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Aim: The aim of the study was to evaluate years of life lost for citizens of the Lodz Province, which is characterized by the lowest life expectancy in Poland, and to identify current trends in this area according to the most common causes of death. Methods: The study material included a database containing information gathered from 470,000 death certificates of Lodz Province inhabitants, who died between 1999 and 2011. In order to calculate years of life lost, the authors applied the SEYLL_p (Standard Expected Years of Life Lost per living person) and SEYLL_d (per death) indices. The analysis of time trends was carried out with the application of joinpoint models. Results: The SEYLL_p measure was 2,300 years per 10,000 males and 1,500 years per 10,000 females in 2011. Cardiovascular diseases contributed to the highest number of years of life lost (SEYLL_p=682 years per 10,000 males and 559 years per 10,000 females). Next were malignant neoplasms (SEYLL_p=505 years per 10,000 males and 437 years per 10,000 females), external causes of death (SEYLL_p=361 years per 10,000 males and 83 years per 10,000 females). The number of years of life lost due to acute myocardial infarction decreased most rapidly, the Annual Percent Change (APC) was -10.1% in males and -3.7% in females. However, heart failure contributed to the highest increase in the number of years of life lost (APC=10.8% in males and 10.9% in females). Conclusions: A further decrease in the mortality rate due to cardiovascular diseases might contribute to the highest reduction of years of life lost. The most effective preventive activities are those aimed at reducing productive years of life lost due to a particular cause of death, i.e. road traffic accidents, suicides, cirrhosis of the liver, alcoholic liver disease, and malignant neoplasms of the trachea, bronchi and lungs.

Aim: Cervical cancer mortality is high in Hungary, with more than 400 deaths per annum. In 2003, a national cervical cancer screening programme was launched to provide screening services for women who otherwise would not use services themselves. The aim of this survey was to study the socioeconomic and lifestyle factors related to participation in the organised cervical cancer screening programme. Methods: A questionnaire-based health survey was conducted using a representative sample of women from 25-65 years of age in 11 Hungarian counties. A logistic regression analysis was used to study the association between participation in the screening programme and socioeconomic and lifestyle factors. Results: 74% (95% CI: 70-77%) of the target population underwent a screening examination within the previous three years. Only 15% (95% CI: 5-35%) of the women, who received an invitation letter and took part in the organised screening programme, had never been previously examined by gynaecologist. The participation rates decreased significantly (p<0.05) for those subjects aged >44 years, retired, participants with low income, living in small settlements, and reported to be heavy smokers. Conclusion: Although the overall proportion of Hungary's population that undergoes regular screening for cervical cancer is not low, the organised national cancer screening programme was ineffective in engaging women not regularly visiting their gynaecologist for examination.

Aim: This study was conducted to determine the breastfeeding and complementary feeding attitudes and practices of women with children aged 12-23 months in three different regions in Turkey. Methods: From 12 geographical regions (Nomenclature of Territorial Units for Statistics - NUTS 1), 3 regions were selected depending on the Turkish Demographic Health Survey 2003 (TDHS) results of nutritional status of children. Then, a weighted, multistage, stratified cluster sampling was used. In total, 1,486 children aged 12-23 months and mother pairs were enrolled. Mothers were face-to-face interviewed with trained health workers to collect information on breastfeeding practices, amount and types of complementary foods introduced and potentially related factors and demographic data filled in a questionnaire. Results: The percentage of ever breastfeeding was 98.7%, no differences were determined among regions for ever breastfeeding (p>0.05). Duration of exclusive breastfeeding was 5.1±2.4 months. The shortest duration of exclusive breastfeeding was found in the good nutritional status region as 4.8±2.4 months (p<0.05). Yogurt, bread, pasta, fruits and vegetables were the foods introduced to the majority of the children. Red meat, poultry and fish were introduced to children in later ages in the low nutritional status region compared to middle and good nutritional status regions. Complementary feeding is introduced earlier than 6 months of age. Conclusions: Raising awareness on appropriate infant and young child feeding practices should be a priority. Enhancing of mothers knowledge, attitudes and practices on breastfeeding and complementary feeding is needed.

