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According to the World Health Organization, there are more than one billion smokers in the world, and tobacco is said to kill half of its users. The European Region of WHO, with only 15% of the world's population, faces nearly one third of the worldwide burden of tobacco related diseases. Millions of lives could be saved with effective and comprehensive tobacco control strategy. In response to this, the World Health Organization has offered a wide range of information and recommendations to governments, organizations, health-care professionals, and tobacco users and non-users worldwide. This paper is focusing on various activities that governments, organizations or even individuals can undertake to help smokers to quit and decrease percentages of tobacco users and save millions of lives.

Objective: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Turkey in 2003 and 2009 to examine changes in tobacco use and important tobacco control measures. Methods: The GYTS were conducted in grades 7-9 in 2003 and 7-10 in 2009 in Turkey. Data in this paper are limited to 13 to 15 year old students. A total of 15,957 students from 202 schools participated in 2003 and 5,054 students from 69 schools participated in 2009. The overall response rate was 92.1% in 2003 and 87.5% in 2009. Results: Between 2003 and 2009 current cigarette smoking did not change significantly for either boys (9.4% to 10.2%) or girls (3.5% to 5.3%). Current cigarette smoking was higher among boys than girls in 2003 and in 2009. In 2009, half of students reported they had been exposed to second hand smoking (SHS) at home and 80% reported they had been exposed to SHS in public places. Three in ten students reported they had been exposed to pro-tobacco advertising in newspapers or magazines; one in ten had an object with a cigarette brand logo on it; and 7% had been offered free cigarettes by a cigarette company representative. Two-thirds of current cigarette smokers reported that they wanted to stop smoking; and almost two-thirds had been taught in school in the past year about the dangers of smoking. Conclusion: Passing and implementing the Law No. 4207 on Prevention of Hazards of Tobacco Products, ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), raising tax on tobacco, and requiring pictorial warning labels were important steps forward for tobacco control in Turkey. However, as to the tobacco control much work yet to be accomplished including developing an effective enforcement plan for all tobacco control efforts.

Aim: The aim of the study was to estimate the awareness of healthy lifestyle behaviours in cardiovascular diseases (CVD) prevention and to find out possible determinants of this knowledge among adult residents of Polish provinces with the highest CVD mortality rates. Material and Methods: A cross-sectional analysis of randomly selected representative sample of 2,211 (51.9% women) aged 20-74 years from Łódź and Lublin voivodeships participating in the National Polish Health Survey WOBASZ. Knowledge on CVD prevention, sociodemographic and lifestyle characteristics were collected by an interviewer-administered questionnaire. Blood pressure, anthropometrics, plasma lipids and glucose were measured according to the WHO MONICA protocol. Results: Approximately 68% of participants, had poor awareness of preventive methods and majority of them were not able to name any specific approach. Most often mentioned method of CVD prevention was relaxing/avoiding stress (51.2%). The least known healthy behaviour was a reduction of salt intake and adequate fruit/vegetables consumption, mentioned by 18.2% and 23%, respectively. About 16.4% of women and 23% of men with risk factors of CVD were not aware of any non-pharmacological preventive method. Poor knowledge of CVD prevention was significantly more prevalent among persons aged ≥65 years, with elementary education level, lower income, living in the rural settings, declaring poor self-rated health. Dietary and physical activity advice given by a primary care physician was significantly related to better knowledge among men with CVD risk factors. Conclusions: There is a need to focus on increasing educational level in this regions, especially in rural settings. Due to important role of primary care physicians in health education, more attention should be paid to individuals with CVD risk factors as their preventive knowledge level is very low and comparable to the level of low-risk individuals.

The aim of this study was to evaluate the cardiovascular risk (CVR) factors and morbidity in a sample of the population that received a brief intervention on cardiovascular prevention seven years ago. All family physicians who participated in the Cardiovascular Prevention Campaign in five Belgian towns in 2002-2003 received a follow-up questionnaire for each participating patient. The questionnaire included questions about new cardiovascular diagnoses, parameters of the latest physical examination and blood tests. Analyses were based on the 318 questionnaires that included essential information such as the date of the latest contact and the new diagnosis or mortality. The proportion of patients with a low CVR decreased from 75% in 2002-2003 to 40% in 2010. Participants showed a significant increase of the abdominal circumference, triglycerides and fasting glycaemia. Only LDL-cholesterol levels decreased significantly (p=0.002). Four percent of the patients died, more male (7%) than female (2%) (p=0.03). One in ten patients presented with a cardiovascular event. Most of the changes are probably attributable to age. It is clear that the long-term effect of a brief intervention only followed by usual care is not sufficient to attain optimal level of cardiovascular prevention.

