, and the Spišská Nová Ves district. Conclusions: Our results can be beneficial for health decision making, since in the Strategic Framework for Health of the Slovak Republic metrics for measuring and evaluating health aspects in Roma communities absent and that prevents them to be correlated with the planned interventions.

This article informs about recent research findings on voluntary and mutual aid in the Czech Republic with a special attention paid to formal volunteering in health and social care. The data suggest that public involvement is comparable to middle-frequency experienced in European countries. In this respect, volunteering is higher in the Czech Republic than in other former Eastern European countries and is an evidence of a successful and rapid restoration of the civic sector. New patterns of volunteering featured by planning, coordination, and contracting have spread out being strongly supported by national and EU policy measures. Managerial patterns of volunteering are dominating in health and social care institutions. Volunteering in health and social care is firmly motivated by emotional altruism; however, reciprocal (instrumental) and normative motivations are also present, though to a lesser extent compared to other sectors of volunteer activities. In the managerial pattern of volunteering altruism is balanced with personal gains and benefits for those who volunteer. Volunteering is deeply embedded in a civic, humanitarian paradigm instead of a religious faith and duty.

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.

Objectives: The study presents the findings of a quantitative research conducted among people aged over 90, who live in a large town of Hungary, Debrecen. The aim of the research was to examine the lifestyle, attitudes, values, and physical and mental condition of old and long-lived people. We laid a special emphasis on the exploration of the life perspectives, mood and mental youth, and their interconnections. Methods: The sociological questionnaire used for data collection (159 questions) was intended to inquire socio-demographic characteristics, dietary habits, health condition, physical activity, and identity features. Further examinations were conducted in order to measure the level of depression using the Geriatric Depression Scale (GDS) and mental condition using the Mini-Mental State Examination (MMSE). We managed to reach out to the elderly living in the town on the basis of family doctors' districts (N = 212). We dealt with a subsample of 115 people since we got answers for all questions from them. During data processing, we applied multivariate statistical methods, first of all linear regression analysis and cluster analysis. We examined the differences between clusters using variation analysis. Results: According to our results, the extremely low educational level of the elderly belonging to the target group did not decrease their life perspectives, but it had a significant impact on the age when their illness begun. We revealed a connection between the mental condition and the level of depression. Better mental condition (higher MMSE) resulted in lower depression level (low GDS). One of our main finding is that the change in the level of depression (GDS) is 13.4% due to the change in the mental condition (MMSE). Conclusions: Physical and mental activity, personal autonomy, a wide range of activities, and avoiding isolation and solitude allow people to experience quality ageing; all these factors can be substantially influenced by the status acquired at a younger age. We believe that it is extremely important for the society to develop guarantees for active old age, which would ensure the optimal balance between the possibilities of physical and mental health, social participation and safety.

Objective: Our aim is to evaluate influenza vaccination rates among the elderly and individuals with underlying chronic disease, and factors that affect vaccination uptake. Methods: The study comprised individuals aged 18-65 years with underlying chronic diseases, and individuals aged over 65 years. Literature-based questionnaires prepared by the researcher regarding vaccination were completed through face-to-face interviews by the principal investigator. Results: A total of 818 participants were included in the study, 257 (31.4%) were males. The mean age of participants was 57.47 ± 14.11 years; 274 (33.5%) were aged 65 years and over. One hundred and three (12.6%) participants stated that they received vaccinations against influenza annually, and 144 (17.6%) stated that they had vaccination against influenza in the 2015/16 or 2016/17 season. Fifty-two (19%) participants aged more than 65 years stated that they received vaccinations against influenza annually, 75 (27.4%) stated that they had vaccination against influenza in the 2015/16 or 2016/17 season. The most commonly determined reasons for not receiving vaccination were not knowing that it was necessary (34%) and believing that vaccination was not necessary because they were healthy (26%). Statistically significantly more participants who gained their knowledge from a physician were vaccinated than those whose knowledge came from other sources (p < 0.05). Participants who considered that they had sufficient information about influenza were vaccinated more frequently, the results were statistically significant (p < 0.05). Conclusion: Informing target risk groups about influenza vaccination by physicians and increasing awareness about influenza may contribute to increasing vaccination rates.

