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Objectives: The health of the Roma population is relatively poor and indicators on municipal level are needed to inform authorities to improve it. The aim of this study was to compare the rate of low birthweights (LBW) and mean birthweight (BW) in municipalities with minor Roma population (MMR) and municipalities with large Roma population (MLR) in Slovakia. Methods: A population-wide, ecological level, cross-sectional study was conducted using data from 2009-2013. Data on proportions of newborns with LBW, on mean birthweight of newborns and on mean ages of mothers at birth were obtained from the National Health Information Centre of Slovakia. Rates of LBW and mean BW were compared between the MMR and MLR groups. Mean age of mothers and rates of unemployment were considered possible confounders. Results: The mean BW was by 183 g higher in the MMR group compared to MLR; the rates of LBW were 4.2% and 8.9%, respectively. Increasing proportions of Roma were significantly associated with increasing rates of LBW and decreasing mean BW, one percent increase in the proportion of Roma was associated with an increase in LBW rate of 0.15% and a decrease in mean LBW of -4.9 grams. Conclusions: Our findings could be used as a proxy for the purposes of policy making, replacing individual level studies with more resource-demanding design.

Objective: This study analyses the differences in birth outcomes between Roma and non-Roma mothers and investigates the potential causes of such differences. Methods: We conducted a retrospective cohort study of 1,989 non-Roma and 799 Roma mothers who gave birth in 2014 and 2015 at the Gynaecology and Obstetrics Clinic of Louis Pasteur University Hospital in Košice. Data on mothers and new-born infants have been obtained from the birth book and from the reports on mothers at childbirth. For low birth weight we considered the weight of a new-born weighing less than 2,500 grams and as for premature birth we referred to childbirth before pregnancy week 37. The file was split by ethnicity and statistically processed in IBM SPSS Statistics 21.0. Results: Our results confirmed a lower birth weight among Roma children (-365.4 grams, p < 0.001). The shorter gestation age and higher risk of premature birth were not statistically significant regarding Roma children. Based on the characteristics of Roma mothers, they are at higher risk of giving birth as minor (OR = 23.64; 95% CI = 15.29-36.54; p < 0.001), as single mothers (OR = 7.13; 95% CI = 5.80-8.76; p < 0.001), with basic education or lack of education (OR = 141.31; 95% CI = 100.47-198.76; p < 0.001). They also have a higher risk of smoking during pregnancy (OR = 23.84; 95% CI = 18.06-31.49; p < 0.001); drinking alcohol (OR = 11.71; 95% CI = 3.36-40.90; p < 0.001) and taking drugs (OR = 8.70; 95% CI = 1.81-42.02; p < 0.001). Roma women attended gynaecologists more rarely. Conclusion: It is therefore important to support the work of community health workers and stimulate collaboration between community health professionals, paediatricians and gynaecologists to overcome institutional barriers in maternity and child care for mothers living in Roma settlement.

Objectives: Physical activity (PA) and adequate macro- and micronutrient intake have favourable influence on the bone status. The aim of this study was to analyse the relationships among PA, anthropometric data, dietary intake and ultrasound bone characteristics in children. Methods: 10-12 years old Hungarian children (N = 123, 59 girls, 64 boys) provided physical activity, diet, anthropometric and bone data. PA was measured with accelerometer (Actigraph GT3X+). Diet was evaluated with three-day, 24-hour food recall. Calcaneal quantitative ultrasound (QUS) bone parameters were registered with Sonost3000 bone densitometer. Results: Nutrition and anthropometry did not differ by gender. The values of broadband ultrasound attenuation (BUA) were significantly higher in boys. Girls spent significantly more time being sedentary, boys had greater light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) levels. The children accumulated more than twice the suggested amount of public health guidelines for MVPA. QUS parameters correlated significantly with vigorous physical activity in boys, and with age, height, weight, fat percentage, and body mass index (BMI) for both genders. There was no significant relationship between nutrition and QUS; however, inadequate vitamin K intake correlated with less favourable bone parameters. Multiple linear regression analysis confirmed the importance of vigorous PA - speed of sound (SOS): β = 0.358, p = 0.006; BUA: β = 0.340, p = 0.007; bone quality index (BQI): β = 0.377, p = 0.002; vitamin K intake - SOS: β = 0.256, p = 0.025; BUA: β = 0.235, p = 0.033; BQI: β = 0.295, p = 0.007; BMI - SOS: β = 0.207, p = 0.064; BUA: β = 0.455, p < 0.001; BQI: β = 0.284, p = 0.008; and age - SOS: β = 0.450, p < 0.001; BUA: β = 0.318, p = 0.004; BQI: β = 0.444, p < 0.001). Conclusions: Changes in the characteristics of ultrasound bone parameters among 10-12 years old children mainly depended on the amount of intense PA, adequate vitamin K intake and anthropometric variables related to age.