Aim: The aim of this study was to assess the orthodontic treatment needs of adolescents in Zagreb, Croatia, in relation to their orthodontic treatment history, caries experience and socio-demographic parameters. Methods: The study sample comprised 1,289 adolescents from 12 randomly selected public schools in Zagreb, Croatia. The subjects were 15-18 years old (mean age 16.3±1.4), and 51% of them were girls. The Dental Aesthetic Index (DAI), the sum of the numbers of decayed, missing and filled teeth (DMFT index), and a questionnaire (covering socio-demographic issues, oral health-related attitudes and behaviours) were employed in this study. The data was analyzed by means of Chi-square test, analysis of variance, and multiple logistic regression models. Results: The DMFT score was higher in adolescents with no orthodontic history (5.2±3.7) than in those who were under orthodontic treatment at the time of the research (4.5±3.2; p=0.043). More than 60% of the adolescents have never undergone any orthodontic treatment, around 24% previously undergone treatment and 15% were under treatment at the time of the research. Overall, 85% of the adolescents' orthodontic appliances were removable, and the girls were more often under orthodontic treatment. One fifth of the studied population had severe or very severe malocclusion. Adolescents with previous orthodontic treatment were more often interested in better teeth alignment, changes in their teeth positioning and continuing orthodontic treatment. Multiple logistic regression model demonstrated that previously treated adolescents, in comparison with their untreated peers, were on average older (p=0.002), were less satisfied with the appearance of their teeth (p=0.001), they had higher malocclusion severity (p=0.046), and fewer dental caries (p<0.001), changed toothbrushes more often (p=0.012), and their mothers attained higher education (p<0.001). Conclusions: Although many adolescents received orthodontic treatment, the severity of their malocclusion was still somewhat high, and they were more often dissatisfied with their treatment outcome. Mothers' educational level was found to be the most important socio-demographic predictor for children's involvement in orthodontic treatment. The caries experience increased in comparison with the Croatian national survey data from 1999.

Aim: Poor eating habits among young adults are a public health concern. This survey examined the eating habits of undergraduate university students in Finland. We assessed students' dietary intake of a variety of food groups, their adherence to international dietary guidelines (whole sample and by gender), and the associations between importance of eating healthy and dietary guidelines adherence (whole sample and by gender). Methods: During the 2013-2014 academic year, 1,189 undergraduate students enrolled at the University of Turku in southwestern Finland completed an online self-administered questionnaire. Students reported their eating habits of 12 food groups, the number of daily servings of fruits/vegetables they consume and how important it is for them to eat healthy. For dietary adherence recommendations, we employed WHO guidelines. Chi-square statistic tested the differences in dietary guidelines adherence between males and females and also the associations between the gradients of importance of healthy eating and the self reported eating habits for each of the food groups, for the whole sample and by gender. Results: We observed high levels of dietary adherence (>70%) for most of the 'unhealthy food' items (cake/cookies, snacks, fast food/canned food, and lemonade/soft drinks), and moderate adherence for most of the 'healthy food' items (>50%) (dairy/dairy products, fruit/vegetables servings/day, fresh fruit, salads/raw vegetables and cereal/cereal products). Fish/seafood, meat/sausage products and cooked vegetables had levels <50% for adherence to the guidelines. Women had better adherence for meat/sausage products, fast food/canned food and for most 'healthy food' items (p≤0.001), whereas men had better adherence for sweets (difference=12.8%, p≤0.001), lemonade/soft drinks (difference=16.7%, p≤0.001) and fish/seafood (difference=6.6%, p=0.040) compared to women. Most students considered important to eat healthy (78.8%). The importance of eating healthy was significantly associated with adherence for all food groups besides sweets and cake/cookies. These associations remained significant for women but some of them not for men (cereal/cereal products, snacks and sweets). Conclusions: The results suggest high adherence to the guidelines mainly for 'unhealthy food' groups, and moderate adherence for healthier food groups. There was also accordance between regarding eating healthy as important and actually eating healthy. However, there are improvements to be considered for specific food groups, as well as gender differences when implementing public health strategies related to food intake.

