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OBJECTIVE: The aim of this study was to report on trends in the prevalence in age at first intercourse of Czech schoolchildren and a difference between sexes.
METHODS: Prevalence in age at first intercourse of Czech schoolchildren was observed under the Health Behaviour in School-aged Children study in the years 2002, 2006, 2010 and 2014. In addition, a random representative sample of children attending 9th grade completed the questions related to sexual behaviour. A total of 4,804 boys and girls at the age of 15 years were included in the study. The chi-square test and analysis of variance were used for data assessment.
RESULTS: Experience with first sexual intercourse before 15 years was confirmed by 16% of boys and 19.4% of girls. Average age of coitarche in both sexes most often ranged between 14 and 15 years. Since 2006 boys had significantly lower age at coitarche. Only in 2010 the girls had first intercourse more frequently than boys. Since 2010 the number of Czech adolescents of both sexes having first intercourse before the age of 15 years has significantly increased. However, a rise in average age of coitarche over 15 years in both sexes occurred in 2014.
CONCLUSIONS: The number of Czech children having a sexual intercourse before 15 years has significantly increased since 2010.

Objectives: We surveyed and compared, by gender, the levels and correlates of achieving the international guidelines of four forms of physical activity (PA): moderate PA (MPA), vigorous PA (VPA), moderate or vigorous PA (MVPA), and muscle strengthening PA (MSPA). The study assessed the associations between achieving the guidelines of the four PA forms and a range of socio-demographic, health and academic performance variables. Methods: Data was collected across the seven faculties of the University of Turku (2013-2014 from a representative sample of 1,189 undergraduates). An English language online self-administered questionnaire assessed frequency and duration of PA/week for each form of PA. We employed cut-offs for the guidelines in accordance with the American Heart Association. Chi-square statistic tested the differences in PA, socio-demographic variables and academic performance between males and females. Binary logistic regression examined the factors associated with achieving the four PA guidelines and linear regression examined the association between the frequency of PA and academic performance. Results: Achievement of PA guidelines was relatively low across the sample. Female students were less likely to achieve the VPA or MSPA guidelines, but were more health conscious and in generally exhibited better academic performace than males. High health awareness and excellent/very good self-rated health were the strongest predictors of achieving all forms of PA. Parents' education level was positively related to likelihood of achieving the VPA, MVPA and MSPA guidelines. Achieving the MPA guidelines (but not VPA or MSPA) was positively associated with subjective perceptions of better academic performance. Conclusions: Achievement of PA guidelines was generally low for this sample of Finnish students, and was associated with positive health status and high health awareness. Universities need a holistic approach to improve awareness of health and promote PA in students' lifestyles.

Objective: The aim of this study was to explore the potential of free comprehensive primary preventive examination (CPPE) combined with cardiorespiratory fitness (CRF) test in terms of its attractiveness for general population and moreover to evaluate the induced behavioural changes. The main focus was on physical activity behaviour (PA). Methods: In 2009-2013, 250 people (100 men, 150 women) aged 18-65 years were examined. CPPE included assessment of health status and lifestyle, CRF test and individualized counselling. Expectations, reasons and motivations for participating were recorded. The sample was evaluated in terms of age, gender, lifestyle, body mass index, body fat percentage, CRF, and health characteristics. Evaluation according to subjective benefits, perceived effects on health and lifestyle was performed after six months using electronic feedback questionnaires (FQ). Comparison was made within groups formed according to the reported increase in PA. Results: People aged 18-39 years accounted for 72.8% of the sample; mean age 34.4±11.0 years; 40.0% were men. Behavioural and health risks were lower in comparison with the general Czech population, but at least 1 of 5 assessed risk factors was present in 88.8% (low fruit and vegetable consumption 74.8%, low physical activity level (PAL) 45.6%, smoking 19.6%, risky alcohol use 18.8%, and stress load 10.4%). The most represented category of CRF was "endurance-trained" (both genders). CPPE was perceived as a source of information concerning health, CRF and lifestyle. 40.0% of men and 30.7% of women were focused on improvement in CRF. The response rate of FQ was 75.6%. Individuals with low PAL and low CRF provided feedback less often (p<0.05). In terms of perceived effect, 84.1% of the respondents implemented some kind of behavioural change; 60.9% reported increase in PA, but only 38.1% reported maintaining improvement in PA after 6 months. A higher proportion of reported lasting changes in PA occurred in subjects who were overweight/obese and in those with low CRF. Participants with low PAL and higher number of lifestyle risks more likely increased their PA only temporarily. Improvement in PA was associated with reported changes in diet (p<0.001). In the group of respondents there was an increase in self-perceived PA (SPA) compared to the baseline (p=0.001). Moreover, individuals who reported increase in PA showed improvement in subjectively perceived health. Conclusion: The testing of CRF appears to be a promising motivating factor for going through the intervention, especially for younger people and men. CPPE is effective at the individual level in terms of providing information and initiating behavioural changes in PA. However, this type of intervention is less attractive and less effective for individuals with a higher behavioural risk profile.

