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Objectives: This study aimed to evaluate the beliefs about third-hand tobacco smoke (THS) among administrative and academic staff at a university. THS is a residual pollutant from tobacco smoke that lingers on surfaces and poses health risks, particularly to children. The study also aimed to understand these beliefs in relation to socio-demographic factors. Methods: A cross-sectional survey was conducted with 332 university employees aged 18 and over. Data were collected between September and December 2023 through face-to-face and online questionnaires. The survey included the Beliefs About Third-hand Smoke (BATHS-T) Scale and questions on socio-demographic characteristics, second-hand smoke exposure, and attitudes towards a smoke-free campus. Beliefs About Third-hand Smoke Scale total and sub-dimension scores increase, it is understood that the participantʼs belief in the negative effects of third-hand tobacco exposure on persistence and health increases. Results: The average age of participants was 36.1 years, with 38.3% being administrative personnel and 61.7% academic personnel. About 40.5% of the participants used tobacco products. The mean total BATHS-T score was 35.6, with health and persistence subscale scores averaging 19.9 and 15.7, respectively. Non-smokers had significantly higher BATHS-T scores than smokers. The participants with children scored higher on the health sub-dimension. Additionally, 78.9% supported a smoke-free campus, and those supporting it had higher BATHS-T scores. Awareness of the harms of second-hand smoke correlated with higher BATHS-T scores. Conclusion: The study highlights that non-smokers and those with children are more aware of THS risks. There is strong support for a smoke-free campus among university staff. The findings suggest a need for increased education on THS, especially targeted at smokers and those without children. Universities can play a crucial role in promoting smoke-free environments and raising awareness about the health risks associated with THS.

Objectives: Smoking remains a significant public health concern in Ukraine. Recent efforts to combat smoking have shown some progress, but Ukraine's current approach largely overlooks the potential benefits of harm reduction strategies. Concurrently, the use of e-cigarettes has been on the rise among Ukrainian adults. Our study aims to estimate the potential impact of e-cigarettes on reducing the mortality rate associated with cigarette smoking in Ukraine. Methods: We conducted a replication study using a dynamic population simulation model initially developed for the US. We ran simulations for 210 e-cigarette scenarios, varying assumptions on how e-cigarettes may affect smoking behaviour and health outcomes. A sensitivity analysis was performed to test the robustness of the results. Results: A substantial majority of e-cigarette scenarios (88.10%) resulted in positive life-years saved (LYS). The LYS ranged from -1.13 to 13.11 million, with a median of 3.17 million, accounting for 4.55% of the total life-years lost (LYL) due to smoking. Among the most plausible e-cigarette scenarios, the LYS varied from 2.73 to 4.88 million (3.92% to 6.99% of LYL due to smoking). Furthermore, these scenarios demonstrated that the long-term smoking prevalence would stabilize at around 5.56-6.40%. Conclusions: Our simulation analysis demonstrates the potential of e-cigarettes to significantly reduce the burden of smoking in Ukraine. Most e-cigarette scenarios result in positive LYS, while scenarios with negative LYS are unlikely. These findings support the idea that the benefits of e-cigarettes outweigh potential harm, aligning with previous studies in other countries.

