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Objective: Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. Methods: The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. Results: The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). Conclusions: In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

Objective: The study aims to present a historical review and analysis of the establishment and development of undergraduate public health (PH) education in Bulgaria from 1878 until 2019. Methods: А search and selection of historical documents was performed, including laws, rules, regulations, government plans, programmes, scientific publications from periodical medical press, journals, specialized monographs, and books. A retrospective analysis of the normative documents related to the organization of the sanitation and public health activities, and to the provision of professional undergraduate education of the public health workforce in Bulgaria has been carried out. The required competences and tasks of the specialists exercising public health control services were extracted. Results: The development in the public health educational activities were followed in three consecutive periods: the newly independent state (1878-1944); the socialist state (1945-1990); the democratizing state (1990-2019). The development of organized PH activities began after the liberation of Bulgaria in 1878. The historical analysis reveals a direct link between the major socioeconomic changes in the country and the organization of PH undergraduate education which passed through dynamic transformations. The professional education in the sphere of PH started with the training of feldshers, followed by sanitary feldsher and sanitary health inspectors performed in secondary vocational medical schools during the socialist period, reaching the stage of undergraduate university PH education provided by medical colleges associated with universities in the third period. Conclusion: Despite the continuous development in the organization of undergraduate PH education in Bulgaria, its content is still not fully compatible with the basic European PH services and actions. There is a growing need for wider standardization and integration of undergraduate PH education in the EU so that the specialty can reach the status of a regulated health profession similar to medicine, nursing, and others.

Objectives: This study aimed to determine trend in polyphenol consumption in the Czech Republic during the last three decades. Additionally, it provides a brief overview of the beneficial effects of polyphenols in several body systems. Methods: Data from the Phenol-Explorer 3.6, a specialized database of polyphenolic substances, were assigned to the resources of the Czech Statistical Office on the consumption of food and beverages in the Czech Republic for the years 1989-2022. The average daily intake of polyphenols was determined by multiplying the average annual consumption of each type of food by the polyphenol content obtained from the database; results were given in milligrams of polyphenols per inhabitant and day. Since the food items in the data sources are not identical, it was necessary to create an extensive model of food categories. Results: The current value of polyphenol intake is 1,673 mg per day per inhabitant; however, this level most likely reflects methodological underestimation. The favourable increase in dietary polyphenol intake in the Czech population - doubling, to be precise - which we observed from 1989 to 2007, has been replaced by the opposite trend in the last 15 years. The current intake of polyphenols corresponds to the level that was already achieved in 2004. Hydroxycinnamic acids (from the group of phenolic acids) are the most prevalent dietary polyphenols, followed by flavanols (from the group of flavonoids). The most frequent source of polyphenols in the Czech population are non-alcoholic beverages such as coffee, tea and juices, followed by fruits, cereals, and vegetables, respectively. Conclusion: Current trend of dietary polyphenol intake in the Czech population is slightly decreasing. This tendency, lasting since 2008, is indisputably negative. Plant polyphenols offer opportunities for inexpensive interventions in health promotion.

Legal regulation, whether we want it or not, plays a role in protecting and promoting individual and public health. This also applies to legislation involving vaccination, especially compulsory vaccination. It is appropriate that legislation should not create barriers to the provision of health care. Where there is legal ambiguity, problems can arise that make the provision of health care more difficult, as we have seen, for example, in the context of the COVID pandemic. Furthermore, in the case of compulsory vaccination, there is a conflict between fundamental rights and freedoms. On the one hand, the right to the protection of personal freedom and bodily integrity, and on the other, the right to life and health. Most compulsory vaccinations concern children. As far as adult vaccination is concerned, this mainly includes compulsory vaccination of medical and social staff caring for patients and operating at biological risk, as well as patient groups also at risk of serious infectious disease. For these reasons, it is essential that the legislation is such that it does not impose a burden where it is not necessary and, on the contrary, allows for optimal protection of persons at biological risk.

Objectives: Influenza A and B viruses cause epidemics every year, with approximately 3-5 million serious cases and about 290,000 to 650,000 deaths worldwide. Most patients die from bacterial complications of influenza. The aim of our study was to describe the clinical pictures of influenza and the development of the complications in seniors over 65 years of age, who were treated in University Hospital Pilsen. The course of the disease and changes in laboratory parameters were evaluated with regard to the method of treatment performed. Methods: A descriptive retrospective study was performed. Clinical and laboratory data of seniors with the diagnosis of influenza were extracted from electronic medical records and later analysed. The data were processed with Excel 2016 and Statistica. Results: A collection of 261 seniors, of whom 218 were hospitalized and 43 treated in an outpatient setting, has been studied. Patients who later developed complications had elevated values of CRP, procalcitonin, urea, and creatinine. The antiviral drug oseltamivir was administered to 226 of 261 seniors. Forty-seven seniors (18.0%) died from influenza and its complications (severe pneumonia with acute respiratory insufficiency or heart failure). Conclusions: The course of influenza in seniors was usually more severe and required hospitalization along with antiviral treatment. The mortality rate in the monitored group exceeded 18%. Annual timely vaccination, but also other preventive measures, and maybe considering other risk groups are methods to prevent severe or even fatal cases of influenza.

