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The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.

Objective: The aim of this study was to determine prevalence of problematic eating behaviour (PEB), associated risk factors, feeding practices including place of meal, variety of diet, and habits of consuming junk food, the mothers' perception of the child growth status in comparison to his/her peers, and the effects on anthropometric measurements. Methods: This study was carried out among children aged 12-72 months who attended the outpatient clinic in the Ihsan Dogramaci Children's Hospital between February-June 2007. Three hundred and thirty-one mothers of children were asked to complete an extensive questionnaire covering socio-demographic characteristics and their child's general eating behaviour and feeding practices at mealtimes. Children with PEB were identified based on their mothers' statements. Results: Three hundred and thirty-one cases were 3.32±1.39 years old. One hundred thirty-five mothers reported having a child with PEB. The mothers described the children's problematic behaviour as: need to walk around with the child during mealtime (45.6%), watching TV during meals (41.9%), picky or fussy eating (39%), vomiting and/or retching (25.7%), retaining food in the mouth for a long time (20.6%), and not eating solid foods (11.8%). In children who had ate neither meat nor vegetables and fruits, took cod-liver oil-containing supplement during the course of the study, and had taken iron supplements in the first year of life, PEB was more frequent than in others. The mean z scores of weight for age (WAZ) were significantly lower in cases with PEB than without PEB. Discussion: Counselling and supporting of the mother/caregiver could alleviate the effect of inappropriate solutions taken by families. Insistence on composing of the diet variety including especially vegetables, fruits and meat may be promoted by provision of alternative cooking/presentation samples to mothers of children who refuse some foods. Pediatricians should be alerted that lower WAZ values may be a warning indicating a problem which may cause stagnated growth in children with PEB.

This article informs about recent research findings on voluntary and mutual aid in the Czech Republic with a special attention paid to formal volunteering in health and social care. The data suggest that public involvement is comparable to middle-frequency experienced in European countries. In this respect, volunteering is higher in the Czech Republic than in other former Eastern European countries and is an evidence of a successful and rapid restoration of the civic sector. New patterns of volunteering featured by planning, coordination, and contracting have spread out being strongly supported by national and EU policy measures. Managerial patterns of volunteering are dominating in health and social care institutions. Volunteering in health and social care is firmly motivated by emotional altruism; however, reciprocal (instrumental) and normative motivations are also present, though to a lesser extent compared to other sectors of volunteer activities. In the managerial pattern of volunteering altruism is balanced with personal gains and benefits for those who volunteer. Volunteering is deeply embedded in a civic, humanitarian paradigm instead of a religious faith and duty.

Backround: It is generally accepted that living in families where there are smokers, children are stressed not only by the harmful physical exposure to second-hand and third-hand tobacco smoke, but also by the negative models of the adult relatives' behaviour, as relatives who smoke can inspire children to imitate this behaviour, influencing attitudes towards, and early experiments with smoking. In this paper, some of the most important results about influence of family smoking on the effects of the anti-smoking educational programme "Non-smoking Is Normal" are described. Methods: The school-based programme was created by medical and educational specialists and targets children at the first level of primary schools (aged from 6 to 11 years). The data about interesting outcomes of the programme (knowledge, attitudes, behaviour) were collected by anonymous questionnaire, administered twice in each school year: one month before the complex of 5 lectures (pre-tests) and 4-5 months after the last lecture (post-tests). The sample of participants (860-910) was divided into four groups, according to the intervention and family backrounds: (1) programme children from smoking families "P-S"; (2) control children from smoking families "C-S"; (3) programme children from non-smoking families "P-NS"; (4) control children from non-smoking families "C-NS". The differences in the frequency of children's answers were analysed using the tests in statistic Epi Info software, version 6.04a (chi-square, Mantel Haenszel, Yates, Fisher). Results: In the programme group, the number of children with smoking relatives was significantly higher than in the control group (80.1% vs. 73.0%, p<0.01) as well as of those who reported frequent/daily exposure to secondhand smoke at homes and/or in cars (49.5% vs. 40.0%, p<0.01). Smoking families significantly influenced the children's seeking of smoking friends (40% vs. 17%, p<0.01). The programme has significantly increased the amount of knowledge about health risks of smoking. Both in the programme and control groups of children from non-smoking families, the frequency of critics of adults smoking was significantly higher all the time of the study (p<0.05 and 0.01 resp.); however, the programme influenced children's opinions about smoking (criticism) only partially. Children's actual intentions about their smoking in the future was fully influenced by their smoking household environment: the number of "future no-smokers" has decreased in time and was significantly less frequent among children from smoking families (p<0.01). The frequency of those willing to smoke significantly increased within the period between 3rd and 5th grades, both in the programme and the control groups (p<0.01). An almost linear increase of active experimentations with cigarette smoking in follow-up monitoring was seen, trends of smoking children were steeper in groups from smoking families. The number of experiments with smoking was significantly lower in programme children of non-smoking parents only at the end of the study (p<0.05). Conclusions: Despite of the effort to initiate parental participation on the primary prevention of smoking, we have confirmed that smoking in families decreased the efficacy of anti-smoking intervention

