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Objectives: Asbestos-related diseases are still a current problem worldwide. What is their occurrence in the Czech Republic? The answer is the subject of this study, which aims to provide a general and regional overview of the situation over the last 20 years with a more detailed focus on mesothelioma, the development of which is highly associated with asbestos exposure and the issue of their recognition as an occupational disease. Methods: In its retrospective reviews, the study is based on analyses of data from the Institute of Health Information and Statistics of the Czech Republic and data from the Czech National Cancer Registry, which also interconnects. Results: In the last 20 years, 512 new cases of occupational diseases from asbestos have been reported, namely 228 cases of pleural thickening, 133 mesotheliomas, 92 asbestoses, and 59 cases of lung cancer. In the last 5 years, mesotheliomas (n = 39) predominated among the reported diseases with a 45% proportion in the total number of 86 cases. The trend in their incidence, as the only one among asbestos-related diseases, is not declining. There was a significant difference in the overall incidence of mesothelioma in a general population and the incidence of occupational mesotheliomas. At the national level, occupational aetiology was acknowledged in only 11.3% of cases of mesothelioma on average. The highest proportion of occupational mesotheliomas and the highest incidence of all asbestos-related diseases were found in regions where the largest asbestos processing plants were located. Conclusion: The authors emphasize the importance of work history for the diagnostic process of asbestos-related diseases and also the need to perform follow-up examinations for their early detection.

Objective: Hand hygiene (HH) compliance is associated with effective prevention of health care-associated infections (HAI), the topic being very important due to current COVID-19 pandemic. There is a growing debate about the role of educational institutions in the low HH compliance of health workers. This study aimed to assess HH knowledge, self-assessment and attitudes of medical students in relation to provided educational background. Methods: A cross-sectional survey (mixed methods-approach) combined with the curriculum analysis and questionnaires. Quantitative method: a questionnaire of knowledge of HH issues (QK), and a questionnaire of self-assessment and attitudes (SAQ) towards HH. Qualitative method focused on an analysis of content of the curriculum documents. Results: 250 (KQ) and 238 (SAQ) questionnaires were analysed from students of general medicine (n = 262; average age 22.5 years). Below-average knowledge of HH and a high self-assessment of knowledge and compliance with HH was reported by 72.2% and 76.0% of students, respectively. Significant differences in knowledge and self-assessment of HH were found among study years and gender. The content analysis has revealed gaps in HH-related information in general medicine educational programme. Conclusions: It is highly expected that there might be some association between low HH knowledge level, false self-assessment and educational programme in medical students.

Objectives: This work aimed to determine the representation and resistance of bacteria belonging to the genus Staphylococcus and Enterococcus on inanimate surfaces of two selected workplaces of the University Hospital of L. Pasteur in Košice (UHLP) and to investigate their importance in the hospital environment. The men's ward of the Department of Internal Medicine (DIM) and the Department of Anaesthesiology and Intensive Care (DAIC) were chosen. Methods: Using sterile sampling kits, a total of 182 swabs were collected from the inanimate surfaces of both UHLP workplaces. The swabs were then transported to a microbiological laboratory and inoculated onto sterile culture media (blood agar containing 5% ram erythrocytes). After culturing (24-48 hours, in a thermostat at constant temperature 37 °C), bacterial colonies were identified by mass spectrometry on a MALDI TOF MS. Bacteria belonging to the genera Staphylococcus and Enterococcus were subsequently separated from the spectrum of identified bacteria. Nosocomial significant strains of staphylococci (Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus aureus) and all isolated enterococci were subjected to susceptibility testing for selected antibiotics using the disk diffusion method - E-tests. Results: Several members of the genus Staphylococcus were identified from the inanimate surfaces of both workplaces. These were mainly coagulase-negative strains - Staphylococcus epidermidis (45), Staphylococcus capitis (34), Staphylococcus haemolyticus (20), Staphylococcus hominis (45), Staphylococcus pasteuri (2), Staphylococcus sroph (1), Staphylococcus simulans (3), and Staphylococcus warneri (4). Staphylococcus aureus strains were also identified (2). Nosocomial significant isolates were tested for susceptibility to the antibiotics cefoxitin (FOX) and oxacillin (OXA). Two members of the genus Enterococcus - Enterococcus faecium (7) and Enterococcus faecalis (8) were isolated. All strains were subject to vancomycin susceptibility testing using the disk method. Conclusion:

Objectives: This is a review article that deals with the question of whether type 2 diabetes is a risk factor for the development of Alzheimer's disease. Methods: We searched the PubMed database and relevant publications were selected for review. The introduction, which describes the possibilities of how type 2 diabetes can affect the development of Alzheimer's disease, is followed by other questions related to this issue: May on the contrary Alzheimer's disease induce type 2 diabetes? What is a relative risk for type 2 diabetes to induce dementia? How type 2 diabetes influence conversion of mild cognitive impairment to Alzheimer's disease? What is the role of antidiabetic medication? Proposition of term "type 3 diabetes" for Alzheimer's disease. Results: Type 2 diabetes mellitus has been shown to increase the risk for cognitive decline and dementia, such as Alzheimer's disease and vascular dementia. Despite extensive research and numerous publications, the mechanisms underlying these associations remain unclear. Conclusions: Because of similar molecular and cellular features among type 1 and type 2 diabetes and insulin resistance associated with memory deficit and cognitive decline, some researches proposed the term "type 3 diabetes" for Alzheimer's disease.

