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The aging of our population represents a most significant demographic change. It represents important challenges and consequences for the nation's economic, social, and health institutions and for the health and well-being of older persons and their families.
Old people over 60 are now the most rapidly growing segment of the population and represent 20% of all Slovak inhabitants. Because of the high prevalence of morbidity and disability among the elderly they are the most important consumers of health care and social care services, both extramural and intramural.
Long-term care is a relatively closed system of health care and social care services. Initially, long-term care policies were formulated as a response to ageing of the population, which brought about growing needs of elderly people for social care and health care, and was associated with relatively rapid increases of necessary costs.
All industrial countries are facing similar problems when it comes to the integration of long-term care. In developed countries, current long-term care focuses on all age groups in need of assistance and support from others due to the limitations caused by their state of health. Long-term care within the public services system does not exist in Slovakia.

The aim of the study was to assess stress on the basis of the excretion rates of stress hormones in occupational groups under mental stress. The investigation includes 293 persons, working in power engineering, education, public health and information sector. The stress hormones adrenaline, noradrenaline and 11-oxycorticosteroids (11-OCS) were followed during the working day using spectrofluorimetric methods. Very high excretion rates of adrenaline, noradrenaline and/or 11-OCS were found with leading radio editors, responsible engineers and operators in nuclear power station (NPS), teachers in secondary schools, designing engineers. In conclusion our data indicate high stress in occupational groups working under high psychological demands, high responsibility, making important managing decisions, low job control and are discussed with regard to the health risk.

Tobacco use prevalence in Europe is characterized by large disparities, with Western nations reporting smoking rates generally below 25%, while Eastern nations have smoking rates usually above 30%. Albania provides a distressing case study for Eastern Europe in which the exposure to the West after the fall of the communist regime dramatically increased the availability of Western-type cigarettes, while adoption of counterbalancing tobacco control measures lagged far behind.
Results based on the representative Albanian Adult Tobacco Survey (AATS) conducted in 2007 suggest that smoking is a major problem, with a 64% smoking prevalence among Albanian men. It is becoming an increasingly greater concern among women, whose smoking prevalence more than doubled since 1990, reaching 19% in 2007. Young women living in urban areas are particularly susceptible to tobacco use; about one-third of them reported that they smoke. About 85% of current smokers smoke daily and with very high intensity, which further increases their risk of dying of smoking-attributable diseases. Smoking and secondhand exposure kill about 3,800 Albanians per year, about one-fifth of all deaths in the country. In addition, tobacco use imposes opportunity costs on Albanian households, which spent $358.6 million on cigarettes in 2007, or about 6% of the gross domestic product (GDP).
To reduce the health and economic burden caused by tobacco use, the Albanian government should implement and enforce evidence-based tobacco control policies such increasing cigarette taxes; promoting cessation, particularly via the health care system; and enacting stricter clean indoor air laws.

Background. Public health research is concerned with population health, determinants of health, health systems research, health promotion, environmental health, health protection, disease prevention and research in other fields of public health. During the last decades, non-governmental organisations (NGOs) are more often entering the field of public health research. This paper presents results of work within SPHERE (Strengthening Public Health Research in Europe), a European Commission funded study aimed to gather information and produce knowledge on the state of public health research in Europe.
Methods. A questionnaire survey was developed and conducted among NGOs enrolled in a database held by the European Public Health Alliance (EPHA). There were 80 replies, and the response rate for NGOs that were members of EPHA was 53%.
Results. There were no significant statistical differences in the responses when analysed for three European groups ['old' member states (EU 15), accession members states in 2004 (EU 10) and EU-associated countries]. The NGOs reported a relatively large international experience, expressed by participation in international public health research, and more often practice work. The main research priorities reported were general public health, environmental health, ADHD, obesity, nutrition, tobacco control. NGOs showed low correlation between their work field and their proposed public health research priorities.
Conclusion. There are growing numbers of NGOs in Europe concerned with public health. This survey indicates their interest also in public health research priorities.

When the HIV epidemic officially hit western Europe in the early 1980s, central and eastern Europe were almost completely spared due to the isolation of the Soviet Union. However, in the mid-1990s, reported new cases of HIV in eastern European countries began to increase exponentially. While there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten priorities listed below are immediate and sometimes innovative research needs in the context of preventing HIV among the most-at-risk populations. While by no means exhaustive, they are intended to point out gaps in existing knowledge and thus serve as inspiration for future research efforts.

