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Objectives: The aim was to explore the patterns of the coronary heart disease (CHD) mortality rates over the past almost 50 years (1968-2014) in the Czech Republic, and to predict the mortality rates in 2015-2019. Methods: The number of deaths from CHD and the population size were stratified by sex and age. The mortality rates were age-standardized to European population. Their values in 2015-2019 were estimated using the joinpoint log-linear regression, local log-linear regression and negative binomial log-linear regression, separately for males and females. Results: A positive change in the trend of the age-standardized mortality rates from CHD was detected after the collapse of communism in 1989. In 1991-2000, the mortality trend was sharply downward, with an annual percent change of -5.8 % for males and -5.2 % for females. In 2000-2014, the decreasing trend was not so sharp (-1.3 % for males and -0.7% for females), yet it should continue in 2015-2019. The crude mortality rates for females are slightly higher than those for males since 2007, however, they are increasing for both sexes. The mortality rates are rising mainly in the age group of 85+ years (in 2014, 25.4% of CHD deaths of males and 54.4% of females occurred at the age of 85+ years). Conclusions: The age-standardized mortality rates are predicted to decrease in 2015-2019, but the crude mortality rates should increase due to increase in average life expectancy. The burden of deaths is moving to the age group of 85 years and older, mainly in females. A total of 26,039 CHD deaths were registered in the Czech Republic in 2014, and 29,653 are predicted for 2019, if the current trends continue.

Objectives: Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia. Methods: A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0. Results: The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio = 3.144), being male (adjusted odds ratio = 3.073), being Chinese (adjusted odds ratio = 2.321) or Iban (adjusted odds ratio = 1.578), central obesity (adjusted odds ratio = 2.145), being overfat (adjusted odds ratio = 1.885), and being an older adolescent (adjusted odds ratio = 1.109). Parental history of hypertension, locality, and physical activity showed no significant associations. Conclusion: The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.

Objectives: The aim of the study was to establish frequency, severity and circumstances of alcohol and drug intoxications in adolescents admitted to inpatient wards in the Czech Republic. Methods: Chief physician of each participating ward (or their designated deputy) searched the patient records for required information. The data was then statistically processed. Results: Thirty inpatient paediatric wards participated in the study (27 district wards and 3 university hospital wards), amounting to more than a third of all paediatric wards in the country. The total number of intoxications reported was 2,176, the majority of which were alcohol-related (84.5%), followed by cannabinoids and, to a lesser degree, amphetamines. The number of alcohol intoxications increased by 22% during the 5-year observation period, whilst the frequency of illegal drugs intoxications remained the same. We also observed an increase in the percentage of alcohol intoxications in girls - from 42% to 45.5%. The mean age at intoxication was low - 15.5 years. The Glasgow Coma Scale in individual episodes of intoxication increased during the study duration/follow up period. The proportion of alcohol intoxications originating in pubs, clubs or other public institutions was 25%. Conclusion: The number of alcohol intoxications has risen during the observation period. The age at which these intoxications occurred is very low. Of serious concern is the fact, that 25% of alcohol intoxications originated in places where alcohol is sold, despite the fact that majority of the adolescents were under the legal drinking age limit of 18 years.

Objective: As a part of regular revision of the List of Occupational Diseases in the Czech Republic, efforts have been made to add a new item so that lumbar spine disease caused by overload may be recognized as occupational one, with adherence to the valid national rules, that is, clinical criteria are met and objective assessment confirms working conditions under which, according to recent scientific knowledge, such an occupational disease develops. The aim is to provide information on the use of a proposed method for working condition assessment in a real setting, based on the initial experiences gained from a pilot study carried out to validate the method. Methods: Working conditions were assessed in 55 individuals with chronic low back pain (25 males, 30 females; mean age 45.6 years; mean length of employment 15.6 years). The assessment was based on estimating compressive force on the L4/L5 intervertebral disc when performing potentially high-risk work tasks which were entered into four types of checklists throughout their work shifts. The compression values were calculated using a special module that was developed. Results: In 24 cases comprehensive assessment of all tasks performed showed fulfillment of the proposed criteria of working conditions needed for recognition of occupational disease. Those included healthcare, foundry and forest workers, production operators, cabinetmakers, locksmiths, bricklayers, etc. In all the cases, lumbar spine overload was associated with work tasks requiring combinations of manual handling of objects and trunk rotation or bending. The criteria were not met in 31 subjects. The mean length of employment was 15.4 and 15.8 years in patients who met and did not meet the proposed criteria, respectively. Conclusion: The proposed method proved to be applicable in occupational hygiene evaluation in a real setting.