Objectives: The purpose of the current study was to analyse the risks of Lyme borreliosis (LB) among 1,070 forestry workers, the influence of responsible behaviour (use of repellents, skin self-inspection) on Borrelia screening result status, and the occurrence of immediate and mid-term symptoms after tick bites and LB positive serological screening test. Methods: The questionnaire was conducted as well as blood tests for LB disease by one-stage serological screening procedure using ELISA for specific B. burgdorferi IgM and IgG antibodies (EuroImmun AG company, Germany). Results: While 39.6% of foresters were LB positive among bitten foresters, as many as 27.0% were LB positive among those, who did not recall any tick attacks at all. Individuals with known history of tick bites had significantly higher odds (1.770×) of being LB positive (p < 0.05), while the use of repellents or skin self-inspection after visiting woods had no influence on LB results. The odds of skin discolouration after tick bites was significantly lower (0.682×) in case of LB positive test compared to LB negative test (p < 0.05), which can be explained by the fact that foresters could be unaware about erythema migrans appearance and timing, considering tick bite and developed later rash as completely separate events. Moreover, 69.1% of the bitten foresters with LB positive result developed no secondary symptoms (excluding those related to the skin), and the most frequent clinical symptoms were arthralgia (24.9%), followed by myalgia (7.6%), headache (5.7%), and damage to facial nerve (2.7%), which are non-specific and can be present in other illnesses. Conclusion: Therefore, the recommendations proposed would be the regular laboratory testing for LB of sensitive and at-risk population, who visits endemic woody areas, irrespective of all other factors involved.

Objectives: The consumption of dietary supplements might prevent the deficiency of necessary nutrients. On the other hand, in cases of overconsumption, adverse effects might occur. In Lithuania, the COVID-19 pandemic provoked an increase in the consumption of dietary supplements. The aim of this study was to reveal the post-pandemic trend of the consumption of dietary supplements among the working-age residents of Lithuania with respect to social and demographic factors and food selection criteria. Methods: A cross-sectional observational study was performed. In total, using the same methods, 3,200 residents were surveyed: 1,600 in 2021 and 1,600 in 2022. Both samples were representative for Lithuania and included residents of Lithuania aged from 18 to 64 years. According to socio-demographic factors (sex, age, level of education, type of place of residence, marital status, number of family members, presence of children under 18 years old in the household, employment status, level of income), COVID-19 experience (presence of COVID-19 cases among friends or relatives, severeness of COVID-19) and food selection criteria (health strengthening, other) the prevalence of the consumption of dietary supplements was compared between the samples. Results: The consumption of dietary supplements accounted for 78.1% and 71.6% of the respondents in 2021 and 2022, respectively (p < 0.001). After the COVID-19 pandemic, the prevalence of the consumption of dietary supplements decreased in the majority of social and demographic groups analysed in this article (p < 0.05). The consumption of dietary supplements remained unchanged among those who selected foods for health strengthening (p = 0.098). Conclusions: The prevalence of the consumption of dietary supplements decreased after the COVID-19 pandemic in most social and demographic groups except those who selected foods for health strengthening.

Objectives: Excessive screen use in early school age is associated with worsened health habits and negative child development in later age. We aimed to assess the time spent on modern and traditional screen-based devices and examine its associations with socio-demographic characteristics. Methods: This population-based cross-sectional observation study was conducted in Czechia, Slovakia and Finland between April and June 2021. Participants (N = 1,915) were parents/caregivers of children attending elementary school grades 1 to 3, selected by stratified random sampling. Children's daily leisure screen time (LST) based on parental reports was the main outcome. Descriptive statistics, mean comparison and linear regression analysis were used for the analysis. Results: The average daily LST was found to be as high as 3.5 hours and significantly associated with most socio-demographic variables. Eighty percent of children exceeded the threshold of two hours of LST per day, which was formerly introduced by the American Academy of Pediatrics. The most important predictor of LST in children was having their screen-based device(s) for their exclusive personal use (EPU). Linear regression with all predictors assessed together confirmed the significant effect of the screen-based devices' EPU, the child's sex and grade, the child's birth order and the parent's education, even when controlled for media parenting practices. Conclusions: Given the widespread availability of smartphones for exclusive personal use among young children, the regulation of EPU and the reinforcement of effective media parenting practices, particularly in families with lower education and income, are critical public health strategies to mitigate the negative impact of excessive screen time on child development and overall well-being.

