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The aim of the study is to present the theoretical background of trend studies in general, to characterize the international Health Behaviour in School-aged Children (HBSC) study and to describe its methodology and changes of the Czech HBSC study between 1994 and 2014. The first part describes various types of trend research studies including their advantages and disadvantages. The second part summarizes the history of the HBSC study in an international context and particularly in the Czech Republic. The final part presents the basic methodological data from six surveys conducted in the Czech Republic between 1994 and 2014.

Objective: The Czech Republic is characterized by high alcohol consumption and is well known as the world's biggest consumer of beer. In contrast, the alcohol consumption in Norway is relatively low. In this article, we describe and discuss alcohol policy development in the Czech Republic since the mid-1980s to the present and its impact on the alcohol consumption and compare our findings, including the dynamics of the total alcohol consumption and the development of drinking patterns among young people, with the situation in Norway. Methods: The study uses the methodology of "process tracing". Selected national statistics, research outcomes and related policy documents were analyzed to identify possible relations between the alcohol consumption and the alcohol policy in two different environments and institutional/policy settings. Results: There was a clear difference in alcohol consumption trends in both countries in the last three decades. Norway was characterized by low alcohol consumption with tendency to decline in the last years. In contrast, the Czech Republic showed an upward trend. In addition, alcohol consumption among Czech youth has been continuously increasing since 1995, whereas the opposite trend has occurred in Norway since the late 1990s. The results revealed that the alcohol-control policies of the Czech Republic and Norway were significantly different during the study period. Norway had a very restrictive alcohol policy, in contrast to the liberal alcohol policy adopted in the Czech Republic, in particular after political transition in 1990. Liberalization of social life together with considerable decline of alcohol price due to complete privatization of alcohol production and sale contributed to an increase of the alcohol consumption in the Czech Republic. Conclusions: Persistently high alcohol consumption among general population and its growth among young people in the Czech Republic pose social, economic and health threats. Norway could provide the inspiration to Czech politicians about effective options in combating these threats.

This educational article/narrative review reflects the European Association for the Study of the Liver (EASL) clinical practice guidelines: management of alcohol-related liver disease. An important change contrasting with the 2012 guidelines is the new terminology of alcohol-related liver diseases. Another important outcome is the strong emphasis on prevention of alcohol use disorder which may be performed at all stages of public health care.

Objectives: Whereas dental materials came in direct or close contact with oral tissue, it is a great concern about the biocompatibility of those materials. This study was performed to evaluate possible DNA damage to buccal cells exposed to dental materials. Methods: This prospective, longitudinal clinical study was conducted over a three months period. Class II restorations were placed in 60 young patients with no previous filling using one of three tested dental materials (two glass ionomers; Ketac Molar and Ionofil Molar and one compomer material; Twinky Star). DNA damage was analysed by micronucleus assays, in buccal exfoliated epithelial cells. Results: In patients treated with Ketac Molar, a significant frequency of micronuclei (p = 0.027) and binucleated cells in samples taken 30 days following restoration (p = 0.029) was confirmed. In patients treated with Twinky Star, a statistically significant increase in the number of binucleated cells in samples taken after 7 and 30 days following restoration (p = 0.001 and p < 0.001, respectively) was observed. In all samples collected 90 days after treatment, there was no statistical difference in the number of any cell changes. Conclusion: In this study long-term biocompatibility of tested materials was confirmed. Glass ionomers and compomers are widely used materials in paediatric dentistry, and this study has proved their safety for usage in children.

Objective: The aim of the study was to determine the effect of physical factors of apartments, educational attainment, nationality and unemployment on the number and distribution of bed bug call inquiries in Budapest, Hungary. Methods: Educational attainment, apartment conditions, the level of unemployment, the ratio of dependent people in the households, nationality and proportion of dependent people were selected as regressors. Monthly ambient temperature values were correlated with monthly call inquiry numbers. Results: Downtown units showed the highest call inquiry rates. Significant positive correlations were found between the call inquiry rates and the ratio of low educational attainment inhabitants (people with ≤ 8 school classes), the rate of small floor area apartments (apartment area < 29 m²), proportions of the comfortless apartments in the district housing stock and proportion of unemployed people on district level as well as proportion of gypsy inhabitants in the districts. Significant negative correlation was found between the call inquiry rates and the average area (m²) of apartments. The number of call inquiries showed expressed, temperature-depending seasonality between March and December 2015. In multiple regression analyses, the level of unemployment and proportion of gypsy inhabitants showed significant correlations with the rate of bed bug call inquiries. Conclusions: Apartment conditions, educational attainment, nationality, unemployment, and the city structure have notable influence on the occurrence of bed bug call inquiries on urban level, although the level of unemployment and nationality seem to be the strongest factors. The annual changes of the ambient temperature have effect on the call inquiry rate.