For several years, some of the countries of the former Soviet Union have experienced the fastest growing HIV epidemic in the world, with the vast majority of reported infections contracted through injecting drug use. However, most governments of the region have been slow to recognize the severity of the problem. The scope and coverage of governmental HIV/AIDS programmes have remained very limited. Harm reduction programmes are mainly financed by external donors, while substitution treatment remains illegal in Russia and unavailable in some other countries of the region. Being based on a review of published and grey literature, this paper explores attitudinal and societal barriers to scaling up HIV programmes in the countries of the former Soviet Union. A major challenge in many countries is negative public attitudes towards people living with HIV, as well as towards those most at risk of contracting the disease: injecting drug users, sex workers, and men who have sex with men. This extends to the actions of state authorities which often pursue a punitive approach to drug users, with high rates of incarceration for minor drug offences. While many of the findings reported here relate to the Russian Federation, there is reason to believe that similar challenges exist in many other countries of the former Soviet Union. More needs to be done to document challenges to HIV prevention and treatment programmes across the region, so that policy interventions can be more effective.

Objectives: Organizations engaged in drug addiction treatment started their activities only recently in Hungary. This paper examines the organisational environment in drug outpatient treatment using the example of Blue Point Foundation (BPF), a non-governmental organization (NGO). The authors describe BPF's organizational structure and functioning related to its effectiveness. Methods: BPF staff members anonymously completed a 59-item questionnaire about its organizational characteristics and functioning. The questionnaire covered demographic data, 50 items of the Quality Control questionnaire and a SWOT (Strengths, Weakness, Opportunities, Threats) analysis. Results: Policy and strategy were considered BPF's best feature, while the management of funds received the lowest rating. The assessment of the staff and that of the organization as a whole was closer to the midpoint of the scale. Discussion: High risk of staff burnout and unstable organizational environment are the most important threats on the NGOs working in addictology in Hungary.

Aim: The aim of this study is to identify and evaluate problems in regional tuberculosis control studies, using an international tuberculosis indicator. Methods: In this retrospective cohort study, the records of a total of 1,776 patients diagnosed with tuberculosis, followed up and treated from 2004-2008 in Mersin were evaluated. Indicators recommended by the World Health Organization were used as assessment criteria. Descriptive statistics were used to summarize data. The Mantel-Haenszel test was used for calculation of the risk between urban/rural, and between male/female which were in different age groups. Results: During the five year period, new case notification rates were reduced and tuberculosis risk shifted to advanced age groups in our region. Tuberculosis development risk increased two-fold among males (p<0.001). One-fifth of the tuberculosis cases had been diagnosed without sputum smears. Sputum microscopy was not done at the end of the initial phase in one-fifth of patients. During the five-year follow-up period, tuberculosis treatment success rate increased from 83% to 91% and cure rate increased from 49% to 67%. The death rate, treatment failure rate, default rate, and transmission rate decreased, and the directly observed treatment implementation increased. Conclusion: Improvements were seen in diagnosis and treatment indicators beginning from 2006; the year when the directly supervised treatment application started. However, use of sputum smear microscopy is inadequate for the diagnosis and treatment of tuberculosis. Tuberculosis control studies should be monitored and evaluated using a tuberculosis indicator.