Objectives: The aim of this study was to investigate annual and seasonal trends in mortality rates from cardiovascular diseases in Hungary between 1984 and 2013. Methods: Annual and monthly mortality and population data were obtained from the Hungarian Central Statistical Office. The annual mortality data by gender and age were available for the following disease classifications of the circulatory system: all cardiovascular diseases, all diseases of the heart, hypertension, coronary heart disease, and cerebrovascular diseases. Six age groups were defined for both sexes. Negative binomial regression was carried out to analyse annual trends in age-standardized mortality rates. The Walter-Elwood method was used to identify seasonal variation using monthly numbers of deaths. Results: Significant decreases in annual mortality rates for all cardiovascular diseases were found, but not for hypertension. Age-standardized death rates were higher for men for all causes, except for hypertension. The greatest sex difference in the average risk of death was observed in the middle-aged groups. The greatest percentage decrease in death rates during the study period was seen for both sexes in the under 35 age group. The lowest percentage change was observed among people aged over 75. Significant seasonality was found in monthly death rates from all causes, with a peak in February. Conclusions: In spite of a decreasing trend in the annual mortality rates for cardiovascular diseases, the Hungarian mortality rate is still high. Moreover, this study demonstrated a significant winter peak in mortality from cardiovascular diseases over a thirty-year period.

Objective: During last years, a significant increase of HIV infection transmitted through sexual intercourse among young adults has been reported in the Czech Republic. The issue of prevention, where sexual education belongs to an important preventive tool, is much more topical than ever before. The level of knowledge and attitudes related to HIV/AIDS among adolescents has not been assessed so far. The aim of our study was to explore this field in a nationally representative sample. Methods: Information was obtained using an anonymous questionnaire that was filled in by 1,627 adolescents 13 to 15 years old selected from a representative sample of 25 elementary and grammar schools in the Czech Republic. Results: Based on the survey results, good knowledge regarding primary HIV/AIDS prevention was noted in the majority of respondents who however tended to stigmatize HIV positive people. Conclusion: The study has confirmed the importance of school as the main source of information (reported by 50.8% of respondents). The result of our study can serve as a starting point in assessment and comparison of the effect of various educational programmes.

Objectives: In Hungary, 37% of women living in poverty were smokers in 2012. There are no valid data of pregnant women's spontaneous smoking cessation. Methods: Our retrospective cohort study (2009-2012) targeted the most underdeveloped regions with an estimated 6-8.5% of Roma population. The sample (N = 12,552) represented 76% of the target population i.e. women in four counties in a year delivering live born babies. Chi-square probe and multivariable logistic regression model (p < 0.05) were used to assess relationship between socio-demographic characteristics and spontaneous cessation. Results: Prior to pregnancy, the overall smoking rate was 36.8%. That of women in deep poverty and Roma was 49.7% and 51.1%, respectively. 70.3% of smokers continued smoking during the pregnancy. Among them 80.6% lived in deep poverty. Spontaneous quitting rate was 23.0%. Factors correlated with continued smoking included being Roma (OR = 1.95), undereducated (OR = 2.66), living in homes lacking amenities (OR = 1.48), and having regularly smoking partner (OR = 2.07). Cessation was promoted by younger age (≤ 18 years) (OR = 0.18), being married (OR = 0.50), and the first pregnancy. Conclusions: Tailored cessation programmes are needed for Roma, older, low-income, and multiparous women who are less likely to quit on their own. Engaging husbands/partners is essential to reduce smoking among pregnant women and second-hand smoke exposure.