Objective: The aim of the study was to determine the effect of physical factors of apartments, educational attainment, nationality and unemployment on the number and distribution of bed bug call inquiries in Budapest, Hungary. Methods: Educational attainment, apartment conditions, the level of unemployment, the ratio of dependent people in the households, nationality and proportion of dependent people were selected as regressors. Monthly ambient temperature values were correlated with monthly call inquiry numbers. Results: Downtown units showed the highest call inquiry rates. Significant positive correlations were found between the call inquiry rates and the ratio of low educational attainment inhabitants (people with ≤ 8 school classes), the rate of small floor area apartments (apartment area < 29 m²), proportions of the comfortless apartments in the district housing stock and proportion of unemployed people on district level as well as proportion of gypsy inhabitants in the districts. Significant negative correlation was found between the call inquiry rates and the average area (m²) of apartments. The number of call inquiries showed expressed, temperature-depending seasonality between March and December 2015. In multiple regression analyses, the level of unemployment and proportion of gypsy inhabitants showed significant correlations with the rate of bed bug call inquiries. Conclusions: Apartment conditions, educational attainment, nationality, unemployment, and the city structure have notable influence on the occurrence of bed bug call inquiries on urban level, although the level of unemployment and nationality seem to be the strongest factors. The annual changes of the ambient temperature have effect on the call inquiry rate.

Objective: HIV testing among people who inject drugs (PWID) in Russia has been documented to be low; however, few studies have been conducted outside of the major metropolitan cities. The aim of this study was to determine how many PWID were aware of their HIV serostatus and what motivators were associated with getting tested for HIV. Methods: Our analysis describes HIV testing behaviours among 593 PWID in Ivanovo and Novosibirsk, Russia. Participants completed a questionnaire and consented to HIV testing. We used logistic regression modelling to determine demographic and behavioural correlates of HIV testing. Results: Self-reported history of HIV testing was 52% in Ivanovo and 54% in Novosibirsk. Prior knowledge of serostatus was very low among PWID who tested positive (3 of 102 in Ivanovo and 0 of 11 in Novosibirsk). The most common reason for testing was doctor referral, and the most common locations were government HIV/AIDS centres and prisons. HIV testing was rarely client initiated or led by a personal motivation for being tested. Conclusions: HIV testing in Ivanovo and Novosibirsk is suboptimal, resulting in poor knowledge of HIV serostatus. More programmes to promote HIV testing among PWID are urgently needed in both cities.

Objectives: Seasonal influenza causes high morbidity worldwide and high mortality in developing countries. As a result, the development of systems for seasonal influenza surveillance has been of great interest. The aim of this study is to explore the potential role of an Emergency Medical System (EMS) call centre to complement traditional surveillance systems of seasonal influenza. Methods: Retrospective observational study in which data on influenza from the system of Notifiable Diseases List (Spanish acronym EDO) and Sentinel Physicians Network (Spanish acronym RMC) were compared with information on calls made to the Principality of Asturias EMS call centre that covers all the region population (1,027,659 inhabitants) based on a set of specific criteria to determine differences and explore this emergency call system as a complementary epidemiological surveillance system. Cases registered by different systems have been compared to the same 68 weeks period, from week 45 of 2011 to week 8 of 2013. Results: RMC reported a total of 2,354 cases of influenza, EDO 43,071 cases and EMS call centre 4,360 "case calls" out of 180,720 total emergency calls. Case series of EDO and EMS call centre have shown a positive correlation (R = 0.42, p = 0.003). Case series from EMS call centre and RMC were correlated (R = 0.38, p = 0.007). Case series from EDO and RMC have shown a strong positive correlation (R = 0.91, p < 0.001). Correlation analysis of the cases reported by the three systems have shown a significant positive correlation between them (p < 0.001). The spike of EMS calls related to the studied influenza syndrome occurs one week in advance compared to traditional epidemiological surveillance systems. Conclusions: EMS call centre data on influenza could be potentially used as a complementary surveillance system to the traditional epidemiological surveillance systems for influenza.