Objectives: The universally recognized indicator of nutritional status, BMI, has some shortcomings, especially in detecting overweight and obesity. A relatively recently introduced normal weight obesity (NWO) describes a phenomenon when individuals are found to have normal weight as indicated by BMI but have an elevated percentage of body fat. Normal weight obese individuals face a higher risk of developing metabolic syndrome, cardiometabolic dysfunction and have higher mortality. No studies have been previously performed which would map NWO in Brno, Czech Republic. Methods: In a sample of 100 women from Brno, we assessed the percentage of normal weight obese individuals using bioelectric impedance analysis (BIA) - three different analyzers were utilized: Tanita BC-545 personal digital scale, InBody 230 and BodyStat 1500MDD. Also, a caliperation method was used to estimate body fat percentage. Various body fat percentage cut-off points were used according to different authors. Results: When the 30% body fat (BF) cut-off was used, up to 14% of the women in our sample were found to be normal weight obese. When the sum of skinfolds or the 35% BF cut-off point are selected as a criterion for identifying normal weight obesity (NOW), only 1 of 100 examined women was identified as normal weight obese; at the 35% BF cut-off, BodyStat analyzer categorized no women as normal weight obese. Also, when the 30% BF or 66th percentile BF cut-off points were utilized, BodyStat identified pronouncedly fewer women from our sample to be normal-weight obese than the two other analyzers. Conclusions: On a pilot sample of Czech women, we demonstrated that depending on the selected cut-off (there is no clear agreement on cut-off points in literature), up to 14% of the examined women were found to be normal weight obese.

Objectives: Lyme disease (Lyme borreliosis) is a transmissible infection, common in the temperate climate zones. It is caused by a group of spirochetal bacteria known as Borrelia burgdorferi sensu lato complex. The aim of the present work was to investigate the incidence rate of borreliosis in different regions of Bulgaria and to identify possible risk factors for its occurrence. Methods: National and regional borreliosis incidence rates for 2009-2018 were obtained from the public database of the National Centre of Public Health and Analyses. Their association with some socio-demographic variables and the geographic location (south or north) of the regions was tested with Spearman's correlation analysis and simple linear regression. Results: The mean annual incidence for the last 10 years (2009-2018) in Bulgaria was 6.9 (range 4.1-11.6) cases per 100,000 inhabitants. We found that the Lyme disease was highly fluctuating at regional level with incidence rates varied from 0.3 to 30.9 per 100,000 inhabitants. Several regions showed significantly higher endemicity for the disease. Socio-demographic factors were not found to be important for Lyme disease frequency while the geographic location in the north part of the country was a significant risk factor for it. Conclusions: Lyme disease is a serious health risk in Bulgaria especially in its northern part - regions on the north are the most vulnerable to a higher incidence of the disease.

Aim: Cancer mortality distribution was investigated by detailed neoplasms groups, age, sex, marital status of deceased, and regions in the Slovak Republic, and examined how these determinants influence the odds of dying due to cancer. Methods: A retrospective analysis of cancer mortality statistics registered in the Slovak Republic during the years 1996-2014. For this time period, data was available only on the underlying subgroups of cancer deaths, place of death, age, year, sex, and marital status. Binary logistic regression was applied for odds of dying calculation influenced by these socio-demographic factors. Results: The most common are deaths from malignant neoplasms of digestive organs in males as well as females. The biggest difference among both genders is recognized in malignant neoplasms of lip, oral cavity and pharynx, where deaths among males are on average 7.9 times higher in comparison to females. As for place of death the Bratislava region reports the highest level of cancer mortality stated at 25.22% of all deaths, on the contrary the Banská Bystrica region reports only 21.40% of all deaths. Age has a negative influence on odds of dying due to neoplasms compared to all other causes of death by 1.7%. In all regions compared to the reference Bratislava region, the odds of dying from neoplasms are lower. Being female diminishes the odds of dying due to neoplasms by 25.7% compared to males. Yearly the relative ratio of dying from neoplasms increases with respect to all other causes of death. When single people are set as the reference category, the relation of the probability of death from cancer to the probability of death due to other causes of death is higher for married, divorced and widowed persons. Conclusions: The results should be taken into account when comparing risk of dying due to cancer among people with the mentioned socio-demographic characteristics. Health policy makers should consider place of death and cancer types while planning hospital care units.