The objective of the study was to estimate the possible association of maternal diseases with the risk of isolated ear congenital abnormalities (IECA) including mainly microtia and anotia in their children. Incidence of acute and prevalence of chronic maternal diseases in the mothers with IECA and in the mothers of their matched controls and all controls without any defects, in addition in the mothers of malformed controls with other isolated defects was compared in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Of 354 cases with IECA, 32 had mothers with high fever related influenza-common cold during the critical period of IECA and it resulted in a higher risk of IECA in their live-born infants (adjusted OR with 95% CI: 4.3, 1.9-7.4) compared with their matched controls. However, the early and effective antifever treatment in these pregnant women prevented them from the IECA. In addition there was an association of maternal otitis media with higher risk of complex defects of middle and external ears (OR with 95% CI: 5.2, 1.6-28.3), however, this association was based on 4 cases only. In conclusion high fever related influenza-common cold with secondary complications may play a role in the origin of IECA, but is preventable with the early and effective antifever treatment of these pregnant women.

Background: The United Nations' Global Population Pyramid is undertaking a shift from pyramid to cube. The concomitant decline in fertility and mortality rates produces a higher portion of older people, and, thus, an increased number of deaths due to cancer and cardiovascular disease (CVD). Limited studies have investigated the effect of health care services on longevity. In this work, findings from studies throughout the world are presented and re-analysed in order to evaluate the effect of health care services on population's health status. Methods: Studies that have assessed the associations of nutritional and other health care services (i.e., physicians supply, technical support, inter-collaboration) on longevity and health status were retrieved (searches in PubMed, EMBASE, Scopus, up to January 2010), and summarized here. Results: Few studies, mostly located in the US and the UK, have evaluated the role of health care services on population's health status. The majority of the studies reported a beneficial association between the frequency of physicians and mortality, while some other studies reported weak or no associations between physician's supply and longevity. Also nutritional services (screening) seem to promote better clinical outcome. Conclusion: Although very few data are available, it seems that there is a positive correlation between the quality and quantity of health care services and longevity. Strong primary health care seems to be effective on the population's health outcome. Active health policy and enhance-ment of health and nutritional services within the health care system may contribute to improved population's health and their overall quality of life.

The Liberec Regional Assembly, as the first among other regions in the Czech Republic, being aware of high importance of health for long-term and sustainable social an economical development, approved the political and strategic document on health improvement through the resolution No. 11 from December 17th 2002. It comes out from the conviction, that health of population is one of the basic conditions of prosperity of region as well as the satisfaction of people. The Regional Assembly approved the draft of Health Policy and decided to propose to the member of the Regional Council managing the health sector an effective system promoting realisation of the Policy. The Regional Assembly wished to reach improvement of key health indicators in the next 15-20 years in cooperation with health and other sectors, communities, nongovernmental organisations, manufacturers, stakeholders and citizens in accordance with European program WHO HEALTH 21. The Regional Assembly wants to create suitable conditions in health care, in prevention of diseases and in health promotion for this purpose. The draft of the Policy was submitted to the Regional Assembly by the Regional Council and it was prepared by special group managed by director of the Regional Hygiene Station which brought a great part of its own initiative in the process of development and realization of the document. The basis of the draft was Report on Health of Population of the Liberec Region, prepared by the Regional Hygienic Station in November 2001. Since this time we have prepared Health Status Report every year, because it is not only starting point of our work but also a tool of evaluation of our effectiveness. It describes health status data, its economical, social and environmental risk factors as well as life style indicators. Regional Health Policy is concentrated into 14 objectives as proposed by the WHO HEALTH 21 and similar Czech program. These 14 selected objectives can be effectively realised in the region. Realisation of Policy is managed by coordinators appointed by the Regional Council. The head of this managing group is the director of the Regional Hygiene Station. Besides permanent working group for the realization health policy there is further important support - Grants in the field of public health. The Regional Assembly provides about 2 mil. CZK every year. Of course Regional Assembly wants to be informed regularly about realization of health policy, i.e. that we have to submit annual report. By now we have submitted the fourth annual report, which at the same time chalks up a new health policy for current year. The range of conducted activities includes health promotion, health protection, primary care, disease management, mobilizing partners for health, education, health impact assessment etc. The Regional Health Policy has some new features with regards to CR: It is governed by well defined improvement of health indicators, it reckons upon cooperation with all sectors and it determines indicators of effect to be monitored.

