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Objectives: The primary aim of this study is to detect and quantify the presence of Sildenafil (SDF) and Tadalafil (TDF) in dietary supplements marketed as natural sexual enhancers in Bosnia and Herzegovina. Additionally, the study seeks to utilize these findings to inform relevant authorities, enabling further testing in reference laboratories and prompting the necessary actions to remove these adulterated products from the market.
Methods: Using high-performance liquid chromatography with diode array detection (HPLC-DAD), 20 samples were analysed for the PDE-5 inhibitors.
Results: The analysis revealed that seven of the samples contained either SDF or TDF, with mean concentrations ± standard deviation (SD) ranging from 2,075.57 ± 0.47 µg/g to 33,808.857 ± 99.43 µg/g, and TDF concentrations ranging from 24.16 ± 0.11 µg/g to 3,994.66 ± 6.95 µg/g.
Conclusion: These findings indicate a significant health risk posed by the adulteration of these products. The widespread presence of these active pharmaceutical ingredients (APIs) in products falsely labelled as natural underscores the urgent need for stringent regulatory oversight and enhanced quality control measures to protect consumer safety. This study adds to the growing body of evidence concerning the adulteration of dietary supplements and emphasizes the critical importance of regulatory compliance and monitoring in safeguarding public health.

Objectives: Given the widespread use of macrolide antibiotics and growing concerns over antimicrobial resistance, this study aimed to investigate recent trends in macrolide consumption in Slovakia and to determine the corresponding changes in Streptococcus pneumoniae resistance in a paediatric cohort.
Methods: We conducted a retrospective analysis of 1,083 nasal swab cultures from children with recurrent respiratory infections and atopy, comparing two distinct 5-year periods: 2008-2012 and 2019-2023. Consumption data was based on the European Centre for Disease Prevention and Control reports.
Results: National data confirmed that Slovakia has one of the highest consumption rates of macrolides, lincosamides, and streptogramins (ATC group J01F) in Europe. The comparative analysis of patient samples revealed a statistically significant 11% increase in erythromycin-resistant S. pneumoniae (p < 0.001) and a 5% increase in clindamycin-resistant strains (p < 0.001) between the two study periods.
Conclusions: The concurrent rise in macrolide consumption and S. pneumoniae resistance in Slovakia highlights a significant public health threat. These findings underscore the urgent need for robust antibiotic stewardship programmes and the promotion of rational prescribing practices to preserve the efficacy of macrolides.

Objectives: Various tools and methods have been proposed to measure physical activity, with the International Physical Activity Questionnaire (IPAQ) being one of the most popular self-reported tools. The study's aim was to test the validity of IPAQ-SF among Greek male and female adults, aged 18-65 years.
Methods: A total of 134 adults (98 males) were randomly selected and participated in the study. The mean age of participants was 37.9 years (SD = 11.6), with 73.1% being male. Translation and back-translation was performed to ensure cultural adaptation. The validity of IPAQ-SF was ascertained using fitness measures (maximum oxygen uptake, VO₂ max, velocity of VO₂ max, maximum heart rate, and heartbeat at 1 min).
Results: Based on the IPAQ-SF, participants engaged in vigorous physical activity for an average of 3 days per week (mean = 68.8 minutes/day), moderate activity for 2.6 days per week (mean = 56.2 minutes/day), and walking for 3.7 days per week (mean = 24.4 minutes/day). The median total MET-minutes/week was 2,751. IPAQ-SF demonstrated moderate validity as modest positive correlations were observed between MET-minutes/week and VO₂ max (rho = 0.3096, p < 0.001), and vVO₂ max (rho = 0.2511, p = 0.008). IPAQ-SF demonstrated higher validity among females and individuals with BMI ≥ 25 kg/m², with correlations reaching 0.5201 (p < 0.001) for VO₂ max in participants with overweight/obesity.
Conclusion: The present validation study suggests IPAQ-SF utility for monitoring physical activity levels in populations with overweight or obesity, while further refinement may be necessary to improve its applicability across all demographic groups.

Objectives: The present study aims to examine trends in adolescent alcohol use over the period from 2014 to 2022. Methods: Data from the last three Health Behaviour in School-aged Children (HBSC) surveys conducted in 2014, 2018 and 2022 were used for this study. Three measures of adolescent alcohol use have been chosen for analyses: lifetime alcohol use, last 30 days alcohol use, and repeated lifetime drunkenness. The analyses comprised calculation of period-specific prevalence estimates and testing of the significance of between-period changes using survey-adjusted logistic regression models. Results: Comparing prevalence rates between the periods, consistent decrease in adolescent alcohol use becomes apparent, particularly for drop of rates in 2018 compared to those in 2014. The corresponding data on the prevalence of lifetime alcohol use among 13-year-old boys was 59.7% in 2014 and 44.2% in 2018; and among 15-year-old boys 80.4% in 2014 and 74.9% in 2018. For 13-year-old girls, the estimated prevalence was 46.9% in 2014 and 41.1% in 2018; and for 15-year-old girls 83.7% in 2014 and 75.9% in 2018. This is the case for repeated lifetime drunkenness, and the decrease is consistent across boys and girls, as well as the respective age groups. In survey waves 2018 and 2022, we do not see a statistically significant decline, but rather a stabilisation of assessed prevalence at a level from the previous wave of the study. Conclusions: The decline in alcohol use among Czech adolescents is part of a global trend of reducing alcohol drinking among young people, on the background of social mechanisms including the change of cultural status of alcohol and changes in young people's leisure preferences.