Objective: Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown. Methods: Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets. Results: The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liver-related deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030. Conclusions: Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.

Objectives: The aim of the study is to determine norms of polymorphic variation in the sequence of permanent teeth in Czech children in order to establish first standards applicable to individuals. Setting out such standards, derived from the population to which they will be applied, are essential for diagnoses in paediatric dentistry, orthodontic treatment planning and for anthropological application. Methods: Dental examinations were performed on a sample of 1,370 children (696 girls and 674 boys) aged 4-15 years. All emerged permanent teeth (other than third molars), when at least some part of crown has penetrated the oral mucosa, and the child's gender were recorded. The frequency of sequence polymorphism was calculated for each gender by counting instances of absent/present and present/absent across all possible intra-arch and inter-arch tooth pairs. Results: Differential frequencies of polymorphic sequences were more common in the inter-arch tooth pairs than in the intra-arch pairs. The most similar frequencies in inter-arch pairs were observed in second mandibular premolar/second maxillary premolar in both genders. However, in the mandible there was a polymorphic sequence in the first molar/central incisor pair in both genders. Furthermore, mandibular polymorphisms were more commonly observed in the sequences of canine/second premolar in girls than in boys. Additionally, canine/second premolar polymorphic sequences were found to be more common in the maxilla in both genders. Conclusions: The data presented in this article are useful in the prediction of tooth emergence sequence in individual Czech children and are important in paediatric dentistry and in orthodontic treatment.

Objectives: The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population. Methods: The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity. Results: The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy. Conclusion: The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

Objective: Basal metabolic rate (BMR) is the main part of the total body energy expenditure. The value of BMR is individual and depends on a lot of factors. The goal of the research was to discover the influence of anthropometric parameters, age and gender, on changes of the BMR values. Methods: A total of 177 individuals of Czech Caucasian origin from South Moravia (BMI 27.3 ± 7.88 kg/m²) aged 18-55 (117 women, 60 men) were included in the study. Selected anthropometric characteristics were measured using a stadiometer (SECA 213) and bioelectrical impedance analysis (Inbody 230). BMR was measured by indirect calorimetry (Cortex Metalyzer 3B). The measured values were statistically evaluated by the regression analysis and least square method (LSM). Results: From the following results that the factors that influence the BMR value statistically significantly (p < 0.05) are: age, gender, body mass index, total body water, and percent of body fat. Conclusion: Body fat and age have both an indirect impact on the basal metabolic rate of the Czech population in working age. However, BMI and the total body water were discovered to have a direct influence on the BMR.

Objectives: This study was aimed to assess the concentration of microbial aerosol and species composition of airborne staphylococci in 10 healthcare facilities in southern Poland including primary healthcare units and hospital wards; and to assess whether the selected components of microbial aerosol pose a threat of severe infections to either patients or the personnel. Methods: The study was conducted at monthly intervals over a period of one year. Air samples were collected by MAS-100 sampler. The number of mesophilic bacteria, mould fungi, actinomycetes and staphylococci was determined on general and selective media. The species identification of staphylococci was conducted using API tests for strains that were pre-selected based on macroscopic and microscopic observations. Results: A total number of 1,584 samples were collected during the sampling period. The numbers of airborne microorganisms varied between the examined premises and between the seasons of the year. The observed differences were statistically significant with one exception for actinomycetes and their differences between the examined premises. The concentrations of mesophilic bacteria varied from 5 to 297 CFU/m³ of air, for Staphylococcus the values ranged from 1 to 96 CFU/m³, for fungi - from 1 to 100 CFU/m³, and the number of actinomycetes ranged from 7 to 321 CFU/m³. Ten species of coagulase-negative staphylococci (CoNS) were identified among 55 isolates with S. saprophyticus and S. warneri being the most frequently detected (n = 14 and 13, respectively). S. haemolyticus, which is one of the most common causal agents of nosocomial infections was observed in four facilities (n = 5). Conclusions: The microbial concentrations varied both between the seasons of the year and between the examined facilities. The highest bioaerosol concentrations were observed in most crowded premises. The identified species of staphylococci, although not typically associated with human infections, are common causal agents of nosocomial infections and infections in immunocompromised people.