Objectives: The medical literature shows that both occupational and environmental exposure to lead affect the human health. Once in organism, lead initial produce the physiological absorption state, then the high absorption state that can be diagnosticated using toxicological investigations. Clinical manifestations appear when the absorbed lead is higher than the eliminated lead, generating the acute or chronic intoxication. The transition from one state to another depends on the exposure time and noxes concentration. The aim of this study is to analyze comparative, using some specific and precocious affected biological indicators, two groups of people occupationally and environmentally exposed to lead.
Methods: We investigated 195 workers from the "melting" sector of a non-ferrous metallurgical plant with the mean age = 31.81±8.19 years and the meantime of exposure = 9.03±6.67 years, and 255 people who work in the administrative sector of the same factory and live in the proximity, with the mean age = 35.66±8.49 years and the meantime of exposure = 7.73±6.16 years. We made clinical exam, bio-toxicological investigations, urinary δ-aminolevulinic acid (ALA-u), zinc protoporphyrin (ZPP), standard questionnaires regarding the effects of lead on the human organism, neurological and psychological examination. The air lead exceeded 71.3 times the maximum accepted values.
Results: We found high values of ZPP, over 10 μg/l, in 78.6% exposed workers and 28.2% people from the environmental group. In the environmental group (aged 20-35 years and length of service under 5 years) 19.1% had ZPP over 10 μg/l. High values of ALA-u, over 10 mg/l, were found in 68.1% of the exposed workers and 27.4% from the environmental group. In the group aged 20-35 years and length of service under 5 years, 62.9% workers and 16.6% controls had values over 10 mg/l. There were concordance between ZPP and ALA-u values (r = 0.567, p < 0.001).
Conclusions: There were significant differences between the exposed and control group regarding the values of the intoxication marker ZPP (p < 0.001) and also for the values of ALA-u, which is specific for the lead intoxication (p < 0.001). There were also significant differences regarding ZPP and ALA-u values between the two groups (aged 20-35 years and working length under 5 years) (p < 0.001). The most affected and sensitive were the younger people. The general and professional morbidity correspond with the clinical and toxicological data.

Objectives: To determine the proportion of high risk patients followed at a tertiary care lipid clinic who met recommended lipid targets and to identify predictors of reaching goal lipid levels.
Research design and methods: A retrospective cohort study of 502 high risk patients followed between 1983 and 2003. Clinical and demographic data and fasting lipid profiles were extracted from each patient's first two clinic visits as well as the most recent visit.
Results: All patients in this study were at high risk of cardiovascular events due to dyslipidemia. At "Visit 1", only 55 (11.0%) of patients were at target TC/HDL-C < 4.0, and 97 (19.3%) of patients met target LDL-C < 2.5 mmol/l. At "Visit 3", 229 (45.8%) patients reached TC/HDL-C target, and 216 (43.2%) patients were at LDL-C target. The mean change in lipid values between Visit 1 and Visit 3 was significant (p = 0.0002) for LDL-C and (p < 0.0001) for TC/HDL-C. The use of statins, niacin, or salmon oil were all significantly associated with reaching TC/HDL-C target and LDL-C target, as well male gender, diabetes mellitus and peripheral vascular disease were also associated with reaching LDL-C target. Increasing age and lower body mass index were associated with reaching goal TC/HDL-C.
Conclusions: The mean absolute changes in lipid values were significant and median lipid levels approached target levels in patients followed at specialized clinic, however the majority of high risk patients are not meeting goal lipid levels.