Objectives: Excess body weight and weight misperception in adolescents are associated with various physical and mental health risks. This study analysed trends in overweight, obesity, body image, and body weight perception among Czech adolescents between 2002 and 2022, considering gender, age and socioeconomic status (SES). Methods: Data were retrieved from the questionnaire of the Health Behaviour in School-aged Children (HBSC) study conducted in 2002, 2006, 2010, 2014, 2018 and 2022 (N = 52,363; 49.9% girls). The difference test between two proportions was used to assess time trends in weight status (WS), body image and body weight perception across gender and SES groups. Logistic regression analysis was performed to examine the likelihood of being overweight/obese, and underestimating or overestimating WS. Results: Between 2002 and 2022, overweight and obesity increased significantly, while non-overweight rates declined across both genders and SES groups, with a greater rise among boys and adolescents from low SES backgrounds. In 2022, more adolescents, regardless the gender and SES, perceived their body as "too thin" compared to 2002. Over the 20-year period, underestimation of WS increased while overestimation decreased among both girls and boys and across all SES groups. Accurate perception of WS rose among girls but worsened among boys. Girls were less likely than boys to be overweight/obese or to underestimate their WS but had higher odds of overestimating it. Conclusions: The significant rise in overweight and obesity, especially in boys and adolescents from low SES backgrounds, during the last 20 years points out to socioeconomic disparities and should be taken into account when creating new policies. An improvement in correct perception of WS among girls and a decline in overestimating WS across genders and SES groups could help reduce risks of developing mental health problems/eating disorders. Conversely, an increase in underestimation of WS may contribute to weight-related health risks.

Objectives: Active school transport (AST), such as walking or cycling to and from school, represents an important source of daily physical activity for adolescents. In recent decades, however, many high-income countries have reported a steady decline in AST. The main objective of this study was to describe long-term trends in active travel to and from school among Czech adolescents aged 11, 13 and 15 years, using nationally representative data collected in five waves of the Health Behaviour in School-aged Children (HBSC) study between 2006 and 2022. Methods: The analysis is based on a total sample of 50,813 adolescents (25,628 boys, 25,085 girls) aged 10.5-16.5 years, with valid self-reported data on travel modes to and from school. AST was defined as walking or cycling as the primary mode of transport. The prevalence of AST was analysed over time by gender and age category. Binary logistic regression was used to assess the associations between AST and survey year, gender, age group, socioeconomic status (Family Affluence Scale), and commuting time to school. Results: Between 2006 and 2022, the prevalence of AST to school declined from 71.6% to 54.9% among boys and from 71.8% to 54.8% among girls. A similar trend was observed for AST from school, although participation remained consistently higher than in the morning. The strongest negative predictors of AST were longer commuting time and higher socioeconomic status. Girls had slightly lower odds of AST than boys, and older adolescents (only in fully adjusted models) were more likely to engage in AST. Conclusions: The long-term decline in AST among Czech adolescents highlights the need for targeted public health and urban planning strategies. In particular, the lower rates of AST to school suggest potential opportunities for morning-focused interventions.

Objectives: Previous studies have identified four distinct patterns of adolescent social media use (SMU): non-active users abstain from social media or engage in online interactions only once a week or less; active users connect with others online daily without any functional impairments related to their SMU; intense users frequently engage with others online but do not meet criteria for problematic use; problematic users report six or more addiction-like symptoms. The following study aimed to assess the prevalence of these SMU patterns among Czech adolescent, examine changes between 2018 (pre-COVID-19) and 2022, and explore age and gender differences to identify at-risk subgroups. Methods: Data were drawn from the Health Behaviour in School-aged Children (HBSC) study among 11-, 13- and 15-year-olds. The study analysed Czech data from the 2017/18 and 2021/22 waves (n = 26,450). Results: Findings revealed marked changes in SMU patterns between 2018 and 2022 among Czech adolescents, which varied by gender and age category. Girls and older adolescents reported higher rates of problematic SMU. The share of non-active users declined, most notably among 11-year-olds. Conclusions: The marked increase in both intense and problematic SMU among Czech adolescents highlights a growing public health concern. Given the established associations between problematic SMU and poorer mental health outcomes, these findings call for the integration of digital behaviour monitoring and education into school-based mental health and prevention programmes. Particular attention should be given to early adolescence and to gender-specific vulnerabilities.