Objective: The aim of the study was to determine trends in the minimum inhibitory concentrations (MICs) of erythromycin used as first-line therapy and alternative antibiotics against Bordetella pertussis (B. pertussis) strains isolated from patients with whooping cough in the Czech Republic (CR) in three periods from 1967 to 2015. Methods: In total, 135 isolates from the years 1967-2015 were analysed. The strains were divided into three groups by the year of isolation: 1967-1999 (42 strains), 2004-2010 (43 strains), and 2011-2015 (50 strains). MIC of selected antibiotics (erythromycin, clarithromycin, azithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole) were obtained by the reference agar dilution method on Bordet Gengou Agar with 15% defibrinated sheep blood. Results: The study set included 70 strains previously tested for MICs of erythromycin and four other antibiotics. In the three study periods, the MICs of the tested antibiotics for B. pertussis were nearly identical. All but a single strain, inhibited by erythromycin at a concentration of 0.03 mg/l, were inhibited by two concentrations of erythromycin and azithromycin (0.06 and 0.125 mg/l). Clarithromycin inhibited the strains from all three study periods at the following concentrations: 0.03, 0.06, and 0.125 mg/l. Any of the 135 strains was inhibited by ciprofloxacin at a single concentration of 0.06 mg/l and by trimethoprim/sulfamethoxazole at three concentrations (0.125, 0.25, and 0.5 mg/l). Conclusion: The study set of 135 Czech strains of B. pertussis isolated in 1967-2015 appears to be homogeneous in terms of the MICs for five antimicrobials. The MICs remained in a narrow range of two to three low concentrations; the unimodal distribution of the MICs suggests the absence of resistance mechanisms. The highest MICs of erythromycin, clarithromycin, and azithromycin were equally 0.125 mg/l, that of ciprofloxacin was 0.06 mg/l, and that of trimethoprim/sulfamethoxazole was 0.5 mg/l. Over the study period of 55 years, the MICs of the study antibiotics remained in the same ranges.

Objective: The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. Methods: We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. Results: HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ² = 5.42; p < 0.05) and decreases with the age of respondents (χ² = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). Conclusion: HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.

Objective: The aim of our study was to investigate the relationship between alcohol-related mortality in Slovak regions, as represented by Nomenclature of Territorial Units for Statistics (NUTS) III level. Methods: We used data from mortality reports spanning 1996-2017 in the Slovak Republic. Data was provided by the National Health Information Centre in Slovakia. We applied two-dimensional correspondence analysis where the dimensions are regions and selected alcohol-related deaths diagnoses are classified by the International Classification of Diseases. Results: Analysis revealed a relationship between the Prešov region and diagnoses I42 - Cardiomyopathy and K29 - Alcoholic gastritis. Furthermore, the Banská Bystrica and Žilina regions correspond to G31 - Degeneration of nervous system due to alcohol and K86 - Alcohol-induced chronic pancreatitis. In the case of K70 - Alcoholic liver disease - the Banská Bystrica, Trenčín and Nitra regions are identified as regions which have an intermediate relationship with this diagnosis. The Trnava region corresponds to F10 - Acute alcohol intoxication. The Trenčín and Nitra regions correspond closely to G62 - Alcoholic polyneuropathy. Perfect correspondence can be seen between the Košice region and K73 - Chronic hepatitis, not elsewhere classified. K74 - Fibrosis and cirrhosis of liver diagnosis also corresponds with the Košice region. Conclusions: The results of this analysis provide valuable insights for national and regional health policymakers in the process of preparing high-quality health regional plans, as well as retrospectively assessing the success of existing health policies and interventions in this area. Facts presented in the study justify the need for specialised health care, which is part of the process of building an Integrated Health Care Centre in Slovakia.

Human biomonitoring (HBM) has a wide range of applications and long tradition both in health care and the field of public health. Its major advantage is the integration of all exposure routes and sources. Since HBM information is an integrated exposure finding it offers the opportunity to trace and mimic a realistic exposure scenario. It reduces the number of assumptions that need to be made when estimating exposure and thus helps to reduce the uncertainties in exposure science. In spite of some challenges, such as further harmonization in the area of HBM, necessity of deriving equivalents of markers of external exposure and addressing the ethical and political aspects of its application, HBM is an efficient and cost-effective way to measure exposure levels of the human body to xenobiotics.