Objective: The aim of this study was to evaluate the rate of contact sensitization to selected cosmetic allergens, i.e. ingredients of dental materials, in students of dental medicine and dental patients. Methods: A total of 50 participants were included in the study: 40 students of dental medicine exposed to the studied allergens during the course of practical education; and 10 randomly selected dental patients without occupational exposure to the investigated substances served as a control group. All of them were patch-tested with colophonium, myroxylon pereirae resin, paraben mix, fragrance mix I, isopropyl myristate, triclosan, polysorbate 80, compositae mix II, and hydroperoxides of limonene. Results: The sensitization rates for colophonium and polysorbate 80 were the highest. For the group of dental students, we established significantly higher sensitization rate for colophonium compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ² = 4.93; p = 0.026), paraben mix (χ² = 3.6; p = 0.05), isopropyl myristate (χ² = 6.56; p = 0.01), and triclosan (χ² = 8.5; p < 0.001); and to polysorbate 80 compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ² = 3.97; p = 0.046), isopropyl myristate (χ² = 5.47; p = 0.02) and triclosan (χ² = 7.34; p = 0.007). Significantly increased concomitant sensitization rate to compositae mix and to hydroperoxides of limonene was established (χ² = 12.55; p < 0.001). Generally, the incidence of concomitant sensitization to the studied allergens in the whole studied population was high. Conclusions: Colophonium and polysorbate 80 could be outlined as sensitizers of paramount importance for both dental students and dental patients. We consider the major importance of exposure to colophonium during the course of practical education in dentistry for the onset of the sensitization. Sensitization to compositae mix was observed only among dental students. We consider the leading role of consumer exposure for the onset of the sensitization to triclosan and to hydroperoxides of limonene. Unexpected and unreported reactions of concomitant sensitization were observed.

Objective: Heat shock proteins act as chaperones at the molecular level and therefore they have been investigated in numerous diseases associated with oxidative stress, including obesity. The aim of this study was to investigate the possible associations of genetic variability in the 3´-untranslated region of the HSPB7 gene (rs1048261) with anthropometric and dietary parameters in a cohort of lean and obese Central European subjects. Methods: A total of 708 Central European Caucasian individuals were enrolled in this study, 415 obese subjects and 293 non-obese subjects. The rs1048261 genotypes were established using a conventional PCR-based methodology. Results: Significant differences were observed in the total daily fat intake between subjects with AT and TT genotypes (82.6 ± 29.2 g vs. 74.1 ± 31.3 g, p = 0.023) and also borderline significance in daily proportion of fat in the diet between AA and TT genotypes (36.0 ± 4.4% vs. 33.3 ± 5.9%, p = 0.061). Based on the linear regression model we found association between rs1048261 genotype and body fat percentage. Conclusions: To the best of our knowledge, this is the first study which reports an association of defined genetic variability in the HSPB7 gene, rs1048261, with obesity and its associated anthropometric characteristics and dietary composition.

Objective: While some countries of the WHO European Region are global leaders in tobacco control, the Newly Independent States (NIS) have the highest tobacco-smoking prevalence globally and a relatively low overall level of the WHO Framework Convention on Tobacco Control (WHO FCTC) implementation. An abridged version of the SimSmoke tobacco control policy simulation model has been developed to project the health impact of implementing tobacco-control policies in line with the WHO FCTC. Methods: Data on population size, smoking prevalence, policy-specific effect sizes and formulas were applied in 11 NIS - Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. The aim was to project the relative reduction in smoking prevalence, number of smokers and number of smoking-attributable deaths resulting from implementing six individual and/or combined WHO FCTC measures. Results: An increase in excise cigarette taxes to 75% of price yields the largest relative reduction in smoking prevalence (range 12.1-44%) for all countries. The projections show that when all six tobacco control measures are fully implemented in line with the WHO FCTC, smoking prevalence in each of the NIS countries can be reduced by at least 39% by the year 2033 (baseline 2015). Conclusion: The projections show that the NIS countries can expect a large number of smoking-attributable deaths just among those smokers alive today, but large reductions in smoking prevalence and smoking-attributable deaths can be achieved if the WHO FCTC demand reduction policies are implemented. The results can be used as an advocacy tool for accelerating enforcement of tobacco control laws in NIS.