Objective: Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown. Methods: Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets. Results: The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liver-related deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030. Conclusions: Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.

Objectives: Smoking is the leading cause of premature mortality and morbidity. The aim of this study was to provide the first national description of organizational capacity and involvement in tobacco control (TC) measures outlined by the WHO Framework Convention on Tobacco Control (FCTC) within the Czech Republic. Methods: Data were collected in a national cross-sectional survey of all 14 organizations engaged in TC activities within the Czech Republic. Organizational capacity (defined as skills, supports, partnerships, resources, and leadership) to implement TC activities, and level of involvement in key FCTC measures were assessed and compared across organizations. Results: Despite the high economic costs of tobacco use, few organizations were involved in TC activities. 50% of all organizations involved in TC activities were non-government or non-profit organizations. Less than one third of organizations reported having a sufficient number of staff or adequate funding to work effectively. Skills for chronic disease prevention (CDP) practice including assessment, identifying relevant practices, developing and implementing initiatives were rated more favourably than skills to evaluate these activities. Level of involvement was ranked highest for activities that focused on creation of smoke-free environments and lowest for activities that focused on raising taxes and sales to minors. Organizations tended to be more involved in individual, rather than population-level prevention strategies. Inadequate funding, insufficient number of staff dedicated to working on TC, and lack of political will were major barriers. Conclusions: This paper provides the first national description of organizational capacity and level of involvement in FCTC measures within the Czech Republic.

Objectives: Survey was conducted to assess state of viral hepatitis care in Central and Eastern Europe (CEE). Methods: Representatives of 16 CEE countries completed on-line survey in April-May 2017 that collected information on basic epidemiology and availability of key services for HCV and HBV infections. Sources of information provided ranged from national surveillance data to expert opinion. Results: The burden of viral hepatitis varied between countries, ranging from 6,500 to 2 million for HCV and from 10,000 to 3 million for HBV. Access to routine HCV RNA testing and genotyping was reported by 11 and 9 countries, respectively. HCV resistance testing was available in 7 countries. Direct acting antivirals (DAAs) were available in 13 countries, most frequently Sofosbuvir and Ledipasvir/Sofosbuvir (12 countries apiece) and Ombitasvir/Paritaprevir/Dasabuvir (9 countries). HBV DNA testing and HBV genotyping were routinely available in 10 and 7 countries, respectively. Eleven countries reported available treatment with Tenofovir. Conclusions: There are gaps in viral hepatitis care in CEE. Despite the availability of registered modern drugs for HCV and HBV, the access to treatment is limited. Ensuring quality health care is essential to reduce the epidemic and achieve the WHO's goal of eliminating viral hepatitis as a major public health challenge.

Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm³ reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. Conclusion: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Objective: Cystic fibrosis is a genetic disorder that affects mostly lungs but also other organs. Modern treatment has transformed once fatal disease of childhood into the chronic disease of adulthood. Hence more patients enter the job market. Very few adolescents with cystic fibrosis receive some formal career guidance. There is still no professional career guidance for them in Slovenia. Methods: Literature on workability of patients with cystic fibrosis was reviewed. Following the articles and Slovenian and foreign manuals the guidelines on career counselling of young patients with cystic fibrosis is proposed, as well as the suggestions for professional qualification of these patients. Results: The results of the studies present that workability of patients with cystic fibrosis is associated to forced expiratory volume in 1 second (FEV₁) (p < 0.05), the achieved educational level more than 3 years of faculty study (p < 0.001-p < 0.013), self-assessment of quality of life (p = 0.005), age (p = 0.01), and the number of admissions to the hospital (p = 0.001). Conclusions: The interactions among work, quality of life and survival require that healthcare workers strive to help their patients with cystic fibrosis to succeed in their professional lives. The young patients should achieve the highest level of education possible and follow their wishes in line with the realistic possibilities.