Objective: Studies about mental health among urban and rural residents are scarce. A limited number of studies report somewhat better mental health in rural settings, despite higher rates of suicides. The main objective of this study was to describe social conditions of the population of Serbia in rural and urban settlements and to assess the differences in the prevalence of mental health disorders. Methods: Propensity score matching of urban and rural persons (2 × 3,569 persons) has eliminated confounding effects from social variables (age, gender, wealth index, education level, employment, family status) and self-rated health. Thus, any statistical differences concerning mental health variables (five-item Mental Health Inventory and clinically diagnosed chronic anxiety or depression) between the two populations were not a result of differences in the matching variables. Results: After matching all variables, the estimated prevalence rate of poor mental health was significantly higher among residents of urban (52.2%) than rural (49.1%) settlements (p=0.012). Conclusions: Almost half of the Serbian population suffers from poor mental health, therefore, there is a need to increase efforts on mental health promotion, prevention and treatment. Our study findings also support the importance of promoting benefits of rural settings for people with mental distress.

Objective: The study aimed to explore changes in the prevalence of psychological distress and co-occurring psychological symptoms among 19-34 years old Finnish university students between the years 2000 and 2012. Methods: The prevalence of perceived frequent psychological symptoms was compared in four nationwide cross-sectional student health surveys with random samples (N=11,502) in the following years: 2000 (N=3,174), 2004 (N=3,153), 2008 (N=2,750), and 2012 (N=2,425). Results: In the time phase from 2000 to 2012, the overall psychological distress (12-item General Health Questionnaire, GHQ-12) increased from 22% to 28%, while there was also an increase in the frequently experienced psychological symptoms (depressiveness from 13% to 15%, anxiety from 8% to 13%, concentration problems from 12% to 18%, and psychological tension from 13% to 18% with a peak prevalence observed in 2008). The co-occurrence of different psychological symptoms increased as well. Psychological distress was more common in females and in older students. Conclusions: The findings suggest an increasing trend of frequent psychological distress among Finnish university students over the years from 2000 to 2012, with the peak prevalence occurring in 2008, which may reflect the growing multifaceted environmental demands.

Objective: The aim of this study was to determine the most common psychosocial risk factors for absenteeism and the extent to which low back pain occurs among Slovenian professional drivers as result of various psychosocial risk factors. Method: The study involved 275 professional drivers, mostly men (mean age 41.6 years). Statistical data analysis was conducted using SPSS package version 21, MS Excel version 2007 and Pajek, version 3. The main method for data processing was regression analysis. Results: The results of the quantitative survey showed that lower back pain is mostly caused by lifting and carrying heavy loads, inadequate working conditions, poor physical fitness, regular nights out, shift work, and stress. Dissatisfaction with work, shift work and unsuitable working conditions significantly affect the incidence of low back pain. Absenteeism is influenced by factors such as dissatisfaction at work, disrespectful attitude of managers, unsuitable working conditions, personal dissatisfaction, lack of understanding of the partner, and enjoying nightlife on a regular basis. Conclusions: The study clarifies the unexplained holistic psychosocial risk factors and treatment effects on health in the population of professional drivers. Such factors can lead to absenteeism. The study also provides initial demonstration research in the Slovenian practice. Furthermore, it provides solutions in a holistic approach to solve the problem of risk factors management.

Objective: Tobacco related comorbidities and treatment of dependence are relevant to clinicians of all disciplines. Clinicians should provide a brief intervention about tobacco use with smokers at each clinical contact (success rate of 5-10 %). Intensive treatment (success rate >30%) should be available to those who need it. Brief intervention is not yet standard clinical practice. Our aim was to assess clinical practice guidelines (CPG) of selected medical professional societies to determine whether or not tobacco dependence treatment recommendations were included. Methods: Between October and December 2013, we conducted a keyword search of CPG for 20 medical professional societies in the Czech Republic. We searched for the keywords "smoking", "tobacco" and "nicotine addiction" in 91 CPG documents, which were freely available on the websites of selected professional societies. We focused specifically on CPG relating to cardiovascular and respiratory diseases as well as cancer. We excluded any CPG focused on acute conditions, diagnostics only, laboratory methods, or administration. Results: There was no mention of smoking in 27.7% (26/94) of CPG documents. Only 16% (15/94) of CPG documents listed smoking as a risk factor. 42.5% (40/94) mentioned smoking related phrases (e.g. "smoking ban"). Only 13.8% (13/94) of CPG included a section on tobacco dependence, referenced tobacco dependence treatment guidelines or mentioned specialized treatment centres where smokers can be referred. Conclusion: Nearly one third of CPG related to cardiovascular and respiratory diseases as well as cancer made no mention of smoking. Despite the clinical significance of smoking, the majority of CPG did not adequately address tobacco dependence and its treatment.