Objective: This study provides a description and analysis of characteristics of the monitoring system for congenital anomalies at birth and prevalence trends in Latvia using retrospective analysis of congenital anomalies at birth with cross-sectional data on prevalence (national data from Latvia, 2000-2010). Methods: There are three main monitoring systems on congenital anomalies among newborns and infants: the Medical Birth Register with data on live births with one or more congenital anomalies at birth, the Register on Congenital Anomalies with genetically approved cases for live births and the National Causes of Death Register with data on stillbirths. Methodological problems were analysed by calculating different prevalence rates. The main outcome measures are as follows: prevalence rate, live birth prevalence rate, major congenital anomalies live birth prevalence rate, and stillbirth rate. Results: The live birth period prevalence was 319.7/10,000 live births, and the major congenital anomalies live birth prevalence was 211.4/10,000. The period total prevalence rate of births was 323.7/10,000 live births and stillbirths. The stillbirth rate due to congenital anomalies was 6.1/10,000 live and stillbirths. The live birth prevalence with congenital anomalies decreased slightly from the year 2000 to the year 2010. Conclusions: The present system of congenital anomaly registration requires improvements for better completeness. Latvia should use the experience of Nordic countries and introduce a mother's and children's identification number to the Medical Birth Register. It would be helpful to link the information from hospitals and perinatal centres together to validate the congenital anomaly diagnoses of newborns after their discharge from the maternity unit. The monitoring system should also include information on pregnancies with congenital anomalies which do not end in birth, especially terminations of pregnancy.

The 21st-century health landscape is shaped by growing global, regional and local interdependence and an increasingly complex array of interlinking factors that influence health and well-being. Most of today's major public health challenges, including noncommunicable diseases, antimicrobial resistance, health inequalities and the health effects of austerity measures in some countries, cannot be addressed effectively without intersectoral and coordinated action at supranational, national and local levels. The 53 countries of the WHO European Region developed and adopted a European policy framework and strategy for the 21st century (Health 2020) as a common, evidence-informed policy framework to support and encourage coordinated action by policy-makers at all levels and in all sectors to improve population health and well-being. This article presents the development process of Health 2020 and its main strategic goals, objectives and content. Further, we describe what is needed to successfully implement Health 2020 in countries and how can WHO provide technical assistance to countries that embark on developing health policy aligned with the Health 2020 policy framework.

Background: Despite implementation of organised screening programme in 2006/2007, cervical cancer (CC) incidence and mortality in Poland are still higher than the average in the European Union. CC and preceding cervical intraepithelial neoplasia (CIN) caused by human papillomaviruses (HPVs) can be prevented by vaccines which are reimbursed in around 20 European countries but not in Poland. CC and CIN can be also detected with the use of HPV tests which are not included in the Polish screening programme. Reimbursement for HPV vaccines and HPV testing requires cost-effectiveness analyses which include country-specific data on the burden and costs of management of cervical neoplasia. Therefore, we investigated the burden of cervical neoplasia and direct costs associated with its detection and management in Poland in 2012 reimbursed by the National Health Fund (NHF) - the only public healthcare insurance institution. We also report administrative costs of the organised screening programme covered by the Ministry of Health. Methods: Data on the burden and reimbursed costs of organised and opportunistic screening as well as management of cervical neoplasia were drawn from the NHF databases. Numbers of women reported with CIN and CC were ascertained. Results: In 2012, there were 765,266 and 1,288,358 reimbursed Pap smears collected within and outside the organised screening programme, respectively. Expenditures on medical and administrative procedures in organised screening reached PLN (Polish Zloty) 41,470,664 and 12,150,398 respectively. The number of women with particular diagnosis and reimbursement for the management of these lesions were as follows: glandular ectropion 208,033 and PLN 37,349,515; CIN1 10,521 and PLN 6,616,375; CIN2 5,812 and PLN 5,071,155; CIN3 6,487 and PLN 7,611,062; unspecified grade CIN 36,575 and PLN 12,352,034; and CC 33,482 and PLN 52,377,006, respectively. In women with ectropion and CIN the total number of local excision/ablative therapeutic procedures on the cervix reached 47,658 and the total number of hysterectomies was 1,321. Conclusion: In 2012, management of approximately 93 thousand women with HPV-related cervical lesions reimbursed in Poland amounted to PLN 84,027,632 which makes it a considerable public health problem. The number of women managed for glandular ectropion is considerable and related costs are high. Total reimbursement for detection, treatment and follow-up of all cervical lesions reaches at least PLN 137 million annually.

Background: Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians.
Method: The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). Results: Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in their health care institutions, the most important identified by respondents in all localities was a perceived lack of financial support for these institutions.
Conclusions: There is a significant difference in the perception of physicians in private and state health care institutions with regard to financial remuneration as well as availability of laboratory diagnostic and treatment equipment and working conditions. Based on the study findings, possibilities to increase Primary Care financing should be considered in order to improve the quality of the delivery of health care services as well as retain physicians within the health care system. Results of this study demonstrate a need of further research to quantify what could be reasonably expected from diagnostic and investigative resources to support health care in Lithuania in current economic situation.