Objectives: Many studies draw attention to the negative consequences of the pandemic or lockdown on the well-being and lifestyle of different sections of the population. This study considers whether changes occurred in dietary regime and level of physical activity during three periods - before the pandemic, during the lockdown, and during the present in older Slovak adults. We also investigate whether individual weights changed during the pandemic. Methods: The study has a cross-sectional design. We collected 436 questionnaires from older adults (60+) living in Slovakia; 277 come from the first phase of online data collection (04/2022-06/2022) in university students of the third age, and 159 from the second phase of offline collection (07/2022-11/2022) in social service facilities. We monitored if there were any changes within the observed periods in the variables of diet regime, physical activity, and BMI. The database has been processed in IBM SPSS Statistics. Results: During the lockdown, the frequency of physical activity decreased (p < 0.001), the quality of movement worsened (p < 0.001), and the time respondents devoted to physical activity during the week decreased (p < 0.001). At present, the variables have increased. Within the dietary regimen, statistically significant changes occurred in appetite and non-alcoholic beverage intake (p = 0.002). However, there were no significant changes in the number of daily meals (p = 0.190), or the amount of alcohol consumed (p = 0.066). The BMI of older men and women did not change after the pandemic (p = 0.519), and it did not differ between men and women either before the pandemic (p = 0.281) or after it (p = 0.449). Also there is no difference between UTA students and social facility living seniors before the pandemic (0.933) and now (0.317). The results showed that even though physical activity significantly decreased during the lockdown, the older adults in our study did not eat more during the lockdown, nor did they gain weight. However, this probably had negative consequences for the quality of their movement. Conclusion: It is essential to simultaneously create compensatory measures while implementing future anti-epidemic (or other) measures. They would help maintain the desired amount of physical activity or other healthy habits on an optimal level.

Objective: Childhood overweight and obesity has been a major global problem for a long time, with a steadily increasing prevalence of obesity and a growing number of cases of serious health complications associated with childhood obesity. The main objective of the study is to assess the prevalence of overweight and obesity in boys and girls before the COVID-19 pandemic in the Czech Republic. Methods: Body height, weight, BMI, and body composition (fat free mass, skeletal muscle mass, body fat, visceral fat area) were assessed in a cohort of 4,475 subjects (2,180 boys and 2,295 girls) aged 6-15 years. Somatic status was assessed by standardized anthropometry and body composition was determined by bioelectrical impedance. The subjects were classified according to BMI in percentile bands (up to 3rd percentile, P3-10, P25-75, P75-90, P90-97, above 97th percentile). Statistical analysis was performed using the software TIBCO Statistica 14.0.015. Results: During growth, statistical differences in the proportion of fat-free mass and fat fractions were found between boys and girls. In boys, there is an increase in muscle mass, in girls, there is an increase in the proportion of fat fraction. Sexual differentiation is pronounced during pubertal growth. By their BMI, 10.32% of the boys and 7.36% of the girls were categorized as overweight, and 8.12% of the boys and 7.71% of the girls were categorized as obese. Using bioelectrical impedance analysis and the percentage of fat fraction, 21.61% of the boys and 21.87% of the girls were categorized as obese; 5.96% of the boys and 8.19% of the girls were found to have visceral adipose tissue posing a health risk (more than 100 cm²). From 2002 to 2019, there was a significant increase of 3.72% in the overweight category for boys and 1.36% for girls, while the obesity category showed an increase of 3.62% for boys and 4.91% for girls. Conclusion: The results confirm the increasing negative trend of overweight and obesity in the BMI and the relative body fat categories in children aged 6-15 years. Greater attention and monitoring of the effectiveness of preventive measures is needed to slow and stop the obesity epidemic which has health, social and economic impacts on the entire society.

Objectives: Overweight and obesity are important concerns for global health. They are characterized by excessive fat accumulation that can harm health. Childhood obesity has reached alarming levels around the world due to urbanization and changes in lifestyle. This trend highlights an urgent need for effective public health strategies to promote healthier lifestyles, prevent chronic diseases, and support the wellbeing of future generations. This study aimed to monitor the impact of the risk factors on blood pressure and lipid profile parameters. Methods: Data were collected from 267 school-age children from Slovakia. The study assessed blood pressure using the sphygmomanometer technique, where systolic (SBP) and diastolic (DBP) blood pressure were measured in a seated position and repeated three times. The pulse rate was evaluated using Ruffier's physical fitness test. Anthropometric measurements included body weight, height, waist circumference, hip, and chest circumference, body mass index (BMI), and fat skinfolds measurement. The children's parents completed a comprehensive questionnaire. The data were statistically evaluated using IBM-SPSS version 19. Results: Our analysis showed a statistically significant difference in SBP between obese and non-obese children (p < 0.001), but no significant differences for DBP and total cholesterol. Similar results were found between normal-weight and overweight children for SBP (p < 0.001), with overweight children showing higher SBP. No significant differences were noted for DBP or total cholesterol. Among children with "bad fitness", 57.9% had elevated SBP, compared to 37.86% with "good fitness" (p < 0.01). Additionally, 41.67% of children with bad fitness had elevated DBP, versus 23.05% in good fitness (p < 0.001). Significant differences in total cholesterol were also observed in these two groups (p < 0.05). Conclusions: The results of this study confirm the importance of monitoring risk factors that significantly influence cardiovascular parameters.