Background: The incidence of mumps has decreased in many countries since the introduction of vaccination programmes, however, in the past decade a rapid increase in the disease occurrence has been reported worldwide. The reason for this situation is still not clear. We present the results of a serological survey carried out in the Eastern Bohemia Region of the Czech Republic during the years 2008-2012. Methods: In total, 2,536 samples of 2,034 patients were examined during the study period. The study cohort was divided into two groups, one consisted of individuals born before the introduction of mandatory vaccination and the other one comprised individuals born after mandatory vaccination started. For the serology analyses the ELISA kits RIDASCREEN Mumpsvirus IgM and IgG (R-Biopharm®, Germany) were used. Results: Out of 2,536 samples (including paired sera), 23.9% (n=606) were positive and 12% (n=304) had equivocal results. Most of the positive samples were obtained from patients aged 17-20 years. Significantly more (p<0.05) positive patients were born after the start of the national vaccination programme (patient group 2) (22.8%) compared to those born before its start (patient group 1) (13.7%). Interestingly, the analysis of data showed that 75.3% of patients falling into group 1 had anti-mumps IgG antibodies, which means that they had contracted mumps, whilst 23.5% of patients of group 2 had undetectable IgG antibodies, even though they should have been vaccinated. Conclusion: The data from our study, with a low number of positive samples in the first years of the study and an increase in the last two years, could suggest the occurrence of outbreaks every 4-6 years.

Increasing bacterial resistance to quinolone antibiotics is apparent in both humans and animals. For humans, a potential source of resistant bacteria may be animals or their products entering the human food chain, for example poultry. Between July 2013 and September 2014, samples were collected and analyzed in the Moravian regions of the Czech Republic to isolate the bacterium Escherichia coli. As a result, 212 E. coli isolates were obtained comprising 126 environmental isolates from poultry houses and 86 isolates from cloacal swabs from market-weight turkeys. Subsequently, the E. coli isolates were tested for susceptibility to selected antibiotics. Resistance of the poultry isolates to quinolones ranged from 53% to 73%. Additionally, the presence of plasmid-mediated resistance genes was studied. The genes were confirmed in 58% of the tested strains. The data on resistance of isolates from poultry were compared with results of resistance tests in human isolates obtained in the same regions. The high levels of resistance determined by both phenotyping and genotyping methods and reported in the present study confirm the fact that the use of fluoroquinolones in poultry should be closely monitored.

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

Objectives: Our study assessed sexually transmitted infections (STI) occurrence and risk behaviours from a sample of the defence forces of Estonia. Previous research on military personnel yields various results on the prevalence of STIs and high risk behaviours. The increasing recognition of high risk behaviours among military personnel is evident given increased programmes that focus on education of drug use and risky sexual behaviours. Many militaries conduct routine, periodic screening for diseases such as HIV and viral hepatitis at entry and pre-foreign deployment. Protecting deployed forces from secondary infections is important as persons with chronic viral infections are living longer, healthier lives and are more frequently serving in military forces. Methods: A cross sectional study used convenient sampling among professional defence forces. Participation was both voluntary and anonymous. Results: Of 186 participants accounting for 7.3% of all forces (86.6% male, mean age 30 years) at selected bases, there were four cases of chlamydia. No cases of gonorrhea, trichomoniasis, hepatitis C, hepatitis B, or HIV were found. One person reported ever injecting drugs. Conclusions: These findings indicate a lower STI occurrence among professional defence forces in Estonia compared with the non-military population. While these rates were lower than expected, as a voluntary study, people suspicious of having an STI might opt not to participate, limiting generalizability to the remainder of the military. Militaries without regular screening programmes could consider regular scheduled testing for STIs, HIV and blood borne pathogens, even if voluntary, especially prior to foreign deployment. Consistent testing would align across many militaries who deploy international peace keepers.

Objective: The incorrect composition of a diet, its atherogenicity, is conducive to the occurrence of lipid disorders, arterial hypertension (HTN), diabetes, and metabolic syndrome (MetS). The aim of the study was to evaluate the prevalence of incorrect anthropometric and biochemical parameters as well as diet atherogenicity. Methods: The study group included 1,520 adults (880 women, 640 men). The nutritional status evaluation was based on respondents' BMI and waist circumference. The diet atherogenicity was estimated using Keys Index (KI) and P/S ratio. Total cholesterol (TCh), LDL cholesterol as well as triglycerides (TG) concentration in blood serum were also evaluated. Results: In 56.8% of women and 60.8% of men waist circumference exceeded referential values. The diets of 71.4% of women and 87.3% of men were atherogenic. HTN was observed in 64.1% of the study population. Hypercholesterolaemia was found in approximately 72% of the respondents. The increased LDL cholesterol concentration were found in 57.5% of women and 64.5% of men. Abnormal concentration of HDL cholesterol occurred among approximately 20% of respondents. Hypertriglyceridaemia was recognised in 26% of women and 44% of men. In the group of women and men with HTN, mean values, i.e. BMI, waist circumference and TG (with TCh concentration additionally noted in men) were found as significant. Normal lipid profile and arterial pressure values were observed in 6.6% of the population. Conclusions: In the diets of men with HTN were observed higher values of KI compared to group without HTN. No significant differences were found in the frequency of occurrence of the analysed parameters either among the group of women with HTN or without it. In the group of men with HTN, the abnormal BMI, waist circumference and TG occurred more frequently.