Objective: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Turkey in 2003 and 2009 to examine changes in tobacco use and important tobacco control measures. Methods: The GYTS were conducted in grades 7-9 in 2003 and 7-10 in 2009 in Turkey. Data in this paper are limited to 13 to 15 year old students. A total of 15,957 students from 202 schools participated in 2003 and 5,054 students from 69 schools participated in 2009. The overall response rate was 92.1% in 2003 and 87.5% in 2009. Results: Between 2003 and 2009 current cigarette smoking did not change significantly for either boys (9.4% to 10.2%) or girls (3.5% to 5.3%). Current cigarette smoking was higher among boys than girls in 2003 and in 2009. In 2009, half of students reported they had been exposed to second hand smoking (SHS) at home and 80% reported they had been exposed to SHS in public places. Three in ten students reported they had been exposed to pro-tobacco advertising in newspapers or magazines; one in ten had an object with a cigarette brand logo on it; and 7% had been offered free cigarettes by a cigarette company representative. Two-thirds of current cigarette smokers reported that they wanted to stop smoking; and almost two-thirds had been taught in school in the past year about the dangers of smoking. Conclusion: Passing and implementing the Law No. 4207 on Prevention of Hazards of Tobacco Products, ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), raising tax on tobacco, and requiring pictorial warning labels were important steps forward for tobacco control in Turkey. However, as to the tobacco control much work yet to be accomplished including developing an effective enforcement plan for all tobacco control efforts.

Introduction: General physicians (GP) play a key role in providing appropriate care for people with dementia. It is important to understand their workload and opinions regarding areas for improvement. Material and Methods: A group of 1,109 GPs working in Mecklenburg-Western Pomerania, Germany (1.633 million inhabitants), were identified, contacted and asked to participate in a written survey. The survey addressed five main topics: (a) the GP, (b) the GP's practice, (c) the treatment of dementia, (d) personal views, attitudes and specific competences regarding dementia and (e) the GP's recommendations for improving dementia-related health care. Results: The survey response rate was 31%. In total, the responding GPs estimated that they provided care to 12,587 patients with dementia every quarter year. The GPs also reported their opinions about screening instruments, treatment and recommendations for better care of dementia patients. Only 10% of them do not use screening instruments, one third felt competent in their care for patients with dementia and 54% opt for transfer of patients to a specialist for further neuropsychological testing. Conclusions: Four conclusions from this study are the following: (a) dementia care is a relevant and prevalent topic for GPs, (b) systematic screening instruments are widely used, but treatment is guided mostly by clinical experience, (c) attitudes towards caring for people with dementia are positive, and (d) GPs recommend spending a lot more time with patients and caregivers and provision of better support in social participation. A majority of GPs recommend abolishing "Budgetierung", a healthcare budgeting system in the statutory health insurance programmes.

Background: Road traffic injury patients admitted to 35 hospitals in Lublin region. Objective: To describe the pattern of road traffic injuries in Lublin county, Poland. Methods: Review of medical records for the period from January 2004 to December 2005. Results: Pedestrians accounted for the largest share of the Road traffic crash (RTC) injury cases (35.8%) and 46.4% of deaths. The highest mortality was observed in motorcycle occupants (7.1%) and victims with abdominal injuries (9.8%). Vulnerable road users represented 71.4% of all RTC deaths, with mortality 5.8%. Early transfers accounted for 82.5% of cases. Mortality in early transfers is 4 times higher than in late transfers. Conclusions: Poland ranks as one of the worst European countries in terms of severity and fatal outcomes of road traffic injuries. Groups of road users in Poland at the highest risk are pedestrians, cyclists, children and young male drivers. The highest mortality rate occurs among road users affected by multiple trauma and head/vertebral column injuries. Alleviation of consequences of road traffic injuries in Poland may be achieved by coordinated efforts and collective responsibility of government, central level agencies, rescue team members and community groups.