Objective: To prove that higher cigarette taxes eventually decrease smoking and do also increase state incomes from tobacco taxes by using Hungarian figures.
Method: Collection and analysis of available data on tobacco use, levels of excise and value added taxes on tobacco products and state incomes originating from the tobacco sector.
Conclusions: In Hungary, regular tobacco tax increases resulted in decreased cigarette consumption and its lower prevalence figures in some population groups. State incomes have increased in spite of regular cigarette tax raises. Therefore, there is on conflict of interest between the health and finance portfolios in supporting further tobacco tax increases. Hungary should use regular, above the inflation tobacco tax raises as means for improving population health. Tobacco control advocates should prevent tobacco companies' attempts aimed at deterring decision makers from supporting such tax policies.

Even though efforts are made to reduce health disparities, promote health for all social groups and improve health outcomes, inconsistencies still exist. Existing evidence shows that lack of funding, lack of properly trained workforce, as well as heavy workload on health care workers, are the most employed explanations for the limited number of health promotion interventions in the area. This paper presents the results of a descriptive study that pursues to render a comprehensive image of health promotion efforts undertaken in rural Transylvania, Romania. This descriptive analysis is conducted on data extracted from a larger dataset, obtained through a study which pursues a cross-sectional design, with a quantitative strategy of inquiry on access to health information in rural Transylvania. The instrument used for data collection is a questionnaire administered by telephone to a sample of medical doctors working in rural medical offices in the studied area (n=226). Results show overall low rates of health promotion activities in the area, as well as low levels of collaboration with other local actors. In the context of behavioral risk factors, this study clearly shows the need of targeted health promotion activities in rural Transylvania in order to improve health outcomes and mitigate health disparities.

The activities of the kraft pulp-mill in Ružomberok have great impact on ambient air quality in the town and the neighboring villages. The malodorous sulfur compounds adversely contribute to the overall emission profile. The reduced sulfur proportion forms the inorganic and organic compounds containing sulfur atoms in their lowest oxidation condition (S^2-). The total sulfur proportion reduced includes hydrogen sulfide, mercaptans, dimethyl sulfide, dimethyl disulfide and other sulfur compounds. Hydrogen sulfide (H₂S) - as mentioned above - is of prime importance. The kraft pulp-mill has measured of hydrogen sulfide contained in ambient air since 2002. The environmental samples were collected in 7 localities in all their selection based on the geographic, climatic and demographic factors. Four exposure localities in the Ružomberok neighborhood, have been defined by the specified criteria. Exposure assessment was made for each exposure locality by determination of the average daily inhalation dose. The average concentration of H₂S reached 5.8 µg.m^-3 in the most polluted locality (Černová, 2003). To complete the health risk assessment, the standard risk characterization procedure was made by the Hazard Quotient (HQ) calculation for hydrogen sulfide exposure. The highest level of HQ, almost 7, was identified in the event of a worst case exposure scenario (using the 95% concentrations), as for exposure group C. Statistically significant decrease of reported H₂S levels was noted during the entire measurement period (-0.25/year, p<0.001).

The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.

Varicella is a mandatory reportable disease in Slovenia but it is not notifiable in most European countries. The aim of the study was to explore the completeness of mandatory varicella reporting in Slovenia. Data were extracted from three electronic datasets, including: mandatory notifiable communicable diseases dataset (SURVIVAL), health statistics dataset - consultations in primary care (ZUBSTAT), and health statistics dataset - hospitalizations (BOLOB). Age- and sex-specific reporting rates were compared during the period 1997-2006. During the ten-year period studied 168,089 cases were recorded via ZUBSTAT, and 128,222 cases by SURVIVAL. On average 76.2% (range: 62.9%-94.9%) were notified. In both datasets, the notified incidence of varicella was highest for preschool children, with a downward shift in age at contracting varicella. The percentage of notified cases decreased with increasing age. The number of hospitalized cases was low for BOLOB and SURVIVAL. On average 74% of hospitalized cases were reported. The mandatory notification system in Slovenia provides enough information to survey age/sex-specific varicella trends in the prevaccine era.

Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system. The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level.