Objective: The aim of the study was to estimate changes in the prevalence of respiratory diseases and disorders between 2003/2004 and 2011/2012 in 13-16 years old children living in Bytom, one of the biggest cities in the Silesia agglomeration and provide the evidence for local policy makers. Methods: Data from two cross-sectional surveys, based on the Polish version of the International Study of Allergy and Asthma in Childhood (ISAAC) questionnaire, conducted in 2003/2004 and 2011/2012 was used. Response rate in the first and the second survey was 68% and 35%, respectively. The number of analyzed observations was 4,041 and 707 from the first and the second survey. The selection bias was controlled with the propensity score matching and potential determinants of analyzed respiratory diseases and disorders were controlled in the multivariable logistic regression model. Results: We found statistically significant increase in asthma ever diagnosed by medical doctor (4.5% vs. 9.6%; p < 0.01), seizures of dyspnea (8.2% vs. 27.7%; p < 0.01), and chest wheeze (9.6% vs. 19.2%; p < 0.01). Conclusion: Our study revealed significant increase in the prevalence of respiratory diseases and disorders after 8 years in adolescents living in the Upper Silesian Industrial Zone. This is a relevant finding which provides the evidence for decision makers in the scope of local public health policies.

Objectives: Central obesity represents an increased risk to develop cardiovascular diseases. Guidelines of international societies suggest estimating central obesity by measuring waist circumference (WC). Robust statistical data in literature provide evidence on the superiority of waist-to-height ratio (WHtR) over WC and body mass index (BMI) for detecting cardiometabolic risk in both genders. Based on measurements of weight, height and waist circumference we compared the prevalence of central obesity using both the above mentioned criteria in the apparently healthy Slovak adults, and compared the prevalence of central obesity to that of general obesity (BMI). Methods: Data collected from 5,184 individuals (45% males) aged ≥18 years in four cross-sectional studies carried out between the years 2009-2012 were subjected to secondary analysis. Results: Waist circumference underestimated central obesity in males and overestimated in females: 37.3% of males and 41.8% of females presented central obesity according to WC, 54.2% males and 34.9% females according to WHtR. 17.3% of males centrally obese according to WC present WHtR < 0.5; while 7.8% of females centrally obese according to their WHtR do not display increased WC. The frequency of central obesity increased with age. According to BMI, the prevalence of overweight was 39% in males and 22% in females; that of obesity was 17% and 15%, respectively. Conclusion: The prevalence of central obesity estimated using WC vs. WHtR differs significantly in Slovak adults. WHtR is considered superior for detection of the risk of future development of cardiovascular afflictions. Thus, further studies addressing the gender-associated discordance of central obesity measures are required to determine whether our results are consistent across geographical regions and ethnic groups.

Objective: The aim of the study was to evaluate results of purified protein derivates (PPD) test applied at the Tuberculosis Dispensary between 2012-2015 in Hatay, Turkey, where a large number of Syrian refugees have migrated since the Syrian civil war began in 2011. Methods: PPD test records from the Electronic Tuberculosis Management System at the Tuberculosis Dispensary from 2012-2015 were analyzed based on nationality, age groups, BCG scar availability, and PPD reaction. The annual risk of tuberculosis infection (ARTI) was calculated based on years for each age group in Turks and Syrian refugees and the trend was evaluated. Student-t, Chi-square, and Mantel-Haenszel tests were used in statistical analyses, p < 0.05 was considered significant. Results: In total, 5,255 PPD tests were made, 15.5% were Syrian refugees. BCG scar was missing in 48.5% of Turks and 87.3% of refugees (p < 0.001). The 0-5 age group represented the lowest rate (Turks 3.2%, refugees 4.3%) and the 19-64 age group represented the highest rate (Turks 51.1%, refugees 54.1%) of positive PPD reaction among individuals without BCG scar. Among individuals without BCG scar, more positive PPD reactions developed in refugees of the 6-18 group than in Turks (Turks 16.9%, refugees 46.4%, p < 0.001). Among individuals with BCG scar, more positive PPD reactions developed among refugees of the 0-5 (Turks 7.8%, refugees 24.0%, p = 0.049) and 19-64 (Turks 36.6%, refugees 58.8%, p = 0.028) age groups. ARTIs between 2012-2015 were 0.2%, 1.0%, 1.3%, and 1.4% among Turks, (except 2012) 2.3%, 0.3%, 2.4% among refugees in the 0-5 age group, 1.1%, 2.0%, 1.7%, and 1.5% among Turks, and 8.5%, 6.6%, 7.3%, and 2.4% among refugees in the 6-18 age group, respectively. Conclusion: Higher positive PPD reactions and ARTIs were found among Syrian refugees, more specifically in the 6-18 age group.

