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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: Metabolic and cardiovascular diseases represent a significant and ever-increasing problem, accounting for nearly one-third of all deaths and leading to significant morbidity. Lifestyle changes, which introduce new risk factors for cardiovascular disease, are leading to an increase in the risk of cardiovascular disease worldwide. The burden of cardiovascular disease can be reduced by careful risk reduction, and as such, primary prevention is an important priority for all. There is strong consensus among international guidelines regarding the necessity of smoking cessation, weight optimization, and the importance of exercise, while guidelines differ slightly in their approach to hypertension and vary greatly in their approach to the optimal lipid profile, which remains a controversial issue. Methods: The work is focused on the analysis of biochemical (glucose, cholesterol and triacylglycerols) and anthropometric (body mass index) parameters in selected probands (n = 140), including men (n = 70) and women (n = 70) in the Bardejov district. Probands were divided into groups depending on age (18-38, 39-50, 51-60, and over 61 years). For statistical evaluation, the program Statistica ver. 12 and ANOVA were used. Results: The results of the study showed statistically significantly higher values of BMI, total cholesterol (TC), triacylglycerides (TG), and glucose (GLU) (p < 0.001) between men and women in the age groups (18-38 years, 39-50 years). In probands from the age group 51-60 years and over 61 years, we found a high level of cholesterol above the reference limit, but a significant difference between men and women was not confirmed. Correlation analysis confirmed the positive correlation between glucose and BMI. Conclusion: Differences in risk-factor (e.g., biochemical and anthropometrics) burden translate into marked differences in the lifetime risk of cardiovascular disease. These differences are consistent across age groups.

Objectives: Vaccine hesitancy presents one of the critical constraints in combating COVID-19 pandemic. The aim of this study was to develop and validate an instrument for measuring factors that contribute to COVID-19 vaccine hesitancy. Methods: The key constructs in the study instrument were factors that constitute the "3C" model of vaccine hesitancy: Confidence, Complacency and Convenience. Using a cross-sectional, online survey design, the 8-item COVID-19 Vaccine Hesitancy Questionnaire was administered to a sample of 667 adult citizens of Serbia in December 2020. We used confirmatory factor analysis to investigate the model that assumes three latent variables. To ensure that the instrument measures the same constructs in different groups, the measurement invariance examination was conducted. To examine criterion validity, Spearman's correlation was applied to determine the association between the instrument total score and the single-item measuring the likelihood of getting vaccinated against SARS-CoV-2. Results: Confirmatory factor analysis established the three-factor structure, with subscales fitting within the "3C" model of vaccine hesitancy comprising confidence, convenience and complacency. The full scalar invariance was found across gender, and the partial scalar invariance was achieved for the age, region and education level. A higher level of the COVID-19 vaccine hesitancy was associated with the lower likelihood to get vaccinated against the SARS-CoV-2 virus. Conclusion: Our scale is brief and consistent, maintaining a good fit across key socio-demographic subgroups. This result implies that the scale could be useful for quick assessment of COVID-19 vaccine hesitancy in various target populations.

Objective: Extrapulmonary tuberculosis (EPTB) in children globally represents a proportion of all cases of tuberculosis, reaching 20% according to published reports. Children are at a higher risk for disseminated TB and extrapulmonary forms. The most prevalent clinical presentations of EPTB in children worldwide are peripheral lymphadenitis and osteoarticular TB. Peritoneal, urogenital, or meningeal tuberculosis is less frequent, and their diagnosis is often difficult. The aim of the study was the determination of EPTB incidence in children in a low-prevalence region over 35 years. Methods: Descriptive retrospective study of the incidence of EPTB in children and adolescents (aged 0-18 years) in the Czech Republic in the years 1987-2021 as reported in the tuberculosis register. Results: Total amount of EPTB cases was 95. The most prevalent form was extrathoracic lymph node TB. The median age was 10 years. Most patients (84%) were Czechs. None of them died. The ratio of pulmonary and extrapulmonary TB was 79.8% to 20.2%. Conclusion: The low incidence of EPTB in Czech children is congruent with a low incidence of TB in the Czech Republic. Our study confirms that the most frequent form of EPTB is peripheral lymph node TB. Our study did not prove a significant change in the trend of EPTB after the cessation of the mandatory Bacillus Calmette-Guerin (BCG) vaccination programme.

Objective: Our study aimed to evaluate the extent of polycyclic aromatic hydrocarbon (PAH) exposure in coke oven workers from Eastern Slovakia by cytogenetic analysis of human peripheral lymphocytes. Methods: A total of 81 peripheral blood samples were collected from PAH-exposed workers (mean age 45.84 ± 9.73 years) and 30 samples constituted the control group (41.93 ± 15.39 years). The samples were processed using routine cytological analysis. Conventional cytogenetic analysis of human peripheral lymphocytes has been used to evaluate the effects of PAHs. Results: Comparison of the aberrant cells in the total exposed with the controls showed a significant difference (p < 0.05). A high level of significance (p < 0.001) was observed when comparing the gaps between the exposed group and the control group. There was a significant difference (p < 0.01) in aberrant cells and chromatid breaks (p < 0.05) in the GR1 working subgroup compared with the control group. The results of the correlation analysis did not show a significant relationship between the length of occupational exposure and the frequency of aberrant cells (r = 0.071, p = 0.529). Similarly, no association was observed between smoking among coke plant workers and the frequency of aberrant cells (r = 0.117, p = 0.538). Conclusion: Cytogenetic analysis showed an increased frequency of chromosomal aberrations in coke oven workers in Eastern Slovakia.