Objectives: Front-of-package nutrition labels are intended to easily convey to consumers comprehensible information about the nutritional composition of pre-packaged food and are thus a tool in the combat against the growing prevalence of nutrition-related disorders, such as obesity, type 2 diabetes, cardiovascular disease, and some types of cancer. The objective of the present narrative review was first to describe Nutri-Score and then to synthesize some of the international scientific evidence for its effectiveness. Guided by scientific data and collective expertise, France formally adopted labelling of pre-packaged food with the 5-colour Nutri-Score label in October 2017 and that move was later followed by Belgium, Spain, Germany, Switzerland, the Netherlands, and Luxembourg. Methods: This article synthesizes evidence from several countries regarding the effectiveness of Nutri-Score and the associated individual-level diet quality index in terms of attitude/behaviour- and health-related outcomes. It also addresses criticism levied at the label. Results: The effectiveness of Nutri-Score has been demonstrated in terms of consumer ability to correctly classify food according to its nutritional quality, the nutritional quality of actual and intended food purchases, and portion size choices. In addition, consumption of foods that are less favourably rated on the Nutri-Score scale has been prospectively associated with chronic disease risk (cancer, cardiovascular disease, metabolic syndrome, etc.). Conclusion: The adoption and implementation of a uniform front-of-package label such as the scientifically validated Nutri-Score on pre-packaged foods/beverages across Europe could be beneficial to consumers at the point of purchase and could help reduce the incidence of diet-related chronic diseases by means of improvement in diet quality.

Objectives: Influenza is a widespread respiratory disease with a potentially risky course. Vaccination is considered the most effective method of prevention. However, only a small portion of the population is vaccinated. Teachers work in a high-risk environment and they have a significant impact on the population through student education. Therefore, the aim of this study was to find out the knowledge and attitudes of pre-service teachers about influenza and vaccination. Methods: A questionnaire survey was conducted to find out what knowledge, attitudes and behaviour pre-service teachers (N = 373) show in relation to influenza and influenza vaccination. It was statistically tested whether there were differences between students with respect to their field of study. Results: The majority of pre-service teachers have a good knowledge of influenza symptoms, however, they often mistaken it for other respiratory diseases. The field of study plays only a partial role in the knowledge. The respondents perceive influenza as an easily spread disease, but they have negative attitudes towards vaccination, and most pre-service teachers think that its disadvantages outweigh the advantages. This was stated primarily by pre-services science teachers. These attitudes are also reflected in the low vaccination rate of the sample (6%). Conclusions: Relatively good knowledge of teachers is not reflected in their attitudes and behaviour. Negative attitudes towards vaccination are most held by pre-service teachers, whose field primarily includes teaching this topic. It can have a significant effect on students' attitudes not only toward influenza vaccines but also to other vaccinations.

Objectives: Lyme borreliosis is a tick-borne disease of increasing incidence and public concern. Our cross-sectional study was aimed at evaluating seroprevalence of Borrelia burgdorferi in a group of respondents from Eastern Slovakia. Methods: In total, 515 blood samples collected in 2013-2016 were analysed with NovaLisaTM, NovaTec - Borrelia IgG/IgM kit (Immunodiagnostica, Dietzenbach, Germany). Positive and equivocal IgG-antibody results were further examined with immunoblotting (LYMECHECK® OPTIMA IgG and IgM kits, BIOSYNEX, France). Data detected by serological methods were matched with those obtained from a questionnaire. Differences between groups by residence/seropositivity were tested by χ² test. The effect of socio-demographic and risk factors on seropositivity of IgG antibodies was assessed using binary logistic regression. Results: IgG antibodies against Borrelia burgdorferi were detected in 67 cases (13.01%) and IgM antibodies in 40 cases (7.8%). Previous tick bite had been noted in 67.2% of these seropositive individuals. Higher seropositivity was observed in men and persons aged over 61 years. Rural residents had higher seropositivity (39%) than those living in urban (29%) areas. Very few of these seropositive persons reported prior symptoms. Conclusion: The study reveals that IgG-seropositivity for Borrelia burgdorferi in Eastern Slovakia is predominant in men and occurs mainly in rural areas. The findings also suggest that exposure to Borrelia burgdorferi (with subsequent antibody response in serum) does occur, mostly without giving rise to clinical Lyme borreliosis.