Objective: This study is designed to evaluate the potential effects of age, period and cohort (APC) on trends in suicide between 1983 and 2013 in Turkey. Methods: Mortality data were obtained from the Turkish Statistical Institute. The data were grouped into seven age groups, four periods and ten birth cohorts. A nonlinear regression model was estimated for both sexes. The effects of age, period and cohort were parameterized using natural spline smoothing functions. Results: There were 61,795 deaths recorded as suicides during the investigated time period, where 64.5% occurred in males (n = 39,862) and 35.5% in females (n = 21,933). There is an upward trend in mortality by age until the end of the study period for males and females. Age effect is decreased until the forties, kept decreasing during the middle ages, and sharply increased after the sixties. The death rates for females declined from 1999 until the end of the study period. For males, the death rates increased until the end of the study period. Conclusion: If the current trends continue, it can be expected that these effects will continue to reduce female mortality and increase male mortality. Future studies on suicide, strongly focused on specific factors attributed to period effects, are needed in Turkey.

Objectives: Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE. Methods: The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data. Results: The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health. Conclusions: The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.

Objectives: Presymptomatic detection of patients with rare diseases (RD), defined by a population frequency less than 1 : 2,000, is the task of newborn screening (NBS). In the Czech Republic (CZ), currently eighteen RD are screened: phenylketonuria/hyperphenylalaninemia (PKU/HPA), congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), medium chain acyl-CoA dehydrogenase deficiency (MCADD), long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD), very long chain acyl-CoA dehydrogenase deficiency (VLCADD), carnitine palmitoyl transferase I and II deficiency (CPTID, CPTIID), carnitine-acylcarnitine translocase deficiency (CACTD), maple syrup urine disease (MSUD), glutaric aciduria type I (GA I), isovaleryl-CoA dehydrogenase deficiency (IVA), argininemia (ARG), citrullinemia (CIT), biotinidase deficiency (BTD), cystathionine beta-synthase-deficient homocystinuria (CBSD HCU), and methylenetetrahydrofolate reductase deficiency homocystinuria (MTHFRD HCU). The aim was to analyze the prevalence of RD screened by NBS in CZ. Methods: We examined the NBS programme in CZ from 1 January 2010 to 31 December 2017, which covered 888,891 neonates. Dried blood spots were primarily analyzed using fluorescence immuno-assay, tandem mass spectrometry and fluorimetry. Results: The overall prevalence of RD among the neonate cohort was 1 : 1,043. Individually, 1 : 2,877 for CH, 1 : 5,521 for PKU/HPA, 1 : 6,536 for CF (1 : 5,887 including false negative patients), 1 : 12,520 for CAH, 1 : 22,222 for MCADD, 1 : 80,808 for LCHADD, 1 : 177,778 for GA I, 1 : 177,778 for IVA, 1 : 222,223 for VLCADD, 1 : 296,297 for MSUD, 1 : 8,638 for BTD, and 1 : 181,396 for CBSD HCU. Conclusions: The observed prevalence of RD, based on NBS, corresponds to that expected, more precisely it was higher for BTD and lower for MSUD, IVA, CBSD HCU, MCADD and VLCADD. Early detection of rare diseases by means of NBS is an effective secondary prevention tool.

Objectives: Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. Methods: We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. Results: Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. Conclusions: The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.

Objectives: Smoking of water pipe (WP) and cigarettes has recently turned into a major global health burden. The present study aimed at assessing WP and cigarette smoking among Zahedan University of Medical Sciences (ZUMS) students in Iran. Methods: A cross-sectional survey was conducted on 500 students in ZUMS (182 males, 318 females). The subjects were selected through randomized cluster sampling. Morgan's chart was applied to calculate the sample size; 96.6% of the attendees completed a questionnaire designed to address the aims of the study. Results: The mean age of the subjects was 21.2 ± 2.4 years. WP and cigarette smoker rates were at 31.2% and 15.2%, respectively. The age of smoking initiation ranged between 15 and 20 years. Friends played crucial roles in triggering the smoking in both groups of WP and cigarette smokers (78% and 54%, respectively). The main reasons for WP and cigarette smoking were entertainment followed by curiosity. Furthermore, males used more cigarette (26.5 vs. 8.7%) and WP (50.6 vs. 20.4%) than females. Among father and mother smokers, respectively, 54.2% and 60% of children were also WP smokers (p = 0.001). Also, 21.9% and 60% of children smoking cigarettes had father and mother smokers, respectively (p = 0.05). Conclusion: Tobacco use, especially for WP seems to be at alarming rates among medical students in Iran. It is highly recommended to control the progressive prevalence of WP smoking by governmental/academic preventive measures as educational and smoking cessation activities.