Background: Homelessness is a form of social pathology, which is for various reasons undesirable and as far as possible limited by efforts such as programmes that assist in transitioning out of homelessness. Because, as time passes, the homeless population undergoes both quantitative and qualitative changes, the process of developing these programmes requires up-to-date information on the extent and profile of this phenomenon that takes into account the characteristics of a given country. Methods: A 12-month study of homeless individuals (ETHOS categories 1.1, 2.1 and 3.1) was conducted between December 2013 and November 2014 in Olsztyn, Poland. Demographic, sociological, psychological, and medical data were collected. Results: The study population comprised 98 homeless individuals. The average homeless individual in our study population was a single (93.88%), most commonly divorced (59.18%), alcohol-dependent (78.57%), smoking (84.69%), middle-aged (54.33 years, SD 9.70) male (92.86%) with a low level of education (10.19 years of completed education, SD 3.09). The individual was most commonly an unemployed person suffering profound privation, living off various types of benefits, and spending a significant proportion of his income on alcohol and cigarettes. The person often resigned from social welfare due to his alcohol dependence. Almost a third of the study population (32.65%) declared that they occasionally went hungry. The principal source of food were meals provided by welfare services (89.80%). Conclusions: Our results indicate that the design of the social welfare system for homeless people should always take into account issues related to alcohol dependence, and each homeless person should be evaluated for possible alcohol dependence. Institutionalised material support provided to homeless individuals should be organised in such a way as to minimise the risk of promoting alcohol and nicotine dependence.

Objectives: The aim of this study was to analyze the relationship between the sense of coherence and the level of mental load among nurses working at a chemotherapy ward. Methods: The study, conducted in 2013, included 164 nurses working at inpatient chemotherapy wards in Krakow, Poznan, Kielce, and Gliwice (Poland). The mean age of the study participants was 43.07 ± 7.99 years. The study was based on a diagnostic survey with Antonovsky's Sense of Coherence Scale (SOC-29) and Meister questionnaire. Results: The levels of Mental Load, Monotony and Unspecific Load, correlated inversely with the levels of Coherence, Manageability, Meaningfulness, and Comprehensibility. Longer work experience was associated with lower levels of Coherence, Manageability and Comprehensibility and higher levels of Mental Load, Overload and Monotony. Age of nurses correlated inversely with the Manageability level. Heavy mental and physical workload turned out to be the main factor causing dissatisfaction of the study participants. Conclusions: Longer work experience and lower levels of Coherence are associated with higher risk for mental overload.

Objective: In Slovakia, thanks to a highly effective vaccination programme, no domestic cases of measles have been reported since 1999. However, there are several outbreaks of measles currently hitting some countries in Europe. Difficulties in reaching the goal of measles elimination make it necessary to monitor the status of the population susceptibility to prevent similar outbreaks in the future. We hypothesize that immunity wanes overtime, which can substantially impact the population susceptibility. This work introduces a model that estimates a proportion of individuals susceptible to measles in the Slovak population in 2015. Methods: Our analysis is based on an age-cohort model that incorporates waning immunity, vaccination schedule and changes in demographic structure. The inputs of the model are data on the vaccination coverage, last seroprevalence survey in 2002 and age structure of the population. Results: In a short-term horizon, waning immunity does not affect the estimated proportion of the susceptible population. However, in a long-term horizon, the antibody titers can fall below the level of protection, which would result in a substantial transfer of initially immune individuals to the compartment of the susceptible ones. Incorporating of waning immunity in the cohort model has indicated that the most susceptible cohorts are not-vaccinated youngest children and cohorts born between 1969 and 1986. Conclusions: Applying the model to the current situation shows that people aged 30-45 years and unvaccinated infants represent the most susceptible groups. Model partially replaces missing seroprevalence survey, but, because the parameters of model and phenomenon of waning immunity are not exactly known, we suggest reintroducing the regular national serosurveys in order to empirically determine the level of susceptibility for measles in Slovakia.

Objective: The study examined the links between pressure pain sensitivity (PPS) measured during preventive medical examination of men, their health status and occupation. Method: A one year (2015-2016) convenience sampling technique was used to gain primary data from actual medical examination, health records (personal and occupational history) and pressure pain sensitivity (PPS) measured by Ull Meter equipment during preventive medical examination of 371 men of different occupations (average age 43.6±10.4 years, range 19-66 years). Measured PPS values of 60 or more indicate high PPS, contrary PPS values to 40 indicate low PPS. Results: 345 men (93%) were considered healthy (without diagnosis of a disease), 26 men (7%) had positive personal history/symptoms of disease. The average of measured PPS values for the whole group was 36.6±9.5 (first measurement) and 36.7±8.5 (second, repeated measurement), suggesting a high reproducibility of the measurements (r=0.80). Decreased PPS values were measured in men without reported diagnosis of a disease compared to men with diagnosed diseases. Elevated PPS values were measured in men with symptoms of neurocirculatory asthenia (NCA) compared to asymptomatic men and also to men with different diagnosis. The group of men with other than NCA symptoms did not differ significantly in PPS values compared to group of asymptomatic men. Road drivers (177 men) did not differ significantly compared to other occupations (194 men). Conclusion: The increased neuropsychological load/stress is connected with increased pain sensitivity to pressure. The PPS method is objective, reliable, simple, and noninvasive evaluation of the impact of stress and may be helpful in assessing medical fitness to work.