Objectives: Sleep is vital for maintaining the health and wellbeing of people of all ages. However, for adolescents, sufficient sleep of adequate duration and quality is critical for profound mental, physical, social, and emotional development. This study aimed to describe trends in sleep duration and late bedtime during school and non-school days in representative cohorts of 11-, 13-, and 15-year-old adolescents from Czechia from 2014 to 2022, and to examine the current associations between late bedtimes/social jet lag and wellbeing indicators among adolescents in 2022. Methods: The analysed sample of 42,101 adolescents aged 10.5-16.5 years was drawn from three nationally representative cohorts of Czech schoolchildren from the last three cycles of the Health Behaviour in School-aged Children study, conducted between 2014 and 2022. Results: Mean sleep duration (hours:minutes) on school and non-school days significantly (p < 0.05) decreased for both boys (schooldays: 8:19₂₀₁₄→7:59₂₀₂₂; non-school days: 9:36₂₀₁₈→9:23₂₀₂₂) and girls (schooldays: 8:20₂₀₁₄→7:55₂₀₂₂; non-school days: 9:58₂₀₁₈→9:41₂₀₂₂) between 2014/2018 and 2022, while the prevalence of insufficient sleep significantly (p < 0.001) increased over the same period (boys schooldays: 35.4%₂₀₁₄→49.2%₂₀₂₂, boys non-school days: 14.9%₂₀₁₈→18.0%₂₀₂₂; girls schooldays: 35.1%₂₀₁₄→51.7%₂₀₂₂, girls non-school days: 9.8%₂₀₁₈→13.3%₂₀₂₂). Adolescents with late bedtimes or social jet lag (> 2 hours) had significantly higher odds (p < 0.001) of skipping breakfast daily, drinking energy drinks daily, being drunk at least twice in their lifetime, experiencing reduced psychological wellbeing and low life satisfaction, reporting irritability, and problematic social media use and internet gaming than those with earlier bedtimes or without social jet lag. Conclusions: It is highly desirable that families, in close cooperation with schools and professional representatives, make efforts to ensure adherence to the recommended length and quality of sleep, as the trend results indicate worsening sleep patterns, deepening social jet lag, and a disturbing increase in adolescent risk behaviours and health complaints related to insufficient sleep.

Objectives: Adolescence is widely recognized as a critical developmental period marked by increased independence and risk-taking behaviours, which often result in medically attended injuries. The aim of the study is to present the trends analyses of self-reported HBSC data on medically attended injuries in Czech adolescents between the years 2002 and 2022 and complement other sources of injuries data in Czech adolescents. Additional objective is to outline the possible use of the above-mentioned data for research purposes by public health professionals and researchers so they can be used for injury prevention purposes. Methods: The overall sample of 44,817 adolescents aged 11, 13 and 15 years (50.3% girls) from the last six cycles of the Health Behaviour in School-aged Children study data collections between 2002 and 2022 was analysed. Results: An adjusted residual analysis of nationally representative data from 2002 to 2022 revealed a significant shift in the pattern of medically attended injuries among Czech adolescents. Across both sexes and all surveyed age groups, there was a notable increase in the prevalence of multiple (2 or more) injuries. Simultaneously, the proportion of adolescents reporting no injuries decreased significantly, particularly among girls, whose injury-free rate dropped from 61.2% in 2002 to 48.2% in 2022. While the rate of single injuries remained relatively stable - without significant change in many groups - the overall injury burden has shifted toward more frequent and potentially severe injury experiences. Logistic regression analysis revealed that the likelihood of reporting at least one injury was highest in 2022, after controlling for gender, age, and family affluence. Boys, 13-year-olds, and children from higher-income families were at increased risk. Conclusions: Medically attended injuries have increased in both frequency and complexity over the last two decades among Czech adolescents. The shifting patterns underscore the urgent need for context-sensitive, age-appropriate, and equity-focused prevention strategies.