EuroSIDA is a pan-European observational study that follows 14,265 HIV-infected patients from 31 European countries, Israel and Argentina, of which 2,560 are patients from eastern Europe (EE). The study group has performed several analyses addressing regional differences in the HIV-epidemic across Europe, where all countries were divided into five regions: south, west central, north, east central Europe and EE. Significant regional differences in patients' characteristics and pattern of AIDS diagnoses were documented. More patients from EE were diagnosed with tuberculosis compared to other regions. Significantly fewer HIV-infected patients in EE, who fulfilled the criteria for starting combination antiretroviral therapy (cART), actually received cART as compared with other regions of Europe. Those, receiving cART in EE had a lower initial virologic response rate irrespectively of the regimen used, although it has improved within years. Besides, treatment failure was more common in this region. Thus, improvements in the clinical management of HIV patients in EE are urgently needed. Strategies include creating scientific collaborations for HIV clinicians as well as teaching clinicians about the most advanced HIV management at clinically oriented courses held in eastern Europe.

Background: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay.
Aims: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. Design: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child's parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification.
Results: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value=0.015) which was due to lower dental caries levels in children with non-deprived social background.
Conclusions: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.

Objectives: Analysis of participation in drug costs by seniors in the Czech Republic in connection with seniors' access to pharmacotherapy. Materials and methods: Quota-sampled guided interview with 450 respondents visiting pharmacy; ratio of men and women approximately 1:2; age over 60 years; 3 regions of the Czech Republic.
Results: Respondent's income was retirement pension in 80 %. More than 55% of respondents did not reach the official state average. Respondents used altogether 1,650 medicines on physician's prescription in the last four weeks. Overall co-payment for medicines was 38,778 CZK, i.e. 86 CZK per patient. Only 27% of respondents used fully reimbursed products. Respondents used together 273 OTC drugs (over-the-counter drugs, e.g. non prescription drugs) in value of 16,540 CZK, i.e. 37 CZK per patient. Average respondent spent on medicines 123 CZK in the last four weeks, i.e. 1.5% of the official state average income. There were respondents, about 10%, searching for the level of co-payment in several pharmacies and more than 8% of respondents had to refuse dispensation of medicines due to co-payment.
Conclusions: Our study demonstrates that there are patients who may fail to gain access to medication due to co-payment in the Czech Republic. The financial participation in health care costs is generally low in the Czech Republic (8.8% of total health expenditures) but there were differences in co-payment levels in patients ranging from 1 CZK to thousands CZK.
In our opinion problem might be in the absence of any instrument limiting the highest individual participation as it is for example in 12-month period in Sweden. In our study co-payments were lower in smaller communities that may be due to better communication between physicians and patients or physicians and pharmacists. We found a critical ethical problem in different levels of co-payment of concrete product.

Background: The reliability of retrospective maternal self-reported information regarding smoking and alcohol drinking during pregnancy seemed necessary to be checked.
Methods: Two groups of congenital abnormalities were selected for the study from the population based Hungarian Congenital Abnormality Registry. The prevalence of smoking and drinking during the study pregnancy was measured in the mothers of 81 cases affected with isolated orofacial cleft and 537 cases with congenital limb deficiencies, and in their matched control pairs without any defect by maternal self-reported retrospective information through a mailed structured questionnaire. In the second step the latter data were checked by an independent personal interview of fathers and other family members at the home visit or in our department using the same structured questionnaire.
Results: The family consensus indicated the low reliability of retrospective maternal self-reported information concerning smoking in the mothers of cases but not in mothers of controls. However, the comparison of retrospective maternal self-reported data and information of close relatives indicated a reported bias concerning the drinking of alcohol beverages during pregnancy in both controls and cases.
Conclusions: Since retrospective maternal self-reported data had low reliability, therefore, data of smoking and alcohol drinking were not collected for the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996.

Aims: To use the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) for the evaluation of birth outcomes beyond congenital abnormalities and to show as example the study of 49 antimicrobial drugs used in Hungary for the reduction of preterm births.
Methods: The population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996, included 38,151 newborn infants without birth defects and this sample represented 1.8% of Hungarian births. Medically recorded gestational age at delivery and birthweight, in addition the rate of preterm births and low birthweight newborns born to mothers with or without different antimicrobial drugs used at least by ten pregnant women were analysed.
Results: Of 49 antimicrobial drugs, two: ampicillin (adjusted POR with 95% CI: 0.8, 0.7-0.9) and clotrimazole (0.8, 0.7-0.9) showed a preterm birth preventive effect. This preterm preventive effect was found mainly after the use of ampicillin and clotrimazole during the first trimester of pregnancy.
Conclusions: Ampicillin and clotrimazole may be effective for the reduction of preterm births due to infectious diseases of pregnant women in general but particularly caused by genital infections. However, the limitation of the data set did not allow the appropriate evaluation of some antimicrobial drugs (e.g. clindamycin).