Background: The paper presents the results od 22-year study of screening and follow-up of haemoglobinopathies in Slovakia, an overview of genetic mutations, the coincidence with hereditary haemochromatosis mutations, and the procedure in genetic councelling. Methods: Between 1993-2015, in three centres in Bratislava and in one centre in Kosice, carriers of beta-thalassaemic genes or other haemoglobinopathies were searched for. Diagnosis was performed by haematologists, whereby the family history was evaluated, together with the overall clinical condition, blood count and blood smear, iron and haemolysis parameters, mutations of hereditary haemochromatosis, and haemoglobin electrophoresis testing. In the last years the haemoglobin division also examined by high performance liquid chromatography (HPLC). Results: A clinical suspicion of the heterozygous form of beta-thalassaemia or other haemoglobinopathies was documented in 554 patients. Of them 32 (5.8%) were foreigners. 213 (38.45%) patients were genetically examined. In 190 (33.93%) of them heterozygote beta-thalassaemia was confirmed. The most frequent mutations were IVS 1.110 (33.15%), IVS 2.1 (33.15%), and IVS 1.6 (14.7%). Evidence of haemoglobin S (heterozygote sickle cell anaemia) was also notable in two non-relative children, whose fathers were of African origin, and one patient from Ghana. One female patient was followed up for haemoglobin Santa Ana (non-stabile haemoglobin previously diagnosed as mutation de novo). In our group, we took care of pregnant patients with haemoglobinopathies. Conclusions: The study showed that there is a higher number of heterozygotes for beta-thalassaemia and rarely haemoglobinopathies in Slovakia. Over the past years, we have recorded an increase number of foreigners coming to our country. It is necessary to continue in search of pathological gene carriers to avoid serious forms of haemoglobinopathies.

Objective: Public health status of populations is multifactorial and besides other factors it is linked to war and conflict. Public health crisis can erupt when states go to war or are invaded; health security may be reduced for affected populations. Methods: This study reviews in aggregate multiple indices of human security, human development and legitimacy of the state in order to describe a predictable global health portrait. Results: Paradigm shift of large global powers to that non-state actors and proxies impact regional influence through scaled conflict and present major global health challenges for policy makers. Small scale conflict with large scale violence threatens health security for at-risk populations. Conclusion: The paper concludes that health security is directly proportional to state security.

Background: Acute coronary syndrome (ACS) is a major health problem and the leading cause of death and disability in Slovakia. This is the first study to describe the prevalence rate of conventional cardiovascular risk factors in patients hospitalized for ACS. Methods: Hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking were documented in 1,567 cases (mean age, SD: 66.1±12.0 years, 34.8% of females) enrolled in the SLOVAKS registry from August 2011 through September 2011. Results: Overall, 83.5% (95% CI, 81.6-85.2%) of the patients with ACS had hypertension, 65.0% (62.5-67.2%) had a hyperlipidemic profile, 32.6% (30.3-34.9%) were diagnosed with diabetes, and 27.6% (25.1-29.8%) were smokers at the time of a heart-related event. Only 5% of patients with ACS lacked any of the 4 conventional risk factors. Higher prevalence rates of all major risk factors, except smoking, were detected in women than in men, in older (≥65 years of age) than younger patients, and in rural (<2,000 inhabitants) than in urban areas. Premature ACS (<45 years of age) was associated with smoking in men, and smoking and hypertension in women. Smoking, in all risk factor combinations, reduced the age at the time of a heart-related event, on average, by 10.0 years in men and by 12.4 years in women. Conclusions: The results of this study suggest an appreciable burden of major cardiovascular risk factors and also highlight differences that may aid the targeting of public health interventions.

Nanoparticles exist for a long time as both inorganic and organic parts of nature. Recently, massive expansion of nanotechnologies is evidenced, together with intentional production of new nanoparticles which have not been in contact with living organisms until now. Besides obvious positive aspects, potential threats related to their exposure should be taken into consideration. Unique physical-chemical properties of nanoparticles cause a high bioactivity following their intake (through air, ingestion and skin) and unrestricted spread in exposed organs. Primary effects of nanoparticles on cellular level represent oxidative stress and reactions leading to apoptosis, autophagocytosis and necrosis. Number of studies indicating contribution of nanoparticles to numerous disorders has been recently increasing. However, detailed mechanisms of health effects are not well known. Similarly, there is insufficient information on life cycle of nanoparticles in the environment. Research in this field as well as legislation is behind rapid development and use of nanotechnologies. Considering absence of mandatory exposure limits and other protective measures, nanomaterials represent a potential threat for population health. Recommendations and guidelines of international institutions can contribute to deal with situation, however, passing of effective legislation both on national and European level is urgently needed.