Objective: The purpose of this study was to determine the prevalence and clinical effect of untreated dental caries in Roma children from eastern Slovakia using dmft/DMFT index and SiC index, association between dental caries development and oral hygiene, dietary habits and preventive dental care. Methods: Dental caries were assessed by recording the dmft index (for primary dentition) and the DMFT index (for permanent dentition) that are used to assess the state of teeth, which expresses the current state of teeth or its development in an individual or the entire population. The SiC index was calculated as the mean dmft of one-third of the population with highest caries scores. The normality of data distribution was tested by Shapiro-Wilk test. P-value < 0.05 was considered statistically significant. Chi-square test was used to compare proportions (oral hygiene, dietary habits and preventive dental visit). Data were analysed using ordered logistic regression and t-test. The study includes questionnaire containing 5 questions about dietary habits, oral hygiene and preventive dental visit. Results: The results of presented study confirmed higher average values of DMFT (3.24) in the population of 12-year-old Roma children and lower average values of dmft (2.5) in the second group (p < 0.05). The value of SiC index represented 6.10 in the group of six-year-old and 7.66 in twelve-year-old children. Logistic regression was performed to test the magnitude of the association between dental caries and related factors. There was statistically significant association between average value dmft/DMFT and dietary habits, oral hygiene, and preventive dental visit in both study groups. Conclusion: The study revealed insufficient oral hygiene of the Roma children population. Systematic implementation of preventive examinations for oral hygiene and health programmes are needed to promote oral health. The study represents a pilot study of the SiC index values in Roma minority population from eastern Slovakia.

Objective: Allergic contact dermatitis (ACD) in the healthcare sector is a major occupational health hazard. There are many reasons for a higher frequency of ACD in healthcare personnel compared to other populations: among others, simultaneous exposure to multiple substances, use of aggressive detergents and wet work. However, studies that systematically correlate skin symptoms with the presence of sensitization investigated through patch tests in specific categories of health workers are very rare and conflicting. Although some studies have reported a correlation between skin disease and night shift, the strength of the evidence is rather limited. The purpose of our study was to investigate by means of patch testing the skin sensitization (SS) to common allergens in the hospital setting in a group of healthcare workers (HCW) reporting symptoms related to dermatitis, according to their job activity and their shift status. Methods: 132 HCWs visiting a health surveillance centre were investigated by means of specific questionnaire for dermatitis, followed by patch test evaluation including 40 haptens of the SIDAPA 2016 series. Results: Skin sensitization was observed in 1/3 of the subjects investigated by patch tests. The nursing job was strongly associated with cutaneous reactivity after controlling for the confounding of gender, age and other factors. Shift work was related to the prevalence of SS. Conclusions: In our study, the nurse's role and shift work were significantly associated with the risk of cutaneous sensitization, in particular for common antigens.

Objectives: Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns. Methods: The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ² tests were used to compare groups. Results: Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ² = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ² = 52.9, p < 0.001), HCV (χ² = 25.9, p < 0.001), and syphilis (χ² = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ² = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ² = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ² = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001). Conclusions: In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.

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Objectives: Healthcare workers are the professional group at higher risk of burnout than others. It is the underlying reason for medical errors and the general decrease in quality of patient care and is related to poor patient-healthcare worker relationships. Healthcare workers who work with military personnel have specificities compared to healthcare workers who work only with civilians. Methods: A cross-sectional study among 171 nurses at the Military Medical Academy was conducted. The questionnaire consisted of items regarding socio-demographic and socioeconomic characteristics, lifestyle characteristics, workplace environment, workplace stress, strategies of stress management, symptoms and signs of workplace-related stress, and the Serbian version of the Maslach Burnout Inventory. Results: The prevalence of burnout was 46.2%. The multivariate logistic regression analysis showed that the burnout was associated with stating that they would not choose the same profession again (OR = 4.54, 95% CI: 1.53-14.50) and with not being interested in the work (OR = 4.86, 95% CI: 1.58-14.92). Conclusion: The prevalence of burnout is relatively high among nurses at the Medical Military Academy in Belgrade and is associated with factors in the work environment.

Objectives: The objective of this study is to address issues faced by doctors working in the COVID-19 units during the second phase of COVID-19 in the Czech Republic, when the country registered the highest per capita rate of new COVID-19 cases in the world. Methods: A prospective study was designed using Google online questionnaire. Inclusion criteria were doctors from medical and surgical specialties working in COVID-19 units. The Czech Medical Association was approached in obtaining permission and helping us distribute the questionnaire with an introductory message with the aims of the study via email to the chairpersons of 18 medical and surgical Czech Societies and their respective members. The online questionnaire link was active for 31 days. Completion of a questionnaire implied consent to participate. Data was collected from the completed responses and statistical analysis was done. Results: Fifteen out of eighteen invited Societies participated in the study. Out of all the transferred or volunteering doctors at the COVID units, 47.6% were from 9 medical specialties and 52.4% from 6 surgical units. The highest transfers were seen amongst male surgeons with 21 to 35 years of work experience, whilst the youngest group of doctors made the highest contribution. There was no statistical significance between the effects of COVID-19 and gender. Despite adequate medical provisions, 42% of all doctors had issues with procedural diagnostic methods, 40% tested positive for COVID-19 and 31% reported staff reduction leading to diminished patients' admissions and compromised care. Doctors from surgical departments experienced more difficulties in working in COVID-19 units. Furthermore, on contraction of COVID-19, 114 doctors asserted a lack of support and another 26% were unaware of any services. Conclusions: Our survey reiterates the relationship between factors related to occupational health and safety, standards of patient care and possibility of medicolegal consequences with the continuing COVID-19 pandemic.