Objectives: No research among Finnish universities grouped students into clusters, based on their lifestyle behavioural risk factors (BRFs), and appraised relationships of the clusters with self-reported burdens, adjusting for confounders. The aim of the study was to undertake this task. Methods: Students (N = 1,169) at Turku University completed online questionnaire comprising socio-demographic variables (age, sex, income, social support), 18 burdens, and 4 BRFs (smoking, alcohol, drug use, food habits). Factor analysis reduced burdens into factors; cluster analysis of BRFs categorized students into clusters. Regression models appraised associations between socio-demographics and clusters with burdens. Results: Mean age was 23 ± 5 years, with 70.4% females, 23.4% smokers, 28.8% problematic drinkers, 21.1% illicit drug/s users, and mean dietary guideline adherence 4.84 ± 1.57 (maximum score of 8 points). Factor analysis of burdens generated four factors: 'Studies' - 3 items; 'Future' - 3 items; 'Relationships' - 7 items; and 'Needs' - 5 items. Cluster analysis produced four BRFs clusters with significantly different BRFs and socio-demographics. Cluster 1 exhibited less risk-taking behaviours, cluster 4 comprised more risk-taking, and the other two clusters fell in between. Regression showed that females were more likely to report all four burdens; higher social support was associated with less burdens generally; older age was associated with less 'Studies' + 'Future' + 'Relationships' burdens; and sufficient income was associated with less 'Studies' + 'Future' burdens. Compared to cluster 1, cluster 3 and 4 membership was more likely to feel 'Needs' burdens; cluster 2 and 3 was more likely to report 'Relationships' burdens (p-range: < 0.05 to < 0.001 for all).
Conclusion: Controlling for socio-demographics, cluster membership was more influenced by students' perceptions of 'Relationships' + 'Needs', rather than academic difficulties of 'Studies' or unsecure 'Future'. Risk taking was more likely with relationship difficulties, isolation, and day-to-day problems (housing, financial situation, health) rather than academic load or concerns for future prospects. Preventive and intervention efforts tackling students' lifestyle behaviours need to consider programmes aimed at better relationship building/maintenance to prevent isolation, while mitigating 'on-the-ground' everyday challenges that students face.

Objectives: The aim of the study was to analyse the attitudes and decisions regarding vaccination in general and against COVID-19 among general practitioner (GP) patients in Croatia, and to identify influencing factors, with particular attention to chronic conditions and anxiety. Methods: A total of 184 patients (stratified by sex and presence of chronic disease) from a GP's offices, aged 18-87 years (average 50.3 ± 1.3 years, 49.5% women) were included. Data were collected using a questionnaire. Results: Attitudes toward vaccination in general did not differ between patients with and without chronic diseases and were not influenced by anxiety. Chronically ill patients were more likely than those without chronic disease to believe in the efficacy of the COVID-19 vaccine and to express fear of contracting SARS-CoV-2 (p ≤ 0.003). Anxiety was associated with fear of infection (p < 0.001), but not with confidence in vaccine safety or efficacy. After controlling for sex, age, education, chronic illness, anxiety, and knowing someone infected and hospitalized with SARS-CoV-2, factors associated with the decision to be vaccinated against COVID-19 were absence of prior infection (OR = 3.9, 95% CI: 1.6-9.5, p = 0.003), history of influenza vaccination (OR = 3.8, 95% CI: 1.4-10.4, p = 0.009), and knowing someone who had died from COVID-19 (OR = 3.2, 95% CI: 1.1-9.7, p = 0.037). Conclusion: The decision to vaccinate against COVID-19 was associated with absence of prior infection, knowing someone who died from the disease, and prior influenza vaccination, but not with chronic illness, anxiety, or socio-demographic factors.

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

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

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

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

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

Objective: The aim of this study was to analyse the knowledge and attitudes about smoking in young people between 16-20 years of age, who were both working and attending the Vocational Education Centre. Methods: This study was conducted with high school students at the Vocational Education Centre. The socio-demographic questionnaire and the Fagerström Test of Nicotine Dependence (FTND) were applied to the students using a face-to-face interview technique. Secondly, interactive educations on smoking-free life and smoking-related diseases were given. At last, CO (carbon monoxide) levels and respiratory functions were evaluated. Results: Of the students 92.9% were males, 37.4% were 16 years, 35.8% were 17 years and 26.9% were 18-20 years old. Among 46.9% of smokers, 75.8% started smoking before 15 years of age, 86.1% were living with smokers. While 70.5% of smokers smoked more than 10 cigarettes daily, 61.3% smoked their first cigarette in the first half hour after waking up. Of the smokers, 28.8% were highly dependent, 13.0% were very highly dependent. CO levels were significantly higher in those who smoked in the workplace, who smoked mostly in the morning time, and those who started smoking at 7 years of age and younger (p < 0.05). FEV1, FVC, FEF25-75 values of morning smokers were significantly lower (p < 0.05). Conclusion: Unfortunately, the first smoking age was very low, the first cigarette of the day was lit in a short time after waking up, and family/friend's attitudes and behaviours were encouraging in this age group. More attention should be paid to this issue and especially new preventive projects should be implemented to protect young people from smoking.

