Fulltext search in archive

Objective: Nanomaterials consist of particles smaller than 100 nm - nanoparticles (NPs). Their nano dimensions allow them to penetrate through various membranes and enter into the bloodstream and disseminate into different body organs. Massive expansion of nanotechnologies together with production of new nanoparticles which have not yet been in contact with living organisms may pose a potential health problem. It is therefore necessary to investigate the health impact of NPs after experimental exposure. Comparison of the effect of TiO₂ and NPs Fe₃O₄ in Wistar rats at time intervals 1, 7, 14 and 28 days was performed by studying the cytotoxic effect in the isolated inflammatory cells from bronchoalveolar lavage (BAL). Methods: Wistar rats were intravenously (i.v.) given a suspension of NPs TiO₂ or Fe₃O₄ (coated by sodium oleate) via the tail vein. After time intervals of 1, 7, 14 and 28 days, we sacrificed the animals under anaesthesia, performed BAL and isolated the cells. The number of animals in the individual groups was 7-8. We examined the differential count of BAL cells (alveolar macrophages - AM, polymorphonuclear leukocytes - PMN, lymphocytes - Ly); viability and phagocytic activity of AM; the proportion of immature and polynuclear cells and enzymes - cathepsin D - CAT D, lactate dehydrogenase - LDH and acid phosphatase - ACP. Results: We found that TiO₂ NPs are relatively inert - without induction of inflammatory and cytotoxic response. Exposure to nanoparticles Fe₃O₄ induced - under the same experimental conditions - in comparison with the control and TiO₂ a more extensive inflammatory and cytotoxic response, albeit only at 1, 7 and 14 days after injection. Conclusions: The results suggest that TiO₂ and Fe₃O₄ nanoparticles used in our study were transferred from the bloodstream to the respiratory tract, but this effect was not observed at 28 days after i.v. injection, probably due to their removal from the respiratory tract.

Objectives: The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix. Method: The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review. Results: Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention. Conclusion: The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level.

Objective: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. Methods: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. Results: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. Conclusion: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.

Objective: In today's world, despite the numerous benefits, increasing demand for computer technology and the influence of widespread internet technology, many people, especially students, have faced impaired mental health and social relationships resulting from internet addiction; therefore, with regard to the contradictory results of preceding studies in the field of internet addiction, this study was designed to determine the prevalence of internet addiction in students of Ahvaz Jundishapur University of Medical Sciences. Methods: This descriptive study was conducted on all students of Ahvaz Jundishapur University of Medical Sciences. For data collection questionnaire and demographic profile of internet addiction test was used. Results: The results showed that internet addiction is common among university students (t = 23.286, p < 0.001). Internet addiction is significantly different between males and females and more prevalent in the male users (t = 4.351, p = 0.001). The prevalence of internet addiction in various categories was 1.6% normal, 47.4% mild, 38.1% moderate, and 12.9% severe. Our analysis also showed a significantly higher proportion of senior students with severe internet addiction (16.4%) compared to junior students (χ² = 30.964; p < 0.001). Conclusion: Based on the findings of this study it can be concluded that there is a considerable internet addiction in medical students, and to prevent risks and complications, health considerations and proper treatments seem to be necessary.

Objectives: Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results. Methods: Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol. Results: 90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders). Conclusions: It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Objective: The aim of the study was to analyze indicators on lung cancer (C33-C34, ICD-10) in Split-Dalmatia County in the period 2003-2012. Methods: Data on lung cancer occurrence for the period 2003-2012 were obtained from the Croatian National Cancer Registry, while mortality data were obtained from electronic database of the Teaching Public Health Institute of Split-Dalmatia County. Croatian census 2011 and population estimates of the Central Bureau of Statistics of the Republic of Croatia were used to calculate the indicators. Results are presented as absolute numbers, shares (%), specific rates per 100,000 population, age-standardized rate (standard European population). Results: There were 2,804 registered patients with lung cancer in the period 2003-2012 in Split-Dalmatia County - 2,179 men (77.71%) and 625 women (22.29%); 2,737 people died from lung cancer in the same period - 2,117 men (77.35%) and 620 women (22.65%). Specific rates of incidence and mortality rates were four times higher among men than among women. From 2003 to 2012, the rate of incidence among men showed a significant decrease, while among women there were no significant changes of incidence and mortality. Conclusions: According to the indicators of incidence and mortality of lung cancer in Split-Dalmatia County, this malignant neoplasm should occupy a high place within County public health priorities measures of prevention programme, targeting risk factors responsible for their formation.