Objectives: Polychlorinated biphenyls (PCBs), a family of persistent toxic and organic environmental pollutants, were associated with multiple organ damages in humans once accumulating. However, association between PCBs exposure and circulatory immune markers were not clear. Methods: Data was collected from participants enrolled in the National Health and Nutrition Examination Survey in 1999-2004. PCBs were categorized by latent class analysis (LCA). Weighted quantile sum (WQS) regression was used to investigate effects of PCBs exposure on circulatory immune markers including leukocyte counts, monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Results: There were 3,109 participants included in the final analysis with blood PCBs levels presented as 3 classes. The high PCBs group had a higher rate of comorbidities. Leukocyte, lymphocyte and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and system immune-inflammation index (SII) were significantly lower in the high PCBs group than in the low PCBs group (all p-values < 0.05). After adjusting for covariant variables, the low PCBs group was positively associated with SII (p = 0.021) and NLR (p = 0.006) in multivariate regression. Significantly negative correlations between PCBs classification and SII (β = -14.513, p = 0.047), and NLR (β = -0.035, p = 0.017) were found in WQS models. LBX028LA showed the most significant contribution in the associations between PCBs and SII, and LBX128LA contributed most significantly to associations with NLR. Conclusion: Our study adds novel evidence that exposures to PCBs may be adversely associated with the circulatory immune markers, indicating the potential toxic effect of PCBs on the human immune system.

Objectives: HIV positivity diagnosis is often accompanied by stigmatization and discrimination, even in developed societies. The aim of the study was to obtain current information on the quality of life of people living with HIV in the Czech Republic, to assess the level and perception of stigmatization and discrimination, and to identify existing problems of people living with HIV concerning health services, family and the public. Methods: Data for the pilot study were collected by convenience sampling between 2021 and 2022. Respondents were recruited from residents of Czech nationality and foreigners living with HIV in the Czech Republic who participated in an ECDC online questionnaire study or attended a convalescent stay for people living with HIV. Likert scales were used to capture key opinions, attitudes and beliefs of respondents. Data were processed using descriptive analysis. Results: The study involved 42 people living with HIV. A total of 77% of the respondents reported that they had learned to live with their HIV-positive status, but 21% admitted to having low self-esteem due to their status. A total of 81% of the respondents had disclosed their HIV-positive status to someone outside of the healthcare setting, however, 40% of the respondents found it difficult to do so. Assault or threats from a sexual partner were reported by 17% of the respondents. A total of 27% of the respondents admitted having been denied or suspended health care, 44% reported inappropriate comments from healthcare workers, and 32% of the respondents avoided visiting the healthcare facility. Alarmingly, 41% of the respondents had been refused dental care at some point in the past because of their HIV-positive status. Conclusions: Although the study presents only limited findings due to the small number of respondents, it is clear that stigmatization and discrimination of people living with HIV exists in the Czech society. It brings the risk of loss of motivation and involvement of people living with HIV in working together with healthcare providers on their treatment. There is a clear need for a larger study to identify the causes of stigmatization and to find ways to prevent it.

Objectives: The acute respiratory syndrome, known as COVID-19, is characterised by high morbidity and increased mortality. Genetic factors may partially explain the differences in susceptibility to and severity of COVID-19. Methods: We have analysed common functional polymorphisms within the OAS1 (rs4767027), TMPRSS6 (rs855791), DPP4 (rs3788979), and ZNF335 (rs3848719) genes in SARS-CoV-2 positive subjects (n = 521, different disease severity) and in population controls (n = 2,559 subjects, COVID-19 status unknown). Results: Neither DPP4 nor ZNF335 were associated with disease susceptibility or severity in the Czech population in any of the models used for calculation. T allele carriers of the OAS1 polymorphism seem to be protective against symptomatic COVID-19 (p = 0.002 calculated for trend; asymptomatic, symptomatic, hospitalised). Similarly, within the TMPRSS6, minor TT homozygotes associated with lower plasma Fe concentrations were underrepresented in the overall patient group (p = 0.044; OR = 0.77, 95% CI: 0.59-0.99), and the difference was mainly driven by the severe COVID-19 subjects. In general, risky homozygotes of these two polymorphisms were less frequent than expected in the group of hospitalised COVID-19 survivors. Conclusions: Common variants within OAS1 (rs4767027) and TMPRSS6 (rs855791) play some role in COVID-19 pathology in the Czech Caucasian population. Whether the depletion of minor allele carriers of these two variants is associated with increased COVID-19 mortality, needs to be analysed in an external confirmatory study.