Objective: We described an impressive cluster of hepatitis C in a single family. Of nine members of the family, six - the mother and five daughters - were affected by chronic hepatitis, hepatitis C virus (HCV) genotype 1b, of which two were co-infected with hepatitis B virus (HBV). Sharing a non-disposable injection equipment for intramuscular medical care was the most likely route of contagion. Twenty years after the first observation, we performed a follow up of this family. Methods: The clinical history was updated, and the members of the family underwent a clinical evaluation, extensive liver laboratory tests, and whole serology for hepatitis C and B. Protein chain reaction for HCV RNA was performed when indicated. The eight spouses of the offspring and their eight children underwent the same evaluation. Results: The main findings of this study are the favourable outcome of the two members of the family mono-infected by HCV, treated with peginterferon and ribavirin (sustained response and free of liver disease), in contrast with the ominous outcome of the two members co-infected with HCV and HBV, who evolved to decompensated cirrhosis, with hepatocellular carcinoma in one case, ultimately leading to death. A further feature is the absence of transmission of HCV to the spouses and to the third generation of children of this family, consistent with the assumption that sexual and vertical transmission is unlikely. Conclusions: A thorough epidemiological investigation of the two first generations of this family, the study of their spouses and children, and the twenty years of follow up provided a strong presumption that the infection with HCV had occurred within this family through the promiscuous use of the same inadequately sterilized glass syringe for intramuscular therapies, as was a common practice during the fifties and sixties worldwide and still is in some part of the world.

Objective: This study is designed to evaluate the potential effects of age, period and cohort (APC) on trends in suicide between 1983 and 2013 in Turkey. Methods: Mortality data were obtained from the Turkish Statistical Institute. The data were grouped into seven age groups, four periods and ten birth cohorts. A nonlinear regression model was estimated for both sexes. The effects of age, period and cohort were parameterized using natural spline smoothing functions. Results: There were 61,795 deaths recorded as suicides during the investigated time period, where 64.5% occurred in males (n = 39,862) and 35.5% in females (n = 21,933). There is an upward trend in mortality by age until the end of the study period for males and females. Age effect is decreased until the forties, kept decreasing during the middle ages, and sharply increased after the sixties. The death rates for females declined from 1999 until the end of the study period. For males, the death rates increased until the end of the study period. Conclusion: If the current trends continue, it can be expected that these effects will continue to reduce female mortality and increase male mortality. Future studies on suicide, strongly focused on specific factors attributed to period effects, are needed in Turkey.

Objectives: Urinary tract infections (UTIs) are common problems in women, and important reason for visiting primary care physicians, resulting in substantial financial burden to community. The aim of this study was to determine the resistance rates of E. coli to commonly prescribed antimicrobial drugs for community-acquired UTIs in women and to establish the association between age and resistance to antibiotics among isolates of E. coli from urine. Methods: The study was designed as a retrospective cross-sectional study during the 5-years period. It was conducted on a sample of urinary tract isolates of E. coli taken from women with community-acquired UTIs. After prevalence of E. coli resistance to antibiotics was established, the analysis of risk factors for emergence of resistance was conducted. Results: There were 10,734 isolates of E. coli, comprising 70.62% of all samples analyzed. E. coli was the most frequently resistant to ampicillin (54.68%), followed by trimethoprim-sulphamethoxazole (37.46%), first and second generation cephalosporins (cephalexin and cefaclor) (29.53% both), and ciprofloxacin (23.80%). Less than 50% of E. coli isolates was sensitive to all three tested antibiotics, and nearly 13% acquired triple-resistance. Prevalence of isolates resistant to two or three agents was higher in the subgroup of women older than 65 years. Conclusions: Empirical choice of antimicrobial agent for community-acquired non-complicated UTIs in women should be individualized on the basis of the patient's age, prevalence of resistance in the local community, and compliance history of the patient.

The aim of this study was to assess the risk factors in the origin of lethal or surgically corrected isolated atrial septal defect secundum. The population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (conducted between 1980 and 1996) comprised 472 atrial septal defect secundum cases, 678 matched controls and 38,151 available controls without any defects; in addition, 21,022 malformed controls with other isolated defects. Medically recorded chronic disorders in the prenatal maternity logbook were evaluated, while acute maternal diseases, drug treatments and pregnancy supplements were analyzed on the basis of both prospective medically recorded data and retrospective maternal information. Acute pelvic inflammatory disease, paroxysmal supraventricular tachycardia and phenolphthalein treatment due to severe constipation of mothers were shown to contribute to the development of atrial septal defect secundum of their children. High doses of folic acid in early pregnancy had positively influenced a minor part of isolated atrial septal defect secundum in foetuses. In conclusion, the obvious genetic predisposition for atrial septal defect secundum is connected with maternal paroxysmal supraventricular tachycardia and triggered by acute pelvic inflammatory diseases and phenolphthalein treatment, while the manifestation of atrial septal defect secundum can be reduced by high doses of folic acid supplementation in early pregnancy.