Objectives: Smoking at the workplace has a negative impact both on employers' economic interests and employees' health. The aim of this study is to describe the current situation, mainly barriers in implementation and resources in the Czech Republic as an example of a Central European country. Methods: We synthesised relevant review papers with our knowledge of the local situation based upon professional experience of both authors. Results: Despite smoke-free laws, some EU workers are still exposed to passive smoking during working hours. The main barriers towards smoke-free workplace implementation are the lack of resources, perception of smoking as a norm, and exceptions for leading personalities and their smoking. Social support increases smoking cessation effectiveness. Low availability of local smoking cessation services is an overall problem in Central Europe. Conclusions: The working environment influences smoking habits. Smoking cessation support is cost-effective not only for the smoking employee but for employers as well. Smoking cessation resources should be available during the working day. No exceptions should be made as they serve as barriers to a smoke-free working environment.

Objectives: The purpose of this study was to identify personal variables and nonoccupational risk factors for carpal tunnel syndrome and to analyse the strength of association of these factors. Methods: We performed a case-control study with 162 cases and 300 controls. We studied consecutive patients with an electrophysiologically confirmed diagnosis of symptomatic carpal tunnel syndrome. Univariate analysis was performed in the case group and control comparing them for presence of various risk factors. Multivariate analysis was carried out through logistic regression. Results: The mean BMI and age were greater in the case group than in the control. Multivariate analysis showed that BMI (OR = 1.05, 95% CI = 1.01-1.11) and arterial hypertension (OR = 4.63, 95% CI = 2.88-7.44) were the only factors significantly associated with carpal tunnel syndrome. The age, cigarette smoking and alcohol drinking were at the edge of significance. Conclusions: Carpal tunnel syndrome is the most common peripheral neuropathy and has been related to occupational activities in some but not all studies. Clarifying this relationship has important implications for workers' compensation systems. Based on our findings, BMI and arterial hypertension are considered to be the most significant risk factors of carpal tunnel syndrome in our study.

Objective: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. Methods: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. Results: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, β = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, β = -2.077) and among highly educated participants (p = 0.018, β = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, β = 4.213). Conclusion: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

Objectives: The aim of this study is to determine the risk factors of childhood diarrhoea in Turkey throughout Turkey Demographic and Health Survey (DHS) 1998 and 2008 data. Methods: This study is a further analysis of the database of children under 5 years of age from the Turkey Demographic and Health Survey. Binomial logistic regression and Chi square analysis were used by weighted data of Turkey Demographic and Health Surveys. Results: In 1998 DHS there were 3,459 and in 2008 DHS 3,463 children under 5 years of age. Diarrhoea prevalence was 30.1% and 18.3%, respectively. Multivariate analysis revealed that household wealth status index, region, mother's education, mother's age (15-19 age), age (under 2 years of age), and sex (male) of the child were the risk factors for 1998 DHS. In 2008 significant risk factors were geographic region, education of the mother and father, breastfeeding status of the child (still being breastfed), mother's age (20-29 age group), and age of child (under 2 years of age). Conclusions: As a result, patterns of the risk factors of diarrhoea has changed from 1998 to 2008 DHS in Turkey. However, impact of factors related with socioeconomic environment such as region and mother's education persisted.