Objectives: The aim of this study was to confirm the relevance of knowledge a dentist has regarding obstructive sleep apnoea (OSA), considering the fact that based on specific risk factors a dentist may be the first clinician to identify patients who are at risk of being affected by this serious condition. Methods: The cohort consisted of 53 subjects who underwent a routine dental examination. Anthropometric data and data on tongue size (Mallampati classification), tonsil size (Friedman classification), daytime sleepiness (Epworth Sleepiness Scale) and systemic risk factors were recorded in a record sheet. On the basis of the monitored parameters, selected subjects underwent polysomnography in order to objectivise the parameters observed. Results: Polysomnography confirmed a 96% success rate in our identifying subjects as being at high risk of developing OSA. This indicates that the parameters monitored during a routine dental examination were properly selected to identify patients with this condition in advance. Conclusion: The relevance of information dentists have about the early identification of patients with OSA may be crucial in the management of further therapy to be provided to these patients.

Objective: The EU global health priorities focus on ensuring better health and well-being for people throughout their lives as well as on reducing inequalities between countries. The COVID-19 pandemic can be understood as a set of several events that directly or indirectly affected the mental health of people around the world. The aim of this study was to identify the main groupings of co-occurrence of all keywords related to the main keywords "COVID-19" and "mental health" acquired through search in the Scopus database using the VOSviewer tool. Methods: Descriptive study based on a bibliometric analysis of the occurrence of the keywords "COVID-19" and "mental health" in scientific articles retrieved from the Scopus database on 31 January 2023 covering period from 2020 to 2022 plus January 2023 in the field of medical research. The result was 1,625 articles extracted into a csv file and inserted into VOSviewer tool. By counting the number of co-occurrences of keywords using the VOSviewer, the final result was 1,211 keywords. Out of the 1,211 keywords 44 different keywords with the total power link strength of association with the keywords "COVID-19" and "mental health" were selected. Results: The presence of high rates and power links of depression and anxiety after the pandemic situation has been confirmed by visualization of keywords in scientific articles retrieved from Scopus database. The keywords "social support", "social isolation", "perceived social support", and "dementia" inform us about potential areas of research and trigger discussion about the impact of the recent pandemic on mental health. Another warning was the occurrence of the keyword "obesity" and its association with health consequences for individuals and society. Among all countries, the United States, the United Kingdom and China contributed the most with scientific publications focusing on pandemic and mental health. Conclusion: The visualization of the keywords "COVID-19" and "mental health", specifically "depression" and "anxiety" create a new area for further research as well as establishing preventive measures leading to protection from mental health damage in the events of possible dangers of this type.

Objectives: Patients suffering from rheumatoid arthritis (RA) are repeatedly affected by oral diseases or problems, including dental caries and periodontal diseases (PDs). Periodontitis and rheumatoid arthritis are chronic inflammatory destructive diseases that share many similarities. The objective of this study was to assess oral health status including examination of hard dental tissues and periodontium in patients with rheumatoid arthritis and compare the results with healthy controls. We hypothesize some interlink between oral diseases and RA. Methods: The epidemiological case-control study involved a total of 64 subjects divided into an experimental group (14 rheumatoid arthritis cases) and a control group (50 healthy individuals). Disease activity in the subjects with RA was assessed by the Disease Activity Score (DAS28). The number of Decayed, Missing and Filled Teeth (DMFT) and Community Periodontal Index of Treatment Need (CPITN) as a basic epidemiological oral health indexes were recorded. Finally, the data were analysed statistically. Results: The RA patients (19.21, SD = 6.95) showed a higher caries index level measured by DMFT than the control group (17.72, SD = 6.19); the difference was not statistically significant (U = 387.5, p = 0.547). In terms of a mean number of teeth decayed (p = 0.078), teeth filled due to caries (p = 0.397), and missing teeth (p = 0.126), the two groups were not significantly different. In terms of periodontal health, a significant difference was observed between the two groups concerning the CPI maximum score (p = 0.003). The RA patients showed higher prevalence of periodontitis than the controls. Conclusions: A complete basic oral examination, along with an oral health instruction including adequate oral and dental hygiene, is crucial to prevent dental caries and periodontal diseases and associated complications in RA patients, since they appear to be more vulnerable than the non-RA population.

Objective: This study aims to describe the outcomes of COVID-19 patients treated with molnupiravir and to explore the associations with various risk factors. Methods: We conducted a single-centre, descriptive, retrospective study without a comparison group. Results: Out of 141 patients, 70 (49.7%) required follow-up outpatient care. In the subgroup of 66 (46.8%) hospitalized patients, 28 (19.9%) developed interstitial viral pneumonia, with 6 (4.3%) deaths. Unvaccinated patients had a higher incidence of pneumonia (p = 0.020), and obesity was a significant risk factor for both pneumonia (p = 0.001) and mortality (p = 0.011). Patients over 60 years (p = 0.040) and those with cardiovascular diseases (p = 0.026) also had increased pneumonia risk. Male sex was associated with a higher risk of death (p = 0.020). Conclusion: Molnupiravir treatment was linked to reduced risks of hospitalization and death, particularly in high-risk patients. Vaccination provided additional protection, and obesity obstructive pulmonary disease and autoimmune diseases were significant risk factors for severe outcomes.