Aim: Access to primary health care is highly connected to the prevention of cancer mortality, since the risk factors threatening health can be early identified. The aim of this paper is, firstly, to explore similarity within and between the regions of the Slovak Republic and cancer mortality patterns, and secondly, to reveal if similar regions are characterised by the similar access to health care or risk factors occurrence. Methods: Data on deaths by sex, type of cancer death and region from 1996 to 2014 is provided by the National Health Information Centre of Slovakia. The relationships between 8 regions and 16 cancer types are described by correspondence analysis for both sexes. Results: The most similar cancer mortality patterns among Slovak regions are between the Nitra and Trnava regions for both sexes, and the Košice region for males. The Prešov region is showed as an outlier from other regions for females, likely due to the highest concentration of Roma marginalised communities. As for access to health care, the Trnava region as well as Nitra region report the lowest densities of physicians, 2.4 and 2.6 per 1,000 inhabitants, respectively. The most serious cancer types mortality is attributed to the digestive organs (C15-C26) in each Slovak region for both sexes with the average proportion of 35.56%. Observed high association between the Nitra region and respiratory cancer (C30-C39) in males may be confirmed by the increased incidence of radon in this region. Similarly, a tight relationship between the Bratislava region and cancer of male genital organs (C60-C63) can relate to the highest proportion of drug users in the Bratislava region. Conclusions: Based on the findings of similar regions in cancer mortality patterns, we recommend to set the same prevention programs in the Trnava and Nitra regions, on the other hand, different preventive interventions should be introduced in the Prešov region.

Objectives: Physical activity (PA) and adequate macro- and micronutrient intake have favourable influence on the bone status. The aim of this study was to analyse the relationships among PA, anthropometric data, dietary intake and ultrasound bone characteristics in children. Methods: 10-12 years old Hungarian children (N = 123, 59 girls, 64 boys) provided physical activity, diet, anthropometric and bone data. PA was measured with accelerometer (Actigraph GT3X+). Diet was evaluated with three-day, 24-hour food recall. Calcaneal quantitative ultrasound (QUS) bone parameters were registered with Sonost3000 bone densitometer. Results: Nutrition and anthropometry did not differ by gender. The values of broadband ultrasound attenuation (BUA) were significantly higher in boys. Girls spent significantly more time being sedentary, boys had greater light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) levels. The children accumulated more than twice the suggested amount of public health guidelines for MVPA. QUS parameters correlated significantly with vigorous physical activity in boys, and with age, height, weight, fat percentage, and body mass index (BMI) for both genders. There was no significant relationship between nutrition and QUS; however, inadequate vitamin K intake correlated with less favourable bone parameters. Multiple linear regression analysis confirmed the importance of vigorous PA - speed of sound (SOS): β = 0.358, p = 0.006; BUA: β = 0.340, p = 0.007; bone quality index (BQI): β = 0.377, p = 0.002; vitamin K intake - SOS: β = 0.256, p = 0.025; BUA: β = 0.235, p = 0.033; BQI: β = 0.295, p = 0.007; BMI - SOS: β = 0.207, p = 0.064; BUA: β = 0.455, p < 0.001; BQI: β = 0.284, p = 0.008; and age - SOS: β = 0.450, p < 0.001; BUA: β = 0.318, p = 0.004; BQI: β = 0.444, p < 0.001). Conclusions: Changes in the characteristics of ultrasound bone parameters among 10-12 years old children mainly depended on the amount of intense PA, adequate vitamin K intake and anthropometric variables related to age.

Objective: The aim of the study was to analyse the occurrence of lead in selected samples of fruit distilled spirits for own consumptions in terms of possible contribution to the occurrence of alcohol-attributable diseases. Methods: In a pilot study, we analysed 18 samples of fruit spirits for own consumption. Most of the samples were distilled in the local growing distilleries in the Žilina Region with exception of 3 samples collected in the Trnava Region (one of them was of Hungarian origin). Sample preparation included previous mineralization with use of microwave decomposition system Multiwave 60 50 Hz. The samples were analysed by atomic absorption spectroscopy with graphic furnace (AAS GBC XplorAA 5000 with GF 5000). Results: The average ethanol level in our samples was higher in comparison with distributed spirits. We detected lead in all samples. In two of them the concentration was lower than the limit of quantitation (LOQ). The highest lead concentrations were observed in plum spirit from Hungary (581.0 μg/l), and in grape spirit made in the Trnava Region (466.3 μg/l). Conclusions: Lead is a widespread contaminant of fruit spirits prepared for own consumption. Taking into consideration its common occurrence and possible multiplicative effect with ethanol, we can assume that lead can contribute to the occurrence of several alcohol-attributable chronic diseases. Due to the insufficient information in this field, our results provide significant insight into the issue and present an important starting point for further research.