Objectives: The primary aim of a hospital is to promote/improve and restore health, thus smoking, whether in its passive or active form, should be banned in all hospital premises for the benefit of employees and patients alike. The Global Network for Tobacco Free Healthcare Services (GNTH) is an international non-profit association formed in 1999. The GNTH’s mission is to implement tobacco-free policies to create a healthy workplace and patients’ environment; help physicians, nurses, and other healthcare workers to stop smoking; and educate all caregivers about tobacco dependence treatment and support them in providing smoking cessation interventions. Methods: Implementation standards and a system of their self-audit for all participating hospitals were developed by the GNTH. We describe both the international and Czech networks, recommended methods for programme implementation and results of self-audit questionnaires completed by Czech participating hospitals. Results: Worldwide, there are 19 national networks with 1,672 members including 56 gold forum members. To date, the largest network has been formed in France (670 members), followed by Spain (580) and Taiwan (209). After the first Czech institution (Prague-based General University Hospital) joined GNTH in 2010, the Czech Republic established its national network in 2017 currently comprising 10 members, of this number 1 gold, 3 silver and 6 bronze national certification level members. The main barriers to better outcomes in the Czech Republic include smoking on outdoor hospital grounds, lack of pharmacotherapy reimbursement and time, and inadequate staff education in the field of tobacco dependence treatment. Conclusions: The Global Network’s mission is to advocate, recruit and enable healthcare services and professionals to implement and sustain effective tobacco management and cessation policies in accordance with the WHO Framework Convention on Tobacco Control (FCTC). A systematic approach supports the quality of care and treatment outcomes for patients as well as healthy workplace conditions for the staff.

Objective: Forced migration caused by wars has led to regression in health parameters, including tuberculosis. This study aims to determine the relationship between living area, family type and the number of contacts among refugees and Turkish citizens diagnosed with tuberculosis. Method: This study was designed using retrospective file scanning. A total of 194 patients with diagnosed TB were included in this study. In addition, patients' addresses were visited and their family lifestyles and living areas were recorded. Results: Of 194 patients in the age range of 1-72 years (mean = 31.15, SD = 15.16), 98 patients were refugees. The number of contacts among refugees was 549, and their total living area was 7,740 m². A total of 57 refugees lived in a communal living situation, and their average living area was significantly lower than that of Turkish citizens. Statistical significance was observed between family lifestyle and habitats. This was found due to the difference between nuclear families and communal living situations. Conclusion: Tuberculosis was found to infect more people in war-related living conditions. This situation is caused by communal living, which refers to people who are not blood relatives living together; this is new information. Communal life should be taken into account in the contact examination of refugees for tuberculosis, and the obstacles to reach health services for refugees living outside of camps should be examined.

Objective: The main aim of this study is to discover and analyse the utilization of health impact assessment (HIA) among HIA certificate holders, and to ascertain their opinions on the current situation in the Czech Republic and on the possible future nationwide implementation of health impact assessment. Methods: The target group of the research was identified as holders of professional competence certificates in the field of public health impact assessment. A structured questionnaire was developed. The first part mapped the recent use of HIA in the Czech Republic, the second addressed the issue of linking HIA to regional policies and to the national strategy, the third aimed to gain information about the preparedness of the Czech Republic for the full implementation of HIA, and the last part focused on quality assessment and capacity building for HIA. Results: The results of the survey point to the inconsistencies in the perception of the whole concept of HIA in the Czech Republic by the professional public, and also to a shortage of experts in this area. There is only a narrow circle of experts, especially in the field of health care. It also lacks an informational base, which assist in the unification of processes in this area. As the results of the questionnaire showed, the problems are the lack of interest in the application of the HIA method and, subsequently, the lack of demand. Conclusion: The collected data showed obstacles and gaps in the implementation of the HIA methodology in the Czech Republic. At the same time it has revealed possible ways to change the current situation, based on the opinions of those who practice this methodology in the Czech Republic.