Objectives: This article deals with the comparison of excise tax revenues from alcoholic beverages and tobacco products with public spending that are spent on treating diseases occurring in consumers of these commodities. Methods: Based on available data, the study estimates direct public expenditures on the treatment of tobacco-related diseases and very frequent alcohol consumption-related diseases in the Czech Republic. These partial results are evaluated in the context of tax revenues from consumption of the mentioned commodities. The analysis works with the data from 1998-2017, which was obtained from the Ministry of Health of the Czech Republic, the National Institute of Public Health, the Customs Administration of the Czech Republic, the Ministry of Finance of the Czech Republic, and the Czech Statistical Office. Results: Medical treatment costs of smoking-related diseases were 18.35-48.19 billion CZK per year in the analysed period. These expenditures in the period 1998-2011 exceeded the annual revenues from the tax on tobacco products (in 2002 by 12.08 billion CZK). Since 2012, the balance has been positive in favour of public spending. Expenditures on the treatment of alcohol-related diseases amounted to 9.66-25.36 billion CZK per year in the given period, the expenditures, except the year 1998, exceeded the revenues from alcoholic beverages taxes (by 14.63 billion CZK in 2009). Conclusions: The study shows that the excise tax revenues for tobacco products do not reach the level of healthcare spending for tobacco-related disease in the most of the analysed period, and this difference increases with the length of consumption, which can be interpreted in such a way that current excise tax revenues potentially mean public healthcare expenditures, which cumulatively exceed revenues from the relevant excise duties.

Objectives: Acrylamide (AA) is considered one of the contaminants that occur in heat-processed agri-food products, which through diet can increase the risk of developing cancer for consumers of all age groups. Methods: This review analysed the level of acrylamide of the most important heat-processed agri-food products that contribute to the dietary exposure of the population of different European countries and the assessment of health risks related to the presence of AA in food. Results: The results of monitoring AA concentrations in agri-food products, reported individually by researchers or projects such as CONTAM in 2015 and the UK Food Standard Agency in 2017, show that some products exceeding the recently set European reference level are reported as such for specific values - mean UB/RLs in µg.kg^-1: French fries (550/500), coffee dry (523/400), coffee substitutes (1,499/500, 400), processed cereal-based baby foods (76/40), potato crisps and snacks (2,214/750), breakfast cereals (744/300), biscuits and crackers (637/350, 400), and coffee substitutes (1,897/500). Average values (µg/kg body weight per day) of exposure to AA from food for different age groups (EFSA) are estimated at 0.4-1.9, but in different European countries, as reported by several studies (including Romania), are between 1.4 and 3.4. Conclusion: Starting from the genotoxic and carcinogenic potential of acrylamide, it is important to regularly monitor the presence of acrylamide and its levels in food and to investigate the food pattern of the population to detect the share of foods at risk of exposure.

Objectives: Proper eating habits ensure human health, so it is important to eat a balanced diet and learn the basics of proper eating from an early age. Adolescence is considered very important period for maintaining good health in terms of nutrition. Methods: In the study, we monitored the eating habits of 182 adolescents aged 14-19 years with different eating habits (73 vegetarians and 109 nonvegetarians) using a questionnaire on nutrition and determination of selected blood parameters - vitamin D, iron and n-3fatty acids. Results: Insufficient levels of vitamin D were determined in the whole group of adolescents, regardless of eating habits. Low iron concentrations negatively affect the biosynthesis of long-chain n-3 fatty acids, which was also reflected in our adolescents with alternative diets. Conclusions: Based on the obtained results, it is necessary to place emphasis on the composition of the diet in adolescent age.

Objectives: The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. Methods: Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. Results: The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. Conclusion: 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.

Celiac disease (CD) is a disorder that affects both children and adults. Over the few last decades, several new atypical cases have been identified through improved diagnostic tools. On the other hand, the onset of CD at a later age, including atypical CD forms whose clinical picture overlaps with other autoimmune diseases, shows that currently there are several unknown gene mutations, which could be responsible for the disease development. Non-celiac gluten sensitivity (NCGS) is entity included by the ingestion of gluten leading to intestinal, or extraintestinal symptoms that improve once the gluten is removed from the nutrition. In this article relationships between genetically modified rodent animals with previously unknown multiple organ changes and CD, respectively NCGS are reviewed. Relationships between the small bowel histological changes and other organs pathology are discussed. Results of research document that changes have similar genetic background and can develop to serious autoimmune systematic diseases, including small bowel inflammation resembling atypical CD or NCGS. These may have extra-intestinal symptomatology but without a clear explanation of causes and differences in their manifestations. Research on animal models helps to discover links between several disorders associated with gastrointestinal damage. New methods based on individual gene mutations can help in atypical adult CD and NCGS recognitions in the future.