Objective: The objective of this research was to determine the prevalence of problematic and risky sexual behaviour after alcohol consumption and the correlation between this prevalence and sex, behavioural factors, problematic drinking, and alcohol consumption characteristics. Methods: A survey of students was carried out at four faculties. Data were gathered via internet and self-administered paper-pencil questionnaires. The analysis employed Pearson's chi-squared test, gross odds ratios and logistic regression to calculate the adjusted odds ratios (OR) and their confidence interval (CI). Results: Problematic drinking was detected by the CAGE test. Sixteen percent of students reached the CAGE score of 2, which indicates a potential threat of addiction, while 6% of students reached even higher problematic scores (3 or 4). Among those respondents who did drink alcohol, 23% had unprotected sex and 21% had sex which they later regretted. There were some differences between male and female respondents with men reporting more instances of risky behaviour. Among university students, problematic and risky sexual behaviour after alcohol use is associated with sex, the intensity of problematic drinking, first drunkenness, the place of alcohol use, and attitude to alcohol use. Conclusions: Problematic drinking and risky sexual behaviour after alcohol consumption exist among students and deserve special attention and response in the form of suitable measures. Problematic and risky sexual behaviour after alcohol consumption among university students is associated with behavioural factors and characteristics of alcohol use that allow a targeted approach to preventive efforts.

Objective: Epidemiological research has shown that air pollution is associated with cardiovascular events, but little is known about short-term effects on blood pressure (BP) and heart rate (HR) in Serbian population. The present study assessed the short-term association between black smoke (BS) and sulphur dioxide (SO₂) levels in urban air and the daily values of blood pressure and heart rate in 98 healthy nonsmoking female volunteers. Methods: Generalized regression model was fitted controlling for temperature, relative humidity, air pressure, season, and the day of the week. Results: There was no association between short-term air pollution exposure and BP and HR, the exposure showed a tendency toward a decrease of diastolic BP and HR, but with no statistical significance. Conclusion: The present findings did not support the conclusion that current levels of ambient BS and SO₂ may have an effect on blood pressure and heart rate in women.

Objective: Worldwide, primary schools are the most important segment of childhood education. The main disturbing source of noise in schools is human speech, the primary component of the learning process. School noise has a negative impact on information processing, teachers and pupils, and communication in the classroom. The study aimed at assessing A-weighted sound pressure levels in primary school classrooms. It was concerned with A-weighted sound pressure levels and their fluctuation during various classes. Methods: The noise was measured with the static calibrated Brüel and Kjær 2260 Investigator sound level meter. The sound pressure levels were measured twice in 12 classes as 11 different subjects were taught to reduce the uncertainty of results due to their potential variability in time. From the instantaneous values, L_A (t), equivalent continuous A-weighted sound pressure levels (L_Aeq,T) and L_Amax were calculated. Results: The mean equivalent A-weighted sound pressure level during lessons irrespective of age and subjects taught was 68.0 ± 3.4 dB (uncertainty of measurement). The highest levels of noise were in physical education and arts; the lowest levels were found for English taught as a foreign language. There were no statistically significant differences in L_Aeq,T depending on the numbers of children in the classes. The main source of noise is pupils. Attention should be paid to negative feelings of noise to reduce L_Aeq,T in schools. Conclusions: Continuous noise pollution, in combination with stress and the mentally demanding nature of the teaching profession, may lead to numerous negative effects on human personality.