In the study the results of the relation between infant (neonatal + post-neonatal) mortality and the gynaecological and unemployment factors are presented. The findings are based on Bayesian modelling and indicate the possible influence of the unemployment situation on mortality, whereas no correlation was found as regards access to the availability of gynaecological health care. The main conclusion is that elevated unemployment which could be referred to a poor socioeconomic situation (amongst other factors) may force pregnant women to pay more attention to improving their life conditions, than to sufficient medical controlling.

The rapid growth of medical knowledge creates a demand for new ways of providing information. Health professionals are dealing with a variety of cases, and as they have no time to visit the library, they need filtered information instantly. Medical knowledge databases and data sets are increasingly available in electronic form, particularly on the World Wide Web. The premise of this medium is that it offers a "world of` knowledge at your fingertips". The reality, however, is somewhat different, as information systems are not well integrated into clinical practice, they prove difficult to find specific information in, and contain content of varying quality. The continued evaluation of the medium in the future, should be beneficial as evidence-based resources available, and these resources are integrated into electronic medical record systems. The DIMDI and OVID CD-ROM databases are presented as vehicles of research in Bio-Medical Sciences.

Introduction: Adolescents often look to mass media for information regarding issues of sexuality. As one form of media, teenage magazines have long constituted a pervasive and effective element of adolescent media exposure. Teenage magazines discuss a number of aspects concerning adolescent sexuality. Considering their potential impact on health related behaviors, the information they provide and the message(s) they send warrant attention.
Aim/Purpose: The aim of this study is to perform a content analysis of sexual development and behavior information presented in Polish teenage magazines. Social Cognitive Theory was used as a theoretical basis for this analysis.
Methods and Materials: The media chosen for this study were general-themed publications targeting an adolescent female audience: Bravo Girl!, Filipinka and Dziewczyna. Each entry was analyzed using a structured key. The specific categories of behavior and development used for this study are: biological information, pedagogic instruction, topics of moral-ethical concern, results of sexual activity, and interpersonal relationships. Each category was then subdivided into separate units.
Results: The findings indicate that Polish teenage magazines predominantly focus on relationships, contraception and sex education. Relationships were most often of a romantic nature and discussed sexual activity or the potential of sexual activity. Non-prescription contraceptive methods were most often discussed, with attention given to pregnancy prevention. Sex education offered detailed information on sexual practices and behaviors with much discussion on losing one's virginity.
Conclusions: The general approach of the analyzed magazines is that adolescents currently are, or soon will be, sexually active. As a result, certain sexual behavior and development issues are discussed in great detail, while other topics are somewhat neglected. Accepting informationseeking during adolescence as commonplace, these findings suggest that teenage magazines hold the potential for influencing adolescent sexual behavior and development.

The aim of this cross-sectional cohort study was to examine practices of clinical examination of heart failure patients in three primary health care regions in northern Finland. Altogether, 825 randomly selected heart failure patients aged 45 years or older, who had special reimbursement for drugs for the treatment of heart failure, were included. Main outcome measures were the frequency of medical visits and the mode of clinical examinations during control visits and symptomatic visits due to heart failure made by general practitioners.
The prevalence of heart failure was 2% among those aged 45-75 years and 18% among the older ones. No differences existed in the incidence of all medical visits made as a result of heart failure, between the regions. ECG recordings, auscultation of the heart and lungs, measurements of blood pressure and recordings of ankle swelling were carried out in 72%, 79%, 85%, 90% and 59% of cases of control visits, and in 78%, 63%, 79%, 77% and 49% of cases in symptomatic visits, respectively. Chest X-ray examinations and recording of liver size were seldom carried out: 16% and 12% in control visits, and 19% and 11% in symptomatic visits, respectively. Important prognostic markers of heart failure were recorded even more rarely: jugular venous pressure, in 1% of control visits and 3% of symptomatic visits and the third heart sound not at all. NYHA grading had been carried out in 8% and echocardiography in 13% of cases.
The prevalence of heart failure was higher than in many clinical studies, suggesting high number of false positive heart failure diagnoses made in primary health care. Some clinical examinations of significant prognostic value in heart failure are underused by general practitioners. Therefore, further education among general practitioners is needed to improve the practices of clinical examination in heart failure patients.

Objective: To study the association between common cold during pregnancy and pregnancy complications and delivery outcomes: gestational age/birth weight, in addition preterm birth and low birthweight.
Method: In the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), 19801996, controls without congenital abnormalities were analysed.
Results: Of 38,151 newborn infants, 5,475 (14.4%) had mothers with common cold. The prevalence of threatened preterm delivery, placental disorders and severe nausea and vomiting was lower while the occurrence of anemia was higher in pregnant mothers with common cold than in mothers without common cold. Mothers with common cold in pregnancy had 0.1 week shorter gestational age, thus the proportion of preterm births (9.8% vs 9.1%) was somewhat larger. However, mean birth weight was somewhat larger (3,305 vs 3,271 g) and the proportion of low birthweight newborns (4.2% vs 5.9%) was smaller.
Conclusion: Common cold during pregnancy does not increase the occurrence of pregnancy complications except anemia, while delivery outcomes showed minor but opposite (higher rate of preterm birth and lower rate of low birthweight) changes.

