Fulltext search in archive

HIV/AIDS is often described as a sexually transmitted disease. In the former USSR, however, the HIV/AIDS epidemic is being driven by injecting drug use among men. This article addresses several widely circulated assumptions about HIV in eastern Europe: that sexual contact is the primary mode of transmission, that women form a major increasing proportion of those infected, and that the disease threatens young people in particular. Because the rate of injecting drug use is extremely high in many eastern European countries, HIV control there cannot just target sexual transmission but must embrace other approaches, such as comprehensive harm reduction.
In the area of treatment, scaling up access to highly active antiretroviral therapy has been a major global priority for the last two years. European efforts to broaden access have been generally quite successful, yet in the two European countries with the greatest need, the Russian Federation and Ukraine, the demand for treatment is growing much faster than its availability.

The study is aimed at the detection and intervention of risk factors for cardiovascular diseases (CVD) and at the part played by stress in their development. The methods applied are designed to eliminate the risks and, simultaneously, to identify the function of the two main parts of stress reaction, i.e., in terms of the extent, level and type of the stressors experienced, and in terms of the level of mental resilience and related psychosocial factors which affect the experiencing of and coping with stress. The purpose of medical examination based on the patient's history, subjective complaints and objective tests, including a study of dietary habits and psychological methods was to establish the status praesens and identify the main risk factors and symptoms leading to ischemic heart disease (IHD). Intervention was performed in subjects with increased cardiovalscular risk factors.

To assess the interval since the last revaccination against tetanus the persistence of antibodies was determined using ELISA test in 128 subject. Levels of antibodies against tetanus higher than the protective level of 0.1 IU/ml were found not only in those revaccinated less than ten years ago, but also in those revaccinated more than ten years before. With increasing length of the interval since last revaccination the antibody levels against tetanus decreased gradually although they remained above the protective level. No basic dependence of that trend on gender or age has been found. In the whole series, antibodies against tetanus exceeded the protective level for up to 20-25 years post last revaccination. This finding together with a favorable epidemiological situation as regards the occurrence of tetanus could eventually enable to prolong the interval for revaccinating adults in the Czech Republic.

There are great differences in the health status of young children in the European Region. Central Asia and the Caucasus are the worst-off areas. After reviewing under-five mortality in the eight countries of this part of Eastern Europe, a new WHO strategy to improve child survival is presented. Adopted in late 2005, the strategy has four main principles: a lifecycle approach, youth participation, equity and intersectoral collaboration.

Introduction: Exposure to low frequency noise (LFN) can lead to vibroacoustic disease (VAD), recognized as a systemic disease with lesions in a broad spectrum of organs. Although gastrointestinal complaints are common among individuals exposed to noise, only few studies tried to evaluate the digestive lesions. The authors performed this study in order to investigate gastric lesions in an animal model of VAD. Material and methods: Adult Wistar rats were exposed to continuous LFN. After five weeks they were sacrificed. The stomachs were studied by light microscopy and scanning electron microscopy, and compared with stomachs of animals kept in silence.
Results: Superficial erosions were present in the noise-exposed animals. Massive cell death of the gastric epithelium was observed, both by light and electron microscopy.
Discussion: The erosions, reflecting cellular degeneration and death, occurred without inflammation, similar to what has been observed in other LFN-exposed organs.

The paper presents the results of a risk assessment analysis of cancer morbidity in Opole province before and after a political transformation in Poland, i.e. in the 1985-1989 quinquennium and the following two equivalent periods of: 1990-1994 and 1995-1999. Measures of morbidity are given and its growth in males and females are compared with the ageing effect as well as with unemployment. In the paper a general conclusion has been drawn suggesting that the socio-economic transformation begun after 1989 and the resulting stress could have been the one of the possible background effects influencing the health status in the region. It must be accentuated, however, that the relation has not been a subject of statistical proving due to a methodological impossibility; a divagated question is offered for scientific concern and open discussion.

Aim: Comparison of cancer mortality rates in four Greek counties during the decades 1979-1988 and 1989-1998 and drawing out of cause and effect relationships that could lead to organization of prevention programs.
Methods: We used the Wilcoxon-White test to statistically compare data between the two decades as well as between the four counties separately.
Results: We found that the total proportional mortality during the decade 1988-1998 significantly increased, compared to 1979-1988, in all counties we studied. We noted a statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 55, p < 0.001 for both decades), of the respiratory system and intrathoracic organs (W = 71, p = 0.009 for 1979-1988 and W = 55, p < 0.001 for 1988-1998) and the skin and breast (W = 136, p = 0.019 for 1979-1988) in Attiki compared to Thessaloniki. As far as Achaia and Trikala are concerned, we found a minor, though statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 78, p = 0.043), of the respiratory system and intrathoracic organs (W = 77, p = 0.035) and the skin and breast (W = 76, p = 0.029) during the decade 1988-1998.
Conclusions: Statistically significant differences were noted concerning the incidence rates between four different counties as well as between two different decades. Although genetic factors might partially explain our results, environmental factors seem to be the main culprits.

The aim of the study was to assess the reliability of questionnaire information on visits to a physician and the use of antibiotics taken for respiratory infections among schoolchildren attending a water-damaged school and a reference group of schoolchildren attending an undamaged school. Two similar questionnaires on respiratory morbidity in two consecutive years were sent to the parents. The information given on the questionnaires was compared with the patient's records of the local health centre. Although the overall total numbers of ambulatory visits in the patients' records and questionnaires seemed to indicate good reliability, a more detailed individual investigation showed poor recall validity from the questionnaires, including a high percentage of unreported visits to the local health centre from both schools. Underreporting was commoner in the control school than in index school. Recall was best for the children who had no visits to a doctor. Use of antibiotics had a better recall than ambulatory visits in both schools. The study indicates that information on health services in questionnaires is not reliable, at least when occurrences in a period of one year or more are evaluated. The use of patient records as a reference of accuracy is also unreliable, unless all the health care services available to the people in the community are covered.

