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Objective: While some countries of the WHO European Region are global leaders in tobacco control, the Newly Independent States (NIS) have the highest tobacco-smoking prevalence globally and a relatively low overall level of the WHO Framework Convention on Tobacco Control (WHO FCTC) implementation. An abridged version of the SimSmoke tobacco control policy simulation model has been developed to project the health impact of implementing tobacco-control policies in line with the WHO FCTC. Methods: Data on population size, smoking prevalence, policy-specific effect sizes and formulas were applied in 11 NIS - Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. The aim was to project the relative reduction in smoking prevalence, number of smokers and number of smoking-attributable deaths resulting from implementing six individual and/or combined WHO FCTC measures. Results: An increase in excise cigarette taxes to 75% of price yields the largest relative reduction in smoking prevalence (range 12.1-44%) for all countries. The projections show that when all six tobacco control measures are fully implemented in line with the WHO FCTC, smoking prevalence in each of the NIS countries can be reduced by at least 39% by the year 2033 (baseline 2015). Conclusion: The projections show that the NIS countries can expect a large number of smoking-attributable deaths just among those smokers alive today, but large reductions in smoking prevalence and smoking-attributable deaths can be achieved if the WHO FCTC demand reduction policies are implemented. The results can be used as an advocacy tool for accelerating enforcement of tobacco control laws in NIS.

Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm³ reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. Conclusion: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Objective: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. Methods: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. Results: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. Conclusion: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.

Traditional approaches and study design in cancer epidemiology have not been very successful in identifying and evaluating adequately the potential risk and/or protective factors associated with the disease. The main reasons for the failure are often due the small study sample size, and inadequate exposure information. In this paper, issues and approaches relevant to these two challenges are discussed. Multicentre study is proposed as a way to increase study size and to mitigate criticism about meta-analysis of independent studies. A multicentre study of large cohort or case-control studies also offer an exciting opportunity to study the contribution of epigenetic events that may be associated with lifestyle and environmental risk factors for human health. Optimizing methods for exposure assessment and how to reduce exposure to misclassification represent a difficult component in epidemiological studies. A potentially useful approach for improving exposure estimation is to rely on biomarkers of exposures. An example is provided to demonstrate how biomarkers of exposures could provide valuable information in addition to exposure measurements in traditional epidemiological studies. Finally, it is argued that risk assessment and the precautionary principle should not be viewed as conflicting paradigms but, rather, as a complementary approach for developing appropriate policies to address risks posed by exposure to carcinogens and a wide spectrum of other health hazards.

Objective: The aim of this analysis was to analyze the presence of the most important cardiovascular (CV) risk factors and to discuss patterns of LDL cholesterol management in the population studied. Methods: We enrolled 961 males, average age of 42.9 ± 4.7, and 851 females, average age of 51.2 ± 3.6. Data on personal, pharmacological and family history, and laboratory examinations were collected. Cardiovascular (CV) risk was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm with modifications according to the guidelines. Results: The distribution of CV risk in the observed cohort was as follows: 24% of the subjects had low, 51% moderate, 17% high and 8% very high risk. The percentage of patients who reached target values of LDL cholesterol was dramatically lower in the groups with very high (1%) and high (3%) risk than in the groups with moderate (14%) or low risk (59%). Dyslipidemia was newly identified in 20% of both sexes. Arterial hypertension was newly diagnosed in 8% of males and 5% of females, and type 2 diabetes mellitus was newly diagnosed in 3% of both the males and females. Dyslipidemia was present in 39% of males and 41% of females; arterial hypertension in 43% of males and 45% of females, and type 2 diabetes mellitus was diagnosed in 11% of the subjects of both sexes. 49% of males and 31% of females were overweight and 32% of both genders were obese. There were 36% of male smokers and 22% of female smokers. 48% of the participants were pharmacologically treated. Non-pharmacological treatment was recommended to 62% of male and to 65% of female participants. Pharmacological intervention was started in 53% of males and 51% of females. In both gender antihypertensive treatment with angiotensin-converting enzyme (ACE) inhibitors (29% of males and 27% of females) and lipid lowering therapy with a statin (28% of males, 27% of females) were the most commonly initiated treatments. In the subgroup of the 101 patients with LDL cholesterol levels > 5 mmol/L 56% were not treated with a statin. The analysis of relationship between the positive family history of any of the followed CV risks showed significant increases of the risk for arterial hypertension, type 2 diabetes mellitus and dyslipidemia. Conclusion: European guidelines suggest general screening for risk factors, including analysis of lipid profiles in the population of 40-year-old males and 50-year-old or postmenopausal women. Our study documents high prevalence and incidence of CV risk factors together with insufficient control of the risk factors in Czech patients of this age range. This finding suggests that preventive examinations should be undertaken earlier (e.g., in 30-year-old males and 40-year-old women). Exact timing of the preventive check-ups to yield the best cost-benefit ratio needs to be verified.