Objectives: Individuals with HIV infection are at an increased risk for a number of infectious diseases, some of which are preventable by vaccination. Unfortunately, little is known about the attitudes of this population group to vaccination, therefore, we decided to find out vaccination coverage against 5 infections among newly diagnosed HIV-infected patients in the Czech Republic. Methods: This cross-sectional study was conducted on newly diagnosed patients who started their follow-up care at the HIV Clinic of Na Bulovce Hospital during the two following years. Vaccination history data and results of serological tests were collected from all participants. Results: Enrolled were 269 HIV-positive subjects (94.1% males) with a mean age of 34.4 years, 64 subjects (23.8%) had tertiary education, 229 (85.1%) were men having sex with men, 32 (11.9%) were heterosexual, and 8 (3.0%) were injection drug users. The mean CD4+ T-lymphocyte count was 556.2/µL, with 149 persons (55.4%) who had a CD4+ T-lymphocyte count > 500/µL, and 68 (25.3%) individuals were late presenters with CD4+ T-lymphocyte count < 350/µL. A vaccination against tetanus was reported by 262 subjects (97.4%), against influenza by 18 subjects (6.7%), against tick-borne encephalitis by 18 subjects (6.7%), against viral hepatitis A by 78 persons (29.0%), and against hepatitis B by 104 subjects (38.7%). For influenza, tick-borne encephalitis and hepatitis A, a significant positive impact of tertiary education was found (p-values < 0.001-0.044). Vaccination coverage against both types of hepatitis was significantly lower in late presenters (p = 0.044 and p = 0.004, respectively). Conclusions: Vaccination rates found in our cohort were except tetanus and hepatitis B in young people low, especially for influenza and tick-borne encephalitis. Higher level of education and less advanced HIV infection were associated with higher vaccination rates. To improve this unsatisfactory situation, more attention should be paid to vaccination.

Aim: The concept of amenable mortality is intended to assess health care system performance. It is defined as "premature deaths that should not occur in the presence of timely and effective health care". The purpose of paper is to analyse differences in amenable mortality across European Union countries and to determine the associations between amenable mortality and life expectancy at birth. Methods: This is a cross-country and time trend analysis. Data on deaths by cause, and five-year age groups were obtained from the World Health Organization database for the 20 European Union countries, throughout the period from 2002 to 2013. The rates of amenable mortality were expressed by the age-standardised death rates per 100,000 inhabitants. We applied the method of direct standardisation using the European Standard Population. Results: Throughout the explored period, the statistically significant variations of the age-standardised death rates in a relation to the European Union average fluctuated from 78.7 per 100,000 inhabitants (95% CI 72.4-84.9) in France to 374.3 per 100,000 inhabitants (95% CI 350.8-397.7) in Latvia. The leading causes of amenable mortality were ischaemic heart disease, cerebrovascular diseases, and colorectal cancer that accounted for, respectively, 42.2%, 19.5%, and 11.3% of overall amenable mortality. As expected, statistically significant strong negative relationship (R² = 0.95; ρ = -0.98) between amenable mortality and life expectancy at birth was proved by linear regression. The concept has several limitations relating to the selection of causes of death and setting age threshold over time, not consideration actually available health care resources in each country, as well as differences in the prevalence of diseases among countries. Conclusions: We found an explicit divide in amenable mortality rates between more developed countries of Western, Northern and Southern Europe, and less developed countries of Central and Eastern Europe. Increasing of amenable mortality may suggest deterioration in health care system performance.