For several years, some of the countries of the former Soviet Union have experienced the fastest growing HIV epidemic in the world, with the vast majority of reported infections contracted through injecting drug use. However, most governments of the region have been slow to recognize the severity of the problem. The scope and coverage of governmental HIV/AIDS programmes have remained very limited. Harm reduction programmes are mainly financed by external donors, while substitution treatment remains illegal in Russia and unavailable in some other countries of the region. Being based on a review of published and grey literature, this paper explores attitudinal and societal barriers to scaling up HIV programmes in the countries of the former Soviet Union. A major challenge in many countries is negative public attitudes towards people living with HIV, as well as towards those most at risk of contracting the disease: injecting drug users, sex workers, and men who have sex with men. This extends to the actions of state authorities which often pursue a punitive approach to drug users, with high rates of incarceration for minor drug offences. While many of the findings reported here relate to the Russian Federation, there is reason to believe that similar challenges exist in many other countries of the former Soviet Union. More needs to be done to document challenges to HIV prevention and treatment programmes across the region, so that policy interventions can be more effective.

Hantaviruses are RNA viruses of the Bunyaviridae family, represented in the Czech Republic by three genospecies: Dobrava-Belgrade, Puumala and Tula. They persist in natural foci of infection. In 2004 to 2009, a local outbreak with 18 reported cases of nephropathia epidemica caused by Puumala hantavirus occurred in the Šumava mountains and foothills and was spacially associated with another outbreak in Lower Bavaria, Germany. In the Jelení locality in the Šumava mountains at 880 m above sea level, we identified a natural focus of infection suspected to be the source of hantavirus infection in forest workers. The focus was characterized geobotanically as a montane mixed forest with the predominance of beeches within the association Dentario enneaphylli-Fagetum, alliance Fagion, sub-alliance Eu-Fagenion, in a cold climate region with a podzolic soil. The biocenoses where hantaviruses are circulating typically show higher microclimate humidity. Their characteristization can be helpful in predicting where hantaviruses are likely to circulate.

Background: Maternal cervical incompetence in pregnancy (CIP) showed an association with a higher rate of preterm births. The objective of this study was to determine the prevalence of CIP in Hungarian pregnant women, to determine the rate of preterm birth, and to check the preventive efficacy of preterm births due to CIP by therapeutic cerclage or bed rest alone. Methods: Analysis of the population-based large data set of 38,151 newborns (without any defects) of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), born during 1980-1996, i.e. 1.8% of Hungarian newborns. Prospective cohort analysis based on medically recorded variables of CIP, birth weight and gestational age. Results: A total of 2,795 (7.33%) newborns born to mothers with CIP. The newborns of mothers with CIP had a shorter gestational age at delivery (39.0 wk) and higher rate of preterm birth (11.1%) than the Hungarian reference sample without CIP (39.4 wk and 9.0%). Of 2,795 pregnant women with CIP 1,112 were treated by cerclage, while 1,683 with bed rest alone. The mean gestational age was shorter both after therapeutic cerclage (39.2 wk) and particularly bed rest alone (38.9 wk). The rate of preterm births was 9.1% and 12.7% after therapeutic cerclage and bed rest alone. Conclusions: CIP is very frequent in Hungary probably due the extremely high number of previous induced abortion performed by dilatation and curettage method. CIP associates with an increased risk for preterm births; however, this increased risk was reduced by bed rest alone and mainly by therapeutic cerclage.

Background: More than 1 in 5 deaths in Hungary can be attributed to tobacco smoking. The role of the public health agency in responding to and ameliorating the tobacco epidemic in Hungary has been, until now, unexplored. This paper explores the social will of the public health agency workers to adopt tobacco control measures. Methods: 269 Hungarian public health workers throughout Hungary completed an electronic survey on the types of programs offered by the public health agency, the perceived level of responsibility to reduce tobacco use, and the social will of the agencies to curb tobacco use. Multivariate analyses were performed to estimate factors which contribute to the social will to curb tobacco use. Results: 48% of public health workers in Hungary report that it is absolutely important for local public health agencies to offer tobacco prevention and cessation programs, but only 3% indicate that they have earmarked funds to support anti-tobacco programs. Most workers favor more programs and policies to curb tobacco use in Hungary, such as taxation (67%) and banning smoking in restaurants (81%) and confined sporting events (93%). Factors positively associated with a stronger social will for tobacco control included being a former or never smoker (versus a current smoker) (p<0.001) and being middle age (40-49, p=0.04 and 50-59, p=0.01) (versus being under the age of 30). Conclusion: Based on a SWOT (strengths, weaknesses, opportunities and threats) analyses, we argue that public health workers have the potential to play an important role in disseminating health promotion programs and advocating for broader statewide policies that could reduce tobacco use and exposure to environmental tobacco smoke. However, such an opportunity is missed with neither designated funding nor a nationally-dedicated office to tobacco control in Hungary.