Aim: The aim of the study was to compare the prevalence and distribution of both low-risk and high-risk HPV infection of the urethra and outer genital region in Croatian men. Thus far there is a consensus that sampling the coronal sulcus and glans of the penis is essential for adequately assessing HPV status in men but less agreement is noted for urethral sampling. Methods: External genital brushing and urethral swabs were taken from 1,342 men during a 12-year period and tested with the hc2 HPV DNA Test using Hybrid Capture 2 technology. Results: The overall prevalence of male HPV infection in this study was 36.66%. Infection with high-risk HPV types (44.72%) was significantly more frequent than infection with low-risk HPV types (28.86%) or co-infection with both low-risk and high-risk HPV types (26.42%). HPV was more frequently demonstrated in the outer genital area (58.33%) when compared to the sole infection of the urethra (17.89%) or infection of both genital sites (23.78%). Conclusions: Results from this study indicate high prevalence of HPV infection in men and suggest that optimal sampling method for the testing of men is the combination of external genital and urethral swabs. Further research about the proper collection of biological samples and testing methods for HPV detection in men is necessary since our future end-goal is to implement standardized guidelines on sampling and diagnostic testing of males.

Aim: The aim of the study was to investigate long-term trends differences in student substance misuse between countries of former Eastern Bloc (FEB) and Western Europe (WEST). Overall data on student substance misuse gathered in five waves of the European School Survey Project on Alcohol and other Drugs (ESPAD) conducted between 1995 and 2011 were pooled and analysed. Findings were compared between FEB and WEST countries at the five time-points of data collection. Methods: Over 396,000 of 16 years old students from thirteen FEB and thirteen WEST countries completed anonymous ESPAD questionnaires. The following data were compared by Wilcoxon test: proportion of students with experience of taking a legal drug at less than 13 years of age (early onset), regular tobacco use, emerging signs of alcohol abuse, and differences in prevalence of illegal drug use. Results: Significant differences in selected variables were found in the early onset of legal and illegal drug use between FEB and WEST countries. On the contrary, no significant differences were present when several random samples from the pool of 26 participating countries were drawn and compared. This strengthens our confidence that the differences between FEB and WEST countries did not occur due to chance. Conclusions: Student drug use in FEB countries tended to follow the trends and patterns of legal and illegal drug use in WEST countries with some time lag. At the times of decline in use of both, legal and illegal substances in the WEST countries, the FEB countries were experiencing increase and later on stabilisation in drug use. The possible explanatory factors including the impact of profound political, cultural and socio-economic changes following the fall of the Iron Curtain in 1989 were discussed. The implications of these trends and suggestions for drug prevention strategies were outlined.

Objective: Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic. Materials: Newly diagnosed HIV/AIDS cases (n=308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T. pallidum exposure. Results: HIV infection was transmitted through heterosexual (n=176) or homosexual (n=131) contact (266 male, 86.3%; age 38.3±11.7 years; CD4+ T lymphocyte count, 330.6±15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T. pallidum exposure. All patients with positive syphilis serology were male (p=0.0026). T. pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p=0.0003). Conclusion: Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

Objectives: Pro-inflammatory cytokines, interleukin-6 (IL-6), demonstrated to be suppressed by interleukin-10 (IL-10) are known to be regulated by the transcription factor nuclear factor-κB(NF-κB). The aim of this study was to ascertain the association between genetic polymorphism of these genes (IL-6(-174), IL-10(-597) and NF-κB1-94ins/del)) and chronic/aggressive periodontitis. Methods: Forty-five patients with chronic periodontitis (CP), 58 patients with aggressive periodontitis (AP) and 38 periodontally healthy subjects were included in this study. Genomic DNA was isolated from whole blood samples. The NF-κB, IL-6, and IL-10 polymorphisms were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: Among subjects for the ins/ins genotypes of NF-κB1 gene, the AA genotypes of IL-10 presented a higher frequency in chronic periodontitis group than in healthy controls (p=0.023). A statistically significant difference in genotyping frequencies between AP group and healthy controls was observed for the IL-6 gene. The AA genotype of IL-10 was overrepresented in CP and AP groups compared to healthy controls (OR=9.93, 95% CI: 2.11-46.7, OR=5.7, 95% CI: 1.22-26.89, respectively). Conclusions: Within the limits of this study, it can be concluded that the IL-10 (-597) AA genotype is associated with susceptibility to chronic/aggressive periodontitis and IL-6 (-174) GG genotypes and G allele seems to be associated with aggressive periodontitis. Clinical relevance: The results of the current study indicate that IL-6 and IL-10 genotypes seem to be associated with aggressive periodontitis. Also, the AA genotypes of IL-10 presented a higher frequency in chronic periodontitis subjects with carrying NF-κB1 ins/ins genotypes.