Background and Aim: Nursing students play a crucial role in sexual health education. Evidence suggests, however, that nursing students had several gaps in their knowledge of HIV transmission. This study investigates how nursing students in Germany assess the potential risks of spreading HIV in defined situations and which factors influence the self-expressed sexual behaviour patterns of these students. Methods: A standardized anonymous questionnaire was administered to a sample (N=617) of nursing students in 2008 and 2013. The survey was conducted during lessons, resulting in a response rate of 100%. Results: For 17.4% of the students, assistance with personal hygiene was associated with higher HIV transmission risk. Also, changing dirty linen (17.6%) and physical examination (14.1%) were also noted similarly risky. The average age of first sexual intercourse was 15.5 years and the number of lifetime sexual partners was 4.3. The higher the average number of lifetime sexual partners, the higher the likelihood to use condoms only sometimes or never (OR 1.11). Forty students reported an unintended pregnancy. The likelihood to be unintentionally pregnant was six times higher among students aged 25 years or older (OR 6.16). Conclusions: The results clearly show that students overestimated HIV transmission risks in most of the situations encountered during health services provided by nurses, but overall sexual health behaviour indicated rather less risky behaviour. Nonetheless, the relatively high rate of unintended pregnancies is quite concerning. The findings underline the need for stronger integration of HIV and sexual education in the curricula of nursing schools in Germany.

Aim: This study presents a comprehensive examination of housing satisfaction in Finland and how it associates with different types of residential area, dwelling and tenure status taking into account socio-demographic and socioeconomic variables. Method: Associations between housing satisfaction and types of residential area, dwelling and tenure status were analysed by multivariate logistic regression using questionnaire data from a random sample of Finnish households (response rate 44%, N=1,308). Results: Respondents from rural areas and those living in houses were statistically significantly (p<0.05) more satisfied with indoor thermal conditions in summer than respondents living in city centres (OR 2.01) and apartments (OR 1.75), respectively. Homeowners were more satisfied with the dwelling (OR 3.19), indoor air quality (OR 1.73) and thermal conditions in winter (OR 2.63), and reported moisture or mould damage (OR 0.37) and neighbour noise disturbance (OR 0.60) less frequently than tenants. Conclusion: Based on this study, the most important factors determining differences in housing satisfaction were tenure status and type of the dwelling. In the context of housing policy development, these results warrant a special consideration of housing quality in rental apartments. The results can also be used for making comparative assessments (e.g. detecting areas of relative strengths or needing improvement) of multifamily buildings and residential areas.

This article investigates elements of tobacco control issues in Romania. Using European Union requirements for tobacco control legislation as a backdrop, it examines the key issues of smuggling, taxation, and unemployment in a transitional economy. Romania has made some progress by adding text and pictorial warnings to cigarette packages and offering comprehensive help to quit smoking. Using empirical examples, it is argued that more progress in tobacco control is needed in the area of increased taxation, enforcement of non-smoking bans, and new legislation requiring advertising bans at point of sale, kiosks, and billboards. This article draws wider public attention to the problems that smuggling and taxation present for tobacco control, helps identify other countries confronting similar issues, and stimulates effective interventions.

Background: Due to the widespread use of bottled water, it is important from a hygienic point of view to ensure that these products have good quality and meet the requirements set out in regulations. Methods and Results: In the period 2000-2013, a large-scale study (2,500 samples) was carried out on the quality of Bulgarian bottled water as per the microbiological parameters laid down in the European and Bulgarian legislation. Standard microbiological methods were applied. Results: There is strong evidence that the most frequently isolated contaminant in these products was Pseudomonas aeruginosa. This agent was found in 274 samples out of a total of 2,500 analysed bottled waters. Because of the absolute prohibition of the presence of this microorganism in the finished product, the manufacturers should not allow their products with compromised quality to reach the market. They are obliged to check the quality of each batch by conducting an internal monitoring of production. When any inconsistencies are established in microbiological parameters, the producers must detect the critical point and apply more effective decontamination measures of the bottling lines. Given the importance of this fact for the health of consumers, the study also included determination of the antimicrobial resistance of P. aeruginosa strains isolated from Bulgarian bottled water. Ten strains of P. aeruginosa, isolated from bottled water and other water habitats in the environment, were tested for the effect of 13 antimicrobial agents by applying the Kirby-Bauer's method. Conclusions: The investigation found that Pseudomonas aeruginosa strains isolated from bottled water are sensitive to Ceftazidime, Amikacin, Ciprofloxacin, and Cefepime and one of them is resistant to Meropenem and Piperacillin. Another important conclusion is that there is no specific behaviour of P. aeruginosa strains originating from different sources to the test antimicrobials. The authors consider that drinking tap water is perhaps a more appropriate way for newborns, infants, elderly, and people with compromised immunity to satisfy thirst than using bottled water.