Introduction: HIV infection is the major public health, social and economic problem in Georgia. Although the HIV epidemic is in its nascent phase in the country, the potential risk for development of a wide spread HIV epidemic is very high.
The aim of this study is to evaluate the effectiveness of ARV treatment principles in Georgia, including treatment and monitoring methods. Materials and Methods: The study included 985 people living with HIV/AIDS in Georgia registered at Infectious Disease, AIDS and Clinical Immunology Research Center since 2004. To ensure universal access to ARV therapy all HIV/AIDS individuals included in the study were investigated by special algorithm, all identified patients requiring ARV therapy were offered treatment and monitored during therapy on treatment effectiveness and side effects.
HIV-1 RNA in plasma was measured by quantitative Polymerase Chain Reaction. For determination of percentages and absolute count of Tlymphocyte subpopulations single-platform immunophenotyping technique using the Becton-Dickinson FACSCalibur flow cytometer was applied. For resistance testing TRUGENE HIV-1 Genotyping Kit with the OpenGene DNA Sequencing System (Siemens) was used. Reasons of treatment failure and mortality rate among ARV treated patients were analyzed.
Results and Conclusions: Treatment was offered to 398 HIV/AIDS patients. 397 patients started treatment, 1 patient refused. Out of 397 HIV/AIDS patients treated 21 patients discontinued, 54 patients died and 322 patients are currently on ARV treatment. Out of the treated patients 281 adults and 11 children are receiving first-line treatment, 27 adults and 2 children are on second-line treatment and 1 adult is receiving salvage regimen. Treatment failure was defined in 52 cases. Among them immunological failure was observed in 7 cases, clinical failure in 1 case and virologic failure in 44 cases. Prevalence of drug resistance among virologic failure cases accounted for 73% and inadequate adherence for 27% cases. Out of drug resistance cases 3% has three-class drug resistance, 84% - two-class drug resistance and 13% found to be resistant to one class. In ARV naive patients the prevalence of drug resistance to any class was 4.33%. The majority of death cases among ARV treated patients was due to non-AIDS related or incurable conditions, while deaths due to AIDS related conditions were mainly associated with delayed referral of patients in already advanced stage of disease. It's worth to mention that the highest number of death cases was due to liver failure in HIV/HCV and/or HBV co-infected patients.

This paper seeks to outline the challenges of tobacco consumption control in the transitional economy of Croatia. It focuses on issues of taxation, high unemployment, and smuggling while attempting to meet European Union (EU) accession requirements for tobacco control legislation that reduces smoking consumption. The issue of tobacco control is not a simple one and requires a multi-pronged approach. While Croatia has made good progress in adopting legislation, it needs to strengthen its efforts both in terms of enforcement and increased taxation of cigarettes.

The paper discusses the question of privatisation of the in-patient care sector in Poland. The references to the general reforming processes are made, as well as the legal context of ownership changes is presented. First part of the article describes the forms of privatisation applied in Poland, such as privatisation of the management, partial privatisation, functional privatisation and total privatisation. The basic data concerning legal regulations currently being in force is also included. Legal status is an important obstacle for the process of privatisation, since the regulations are incoherent and ambiguous. The project of Commercialisation and Privatisation of Independent Public Health Care Facilities Law was presented in 2001, but the political situation was unfavourable for such a regulation. The paper discusses also the potential profits that may be gathered during the privatisation, which may be proved by the experiences in the field of out-patient care, as well as the examples of other countries. It is stated that success of privatisation depends on changes in the structure of sources of financing health care system. The last part of the article describes the previous course of privatisation processes of in-patient sector. Presently about 18% of hospitals in Poland are private facilities, but their role in the system is marginal. The case of hospital in Więcbork, which was the first bankrupt private hospital in Poland, is presented as the example of dangers caused by the invalid law. The final conclusion is that there is an urgent need in Poland to create clear and coherent legal frames for the privatisation of hospitals, as well as harmonisation of the changes with general reforms of the health care system.