Objectives: Imposing taxes on unhealthy goods can generate income, raise people's health awareness, and eventually decrease the prevalence of chronic diseases. Our aim was to assess the impact of Hungary's public health product tax (PHPT) since its implementation in September 2011. Differences in purchasing habits between households with different income statuses were also compared. Methods: A retrospective, descriptive analysis of tax bases and income was carried out, and an interrupted time series analysis using the generalised least squares method was performed to examine the changes in trends regarding the purchase of taxable products before and after the implementation of the tax. The amount of tax base (in kilograms or litres), income (in HUF and EUR), and annual purchased quantity of food and beverage groups per household were assessed. Data were derived from the National Tax and Customs Administration of Hungary and the Hungarian Household Budget and Living Conditions Surveys. The study sample was composed of households who participated in the surveys (mean = 8,359, SD = 1,146) between 2006 and 2018. Results: The households' tax bases and incomes increased constantly (with a few exceptions). The total revenue was 19.49 billion HUF (67.37 million EUR) in 2012 and 59.19 billion HUF (168.55 million EUR) in 2020. However, the households' purchasing habits did not change as expected. A significant short-term decrease (between 2012 and 2013) in purchasing unhealthy goods was observed for three groups: soft drinks (p = 0.009), jams (p = 0.047), and fruit juices (p = 0.038). Only soft drinks showed a significant decreasing trend in the post-intervention period between 2012 and 2018 (p < 0.001). Conclusions: We concluded that the PHPT did not decrease households' unhealthy food purchasing trend, although it has a positive effect as it can create revenue for health care and health-promoting programmes.

Epidemiological data consistently show sustained upward trend in the incidence of cancer. The International Agency for Research on Cancer (IARC) estimated that in 2018 more than 18 million people were diagnosed with cancer, and in about 9.6 million cases cancer could be the cause of death. At the same time, an increasing percentage of overweight and obesity is observed in both adults and children. According to the World Health Organization (WHO), in 2016 over 1.9 billion (39% of the population) of adults were overweight, of which over 650 million (13%) were obese. Obesity is closely related to the risk of cancer development. Excessive body weight is considered as a second risk factor for the development of specific cancers after smoking. According to IARC data, high BMI index may be the cause of up to half a million cancer cases per year. In addition, overweight and obesity contribute to increased mortality due to malignancies - it is estimated that they are the cause of death in 20% of women and in 14% of men. Data from the American Cancer Society indicate increased mortality due to pancreatic cancer, liver cancer, multiple myeloma, and Hodgkin's lymphoma in connection with the occurrence of excessive body weight. The study tried to confirm the influence of obesity on the risk of cancer. To achieve this, risk factors such as excessive adipose tissue, chronic inflammation, hyperinsulinaemia and hyperglycaemia, sex steroids, and microbiome were taken into account. In addition, the study presents a simple method of estimating the risk quotient of chances of developing malignant tumors in people with excessive body mass and methods of cancer disease prevention. According to the current state of knowledge, the modification of factors significantly affecting the risk of falling ill may contribute to reducing the risk of cancer. In view of the above, the importance of the problem of overweight and obesity in society and their impact on the occurrence of some types of cancer should be emphasized. Thus, the understanding of excessive body weight as a serious health and social problem sets one of the priorities in the area of public health.

Objectives: In the Czech Republic, asbestos has been classified as a known human carcinogen since 1984. The use of asbestos-containing products was limited to scenarios where the use of other materials was not possible. Since 1997, the manufacture of asbestos materials has been forbidden, and in 1999, the import, manufacture and distribution of all types of asbestos fibres was legally banned by Act No. 157/1998 Coll. Although the use of asbestos is forbidden, the risk of exposure still exists given the ongoing demolition and reconstruction of buildings in which asbestos has been used. In addition, a novel risk has arisen through the quarrying of asbestos-containing aggregates and their subsequent use. The aim of this paper was to describe and evaluate asbestos in terms of history, legislation, current risk of occupational exposure and its health consequences in the Czech Republic over the last three decades. Methods: This retrospective descriptive study used the collected data on occupational exposure and occupational diseases. The counts of workers occupationally exposed to asbestos were obtained from the Registry of Work Categorization; the numbers and structure of occupational diseases caused by asbestos were taken from the Czech National Registry of Occupational Diseases. Data on the total number of mesothelioma cases recorded in the Czech National Cancer Registry was provided by the Institute of Health Information and Statistics of the Czech Republic. Results: A total of 13,112 subjects were registered as occupationally exposed to asbestos during the period 2001-2020. A total of 687 cases of asbestos-related occupational diseases were reported in the period 1991-2020 in the Czech Republic, comprising 178 cases of asbestosis, 250 cases of pleural hyalinosis, 168 cases of pleural or peritoneal mesothelioma, 90 cases of lung cancer, and one case of laryngeal cancer. The data from the Czech National Cancer Registry, available for a shorter period (1991-2018), reveal 1,389 cases of mesothelioma, of which only ~11% were recognised as occupational, despite the fact that the occupational causality of mesotheliomas is estimated to be up to 90% of mesotheliomas. Moreover, the latency of mesotheliomas since the last occupational exposure reached up to 50 years and this trend is still slightly increasing, unlike asbestosis, where a high cumulative dose of inhaled asbestos is needed. The real proportion of occupational lung cancers may obviously be even higher, especially in smokers, where occupational causes including asbestos are not suspected by most physicians. Conclusion: Czech data on asbestos-related occupational diseases, especially cancers, are grossly underestimated, which is most apparent through the low proportion of mesotheliomas diagnosed as occupational. Asbestos materials in older buildings remained in situ and may represent a danger during reconstruction works. The current source of exposure appears to be quarrying of asbestos-containing aggregate and its subsequent use. Awareness of the professional community is therefore crucial, not only for the possibility of compensating those affected, but also for the early detection of the diseases through the dispensary of exposed persons.