Aim: Local prevalence estimates of problem drug use (PDU) are crucial in the process of assessment of drug situation and trends and for the planning of evidence-based policy responses. The aims of our study are twofold: to estimate the number of problem drug users (PDUs) in the Czech capital city in 2011, and to examine the usability of the capture-recapture method (CRM) modified for data from low-threshold programmes (LTPs) for drug users. Method: Six independent LTPs provided data for analysis (SANANIM, Drop-in and Progressive, each of these providing one drop-in centre and one outreach programme). After adjustment of the standard CRM formula for cases without an individual identifier, the overlaps between programmes were calculated and the size of hidden population was estimated. Results: In total, it was estimated that there were 10,754 PDUs in Prague in 2011. The current estimate is in line with estimates obtained previously using another indirect standard approach - the multiplier method. Conclusion: The modified version of CRM thus proved a reliable method for local PDU estimates.

Aim: The problem of family care for people dependent on another person has only recently become a focus of research. As demand for health and social services has not been adequately met by public service providers, growing attention has been given to informal care and the integration of families within systems of health and social care at the community level. This paper presents the results of a survey on informal carers' views and opinions under the current conditions of social support in the Czech Republic. The survey was based on theoretical concepts of caring societies, deinstitutionalization, refamilization, and integrated community care, and aimed to shed light on caring families' experiences and needs in the Czech Republic. Methods: Family lay carers completed an original self-administered questionnaire. A convenient sample of 200 family carers was selected. Results: The survey collected information about the most influential factors in determining whether the families continue to provide care for their relatives in the household. More than 50% of the caregivers provide care from moral and emotional reasons. Financial problems, risk of losing their jobs, and further deterioration of health of the person they care for emerged as key risk factors, but overall, determination among carers to continue providing care "at any cost" was high (53%). Conclusions: Involving local communities and services, e.g. general practitioners (GPs) to a greater extent in the coordination of various social and health services, and in support mechanisms at the juncture between informal and formal care would make it easier for family carers to continue providing long-term care.

Aim: According to the World Health Organization, central obesity is increasing alarmingly worldwide. Neck circumference is a relatively new method of differentiating between normal and abnormal fat distribution. The aim of this study is to determine the association between neck circumference and central obesity in young Turkish male and female university students. Methods: A community of university students based cross-sectional study was conducted on 319 males and 838 females and investigated the association between neck circumference and other anthropometric variables by gender. Results: In male subjects, the neck circumference revealed a positive correlation with the body mass index (r=0.684, p<0.01), waist circumference (r=0.686, p<0.01) and waist/hip ratio (r=0.534, p<0.01). Similarly, in female subjects neck circumference revealed a positive correlation with the body mass index (r=0.482, p<0.01), waist circumference (r=0.479, p<0.01) and waist/hip ratio (r=0.246, p<0.01). Conclusion: Our study has demonstrated that the positive correlation between neck circumference, which is a simple and fast anthropometric measurement, and visceral obesity, is also applicable to university students.

Aim: To assess the relationship of children's physical activity and sedentary screen time with overweight and obesity in children living in different environments (town and city) in Lithuania. Methods: An analysis of anthropometric data from 532 children living in town and city areas was performed. A youth physical activity questionnaire (YPAQ) was conducted to evaluate physical activity and sedentary screen time. Results: The prevalence of overweight and obesity among the children was 25.5% in the town and 18.6% in the city. Children living in the town on average engaged 9.3 min/day less in moderate to vigorous physical activity (p=0.050) and had 33.2 MET-min/day lower energy expenditure than children living in the city. Sedentary screen time was extremely high on weekends in both town and city children. Conclusions: A higher prevalence of overweight and obesity and a lower amount of moderate-to-vigorous physical activity was found in children living in the town compared to children living in the city.