Introduction and Aims: It is beyond any doubt that nicotine yield in cigarettes as determined using standard ISO method bears almost no relation to smokers' actual intake. However, the ISO method is still in use in many countries where the government is responsible for controlling and monitoring cigarette quality. The aim of the study was to measure the nicotine yield in single cigarettes and to evaluate their statistical distribution among the same brand. Materials and methods: Nicotine yields were measured according to the ISO method in single cigarettes of the twenty most popular Polish brands of cigarettes. Results: Relative standard deviation of nicotine yields in single cigarettes of the same brands varied from 16% to 34%. Relative differences between nicotine yields in a single cigarette of a particular brand and the mean value varied from -65% to +76%. Discussion and Conclusions: The results indicate high variation in nicotine yields between cigarettes of the same brand. Such variation might affect compensatory smoking. This provides another reason why yields estimated using the standard ISO method are potentially misleading to smokers. Further studies are needed to better understand the implications of within-brand variability in yields for tobacco product regulation.

The authors investigated the relationship between household environmental tobacco smoke (ETS) exposure and prevalence of respiratory symptoms and diseases as well as absenteeism related to respiratory illness in schoolchildren. The study sample consisted of 1,074 children aged 7-11 years from three primary schools in Niš (Serbia). ETS exposure was associated with wheezing (OR=1.48; 1.09-2.01), bronchitis (OR=1.66; 1.23-2.23), headache (OR=1.45; 1.08-1.95), and fatigue (OR=1.38; 1.02-1.85) in exposed children. The other risk factors with possible influences weren't assessed. There was no statistically significant difference in the number of physicians' visits as well as in absenteeism from school due to illness in children exposed to ETS in comparison to non exposed children. The tobacco smoke effect on children is an essential and urgent problem with life lasting negative health effects which are preventable.

The population of the Region (Central Europe, Eastern Europe, and Israel) is ageing, necessitating preventative programmes to maintain a healthy and active lifestyle in older age groups. Invasive pneumococcal disease (including bacteremic pneumonia, bacteremia without a focus, and meningitis) has higher incidence, morbidity and mortality in older adults and is a substantial public health burden in the ageing population. Surveillance in the Region establishes a significant burden in older adults of invasive pneumococcal disease (IPD), which still appears to be under-estimated as compared with other countries, and this warrants an improvement in surveillance systems. The largest proportion of IPD in adults is bacteremic pneumonia. Community-acquired pneumonia (CAP), largely attributable to S. pneumoniae, can be bacteremic or non-bacteremic; the non-bacteremic forms of CAP also represent a significant burden in the Region. The burden of pneumococcal disease can be reduced with programmes of effective vaccination. Recommendations on pneumococcal vaccination in adults vary widely across the Region. The main barrier to implementation of vaccination programmes is low awareness among healthcare professionals on serious heatlh consequences of adult pneumococcal disease and of vaccination options. The Expert Panel calls on healthcare providers in the Region to improve pneumococcal surveillance, optimize and disseminate recommendations for adult vaccination, and support awareness and education programmes about adult pneumococcal disease.

Objectives: The purpose of this study was to assess gender differences regarding perceptions of smoking between Romanian non-smoking boys and girls, to facilitate the development of effective smoking prevention programmes. Methods: Cross-sectional data were obtained in 2006 by means of written questionnaires among 981 non-smoking school students aged 13-14 years from Cluj-Napoca, Romania. Results: The results reveal that girls were more convinced than boys that smoking would result in several positive outcomes such as helping them getting more attention and becoming easier part of the crowd. Moreover, girls declared lower self-efficacy in refraining from smoking when friends smoke or offer them a cigarette. Parental norms regarding smoking seem to be less restrictive for boys than for girls. Conclusions: The gender differences found in our study do not warrant specific smoking prevention programmes for boys and girls, but it is advisable to include gender-specific issues in prevention activities targeting Romanian adolescents aged 13-14 years.