Objectives: This study aimed at evaluating the serum redox status in type 2 diabetes mellitus (T2DM) accompanied with an imbalance in iron concentrations. Methods: Diabetic patients were grouped according to serum iron levels [normal (DNFe), low (DLFe), and high (DHFe)], and their clinical and redox parameters [total sulfhydryl groups (tSH), uric acid (UA), and total bilirubin (tBILI) as non-enzymatic antioxidants, and malondialdehyde (MDA) and advanced oxidation products of proteins (AOPP) as markers of oxidative stress] were determined. Results: Glucose and HbA1c levels in the T2DM patients did not differ in function of serum iron. T2DM was associated with reduced tSH levels. In the diabetic patients, tSH, UA, and tBILI negatively correlated with MDA, as well as HbA1c with UA. Accordingly, AOPP and MDA were higher in the diabetic groups compared to the controls. The reduced antioxidant capacity was particularly pronounced in the DLFe group, which was further characterized by lower levels of UA and tBILI compared to the other groups. Subsequently, the level of MDA in the DLFe group was higher compared to the DNFe and DHFe groups. The positive correlation between serum iron levels and the antioxidants UA and tBILI, in conjunction with the negative correlation between serum iron levels and the markers of oxidative stress in the diabetic patients, corroborated the indication that comparatively higher level of oxidative stress is present when T2DM coexists with decreased iron levels. Conclusions: T2DM-associated redox imbalance is characterized by a decrease in serum total sulfhydryl groups and low serum iron-associated reduction in uric acid and total bilirubin levels, accompanied by increased oxidative stress markers. The relatively noninvasive and simple determination of these parameters may be of considerable interest in monitoring the pathophysiological processes in T2DM patients, and may provide useful insights into the effects of potential therapeutic or nutritional interventions.

Objectives: The significant differences in the fingerprint pattern frequencies in type 2 diabetes mellitus (T2DM) patients and controls could be a possible way to identify patients with a risk of developing T2DM. The results could be used in the earlier diagnosis and treatment. The study was undertaken to find out the reliability of fingerprint patterns as a possible predictive tool for T2DM diagnosis. Methods: A total of 1,260 fingerprints were acquired using the optical contact sensor DactyScan 26i. The results of the qualitative analysis of the fingerprint pattern frequencies have been compared between T2DM patients and controls and also between the fingers to each other. We have detected the frequency of patterns: plain arch (Ap) and tented arch (At), radial loop (Lr), ulnar loop (Lu), double loop (Ld), spiral whorl (W), and plain whorl (concentric) (Wp). Statistical analysis was performed using Pearson's chi-square by Statistica ver. 12. Results: We found statistically significant differences (p < 0.05) in the frequency of individual dermatoglyphic patterns among patients with diabetes and healthy controls as follows: in the left thumb (L1) in a radial loop, double loop and spiral whorl pattern; in the left middle finger (L3) in a tented arch and radial loop; in the right ring finger (R4) in a tented arch, spiral and plain whorl; and in the right little finger (R5) in a tented arch and spiral whorl. Conclusion: Fingerprint pattern frequencies might be used as another screening tool and indicator in T2DM prevention. Qualitative analysis of fingerprint patterns could be useful regarding the additional prevention diagnostics of T2DM in the population.

Objective: Thyroid diseases are among the most common endocrinopathies and metabolic disorders. Hypothyroidism is caused by insufficient production of thyroid hormones with a higher prevalence in women. Causes for the development of endocrine diseases may be mutations in genes that encode peptide hormones. The aim of this scientific study was to determine the genotype and allele frequencies of the rs104893657 variant of the PAX8 gene and to determine the genotype versus phenotype association. Methods: The study population consisted of 135 women from northeastern Slovakia who were divided on the basis of screening into two groups: a control group without diagnosed hypothyroidism (CG = 67) and a group of women with hypothyroidism (HY = 68). Biochemical markers - thyroid-stimulating hormone (TSH), prealbumin (PREA), calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) were determined using Cobas Integra 400 plus, Cobas e411 analysers (Roche). Genotyping was performed using TaqMan^® SNP Genotyping Assay instrument 7500 Fast Real-Time PCR Systems (Applied Biosystem). Results: Student's t-test revealed a statistically significant difference between CG and HY in biochemical parameters: TSH (p < 0.001), P (p = 0.008). By Chi-square test we found no statistically significant difference in the representation of genotypes (p = 0.788) in the rs104893657 polymorphism of PAX8 gene. The T allele was not associated with hypothyroidism in Slovak women (p = 0.548). In CC genotype we found statistically significant difference between CG and HY in parameters TSH (p < 0.001) and P (p = 0.006). Conclusion: The mutant T allele was detected at low frequency in both groups of women studied. The association of the T allele with the development of hypothyroidism in Slovak women was not confirmed. The results of this work provide initial information on the distribution of genotypes and alleles in the studied variant of PAX8 gene in the Slovak female population.