Objectives: Evidence that health interventions work is not enough to ensure implementation into policy and practice. The complexity of public health systems requires more diverse actions. This paper proposes a conceptual model to enhance understanding of interlinking factors that influence the evidence implementation process. Methods: A literature review was conducted to explore factors that influence the process of evidence implementation in complex public health systems, including research findings and observations from 32 case studies of injury prevention interventions underway in 24 countries and results from evidence research networks. Concepts and themes identified through a critical review were organised, ordered and interlinked to build the model. Results: An Evidence Implementation Model for Public Health Systems and four concepts or themes: Evidence implementation target; Actors involved in implementation; Knowledge transfer; and Barriers and facilitators to evidence implementation were developed to provide a simplified, yet broad framework that highlights multiple factors and back and forth inter-linkages within and between the concepts that influence the uptake of evidence into public health systems policy and practice. Conclusions: Understanding the factors discussed within and amongst the four concepts of this model should ultimately help to positively influence the uptake of evidence into real world public health systems. This model has relevance for decision makers, researchers, knowledge brokers, and implementers.

Objectives: Vaccine preventable diseases (VPDs) continue to pose a significant threat to healthcare workers (HCWs) while immunization among this group remains low. HCWs' behaviours as well as facilitators and barriers towards their vaccination for a number of VPDs were explored through an EU-wide survey. Methods: HCWs across the EU answered online survey that explored attitudes and behaviours towards vaccination for a number of VPDs. Response data were adjusted based on weights estimated by HCWs' country and working profession according to WHO statistics. The survey was delivered between October 2012 and April 2014. Results: Analysis was based on responses from 5,424 HCWs from 14 European countries. The majority (86.7%) had a positive attitude regarding immunizations. HCWs considered influenza (86.4%), viral hepatitis type B (71.9%) and tuberculosis (59.1%) as higher risk diseases for occupational exposure in the workplace. However, 43.8% reported not receiving a seasonal influenza vaccine in the last 10 years and 65.6% reported not receiving the pandemic influenza vaccine in 2009. Main enablers towards immunizations included believing in vaccine protection and easy, free of charge access to vaccines in the workplace. Barriers to up-to-date immunizations differed according to disease but included concerns about short- and long-term effects. Conclusion: Although the concept of mandatory vaccination seems to be favoured by many health professionals in Europe, it remains a controversial subject both among HCWs' profession categories and also among different countries. Interventions to increase vaccination among HCWs would benefit by tailoring their approach according to disease and target group.

Objective: The aim of the study was to evaluate caries prevalence in a sample of schoolchildren aged 6 to 16 years from rural and urban areas in Croatia. Methods: Using standardized World Health Organisation (WHO) criteria, the oral health status of 1,589 children (265 from rural and 1,324 from urban areas) was assessed by recording the following indices: DMFT (decayed, missing, filled permanent teeth), deft (decayed, extracted, filled primary teeth), DMFS (decayed, missing, filled surfaces - permanent teeth), defs (decayed, extracted, filled surfaces - primary teeth) and SiC (Significant Caries Index). Rural areas were Štitar and Babina Greda municipalities in Slavonia and urban areas were the cities of Županja (Slavonia), Zagreb and Dubrovnik. Results: Half of the examined children (50.0%) had caries (D component in DMFT), with 46.0% of these being from urban and 70.2% from rural areas. The median DMFT among children was 2, 4 (rural) and 2 (urban) (p < 0.001). Among 12-year-olds, the median DMFT was 4 (rural) and 3 (urban), and mean DMFT was 3.4. The median DMFS for rural area was 5 and for urban area 3 (p < 0.001). The median deft was 1.00 for rural and 1.00 for urban, while the highest value was found among 6-year-olds at 9 in rural and 7 in urban areas. The median SiC was 4, 4 (urban) and 5 (rural). Conclusion: Schoolchildren from urban and rural areas in Croatia differ significantly in caries prevalence. They fall into the medium DMFT classification group according to the WHO, which indicates the need for a comprehensive oral health preservation programme.

Objectives: Previous studies have observed notable unexplained geographic differences in incidence of kidney cancer in Europe. Lithuania is among the countries with the highest incidence and mortality. Our objective was to investigate the effect of different lifestyle, anthropometric and biological factors on the risk of kidney cancer in Lithuanian men. Methods: This population-based cohort study included 6,849 men initially free from cancer. During the follow-up (1978-2008), 79 incident cases of kidney cancer were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). Results: Risk of kidney cancer was significantly associated with increasing body mass index (BMI), the adjusted HR for ≥ 35 vs. < 25 kg/m² was 3.00, 95% CI 1.10-8.19 and the HR per 1 unit increment of BMI was 1.07, 95% CI 1.01-1.14. In overweight men (BMI ≥ 25 kg/m²), the HRs for kidney cancer per 10 mmHg increment of systolic or diastolic blood pressure were 1.10, 95% CI 0.96-1.25 and 1.26, 95% CI 1.01-1.56, respectively. We found no significant association between smoking, alcohol consumption or total serum cholesterol level and kidney cancer risk. Conclusions: This study supports a link between increased BMI and the development of kidney cancer among men in Lithuania. Hypertension appears to be associated with risk of kidney cancer in overweight men, although the assessment was limited by the lack of statistical power.