Objective: The aim of the study was to evaluate caries prevalence in a sample of schoolchildren aged 6 to 16 years from rural and urban areas in Croatia. Methods: Using standardized World Health Organisation (WHO) criteria, the oral health status of 1,589 children (265 from rural and 1,324 from urban areas) was assessed by recording the following indices: DMFT (decayed, missing, filled permanent teeth), deft (decayed, extracted, filled primary teeth), DMFS (decayed, missing, filled surfaces - permanent teeth), defs (decayed, extracted, filled surfaces - primary teeth) and SiC (Significant Caries Index). Rural areas were Štitar and Babina Greda municipalities in Slavonia and urban areas were the cities of Županja (Slavonia), Zagreb and Dubrovnik. Results: Half of the examined children (50.0%) had caries (D component in DMFT), with 46.0% of these being from urban and 70.2% from rural areas. The median DMFT among children was 2, 4 (rural) and 2 (urban) (p < 0.001). Among 12-year-olds, the median DMFT was 4 (rural) and 3 (urban), and mean DMFT was 3.4. The median DMFS for rural area was 5 and for urban area 3 (p < 0.001). The median deft was 1.00 for rural and 1.00 for urban, while the highest value was found among 6-year-olds at 9 in rural and 7 in urban areas. The median SiC was 4, 4 (urban) and 5 (rural). Conclusion: Schoolchildren from urban and rural areas in Croatia differ significantly in caries prevalence. They fall into the medium DMFT classification group according to the WHO, which indicates the need for a comprehensive oral health preservation programme.

Objectives: To our knowledge this is the first study measuring personal exposure to carcinogenic polycyclic aromatic hydrocarbons (cPAHs) bound to airborne particulate matter ≤ 2.5 µm (PM_2.5) in periods of high air pollution (smog episode) in which citizen were tracked. Methods: Measurements were performed in industrial regions of the Czech Republic: Ostrava, Karviná, Havířov. The city of Prague served as a control. Personal monitoring was conducted by active personal monitors for 48 hours. Non-smoking city policemen from Prague, Karviná and Havířov, office workers from Ostrava city and volunteers from Ostrava-Radvanice and Bartovice participated in the study (N = 214). Results: The average personal exposure to benzo[a]pyrene (B[a]P) was highest in Ostrava (17.2 ng/m³), followed by Karviná, Havířov, Radvanice and Bartovice, and Prague (14.2, 12.0, 9.3, and 2.8 ng/m³, respectively). We tested for association between the personal exposure to cPAHs and various health-related factors extracted from the questionnaires, including lifestyle factors and day-to-day activities. Conclusions: Exposure to outdoor cPAHs, environmental tobacco smoke (ETS), commuting, and time spent indoors (in restaurants, workplace or home) were found to be the main determinants of the personal exposure. Daily cPAHs measurements in highly polluted areas are needed for evaluating the personal exposure and to avoid its underestimation resulting from stationary monitoring.

Objective: Water-pipe smoking has become a serious public health threat worldwide. In order to raise awareness of adverse effects and transmission of bacteria via water-pipe smoking, we aimed to identify the bacteria and their antimicrobial resistance profiles that colonize different parts of waterpipes. Methods: We examined totally 182 water pipes from 7 lounges (in Turkey) used in public places and we collected 728 culture samples in total by microbiological methods. We used disposable sterile swabs to sample the inside and outside of the mouthpiece, and the handling piece and sterile injectors were used to collect 5 mL of water from the water pipe bowl. Results: There was a significant (p < 0.05) difference in microbial contamination (growth/presence of bacteria and fungi) among the parts of the water pipes sampled. There was a significant (p < 0.05) difference in the number of bacteria growing (microbial load) among the parts of the water pipes. Only one narghile lounge out of seven, which had 13 water pipes, had a hygiene procedure. The water jars are often contaminated with Gram-negative bacteria. Conclusion: Water pipes, especially the interior and outer part of the mouthpieces and the handle, are colonized by microbes and pose a risk of infection. Procedures for water pipe hygiene should be developed, periods should be defined, and the owners and employees of establishments and water-pipe smokers should be educated in this regard. Water-pipe smoking is a threat to public health and should be regulated by the state.