Aim: The aim of the study was to further clarify the origin of Escherichia coli O104:H4 outbreak in Germany in 2011 (German Ec) as the likelihood of a deliberate act has not been excluded in previous analyses. Methods: We use an original and the most detailed scoring method so far, with 33 parameters pertaining to the source of infection/reservoir or possible perpetrator, pathogen or biological agent, transmission mechanism/factors or means/media of delivery, and population at risk or target. Results: Total scores for a deliberate or accidental epidemic indicate that the outbreak was more probably caused unintentionally, presumably due to technical accidents or hygienic shortcomings in the food chain. Conclusions: The validity of the present assessment is limited by the lack of data on the reservoir of the pathogen, the source of infection, and the mode of food contamination. Conclusive evidences on these parameters are essential for the final clarification of the outbreak origin.

The aim of this study was to explore the knowledge and perception of specific patients' rights and the problems experienced with their fulfilment among the Belgian population. Participants were recruited through patient association groups and health insurance companies. They completed an Internet-based questionnaire with 20 questions concerning patients' rights. In total, 309 persons completed all questions. The mean age of participants was 46 years (SD=15), 58% of them were women. Participants judged patients' rights concerning the end of life (88%), affordable health care (87%) and information about health status (85%) as the most important issues. Participants particularly showed concern about their legal rights for care offered in the patients' own language (21%), euthanasia (15%) and affordable health care (14%). The most important problems experienced so far were related to care offered in the patients' own language (12%), affordable health care (11%) and access to their medical file (7%).

Aim: The Ostrava region suffers from high levels of air pollution during winter inversions. We investigated the association between short-term elevations of air pollutant concentrations and worsening of respiratory problems, use of asthma medication and restriction of daily activities in asthmatic patients in Ostrava. Methods: One-hundred and forty-seven child and adolescent patients (aged 6-18 years) with a confirmed diagnosis of mild to moderate persistent asthma were included in the study. Participants' parents completed diaries covering the period of November 2013 to February 2014; this analysis included 18,228 person-days. Daily smoothed maps of outdoor concentrations of particulate matter (PM10), nitrogen dioxide (NO2) and sulphur dioxide (SO2) were constructed from routine monitoring data, and participants' daily exposures were estimated on the basis of time spent at home and at school. The associations between health outcomes and exposure to air pollutants were estimated using the multiple logistic regression method. Results: The odds ratios (OR) of the combined outcome for wheezing and/or difficulty in breathing, per 10 µg/m³ increase in the mean 24-h exposure were 1.07 (95% confidence interval 1.04-1.11) for PM10, 1.30 (1.18-1.44) for NO2, and 1.37 (1.18-1.59) for SO2. Additional inhaler use (in addition to usual medication) was also more frequent at higher air pollutant concentrations; the odds ratios per 10 µg/m³ increase in the mean 24-h exposure were 1.05 (1.02-1.07) for PM10, 1.19 (1.10-1.30) for NO2, and 1.26 (1.11-1.43) for SO2. Associations were less consistent for other health outcomes. Conclusions: These results suggest moderately strong associations between air pollutant concentrations and respiratory difficulties among asthmatic children and adolescents. More detailed analyses are required to confirm these preliminary findings.