Aim: The aim of the study was to assess the self-reported oral health behaviour of Scandinavian and Polish medical students studying in Poland. Methods: Three hundred and fifty subjects took part in the questionnaire survey. They were the 4th to 6th year Scandinavian and Polish medical students attending the same medical school. Test-retest reliability demonstrated an accepted level of kappa > 0.50. The questionnaire comprised issues dealing with demographics, dental health behaviour, fluoride tablet recommendation, self-rated oral health, and smoking habit. Statistical analyses were performed using the Fisher-Freeman-Halton test, Fisher's exact test and the multiple logistic regression. A p value<0.05 was considered significant. Results: Gender and nationality statistical differences were observed regarding the frequency of visiting a dentist: more Polish females visited a dentist less than a year ago (p=0.011), the reasons for visiting a dentist - check up, filling (p=0.002; p=0.040); the frequency of tooth brushing was higher among Polish females compared to Polish males and Scandinavian females (p<0.001; p<0.001). Polish males ate sweet snacks significantly more often than Polish females and Scandinavian males (p=0.018; p=0.004). In the logistic regression analysis factors were independently associated with visiting a dentist at least once a year: female gender (OR=2.310; 95% CI 1.381-3.865), Polish nationality (OR=3.833; 95% CI 2.293-6.408). Associations with the female gender were significant for the following dependent variables: visiting a dentist more than a year ago (OR=1.913; 95% CI 1.192-3.070), brushing teeth at least once a day (OR=3.759; 95% CI 1.567-9.017), and use of dental floss (OR=2.249; 95% CI 1.445-3.503). Polish nationality was associated with an increasing rate of brushing teeth for at least 3 minutes (OR=2.435; 95% CI 1.526-3.885), and smoking cigarettes (OR=2.340; 95% CI 1.336-4.098). Conclusions: Better prognosis for maintaining good oral health was established in the Scandinavian group of students. Polish females took greater care of their teeth than Polish males and the majority of their Scandinavian counterparts.

Objective: A new 'normal' in global affairs may be erupting from large global powers to that of non-state actors and proxies committing violence through scaled conflict in a post-Westphalian world generating significant global health policy challenges. Health security of populations are multifactorial and indirectly proportional to war, conflict and disaster. Preventing conflict and avoiding the health vacuum that occurs in war and violence may be best practices for policy makers. This paper considers an approach of applying clinical primary prevention principles to global health policy. Methods: Brief policy review of current standards and practices in health security in fragile and failed states and prevention; and definitions discussion. A short case study series are presented with best practices, with risk and outcome review. Results: The global balance of power and order may be shifting through geopolitical transference and inadequate action by major global power brokers. Health security in at risk nation-states may be decreasing as a result. Conclusion: Small scale conflict with large-scale violence threatens health security and may experience increased incidence and prevalence in fragile and failed states. Preventative policy to resuscitate fragile and failed states and prevent further external and internal shocks may support health and promote a positive feedback loop of further state stability and increased health security. Public health policy shift to mitigate state failure and public health crisis in war and conflict through the basis of primary prevention may provide best practices and maximize health security for at risk populations.

Objective: The aim of the study was to evaluate alcohol consumption in a representative sample of the population of the city of Brno, as part of research on cardiovascular risk factors. Methods: Cross-sectional survey on a sample of 2,160 randomly selected residents 35-65 years old was carried out. For the invited volunteers who became a part of the investigation, alcohol consumption was determined in a controlled, face to face interview structured in accordance with a special questionnaire form. The frequency of alcohol consumption during the previous year was determined, in more detail during the last month (including quantification using "units of alcohol", their normal and maximum level of drinking, and any association between alcohol consumption and meals), and during the last week in the form of a complete, beverage specified and quantified 7-day recall period. Typical patterns of alcohol consumption were explored by the means of cluster analysis. Results: During the past 12 months, 90.0% of the men and 79.0% of the women had consumed alcohol, the rest can be considered abstinent. The most commonly reported frequency was 2-4 times per week (35.6% of the men), or 1-3 times per month (22.8% of the women). Daily or almost daily consumption was reported by 24.8% of the men and 12.8% of the women. The number of units of alcohol consumed usually on one occasion amounts to an average of 3.88 ± 4.80 for the men and 2.25 ± 1.39 for the women, but the amount most often cited by both sexes was 2 drinks (36.4% of the men and 40.4% of the women). The largest amount consumed on any occasion during the last 30 days was 5 or more units in 69.3% of the men, and in 33.9% of the women it was 4 or more units (this amount of alcohol leads to a blood alcohol concentration (BAC) of 0.08, the border of drunkenness). In 19.9% of the men and 7.5% of the women, this border was exceeded more than 5 times in the past month. Only 14.7% of the men and 10.3% of the women reported that the majority of their alcohol consumption occurs with food; on the contrary, 64.3% of the men and 77.6% of the women drinkers drink it either always without food or only rarely with it. During the past week, 81.6% of the men and 63.4% of the women drank alcohol (p < 0.001, chi-square). The average value of consumption for one man was 11.57 ± 11.91 doses, and for one woman 4.68 ± 6.38 doses per week (p < 0.001, t-test). A total of 17.8% of the men exceeded the limit of 21 doses per week, and 7.4% of the women exceeded 14 doses/week. After converting the weekly consumption into the number of units of alcohol per week expressed in litres per year, the total average consumption was 5.01 ± 6.36 litres; for the men 7.26 ± 7.62 litres and for the women 3.02 ± 4.08 litres of pure alcohol per person annually. Consumption during the week was not uniform (p < 0.001, ANOVA), with the highest occurring on Saturday, followed by Friday. The men mostly drank beer (62.9% of the total volume of alcohol), the women wine (68.6%). The cluster analysis identified 5 clusters of respondents, based on a set of alcohol consumption variables, as follows: very heavy drinking (1.6% of the respondents who drink alcohol); heavy drinking (8.8%); binge drinking (6.3%); mod