Beryllium has an impact on the human health of professionally or non-occupationally exposed people. Current evidence suggests that beryllium acts as a hapten with limited antigenic properties and is presented by antigen presenting cells to CD4⁺ T cells, which possess specific antigen receptors. The immunological changes in humoral immunoreactivity were considered biomarkers of beryllium exposure. In the present, due to the development of immunologic knowledge, tests of cellular immunity have promising potential for further research in this field. The historical view of the immune response to beryllium in acute and/or chronic beryllium disease is an example of the development of the interaction between mechanisms of innate and adaptive (specific), humoral and cellular immunity. The authors emphasize the increasing importance of immunological aspects in the studies of health impacts of human exposure to environmental pollutants.

Objective: The poor health of Roma is well documented, but there is only limited data regarding the health of Roma children. The aim of this study was to describe the socioeconomic status, health related behaviour, and health of children living in segregated Roma settlements, and to compare the data with that of non-Roma children. Methods: In March-April of 2011, a cross-sectional questionnaire-based survey among 11-year-old (211 boys and 252 girls) and 13-year-old (205 boys and 247 girls) children living in Roma settlements was performed (response rate: 91.5%). These data were compared with data from the Health Behaviour in School-Aged Children (HBSC) survey carried out in 2009/2010. Results: The parents of Roma children were substantially less educated and less likely to be actively employed, and Roma children reported lower material welfare than non-Roma ones. The prevalence of consuming sweets and soft drinks at least 5 times per week was 1.5-2 times higher among Roma children. The prevalence of regular intense physical activity was higher at the age of 13 years among Roma boys, while physical inactivity was substantially higher in both age groups among Roma girls. Almost one quarter of Roma children and approximately 14% of non-Roma children had tried smoking at the age of 11. More Roma boys tried alcohol at the age of 11 than non-Roma ones. One in ten Roma children was obese in both age groups. The self-rated health status of Roma children was worse than that of non-Roma children. Conclusions: Children living in Roma settlements reported poorer socioeconomic conditions, higher consumption of sweets and soft drinks, earlier smoking and alcohol initiation, and worse self-rated health, but with some exceptions do not differ in fruit or vegetable consumption and BMI from general child population. To promote health of children living in Roma settlements, a multi-sector approach, special health education, plus social and health promotion programmes are needed.

Objective: Mercury dental amalgam restorations are an important source of chronic exposure to mercury in the whole population and special attention should be paid not only to occupational exposure to mercury during the preparation and administration of amalgam. The authors' report is an up-to-date contribution to the health risk assessment of mercury use in dentistry, namely occupational exposure to mercury in dentists working with dental amalgam and exposure to mercury in persons treated with amalgam dental restorations. Methods: Determination of total mercury in samples of biological material (urine, hair) was performed during 2017 and 2018 in 50 persons by the AAS method using the mercury vapour generation technique at 254.6 nm. Results: Current dental exposures based on the most recent findings do not exceed acceptable risk levels and are below the biological limit of mercury in urine valid for occupationally exposed persons (100 μg.g^-1 of creatinine), namely median value was 1.48 (min. < limit of detection (LOD), max. 17.14) μg.g^-1 of creatinine (40 persons), total mercury content in hair of dental personnel expressed as median value was 0.340 (min. 0.060, max.1.628) μg.g^-1. In controls (10 persons) was total mercury content in urine expressed as median value 0.36 (min. < LOD, max. 2.74) μg.g^-1 of creatinine, in hair was median value 0.224 (min. 0.059, max. 0.453) μg.g^-1. Conclusions: Authors support opinion that amalgam fillings in the oral cavity are a permanent source of mercury for the body itself.