The aim of this paper is to introduce the digitalization process and its effects on better reach of the target population. Progress in the digitalization and e-health tools worldwide enables new opportunities in prevention, diagnostics and treatment for people living with HIV (PLHIV) and people in the risk of HIV infection, hepatitis C (HCV) and other sexually transmitted infections (STIs), especially in the context of the COVID-19 pandemic. The system already used for voluntary counselling and testing (VCT) at the CheckPoint Centre Zagreb run by the non-governmental organization (NGO) Croatian Association for HIV and Viral Hepatitis (CAHIV) was upgraded and adapted (due to the COVID-19 prevention epidemiological measures) and developed for implementation of the pilot project of feasibility and acceptability of home HIV self-testing (HIVST) among men who have sex with men (MSM) in Zagreb. A special feature of the HIVST mobile application enables an innovative approach in collecting clients' test result feedback. This paper presents the method of use digitalization of the VCT and HIVST activities to support and increase availability of screening testing. Described procedures of new technologies application in VCT services and preliminary results of the HIVST pilot project indicate that technology-delivered interventions can contribute and improve access and utilisation of HIV/STI prevention and care services.

Objectives: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are the two leading viruses that cause the greatest number of virus-related morbidities in the world. HIV/HBV coinfection is correlated with high morbidity and mortality. For this particular reason hepatitis B vaccination is crucial for people living with HIV. Methods: Patients who are being followed-up for HIV/AIDS and who have received a hepatitis B vaccine in 4 HIV clinics over a 5-year time period have been studied. Our multi-centered, retrospective, cross-sectional and observational study investigates factors that affect hepatitis B vaccination immune response of individuals living with HIV. The patients have been studied for the parameters such as age, sex, CD4 count at the time of diagnosis or vaccination, HIV-RNA levels, comorbidities, vaccine dosage, success of immunization after vaccination, and the demographics of the patients who have and have not developed immunity. Results: Of 645 patients that are being followed-up in our clinics, 158 received hepatitis B vaccine; 39 of these 158 patients have been excluded from the study because they did not fulfil the inclusion criteria. Finally, 119 patients were evaluated in the study, 17 of the patients (14.3%) were females and 102 (85.7%) were males. The median age was 41.11 ± 10.09 (min-max: 18-75). Twenty-three of the patients (19.3%) were at the stage of AIDS during diagnosis while 80.7% were at the stage of HIV infection. Ninety-one of the patients (76.5%) have been administered a single dose hepatitis B vaccine on the standard 0, 1st, 6th month vaccination schedule, whereas 23.5% were administered a double dose on the same vaccination schedule. When further evaluated to find whether the patient was able to develop sufficient immunity (anti-HBs ≥ 10), it was found that the immune response was statistically significantly higher in the patients whose CD4 count was greater than 200 at the time of the first diagnosis and vaccination (p = 0.05 and p = 0.001, respectively). The patients have also been evaluated according to the number of doses they received (1 vs. 2). The immune response of the patients who received two doses was statistically significantly higher (p = 0.041). Conclusion: We can conclude that in the patients with CD4 count less than 200 at the time of their diagnosis and vaccination a high dose recombinant hepatitis B vaccine should definitely be administered as the normal dose and higher dose have similar side effect profiles and the higher dose provides greater immunity.

Objective: The aim of the study was to evaluate the knowledge and perceptions of the pregnant women presenting to our hospital for seasonal vaccination for influenza and to determine the factors associated with it. Method: In this cross-sectional study pregnant woman presenting to our hospital between October 2018 and March 2019 were evaluated. A non-validated, well-detailed questionnaire addressing the vaccination rates, participants' perceptions about the facts behind the vaccination for influenza and the factors associated with refusal of vaccination was performed. Women's knowledge level provided by their healthcare providers was also questioned. Results: A total of 250 participants were included in the study. The average age of the patients was 28.85 ± 5.42 years (range 18-43); and the average pregnancy week was 19 ± 9.75. It was determined that 98% (n = 245) of the participants did not have any vaccinations before, and 98.8% (n = 247) did not have any vaccination during their current pregnancy. 65.2% (n = 163) of the participants did not know that the vaccination for influenza was safe in pregnancy; and 64% (n = 160) did not know that the vaccination for influenza was recommended in pregnancy. The most frequent responses given by the participants to justify their refusal for the vaccination was "my doctor was against" and "it can be harmful to my baby" (25.6% and 24%, respectively). It was determined that 98.4% (n = 246) of the participants were not recommended about the vaccination for influenza by any healthcare centres; and 92.8% (n = 232) did not receive any information on vaccination for influenza. Conclusion: The knowledge of the participants on vaccination for influenza was inadequate and had misconceptions. The inadequacy of healthcare employees, government institutions and the media may have played roles in this outcome. The reasons underlying the inadequacy of the healthcare providers on vaccination for influenza may be questioned.