Aim: This study aimed to evaluate the prevalence of overweight and obesity derived from measured data of weight and height in a cross-sectional sample of adolescents in the Italian region of Lazio and to analyse their association with different socio-demographic factors. Methods: The study was conducted in a representative sample of 15-16-year-old adolescents recruited in secondary schools between December 2011 and May 2012. 369 adolescents were investigated. Body weight, height and waist circumference were measured. The BMI of each subject was calculated, and the prevalence of overweight and obesity was determined by age and sex using the IOTF reference values and WHO growth standards. Waist circumference/height ratio (WC/Ht) was calculated and the subjects were classified using the cut-off of 0.5: WC/Ht≥0.5 and WC/Ht<0.5. Selected socio-demographic characteristics were assessed via questionnaire. Results: The percentages of overweight and obesity were high, 15.4% and 7.9%, respectively, with significant difference between males and females (19.1% vs. 12.6% for overweight and 11.1% vs. 5.3% for obese) using the IOFT reference. The ratio WC/Ht≥0.5 was observed in 12.7% of the sample (all the obese and 29.8% of the overweight subjects). Multiple logistic regression analysis indicated that gender, school municipality, mother's employment status, and family structure had a significant effect on ponderal status (overweight/obesity vs. normal weight). Conclusion: These findings show a high prevalence of body weight excess associated with socio-demographic factors in the Italian sample investigated, and the need for effective public health interventions to combact obesity with particular attention to disadvantaged adolescents.

Aim: The aim of this observational study was to investigate the intake of dietary fibre and its sources among Polish adolescents according to prevalence of overweight after adjustment for age and gender. Methods: The study sample consisted of 1,565 students, including 48% boys and 52% girls aged 13-18 with normal weight, overweight and obesity. Dietary information was reported using the Block Screening Questionnaire for Fruit/Vegetable/Fibre Intake. The nutritional status was assessed on the basis of body mass and height measurements. The statistical analysis used one-factor logistic regression, multiple linear regression, trend estimation and a comparison of mean values. Results: Adolescents consuming white bread and rolls with a frequency ≥4 times/week had OR=0.74 (95% CI 0.56-0.97) for overweight and obesity compared to adolescents with less frequent consumption. For other fibre sources and overall dietary fibre no significant differences were noted in consumption frequency between adolescents with normal weight and overweight/obesity. Overall, boys were more often overweight and obese than girls. Girls had a higher intake of dietary fibre, fruit, fresh vegetables, dark bread and rolls, and lower intake of potatoes, beans and white bread and rolls than boys. Older age was associated with a decrease in the consumption of fruit juices, fruit, potatoes, white bread and rolls, and dietary fibre in girls and a decrease in fruit and fresh vegetable consumption in boys. Conclusion: The intake of dietary fibre was not associated with the prevalence of overweight. As to the fibre sources, only a higher consumption of white bread and rolls decreased the chance of the occurrence of adolescent overweight. The consumption of dietary fibre and its sources was related to the age and gender of adolescents.

Background: The introduction of the surveillance of invasive pneumococcal diseases (IPD) in 2007 has helped to monitor changes in serotype occurrence in the Czech population and assess the impact of routine immunisation against IPD on the child population under 5 years of age. Methods: Observational study of childhood IPD in the Czech Republic based on the state public health surveillance data comparing pre-immunisation (2007-2008) and post-immunisation (2012-2013) periods. Results: In the child population there was an overall decline in IPD occurrence of 46.6% (95% CI 63.4-21.9) observed during the post-immunisation period. There was even greater decrease of 71.6% (95% CI 50.4-83.8) in vaccinated children. In the post-immunisation period, Prevenar 13 (PCV13) and Synflorix (PCV10) contributed to a vaccine-type IPD reduction of 95.4% (95% CI 67.0-99.4) and 76.9% (95% CI 36.0-91.7), respectively, compared to unimmunised children. The occurrence of 10 serotypes contained in both commercial vaccines also decreased in unvaccinated children by 61.4% (95% CI 14.5-82.6). However, a rise in the risk of non-vaccine and unspecified serotype acquisition by up to 153% was revealed in unimmunised children when comparing post-immunisation and pre-immunisation periods. Conclusions: The findings suggest a shift in IPD caused either by vaccine or non-vaccine serotypes between immunised and unimmunised populations of children, which could result in increased incidence of IPD caused by non-vaccine serotypes. Therefore, routine immunisation using only one vaccine with broader serotype coverage together with a higher vaccination rate could raise hopes of further decrease in IPD in the child population.

The International Classification of Functioning, Disability and Health (ICF) is a common language for different professions in the health, social, educational and vocational systems for lawyers, decision makers and politicians. It deals with how to describe health conditions, functional health and disability. It gives detailed operational definitions of different functions that constitute health. From body function and body structure to activities of daily living and participation in society. ICF has brought international consensus on definitions and provided a framework to describe public health and disability.