Objectives: Long-term care for people with chronic illnesses and disabilities present an urgent challenge around the world. Existing systems of care, which typically rely on unpaid family members, are not by themselves enough to meet growing demands. This analysis includes survey on the structure of services provided in selected social facilities in Slovakia.
Methods: The survey on structure of provided services includes social facilities providing services to the target groups involved in this analysis: Elderly people in retirement age; Disabled and chronically ill citizens in working age. For data collection from social facilities we used questionnaire method. The data were obtained from the managements of these facilities (n=405).
Results: In social facilities, the age range of clients was 76-85 years (31%); the length of stay of a patient in a social facility was in 36% patients 11 years and longer. The most frequently performed activities in employees were related to services and activities (31%) and social care (30%). For 52% social facilities is waiting time 1 year and longer. The length of stay of patient in social facilities is affected in 83% by combination of health and social problems and as to the diagnosis structure the most prevalent conditions are ischemic heart diseases, heart attack, hypertension (39%), locomotor disease (36%). In 2006 the budget resources of social facilities were in 72% contributions from the state budget.
Conclusion: Long-term care is closely interlinked with other programmes and systems, which can reduce the need for long-term care or which complement it.

The aim of this study is to provide an easy tool to identify patients with a high cardiovascular risk, especially those qualifying for lipid-lowering treatment. The decision to treat with lipid-lowering drugs was assessed with five new risk algorithms. The Five Risk algorithm (5R) takes into account male gender, high systolic blood pressure, high total cholesterol, smoking and high blood sugar as independent risk factors. Patients with three independent risk factors qualify for lipid-lowering treatment. Compared to the Framingham Risk Score, the 5R has a Kappa coefficient of 0.62. Compared to the SCORE, the Six Risk algorithm (6RDF) has a Kappa coefficient of 0.70. The 6RDF uses only four independent risk factors (male gender, high systolic blood pressure, high total cholesterol and smoking) but having diabetes or a family history of premature coronary heart disease are exclusion criteria for which treatment with lipid-lowering drugs is always indicated.

The aim of the study was to analyse the self-reported use of health services among the older Estonian population, to explain the predictors of health care utilisation and to study access to health services in comparison with other population groups. In November 2005, a randomly sampled Estonian residents aged 15-64 (n=1264) and 65-74 (n=182) was personally interviewed using structured questionnaires. Of the respondents aged 65-74, 81% reported having visited a general practitioner (GP) or specialist during the previous 12 months. Compared to younger people they used health services more often, except dental care. No significant differences were found in comparison with the waiting times to see the general practitioner or specialist between the younger and older population groups. Compared to the rest of the population people aged 65-74 were more satisfied with their access to health services. The probability of visiting a GP was higher for those respondents who had health problems and lived in rural areas. The presence of chronic illness also had an effect on the use of specialist services and ambulance services. Higher education, living in an urban area and having a family member with a chronic illness predicted the use of ambulance services as well. Younger age, higher income and higher education were predictors of the use of dental services. The availability of and access to health services for older people in Estonia are comparable with other groups of the population.

Aim. Bulgaria joined the European Union in 2007. This study aims to analyse Bulgarian scientific health output over a five year period before enlargement, highlighting both its interests and concordance with European health recommendations.
Methods. A bibliometric analysis was undertaken in MEDLINE between 2000 and 2004 according to a year-by-year bibliographic search. The articles were classified by fourteen fields according to the main European Union health report recommendations.
Results. 2,176 articles were found, distributed as follows: 15.63% in 2000, 20.50% in 2001, 20.63% in 2002, 19.9% in 2003 and 23.25% in 2004. 89.48% of the articles were written in English, 78.81% of the total scientific output was published abroad. Most of the articles were signed by Bulgarian authors and were carried out in Bulgarian research centers.
Conclusion. Increased number of articles was noted mainly in the basic research field and global clinical medicine. Bulgarian research priorities generally were aligned with the European Union health recommendations. More sources are recommended to be consulted and more analysis conducted of the Bulgarian research.