Objectives: The paper analyses real-world data on cost of treatment in patients after stroke hospitalized in early rehabilitation units within comprehensive stroke centres in the Czech Republic. This is the first study of the kind in the Czech Republic, while such information is extremely rare worldwide. Stroke treatment witnessed a dramatic development in the last years, when the main progress was due to establishment of specialized (comprehensive) stroke units incorporating also early rehabilitation. There is a general agreement among clinicians that early rehabilitation is beneficial for patients after stroke. Methods: Costs of early rehabilitation after stroke were calculated by the micro-costing method alongside a pragmatic study in three Czech hospitals. Patients were transferred to specialized early rehabilitation units usually on 7th to 14th day after stroke onset and received four hours of interprofessional rehabilitation per day. Results: The analysis of data collected during the prospective observational research of 87 patients proved significant differences between patients. The average costs of hospitalization were determined to be CZK 5,104 (EUR 194) per one day of intensive rehabilitation in seriously affected patients early after stroke. These costs differed significantly between hospitals (p-value < 0.001); the structure of direct costs was quite stable, though. About 60% of these costs were due to nursing and overhead, while no more than 15% were consumed by therapists. Conclusions: The treatment of patients after stroke in specialized stroke units proved to be beneficial for the patients increasing the number of those re-integrated in family and community life.

Objectives: Recent literature indicates a decline over time in adolescent mental wellbeing but results are inconsistent and rely mainly on data from Western societies. This study investigates time trends in adolescent mental wellbeing (psychological and somatic complaints, life satisfaction) among Czech adolescents and explores the moderating role of gender, age and socioeconomic status. Methods: Nationally representative data from 29,376 Czech adolescents (50.8% girls, mean age = 13.43; SD = 1.65) across five Health Behaviour in School-aged Children (HBSC) surveys (2002, 2006, 2010, 2014, 2018) were used. Hierarchical regression models estimated national trends in adolescent mental wellbeing and established the moderating role of gender, age and socioeconomic status. Results: From 2002 to 2018, an increase in the psychological complaints was observed. Life satisfaction decreased over time up to 2014 only, whereas somatic symptoms increased until 2010, followed by a decline in 2014 and 2018. Girls, older adolescents and those from low family affluence reported poorer mental wellbeing. Gender gap increased over time for psychological complaints and life satisfaction. Socioeconomic inequalities gap remained stable over the investigated timeframe. Conclusions: Our findings do not provide evidence for substantial temporal changes in mental wellbeing among adolescents in the Czech Republic. Yet, the increase in psychological complaints has been consistent which is an indicator of a small decline over time in adolescent mental wellbeing. Furthermore, the gender gap in mental wellbeing increased over time, whereas the age and socioeconomic differences remained relatively stable. This calls for the attention of public health professionals and policy makers from the Czech Republic.

Objectives: Maintaining cleanrooms in a hospital is a key part of preventing healthcare-associated infections (HAIs). The aim of this work was to verify the effectiveness of anti-epidemic measures to ensure air quality in cleanrooms in a tertiary care hospital. Methods: The study was based on the application of anti-epidemic measures and verification of their effectiveness by regular indoor air monitoring between the years 2014-2019. Monitoring was performed according to a recommended procedure based on European standards for cleanrooms. Results: The results demonstrate a reduction in the number of airborne particles and the number of colonies, as well as the elimination of fungi and conditioned pathogens in air samples. Conclusions: The authors emphasize the importance of established anti-epidemic measures and regular monitoring for the prevention of HAIs.

Objective: This study aimed to assess the relative load of the midfoot and the metatarsals of both feet when schoolchildren walked with backpacks of different loads. Methods: A group of 12 healthy girls (9.9 ± 0.8 years; 33.8 ± 6.7 kg, 1.40 ± 0.10 m) walked barefoot to assess plantar pressures during gait without load (L0%) and with a loaded backpack equal to 10% (L10%) and 20% (L20%) of their body weight. A Footscan® system (RSscan International, Belgium) was used to determine the contact area and relative pressure impulse in the midfoot and metatarsals on the dominant (DL) and non-dominant legs (NL). Results: The effect of load was significant for the contact area of the midfoot for both NL (p = 0.013) and DL (p = 0.001). In the metatarsals, there was significantly greater relative impulse during L10% compared to L0% in the first (p = 0.041) and second (p = 0.050) metatarsals of the DL. Comparing the NL and DL showed significantly greater relative impulse on the DL in the fourth metatarsal during L10% (p = 0.023), greater contact area in the fifth metatarsal during L0% (p = 0.050), and greater impulse in the midfoot during L20% (p = 0.028) on the NL. Conclusions: The school backpack load influences relative plantar pressure distribution, especially in the midfoot. Further, our findings suggest greater propulsion of the DL and supporting function of the NL.