Background: In 2007 the European Commission issued the White Paper: "Together for Health". Considered the EU Health Strategy for the years 2008-2013, it offers the cornerstones for setting priorities in EU health actions. Objectives: The public health framework offered in this strategy is explicitly built on shared values - including the overarching values of universality, access to good quality care, equity and solidarity that reacted to certain health care challenges within the EU. This article analyses the Health Strategy via its ethical scope and considers implications for future health policy making. Methods: The Health Strategy and related documents are scrutinised to explore how the mentioned values are defined and enfolded. Additionally, scientific databases are searched for critical discussions of the value base of the Health Strategy. The results are discussed and reasoned from a public health ethical perspective. Results: The Health Strategy is barely documented and discussed in the scientific literature. Furthermore, no attention was given to the value base of the Health Strategy. Our analysis shows that the mentioned values are particularly focussed on health care in general rather than on public health in particular. Besides this, the given values of the Health Strategy are redundant. Conclusions: An additional consideration of consequentialist public health ethics values would normatively strengthen a population-based health approach of EU health policy making.

Background: Social influences are among the most important factors associated with children's and adolescents' smoking. Social norms in families, peer groups, professional and municipal communities influence the individuals ones by the process of socialization obtained mainly by interactions and observations. Especially social context of the home environment expressed by household smoking restriction serves as a socialization mechanism that dissuades from the using of tobacco. Parental anti-smoking socialization practices (their attitudes and knowledge about children smoking, discussion about smoking in appropriate quality and frequency, smoking environment in homes) are influenced by their education and family status. Methods: Markers of social environment (the level of mothers' and fathers' education, family status) were investigated during interview with 5th graders included in the cohort participating in the programme "Non-smoking Is Normal". Data about the self-reported exposure to passive smoking at homes and cars were taken into consideration. Information about discussions with parents about smoking, opinions about adults smoking, experimentation with smoking, and concurrent decision about smoking in the future were obtained from 766 children aged 11 years. Those who did not know parental education or family status were excluded from the evaluation. Differences were evaluated using the chi-square, Mantel-Haenszel, Fisher and Yates corrected tests in the statistic software Epi Info, version 6. Results: The level of mothers' and fathers' education significantly influenced the exposure of children to passive smoking. Compared to families of higher educated parents, children living in families with middle and low levels of parents' education were significantly more exposed to environmental tobacco smoke at home and in car (RR 1.38; 95% CI 1.04-1.83) and fewer of them live in non-smoking environments. In the whole cohort, 67.5% children have not smoked even one puff yet, 17.2% reported one single attempt, and 15.4% smoked repeatedly. The level of parents' education had no influence on children's concurrent smoking experimentation or on their concurrent decision about smoking in the future. There was also no difference in number of children who obtained cigarettes from their parents and parents' level of education (about 6%). When the level of maternal education was combined with the family status, significant differences were found. Compared to children living with two biological parents (highly educated mother), children from other groups more often reported current experimentating with smoking and lower number of those decided not to smoke in the future. No significant differences were found in other markers of knowledge and attitudes between children from analysed social family groups. Conclusion: In our study, the parental education has significantly influenced exposure of children to passive smoking at homes and in cars, but had no effect on children's opinions and attitudes about smoking. Higher education of mothers and family status significantly lowered the frequency of current experimentation and decision about future smoking among children living in families with two biological parents of whom mother attained higher education. It is

Varicella is a mandatory reportable disease in Slovenia but it is not notifiable in most European countries. The aim of the study was to explore the completeness of mandatory varicella reporting in Slovenia. Data were extracted from three electronic datasets, including: mandatory notifiable communicable diseases dataset (SURVIVAL), health statistics dataset - consultations in primary care (ZUBSTAT), and health statistics dataset - hospitalizations (BOLOB). Age- and sex-specific reporting rates were compared during the period 1997-2006. During the ten-year period studied 168,089 cases were recorded via ZUBSTAT, and 128,222 cases by SURVIVAL. On average 76.2% (range: 62.9%-94.9%) were notified. In both datasets, the notified incidence of varicella was highest for preschool children, with a downward shift in age at contracting varicella. The percentage of notified cases decreased with increasing age. The number of hospitalized cases was low for BOLOB and SURVIVAL. On average 74% of hospitalized cases were reported. The mandatory notification system in Slovenia provides enough information to survey age/sex-specific varicella trends in the prevaccine era.