In recent years increasing pressure to limit the powers of the Czech public health authorities in the field of food safety has been noticed. An approach to safe food production and official controls depends on diverse and complex socioeconomic factors in the context of political and legislative framework within which food producers and official controllers exist. Official controls are those activities carried out by the competent authorities (CA) or delegated bodies) in Member States to verify business compliance with the requirements set out in agri-food chain legislation. The presented text compares the effectiveness of national food safety systems in the Member States (MS) of the European Union (EU). Under the current EU legislation, each MS shall appoint the competent authorities responsible for the purposes of European legislation in the field of food safety and for performance of official controls. Member States shall ensure that official controls are carried out regularly, on a risk basis and with appropriate frequency to achieve the objectives set out in the European legislation. For evaluation were used the country profiles of Member States, as published in 2011-2015. From the perspective of the European Commission current system of official controls in the Czech Republic is rated as one of the most effective and least problematic. When comparing various systems in Member States it is not possible to decide which control system is more efficient, i.e. system based on one competent authority or relying on several competent authorities.

Objective: Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published. Methods: The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve. Results: The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS). Conclusion: The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive.

Objective: Tick-borne encephalitis virus (TBEV) is most commonly transmitted to humans via the bite of an infected tick. Alimentary infection through the consumption of TBEV-contaminated dairy products is also well-documented and is responsible for some diseases in endemic areas. The aim of the study was to emphasize the risk of contracting tick-borne encephalitis (TBE) by consuming raw milk and dairy products and to describe TBE epidemics in Slovakia for the period 2012-2016. Methods: The data on epidemics were obtained from the Annual Reports for the period 2012-2016 available on the website of the Public Health Authority of the Slovak Republic. Medical records of patients hospitalized during epidemics were provided by the Department of Infectology and Travel Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, and the Louis Pasteur University Hospital in Košice. Results: During the period 2012-2016, 13 smaller or larger TBE epidemic outbreaks were recorded in the Slovak Republic. The two outbreaks of TBE reported in 2012 were associated with the consumption of raw goat's milk and dairy products. The first case was an outbreak involving 12 infected people in the Lučenec District. The second case was a family outbreak in the Žilina District, where 3 persons out of 4 family members were infected. In 2013, one epidemic was reported involving 5 persons following the consumption of sheep's cheese from a farm in the Prešov District. One outbreak with 11 cases was reported in 2014. The investigation confirmed its association with the consumption of sheep's cheese in a restaurant located in the Ružomberok District. In 2015, 4 epidemics were described related to the consumption of goat's/sheep's milk and cheese (Žilina District, Krupina District, Kysucké Nové Mesto District, Trenčín District). In 2016, there were 5 TBE epidemics related to the consumption of milk and dairy products. The largest TBE epidemic outbreak in the last 5 years occurred in the Košice District. In this outbreak approximately 500 people were exposed, and 44 contracted the disease. Infected persons confirmed consumption of sheep's cheese from a farm. Conclusions: Consumption of milk and dairy products made only from pasteurized milk, as well as the immunization of humans and animals are the most effective preventive measures against TBE.

Objective: The aim of this seroepidemiological study was to determine the current prevalence of antibodies against tick-borne encephalitis virus (TBEV) in the representative group of Slovak population with included potential risk factors for TBEV. Methods: Representative group consisted of 428 persons (also with possible exposure to risk factors for tick bite or raw milk consumption). Serum samples were screened by commercial enzyme-linked immunosorbent assay (ELISA). The persons involved in the study completed questionnaires with general demographic, epidemiological and clinical data. During the analysis, we used linear regression to interpret the influence between selected variables. Results: We detected 1.2% prevalence of positive IgG and 1.6% prevalence of positive IgM antibodies in all tested groups. Our results also confirmed that the following risk factors such as tourism, hunting, fishing, and consumption of raw milk are significantly associated with the prevalence of specific antibodies against TBEV. Conclusion: The results of seroprevalence obtained by this study confirm the possibility of infection with TBEV among respondents exposed to possible contact with ticks.