This special issue of the CEJPH focuses on air pollution and its public health effects. Despite the fact that the body of knowledge of possible health effects of air pollutants is growing over the last two decades, mainly as a result of multiple epidemiological studies conducted all over the world, many questions still remain unanswered. As the air pollution in the Silesian part of the Czech Republic, and in the Ostrava Region in particular, is a significant environmental phenomenon in Europe, the data on pollution exposure, types, and health effects at various levels could be an important contribution to the body of evidence on this (sometimes) seemingly local issue. Although this is one of the most polluted areas of Europe, apart from the conclusions of the Silesia Project (with the participation of the US EPA) and Caesar Project (with the participation of the WHO) from the 1990s, only a few studies addressing some aspects of air pollution appeared. To collect all available and credible data on air quality in this region and related impacts on human health and to submit them to the reader in a single issue (this issue contains three review articles) was the first reason for publishing this special issue.

Aim: This retrospective study was designed to analyze expression patterns of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu in Albanian patients with breast carcinoma to identify their relationships with tumor size, histological grade (HG), lymph node metastasis and relapse. Methods: Patients with either biopsy or metastatic relapse were identified. Demographics, tumor characteristics, ER, PR, and HER2/neu status were retrospectively obtained from the medical records of patients treated with breast cancer during 2006-2011. Hormonal receptors and HER2/neu were assessed by immunohistochemistry. Association of ER, PR and HER2/neu with clinicopathological and molecular characteristics were studied using Fisher's test. P value ≤0.05 was considered significant. Results: There were 110 patients included in the study. Mean patient age was 51.08±10.75 years. The overall immunoexpression of ER, PR and HER2/neu were found positive in 76 (69%), 73 (67%), and 16 (41%) patients, respectively. ER- was associated with higher histological grade (24% vs. 9.2%) and PR+ with tumor size (T2, 78.3 vs. 64.3) (p=0.02 and 0.05, respectively). ER and PR expression were significantly decreased in HER2/neu positive cases while HER2/neu levels correlated with tumor size (p=0.03) and nodal metastasis (p=0.03). No association was detected between ER, PR, HER2/neu and relapse. Conclusion: A combination of ER, PR and HER2/neu and prognostic factors could be of clinical value by defining subgroups in Albanian breast cancer patients that might benefit from more aggressive treatment.

Aim: Alcohol consumption among adolescents is a serious public health problem in South Korea. Our study examined the relationship between alcohol consumption and academic achievement in Korean adolescents. In 2011, 75,643 students from seventh to twelfth grade participated in the Seventh Korea Youth Risk Behaviour Web-based Survey (KYRBWS-VII). Method: We performed multivariate logistic regression analysis to examine the associations between alcohol consumption, frequency of severe alcohol intoxication, and academic achievement for both girls and boys. Results: Compared to non-drinkers, the odds of achieving average or higher academic performance significantly decreased for both boys and girls with increasing number of days per month with reported alcohol consumption (p≤0.008). Further, odds of achieving average or higher academic performance significantly decreased with increasing amounts of alcohol consumed compared to non-drinkers (p≤0.026). Additionally, the odds of achieving average or higher academic performance according to the frequency of severe alcohol intoxication were only significantly decreased for 1-2 days per month of severe intoxication (p<0.001). Conclusion: Both boys and girls with increased alcohol consumption and frequency of severe alcohol intoxication had below average academic achievement in Korea. To improve academic achievement, we recommend interventions that reduce alcohol consumption among adolescents.

Aim: The aim of the study was to determine the reliability and validity of the agreement between the Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) in classifying asthma control in the Czech Republic. Methods: A sample of 316 people with asthma was recruited from the Clinic of Tuberculosis and Respiratory Diseases of the University Hospital in Ostrava between November 2011 and July 2012. Two questionnaires were used in this study, the Asthma Control Test and Mini Asthma Quality of Life Questionnaire (Mini-AQLQ). Regardless of the questionnaire results the asthma specialist assessed the asthma control status of enlisted patients according to the criteria described in the GINA 2006 guidelines. Results: The internal consistency of the five-item ACT was good. The ACT score of ≥20 predicted GINA-defined controlled asthma in 29% of cases with a sensitivity of 65% and specificity of 89%. The kappa level of agreement between the ACT classification and GINA classification of asthma control was 0.29, suggesting fair agreement. The ACT score showed the strongest correlation with the specialists' rating, followed by the FEV₁ percent predicted. Overall, in line with previous studies we confirmed significant relationship between the ACT scores and FEV₁ and health related quality of life. Conclusions: ACT is a reliable and simple tool that might be a significant asset in the management of outpatients with asthma in the Czech Republic. The ACT score correlates well with lung function parameters and health related quality of life. It appears to be a good tool to predict GINA-defined 'not-controlled asthma'.