Objective: The main goal of the study was to find out the general public's awareness of stroke, the relations between the awareness of stroke and socio-demographic factors, and awareness of stroke and experience of stroke. Methods: The combination of a non-standardized questionnaire on the stroke prevention and a standardized questionnaire on the identification of the general health literacy (HLSQ-16) was used. The sample was chosen using a quota choice. The sample structure corresponded with the composition of the Czech population with regard to regions, sex and age. These features were determined as representative. The sample consisted of 1,004 respondents. Results: The general awareness of stroke is high in the Czech Republic. Most of the respondents (97.2%) stated that they had ever heard of stroke. This basic awareness is influenced by the sex and marital status of the respondents. Almost one half (42.2%) of the general public would welcome more information on stroke. Women showed significantly higher interest in the information than men. Significantly higher interest could be seen in elderly respondents while younger respondents said significantly more frequently that they were not interested in the information. Married respondents showed a significantly higher degree of awareness. Rural respondents expressed higher interest in the information. The interest in the information dropped with higher education. The interest was significantly influenced by the respondents' sex, place of residence, marital status, and education. Almost 1/4 (24.3%) of respondents mentioned stroke incidence in their families. Our study proved that this incidence significantly varied in dependence on the respondents' sex, age, marital status and education. Further questions were focused on the sources of information on stroke. The most important sources include internet, which was named by nearly one half (48.6%) of respondents, and it was found that women could use the sources of information more frequently than men. Women used all sources of information on stroke (internet, television, families, GPs) more than men. Conclusion: The Czech respondents' interest in stroke is significantly influenced by their sex, age, place of residence, marital status, and the respondents' education. The findings play a role in the focus on preventive activities in this area. It is necessary to implement the general public education not only in general practitioners' offices but also in mass media in order to improve the awareness of stroke.

Objective: This study aims to identify predictors of the lifetime prevalence of methamphetamine use in the population of Czech disadvantaged neighbourhoods. Methods: Using data from a face-to-face representative survey, two types of analysis were performed. A bivariate analysis (unadjusted odds ratios estimated with logistic regression) was conducted to determine the relationship with a dependent variable (lifetime prevalence of methamphetamine use). Subsequently, three multivariate binomial logistic regression models (socio-demographic and socioeconomic status, incarceration and victimization, mobility and space) were conducted to control for the influence of other variables. Results: In a series of multinomial logit models, we have found the following predictors to be significantly associated with lifetime prevalence of methamphetamine use: age, gender, Roma ethnicity, net monthly household income, unstable housing, lifetime experience with incarceration, lifetime experience with discrimination, urban-rural divide, and index of rural peripheralization. Conclusions: The results suggest that methamphetamine users are multidimensionally disadvantaged and therefore constitute a vulnerable group with specific needs. This should be considered when designing services and policies targeting methamphetamine use in disadvantaged neighbourhoods.

Objective: The aim of the study was to investigate risk factors for S-ECC among infants under 24 months of age living in Banja Luka, Bosnia and Herzegovina. Methods: A cross-sectional population-based study was carried out. Considering inclusion criteria, the total sample consisted of 192 examined infants under 24 months of age. Parents/caregivers were interviewed ahead of each dental examination of children. Following data collection, outcome measures were: the presence/absence of S-ECC (children with at least one active early carious lesion on the smooth surfaces of the maxillary anterior teeth/caries-free children) and the severity of dental caries (no caries, initial caries and cavitated caries lesion). Results: Overall results of the study indicated that 22.9% of infants had initial caries, while 12.0% (95% CI: 8.1-17.3) of infants had at least one cavitated carious lesion. Multivariate logistic regression analysis showed that the age of infants (p < 0.001) and family monthly income (p = 0.003) variables were statistically significant predictors for the development of caries. Conclusions: This research found that the most important risk predictors for the development and severity (intensity) of S-ECC in infants under 24 months of age were low monthly income of parents and the infant's age.