Objectives: Since 2009 the number of unvaccinated children in Poland has been regularly increasing. The purpose of the study was to learn what parents who decide to vaccinate their children feel and believe about their children's vaccines and in particular to find out how these sentiments and beliefs affect their attitude and decision-making with reference to vaccinations. Methods: The interviews were conducted during an immunization visit of parents whose children are covered by immunization schedule; 53 parents aged 23 to 48 years took part in the study. Most study participants were high school or university graduates living in rural areas. Children were 1 week to 5 years old. Thematic analysis was used to analyse interview data. Results: Identified factors shaping the parents' positive attitude to vaccination included conviction of necessity of vaccines (effective disease prevention, safety, favourable benefit-to-risk ratio, and concerns about the child). The general anti-vaccination belief was that vaccines are unnecessary. External factors, mainly authority figures and media broadcasts, affect parents' beliefs and decisions. Conclusions: Various factors affect parents' decision concerning immunization of their children. Both compulsory and recommended vaccines should be provided free-of-charge. Choice overload should be reduced. Paediatricians should address parental vaccine hesitancy.

Objectives: The modern rise of vaccine rejection in society can alter the current progress that has been made towards the control and prevention of certain diseases, possibly even resulting in epidemics involving these preventable diseases. The aim of this study is to analyse the knowledge, attitude and behaviours of parents in Malatya city who rejected childhood vaccines. Methods: This descriptive, cross-sectional study was conducted between September-November 2019. The study includes parents who rejected vaccines and are registered in the family medicine clinics of Malatya city - total of 453 participants. The objective was to include all parents and avoid a sampling procedure. However, only 151 (33%) parents agreed to participate. These parents who rejected vaccines were individually contacted by phone. Descriptive data was represented by number (n) and percentage (%). The chi-square test was utilized in the statistical analysis of data and p < 0.05 was considered significant in all evaluations. Results: Mothers in the study group had a mean age of 26.07 ± 3.64, while the fathers were on average 30.03 ± 4.59 years of age; 98% of parents were aware of the health risks that vaccine rejection presented; 93% of parents were not satisfied with the explanation, insight, and advice that the healthcare personnel provided regarding vaccines. All parents of the study group stated the following: vaccines should not be administered because other children in their close environment acquired a disease as a result of vaccination, vaccines can harm the immune system of children - not yet fully developed, vaccines are unsafe and endanger the health of children. Conclusions: It can be said that parents who have obtained a lot of false information possess altered decisions and views on vaccinations, to the point where they accept the risks presented by preventable diseases. In addition, individuals lose trust following negative experiences with vaccination.

Objectives: The aim of the study was to evaluate the immune status of young people from the Vojvodina province, Serbia, through the detection of IgG antibodies specific for the L1 protein of HPV types 6, 11, 16, and 18 contained in quadrivalent vaccine. Methods: The study enrolled 514 healthy persons of both genders, aged between 18 and 30 years. All potential participants were informed about the project's aims by trained interviewers before venous blood collection. Also, participants completed a specially designed anonymous questionnaire to identify socio-demographic characteristics and individual behaviours associated with HPV seroprevalence. VPL HPV L1-specific IgG antibodies were measured using a semi-quantitative HPV IgG ELISA kit (Dia.Pro, Italy). Results: A total of 472 (91.8%) young subjects had no detectable antibodies against high- and low-risk HPV types covered by the quadrivalent vaccine. A slightly higher number of seropositive individuals were detected in the age group of 26-30 years compared to younger than 25. Multivariate analysis showed that the number of lifetime sexual partners was the most powerful predictor of HPV seropositivity (OR = 3.483, 95% CI: 1.294-9.379). Conclusions: Obtained data point out low levels of naturally induced HPV-specific serum antibodies among the target population in the Vojvodina province. The present work highlights the significance and potential benefits of HPV vaccination. Routine HPV vaccination should be the public health priority in our country and should be included in the national immunization programme as soon as possible.