Objectives: This study assessed trends in tobacco use in students of the Third Faculty of Medicine of Charles University in the Czech Republic between academic years 2012/13 and 2019/2020. Methods: Two cross-sectional surveys designed to obtain information on smoking history, smoking status, tobacco products use, and cessation were conducted among 382 students of the 6-year Master's Study Programme (General Medicine) and the 3-year Bachelor's Study Programme (Public Health) in 2012/2013; and among 580 students of General Medicine and of the Bachelor's Study Programmes (Public Health, Dental Hygiene and Nursing) in 2019/2020. Results: Regular/daily smoking was reported by 4.4 ± 2.4% (with 95% CI) of General Medicine students and 4.8 ± 4.1% of Public Health students in 2012/2013, and 1.3 ± 1.1% of General Medicine students and 14.4 ± 4.8% of students of bachelor studies in 2019/2020. The share of regular and occasional smokers was higher among junior students in both academic years (23.9 ± 5.1% and 20.1 ± 4.7%, respectively) compared to senior students (23.6 ± 9.8% and 9.6 ± 5.7%). Cigarettes were the most common products used in both academic years (67.0 ± 4.7% and 45.5 ± 4.0%). There was a significant increase in proportion of students using more tobacco products in the course of the time (from 12.1 ± 3.1% to 53.7 ± 4.1%). The proportion of students who quitted smoking has risen from 11.4 ± 3.2% to 16.1 ± 3.0%. On the contrary, the proportion of students who started smoking has dropped from 15.9 ± 3.7% to 2.9 ± 1.4%. The proportion of non-smokers has risen from 57.6 ± 5.0% to 65.3 ± 3.9%. Conclusions: The study revealed some positive trends concerning tobacco use in students (decline in regular smokers among students of General Medicine, senior students, cigarette smokers, water pipe smokers; rise in non-smokers), but also negative ones (rise in regular smokers among students of Public Health, students who used more tobacco products).

Objectives: The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university. Methods: Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables. Results: Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined. Conclusion: Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

Objectives: Industrially produced trans fatty acid (iTFA) have adverse health effects and thus their consumption should be limited. The aim of this study was to determine and compare the iTFA content in frequently consumed food products by young adults from the Serbian and Slovenian market with supposedly elevated iTFA content in 2015. At the time of this study, there was no recommended limit of iTFA in both countries, and reduction of iTFA in foods was on voluntary basis. Methods: We determined iTFA content in food products, 19 from the Serbian and 22 from the Slovenian market, blinded and analysed in the same analytical run. Contents of fatty acids (FA) methyl esters were analysed by capillary gas chromatography with a flame ionisation detector. Heptadecanoic acid was used as internal standard. Individual FA along with TFA were expressed as percentages of total measured FA. The amount of each FA in the sample was then calculated from the response factor and the transformation factor of the FA from the FA methyl ester content. Results: Elaidic acid (C18:1t) was found as the most abundant TFA in analysed products, ranging from 0.52 g/100 g of total FA in chocolate candy up to 60.4 g/100 g in a salami from Serbian market. In Slovenian products, the values for elaidic acid were lower, 0.04-3.95 g/100 g of total FA, except in one type of wafers (24.3 g/100 g). Conclusions: The majority of analysed products from the Serbian and three from Slovenian market exceeded the recommended WHO and EU limit of 2% iTFA of total fat in foods. Samples of frequently consumed salami, wafers, tea biscuits, and snacks were identified as products with potentially higher burden of iTFA in diets of young adults in Serbia.

Objectives: Mad honey poisoning is a common public health problem that can be seen in many parts of the world. In this study, the symptoms and clinical findings of mad honey poisoning cases and their distribution worldwide were investigated based on current data. Methods: PubMed, Scopus, Web of Science and Google Scholar databases were searched. The demographic characteristics of the cases, clinical findings, amount of consumed honey, duration of hospitalization, and data of the region where mad honey was produced were recorded. Results: 900 cases were identified. The majority of poisoning cases (91.44%) were reported from mad honey produced in Turkey, Nepal (4.67%) came second and Korea (1.56) third. The majority of cases in Turkey were due to honey produced in the Black Sea Region. It was also determined that the mad honey was produced in the west Black Sea Region in most of the cases (35.22%), followed by the east Black Sea Region with a rate of 33.22%. In poisonous cases, it was determined that the mad honey was mostly produced in Rize, followed by Trabzon and Kastamonu, respectively. The most common signs of mad honey poisoning were bradycardia (88.48%) and hypotension (76.04%). Conclusion: The majority of cases have been reported from Turkey. When examining where the mad honey was produced in Turkey, it was seen that the western Black Sea Region came first, and the eastern Black Sea Region came second. Rize came first among the provinces, followed by Trabzon and Kastamonu. There is a parallelism between the distribution of mad honey poisoning cases and the distribution areas of Rhododendron species. However, although Rhododendron species show a widespread distribution throughout the world, why the majority of the cases were reported from Turkey draws attention as an issue that needs to be investigated.