Objectives: The aim of the study was to assess the prevalence of burnout syndrome and mobbing, to determine their mutual relationship, and to identify predictors related to the probability of occurrence of burnout syndrome in general nurses working in hospitals. Methods: The work is designed as a cross-sectional study. The research took place in 2018 and the sample included 250 general nurses. Statistical evaluation was performed by means of descriptive statistics, Spearman's correlation coefficient, and logistic regression. Three standardized questionnaires were used - Maslach Burnout Inventory, Negative Questionnaire Act and SUPSO. Results: The research revealed burnout syndrome in the area of emotional exhaustion in 28.8% of nurses, of depersonalization in 15.2%, and in the area of personal accomplishment in 38.4%. 51.2% of nurses never experienced mobbing at workplace, one act of mobbing over the last six months was reported by 17.6% of respondents, two and more acts by 31.2%. Logistic regression revealed that the probability of occurrence of burnout syndrome in the area of emotional exhaustion is influenced by age, sex and by the size of an urban area, it is increased by anxiety and depression. In the area of depersonalization the probability of incidence increases with impulsiveness and dejection. In the area of personal accomplishment the probability of burnout syndrome incidence is increased by the lack of psychological wellbeing and activeness, by restlessness and impulsiveness. Though there were found significant relationships between all component parts of burnout syndrome and mobbing, multivariate logistic regression did not show the impact of any component part of mobbing on the probability of occurrence of burnout syndrome. Conclusions: The research revealed that the probability of burnout syndrome incidence is related to socio-demographic factors as well as to an individual's psychological states and perceptions. Direct impact of mobbing on the probability of burnout syndrome incidence was inconclusive.

Objective: Cardiorespiratory fitness (CRF) is defined as the capacity of the cardiovascular and pulmonary systems to meet the oxygen demands of the body during physical work. Poor CRF is connected with a higher risk for the development of various noninfectious diseases such as cardiovascular disease or malignancies. The standard test for the assessment of CRF is exercise testing with the measurement of maximal oxygen consumption (VO₂ max). Standard VO₂ max values for adult men and women in the Czech Republic have been available since the 1970s without being updated. According to experts, these standard values are now unusable for contemporary CRF measurements of the population in the Czech Republic. The Fitness Registry and the Importance of Exercise: a National Database (FRIEND) - 4,494 patients (1,717 men) defined new standard values for bicycle ergometry CRF for the population in the United States of America. The aim of the study was the statistical comparison of VO₂ max values (reference standards) in the 1970s population in the Czech Republic with the new reference standards of the FRIEND registry. Methods: All analyses were performed using IBM SPSS statistics and all tests with a p-value of less than 0.05 were considered statistically significant. Results: VO₂ max norms for women in the Czech population were higher in all age categories with statistically significant differences in the categories 30-39, 40-49 and 50-59 (p < 0.001). In the male population aged 20-29 years, VO₂ max was significantly higher in the FRIEND registry (p < 0.001) in contrast to the other age categories, 30-39, 40-49 and 50-59, which were significantly higher in the Czech population (p < 0.001). Conclusions: Czech VO₂ max population norms from the 1970s are (with the exception of age category 20-29 years) higher than values from the recent FRIEND registry.

Objective: Acrylamide is a toxic compound found in occupational and non-occupational environment. It originates from industrial use, technological processes in construction as well as food production, water purification, and laboratory use. Adverse effects including neurotoxicity, probably carcinogenicity, genotoxicity, teratogenicity, and reproductive toxicity were reported in many studies. Our study is focused on acrylamide content in selected food products in the Czech Republic. Method: In this study, we determined acrylamide content in selected samples of commonly consumed food products (potato chips, biscuits, popcorn, corn flakes, breakfast cereals, and baked muesli). Results: The concentration of acrylamide in most samples of potato chips, biscuits and popcorn exceeded the benchmark limits. The acrylamide content in samples of potato chips from one manufacturer in 4 cases out of 5 analysed samples exceeded benchmark limit. On the other hand, no corn flakes sample acrylamide content from the same manufacture exceeded the benchmark limit. With 20 of all analysed samples exceeding the benchmark levels for acrylamide, it can be concluded that 47.6% of samples did not comply with the benchmark level. Conclusion: Dietary intake of frequently consumed food products with the acrylamide content exceeding the recommended comparative value could have adverse effects on the human health. Our study confirmed high amount of acrylamide in some selected food samples. The reduction of dietary burden with acrylamide is possible by complying with the correct technological principles in food preparation.

Objectives: Acrylamide is a toxic compound that can be found it both occupational and non-occupational environments. This study focuses on its sources and health effects of its exposure. Methods: Adverse effects of acrylamide, especially carcinogenic, genotoxic, and teratogenic were reported in many studies conducted on animals. Neurotoxicity was reported in workers exposed to acrylamide in the occupational environment. Another important source of populations' exposure to acrylamide is their nutrition. Results: This study focuses on humans' exposure to acrylamide from various sources and its harmful effects on their health. Conclusions: Dietary intake of acrylamide, as well as occupational exposure, cigarette smoking, cosmetics usage and other environmental sources could have a significant effect on human health.