Objective: The aim of our study was to investigate the relationship between alcohol-related mortality in Slovak regions, as represented by Nomenclature of Territorial Units for Statistics (NUTS) III level. Methods: We used data from mortality reports spanning 1996-2017 in the Slovak Republic. Data was provided by the National Health Information Centre in Slovakia. We applied two-dimensional correspondence analysis where the dimensions are regions and selected alcohol-related deaths diagnoses are classified by the International Classification of Diseases. Results: Analysis revealed a relationship between the Prešov region and diagnoses I42 - Cardiomyopathy and K29 - Alcoholic gastritis. Furthermore, the Banská Bystrica and Žilina regions correspond to G31 - Degeneration of nervous system due to alcohol and K86 - Alcohol-induced chronic pancreatitis. In the case of K70 - Alcoholic liver disease - the Banská Bystrica, Trenčín and Nitra regions are identified as regions which have an intermediate relationship with this diagnosis. The Trnava region corresponds to F10 - Acute alcohol intoxication. The Trenčín and Nitra regions correspond closely to G62 - Alcoholic polyneuropathy. Perfect correspondence can be seen between the Košice region and K73 - Chronic hepatitis, not elsewhere classified. K74 - Fibrosis and cirrhosis of liver diagnosis also corresponds with the Košice region. Conclusions: The results of this analysis provide valuable insights for national and regional health policymakers in the process of preparing high-quality health regional plans, as well as retrospectively assessing the success of existing health policies and interventions in this area. Facts presented in the study justify the need for specialised health care, which is part of the process of building an Integrated Health Care Centre in Slovakia.

Objective: Drawing on qualitative analysis of selected historical documents, the paper seeks to provide a definition of the general characteristics of the first institutional alcohol treatment facilities in today's Czech Republic and Slovakia, taking into account the historical context of the first half of the 20th century. An additional aim was to point out the importance of archival research and its contribution to understand the determinants of alcohol-related agenda and alcohol treatment. Methods: The basic data platform was generated by analysis of historical documents pertaining to the subject matter under study and to institutional processes in different periods. The data was processed using the open coding method (as part of the grounded theory approach) and other specific methods based on the matching of data from scientific and professional literature and archives in different periods. Over 1,100 pages of text from relevant archival materials were analysed. This research is original, no such systematic analysis of historical documents on this subject matter has been conducted on such a scale with the intention of identifying the general correlates of the historical development of an alcohol-related agenda and alcohol treatment. Results: The establishment of the first institutional facilities intended to provide treatment for alcohol dependency was based on the notion of addiction as a disease, which needs to be treated in dedicated facilities applying an individualised approach. The circumstances of the establishment of the facilities under analysis were similar. Their existence was made possible by distinguished personalities rather than a general belief and social pressure that the issue of alcohol addiction should be addressed. This also explains the fact that the occupancy of these facilities never reached their full capacity, that they were not self-reliant in economic terms, and that they did not readily resume their operation after 1945. Conclusions: The analysis of the establishment, operation, and dissolution of these facilities at the time reveals the discontinuity in the approach to alcohol abuse and its treatment in the context of the historical development and perception of alcohol-related problems in Czech and Slovak society in the first half of the 20th century. Significant social changes occurred after 1948. New legislative instruments were used to enforce treatment based on a principle that was different from the previous approaches. The results of our study also make it possible to reveal the intensity of apparent individual and institutional motives in the process of the development of alcohol treatment in historical terms and its projection into different post-war periods. The understanding of these correlates will help in designing additional trajectories of research into the effects of social and political changes on addiction treatment and thus identifying the intensity of the historical development and its influence on the perception of addiction treatment at present. These findings will also be of great importance for a historical comparative analysis, including overlaps with the development of recent theories, and will support the emergence of new areas of study for the social sciences.

Objective: Recent developments in online lotteries and betting and in digitalization of land-based gambling devices bring new opportunities to track behaviour of individual players and to identify and address developing problem in its initial stages. Early identification of gambling disorder allows for timely intervention and increases the likelihood of successful recovery and minimises harms. Our review aims to examine what on-site strategies are available in both online and offline gambling venues to early identify and address the developing gambling problem while also assessing their effectiveness and strength of the evidence. Methods: We searched main academic databases and other internet resources and collected 67 peer-reviewed papers and grey literature documents that describe one or more such strategies. Results: Available measures ranged from information provision, gambling behaviour surveillance and associated personalized interventions to setting limits and self-exclusion. Conclusions: Although a number of methods how to address disordered gambling are available to gambling operators, there is still insufficient evidence about the validity and reliability of identification strategies and about effectiveness of the intervention methods.