Objectives: The use of alternative water sources such as rainwater or greywater (i.e., wastewater excluding water from toilets) for non-potable purposes may save water but, on the other hand, can also pose health risks to users. The main health risks come from microorganisms (such as bacteria, viruses, fungi, and protozoa). This work aims to analyse especially microbiological quality of rainwater and greywater used inside buildings in detail and to expand the existing knowledge about the potential health risks associated with these alternative water sources. It also considers methodological problems during E. coli and coliform bacteria detection. The final objective is to discuss requirements and appropriate indicators for monitoring recycled water quality. Methods: We examined 30 buildings with non-potable water systems in the Czech Republic and analysed a total of 137 samples of rainwater and 120 samples of greywater. From these 30 buildings, eleven, 5 of which used rainwater and 6 of which used greywater, were sampled regularly for 1-2 years for basic chemical parameters, various faecal indicators, C. perfringens, Legionella spp. and P. aeruginosa. Occasionally, samples were analysed also for the presence of environmental mycobacteria, amoebas, viruses, and selected pathogens. Results: Nearly three quarters of rainwater samples contained the faecal indicators E. coli or enterococci, or both, and in samples from several buildings also Clostridium perfringens was repeatedly detected. Untreated and treated rainwater were in respect to microbiological quality similar, suggesting that treatment processes were not very efficient. In greywater samples, beside faecal indicators, also P. aeruginosa and thermotolerant amoebas were repeatedly detected. Treatment technologies used for greywater were more efficient than those for rainwater systems. Conclusion: Based on the results we evaluated appropriate indicators for monitoring recycled water quality and drafted the first Czech regulation for non-potable water.

Objectives: This paper explores education-, income- and occupational class-related inequalities in risky health behaviours including into models all three factors together as well as their interactions, which has not been undertaken by previous studies analysing socioeconomic status (SES) related differences in risky health behaviours. Methods: Our data source is the special module "Social Inequalities in Health" included into the European Social Survey Round 7 (ESS R7) and conducted in 20 European countries. We run nine separate multilevel binomial logistic regression analyses for all the risky health behaviours with all our independent and control variables including country as the second level random intercept. Into all the models we also included interaction terms to consider possible moderating effects of separate independent variables. Results: Education and income emerged as factors most consistently related to risky health behaviours, but occupational class differences were also found to be significant: eating vegetables or salad less than once a day and being daily smoker is positively related to lower SES as measured by all three indicators; eating fruits less than once a day is related to lower income and occupational class, while drinking alcohol at least several times a week is positively related to higher education and higher income; being physically active for less than 3 days per week is positively related to lower education; patterns of heavy smoking and binge drinking are inconsistently related to SES variables. We also found considerable regional variation, especially in fruit and vegetable consumption, being physically active and alcohol consumption patterns. Conclusions: Without careful theoretical consideration linking SES and risky health behaviours, education, income and occupational class cannot substitute each other in the study of SES-related differences of health behaviours, as assumed in the larger part of research on the subject.

Objectives: In this review, we present a contemporary look at the management of travellers' diarrhoea (TD), and we discuss the potential role of a microbiome as well as the administration of live microorganisms in order to prevent TD. Methods: We performed a comprehensive search using the PubMed and Web of Science databases for the period 2014-2021, looking for original and review articles on travellers' diarrhoea. Results: TD belongs among the most frequent illnesses experienced by travellers. For the most part, it is manifested as an acute yet self limiting condition, and only in a few cases proceeds to a prolonged form. Epidemiological analyses have shown that the majority of TD cases are caused by bacterial infections. In practice, pharmacological therapy is often used in the prevention and treatment of TD, since patients naturally seek preventive measures against the development of its severe course and its impact on planned activities. Bismuth salicylate is a strongly recommended TD prophylaxis but is not available on all European Union markets. Although the antibiotic prophylaxis is not generally recommended in guidelines, some antibiotic or chemotherapeutic agents are accessible over-the-counter in certain countries, and travellers are routinely encouraged to use them preventively. This routine can alter the microbiome of the traveller and promote the spread of drug resistant bacteria in their place of residence. Probiotic administration is considered safe, although the quality of evidence in favour of its prophylactic use in TD is currently low. Conclusions: The challenge for public health authorities is to educate personnel that can directly influence the behaviour of travellers through safe and effective pharmacological alternatives to antibiotics. Manipulation of the gut microbiome using specific probiotic strains can represent a safe and promising intervention.