Objectives: The availability of information on healthy products does not ensure the empowerment of people with the knowledge on how to choose or avoid food products or dishes depending on unhealthy factors. Public knowledge and beliefs of unhealthy food effects on health needs to be evaluated so that appropriate measures can be taken to properly inform people and relevant socio-demographic groups. Methods: The original survey questionnaire containing questions about specific food groups and various health effects was compiled. A total of 1,007 respondents, Lithuanian residents aged 18-75 years, were surveyed in March 2019. Multilevel stratified probability sampling method was used for data representativeness. Results: Almost half of respondents (46.2%) knew that deep-fried food could cause cancer. The majority of respondents (68.4%) were aware that sugar causes obesity and 61.7% were aware that sugar increases the risk of diabetes mellitus; 41.6% (more often those living in non-rural areas) know that grilled meat may cause cancer. More than half of respondents (57.2%) (more likely those living in non-rural areas and those with a university degree) were aware that smoked meat products may cause cancer. Only 46.4% were aware of the fact that salt raises blood pressure and the risk of cardiovascular diseases. Conclusion: Only about half of Lithuanian residents aged 18-75 were aware of the scientifically proven harmful effects of unhealthy food groups. Socio-demographic factors influence the knowledge and beliefs of the population.

The main objective of this study is to describe the most common childhood diseases occurring in the Theresienstadt ghetto during the Second World War as well as applied anti-epidemic measures. A partial objective is to describe medical and nursing care of sick child prisoners. The data was obtained by the method of synthesis of primary and secondary data with the highest importance after adequate external source criticism using selected monographs, memoirs, survivor diaries, Orders of the day by the Council of the Elders and Reports of the Jewish self-government of the Theresienstadt ghetto from 1941 to 1945, the Archives of the Jewish Museum in Prague, the Ghetto Museum, the Museum of the History of Polish Jews in Warsaw, Post Bellum online electronic collection of oral historical interviews, and witness accounts. The validity of the presented conclusions is ensured by comparing data from several sources. The most common infections in Theresienstadt children were enteritis, scarlet fever, infectious jaundice, measles, mumps, rubella, varicella, black cough, pneumonia, otitis media, and typhoid fever. Most of these infections had entirely atypical symptomatology or complications. Children were hospitalized in children's hospitals, in children's rooms of hospitals for adults and infirmaries in children's homes. Albeit diagnostic methods had a high standard, options of treatment were very limited. The most common treatments included bed rest, diet and cold compress. Occasionally, chemotherapeutic agents (e.g. a sulphonamide drug Prontosil) and Aspirin were available. The anti-epidemic measures in the ghetto focused on hygiene, enhancing children's immunity, vaccination and pest control.

Objective: The aim of the study was to determine the prevalence and severity of early childhood caries (ECC) among different social groups of preschool children in ethnic and multilingual diverse community such as South Backa District (SBD), Republic of Serbia. Methods: This survey was a cross-sectional analytical study and sample type has been projected by simple random choice of 13-71 months old children together with their parents of varied socioeconomic status (SES) and nationality in SBD. Preschool children were randomly selected through a two-stage cluster sampling procedure and parents were invited to answer the questionnaire regarding SES, native language, education, and income issues. The WHO caries diagnostic criterion was used and the severity of ECC was defined by Wine's modified criteria. The data was further analyzed using the SPSS for Windows Microsoft Excel, version 21. The percentage of caries-free children was compared using the χ² test, and one-way ANOVA was used to compare the mean disease indices at the 5% significance. Results: A total of 341 children were examined and the prevalence of ECC was 30.5%. "White spot" initial caries lesions were the most prevalent form and the highest disease frequency was found in male children (p = 0.038), who did not speak official Serbian language (p = 0.009), in children of the part-time employed parents (p < 0.001), with elementary education (p = 0.001), in low monthly income families (p = 0.023), and Roma ethnic group. Conclusions: The complex interaction of risk factors like social environment along with ethnicity and Serbian language ignorance had a significant influence on the prevalence and severity of ECC in preschool children of this multi-ethnic region.