Objective: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. Methods: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. Results: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, β = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, β = -2.077) and among highly educated participants (p = 0.018, β = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, β = 4.213). Conclusion: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

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.

Objective: Mercury dental amalgam restorations are an important source of chronic exposure to mercury in the whole population and special attention should be paid not only to occupational exposure to mercury during the preparation and administration of amalgam. The authors' report is an up-to-date contribution to the health risk assessment of mercury use in dentistry, namely occupational exposure to mercury in dentists working with dental amalgam and exposure to mercury in persons treated with amalgam dental restorations. Methods: Determination of total mercury in samples of biological material (urine, hair) was performed during 2017 and 2018 in 50 persons by the AAS method using the mercury vapour generation technique at 254.6 nm. Results: Current dental exposures based on the most recent findings do not exceed acceptable risk levels and are below the biological limit of mercury in urine valid for occupationally exposed persons (100 μg.g^-1 of creatinine), namely median value was 1.48 (min. < limit of detection (LOD), max. 17.14) μg.g^-1 of creatinine (40 persons), total mercury content in hair of dental personnel expressed as median value was 0.340 (min. 0.060, max.1.628) μg.g^-1. In controls (10 persons) was total mercury content in urine expressed as median value 0.36 (min. < LOD, max. 2.74) μg.g^-1 of creatinine, in hair was median value 0.224 (min. 0.059, max. 0.453) μg.g^-1. Conclusions: Authors support opinion that amalgam fillings in the oral cavity are a permanent source of mercury for the body itself.

Objective: The aim of the study was to analyze indicators on lung cancer (C33-C34, ICD-10) in Split-Dalmatia County in the period 2003-2012. Methods: Data on lung cancer occurrence for the period 2003-2012 were obtained from the Croatian National Cancer Registry, while mortality data were obtained from electronic database of the Teaching Public Health Institute of Split-Dalmatia County. Croatian census 2011 and population estimates of the Central Bureau of Statistics of the Republic of Croatia were used to calculate the indicators. Results are presented as absolute numbers, shares (%), specific rates per 100,000 population, age-standardized rate (standard European population). Results: There were 2,804 registered patients with lung cancer in the period 2003-2012 in Split-Dalmatia County - 2,179 men (77.71%) and 625 women (22.29%); 2,737 people died from lung cancer in the same period - 2,117 men (77.35%) and 620 women (22.65%). Specific rates of incidence and mortality rates were four times higher among men than among women. From 2003 to 2012, the rate of incidence among men showed a significant decrease, while among women there were no significant changes of incidence and mortality. Conclusions: According to the indicators of incidence and mortality of lung cancer in Split-Dalmatia County, this malignant neoplasm should occupy a high place within County public health priorities measures of prevention programme, targeting risk factors responsible for their formation.

Objective: The study aimed at assessing the potential benefit of prostate health index (PHI) for early detection of prostate cancer (PCa) and the use of PHI as a marker predicting the presence of PCa before performing prostate biopsy. Methods: The study comprised 55 males who underwent prostate biopsy. Before the procedure, blood samples were collected to test prostate specific antigen (PSA) and free/total PSA ratio (%fPSA) and PHI was calculated. Receiver operating characteristic (ROC) analysis was used to assess the benefit of these values for predicting the presence of PCa. Results: Based on histological examination 31 males were diagnosed with PCa, the remaining 24 were negative. Among the PCa patients, 39% had a Gleason score of 6, 26% had a score of 7 and 35% had a score of 8-10. There were statistically significant differences in PHI and PSA between males with and without PCa. The areas under the ROC curve for %fPSA, total PSA and PHI were 0.712, 0.746 and 0.789, respectively. PHI showed the best predictive ability to estimate biopsy results. If the cut-off criterion PHI > 36.4 (77.42% sensitivity, 66.67% specificity) had been used, 41.7% of males would have avoided unnecessary biopsy. Conclusion: The use of PHI may considerably improve the accuracy of PCa detection in patients with elevated PSA and thus reduce the number of unnecessary biopsies.