Objective: Anxiety and depression in patients following cerebrovascular accidents are among frequently occurring complications of the medical condition. The consequences affect personal, family, professional, and social life. They cause severe functional and cognitive impairments, limit the ability to perform normal daily activities, which can result in complete disability. The aim of the study was to monitor the occurrence of anxiety and depression in patients following cerebrovascular accidents hospitalized in neurological departments in the region of eastern Slovakia. Methods: A total of 101 patients following cerebrovascular accidents, aged from 48-86 years, were included in the descriptive study. Demographic and clinical data were obtained from patients and from medical records. We determined the occurrence of anxiety disorders, depression and emotional distress in patients following cerebrovascular accidents using a standardized Hospital Anxiety and Depression Scale (HADS) questionnaire. Results: Data analysis confirms a high incidence of anxiety in the HADS-A subscale (9.23 ± 4.13) and depression in the HADS-D subscale (9.09 ± 4.43) during the hospitalization phase of the disease. It demonstrates the pathological occurrence of anxiety states in 37%, depression in 36%, emotional distress in 36%, and a serious degree of combination of pathological values of the anxiety subscale and the depression subscale in 27% of patients. The existence of a strong positive correlation between anxiety and depression indicators was confirmed. Conclusion: The results confirm a high prevalence of anxiety and depression in the acute phase of the disease. The findings indicate that patients recovering from cerebrovascular accidents not only face physical difficulties and loss of independence but also struggle with anxiety and depression, which can negatively impact and slow their recovery. Given the high frequency of these psychological conditions, further research is needed to enhance the quality and effectiveness of care provided to patients with cerebrovascular accidents.

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

Objectives: Dietitians are well qualified to work as nutrition professionals on interprofessional healthcare teams and to provide education to health professionals at academic institutions. However, opportunities for the knowledge and utilization of dietitians in health care are different around the world. With rising global rates of nutrition-related diseases and the availability of university-based dietetic programmes, it is important to consider factors that may impact opportunities for dietitians in different countries. Thus, this study aimed to explore perceptions about the role of dietitians in medical care and medical education in the Czech Republic.
Methods: Thirty-six students and faculty members from a Czech medical school participated in semi-structured interviews focusing on the role of dietitians. Interviews were transcribed, coded, and analysed using thematic analysis.
Results: From the central theme regarding the perceived role of dietitians in medical care and education, three sub-themes emerged: limited awareness and interaction in the clinical setting; importance in interprofessional care; and essential member of the medical school faculty. Conclusions: Participants expressed support for dietitians in interprofessional collaboration and medical education but identified that they had limited interaction clinically and a lack of awareness about their role as nutrition experts in medical care. To support dietitians' involvement in interprofessional collaboration and to combat and improve outcomes for nutrition-related diseases, additional research is needed to recognize possible barriers along with identifying and assessing strategies to increase awareness and recognition among medical students and faculty about the role of dietitians in medical care.

Objectives: An unhealthy lifestyle, inappropriate eating habits, and inadequate physical activity are the most common risk factors affecting health and causing the premature onset of non-communicable diseases. The study aimed to evaluate lifestyle factors, eating habits, and daily regimens in a sample of Slovak adolescents. Methods: The sample involves 524 students aged 15-22 years attending selected secondary schools from the model region of Bratislava, the capital of Slovakia. We assessed the prevalence of selected lifestyle factors and investigated the relationship between negative lifestyle factors and the presence of overweight and obesity. Results: We found eating irregularities including avoidance of school lunch, inadequate daily consumption of vegetables, dairy products and wholegrain foods, and the high consumption of sweets and sweetened beverages. The prevalence of excess weight and obesity in the sample was 18.4%. Compared to the non-obese, overweight or obese students had significantly lower daily consumption of vegetables and used to avoid sports more frequently. Almost 37% of students did not do sports at all. Students who were not doing sports on regular basis used to skip breakfast more frequently, they ate fewer vegetables and more sweets and spent considerable time in sedentary activities. Conclusion: In the sample of secondary school students, we investigated several negative lifestyle factors and the relatively high prevalence of overweight and obesity. The results of the study can be used for the development of preventive measures to protect and promote the health of children and youth.

