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Patients with autoimmune hepatitis (AIH) are a group at risk of disease exacerbation or relapse of the underlying disease should they fall ill with infectious hepatitis A (HAV) or B (HBV). Therefore, it seems appropriate to protect this group of persons against HAV and HBV disease by vaccination. An open study evaluated the safety, reactogenicity and immunogenicity of a combined HAV and HBV vaccine in 10 patients with AIH (6 patients aged 1-15 years and four patients aged 16+ years). The vaccine was administered using a three-dose vaccination schedule (0, 1 and 6 months). The vaccine course was well tolerated, safe and did not aggravate the clinical course of the underlying disease. Patients responded with 100% seroconversion for antibody to the HAV vaccine component and geometric mean antibody concentration (GIVIC) comparable to healthy cohorts. Response to the HBV component antigen was comparable to previous reports of HBV vaccination in immune compromised individuals with lower GMC than observed in healthy populations. One month after the third vaccine dose (month 7), all six vaccinees in the 1-15 years age group developed protective levels of anti-HBs as compared to two of the four vaccinees in the 16+ years age group.

The authors analyzed two hospital outbreaks of epidemic keratoconjunctivitis (EKC), one at the Department of Ophthalmology (30 cases) and another one at the Department of Premature Newborns (22 cases). In both outbreaks, EKC was diagnosed in inpatients (16 and 6 respectively), outpatients (5 and 3 respectively), healthcare workers (HCWs) (3 and 5 respectively), and relatives of EKC patients (6 and 8 respectively). Implemented infection control measures included isolation precautions, improved disinfection and hand-washing of both hospital and outpatient department personnel. Shortly after implementation of control measures the rate of infection transmission started to decrease significantly.

On the Czech set of European Longitudinal Study of Pregnancy and Childhood (ELSPAC), we tried to verify whether it is possible to confirm the results of foreign studies which found out that the both prenatal and postnatal exposure of newborns to chemicals on cigarette smoke could influence the newborns'morbidity in the first six months of their life.
Mothers, who served as sources of data about their smoking behaviour during the pregnancy and after the birth as well as information about the health status of the children after the birth (N=3,871) were divided into four groups: 1. women who never smoked (74.3%), 2. women who stopped smoking in pregnancy and started to smoke after delivery (18.3%), 3. women who smoked both during pregnancy and after delivery (7.2%), 4. women who smoked during pregnancy and stopped after delivery. Unfortunatelly, the last group was very small (only seven mothers) and did not allow assessment of exclusively prenatal exposition.
Sucklings from Czech ELSPAC set exposed to chemicals in cigarette smoke either only after the birth or also during the prenatal period, showed significantly higher occurence of different symptoms of respiratory tract damages and their complications (like otitis media) when compared to children of non smoking mothers. Due to illnesses during the first six months after the birth, their parents had to look more often for the consultations of physician, including hospitalization. Our results, as well as results of foreign studies, confirm, that smoking of mothers during the pregnancy and after the birth represents significant risk for the first months of life. Illnesses of children in this early period can cause longitudinal consequences which emerge during the childhood as well as in adulthood. They also represent a strong stressogenic factor. Children's health consequences of exposure to cigarette smoke request very often intensive and expensive care within health system.
Our results are the same as those of foreign studies and confirm that both prenatal and postnatal exposure to chemicals of cigarette smoke is significant risk factor which negatively influences the health status on the early periods life.

The German health care system has been based on the Hospital Financing Act, which the German government introduced in 1972. According to that, the federal states plan hospitals and make investments. The health insurance funds finance the operating costs. But now the Hospital Financing Act is obsolete, because both the health insurance funds and the federal states are in financial trouble and try to avoid the costs, which are nevertheless rising. In order to freeze costs, the legislators have introduced a new remuneration system, called DRGs (Diagnosis Related Groups), which will be mandatory from 2007 onwards. In this system, the treatment provided will be coded and remunerated on the basis of the primary diagnosis. Periods of hospitalisation and different remuneration systems will no longer be relevant. Transparency and quality will thus be promoted, and the upshot will be more competition among the hospitals. Hospitals that cannot meet quality standards will lose patients and will ultimately have to close. Other participants in the health care system, such as, for example, nursing staff, physicians, pharmacies, rehabilitaion centres and patients, will also be concerned in many ways. The consequences of the DRGs for the health care system, its future development and possible alternatives are discussed in this article.

Purpose: This issue is an attempt to assess patients' role as regards their compliance, respectively their non-compliance. The authors try to elucidate the factors concerning the patient-physician interrelation and patient-pharmacist interrelation that influence the non-compliance in order to increase the compliance rate.
Methods: Standard individual questionnaires and interviews were developed and applied to study an attitude to compliance and non-compliance among different categories of patients, suffering from chronic diseases.
Results: The obtained results show that the main reasons, influencing the patients' non-adherence to physicians' advise are: the high price of the drugs, the overburdened daily regimen, negligence, distrust towards the treatment and others. The insufficient information in the patient's leaflet together with the inappropriate drug form appears to be the main factors that cause non-compliance. This happens especially in the cases, when the patients are treated with more than one drug in different drug forms and particularly it concerns elderly people.
Even though the compliance among the patients investigated was comparatively high (50% to 92%), possibility for improvement still exists if the treatment that have to be initiated could be individualised. Thus the level of compliance will be improved and increased.
Discussion: The results from the data analysis show a great variation in the level of compliance among the chronic patients in Bulgaria. It ranges from 50 to 92%, depending on the type of the chronic disease and on the age of the patients. This fact shows the necessity for improvement of the different factors that has to begin as soon as possible.