Objectives: The aim of the study was to determine the prevalence of metabolic syndrome (MetS) and its association with the use of tobacco smoking and caffeine consumption among Palestinian university students. Methods: A cross-sectional study was conducted in 2020 among university students at An-Najah National University in the West Bank. MetS was diagnosed according to the National Cholesterol Education Programme. We employed adjusted multiple logistic regression models to address the association between MetS and tobacco smoking and caffeine consumption. Results: The number of participants was 392. The findings revealed that 9.2% of the students met the diagnostic criteria for MetS, with a significantly higher prevalence in males (14.1%) than females (4.8%) (p = 0.001). The study highlighted various substance use rates among participants: 20.2% smoked cigarettes, 28.6% smoked waterpipes, 5.6% smoked e-cigarettes, and 39% consumed energy drinks. Coffee (83.9%) and black tea (84.7%) were also widely consumed. Mean values of triglyceride level (p = 0.006), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.016) were higher in cigarette smokers than nonsmokers. Energy drink consumers had higher levels of triglycerides than non-consumers (p = 0.015). Tea consumers had decreased mean values of fast blood sugar (p = 0.020) than non-users. The adjusted binary regression revealed that cigarette smokers were at greater risk of MetS (OR = 3.48, p = 0.009), and black tea consumers were less likely to have MetS (OR = 0.37, p = 0.032). Furthermore, increased BMI was associated with an increased risk of MetS (OR = 1.09, p = 0.008). Moreover, waterpipe smokers were at a higher risk of having high triglyceride levels (OR = 5.18, p = 0.027). Conclusion: The study illustrates the health implications of tobacco and energy drink consumption on MetS among Palestinian university students, underlining waterpipe smoking as a pressing health concern linked to elevated triglycerides. These results clarify the MetS burden in Palestine and explore new risks and protective factors.

Objectives: Higher-than-recommended sugar consumption (< 10% of total energy intake; WHO) leads to negative health impacts and the development of serious diseases. Sugar-sweetened beverages (SSBs) proved to be among the leading sources of free sugar intake, as they contain large amounts of added sugar. Our article aims to propose tax measures that will help change consumer behaviour and reduce SSBs consumption. Methods: For a comparison of the forms of taxation, the experience of seven countries (Denmark, France, Hungary, Italy, Poland, Catalonia - Spain, and the UK) were analysed. The evolution of sugar consumption, consumption of sweetened drinks and obesity before and after the introduction and/or abolition of the sugar tax were reviewed. Results: States that implemented a tax on SSBs were able to reduce SSBs consumption in the first year after the tax was introduced when states with a sugar-content-based tax have implemented it more effectively than states with a volume-based tax. Based on this finding, we propose basic design assumptions for the tax that can be used in European countries that have not yet introduced the tax. Progressive taxation divides beverages into 3 bands. The basic assumption is to encourage the desired consumer behaviour, i.e., consumption of SSBs with lower sugar content. The proposed tax design is applied to the conditions of the Czech Republic as a model case study. Conclusions: The results of our study suggest that SSBs taxation could be an effective policy intervention to improve population health by reducing the health impacts of SSBs among children and adolescents, although further studies are needed to prove the causality of the described associations.

Objectives: Medical students experience worse psychological well-being than the general population. Social determinants of health (SDOH) relate to conditions in which people live, work, and age and significantly influence mental health. This study examines the association between depressive symptoms and SDOH in medical students from four countries: Czechia, Iran, Kenya, and Venezuela. Methods: An online cross-sectional survey was conducted in the spring of 2022. The questionnaire focused on depressive symptoms (using a validated psychiatric scale DASS-21 to assess mental health) and various SDOHs. Results: A total of 2,033 medical students participated in the survey, with a median age of 23.0 years; 64.8% were females; 60.8% of respondents had some degree of depressive symptoms (mild-to-moderate 32.5%, severe-to-extremely severe 28.3%). Several SDOHs, such as low engagement in social life, low personal funds, and low social class, were strongly associated with severe-to-extremely severe depressive symptoms (p < 0.001), and the associations differed among countries. The prevalence of severe-to-extremely severe depressive symptoms varied significantly across the four countries, with Iran having the highest prevalence (OR = 2.1 compared to Czechia), followed by Czechia (OR = 1, reference value), Kenya (OR = 0.9), and Venezuela (OR = 0.6). Conclusion: The study demonstrates the high prevalence of depressive symptoms among medical students from four global regions and the significant association with specific SDOH. Notably, the variation in prevalence across countries and differential relationships with SDOH underscore the importance of considering transcultural factors in research and management to improve mental health among medical students.

Objectives: Having adequate level of health literacy is a very powerful tool of improving health. "Emerging adulthood" is described as a period between age of 18-25 years, characterized by changing life circumstances, developing personality and exploring possibilities. The aim of this study was to establish the relationship between health literacy and socioeconomic status of young adults in Serbia and their individual influence on the reproductive health and sexual behaviour. Methods: This research was conducted as observational, cross-sectional study. We used STOFHLA to assess the health literacy level of young people and general information questionnaire for demographic, social and economic characteristics of respondents, health knowledge and behaviour in the area of reproductive health. Chi-square test was performed to assess the existence of association between categorical variables using the Statistical Package for the Social Sciences (SPSS). Results: Results of our research found significant connection between levels of health literacy and age groups, marital status, but also connection with living in rural place. Socio-demographic factors and health literacy levels had significant impact on various aspects of sexual behaviour and reproductive health knowledge. Conclusion: The importance of this research is reflected in its contribution to a clearer understanding of the impact of health literacy and socioeconomic status on the reproductive health of young people in Serbia, with the aim of improving public policies, health interventions and educational programmes, which would contribute to reducing health inequalities, improving health outcomes, and developing targeted educational initiatives.