Objectives: Childhood obesity has become a worldwide public health concern over the past decade, counting Bosnia and Herzegovina (BiH). The Childhood Obesity Surveillance Initiative (COSI) was established by the World Health Organization (WHO) to address the lack of standardized surveillance data on childhood obesity. However, BiH and its entity, Republic of Srpska (RS), are failing inclusion in such initiative, which hinders efforts to monitor and address the issue. Henceforth, the objective of this nationally funded study was to gather and analyse data on the prevalence of overweight and obesity among primary-school children in RS by implementing the COSI methodology. Methods: Weight, height, and BMI of first, second, and third grade children (aged 6-8), from 11 schools (N = 2,030) in the RS region was analysed according to the standardized COSI protocol. Results: The prevalence rates of overall overweight (OW) and obesity (OB) observed were 14.37% (OW 9.09%, OB 5.21%). No gender-related differences were noted (boys 14.36%, girls 14.88%). Conclusions: These findings highlight a concerning trend of increasing overweight and obesity prevalence with age among primary-school children in the RS.

Introduction: The global burden of chronic diseases, including cardiovascular disease, remains a significant public health challenge. The Life's Simple 7 (LS7) score was developed as a tool to evaluate cardiovascular health behaviours and habits and identify high-risk individuals. The present study aimed to assess the distribution of LS7 scores among educational strata. Methods: The study population consisted of 3,383 asymptomatic individuals screened for colorectal cancer at a single centre in Austria. We split patients into lower (n = 1,055), medium (n = 1,997), and higher (n = 331) education, based on the International Standard Classification of Education (ISCED). Cox regression models were utilized to determine the association between education and mortality over a median follow-up period of 7 years. Results: Individuals with higher educational status had a significantly higher prevalence of ideal cardiovascular health metrics, as defined by the LS7 score, compared to those with medium and lower educational status: n = 94 (28%) vs. n = 347 (17%) and n = 84 (8%), respectively, (p < 0.001). In the Cox regression analysis, both medium (HR = 0.61, 95% CI: 0.43-0.84, p < 0.001) and higher educational status (HR = 0.44, 95% CI: 0.19-1.01, p = 0.06) were associated with all-cause mortality, as was the LS7. Conclusion: Our findings highlight a significant association between lower educational status and poorer cardiovascular health, as assessed by LS7, which persisted even after multivariable adjustment. Additionally, both educational status and LS7 were associated with increased mortality, underscoring the significance of our results. These findings have important implications for public health, as screening and prevention strategies may need to be tailored to meet the diverse educational backgrounds of individuals, given the higher prevalence of unhealthy lifestyle behaviours among those with lower educational status.

Objective: Trace elements are essential for the biochemistry of the cell. Their reference values have been found to differ considerably in pregnant women stratified by age, place of residence, anthropometric status, and length of pregnancy. In optimal amounts, these elements reduce the risk of pregnancy complications. Subclinical hypothyroidism in pregnancy is associated with adverse maternal and neonatal outcomes. The aim of the study was to determine the effects of zinc (Zn), copper (Cu), magnesium (Mg), and rubidium (Rb) on pregnant women in an iodine deficiency region and find the relationship with the thyroid status and nutrition. Methods: We evaluated the iodine status of 61 healthy pregnant women from an iodine deficient region in Bulgaria. Thyroid stimulating hormone (TSH) and thyroxin free (FT4) levels were measured using ELISA. Results: We found elevated levels of copper that differed the most between the first and second trimesters; Cu and TSH were found to be positively correlated (р < 0.05). Lower Cu levels were found in pregnant women consuming pulses more than 2-3 times a week (р = 0.033). The women consuming fish more than 2-3 times a week had higher levels of Rb. We found a pronounced iodine deficiency in more than half of the examined women in the first to third trimesters, without any effect of pregnancy on the ioduria (р=0.834). All second and third trimester cases were associated with severe ioduria (< 150 µg/L). Conclusion: The high Cu levels were associated with subclinical hypothyroidism (SCH) and less pulse consumption during pregnancy in an iodine deficiency endemic area. SCH was found in 24% of the pregnant women in such an area while in 13% of them SCH had progressed to overt hypothyroidism.