Objectives: Smoking has been extensively investigated as a risk factor for periodontal disease and many studies have confirmed it. The aim of this study was to show data from Croatia on periodontal health among high school students, with the focus on association of tobacco use and oral hygiene habits, and the periodontal parameters. Methods: Pocket probing depth (PPD), bleeding on probing, supragingival calculus, and oral hygiene habits were recorded for each examinee out of 517 high school students. PPD was measured at 4 interproximal sites on all first molars and central incisors (index teeth). Results: There were 34.6% smokers among subjects, who started smoking on average at the age of 14. More than half of the smokers (55.3%) smoked 1-10 cigarettes per day and intensity of smoking increased with age. PPD was significantly greater (p = 0.012) in smokers (1.69 mm) than in non-smokers (1.59 mm). In non-smoking subjects, increased values of PPD were in direct proportion to the reduced frequency of brushing, while there was no difference in smokers. The number of cigarettes smoked and duration of smoking had a great influence on PPD. Smokers had on average more teeth with supragingival calculus than non-smokers, while non-smokers had more bleeding on probing, and the difference was statistically significant (p < 0.001). Conclusions: This study indicated that cigarette smoking was associated with decreased periodontal health even in this young population. Irregular oral hygiene was associated with decreased periodontal health only in non-smokers. Therefore, it should be important to inform young smokers about the negative effects of cigarette smoking on periodontal health, to provide consultations and reinforce smoking prevention measures.

Objectives: Eating habits, regular fluid intake, lifestyle and body composition are a primary point of research. The research focused on urolithiasis approaching potential danger, trying to interpret risk factors responsible for urolithiasis and disease recurrence. Methods: Research file contains 166 patients suffering from urolithiasis, 87 (52.4%) males and 79 (47.6%) females, and 172 healthy subjects from control group. All data was accessed using fully anonymous and confidential questionnaires, then evaluated in the statistical GNU PSPP 1.4 software. Results: More than 3/4 patients have a BMI higher than 24.9 and almost 40% of subjects have obesity class I, II, or III. Patients have higher BMI than subjects (d = 1.285; p < 0.001), and females have significantly higher BMI than males (d = 0.385; p = 0.007). Female patients have higher BMI than Slovak healthy females (p < 0.001; MD = 4.581; CI: 3.24-5.93). Patients have a lower daily water intake than subjects (φc = 0.157; p = 0.04) and more than ²/3 of patients have insufficient water intake. Sedentary employment prevails markedly in patients than in subjects. Patients are much less physically active than subjects (φc = 0.633; p < 0.001) and the difference is rising with increasing age of patients (ρ = - 0.232; p = 0.003). Low physical and working activity are characteristic for patients in this study. Patients smoke more often in comparison to subjects (φc = 0.261; p < 0.001). Patients consume more meats (red and white), cocoa and lentils. A lot of patients exceed recommended daily intake of pork and beef. Conclusions: Many conditions are different for the healthy population and patients' group. High BMI, low fluid intake, exceeded red meat consumption, and low physical activity are the strongest factors for developing urolithiasis. Patients should consume more fluids daily, exercise frequently and vigorously, and lower amount of red meat consumed.

Objectives: The participation of families in childhood vaccination decreases slightly every year around the world. Parents arrive at a decision that vaccines are not safe for their children due to many sources of misinformation. The aim of this study was to investigate the relationship between vaccine hesitancy, vaccine knowledge status and socio-demographic characteristics of the children's parents. Methods: In this cross-sectional study, 361 parents of children aged 5 years and under, who were admitted to our paediatric outpatient clinic, were included. The parents received scores between 0-20 points according to the correct answers they gave to the questions asked. Results: Although all parents had a positive attitude towards vaccination, some myths, e.g. that vaccination could weaken the child's immune system because it contains heavy metals which could cause infertility and that complementary and alternative medicine could replace vaccination, are thought to be real by 1.7% to 34.6% of the parents. Conclusions: Since the presence of misinformation may lead to vaccine hesitancy and incomplete vaccination, healthcare personnel have important duties and responsibilities for this group.

Objective: Recent developments in online lotteries and betting and in digitalization of land-based gambling devices bring new opportunities to track behaviour of individual players and to identify and address developing problem in its initial stages. Early identification of gambling disorder allows for timely intervention and increases the likelihood of successful recovery and minimises harms. Our review aims to examine what on-site strategies are available in both online and offline gambling venues to early identify and address the developing gambling problem while also assessing their effectiveness and strength of the evidence. Methods: We searched main academic databases and other internet resources and collected 67 peer-reviewed papers and grey literature documents that describe one or more such strategies. Results: Available measures ranged from information provision, gambling behaviour surveillance and associated personalized interventions to setting limits and self-exclusion. Conclusions: Although a number of methods how to address disordered gambling are available to gambling operators, there is still insufficient evidence about the validity and reliability of identification strategies and about effectiveness of the intervention methods.