Objectives: The aim of the study was to evaluate widespread dietary supplements (DSs) use among the military population. There is no recent study to comprehensively evaluate the prevalence of DS use among the military population. Therefore, this systematic review and meta-analysis aimed to present an overview and estimate of the overall prevalence of DSs use among the military population. Methods: PubMed, Scopus, Web of Science, and Google Scholar databases were searched up to September 2023 using relevant keywords. All original articles written in English evaluating the prevalence of DSs use among the military population were eligible for this study. The risk of bias assessment of the included studies was done using the Joanna Briggs Institute critical appraisal checklist. The meta-analysis was performed utilizing a random-effects model and STATA software. Results: In total, 32 cross-sectional studies were included in this review. The prevalence rate of DS use in the overall military population was 57% (95% CI: 49-64); this rate was higher in the studies that were carried out in the USA and the studies with a sample size lower than 10,000 members. Eleven studies reported adverse effects (AEs) following DSs use in the military population, the pooled effect size of them was 13.0% (95% CI: 6-20). The most common AEs reported by military personnel were abdominal pain, nausea, vomiting, and diarrhoea, however, they did not include any serious complications. Conclusion: The findings indicate that the prevalence of DSs use among the military personnel was high. Moreover, some studies reported AEs following DSs use such as gastrointestinal symptoms. Promotion of knowledge and informed attitudes regarding the DSs use in the military population could be useful.

Objectives: The aim of the study was to analyse the role of conservative treatment and regional differences in 30-day hospital mortality for acute myocardial infarction (AMI) patients in the Czech Republic. Methods: Using administrative data from Czech health insurance companies for 2018-2020, we employed a probit model to examine factors influencing mortality across 13 complex cardiovascular centres, calculating average marginal effects to ensure interpretable results. Results: Conservative treatment was associated with a 4.7 percentage point increase in 30-day mortality compared to percutaneous coronary intervention (PCI) treatment (95% CI: 3.6-5.7). This effect varied significantly across different types of AMI and healthcare providers, with regional variations in mortality ranging from 0 to 4.3 percentage points relative to the best-performing centre. Conclusions: Higher proportions of conservative treatment significantly contribute to increased 30-day mortality in complex cardiovascular centres. The persistent regional variations after controlling for patient characteristics suggest the need for standardized treatment protocols and improved data collection systems to reduce disparities in outcomes.

Objectives: The aim of this study was to examine the frequency of fatalities in injuries in traffic accidents in Montenegro, identify contributing risk factors, and determine the most vulnerable participants in these accidents. Methods: The research was designed as a retrospective descriptive study. Participants were people admitted to the Urgent Centre of Clinical Centre of Montenegro due to injuries in traffic accidents that resulted in serious bodily injury or death in the period from 2011-2020. We presented data using descriptive statistics. The square test was used to examine the association between the outcome of traffic injury with sex, age, category of injury, type of traffic participant, and injury localisation. Additionally, we used logistic regression to estimate the best predictor value of these variables for outcome. Results: It was found that 44.7% of injured people died, the most frequent fatal outcome was registered in patients with central nervous system injuries (73.2%), then in patients with asphyxia (47.0%), and patients with bleeding (40.5%), χ² = 27.530, p < 0.001. The most frequently injured traffic participants were drivers, but the highest number of deceased were among cyclists. Also, logistic regression showed that the category of injury was the most predictive impact on outcome in traffic-injured correspondents (p < 0.001). Conclusion: Among the injured, the highest number are drivers, and the fatal outcome mostly depends on the injury category. Nearly half of those injured in traffic accidents die, especially those with central nervous system injuries and cyclists. Therefore, special attention should be given during public health campaigns related to traffic accident prevention, focusing on this injury and this category of traffic participants.

Objectives: Chronic back pain is the most common cause of incapacity for work. The purpose of the study was to determine the effectiveness for activating the function of the deep stabilization system (DSS) in patients with chronic low back pain. Methods: The effectiveness of three different methods was compared: Pilates method (PM), dynamic neuromuscular stabilization and balance aids on deep stabilization system function and pain perception in the lumbar spine. The group consisted of 75 patients. Results: The results show differences in the effectiveness of the methods depending on the observed characteristics. The least significant differences were observed when comparing the Pilates method to balance aids. No statistically significant difference was observed in four out of five areas. The only area where a statistically significant effect of the exercise method got recorded was the intra-abdominal pressure test (p < 0.05). The lowest change was recorded in the measured values using the intra-abdominal pressure test at PM, and the highest change was recorded in Thomayer's values at dynamic neuromuscular stabilization. Conclusion: By comparing the three methods it was noted that each of them has its own positive reaction to the pain and the muscular apparatus. The most appropriate method to affect DSS function appears the dynamic neuromuscular stabilization (DNS) concept, where was the most significant improvement in DSS activation and the most significant reduction in chronic low back pain.