Objectives: Although a number of human Legionnaires' disease in tourists are recorded annually in Europe, there are few cases where a direct link can be made between the infected person and the source of infection (hotel or other accommodation). We present a scheme followed in order to track down and identify the source of infection in a tourist suffering from L. pneumophila sg 5 infection, who was accommodated in seven different hotels during his holidays in the island of Crete, and we comment on various difficulties and draw-backs of the process. Method: Water samples were collected from the seven hotels where the patient had resided and analyzed at the regional public health laboratory using cultivation and molecular tests. Results: Of 103 water samples analyzed, 19 (18.4%) were positive for Legionella non-pneumophila and 8 (7.8%) were positive for L. pneumophila. A successful L. pneumophila sg 5 match was found between the clinical and environmental sample, which led us to the final identification of the liable hotel. Conclusion: Timely notification of the case, within the the European Legionnaires' Disease Surveillance Network (ELDSNet) of the partners involved, is crucial during a course of travel associated with Legionella case investigation. Moreover, the urinary antigen test alone cannot provide sufficient information for the source identification. However, acquiring clinical as well as environmental isolates for serogroup and SBT identification is highly important for the successful matching.

Objective: The aim of this study is to analyse the symptomatic response of elderly people to heat burden and indoor air quality exposure, and to create an index, the basis on which healthcare workers could react and prevent heat-related illnesses when the first symptoms appear. Methods: The impact of the indoor thermal environment was studied with regards to Humidex and indoor air quality by CO₂ concentrations on elderly people's symptomatic response. It was a natural experiment in which two different groups of elderly people (> 65 years) were observed: the first group had a diagnosed cardiovascular disease, and the second group did not have the disease. Results: The results show that the expression and aggravation of symptoms are related to an increase of heat burden and low indoor air quality. The symptoms under analysis do not have the same frequency distribution of intensity and, therefore, cannot be interpreted as a single universal symptom index. Instead, two indices must be created separately for both general and specific symptoms. Conclusions: Healthcare workers should be educated about the interactive influences of the thermal environment and the air quality on health. Unsuitable conditions could be ascertained by the nursing home occupants' symptomatic response.

Aim: The aim of the study was to assess the self-reported oral health behaviour of Scandinavian and Polish medical students studying in Poland. Methods: Three hundred and fifty subjects took part in the questionnaire survey. They were the 4th to 6th year Scandinavian and Polish medical students attending the same medical school. Test-retest reliability demonstrated an accepted level of kappa > 0.50. The questionnaire comprised issues dealing with demographics, dental health behaviour, fluoride tablet recommendation, self-rated oral health, and smoking habit. Statistical analyses were performed using the Fisher-Freeman-Halton test, Fisher's exact test and the multiple logistic regression. A p value<0.05 was considered significant. Results: Gender and nationality statistical differences were observed regarding the frequency of visiting a dentist: more Polish females visited a dentist less than a year ago (p=0.011), the reasons for visiting a dentist - check up, filling (p=0.002; p=0.040); the frequency of tooth brushing was higher among Polish females compared to Polish males and Scandinavian females (p<0.001; p<0.001). Polish males ate sweet snacks significantly more often than Polish females and Scandinavian males (p=0.018; p=0.004). In the logistic regression analysis factors were independently associated with visiting a dentist at least once a year: female gender (OR=2.310; 95% CI 1.381-3.865), Polish nationality (OR=3.833; 95% CI 2.293-6.408). Associations with the female gender were significant for the following dependent variables: visiting a dentist more than a year ago (OR=1.913; 95% CI 1.192-3.070), brushing teeth at least once a day (OR=3.759; 95% CI 1.567-9.017), and use of dental floss (OR=2.249; 95% CI 1.445-3.503). Polish nationality was associated with an increasing rate of brushing teeth for at least 3 minutes (OR=2.435; 95% CI 1.526-3.885), and smoking cigarettes (OR=2.340; 95% CI 1.336-4.098). Conclusions: Better prognosis for maintaining good oral health was established in the Scandinavian group of students. Polish females took greater care of their teeth than Polish males and the majority of their Scandinavian counterparts.