Objectives: Evidence that health interventions work is not enough to ensure implementation into policy and practice. The complexity of public health systems requires more diverse actions. This paper proposes a conceptual model to enhance understanding of interlinking factors that influence the evidence implementation process. Methods: A literature review was conducted to explore factors that influence the process of evidence implementation in complex public health systems, including research findings and observations from 32 case studies of injury prevention interventions underway in 24 countries and results from evidence research networks. Concepts and themes identified through a critical review were organised, ordered and interlinked to build the model. Results: An Evidence Implementation Model for Public Health Systems and four concepts or themes: Evidence implementation target; Actors involved in implementation; Knowledge transfer; and Barriers and facilitators to evidence implementation were developed to provide a simplified, yet broad framework that highlights multiple factors and back and forth inter-linkages within and between the concepts that influence the uptake of evidence into public health systems policy and practice. Conclusions: Understanding the factors discussed within and amongst the four concepts of this model should ultimately help to positively influence the uptake of evidence into real world public health systems. This model has relevance for decision makers, researchers, knowledge brokers, and implementers.

Objective: The two main aims of our study were to assess the quality of life (QOL) of patients with moderate or severe psoriasis treated by Goeckerman therapy and to compare QOL of our patients on the date of admission and 1 month after their discharge. Methods: We performed a prospective study on 51 patients treated for chronic plaque psoriasis by Goeckerman regimen (GR). The psoriasis area involvement and severity was measured using the Psoriasis Area and Severity Index (PASI). Patients' health-related QOL was evaluated using Psoriasis Disability Index (PDI). Results: In our study we demonstrated that the QOL of this sample of 51 patients with severe forms of psoriasis was relatively good; an average PDI value on the day of admission was 9.02, which represents a small effect on patient's QOL. We did not find any significant differences in QOL between younger and older respondents or between men and women. Despite good treatment efficiency, we did not find improvement in QOL 1 month after discharge. Conclusions: The QOL of our patients was relatively good. This could be explained by the fact that our patients have been suffering from psoriasis for many years and have probably adapted to their disease. QOL of our patients was not directly dependent on the extent and intensity of skin changes. Further studies on the connection between psoriasis therapy and patients' QOL are still highly needed.

Objective: The study examined the fatty acids composition and main nutrients composition in two freshwater fish species in the Czech Republic during one year. Methods: Samples of common carp and rainbow trout were taken from a market chain during a year. All samples were homogenized and analyzed for lipid, protein, water, and ash contents. Energy value (E), sum of polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA) and saturated fatty acids (SFA), atherogenic index (AI) and thrombogenic index (TI) were then calculated. Results: The freshwater fish on the Czech market chain have beneficial average value content of unsaturated fatty acids, Σ MUFA+PUFA in carp is 69.46% of all fatty acids, similar average value of Σ MUFA+PUFA - 70.83% is in rainbow trout. The calculated average value of AI in carp is 0.52 (SD = 0.06), AI in rainbow trout is 0.63 (SD = 0.07), the average TI in carp is 0.63 (SD = 0.09), TI in rainbow trout is 0.49 (SD = 0.05). Conclusion: Freshwater fish in the Czech market chain have beneficial value of PUFA, so AI and TI indices are low in both species of analysed fish. Regular consumption of fish meat is important in the prevention of cardiovascular diseases.

Objective: The purpose of this article is to describe current research trends in medical tourism and implications for public health, especially in destination countries. Methods: The methods used for this article include a literature review of available sources on the research topic in the world's acknowledged databases Web of Science, Scopus, MEDLINE, and ScienceDirect. Results: The findings indicate that there is no consensus on the definition of medical tourism. However, there are a few conceptual models which can be used in further medical tourism research and practice. The findings also reveal that there are still certain issues, which hinder the fast growth of medical tourism, such as unclear impact on healthcare systems, ethical concerns or a lack of effective tools for the measurement of quality assurance of the medical tourism services and their products. Conclusions: There is a need for data collection on medical tourism, both at national and worldwide level to provide a realistic picture of this evolving field of tourism as well as implications for public health in destination countries.