Objectives: The aim of this study is to determine the incidence of Mycoplasma pneumoniae pneumonia (MPP) in children and adolescents in Prague, Czech Republic, between January and July 2024, and to compare the findings with data from the preceding period. Methods: A retrospective analysis of data of paediatric patients at our single tertiary care facility was conducted. Two distinct patient cohorts were subjected to analysis: the first comprising individuals who had been hospitalised between January 2019 and July 2024, and the second consisting of outpatients who had been treated during the periods of January to July 2023 and January to July 2024. Results: A 12.3-fold increase in the number of outpatients diagnosed with MPP was observed between January and July 2024 in comparison to the same period in 2023, with 111 cases reported in 2024 versus 9 cases in 2023. A total of 23 patients were hospitalised with MPP between January 2019 and July 2024, with 15 of these hospitalisations having occurred between January and July 2024. The median age was 12 years, with an age range of 1 to 17 years. The majority of cases presented with a high fever, chest pain, and required oxygen support. A failure of the clarithromycin treatment was observed, resulting in 19.48% of doxycycline prescriptions being issued due to a prior failure of clarithromycin treatment. During the monitoring period, no cases of treatment failure with doxycycline were documented. Conclusion: The present study demonstrates an emerging trend of increased incidence of Mycoplasma pneumoniae pneumonia in the paediatric population during the initial seven months of 2024 in the Czech Republic. Doxycycline has been demonstrated to be the optimal antibiotic for the treatment of MPP and in accordance with the prevailing practice in other states it should be included in the therapeutic regimen even in children under the age of eight. The authors put forward recommendations for the implementation of measures aimed at reducing the negative impact of MPP on public health.

Objectives: Nanotechnology is a fast-growing field in both science and industry. However, experimental studies brought warning data concerning the negative effect of engineered nanoparticle exposure leading to oxidative stress, inflammation, decreased immune cell viability, and genotoxicity. The consequences of human exposure may appear with decades of latency. Therefore, more data is needed to identify the hazardous effects of nanoparticles. Exposure should be under control and biomarkers of effect are urgently searched. Methods: Exposures of researchers working with nanocomposites were measured in yearly intervals for 5 years and biomarkers of oxidative stress and/or antioxidant capacity were analysed. Exposure to aerosols with nanoparticles was measured repeatedly using online and offline instruments during both the machining of geopolymer samples with epoxide resin and nanoSiO₂ filler and metal surface welding. The levels of biomarkers of oxidation of lipids, nucleic acids and proteins were analysed in exhaled breath condensate (EBC) of researchers and controls in 2016-2018. In 2019 and 2020, glutathione was measured in plasma to assess their antioxidant status. The trends in both exposure and EBC biomarkers' levels were analysed. Results: On average, 21 researchers were examined yearly (aged 40 ± 5 years, exposure 14 ± 3 years). After 5 years, the mean mass concentration dropped from 0.921 to 0.563 mg/m³ and mean total number of particle concentrations from 146,106 to 17,621/cm³. The majority of biomarkers of oxidation of lipids, proteins and nucleic acids decreased (p < 0.05) during repeated measurements from the highest levels being mostly found in 2016. Glutathione in plasma in 2019-2020 was elevated (p < 0.01) as compared to controls. Conclusions: The adaptation of long-term exposed researchers may give a plausible explanation. However, to our meaning, the precautionary principle and higher attention of the employers to the potential risk of nanoparticles by reducing nanoparticles exposure by almost one order of magnitude played the key role.

Objectives: COVID-19 disease, which has caused a global pandemic, poses significant threat to the healthcare system as healthcare workers (HCW) are at an elevated risk of contracting the disease and being temporarily removed from their regular duties. This study analyses and evaluates a cohort of employees at the University Hospital Ostrava (UHO) who applied for the recognition of COVID-19 as an occupational disease. Methods: The disease characteristics and risk factors for severe cases of COVID-19 were analysed for all 474 claimants who applied for recognition of an occupational disease during the reporting period (March 2020 to November 2022) and were obtained from medical records. Statistical evaluation was performed using Fisher's exact test, Pearson's chi-square test and logistic regression analysis. Results: The largest number of diseases was objectified in the period from September to November 2020. The most frequently reported symptoms were subfebrilia or febrilia (81.4%), olfactory dysfunction (75.1%), and dry cough (74.3%). A severe course of COVID-19 was experienced by 15.4% of the cohort. Additionally, 76.8% reported having at least one chronic disease. The risk of severe course was found to increase with the number of chronic diseases (p = 0.017). Individuals with chronic respiratory disease (CRD) had a 2.75-fold increased risk, and women had an approximately threefold increased risk. Higher risk was also associated with increasing age. Conclusions: Healthcare workers face a heightened risk of severe COVID-19, particularly among those with CRD, women and older age. Identifying these risk factors underscores the need for targeted preventive measures and early interventions to protect this vulnerable group and reduce the incidence of severe outcomes.