Objectives: The aim of the study was to determine the trend and methods of violent deaths (suicide and homicide) in adolescents aged 15-19 years in Serbia. Methods: Mortality database was drawn from the Statistical Office of Serbia from the 1997-2019 period. To calculate the annual percentage change (APC) of mortality rate (MR) with corresponding 95% confidence interval we used join point regression analysis. Statistical analyses were also performed using the chi-square test and Spearman's rho correlation. Results: The average suicide rate was 3.65 per 100,000 and homicide rate was 1.36 per 100,000 adolescents. The boys to girls ratio was 4.2 for suicides and 2.7 for homicides. Among girls, suicide rate significantly decreased (APC -20.7%; 95% CI -32.5 to -6.8) and homicide rate insignificantly decreased (APC -19.3%; 95% CI -37.8 to 5.1). Among boys, suicide rate significantly decreased (APC -4.6%; 95% CI -7.0 to -2.0) as well as homicide rate (APC -7.7%; 95% CI -11.5 to -4.3). The most common method of suicide was hanging (195, 44.3%) and nearly one third (198, 32.6%) of violent deaths were caused by firearms. Significantly negative correlation was observed between the Human Development Index (HDI), gross domestic product (GDP) per capita and MR due to suicides and homicides among both genders (p < 0.05). Conclusions: Increase of GDP and HDI, national preventive intervention and strict application of the provisions of the law regarding the possession and storage of weapons must be implemented in order to continue reducing violent deaths among adolescents.

Objectives: The aim of the study was to ascertain the incidence, circumstances and causes of sudden cardiac death in persons aged 1-40 years in the Czech Republic. Methods: De-identified autopsy reports of all individuals who died suddenly between the ages of 1-40 years during the period 2014-2019 inclusive in a selected area of the Czech Republic were analysed retrospectively. Persons with substantial cardiovascular pathology defined by histopathological criteria and those with a negative autopsy were included in the study. The latter were designated as sudden arrhythmic death syndrome. Results: In total, 245 sudden cardiac death cases were identified resulting in an incidence rate of 2.4/100,000 person-years. Among the deceased, we found an enormous gender gap with men representing 81% of cases. More than 80% of deaths occurred during everyday activities or sleep, whereas only 7% were sports-related. The most common cause of death was coronary artery disease detected in 38%, which was followed by cardiomyopathies in 15%, sudden arrhythmic death syndrome in 12%, left ventricular hypertrophy in 10%, and congenital heart defects in 7%. Conclusions: Coronary artery disease is the predominant cause of sudden cardiac death in the young population of the Czech Republic. Hence, effective preventive measures targeted at the reduction of risk factors associated with early coronary artery disease should be reinforced. The second most prevalent cause in our population are potentially heritable heart conditions such as cardiomyopathies and sudden arrhythmic death syndrome. This fact has already prompted the introduction of molecular autopsy and cardiogenetic care for relatives in the Czech Republic.

Objectives: The aim of the study was to identify the prevalence and risk factors of myopia and high myopia in students from primary school and junior high school in Shandong. Methods: A total of 35,614 subjects completed the visual acuity test, refraction error measurement, and questionnaire in 2019. The visual acuity test was performed using the standard logarithmic visual acuity chart and the refractive error was measured by an automatic refractometer without cycloplegia. Results: The average age was 12.38 ± 1.78 years, with 18,501 boys and 17,113 girls. The overall prevalence of myopia and high myopia was 68.02% and 5.90%, respectively, and reached up to 85.54% and 13.13% for the grade 9 students. The risk factors included girls, parental myopic history, time spent doing homework, and less sleep time. Performing eye exercise was significantly associated with a lower risk of myopia. Use of mobile devices and reading while lying down were only related to myopia, not high myopia. Conclusion: The prevalence of myopia and high myopia is at a high level. In addition to genetic factors, continuous close work and a lack of sleep was an important factor associated with children myopia and high myopia.

Objectives: The beta-lactamases with extended spectrum of activity (ESBL) are medically one of the most important group of enzymes. Another group of beta-lactamases representing of Enterobacteriaceae is group of the AmpC-type cephalosporinases. The presented study provides identification and determination of the spectrum of resistance against different and clinically used antimicrobial drugs in the clinical isolates of Escherichia coli. Methods: These isolates had origin in different departments of the L. Pasteur University Hospital in Košice. The goal was the detection of beta-lactamase production with extended-spectrum effect and testing of AmpC-type cephalosporinases by several phenotypic tests in clinical isolates. MALDI-TOF MS analysis was performed on a Microflex MALDI Biotyper. Samples were positively tested for ESBL with the use of the disc diffusion method. PCR were performed with a series of primers designed for the detection of Ambler class A, B and C beta-lactamase genes. Results: For all 485 isolates, we determined the production of ESBL, which we detected in 166 E. coli isolates, which represents a 34.2% prevalence of ESBL production. It is clear from the results that the prevalence of ESBL-producing E. coli out of the total number of E. coli investigated reached 34.2%. In the monitored period, we confirmed at least one resistance gene from 485 E. coli in 188 positive isolates. Conclusions: We describe a complex ESBL epidemiology. The study revealed a high rate of ESBL-producing E. coli isolates; bla_TEM and bla_SHV enzymes dominated in ESBL-positive E. coli isolates in the L. Pasteur University Hospital in Košice.