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

Objectives: Cervical cancer represents a significant public health concern worldwide, particularly among women of reproductive age. According to data from the Cancer Registry of the Republic of Serbia for the year 2022, cervical cancer is the fourth most common cancer in women, with an age-standardized incidence rate (ASIR) of 24.8/100,000 and the fourth leading cause of mortality, with an age-standardized mortality rate (ASMR) of 10.2/100,000. This study aimed to analyse the association between socio-demographic factors, unmet healthcare needs, and cervical cancer screening use among women in Serbia.
Methods: Research was conducted as a cross-sectional study on a sample of 3,980 women aged 25-64 in Serbia. Three types of questionnaires were used as a research instrument. The association of missed cervical smear tests in the last 3 years with independent variables was examined by univariate and binary logistic regression model.
Results: According to socio-demographic characteristics, the likelihood of missing a cervical smear test in the last 3 years increased with age, being highest among older women (OR = 1.91, 95% CI: 1.88-1.94), lower-income categories (OR = 1.76, 95% CI: 1.74-1.78), and women with the lowest levels of education (OR = 1.49, 95% CI: 1.47-1.52). The logistic regression model revealed significant territorial disparities, with the highest predicted probability for women from South and East Serbia (OR = 1.73, 95% CI: 1.70-1.76). Additionally, distance/transportation and financial constraints were significantly associated with missed cervical smear tests in the last 3 years (OR = 2.05, 95% CI: 1.99-2.11; OR = 1.10, 95% CI: 1.08-1.12, respectively).
Conclusions: Socioeconomic disparities in cervical cancer screening remain a challenge. This study highlights the need to allocate resources to areas in need of improvement and also to conduct comprehensive evaluations of screening systems, which can lead to significant reductions in cervical cancer incidence and mortality.

Objectives: In the Czech Republic, employers and employees are bound by legal regulations that ensure occupational health and safety. These regulations are based on international conventions of the International Labour Organization and directives of the European Parliament and Council and have long been incorporated into Czech legislation. During the COVID-19 epidemic, emergency and crisis measures led to a limitation of occupational health examinations (OHEs) in the Czech Republic, which represented a significant disruption of the occupational health and safety system. The aim of the study was to assess the impact of these measures in order to find the right model for providing occupational health services in similar situations in the future. Methods: The method used was a survey, with participants including representatives of employers, state organizations, and employees (trade unions). Results: Participants from all three groups showed differing views on limiting OHEs during emergencies. While representatives of public administration and employers were generally open to postponing or adjusting pre-employment or periodic OHEs for non-hazardous work, the majority consistently opposed any limitation of OHEs for hazardous work. Statistical differences were observed particularly in attitudes toward future regulation of OHEs during epidemics. Conclusions: The dominant conclusion of the survey is a strong recommendation against limiting initial occupational health examinations for jobs with occupational risks and in high-risk work categories.

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

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

Objective: The aim of the study was the assessment of adherence to antiretroviral (ARV) treatment in a population of people living with HIV (PWH), improving the awareness of PWH, drawing attention to the risk of developing HIV drug resistance and subsequent treatment failure. Methods: The basic cohort consisted of PWH followed up long-term at the HIV centre of the University Hospital Pilsen. Adherence to treatment was assessed by ARV levels. Nucleoside analogs were determined in urine by high pressure liquid chromatography (HPLC), in relation to clinical data, viral load (HIV RNA), and absolute CD4 and CD8 T cell counts. To assess mental and physical state of the patients, a modified SF-36 questionnaire was used to measure social relationships, education and ability to relax. Results: From a group of 131 PWH, 18 (13.7%) with zero levels and 113 (86.3%) with any detectable ARV levels were followed for 6-12 months. A statistically significant lower viral load was demonstrated in patients who adhered to the treatment at the time of the test as indicated by ARV levels in the urine. CD4 T lymphocyte values in adherent patients were, as expected, statistically significantly higher. A significant difference for CD8 T lymphocyte was not demonstrated. A survey assessed subjective factors influencing the degree of adherence. PWH consider important: quality care enabling trust, low risk of developing opportunistic infections, self-sufficiency, quality of sleep, managing leisure activities, and good family relationships. Quality of life evaluation and satisfaction in the monitored areas were similar in both groups of PWH. Conclusions: Non-adherence leads to deterioration of CD4 and viral load levels and may be the cause of the development of HIV drug resistance and treatment failure on the part of the patient. PWH with zero or low urinary nucleoside levels were repeatedly instructed about the need for regular and sustained medication use. Regular checks with a laboratory examination service are needed to detect early emergence of resistance and side effects of the treatment, which are initially only detectable in the laboratory.