Objectives: Millions of children suffer from the harmful effects of tobacco smoking. The aim of this study was to investigate the health perceptions of preschool paediatric patient's parents and their beliefs and attitudes towards third-hand smoke. Methods: This cross-sectional study was conducted with the parents of pre-school paediatric patients. A questionnaire including the socio-demographic information form, the Beliefs About Third-Hand Smoke (BATHS-T) scale and the Perception of Health Scale (PHS) were applied to the participants. Results: Of the 500 parents participating in the study, 74.6% were mothers. Among participants 440 (88.0%) stated that they had never heard the term third-hand smoke (THS). The mean BATHS-T score of the mothers (39.20 ± 5.79) was higher than the mean BATHS-T score of the fathers (36.94 ± 5.85) (p < 0.001). Regarding tobacco use, 10.5% of mothers and 49.6% of fathers were smokers (p < 0.001). PHS total scores were higher in those who were aware of THS (52.95 ± 7.15) compared to those who had never heard of THS (49.66 ± 6.99) (p = 0.001). Unfortunately, 17% of the children were exposed to tobacco smoke indoors in spite of tobacco bans. Conclusions: In this study, although general awareness of THS was low, it was found to be associated with health perceptions. Parents should be informed about THS to protect their children from exposure and to convince the smokers to quit.

Objectives: The General University Hospital in Prague (GUH) is one of the largest hospitals in the Czech Republic. The prevalence of smoking among hospital staff is monitored as part of its Health Promoting Hospitals (HPH) network membership. Methods: This study employed a cross-sectional design, utilizing anonymous questionnaires distributed to all hospital employees in the years 2012 and 2023 through the hospital's electronic system (response rates 25% and 28%, respectively). Data were analysed using chi-square tests to compare smoking prevalence across time and among subgroups based on profession, sex and age group. Results: The total prevalence of smoking decreased from 38.4% in 2012 to 14.5% in 2023. Among all doctors, the rates fell from 15.86% to 6.75% (p < 0.001). For male doctors, the figures changed from 17.05% to 9.27% (p = 0.012), while for female doctors, the rates decreased from 15.22% to 5.24% (p = 0.001). Among nurses, the smoking prevalence declined from 44.59% to 17.64% (p < 0.001). Conclusion: The statistically significant reduction in smoking rates (p < 0.05) among both doctors and nurses is encouraging; however, there remains room for improvement. An increase in the use of other tobacco products was observed, particularly among nurses.

Objectives: Screening of asymptomatic patients upon hospital admission became a key strategy to prevent nosocomial transmission of SARS-CoV-2 during the COVID-19 pandemic, particularly in facilities treating immunocompromised patients. Rapid antigen tests (RATs) were widely used due to their speed, but their reliability in detecting potentially infectious individuals remained debated. In parallel, the role of immunosuppression, especially in solid organ transplant (SOT) recipients, as a risk factor for asymptomatic positivity and prolonged viral shedding raised additional concerns. The aim of the study was to evaluate the diagnostic performance of rapid antigen testing compared to RT-PCR in asymptomatic patients admitted to a high-risk hospital, and the difference in SARS-CoV-2 PCR positivity between asymptomatic patients with and without a history of solid organ transplantation.
Methods: We retrospectively analysed 17,086 paired RAT and RT-PCR tests collected from 11,858 asymptomatic patients admitted to a tertiary care hospital between October 2020 and October 2022. Viral load was assessed via PCR cycle threshold (Ct) values. The sensitivity and specificity of RATs were calculated using PCR as the reference (Ct < 28).
Results: RATs showed a sensitivity of 83.5% and a specificity of 99.3% in detecting patients with high viral loads (Ct < 28). False negatives occurred predominantly in cases with low viral loads (Ct ≥ 28). SARS-CoV-2 PCR positivity was significantly higher in SOT patients (5.4%) than in non-transplant patients (3.2%) (p < 0.001), a difference that was consistent across viral variants.
Conclusions: RATs reliably identified the majority of asymptomatic patients with high viral loads who pose a risk of in-hospital transmission. SOT recipients represent a high-risk subgroup for asymptomatic SARS-CoV-2 carriage, underscoring the importance of rigorous admission screening protocols in specialized healthcare settings.

Human immunodeficiency virus 2 (HIV-2) is a retrovirus related to HIV-1. It is believed to have evolved from the simian immunodeficiency virus (SIV). The disease caused by HIV-2 is manifested by a slower progression compared to HIV-1. Data from West Africa show that 37% to 50% of HIV-2 infected people have undetected or very low viremia and if left untreated, have a much more gradual decline in CD4 T lymphocytes, thus longer survival. However, treatment should not be postponed even in this case, because the course of immune reconstitution inflammatory syndrome (IRIS) in people with HIV-2 is more severe than in HIV-1, and also the year-on-year increase in the number of CD4 T lymphocytes is approximately half that of HIV-1. Approximately 6% of people living with HIV-2 (PWH2) can be defined as non-progressors and 9% as elite controllers. However, most untreated PWH2 develop AIDS.