There is an increasing interest in the use of hospital admission for Chronic obstructive pulmonary disease (COPD) in studies of short-term exposure effects attributed to air pollutants. However, little is known about the effect of air pollutants on COPD symptoms. This study was undertaken to determine whether there was an association between air pollutant levels and both hospital admissions and symptoms for COPD. For model comparison, we present Generalized Linear Model, Generalized Additive Model and a general approach for Bayesian inference via Markov chain Monte Carlo in generalized additive model. Furthermore, for comparing the predictive accuracy, Artificial Neural Networks (ANN) approach is given.

The Roma are the most populous marginalised community in Europe and have some of the greatest health needs. There is a higher prevalence of communicable and non-communicable diseases within the community and significantly shorter life expectancies than national averages. Efforts by governments across Europe to address these health inequalities have been relatively weak and the Roma suffer poorer access to health care, education and employment in every country that they inhabit in comparison to the majority population. As the socioeconomic determinants of health become better understood over the past decade, it is becoming clear that societies with greater inequalities are less healthy overall. It is important for public health across Central and Eastern Europe that the health needs of the Roma are prioritised by governments concerned. We provide a review of the literature on the health inequalities of the Roma community in Europe.

After 1970 the preexisting gap in population health between democratic Europe and communist countries became even more prominent. While in the democratic Europe there was a progressive rise in life expectancy associated with the decline in ischaemic heart disease (IHD), the trend on the other side of the iron curtain was exactly reverse. After the fall of communism in 1989 population health in the post-communist central Europe (CE) rapidly signalled a favourable recovery. This biphasic trend in post-communist countries is very remarkable. Most remarkably the decline in IHD mortality started soon after the demise of totality, even before the modernization of health care (new more effective medications and diagnostic technology), public campaign against smoking and improved supply of protective nutrients got chance to attain an important role. The decades-long psychosocial depression of communism was rapidly replaced with a promise of a better future. It is generally accepted that psychosocial factors are powerfool tools in the pathogenesis of IHD.

Smoking is the most preventable cause of death worldwide. The regularity of visits of patients to dental offices offers a valuable contact for health professionals and the healthcare system to initiate anti-smoking activity. However, these contacts remain unutilized and there is little interaction between doctor and patient with regard to prevention of smoking and its consequences. The aim of this study was to evaluate the current situation and attitudes towards smoking and giving up smoking among dental professionals. A survey was carried out in the sample consisting in total of 342 participants, 212 students of dentistry and 130 dentists. Students were asked to complete a questionaire during the enrolment period; dentists were asked to complete the questionnaire while attending an annual compulsory in-service training course at the University of Szeged. The data were analysed statistically using SPSS 10.0 software, significance was tested using the Mann-Whitney U test and results were compared with data from a similar study conducted by the same research group in 2004 in which general knowledge and attitude towards smoking and giving up smoking was measured and evaluated. Results demonstrated that there is a lower number of smokers among dental professionals (dentists: 22.3%; students: 20.3%) than in the Hungarian general population and high interest in encouraging and assisting patients in giving up smoking (dentists: 45%; students: 54%). Comparing the results of this study to earlier data collated in 2004, we find a decreasing ratio of smokers among students (34% in 2004 and 20.3% in 2011). An increasing need for information about smoking cessation, tobacco related health hazards and the lack of detailed knowledge about methods and patient education were identified.