Objectives: The aim of the study was to examine body-image dissatisfaction in adolescents aged 13-15 years reporting to be on a diet and to assess gender and age differences in weight-reduction behaviour in Slovak adolescents. Methods: Data on a representative sample of 2,765 adolescents (mean age 14.37 years) from the Slovak part of Health Behaviour in School Aged Children Study carried out in 2014 were analysed. Self-reported body-image dissatisfaction and engagement in weight-reduction behaviour of 13 to 15-year-old adolescents was assessed using multiple logistic regression models. Results: More that 20% of boys and 35% of girls perceived themselves to be too fat. Girls reported being on a diet more frequently than boys (28.8% vs. 14.9%). The most frequent weight-reduction behaviours were drinking more water (67.7%), eating more fruits and vegetables (67.1%), and consuming fewer sweets (60.5%) and soft drinks (51.7%). Girls prevailed above boys in the use of these dietary methods. Age differences were not apparent, except for smoking, believed to help in weight reduction and used upmost by 15-year-olds (8.9%) followed by 14 and 13-year-olds, 6.0% and 4.1%, respectively. Conclusions: Body-image dissatisfaction and weight-control behaviour are issues particularly in girls, however, they did not necessarily correspond with actual obesity. The most commonly used weight-reduction behaviours are in the same way important aspects of a healthy lifestyle. There is room to improve obesity control, particularly within primary health care.

Objective: The authors researched the incidence of suicidal thoughts and related factors in 123 patients of the psychiatric ward of the Hospital of České Budějovice with diagnosed attempted suicide in their medical history for the period from January 2013 - June 2015. Methods: The research was carried out in two stages. At the beginning of the hospitalization, quantitative data collection was implemented using a semi-structured questionnaire, followed by qualitative research conducted with semi-structured phone conversation, based on previous patient's written consent. The research data were statistically processed to obtain information about the character of relations among individual characteristics. To quantify them, the Bayesian Network (BN) was constructed, and to identify relations among individual characteristics, the Hill-Climbing algorithm was used. Before deriving the network, variables were discretized. The network parameters were set based on a data matrix using the maximal plausibility method. Results: The results of analysed set show that the probability of suicidal thoughts is high, achieving a value of 0.750 (0.781 for women and 0.724 for men). If the patient visits a contact centre for drug-addicted persons, the probability of suicidal thoughts decreases to 0.683. If the patient visits a psychotherapist, the values of 0.736 are achieved. If a daily care centre is visited, the estimated risk rises to 0.832 and the probability of the patient repetitively attempting suicide is 0.606. If the interviewed person regularly consumes alcohol, the probable relapse amounts to 0.616. But if the person consumes alcohol from time to time, the probability rises to 0.701. In case of abstinence, the probable relapse decreases to 0.565. Conclusions: The incidence of suicidal thoughts in observed patients was high, and the amount of risk was influenced by gender, by visiting follow-up care facilities, psychotherapy, and particularly by the frequency of alcohol consumption. Intermittent alcohol consumption is the highest-risk factor in connection with relapsing suicide. In case of psychiatric patients with attempted suicide in their medical history, all verified preventive and therapeutic procedures that can contribute to prevention of relapses should be used within follow-up professional care. Specific approach of the closest social environment, medical literacy of the population and state safety measures are important.

Objective: A worldwide syphilis incidence increase was recorded at the beginning of the new millennium, occurring primarily among men who have sex with men (MSM). The aim of this study was to analyse the epidemiological situation of syphilis in the Belgrade population between 2005 and 2014 and to examine the characteristics of an early syphilis outbreak among MSM in Belgrade in 2014. Method: Reporting of syphilis is compulsory in Serbia. Routinely reported data were analysed along with data collected from patients' charts. Results: During the period observed, syphilis incidence increased from 1.07 per 100,000 in 2005 to 4.1 per 100,000 in 2014 (383.2%). From 2005 to 2009, syphilis rates in Belgrade were low, around 1 case per 100,000 people. The first outbreak was registered in 2010. The new incidence increase happened in 2012, and again in 2014 when it was the highest. These incidence changes were registered mainly in men, where the frequency of syphilis was much higher than in women. In 2014, primary syphilis was diagnosed in 20 cases, secondary syphilis in 42, and early latent syphilis in 9 patients. Fifty-seven were MSM, 10 were heterosexual men and 4 were women. Twenty-four cases, all MSM were co-infected with HIV. Majority of patients acquired infection in Belgrade, while in 42/71 cases oral sex was the only risk factor. In comparison with HIV negative, HIV positive syphilis patients were older, more frequently unemployed and MSM. They also more frequently had sex with unknown partners and were diagnosed in the secondary stage of infection. Conclusions: Study results underline the need for coordinated and expeditious surveillance, partner services, enhanced screening of population at risk, health education, as well as early diagnosis and treatment.