Objectives: The study focuses on the 2012 methanol outbreak in the Czech Republic. The main goal of the present study was to apply analytical and descriptive tools to selected qualitative and quantitative processes related to the 2012 methanol outbreak in the Czech Republic. The secondary goal was to study and evaluate in detail their potential for creating integrated conceptual national policies aimed at eliminating the risk of methanol poisoning in the future. Methods: The presented qualitative analysis focused on the content of documents published by Czech public authorities - the Ministry of Health, the Ministry of the Interior, the Czech Agriculture and Food Inspection Authority, and the Regional Public Health Authorities - as well as the content of the relevant legal regulations. Moreover, statistical data concerning the number of hospitalisations and deaths due to the methanol intoxication were used to provide a background to a detailed description of the relevant facts. Results: In procedural terms, most of the analysed measures focused on a strongly restrictive regulation of sales, regular information channels designed to protect consumers on the national as well as international level, and elimination of further health and economic risks stemming from the dangerous alcoholic products that had already entered distribution networks. The health, social and economic consequences of such activities are quantified at a highly aggregated level. The analysed institutional ties are evaluated also in the context of international documents: the European Action Plan to Reduce Harmful Use of Alcohol 2012-2020 and the Global Strategy to Reduce Harmful Use of Alcohol, and their current potential for steering public policies is assessed. Conclusion: The analysis and evaluation of procedural activities carried out after the methanol outbreak have laid the foundations for a multidimensional study that can contribute to integrated national policy concepts aimed at preventing these and similar negative health, societal and economic consequences. Six years after the methanol outbreak, national and regional health policies have reflected no findings concerning the experience of patients whose health was impaired due to methanol, and the economic cost of the event has not been calculated. The quality of life of these patients has greatly decreased due to permanent or partial incapacity and serious upheavals of their and their families' economic and social conditions. This opens the question of researching and evaluating multiple aspects of health, social and economic impacts of harmful use of alcohol and setting up processes to mitigate these impacts.

Objective: Alcohol use is one of the ten most common risk factors threatening global health that is avoidable (ranked fifth after smoking). It is involved in high rates of liver cirrhosis, epilepsy, hypertension, cerebrovascular and mental illness. Negative consequences of family and social drinking are also very significant. The aim of the study is to quantify the gender and age-differentiated disparities in alcohol-related mortality in the population over 16 years between the years 1996-2017 in Slovakia. Methods: We used data from mortality reports within 1996-2017 provided by the National Health Information Centre in the Slovak Republic. We applied two-dimensional correspondence analysis where dimensions are age and chosen causes of deaths induced by use of alcohol and classified by the International Classification of Diseases. Results: In case of males, we found that K74 - Fibrosis and cirrhosis of liver diagnosis almost perfectly corresponds to age 66-75 years, and we documented strong correspondence between K70 - Alcoholic liver disease and age 46-55 years. For females, the most robust finding is that K70 - Alcoholic liver disease corresponds relatively similarly with age groups 26-35, 36-45, 46-55. The results of the analysis allow us to obtain a detailed overview of the development of mortality in individual alcohol diagnoses and their intervention in individual age groups by gender. Mortality for some diagnoses affects the young female as well as male population. We observed that there are systematic differences in alcohol-induced mortality between males and females. Conclusions: In such development of the alcohol-related mortality structure, the priority remains the permanent provision of primary, secondary and tertiary prevention at the individual and population level. The results of our analysis represent a valuable platform for health and social policymakers to develop quality national and regional health strategies aimed at eliminating the consequences of alcohol use. Lessons learned from our analysis will be supported by our other geographically oriented analytical lines to link identified and quantified regional disparities in the mortality of alcohol diagnoses to the availability of health care to treat these diseases.