Objectives: The aim of this work is to compare the current prevalence of selected risk factors in cardiovascular diseases in the Czech general population in a particular region with a selected population of Czech soldiers in a particular military unit. Methods: Within medical preventive examinations, data from 684 civilians aged between 30-60 years were obtained (405 men and 279 women). Within compulsory medical preventive examinations, data from 659 soldiers from a particular military unit aged between 30-60 years were obtained (576 men and 83 women). Anthropometric parameters such as height and body weight were monitored and then used to calculate the values of Body Mass Index (BMI) and waist circumference. From biochemical parameters the following values were monitored: glycaemia, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, ALT, and GGT. As for the demographic data, age and gender were processed. In the cohort of male soldiers a questionnaire was used to find the extent of cigarette smoking, frequency of using alcoholic drinks and performance of regular physical activities such as aerobic exercises. Results: As for cardiovascular risk, assessed anthropometric parameters in monitored female age categories are statistically significantly lower (p < 0.05) in women in the Army of the Czech Republic (ACR) compared to the female civilian population. Most of the biochemical parameters also display values that indicate the female military population is healthier than the civilian in these parameters. On the other hand, assessed anthropometric parameters in monitored male age categories are statistically significantly lower (p < 0.001) in civilian men compared to the male military population. Most of the assessed biochemical parameters show statistically significant health-indicative values in the male civilian population as well. Conclusion: This work revealed differences in anthropometric and biochemical parameters between the examined civilian and military populations. As for cardiovascular risk, the main findings are significantly worse anthropometric and biochemical parameters in the selected male military cohort compared to the male civilian cohort.

Objective: Recent experimental studies point to a high reactivity of nanoparticles and the potential of sunscreens to penetrate the skin. We measured 20 markers of oxidative stress and inflammation to find out whether skin exposure to nanoTiO₂ sunscreen may elevate the level of the markers in exhaled breath condensate (EBC) and urine of exposed subjects, as was suggested by our earlier study. Methods: Six volunteers (3 males and 3 females), with a mean age of 48.0 ± 6.7 years, used commercial sunscreen for three days continuously. The first samples were collected before the test. The second samples were collected on day 4, before the sunscreen was washed off, and the third samples on day 11. The following biomarkers were measured: malondialdehyde, 4-hydroxy-trans-hexenal, 4-hydroxy-trans-nonenal, aldehydes C6-C12, 8-isoProstaglandin F2α, o-tyrosine, 3-chlorotyrosine, 3-nitrotyrosine, 8-hydroxy-2-deoxyguanosine, 8-hydroxyguanosine, 5-hydroxymethyl uracil, and leukotrienes B4, C4, D4, and E4, using liquid chromatography-electrospray ionisation-tandem mass spectrometry. Results: In the urine, 4-hydroxy-trans-hexenal was significantly higher in post-exposure sample 2, and the same trend was seen in all urinary markers. In EBC, no difference was seen between the mean values of 20 post-test markers as compared with pre-test samples. Conclusion: This study suggests potential side effects of the sunscreen - borderline elevation of markers of oxidative stress/inflammation - which may relate to the absorption of the nanoTiO₂, and the non-significant difference may be explained by the small number of subjects. The effect was not seen in EBC, where nanoTiO₂ was not found. A larger study is needed, as according to our previous study, the beneficial effect of the sunscreen to suppress oxidative stress caused by UV radiation may be questioned.

OBJECTIVE: Screen-based behaviours such as watching television or computer use are among the most prevalent sedentary behaviours adolescents spend time on. There is a lack of recent estimates on prevalence and changes in the amount of time spent on screen-based behaviour across Central and Eastern Europe. The main aim is to assess the trends in the prevalence of current recommendations for the screen time (≤2 hours per day) of school-aged children in the Czech Republic between 2002 and 2014.
METHODS: We used an internationally established methodology based on the Health Behaviour in School-aged Children (HSBC) study. Data was derived from Czech national representative samples of 11-, 13- and 15-year-olds collected in the years 2002 (N=4,065), 2006 (N=4,170), 2010 (N=3,962) and 2014 (N=4,338).
RESULTS: The results indicated that the boys and girl surveyed in 2014 are up to two times more likely to meet the current recommendations for watching television in comparison with groups of schoolchildren of the same age surveyed in 2002. In contrast, computer use by adolescents increased markedly between 2006 and 2014. Taking total screen time into account, spending two hours per day or less on it decreased significantly among boys (OR=0.74, 95% CI=0.62-0.89) and girls (OR=0.80, 95% CI=0.70-0.92) between 2006 and 2014.
CONCLUSIONS: As screen time is an important indicator of time spent in a sedentary way, our findings call for more interventions to reduce the time that school-aged children spend in front of screens.