Objective: Metabolic syndrome is a combination of clinical risk factors for cardiovascular disease as well as for diabetes. Metabolic syndrome arises from insulin resistance accompanied with abnormal adipose deposition. The aim of our cross-sectional time trends study was to characterize the prevalence of metabolic syndrome and its five risk determinants among the clients of Health Advice Centres of Regional Public Health Authorities in Slovakia. The study was stratified by gender and age groups during the 10 year period from 2003-2012. Methods: Prevalence data were estimated in adults and children (≥ 10 years, N = 79,904) from the nationwide electronic database of Health Advice Centres of Regional Public Health Authorities in Slovak Republic "Test of healthy heart" from 2003 to 2012. Results: The overall prevalence of metabolic syndrome was 30.2% in males and 26.6% in females, abdominal obesity was confirmed in 48.3% of males and 53.9% of females. Increased triglyceride level has higher prevalence among males (33.3%) compared to females (24.2%). Blood pressure (BP) values and fasting glucose values were significantly higher in males (58.2%) than females (41.9%). During the 10 year period from 2003 to 2012, we confirmed an increased trend in the age-adjusted prevalence of metabolic syndrome. Abdominal obesity and elevated triglycerides had also increased time trends prevalence in both sexes. The prevalence of people without risk determinants of metabolic syndrome had a time decreasing trend. A surprising finding is a decrease in the proportion of persons with suboptimal HDL-cholesterol. The proportion of people with elevated BP and glucose showed little change during the reporting period. Conclusion: The increasing prevalence of metabolic syndrome, abdominal obesity, and elevated triglycerides highlights the urgency of addressing these health problems as a healthcare priority to reduce cardiovascular mortality in the Slovak Republic.

Aim: The aim of this study was to compute the potential gains in life expectancy (PGLEs) if the five main groups of non-communicable disease deaths were eliminated in the Slovak population during 1996-2014, and to decompose PGLEs by five-year age groups. Methods: PGLEs were computed from mortality reports for deaths from ischaemic heart disease (I20-25), cerebrovascular diseases (I60-I69), cancer (C00-C97), diabetes mellitus (E10-E14), and chronic respiratory diseases (J30-J98) using the life table decomposition technique. Results: In 2014, life expectancy at birth was 76.87 years compared to 72.87 in 1996. The highest impact on life expectancy was recorded for ischaemic heart disease and PGLEs have changed from 3.9 years to 4.6 over 1996-2014. However, the trends for other diseases did not fluctuate. The PGLEs of cancer, as the second most influential disease, increased from 3.3 years to 3.6. Conversely, a slight decline was observed in cerebrovascular diseases from 1.13 years to 1.12, and diabetes mellitus from 0.14 years to 0.13. The proportion of diabetes mellitus and chronic respiratory diseases in PGLEs was low, approaching zero. As far as PGLEs among age groups in 2014 are concerened: whereas PGLEs for ischaemic heart disease mortality reduction are very similar among all age groups they are mostly on the decrease from other causes of death. However, PGLEs reached a value of 0.13 years in the 0-54 years age-group for diabetes mellitus; this means that the number of years of life lost are the same for 54 year old people and younger, with the impact of diabetes mellitus declining at age 55 and over. The same scenario is apparent for cerebrovascular diseases. The impact of mortality from other causes of death is decreasing with age. Conclusions: Our findings suggest that optimum benefit would be gained from prevention programs for reduction of ischaemic heart disease mortality in all age groups.

Aim: The concept of amenable mortality is intended to assess health care system performance. It is defined as "premature deaths that should not occur in the presence of timely and effective health care". The purpose of paper is to analyse differences in amenable mortality across European Union countries and to determine the associations between amenable mortality and life expectancy at birth. Methods: This is a cross-country and time trend analysis. Data on deaths by cause, and five-year age groups were obtained from the World Health Organization database for the 20 European Union countries, throughout the period from 2002 to 2013. The rates of amenable mortality were expressed by the age-standardised death rates per 100,000 inhabitants. We applied the method of direct standardisation using the European Standard Population. Results: Throughout the explored period, the statistically significant variations of the age-standardised death rates in a relation to the European Union average fluctuated from 78.7 per 100,000 inhabitants (95% CI 72.4-84.9) in France to 374.3 per 100,000 inhabitants (95% CI 350.8-397.7) in Latvia. The leading causes of amenable mortality were ischaemic heart disease, cerebrovascular diseases, and colorectal cancer that accounted for, respectively, 42.2%, 19.5%, and 11.3% of overall amenable mortality. As expected, statistically significant strong negative relationship (R² = 0.95; ρ = -0.98) between amenable mortality and life expectancy at birth was proved by linear regression. The concept has several limitations relating to the selection of causes of death and setting age threshold over time, not consideration actually available health care resources in each country, as well as differences in the prevalence of diseases among countries. Conclusions: We found an explicit divide in amenable mortality rates between more developed countries of Western, Northern and Southern Europe, and less developed countries of Central and Eastern Europe. Increasing of amenable mortality may suggest deterioration in health care system performance.