This study responds to the priorities of the National Health Strategy aimed at control and mitigation of the hazardous effects of the workplace factors on cardio-vascular diseases of people in active working age from the branch "Mining industry".
The aim of this work is to study the vegetative balance (by analysis of heart rate variability - AHRV) and the correlations with the state of miners' hearing functions.
Sixty eight miners (diggers and mate-diggers) from mining industry were studied. This paper treats the results of AHRV examination of 25 miners who have no major and additional causes, leading to hearing injury - traumas, other diseases, medicines, etc.
The analysis of heart rate variability was made by computer analysis of heart rate and variability. Standard ECG electrodes at bi-polar breast lead-off were used for recording ECG signals. The echo-cardiographic signal was converted by an ECG converter board into epochs of cardiac events (R-R intervals) for 10 minutes. The principal indices of heart rate variability were analysed.
The obtained results provide the ground for further comprehensive studies on different workers contingents from other industries in order to detect workers with initial changes in the hearing analyser and to establish the corresponding pathogenetically based registration, monitoring, and treatment system.
The studies conducted for monitoring the dynamic of vegetative equilibrium reflect the degree of disturbed heterostasis by chronically manifested sympatic activity in miners, diagnosed by AHRV indices.
The revealed significant relationships between hearing changes and AHRV indices prove the presence of an extra-aural paraprofessional effect and statistically significant relations with the changes in the critical organ.
The revealed highly significant correlations between AHRV indices and hearing show a significant relationship between the physiological vegetative level (assessed by AHRV) and the hearing status at chronic exposure to work-related stress factors in miners.
The chronic sympathicotonia is an additional pathogenic factor (besides acoustic stress) manifested by spastic changes in the microcirculation of the cochlear neuroreceptor elements.

After the profound economic and political changes most of the East European countries started market-oriented reforms. During the last 10 years rapid development of the private pharmaceutical sector and a slow privatisation process was observed. The balance between the private and public sector became very important for achieving NDP goals. The goal of this study is to evaluate the availability and development of the NDP structures in East European countries - Bulgaria (BG). Romania (Rom), Macedonia (Mac), Bosnia Herzegovina (BiH). For the assessment of the availability of NDP structures a questionnaire focused on seven main NDP components was used. These components are: legislation and regulations; essential drug selection and drug registration; drug allocation in the health budget/public sector financing policy; public sector procurement procedures; public sector distribution and logistics; price policy; information and continuing education on drug use. According to the survey the most developed NDP structures are drug legislation and regulations (incl. quality control), drug registration and drug distribution. We can assume that the people have access to different drugs of appropriate quality and in time. The systems for public drug financing, procurement and price policy are under developing or not efficient enough. The financial availability of drugs is difficult. There is a lack of objective drug information and postgraduate education is not oriented on the ED. It means that there is no guarantee for rational drug prescription and usage of drugs on the markets.

Unintentional and intentional injuries are a major cause of morbidity and mortality among children under the age of 19. The large number of premature death and disabilities due to injury and accompanying high economic cost, including public sector expenditures, emphasize the need to reduce the burden of injury. Productivity losses are greater from injury than from the three other leading causes of death - heart disease, stroke and cancer. Implementation of known injury-control interventions can substantially reduce the incidence, severity, and accompanying cost of injury. Because financial resources are limited, decision-makers need to consider the cost and effectiveness of alternative prevention strategies. Injury causes with the highest cost per injury could make a priority, especially within maternal and child health programs; as an alternative, projected total injury cost could determine program priority.

The European Union (EU) has been active in tobacco control policy since 1985 when the Milan Council announced its intention to establish a Europe Against Cancer (EAC) Programme, although it had previously adopted several Directives on aspects of tobacco taxation prior to this date. Shortly after the establishment of the EAC first action plan the European Commission presented its first legislative proposals on tobacco control. Three of these proposals on labelling and maximum tar yields became Directives by 1992. The fourth on tobacco advertising finally became law in 1998 and is currently being transposed into national law in the 15 EU Member States. In 1996 the Commission published a Communication on the future of EU tobacco control and in 1999 at the 2^nd European Conference on Tobacco or Health the Social Affairs Commissioner announced his intention to bring forward further legislative proposals to amend an consolidate existing EU legislation in this sector. This article is intended to present an overview of EU tobacco control legislation from 1970 until 1998 and to look at future options post year 2000.

Many studies were made throughout the world regarding the medical and technical aspects of hand-arm vibration since the first description by Loriga in 1911 of the vibration syndrome. Despite that the protection of operators against vibration hazards had progressed very slowly in practice with one notable exception, the case of chain saw users for whom several countries developed a comprehensive programme to eradicate the diseases successfully; regulations, antivibration tools, medical screening, preventive treatment. If all these actions are not carried out simultaneously in an industrial sector the transmission of knowledge from the laboratory to practice may be a failure or very costly in money, time and energy, as this article will show it in the case of suspended rammers and breakers.

The National Institute of Public Health in Prague is the prominent institution in the Czech Republic responsible for public health and disease prevention. According to a conceptual document, approved by the Minister of Health in 1994, the main areas of function in the years 1995-2000 will be:
1. Science and research in preventive disciplines, especially in hygiene, epidemiology and microbiology, surveillance and monitoring of diseases and their determinants.
2. Professional expert activities for the national health surveillance, for state administration, and for the general public.
3. Reference activities and participation in accreditative procedures.
4. Collaboration in development, implementation, and evaluation of the National Health Program.
5. Participation in postgradual education in the fields of health protection and promotion, hygiene, epidemiology and microbiology.
The function of the Institute will continue its 70-year old tradition with strong national and international reputation.