The aim of the study is to present the theoretical background of trend studies in general, to characterize the international Health Behaviour in School-aged Children (HBSC) study and to describe its methodology and changes of the Czech HBSC study between 1994 and 2014. The first part describes various types of trend research studies including their advantages and disadvantages. The second part summarizes the history of the HBSC study in an international context and particularly in the Czech Republic. The final part presents the basic methodological data from six surveys conducted in the Czech Republic between 1994 and 2014.

OBJECTIVE: Overweight and obesity in adolescents is associated with many health risks and considerable direct and indirect healthcare costs. The purpose of this study is to examine trends in the prevalence of overweight and obesity in 11-, 13- and 15-year-old adolescents in the Czech Republic from 1998 to 2014.
METHODS: Data from five self-reported survey rounds (1998, 2002, 2006, 2010, and 2014) of the Health Behaviour in School-aged Children Study (HBSC) were used to assess trends in overweight and obesity among Czech adolescents. The total sample consisted of 19,103 adolescents (51.2% girls). A logistic regression analysis was used to assess trends in different age and gender categories.
RESULTS: From 1998 to 2014 a significant increase in the prevalence of overweight and obesity was observed among boys in all age categories (11 years old 22.2%1998- 28.3%2014; 13 years old 17.9%1998- 26.7%2014; 15 years old 9.8%1998- 20.8%2014) and among 15-year-old girls (6.0%1998- 10.9%2014). None of the age and gender categories showed an overall decrease over the 16-year period. In boys, the prevalence of overweight was significantly higher with steeper negative trends compared with girls. However, stabilization in overweight rates was observed between 2010 and 2014 in all age and gender groups.
CONCLUSION: Nationally representative self-reported data show a significant increase in overweight (including obesity) prevalence among children from 1998 to 2014 in the Czech Republic. The results also suggest stabilization in overweight prevalence between 2010 and 2014. Continuing research is needed to determine future trends while interventions aimed at reducing overweight and obesity in children should be implemented on different levels of public policy.

OBJECTIVE: Screen-based behaviours such as watching television or computer use are among the most prevalent sedentary behaviours adolescents spend time on. There is a lack of recent estimates on prevalence and changes in the amount of time spent on screen-based behaviour across Central and Eastern Europe. The main aim is to assess the trends in the prevalence of current recommendations for the screen time (≤2 hours per day) of school-aged children in the Czech Republic between 2002 and 2014.
METHODS: We used an internationally established methodology based on the Health Behaviour in School-aged Children (HSBC) study. Data was derived from Czech national representative samples of 11-, 13- and 15-year-olds collected in the years 2002 (N=4,065), 2006 (N=4,170), 2010 (N=3,962) and 2014 (N=4,338).
RESULTS: The results indicated that the boys and girl surveyed in 2014 are up to two times more likely to meet the current recommendations for watching television in comparison with groups of schoolchildren of the same age surveyed in 2002. In contrast, computer use by adolescents increased markedly between 2006 and 2014. Taking total screen time into account, spending two hours per day or less on it decreased significantly among boys (OR=0.74, 95% CI=0.62-0.89) and girls (OR=0.80, 95% CI=0.70-0.92) between 2006 and 2014.
CONCLUSIONS: As screen time is an important indicator of time spent in a sedentary way, our findings call for more interventions to reduce the time that school-aged children spend in front of screens.

OBJECTIVE: Active commuting (AC) is an important factor in increasing the total daily physical activity (PA) in children, which is significant for their health and positive physical behaviour in adulthood. The objective of the study was to describe trends in active commuting to school among Czech girls and boys aged 11-15 years from 2006 to 2014, using data from the Health Behaviour in School-aged Children (HBSC) study.
METHODS: To investigate trends in AC among Czech children of school age data obtained from the HBSC surveys carried out in 2006, 2010, and 2014 was used. The study sample comprised 12,273 respondents, out of whom 5,992 (48.8%) were boys and 6,281 (51.2%) girls. The overall trends in AC were evaluated using logistic regression analysis.
RESULTS: Compared with 2006, there was an overall decrease in AC among the 13-year-old boys and 13-year-old girls (boys - 1.8% in 2006 to 50.1% in 2014, girls - 69.3% in 2006 to 46.3% in 2014). The proportion of children AC (walking and cycling) to school significantly decreased from 74.3% in 2006 to 53.4% in 2014.
CONCLUSION: This study demonstrated that AC to school decreased sharply among Czech children of school age from 2006 to 2014. However, walking was the most frequently used mode of travel. The boys were significantly more likely to cycle to school compared to the girls. PA interventions for youth should encourage participation in AC to school in the Czech Republic.