Objectives: Demographic differentiation caused by the history of migration in the Czech and Slovak Republics led the authors of this article to analyse generational differences in the groups of foreigners living in the Czech Republic (CR) and the impact of generational differences on selected aspects of their social situation and perceived health. The crucial research question was whether and to what degree do different generations of foreigners vary from each other and what impact this has had on their social situation and health determinants. Methods: The main goal was to examine mutual relationships between selected characteristics of social situation and health determinants in various groups of foreigners living in the CR. A total of 1,003 questionnaires among foreigners officially living in the Czech Republic were collected and analysed. In the area of subjective perception of health, a comparison of foreigners with Czech citizens (representative sample of Czech seniors; 1,172 respondents) in the age category 65+ was made in order to find out whether this perception differs between senior foreign nationals and senior Czechs. Results: Older individuals (50-64 years and 65+ years) appeared to have the best integration into Czech society. This age generation felt positive about stay and migration status in the CR. Older foreigners differ from older Czech citizens who tend to refer to their health as very good to rather good compared to foreigners who described their health as neither good nor bad. The middle generation (30-49 years) of foreigners was characterized by hard work and the initial stages of integration into Czech society. This group also reported positive feelings about living in the CR relative to their home country. Conclusion: The oldest generation of foreigners is the best integrated in the Czech Republic (with regard to selected aspects tested in this article). This generation is able to offer new immigrant effective integration strategies. However, they assess their subjective health one degree worse in comparison with Czech seniors (representative sample), this finding should lead to the setting of preventive programmes related to a healthy lifestyle, including lifestyle for foreigners living in the Czech Republic.

Background: The purpose of this study was to determine the foot arch shape and the associated health status in a selected sample of individuals belonging to the adult majority population of eastern Slovakia and to evaluate which of the observed factors are involved in the occurrence and development of foot arch abnormalities. Methods: The weight and height of probands were measured according to standard anthropometric methods using a personal scale and an anthropometer. The BMI index was calculated for each proband from the measured data. A Pod4Foot Classic podoscope was used to obtain the plantograms. The Chippaux-Smirak index method was used to evaluate the plantograms. The study includes a questionnaire containing questions about factors affecting the foot arch shape. Results: The arch of the right foot was supported by the effect of wearing shoes at home (p = 0.013). There was an association between wearing high-heeled shoes and foot arch disorder, both on the right (p = 0.011) and left (p = 0.045) foot. There was no significant relationship between the prevalence of overweight or obesity, between wearing orthopaedic insoles in shoes without a prescription, wearing orthopaedic footwear at home, between sport or static and active work and foot arch disorder in our study. Conclusions: Most of the probands had a bilaterally normal arched foot, which is a positive result. Nowadays, there are a large number of orthopaedic devices on the market that help to shape the arch of the foot properly, but it is not correct to use these devices arbitrarily, without a doctor's prescription and a diagnosis of foot arch deviation.

Objectives: Due to nano-dimensions (less than 100 nm), can nanoparticles probably penetrate through various membranes and travel from the bloodstream to other organs in the body. The aim of our study was to find out whether NPs Fe₃O₄ (coated with sodium oleate) injected into the tail vein of laboratory Wistar rats pass through the bloodstream to the respiratory tract (in comparison with a control group); and if so whether increasing doses of NPs Fe₃O₄ have an escalating harmful effect on selected bronchoalveolar lavage (BAL) parameters. Methods: Wistar rats were intravenously given 3 doses of the suspension of NPs Fe₃O₄ (0.1% LD50 = 0.0364, 1.0% = 0.364 and 10.0% = 3.64 mg/kg animal body weight). Seven days later, we sacrificed the animals under anaesthesia, performed bronchoalveolar lavage (BAL), and isolated the collected cells. Many inflammatory and cytotoxic BAL parameters were examined. Results: Both inflammatory and cytotoxic BAL parameters affected by Fe₃O₄ suspension were changed compared to control results, but not all were statistically significant. Thus, the NPs Fe₃O₄ passed through the bloodstream to the respiratory tract and affected it. The highest concentration of NPs Fe₃O₄ (10%) had the most influence on BAL parameters (7 of 12 parameters). Only 3 parameters showed a pure dose dependence. Conclusion: We assume that the adverse effect of Fe₃O₄ NPs in our study is probably not correlated with the dose, but rather with the size of the particles or with their surface area.

Objectives: Globally, child mortality from external causes is in decline, but it is still among the leading causes of child deaths. The aim of this first national study was to determine trends of mortality rates from external causes among children aged 1-14 years in Serbia. Methods: Mortality data were collected from the database of the Statistical Office of Serbia. Joinpoint analysis was used to assess the average annual percentage change (APC) and the corresponding 95% confidence interval (CI) in mortality from 1997 to 2016. Results: In the 1997-2016 period, there were 1,388 child deaths from external causes. They contributed to 29.4% of child mortality in total, from 34.8% in 1997 to 21.8% in 2016. Mortality rate was two times higher among boys (8.1 per 100,000) than girls (4.1 per 100,000). Transport accidents (37.6%), followed by drowning and submersion (18.2%), represented more than half of all deaths due to external causes. Since 1997, mortality rate showed a significant downward trend in boys by -5.4% (95% CI -6.8 to -3.9) yearly for unintentional injuries and significantly by -10% (95% CI -19.0 to 0.1) yearly for intentional injuries. Among girls, death rate for unintentional injuries decreased significantly by -7.1% (95% CI -9.0 to -5.1) yearly and decreased insignificantly for intentional injuries by -2.1% (95% CI -15.3 to 13.1) yearly. Conclusions: The external causes of death, despite the substantial decline in mortality, are still present among children aged 1-14 years in Serbia. Therefore, implementation of nationwide programmes for prevention of external causes of death is urgent.