Objective: Alcohol abuse is related to a wide variety of negative health outcomes including mortality in older people. Alcohol abuse in older people is characterised by certain specific features uncommon in general adult population. The main objective of this study was to analyse the autopsy protocols of deceased older people in relation to blood alcohol concentration (BAC), sex, age, and manner of death. As a positive BAC, > 0.20 g/kg was accepted. Methods: The sample consists of 1,012 deceased older people (i.e. aged 65 years and over) selected out of 2,377 autopsied subjects in the period from 2003-2013. Subjects included into the sample were chosen via the proportional sampling method. Data (BAC, sex, age, and manner of death) was recorded in a single structured protocol. Data was evaluated statistically (Kolmogorov-Smirnov two-sample test, Wilcoxon two-sample test, risk ratio). Results: Among older people, there has been a statistically significant correlation of natural death with sex (men died earlier) and with increased BAC (people with positive BAC died earlier). In case of violent death there is a difference in the types of accidents in older people with positive BAC (> 0.2 g/kg) and with negative BAC (≤ 0.2 g/kg). Drowning is more common in older people with positive BAC. Conclusions: Health campaigns in Europe and the Czech Republic aimed at reducing alcohol consumption mainly deal with young people. Alcohol abuse has an impact on premature mortality even in older people. As shown by this study, older people with positive BAC die significantly earlier.

We would like to submit the following correction to our recently published paper due to an error in the Table 2. The corrected Table 2 is given below by the PDF icon.

Objectives: Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. Methods: We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. Results: Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. Conclusions: The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.

Objective: Cystic fibrosis is a genetic disorder that affects mostly lungs but also other organs. Modern treatment has transformed once fatal disease of childhood into the chronic disease of adulthood. Hence more patients enter the job market. Very few adolescents with cystic fibrosis receive some formal career guidance. There is still no professional career guidance for them in Slovenia. Methods: Literature on workability of patients with cystic fibrosis was reviewed. Following the articles and Slovenian and foreign manuals the guidelines on career counselling of young patients with cystic fibrosis is proposed, as well as the suggestions for professional qualification of these patients. Results: The results of the studies present that workability of patients with cystic fibrosis is associated to forced expiratory volume in 1 second (FEV₁) (p < 0.05), the achieved educational level more than 3 years of faculty study (p < 0.001-p < 0.013), self-assessment of quality of life (p = 0.005), age (p = 0.01), and the number of admissions to the hospital (p = 0.001). Conclusions: The interactions among work, quality of life and survival require that healthcare workers strive to help their patients with cystic fibrosis to succeed in their professional lives. The young patients should achieve the highest level of education possible and follow their wishes in line with the realistic possibilities.