Objectives: The Czech Republic ranks among countries with the highest alcohol consumption per capita. Several older studies discuss Czech media portrayal of health effects of alcohol, but we found no recent analysis of media portrayal of harms caused by alcohol consumption. Our analysis aims to fill this gap in. Methods: The dataset of texts (n = 903) consisting of articles from press, radio, television and the internet published within a 30-day interval in 2017 (Newton Media computerized database) was coded and analyzed using mixed quantitative and qualitative approach to content analysis. The frequency of references to acute and long-term alcohol harms of various types were counted, and the results were compared to the classification of (alcohol) harms by the Independent Scientific Committee of Drugs (ISCD). Results: The short-term intoxication effects in the areas of crime and road safety, in particular reports on traffic accidents, are over-represented, while topics describing the impact of alcohol use on health, family and society, as well as economic costs or environmental issues seem to be marginal. That corresponds to the fact that police and courts were the information source in more than half of the articles, while information sourced from physicians, sociologists and drug field professionals was rather scarce. Conclusions: Media portrayal of the harms caused by alcohol use does not match up to real harm effects on the society. In terms of public health, it is imperative to strengthen media presentation of the impact of alcohol use on health and social issues.

Objective: Human resources are crucial for addiction treatment and prevention services, as well as for science and research. The aim of this historical case study is to explain and demonstrate the role of specialized university academic degree study programmes in addictions in the context of a national institutional infrastructure. This specific group of very highly specialized academic programmes represents the highest level of professional development and is producing a totally new generation of addiction specialists with a very distinctive professional identity. Methods: The study protocol is based on a case study research design and the case is defined as the historical development of addiction specialized institutions closely related to self-help, prevention, and treatment activities on the historical territory of the Czech Republic. We identified relevant historical sources related to establishing and/or running activities or institutions according to the categories specified in our concept of the national institutional infrastructure. All the materials and sources that were collected were sorted according to a timeline and categories of institutions and we systematically determined the first recorded activity/institution in each particular category. For this simple sorting system we used open and selected coding according to Grounded Theory. Results: The public health model developed by Thomas Babor recognizes six different structural mechanisms to support university-based programmes in addiction studies: specialized journals, research centres, professional societies, specialized libraries and documentation centres, training and education programmes and institutions, and funding agencies. We attempted to redefine the concept of addiction studies within the broader context of the addiction field and added three additional mechanisms of support: public interest groups, self-help groups, and service providers. Using a historical case study in the Czech Republic, we demonstrate the potential for a broader context and interaction between these support mechanisms and academic institutions hosting academic programmes in addiction studies. Conclusion: The process of establishing integrated addiction studies programmes at Charles University in the Czech Republic had its origins in, and support from, various national institutions and professional organizations. This allowed the university to develop academic programmes at the bachelor's, master's, and Ph.D. levels. The availability of career opportunities for advanced-level addiction professionals in the Czech Republic was also a critically important factor in developing sustainable academic programmes in addiction studies. Our experience is that the creation of successful and sustainable academic programmes for addiction professionals is difficult to achieve without broad infrastructure support, national advocacy efforts, and legislative change at the national level.

Objectives: To our knowledge this is the first study measuring personal exposure to carcinogenic polycyclic aromatic hydrocarbons (cPAHs) bound to airborne particulate matter ≤ 2.5 µm (PM_2.5) in periods of high air pollution (smog episode) in which citizen were tracked. Methods: Measurements were performed in industrial regions of the Czech Republic: Ostrava, Karviná, Havířov. The city of Prague served as a control. Personal monitoring was conducted by active personal monitors for 48 hours. Non-smoking city policemen from Prague, Karviná and Havířov, office workers from Ostrava city and volunteers from Ostrava-Radvanice and Bartovice participated in the study (N = 214). Results: The average personal exposure to benzo[a]pyrene (B[a]P) was highest in Ostrava (17.2 ng/m³), followed by Karviná, Havířov, Radvanice and Bartovice, and Prague (14.2, 12.0, 9.3, and 2.8 ng/m³, respectively). We tested for association between the personal exposure to cPAHs and various health-related factors extracted from the questionnaires, including lifestyle factors and day-to-day activities. Conclusions: Exposure to outdoor cPAHs, environmental tobacco smoke (ETS), commuting, and time spent indoors (in restaurants, workplace or home) were found to be the main determinants of the personal exposure. Daily cPAHs measurements in highly polluted areas are needed for evaluating the personal exposure and to avoid its underestimation resulting from stationary monitoring.

Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well.