This study, aimed at the primary prevention of smoking behaviour in children and adolescents, attempts to find the main factors that distinguish smokers and non-smokers in the period of their first experimentation with cigarettes. There are only a few studies dealing with investigations into current motivations of teenagers as to whether or not to smoke. The programme entitled "Normal is not to smoke", using evaluation questionnaires given to children in the 3rd and 5th classes, also contains - among many other things - specifics on reasons children have for making the decision whether to become a smoker or non-smoker. The results are reported in this paper. Methodology: Responses concerning potential inclination to smoking that were collected from children on the basis of questionnaires were categorized into the following groups: image, the influence of a role model, the effects of smoking, curiosity. Reasons for non-smoking were categorized into the following groups: health, aesthetic, economic, restrictive, other aspects. Children were also asked to describe smokers by using three pairs of opposite characteristics: education, success, wealth. The frequencies of answers were analysed for the whole set, for boys and girls and for children with different smoking behaviour; the differences were evaluated using the statistical programme EPI INFO, version 6. Results: A total of 1153 children in the 3rd class and 799 children in the 5th class completed the questionnaire. Motivations for smoking were given by nearly 17% of children in the 3rd class and by nearly 27% of the same cohort in the 5th class. Aspects such as image (41.9% vs. 46.2%) were mentioned most frequently, by boys more frequently than by girls (OR 1.77; 95% CI 0.93-3.36; p=0.06), by children from smokers' families more frequently than by children from non-smokers' families (OR 1.33; 95% CI 0.69-2.57; p=0.3) and more frequently by children with repeated attempts to smoke (OR 3.93; 95% CI 2.32-6.65) or children who had only had a single smoking attempt (OR 3.18; 95% CI 1.52-6.75). Also the role of models (parents, relatives, friends) was often mentioned (12.9% in the 3rd class and 10.2% in the 5th class). Potential beneficial effects of smoking were expressed by 13% of children in the 3rd class and by 55% of children in the 5th class (p<0.0001). About 40 % of children considered smoking as effective coping with stress and about 20% of them declared smoking for mood improvement. Beneficial effects of smoking significantly more often described children with repeated smoking attempts (OR 2.91; 95% CI 1.73-4.89; p<0.001). Children often linked smoking to the less educated and less successful social groups but also to the rich. In both investigations, health aspects were the most common reasons for choosing not to smoke (69.2% vs. 73.3%), being more frequently presented by girls and non-smokers. A significant shift in the negative aesthetic perception of smoking (14.1% in the 3rd class vs. 40.2% in the 5th class) and economic disadvantages of smoking (3.9% vs. 24.8%) was observed in the given period of time. Restrictive reasons were given only rarely by pupils in the 3rd class (0.7%), unlike pupils in the 5th class who feared the reaction of their parents (24.8%). Conclusion: Our study provi

Background: More than 99% of cervical cancers are positive for high-risk human papillomaviruses (HPVs). The interaction of human papilloma virus oncoproteins E6 and E7 with cell cycle proteins leads to disturbances of the cell cycle mechanism and subsequent alteration in the expression of some proteins, such as p63, p53 and Ki-67. Objectives: In this study, we have compared alterations in the expression of these aforementioned proteins in squamous cell carcinoma of the cervix with different patterns.
Materials and Methods: Twenty-six formalin-fixed parafinembedded samples of infiltrating squamous cell carcinoma selected from thirty Papanicolaou smear-positive samples have been assessed using the standard HE stain and SABC (streptavidin biotin complex) indirect tristadial immunohistochemical method for Ki-67, p53, p63 and HPV. Data was statistically analyzed using the t-Student parametric test, paired two samples for mean variance, by using MS-Excel 2003 running under Windows XP Professional.
Results: p53 was expressed in 14 of 26 cases (53.86%), ranging from 5% to 30% (mean = 0.05, SD = 0.07), p63 was expressed in 25 of 26 cases (96.15%), ranging from 25% to 80% (mean = 0.50, SD = 0.19), Ki-67 was positive in 20 of 26 cases (76.92%), ranging from 10% to 50% (mean = 0.24, SD = 0.20). HPV stain was positive in all studied cases. The expression patterns of these markers were correlated with the histopatological diagnosis and infection with HPV. Statistically significant positive and negative correlations were noticed between p63 and Ki-67 (r = 0.33, p < 0.001) and between p63 and p53 (r =-0.5, p < 0.001).
Conclusions: The significant increase in the expression of the analyzed immunomarkers was constantly observed in cases with late stage of cervical carcinogenesis. The immunomarkers p63, followed by Ki-67 showed better correlation with cancer progression than p53. This observation will be used in clinical practice targeting to identify those patients requiring a more aggressive treatment.