OBJECTIVE: School is a place where students spend most of their daytime hours. Previous studies indicate that the class climate significantly affects students in both positive and negative ways. The aim of our study is to describe the trends in the psychosocial school environment based on four surveyed years in the Czech Republic.
METHODS: The trends in perception of school were assessed by the standardised self-reported HBSC questionnaire from data collected in 2002, 2006, 2010, and 2014. The overall sample included 8,530 girls and 8,087 boys. Data was analysed separately by gender and three age categories 11, 13, and 15 years. Trends were calculated using descriptive categories and percentages. To identify factors influencing school likeness we used binominal logistic regression.
RESULTS: Results showed that school satisfaction declines with age both in boys and girls in each of four surveyed periods. Students who do not feel a high level of support from the teacher are more prone to negative perceptions of school. School duties in both genders were perceived to be greater and more stressful in 2014 than in 2002.
CONCLUSIONS: Interventions to support the perception of psychosocial school environment via the educational system should, therefore, take the aforementioned variation into account.

OBJECTIVE: Bullying in school is a public health concern which continues to be a serious threat to physical and emotional health of children and adolescents. The purpose of this study is to examine trends in bullying behaviour among school-aged children in the Czech Republic.
METHODS: Data were obtained from cross-sectional self-report surveys in the years 1994-2014 as a part of the Health Behaviour in School-aged Children study (HBSC) from a representative sample of 11-, 13-, and 15-year olds.
RESULTS: The highest proportion of children who bullied others (20-47%) occurred during the years 1994 and 1998. The logistic regression models showed significant decreasing trends in bullying others and also in being bullied, regardless of age and gender.
CONCLUSION: The decreasing trend in bullying may be the consequence of a preventive policy in the Czech Republic, but also a change in the understanding of the concept of bullying in society.

OBJECTIVE: Good parent-child communication is associated with adolescent well-being. The aim of the present study was to report time trends in parent-adolescent communication in biological and stepfamilies in the Czech Republic between 2002 and 2014 and to assess gender and age differences.
METHODS: The research sample consisted of 16,160 adolescents aged 11, 13, and 15 years (48.1% of boys) who participated in the 2002, 2006, 2010 and 2014 surveys within the Health Behaviour in School-aged Children (HBSC) study in the Czech Republic. The trends in family communication were evaluated using logistic regression.
RESULTS: Compared with 2002, a significant increase in the ease of communication with biological parents was observed in 2014. On the other hand, the adolescents' perception of communication with stepparents did not change in this period. Compared with the girls, a higher rate of boys reported communication with their father or stepfather as being easy throughout the study period. The ease of talking to biological parents decreased with age.
CONCLUSION: The growing positive trend demonstrated an improvement in communication in intact families at the beginning of the 21st century, while communication with stepparents remained unchanged from 2002 to 2014. The increase in rates of ease of communication with biological fathers was reported by both genders. However, the ease of talking to biological mothers grew mainly among boys.

OBJECTIVE: The aim of the article is to examine trends in tobacco consumption among the Czech school-age population.
METHODS: For the analysis, data from the Czech Health Behaviour in School-aged Children project, conducted between 1994 and 2014 were used. Trends in tobacco smoking were determined separately for boys and girls, applying the binary logistic regression with survey period as an independent variable for the smoking status.
RESULTS: The analysis showed that there have been significant changes in adolescent tobacco smoking for the recent 20 years. While the share of current school-aged smokers was continuously increasing since the mid-1990s, the trend reached its peak in the mid-2000s.
CONCLUSION: In recent years, the prevalence of adolescent smokers has significantly declined in the Czech Republic. Despite this recent decline, adolescent smoking remains a major challenge for the national health policy.