Objectives: Alternative tobacco product (ATP) use is popular among adolescents in Western countries, however, little is known about factors influencing ATP experimentation in Europe. The aim of this study was to explore factors associated with ATP experimentation, and to identify patterns of ATP experimentation among Hungarian adolescents who had ever tried manufactured cigarette smoking. Methods: Logistic regression analyses were applied to estimate the relationship between individual cigarette smoking experiences, social smoking influences, demographics, and ATP experimentation (roll-your-own (RYO) cigarettes, cigars/cigarillos, waterpipe, traditional pipe and flavoured cigarettes) in a cross-sectional sample of 8th and 11th grade students (N = 1,067, 56.0% of girls) who had ever tried manufactured cigarette smoking in six metropolitan cities of Hungary. Latent class analysis (LCA) was performed to identify patterns of different ATP use. Results: Almost 90% of the sample had ever tried ATPs and significantly more commonly older (91.8%) versus younger (79.8%) students. Waterpipe was the most popular product to try followed by flavoured cigarettes, cigars/cigarillos, RYO cigarettes, and pipe. Boys were more likely to report ATP experimentation compared to girls. Younger age of cigarette smoking experimentation, greater frequency of past month cigarette smoking and history of ever daily smoking for 30 days showed strong association with ATP experimentation. Students with one or more smoking friends were more vulnerable to experiment with ATPs. Weekly allowance, school academic achievement and household smoking exposure showed no effect on the experimentation. LCA identified four subgroups of ATP experimenters comprising intense polytobacco experimenters (38.4%), mainly waterpipe experimenters (34.2%), moderate polytobacco experimenters (14.9%), and less interested experimenters (12.5%). Conclusion: Tobacco prevention programmes targeting adolescents should emphasize the risks of using ATPs in addition to manufactured cigarettes. Accessibility of ATPs should be better regulated and restrictions should be strongly enforced in order to prevent potential harmful consequences of adolescent polytobacco use.

Objectives: Vaccine preventable diseases (VPDs) continue to pose a significant threat to healthcare workers (HCWs) while immunization among this group remains low. HCWs' behaviours as well as facilitators and barriers towards their vaccination for a number of VPDs were explored through an EU-wide survey. Methods: HCWs across the EU answered online survey that explored attitudes and behaviours towards vaccination for a number of VPDs. Response data were adjusted based on weights estimated by HCWs' country and working profession according to WHO statistics. The survey was delivered between October 2012 and April 2014. Results: Analysis was based on responses from 5,424 HCWs from 14 European countries. The majority (86.7%) had a positive attitude regarding immunizations. HCWs considered influenza (86.4%), viral hepatitis type B (71.9%) and tuberculosis (59.1%) as higher risk diseases for occupational exposure in the workplace. However, 43.8% reported not receiving a seasonal influenza vaccine in the last 10 years and 65.6% reported not receiving the pandemic influenza vaccine in 2009. Main enablers towards immunizations included believing in vaccine protection and easy, free of charge access to vaccines in the workplace. Barriers to up-to-date immunizations differed according to disease but included concerns about short- and long-term effects. Conclusion: Although the concept of mandatory vaccination seems to be favoured by many health professionals in Europe, it remains a controversial subject both among HCWs' profession categories and also among different countries. Interventions to increase vaccination among HCWs would benefit by tailoring their approach according to disease and target group.

Objectives: The aim of this study was to gather information on demographic and health indicators, primarily vaccination status, of Syrians under temporary protection in five provinces of Turkey and to develop infrastructure for vaccination planning. Methods: The population under study consists of 89,986 Syrian children, 0-4 years of age, residing in Ankara, Mersin, Gaziantep, Izmir, and Bursa. Initially, we planned to evaluate 2,339 children, although a total of 2,827 children were evaluated by the end of the study. Results: Of these children, 74% were born in Turkey, while 20% were born in Syria. In addition, 22.4% (n = 634) of the children were never vaccinated, and of these, 67.0% (n = 425) were born in Turkey. In other words, one in five Syrian children born in Turkey (20.3%) had never been vaccinated. Of the Syrian children under temporary protection, the missing vaccinations were as follows: hepatitis B (54.7%); Bacillus Calmette-Guérin (62.5%); five-component combined vaccine (64.6%); conjugated pneumococcal vaccine (58.0%); oral polio vaccine (70.8%); measles, mumps, and rubella (76.6%); varicella (66.8%); and hepatitis A vaccine (76.0%). Conclusion: It is important to increase the immunization rates of Syrian children under temporary protection and establish regular vaccination procedures.