Objective: Medical students usually do not meet the recommendations on the minimum level of physical activity, despite knowing the impact that physical activity has on the prevention and treatment of various diseases. Medical students are considered to be insufficiently physically active. The aim of this study is to determine the prevalence of physically active fifth-year medical students at five universities in Serbia, as well as to identify factors associated with insufficient physical activity of students. Methods: A cross-sectional study was performed in the population of fifth-year medical students from five different universities in Serbia. The research instrument was a questionnaire specially designed based on similar research. Descriptive and analytical statistics methods were used in statistical analysis. Results: The study included a total of 573 fifth-year medical students from five universities in Serbia: 311 (54.3%) Belgrade; 86 (15.0%) Kragujevac; 58 (10.1%) Nis; 66 (11.5%) Kosovska Mitrovica; 52 (9.1%) Novi Sad. Insufficient physical activity was statistically significantly associated with studying at the University of Kosovska Mitrovica (OR = 3.98, 95% CI: 1.83-8.57). There was a statistically significant difference in the frequency of anti-anxiety medications use in the last 12 months between students with sufficient and insufficient physical activity (p = 0.040) as well as in the average number of cigarettes smoked per day between students with sufficient and those with insufficient physical activity (2.82 ± 6.35 vs. 4.50 ± 8.29, p = 0.043). There was also a statistically significant difference in the average score on the Beck's depression scale between students with sufficient and students with insufficient physical activity (6.51 ± 6.59 vs. 10.03 ± 9.37, p < 0.001) and in the average score on Zung's anxiety scale (34.86 ± 8.18 vs. 38.07 ± 8.71, p = 0.003). Conclusion: A high percentage of medical faculty students (86.6%) are physically active. Differences in the level of physical activity were observed between students of these five universities as well as between students with different levels of physical activity.

Objective: Acute flaccid paralysis (AFP) is a major neurological problem. Turkey has accepted over 4 million refugees since 2011 due to the wars in neighbouring countries. In the long term, refugees can have adverse effects on the limited resources of health, sanitation, water supply, foodstuff, and shelter services of host countries, precipitating the transmission and spread of enteroviruses causing AFP. This study examines the 13-year surveillance and incidence of AFP cases in southeast Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before (2007-2010) and after (2011-2019) 2011, when the refugee movements emerged. Methods: The records of cases reported from southeast part of Turkey with suspected AFP between January 2007 and December 2019 were reviewed retrospectively. Results: Of the patients, 121 (58.5%) were male. Mean age was 80.36 ± 46.67 months. Eighty-five (41.1%) were aged 60 months or younger. The number of patients under 60 months increased significantly after 2011. Mean incidence was calculated as 0.88 cases/100,000 person years versus 1.58 cases/100,000 person years in the period before and after 2011, respectively. Guillain-Barré syndrome (GBS) was the most common cause of AFP in both periods. As of 2011, however, the incidence of acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, detected from 9.1% of stool samples. Conclusion: Although refugee movements appear to may have adverse effects on AFP incidence and surveillance outcomes, larger studies involving the whole country, particularly at places where no refugees settled, are needed to achieve more conclusive evidence.

Regarding the vaccination of children, it can be said that there are basically three vaccination policies in the world, one of which is usually used in particular country depending on the national legislation. These are the mandatory vaccination policy, mandatory vaccination policy for school entry and recommended vaccination policy. The mandatory vaccination policy and the mandatory vaccination policy for school entry face obstacles consisting of conflicts between fundamental human rights and freedoms. This is, for example, a conflict between the right to health and the right to life on the one hand and the right to protect the inviolability of the person and body integrity or the right to personal freedom, freedom of movement, residence, etc., on the other. Another issue is the right to undisrupted school attendance, based on both compulsory schooling and the right to education. This article looks at different approaches to the vaccination of children in different countries. It provides an illustrative comparison of approaches to vaccination of children in selected countries. It is obvious that the essential problems with organizing and ensuring the vaccination of children are and will be associated with the indicated conflicts of fundamental human rights. It is therefore necessary to search and try to find the optimal policy for undergoing the necessary vaccinations and thereby creating herd immunity, of course for those infectious diseases where this is possible. These efforts are necessary for sufficiently effective protection of individual and public health.

Objectives: The aim of this analysis was to compare selected health status indicators of the Albanian and Polish populations, pertinent to two former communist countries in Central and Eastern Europe (CEE). Methods: This analysis was based on the estimates related to the Global Burden of Disease (GBD) 2019 study, reported by the Institute for Health Metrics and Evaluation (IHME). For Poland, IHME uses data mainly from the Central Statistical Office of Poland, whereas for Albania the information is based on the reports from the National Institute of Statistics. Results: In 2019, life expectancy at birth was slightly higher in Albania compared to Poland (78.5 years vs. 78.1 years, respectively). Mortality rate from noncommunicable diseases was similar in both countries (about 520 deaths per 100,000 population). In 2019, the main risk factor for the overall mortality in both countries was the high systolic blood pressure. In Albania, high systolic blood pressure accounted for almost 32% of deaths from all causes, whereas in Poland it accounted for only 21% of all deaths. The second main risk factor in Albania concerned the dietary factors which were responsible for almost one in four deaths. In Poland, the second main risk factor for all-cause mortality concerned tobacco which was responsible for one in five deaths. The third leading risk factor in Albania was tobacco (responsible for one in five deaths), whereas in Poland it concerned the dietary risks (responsible for about 19% of the all-cause mortality). Conclusions: This analysis provides useful information about the current health status of two populations pertinent to the former Communist Bloc in CEE. While health indicators can provide important information about the differences in health status between populations, it is important to interpret these indicators in the context of the specific challenges and limitations facing each country.