OBJECTIVE: The aim of the study was to examine trends in the prevalence of lifetime cannabis use among the Czech 15-year old students.
METHODS: Data from the nationally representative Health Behaviour in School-aged Children Survey, conducted in the Czech Republic in 2002, 2006, 2010 and 2014, were used. Trends in cannabis use among both boys and girls were modelled through binary logistic regression with period as a predictor of the lifetime cannabis use.
RESULTS: The prevalence of lifetime cannabis use has significantly decreased among young Czechs, particularly among boys. Gender differences in cannabis use have been also gradually decreasing since 2002, with no significant differences between genders in recent period.
CONCLUSIONS: Although there are positive changes in the prevalence of adolescent cannabis use, from the European perspective, Czech students still belong to those with significantly higher rates in this respect. Thus, alongside with the use of other substances, adolescent cannabis consumption remains an important challenge for the national public health policy.

OBJECTIVE: The aim of the study is to examine cross-sectional time trends of life satisfaction and self-rated health in a representative sample of Czech children aged 11, 13 and 15 years using the Health Behaviour in School-aged Children (HBSC) study data from the Czech Republic.
METHODS: Data from survey years 2002, 2006, 2010 and 2014 was used. The sample consisted of 16,357 participants (48.5% of boys). Life satisfaction (LS) was measured by Cantril's ladder; self-rated health was measured through the simple item "Would you say your health is: excellent, good, fair, poor".
RESULTS: Most of the children were satisfied with their lives in all surveyed years (mean LS scores range from 7.21 to 7.51; maximum 10). LS was consistently significantly associated (p<0.001) with age and gender. Overall, children and adolescents in the Czech Republic also reported good health. In total, 87.6% of respondents from all samples reported their health as excellent or good. Gender was found to be significantly associated with self-rated health (p<0.05) in all surveyed years.
CONCLUSIONS: No permanent trends in both followed indicators have been seen in the examined period.

OBJECTIVE: Brushing one's teeth twice a day is the main self-care method to prevent the most prevalent non-communicable diseases. The aim of the study is to describe the trends in brushing teeth in 11-, 13-, and 15-year-old Czech children between 1994 and 2014.
METHODS: One question about oral health from the HBSC study protocol was used in the six surveys (1994, 1998, 2002, 2006, 2010, and 2014). Altogether, 21,170 answers from boys and girls were analyzed using statistical description and binominal logistic regression.
RESULTS: The findings showed that the prevalence of brushing their teeth more than once a day increased throughout the twenty years, more so in boys, but a preventive programme is still needed to educate the 21-38% of those who brush their teeth less than twice a day.
CONCLUSION: Although the recommended frequency of brushing their teeth has increased among Czech school-aged children, it still lags far behind the recommended twice-a-day regularity, especially among boys.

OBJECTIVE: Due to the importance of surveillance of injuries and accidents in the Czech Republic, the purpose of this study was to report the temporal trends of injuries of Czech adolescents between 2002 and 2014.
METHODS: Adolescents (N=20,038) from the Czech Republic, that took part in the 2002, 2006, 2010 and 2014 HBSC study, reported the frequency of medically attended injuries in the past 12 months. Repeated binary logistic regressions with different years as reference categories were performed.
RESULTS: Less than half (44.7%) of all Czech adolescents reported they had experienced at least one medically attended injuries in the past 12 months, with boys experiencing more injuries than girls (p<0.001), and the injuries were more common in older adolescents. Fewer boys reported injury in 2014 when compared to 2002 (OR, CI: 0.81, 0.72-0.90), there was also a significant decrease in injuries among girls between 2014 and 2006 (OR, CI: 0.77, 0.69-0.86).
CONCLUSIONS: The trend was not linear amongst boys. Along with improved safety promotion education, the rate of injuries decreased among adolescents between the years 2002 and 2014.