Objectives: 1. to determine the incidence of HPV infection by PCR and genotyping, 2. to determine the most frequent genotypes of HPV in Romania in CIN lesions for the next strategy of vaccination of the population (women or men).
Materials and Methods: Between 2005 and 2007 we investigated 1,200 women for the presence of HPV by means of LIPA method which can now detect sixteen HPV genotypes in single or multiple infections by PCR and hybridizations on strip.
Results: In our study the HPV prevalence was 73%. In HPV positive group 46% were single HPV infections, 41% were multiple infections and 13% were undetectable. Most frequent were HPV-HR genotypes (59%), followed by mixed infections with HPV-LR+HR genotypes (23%), HPV-LR (7%) and HPV-X (13%). The most frequent HPV genotypes in our study group were HPV-16 (44%), followed by HPV-31 (42%), HPV-66 (40%), HPV-6 (35%), HPV-53 (33%), HPV-51 (30%), HPV-18 (19%), HPV-33 (16%), HPV-52 (10%) and HPV-11 (9%). In the respective categories of cytological findings the distribution of HPV genotypes was: ASC-US - HR-HPV 43%; mixed HR/LR-HPV 29%; LR-HPV 29%, L-SIL - HR-HPV 88%; mixed HR/LR-HPV 13%, H-SIL - HR-HPV 62%; mixed HR/LR-HPV 33%; HR-HPV 5%, CIS - HR-HPV 100%. The highest prevalence of HPV was in the age category of 26-30 years, which represented 44 % of the study group.
Conclusions: The high incidence of HPV infections in Romanian population is correlated with the high incidence of cervical cancer in Romania, which is the second highest in Europe. Using highly sensitive detection assays for HPV the primary screening for cervical cancer might be improved in comparison to the use of Pap test. The most frequent HPV genotypes in Romania are: HPV-16, -31, -66, -6, -53. Therefore these genotypes should be included in the complex vaccine for Romania. It might be also interesting to correlate HPV distribution in our country with the prevalence of HPV types in other Balkan countries.

Objectives: Analysis of participation in drug costs by seniors in the Czech Republic in connection with seniors' access to pharmacotherapy. Materials and methods: Quota-sampled guided interview with 450 respondents visiting pharmacy; ratio of men and women approximately 1:2; age over 60 years; 3 regions of the Czech Republic.
Results: Respondent's income was retirement pension in 80 %. More than 55% of respondents did not reach the official state average. Respondents used altogether 1,650 medicines on physician's prescription in the last four weeks. Overall co-payment for medicines was 38,778 CZK, i.e. 86 CZK per patient. Only 27% of respondents used fully reimbursed products. Respondents used together 273 OTC drugs (over-the-counter drugs, e.g. non prescription drugs) in value of 16,540 CZK, i.e. 37 CZK per patient. Average respondent spent on medicines 123 CZK in the last four weeks, i.e. 1.5% of the official state average income. There were respondents, about 10%, searching for the level of co-payment in several pharmacies and more than 8% of respondents had to refuse dispensation of medicines due to co-payment.
Conclusions: Our study demonstrates that there are patients who may fail to gain access to medication due to co-payment in the Czech Republic. The financial participation in health care costs is generally low in the Czech Republic (8.8% of total health expenditures) but there were differences in co-payment levels in patients ranging from 1 CZK to thousands CZK.
In our opinion problem might be in the absence of any instrument limiting the highest individual participation as it is for example in 12-month period in Sweden. In our study co-payments were lower in smaller communities that may be due to better communication between physicians and patients or physicians and pharmacists. We found a critical ethical problem in different levels of co-payment of concrete product.