Objective: The aim of this study was to evaluate the rate of contact sensitization to selected cosmetic allergens, i.e. ingredients of dental materials, in students of dental medicine and dental patients. Methods: A total of 50 participants were included in the study: 40 students of dental medicine exposed to the studied allergens during the course of practical education; and 10 randomly selected dental patients without occupational exposure to the investigated substances served as a control group. All of them were patch-tested with colophonium, myroxylon pereirae resin, paraben mix, fragrance mix I, isopropyl myristate, triclosan, polysorbate 80, compositae mix II, and hydroperoxides of limonene. Results: The sensitization rates for colophonium and polysorbate 80 were the highest. For the group of dental students, we established significantly higher sensitization rate for colophonium compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ² = 4.93; p = 0.026), paraben mix (χ² = 3.6; p = 0.05), isopropyl myristate (χ² = 6.56; p = 0.01), and triclosan (χ² = 8.5; p < 0.001); and to polysorbate 80 compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ² = 3.97; p = 0.046), isopropyl myristate (χ² = 5.47; p = 0.02) and triclosan (χ² = 7.34; p = 0.007). Significantly increased concomitant sensitization rate to compositae mix and to hydroperoxides of limonene was established (χ² = 12.55; p < 0.001). Generally, the incidence of concomitant sensitization to the studied allergens in the whole studied population was high. Conclusions: Colophonium and polysorbate 80 could be outlined as sensitizers of paramount importance for both dental students and dental patients. We consider the major importance of exposure to colophonium during the course of practical education in dentistry for the onset of the sensitization. Sensitization to compositae mix was observed only among dental students. We consider the leading role of consumer exposure for the onset of the sensitization to triclosan and to hydroperoxides of limonene. Unexpected and unreported reactions of concomitant sensitization were observed.

Objective: In recent years new infectious diseases, i.e. emerging or re-emerging diseases, have been coming to the forefront. Currently, microsporidia, considered to be a major cause of emerging and opportunistic infections particularly in immunocompromised individuals, are also included in this group. Therefore, the aim of our study was to map the prevalence of Encephalitozoon intestinalis and Enterocytozoon bieneusi infection in a group of patients and to compare it with the occurrence of specific antigens in immunocompetent people. Methods: Detection of spores of both pathogens in faecal samples was performed by an immunofluorescence test using species-specific monoclonal antibodies. Results: Positivity to E. intestinalis in 91 examined immunosuppressed patients reached 33% (30/91), while only 4.3% (3/70) of the control group samples were found to be positive (relative risk 7.7, p < 0.001). In case of E. bieneusi 14.3% (13/91) of immunocompromised patients were positive, as were 5.7% (4/70) of people from the control group (relative risk 2.5, p = 0.095). Conclusion: In case of development of any opportunistic infection, the infection is detected and removed in most cases at an early stage. The incidence of clinically manifested microsporidiosis in patients with immunodeficiency is rare as they are under constant medical supervision. However, we must not forget about opportunistic infections, and in case of any non-specific symptoms it is necessary to exclude or confirm the diagnosis for immediate treatment.

Objective: We examined the prevalence of unintentional injuries and associated risk factors among university students in Canakkale city, Turkey. Methods: A cross-sectional study was conducted in 2007-2008. A total of 4,762 students completed the questionnaire. Risk factors associated with the rate of accidents were assessed by chi-square analysis and effects of these factors on unintentional injuries were described by logistic regression analysis. Results: The rate of unintentional injuries among university students was 14.9% during the previous 12 months. The most reported injuries occurred on the road (43.8%), at home (33.2%) and outside the home (26.9%) such as workplaces, schools or sports venues. The prevalence of unintentional injuries was significantly higher in males than females (18.1% vs. 12.0% p<0.05). Results of the logistic regression analysis indicated that male gender (OR 1.51), studying in college and vocational school (OR 1.34), perception of very bad (OR 0.49) or good economic status (OR 0.49), drinking alcohol (OR 1.52), using illicit substances (OR 1.70), having a diagnosed illness (OR 1.36), or having risk of developing depression (OR 1.54) had significant effects on the risk of unintentional injuries (p<0.05). Conclusions: This study indicated that male gender, studying in college and vocational schools, illicit substance use, poor economic conditions, having a diagnosed illness and risk of developing depression can be risk factors for unintentional injuries among university students. Public health training programmes giving priority to high-risk groups such as university and high school students may be a valuable tool in reducing unintentional injuries among young people.

Although obesity is a multifactorial disorder caused by various behavioural, genetic and environmental influences, early life factors affecting certain critical periods during childhood (prenatal period, adiposity rebound period at 3-5 years and around 5-7 years, as well as puberty) are important in promoting obesity in adulthood. The objective was to determine the association between the birth weight, birth length, breastfeeding and time of introduction of complementary food with obesity among 302 healthy Caucasian children 6-7 years old. Binary logistic regression analysis was used to assess the impact of a number of perinatal and socioeconomic confounding factors on the likelihood for overweight and obesity among children. The level of significance was set at p<0.05. Our findings indicate that duration of breastfeeding for at least 3 months, with introduction of complementary food after the age of 6 months have an important role in preventing obesity. This findings are crucial for planning preventive strategies to prevent further increases in the prevalence of overweight and obesity.