The aim of the study was to assess the reliability of questionnaire information on visits to a physician and the use of antibiotics taken for respiratory infections among schoolchildren attending a water-damaged school and a reference group of schoolchildren attending an undamaged school. Two similar questionnaires on respiratory morbidity in two consecutive years were sent to the parents. The information given on the questionnaires was compared with the patient's records of the local health centre. Although the overall total numbers of ambulatory visits in the patients' records and questionnaires seemed to indicate good reliability, a more detailed individual investigation showed poor recall validity from the questionnaires, including a high percentage of unreported visits to the local health centre from both schools. Underreporting was commoner in the control school than in index school. Recall was best for the children who had no visits to a doctor. Use of antibiotics had a better recall than ambulatory visits in both schools. The study indicates that information on health services in questionnaires is not reliable, at least when occurrences in a period of one year or more are evaluated. The use of patient records as a reference of accuracy is also unreliable, unless all the health care services available to the people in the community are covered.

The study is aimed at the detection and intervention of risk factors for cardiovascular diseases (CVD) and at the part played by stress in their development. The methods applied are designed to eliminate the risks and, simultaneously, to identify the function of the two main parts of stress reaction, i.e., in terms of the extent, level and type of the stressors experienced, and in terms of the level of mental resilience and related psychosocial factors which affect the experiencing of and coping with stress. The purpose of medical examination based on the patient's history, subjective complaints and objective tests, including a study of dietary habits and psychological methods was to establish the status praesens and identify the main risk factors and symptoms leading to ischemic heart disease (IHD). Intervention was performed in subjects with increased cardiovalscular risk factors.

Substantial social and environmental changes in a global world as well as a new paradigm of medicine emphasizing high technology and evidence based approach bring to the current medicine many paradoxes. Undoubtedly, new era creates many positive opportunities and challenges for medical professionals. On the other side, traditional concept of medicine as basically humanistic "helping profession" is rather threatened. In this context, there is a need for a re-defining of medical curricula and to offer to the medical students the concepts and ideas which reflect a current development. Traditional public health terms such as "Primary Prevention", "Health Promotion", "Health Protection", "Health Determinants" should be re-defined and the new ones such as "Quality of Life" and "Sustainable Future" must be introduced as an integral part of medical education. The relevant concepts are discussed in the context of specific situation of the health care transformation in Central and Eastern European Countries.

Although large-scale epidemiologic studies, as well as interventional trials have provided strong evidence of a consistent and robust association between physical activity and cardiovascular disease, the effect of exercise on the burden of stroke is not well understood and appreciated. This review has a purpose to summarize the literature on the effect of physical activity on stroke morbidity and mortality, and to provide current scientific evidences.

Aims: To study the role of maternal employment status as indicator of socioeconomic status in the origin of isolated orofacial clefts (OFC) and in the use of periconceptional folic acid/multivitamin supplementation.
Methods: 1,975 cases with OFC (1,374 cases with cleft lip ± palate and 601 cases with posterior cleft palate), 38,151 population controls without any defects and 20,868 patient controls with other isolated defects were compared in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996.
Results: The proportion of professionals and managerials was lower, while the proportion of unskilled workers, housewives and others was higher in the mothers of cases with OFC compared with the population control group. However, the comparison of OFC and patient control groups did not show any difference in the employment status of mothers. A lower level of folic acid supplementation occurred in the professional and skilled worker mothers of cases with OFC compared with the population control group. This difference was confirmed by the comparison of folic acid used by mothers of cases with OFC compared with patient controls. An infrequent multivitamin use was displayed in the studied groups. Conclusions: The prevalence of OFC at birth shows a slightly lower maternal employment status as indicator of socioeconomic status than in the population control group. The higher level of maternal education does not imply a higher rate of folic acid supplementation in the group of OFC.

A comparative study on the efficacy of peracetic acid and sodium hypochlorite in inactivating resistant stages of microorganisms such as Cryptosporidium, Giardia and Cl. perfingens was carried out. Furthermore the evaluation of the potential reciprocal correlation among the concentrations of the organisms was performed. The results obtained indicate that, at the same experimental conditions, peracetic acid and sodium hypochlorite have nearly similar reduction power against the resistant stages of Giardia and Cl. perfringens. Both the oxidants are instead less efficient in the abatement of Cryptosporidium oocysts. Findings have also confirmed our previous studies on the absence of association between Clostridium and the protozoa.