Objective: This article briefly summarizes the results of existing research on metabolically healthy obesity in the context of health risks. Methods: The PubMed database was searched for relevant meta-analyses addressing metabolically healthy obesity in the context of health risks. Results: We included a total of 17 relevant meta-analyses in this review. The results of the studied meta-analyses showed that metabolically healthy obesity may be only a transient condition associated with an increased risk of developing metabolic abnormalities in the future. People with obesity without metabolic abnormalities have an increased risk of type 2 diabetes, cardiovascular disease, cancer, chronic kidney disease, and depressive syndrome. In addition, all people with obesity are at risk of pathogenesis resulting from the mechanical stress caused by presence of abnormal adipose tissue, such as sleep apnoea syndrome or skin problems. Conclusion: Based on the results of meta-analyses, we recommend motivating all obese patients to change their lifestyle regardless of the presence of metabolic defects.

Objectives: The current study examined the links and interactions among headaches, screen-based media use, physical activity, sleep, and the family environment in Lithuanian school-aged children during the second COVID-19 lockdown. Methods: The study comprised data of 541 children aged 7-14 years from different Lithuania regions, and without chronic health conditions or developmental disorders. Information about the child was provided by their parents or caregivers who filled questionnaire on child's screen time, sleep duration and quality, physical activity, parental distress, parent-child relationship, history of child's headaches and infectious diseases. Results: During the study period, 54% of the children had headaches, and the frequency was positively associated with child's age, screen time and parental distress, as well as negatively related to physical activity (PA), sleep quality, and the parent-child relationship. Parental education was related to child's PA, screen time and sleep quality. The results of binary logistic regression analysis and path analysis revealed that sleep quality and parental distress were significant predictors of headaches in children. Conclusions: Family and child or adolescent education and lifestyle modification aiming to improve sleep hygiene and PA, and to reduce screen-based sedentary behaviour should be provided. Family centred approach for more effective coping with distress and improvement of parent-child relationship is also important in treating child and adolescent headache.

Objectives: The aim of the study was to synthesize the body of knowledge on the factors that are important to the process of returning to work after ischaemic stroke in young adults under 55 years of age. Methods: Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA checklist for scoping reviews were used. A total of 2,249 studies were identified through a bibliographic search in six databases. Results: A total of ten studies were finally selected to respond to the research questions. Eight studies were quantitative observational studies, and two studies had a case study design. The rate of returning to work varied between the studies. The frequency of returning to work in young stroke patients, independent of the time of assessment, ranged from 42.4% to 86%. Returning to work after ischaemic stroke in young adults is a complex process and multidimensional problem which is affected by clinical variables (level of neurological deficits, cognitive ability, independency in activities of daily living, fatigue and depression, cardiovascular factors), as well as the socioeconomic and occupational status. Conclusion: There is insufficient evidence concerning interventions promoting return to work. Future studies should focus on examining effective interventions to help young stroke survivors return to work.

Objectives: Celiac disease (CD) is a chronic autoimmune disorder caused by a complex interplay between genetic and environmental factors. The main goal of our case-control study was to analyse the association of environmental factors with the odds of CD development in a sample of the Slovak population. Methods: Data were collected from 1,226 respondents (534 CD patients and 692 controls) by a questionnaire. The impact of analysed parameters on the chance of disease development was assessed by multiple regression analysis and expressed as odds ratios (OR). Values of p < 0.05 were considered statistically significant. Results: In the patient group, celiac disease was significantly more prevalent in women than in men (OR = 1.52, p = 0.010). Respondents with a positive family history of CD showed 2.9-fold higher odds of CD compared to others (p < 0.001), and respondents with coexisting autoimmune diseases had 2.6-fold higher odds of CD (p < 0.001). Subjects who had taken antibiotics at least three times a year during childhood had 1.95-fold higher odds of developing CD compared to those who took them less frequently or not at all (p = 0.022). Conversely, individuals who were breastfed in infancy had lower odds of CD compared to non-breastfed respondents (OR = 0.53, p < 0.001). The mode of delivery (vaginal vs. caesarean section), overcoming severe infections, and the timing of gluten introduction in childhood did not show a statistically significant effect on the odds of developing CD. Conclusion: Based on our data, being female, having a positive family history of CD, suffering from another autoimmune disease, and frequent use of antibiotics are factors associated with an increased chance of developing CD. On the other hand, breastfeeding in infancy seems to have a protective effect. Our findings highlight the importance of further research in understanding the complexities of this autoimmune condition and providing a foundation for prevention strategies.