Aim: The aim of the study is to investigate the relationship between sickness presence and stressful life events among health care workers. Methods: Data were gathered from all health care workers at the University Medical Centre Ljubljana employed there in the period between 1 January 2010 and 31 December 2010. Each employee obtained a questionnaire composed of two standardized international questionnaires. Results: There were 57% of sickness present health care workers among the participants. The sickness present reported to have more diseases of family member than the non-sickness present (OR=1.5; 95% CI=1.2-2.0), loan (OR=1.4; 95% CI=1.1-1.6), their partner lost job (OR=1.4; 95% CI=1.0-1.8), or they changed the place of living (OR=1.4; 95% CI=1.0-2.0). Conclusions: The results of the study indicate that stressful life events with economic consequences might have an important influence on sickness presence.

Aim: Breastfeeding is universally accepted as the optimal way to nourish infants. There is evidence that socio-demographic factors, including immigrant status, are related to infant feeding practices. The aim of the present study was to identify the factors which are associated with breastfeeding initiation and duration, with special focus on the role of immigrant status of the mother in breastfeeding practice. A sample of mothers giving birth and living in Athens, Greece, was investigated. Methods: 428 mothers (438 infants) were recruited in the maternity ward of a Tertiary University Hospital, and were interviewed using a structured questionnaire. Monthly telephone interviews were subsequently conducted until the sixth postpartum month. Multivariate logistic regression models were used to quantify the association of socio-demographic parameters with breastfeeding initiation. Cox regression analysis was employed to assess related factors that might influence breastfeeding duration. Results: Being an immigrant was positively associated with exclusive as well as partial breastfeeding initiation (OR 7.97, 95% CI 1.02-62.19). Immigrant mothers were also 0.35 times less likely (95% CI 0.21-0.58) to stop breastfeeding earlier, compared to the native ones. Several other factors were deemed important either for breastfeeding initiation or its duration but not for both aspects of breastfeeding practice. Conclusion: Maternal immigrant status was found to be consistently associated with breastfeeding initiation and duration in this study sample. Health professionals, health policy makers and politicians should remain attuned to the cultural backgrounds which have created strong breastfeeding traditions, to further promote breastfeeding practice in Western countries.

Aim: Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The aim of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes). Methods: We have investigated 24 hours urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control. Results: Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (p<0.001, p=0.002, p=0.002, and p=0.005, respectively). The differences remained significant after adjustment to hypertension, dyslipidemia, age, and BMI. No difference was found between either the hypertensive and non-hypertensive or dyslipidemic and non-dyslipidemic patients. There was no significant relation of bisphenol A level to diabetes, hypertension, dyslipidemia, age, and BMI. Conclusions: Urine levels of four phthalate metabolites were significantly higher in type 2 diabetics independently on specified predictors. Phthalate levels can be in relation to beta cell dysfunction in type 2 diabetic patients but this study was not able to show if the relation is causal.

Aim: The Czech Republic is one of the leading European countries in incident cases of malignant melanoma (MM), which is on the rise. The study objective was to assess the strength of associations between MM and the known generally accepted risk factors for MM in the population of the Czech Republic. Methods: The study was designed as a case-control study where cases were incident cases of MM detected at the Department of Dermatology and Venereology of the Bulovka Hospital. Controls were selected from cancer-free patients admitted to departments other than Dermatology and Venereology. Validated questionnaires were used to collect demographic, epidemiological, and clinical data. Results: The binary logistic model shows the main risk factors for MM: male, female (OR=0.292, 95% CI=0.175-0.486), a changed mole (OR=6.371, 95% CI=3.774-10.756), a history of skin cancer (OR=95.704, 95% CI=37.241-10.756), and sunbeds use (OR=3.594, 95% CI=1.288-10.028). Using sunscreen products was considered as a protective factor against MM (OR=0.253, 95% CI=0.137-0.466). Conclusion: The primary and secondary prevention increasingly emerges as a public health priority in the effort to reverse the negative trend in cases of MM and mortality from this disease in the Czech Republic. A prerequisite for an effective secondary prevention through screening is, among others, the identification of the population groups at highest risk for MM.