Objectives: Understanding immune response is critical for control of COVID-19 pandemic. However, recent studies show that vaccine-induced humoral immunity may not be long-lasting and weaker in SARS-CoV-2 variants of concern. Methods: In May 2021, 253 self-nominated persons were tested for antibodies against SARS-CoV-2 in 1 to 104 days (mean 41, median 28) after two doses of Moderna and Pfizer-BioNTech vaccines in the city of Brno, Czechia. Two point-of-care iCHROMA™ II immunofluorescence assays were used: COVID-19 Ab against mix of SARS-CoV-2 nucleocapsid and spike proteins (IgG Ab); and COVID-19 nAb against S1-RBD protein (nAb). Results were analysed in relation to gender, age, vaccine, and past COVID-19 disease. Results: Antibodies nAb were detectable in 92.9% (95% CI: 89.7-96.0) of vaccinees. We observed statistically insignificant decrease of positive results from 93.9% (95% CI: 89.5-98.3) and 97.0% (95% CI: 92.8-100.0) in the first and second month after vaccination, respectively, to 91.7% (95% CI: 83.8-99.5) and 78.3% (95% CI: 61.4-95.1) in the third and fourth month, respectively. Quantitative results showed decreasing level of nAb in both genders, age groups and vaccines. Higher levels of nAb were found in younger age group and in COVID-19 convalescents. IgG Ab showed little dynamics in time. Conclusions: We found robust humoral response after vaccination with mRNA vaccines, however, decreasing nAb levels suggest that vaccine-induced humoral immunity is rapidly waning. This finding is relevant for adjustment of vaccination strategies with regard to inclusion of booster dose(s).

Objectives: The aim of this study is to evaluate accidental findings of axillary lymphadenopathy during breast examination. Postvaccination axillary lymphadenopathy is a possible cause of adenopathies but these findings used to be exceedingly rare. Nowadays, after Covid-19 vaccination it is found more often. Covid-19 vaccination started at the end of December 2020 with two types of vaccine, Moderna and Pfizer-BioNTech in the Czech Republic. The aim of this article is to present a single centre experience with Covid-19 lymphadenopathy during the general vaccination in the Czech population and summarization of recommendations. Methods: In January to February 2021 ultrasound revealed axillary lymphadenopathy in several patients during breast examination in our certified centre. In four of them it was concluded as lymphadenopathy after Covid-19 vaccination. A search (using databases PubMed and Google Scholar) of the available literature for the years 2020 and 2021 was performed. Results: These four patients were examined during the first two months of 2021. In all of them pathological lymph nodes with typical sonographic signs were seen in the ipsilateral axilla. We searched the literature for follow-up recommendations and summarized them in our article. Conclusion: Accidental findings of axillary lymphadenopathy during ultrasound breast examination will be more often. There will be more cases of lymphadenopathy with an increasing number of people being vaccinated against Covid-19.

Objectives: In 2020, measures against the spread of COVID-19 were adopted, including nationwide school closures, restrictions on the free movement of persons and leisure time sports activities. The aim was to assess the impact of COVID-19-associated restrictions on the performance of paediatric and adolescent competitive athletes by comparing basic anthropometric and performance parameters. Methods: The sample comprised 389 participants (115 girls, 274 boys). All participants were examined during regular preventive sports health checks from September to November 2019 and a year later. At the initial examination, the mean age of the entire sample was 12.2 ± 2.7 years (median 12.0, minimum 7.0; maximum 17.0). The examination consisted of a complete medical history and physical examination including maximal exercise testing on a leg cycle ergometer. Results: In the entire sample, as well as in the boy and girl subgroups, body height, weight, body mass index (BMI), BMI percentile, and power output significantly increased according to a percentile graph for boys and girls in 2020. A reduction in power output (W/kg) was found. By 2020, W/kg dropped in 56.4% of the youngest participants (7-13 years), 75% of those aged 14-16 years and 64.9% of the oldest individuals (16-17 years). The percentage of the youngest children with power output reductions was statistically significantly lower than the percentages of the other age subgroups (p = 0.007). There were no significant differences in results between genders. Conclusions: Performance and anthropometric parameters worsened especially among older children. This should be reflected when planning epidemic measures in case of any similar situation in the future.

Objective: Exposure to third-hand smoke (THS) poses health risk, especially for children. THS is mostly ignored in Turkey. The aim of this study is to adapt the Beliefs about Third-Hand Smoke (BATHS) scale to Turkish. Methods: The BATHS scale consists of 9 items, and the data collected from 273 people was considered sufficient for analyses in this methodological study. The BATHS scale is translated into Turkish and confirmatory factor analysis (CFA) was performed for the construct validity analysis of the scale. Results: The correlation between the overall BATHS scale and its two sub-dimensions was 0.937 (p < 0.001), and the correlation between the health and persistence sub-dimensions was 0.775 (p < 0.001). Since there was a statistically positive and highly significant relationship, the adapted BATHS scale was considered structurally compatible with the sub-dimensions. The reliability value of the entire scale is 0.90. Test-retest correlation values between the health and persistence dimensions were between 0.745 and 0.960, the values obtained were above 0.70 and had a statistically positive and high level of significant relationship (p < 0.001). Conclusions: It is concluded that the Turkish version of the BATHS scale is reliable and valid. This scale will allow further research and training on third-hand smoke exposure. Tobacco control programmes success will improve.