Objective: The human body is colonized by bacteria, fungi and viruses. Resident commensal bacteria are a fundamental line of resistance to colonization by exogenous microbes. They actively regulate the production of nutrients by the host through a negative feedback mechanism, in order to prevent the availability of nutrients for potential pathogens. While only a small fraction of these microorganism may be pathogenic, the relationship between host and commensal microbiome is now studied as a whole, impacting several aspects of the host biology. Some studies have made clear the progresses in examining the role of microbiome on transplants and graft versus host disease (GVHD) severity and its pathogenesis: the risk of complications from allogenic hematopoietic stem cells transplantation (HSCT) is greater with the highest mortality if a patient has a lower bacterial diversity in the gut prior to the transplantation process beginning. Microbiota-associated molecular patterns are directly recognized by pathogen recognition receptors. The development of molecular methods has greatly expanded our knowledge of the composition and function of the microbiome in health and disease, shortening the response times vs. microbiological culture tests. The gut flora can make the difference when it comes to allo-HSCT. The aim of the study was to monitor microbiome of 10 children during allo-HSCT. Methods: Oral specimens and gut faecal microbiome (100 grams) samples were collected at 2, 16, 24 days. The samples were analysed by polymerase chain reaction and primary sequencing was done. To calculate the biodiversity of microbiome the Shannon index and the Observed species index were chosen. Results: Our study suggests some differences in the diversity indices (DIs) in 5 children affected by GVHD vs. not affected. The DIs in oral and faecal specimens show in all patients a diminution in the post-transplant phase with an improvement in species diversity after 16 days from the transplant. The Observed species index in faeces specimens after 16 days was higher in patients which had not GVHD; moreover, patients with GVHD showed a deterioration at 24 days. Oral specimens after 24 days showed a parallel trend in the two groups. The Shannon index shows a downward trend in faeces specimens of the children with GVHD at 24 days; the children without GVHD recover a good trend of entropy. Oral specimens at 24 days show low entropy in the two groups. Very aggressive bacterial species as Cronobacter and Routella in the faeces specimens of a child had not serious consequences for disease status: Cronobacter were not present 24 days after transplantation. Conclusions: The data show the microbial metabolome could have an impact on patients with GVHD vs. no GVHD. A better understanding of the role of the oral and gut microbiome in GVHD can give directions to move towards the development of innovative approaches for preventing GVHD following allo-HCT, reducing also antibiotic therapy.

Objective: In the Austrian population approximately 350,000-400,000 cases and 1,000-1,200 deaths are observed during an average epidemic, which puts influenza-related deaths on top of the list of vaccine-preventable cases of death. In face of extensive vaccination recommendations, the current vaccination rate of the general population of about 6% is one of the lowest worldwide. The objective of this study was to provide an update regarding the use of influenza vaccination in Austria over the period 1982-2015. Methods: This paper presents data on influenza vaccine use in Austria displayed by the number of distributed doses per 1,000 population over a period of 33 years. Further data was collected from representative population-based telephone surveys. Results: Austria has always been among the countries with a low number of distributed doses of influenza vaccine. The highest number ever was reached in 2006 with 142 doses/1,000. From 2007 onwards, a steady decrease happened to 62 doses/1,000 in the 2015/16 season, which corresponds to the level of the mid-nineties. Conclusion: Despite the fact that Austria is a country with comprehensive recommendations for influenza vaccination, this vaccination continues to be misjudged by the Austrian population and many areas of the medical system. From a public health point of view, this situation is not acceptable. Efforts must be increased to attain a much higher vaccination rate, e.g. the importance of the healthcare workers' influence must be recognized, the options of social marketing have to be utilized and studies on the main barriers in Austria are urgently needed.

Objectives: The aim of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis. Methods: In patients with any stage of newly diagnosed syphilis swabs were performed from urethra, rectum, pharynx and cervix according to the gender and type of sexual intercourse. From these smears standard validated nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections were done. Results: From 548 (488 men, 60 women) screened patients co-infection was detected in 15.9% of the cases. The majority of the co-infections (86.2%) were asymptomatic. The overall prevalence of chlamydial infection was 11.1% and 8.8% for gonococcal infections. In men who have sex with men (MSM) the prevalence of co-infections was significantly higher (20.0%) than in heterosexual men and women (4.2%) (p < 0.001). In MSM patients the presence of co-infection was significantly associated with HIV infection (p < 0.001). Among MSM 9.6% of the tests detected infection in anorectal site, while prevalence in urethral (2.8%) and pharyngeal (2.4%) localization was significantly lower. In heterosexual patients prevalence was less than 2.0% in all anatomic sites. Conclusions: The implementation of screening tests in case of sexually transmitted infections in patients with newly diagnosed syphilis is an important part in the management of this disease. These results suggest that screening of asymptomatic heterosexual patients leads to detection of minimum co-infections, but in MSM (especially HIV positive) should always be performed at least in anorectal site, where asymptomatic co-infections are common.