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: The Czech Republic is characterized by high alcohol consumption and is well known as the world's biggest consumer of beer. In contrast, the alcohol consumption in Norway is relatively low. In this article, we describe and discuss alcohol policy development in the Czech Republic since the mid-1980s to the present and its impact on the alcohol consumption and compare our findings, including the dynamics of the total alcohol consumption and the development of drinking patterns among young people, with the situation in Norway. Methods: The study uses the methodology of "process tracing". Selected national statistics, research outcomes and related policy documents were analyzed to identify possible relations between the alcohol consumption and the alcohol policy in two different environments and institutional/policy settings. Results: There was a clear difference in alcohol consumption trends in both countries in the last three decades. Norway was characterized by low alcohol consumption with tendency to decline in the last years. In contrast, the Czech Republic showed an upward trend. In addition, alcohol consumption among Czech youth has been continuously increasing since 1995, whereas the opposite trend has occurred in Norway since the late 1990s. The results revealed that the alcohol-control policies of the Czech Republic and Norway were significantly different during the study period. Norway had a very restrictive alcohol policy, in contrast to the liberal alcohol policy adopted in the Czech Republic, in particular after political transition in 1990. Liberalization of social life together with considerable decline of alcohol price due to complete privatization of alcohol production and sale contributed to an increase of the alcohol consumption in the Czech Republic. Conclusions: Persistently high alcohol consumption among general population and its growth among young people in the Czech Republic pose social, economic and health threats. Norway could provide the inspiration to Czech politicians about effective options in combating these threats.

Objective: Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Methods: Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Results: Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Conclusions: Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.

Objective: The aim of the study is to comprehend results of the influenza lab surveillance system in the Republic of Macedonia after the 2009 pandemic and to determine the main characteristics of four consecutive epidemic seasons (from 2010/2011 until 2013/2014). Methods: As part of the universal surveillance system, nasal and throat specimens were collected from patients. After extraction of RNA, the CDC real-time RT-PCR assays for the detection of influenza types and subtypes were performed. Results: Out of 920 tested samples, 406 (44.1%) laboratory confirmed cases of influenza were found. Influenza activity begins as early as December and continues until the end of April with peaks in January or February with predominant influenza A and A/H1N1pdm. Influenza A viruses start their activity at week 49 to 52 and subside at week 17. Usually two peaks appear, the first one between week 2 and 4 and the second one between week 6 and 9. Subtype A/H1N1pdm was dominant among influenza A types in the 2010/2011 and 2012/2013 seasons. A/H3N2 was the only circulating influenza virus in the 2011/2012 season. Influenza B season is shorter and has only one peak, between weeks 2-5. Usually the influenza B viruses emerge in later stages than influenza A viruses, except for the first post-pandemic season. Conclusion: Results revealed that post-pandemic influenza seasons in Macedonia were rather different. Although the influenza season pattern is similar to patterns in some countries of the WHO European region, some unique characteristics were observed.

Objective: The aim of the study was to determine trends in the minimum inhibitory concentrations (MICs) of erythromycin used as first-line therapy and alternative antibiotics against Bordetella pertussis (B. pertussis) strains isolated from patients with whooping cough in the Czech Republic (CR) in three periods from 1967 to 2015. Methods: In total, 135 isolates from the years 1967-2015 were analysed. The strains were divided into three groups by the year of isolation: 1967-1999 (42 strains), 2004-2010 (43 strains), and 2011-2015 (50 strains). MIC of selected antibiotics (erythromycin, clarithromycin, azithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole) were obtained by the reference agar dilution method on Bordet Gengou Agar with 15% defibrinated sheep blood. Results: The study set included 70 strains previously tested for MICs of erythromycin and four other antibiotics. In the three study periods, the MICs of the tested antibiotics for B. pertussis were nearly identical. All but a single strain, inhibited by erythromycin at a concentration of 0.03 mg/l, were inhibited by two concentrations of erythromycin and azithromycin (0.06 and 0.125 mg/l). Clarithromycin inhibited the strains from all three study periods at the following concentrations: 0.03, 0.06, and 0.125 mg/l. Any of the 135 strains was inhibited by ciprofloxacin at a single concentration of 0.06 mg/l and by trimethoprim/sulfamethoxazole at three concentrations (0.125, 0.25, and 0.5 mg/l). Conclusion: The study set of 135 Czech strains of B. pertussis isolated in 1967-2015 appears to be homogeneous in terms of the MICs for five antimicrobials. The MICs remained in a narrow range of two to three low concentrations; the unimodal distribution of the MICs suggests the absence of resistance mechanisms. The highest MICs of erythromycin, clarithromycin, and azithromycin were equally 0.125 mg/l, that of ciprofloxacin was 0.06 mg/l, and that of trimethoprim/sulfamethoxazole was 0.5 mg/l. Over the study period of 55 years, the MICs of the study antibiotics remained in the same ranges.