Objectives: During the covid-19 pandemic, protective equipment such as respirators and masks were widely used to protect respiratory tract. This disposable protective equipment is usually made from plastic fibre-based nonwoven fabrics. If used masks and respirators are improperly discarded, they pollute the environment by becoming a source of micro and nanoplastics. The aim of the study was to find out how stable the materials of protective equipment are and how released nano and microplastics can affect aquatic and soil organisms. Materials: The input materials used to produce respirators and masks were tested for their thermal stability and resistance to the release of plastic particles into the environment. To determine the thermal stability of the materials, a simultaneous thermal analysis - thermogravimetry (TGA) and differential scanning calorimetry (DSC) were performed. Results: Materials of masks and respirators are stable at temperatures common to temperate climate zone. However, the possible effects of chemical reactions of the materials with the environment were not considered during the measurement. The materials were also subjected to ecotoxicity tests according to European standards. Conclusion: While the leachate obtained by shaking the materials in water did not show acute toxicity to the selected aquatic organisms, the material itself had a significant effect on selected soil organisms (springtails).

Objectives: Hepatitis E virus (HEV) has recently become endemic in Europe, however, it is often a remnant neglected by clinicians as the causative agent of acute and chronic hepatitis and is often misdiagnosed as a drug-induced liver injury. The infection rate in European pig farms is estimated to be around 15-20%, therefore, the primary source of HEV infections might be poorly prepared pork meat. As HEV infections may occur more often in clinical practice than previously thought, the present paper aims to analyse the seroprevalence of HEV in patients with acute hepatitis over a period of 14 years in Csongrád County, Hungary. Methods: The sera of 4,270 hepatitis patients collected between 2004-2018 were tested for cumulative anti-HEV IgG/IgM. Furthermore, 170 IgM positive sera were tested for the presence of viral RNA by RT-qPCR. Results: Between 2012-2018, the cumulative seroprevalence has increased 9.18 times, and between 2013-2018, IgM prevalence has increased 12.49 times. Viral RNA was detectable in 12.35% of IgM positive sera. Conclusion: The present paper presents data showing that the seroprevalence of hepatitis E virus has increased markedly over the course of the last decade in Hungary and in other European countries as well. The exact reason behind this phenomenon is yet to be determined. To assess the dynamics and the reason for this increase in prevalence, pan-European, multicentre studies should be conducted.

Objectives: Diabetes mellitus type 2 (T2DM) is a multifactorial and polygenic disorder characterised by chronic hyperglycaemia accompanied by impaired lipid, carbohydrate, and protein metabolism. The disease is associated with several genetic polymorphisms, including the FokI polymorphism in the vitamin D receptor (VDR) gene. Methods: We conducted a study of 327 probands (191 T2DM patients, 136 controls), with a mean age 65.06 (SD ± 10.88) years of patients with T2DM and 58.89 (SD ± 6.59) years in the healthy probands. We investigated the association between FokI polymorphism and biochemical parameters in T2DM patients in the Slovak population. Anthropometric measurements, biochemical, and genetic analysis were statistically evaluated by Statistica ver.13 software using t-tests. Results: Biochemical analysis confirmed significantly higher mean values of total cholesterol (TC), triglyceride (TG), glucose (GLU), and uric acid (UA) (p < 0.001) in T2DM probands and statistically significantly lower values of high-density lipoprotein (HDL), cholesterol and vitamin D (p < 0.001). Allele frequencies and genotype distributions of the FokI (rs2228570) polymorphism were not significantly different between T2DM patients and controls (p = 0.909). Patients with T2DM and TT genotype had the highest glucose level of 11.39 (SD ± 2.32) uU/ml (p < 0.001). Conclusion: Our study did not provide evidence for an association of the investigated FokI polymorphism of the VDR gene with T2DM in the Slovak population. Further research is needed to evaluate the impact of single nucleotide polymorphisms (SNPs) in the VDR gene, focusing on related genetic analyses in a larger T2DM cohort.

Objectives: In Czech children, the burden related to the high body-mass index is rising. In the last three decades, Western eating patterns have influenced Czech children's diet, including the high consumption of sugar-sweetened beverages. This narrative review aims to evaluate evidence of the trend of sugar-sweetened beverages consumption in Czech children and its impact on the prevalence of childhood abnormal adiposity. Methods: A comprehensive literature review in MEDLINE (PubMed) and a hand search using references in identified articles were performed. The inclusion criteria were population-based studies of randomly selected samples of children from 0 to 18 years old, data involving the Czech population, published from 1990 to 2021. The results were organized into three sections - childhood abnormal adiposity, SSBs consumption, and the association between SSBs consumption and abnormal adiposity. Results: The studies showed a significant increase in abnormal adiposity in both genders and all age categories. The highest prevalence of abnormal adiposity was observed in boys and younger children. On the contrary, sugar-sweetened beverages showed a significant decline in daily consumption among Czech children of both genders and all age categories. No results were found for consequences of abnormal adiposity concerning sugar-sweetened beverages consumption. Conclusion: Findings from this review could serve public health experts to detect the areas of a gap in research and establish potential interventions in vulnerable groups. Observation of potential obesogenic contributors - including sugar-sweetened beverages - should be an integral part of effective action against the obesity pandemic.