Objectives: Indoor air toxicity is of major public health concern due to the increase in humidity-induced indoor mould exposure and associated health changes. The objective is to present evidence for the causality of health threats and indoor mould exposure. Methods: PubMed search on the following keywords: dampness, mould, indoor air quality, public health, dampness, and mould hypersensitivity syndrome, sick building syndrome, and building-related illness as well as information from the health authorities of Bavaria and North Rhine-Westphalia, the Center of Disease Control (CDC), World Health Organisation (WHO), and guidelines of professional societies. Results: The guidelines of professional societies published in 2017 are decisive for the assessment of the impact of mould pollution caused by moisture damage on human health and for official regulations in Germany. Until 2017, a causal connection between moisture damage and mould exposure could usually only be established for pulmonary diseases. The health risk of fungal components is apparent as documented in the fungal priority pathogens list (FPPL) of the WHO. Since 2017, studies, especially in Scandinavia, have proved causality between moisture and mould exposure not only for pulmonary diseases but also for extrapulmonary diseases and symptoms. This was made possible by new test methods for determining the toxicity of fungal components in indoor air. Environmental medical syndromes, e.g., dampness and mould hypersensitivity syndrome (DMHS), sick building syndrome (SBS), building-related symptoms (BRS), and building-related illness (BRI), and fungal pathogens, e.g., Aspergillus fumigatus, pose a major threat to public health. Conclusion: There is evidence for the causality of moisture-induced indoor moulds and severe health threats in these buildings. According to these findings, it is no longer justifiable to ignore or trivialize the mould contamination induced by moisture damage and its effects on pulmonary and extrapulmonary diseases. The health and economic implications of these attitudes are clear.

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

Objective: The main objective is to confirm a hypothesis that atherosclerosis, through various mechanisms, considerably influences cognitive impairment and significantly increases the risk for developing dementia. Complete sample should be 920 individuals. The present study aimed to analyse epidemiological data from a questionnaire survey. Methods: The work was carried out in the form of an epidemiological case control study. Subjects are enrolled in the study based on results of the following examinations carried out in neurology departments and outpatient centres during the project NU20-09-00119 from 2020 to 2023. Respondents were divided into four research groups according to the results of clinical examination for the presence of atherosclerosis and dementia. The survey was mainly concerned with risk factors for both atherosclerosis and dementia. It contained questions on lifestyle factors, cardiovascular risk factors, leisure activities, and hobbies. Results: Analysis of the as yet incomplete sample of 877 subjects has yielded the following selected results: on average, 16% of subjects without dementia had primary education while the proportion was 45.2% in the group with both dementia and atherosclerosis. Subjects with dementia did mainly physical work. Low physical activity was more frequently noted in dementia groups (Group 2 - 54.4% and Group 3 - 47.2%) than in subjects without dementia (Group 1 - 19.6% and Group 4 - 25.8%). Coronary heart disease was more frequently reported by dementia patients (33.95%) than those without dementia (16.05%). Conclusion: Cognitively impaired individuals, in particular those with vascular cognitive impairment, have poorer quality of life and shorter survival. Risk factors contributing to such impairment are similar to those for ischaemic or haemorrhagic stroke. It may be concluded that most of the analysed risk factors play a role in the development of both atherosclerosis and dementia.

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

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

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

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