The prevalence of IgG antibody specific to the rubella virus was assessed in 207 consenting pregnant women. The women were in the age range of 14 to 40 years (mean 25.8 years) and parity range of 0 to 8 (mean para 4), in their first and second trimesters of pregnancy. All attended the antenatal clinic of a tertiary health facility (University of Maiduguri Teaching Hospital) in northeastern Nigeria.
Of the 207 serum samples tested, 112 (54.1 %) were positive for rubella IgG antibody. In this area therefore, the proportion of susceptible pregnant women to rubella virus is up to 46 %.
The results from this study also indicated that with increased maternal age the percentage of immune women increased significantly (P=0.04382) from 23.8 % in the 14 to 19 years age group to 74.4 % in the age group of 30 to 40 years.
There was again a gradual increase in rubella seroprevalence from 43 % amongst primigravidae to 59 % and 78 % in multiparous and grandmultiparous women respectively.
The pregnancy outcome was normal in 27 % of the women studied, with miscarriage occurring in 24.6 % and 24.2 % each had a premature delivery and stillbirth. There were 30 (58.8 %) miscarriages, 27 (54 %) premature deliveries and 30 (60 %) stillbirths, with no clinically detectable malformations in 25 (44.6 %) of all the deliveries from the immune women. There is therefore, an increase in the number of rubella immune women with each of the pregnancy outcomes compared to the non-iminune ones. Hence, the need to protect children of these susceptible women from contracting congenital rubella and its sequelae by including routine rubella vaccination of all women of childbearing age in the current programme on immunization.

Waste landfills are a potential hazard to health. Public concern exists about this potential hazard and researchers agree that further research is required on this field. The objective of the study was to investigate the association between waste landfill location and congenital anomalies risk in Denmark. The study was a multisided epidemiological geographical comparison study of risk of congenital anomalies combined and congenital anomalies of the cardiovascular and nervous systems with maternal residence in the vicinity of 48 Danish waste landfills compared with those living further away in the years 1997 to 2001. We used routine health and population data in Geographical Information System (GIS) to investigate the risk. The subjects were 2,477 live birth with congenital anomalies.
All relative risks in the proximal zones of 0-2 km were set to 1 for comparison. For all anomalies combined relative risk in the middle zones of 2-4 km joint was 0.991 and in the distal zones of 4-6 km joint the relative risk was 1.013. For congenital anomalies of the nervous system, the relative risk in the middle zones was 1.226 and in the distal zones 1.113. For congenital anomalies of the cardiovascular system, the relative risk in the middle zones was 0.926 and in the distal zones 0.854. This result was not supported by the aggregated risk ratio mean.
We found no association between waste landfill location and congenital anomalies combined or of the nervous system. However, we found small excess risk for congenital anomalies of the cardiovascular system. No causal mechanisms are available to explain these findings, but alternative explanations include approximated birth rates and residual confounding. It is our recommendation that more comprehensive multisided studies will be executed to examine the safety of waste landfills.

Patients with autoimmune hepatitis (AIH) are a group at risk of disease exacerbation or relapse of the underlying disease should they fall ill with infectious hepatitis A (HAV) or B (HBV). Therefore, it seems appropriate to protect this group of persons against HAV and HBV disease by vaccination. An open study evaluated the safety, reactogenicity and immunogenicity of a combined HAV and HBV vaccine in 10 patients with AIH (6 patients aged 1-15 years and four patients aged 16+ years). The vaccine was administered using a three-dose vaccination schedule (0, 1 and 6 months). The vaccine course was well tolerated, safe and did not aggravate the clinical course of the underlying disease. Patients responded with 100% seroconversion for antibody to the HAV vaccine component and geometric mean antibody concentration (GIVIC) comparable to healthy cohorts. Response to the HBV component antigen was comparable to previous reports of HBV vaccination in immune compromised individuals with lower GMC than observed in healthy populations. One month after the third vaccine dose (month 7), all six vaccinees in the 1-15 years age group developed protective levels of anti-HBs as compared to two of the four vaccinees in the 16+ years age group.

Aims: To study the role of maternal employment status as indicator of socioeconomic status in the origin of isolated orofacial clefts (OFC) and in the use of periconceptional folic acid/multivitamin supplementation.
Methods: 1,975 cases with OFC (1,374 cases with cleft lip ± palate and 601 cases with posterior cleft palate), 38,151 population controls without any defects and 20,868 patient controls with other isolated defects were compared in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996.
Results: The proportion of professionals and managerials was lower, while the proportion of unskilled workers, housewives and others was higher in the mothers of cases with OFC compared with the population control group. However, the comparison of OFC and patient control groups did not show any difference in the employment status of mothers. A lower level of folic acid supplementation occurred in the professional and skilled worker mothers of cases with OFC compared with the population control group. This difference was confirmed by the comparison of folic acid used by mothers of cases with OFC compared with patient controls. An infrequent multivitamin use was displayed in the studied groups. Conclusions: The prevalence of OFC at birth shows a slightly lower maternal employment status as indicator of socioeconomic status than in the population control group. The higher level of maternal education does not imply a higher rate of folic acid supplementation in the group of OFC.

Young people are our human capital for the future, therefore child and adolescent health has attracted considerable political and professional attention in recent years. Health is indivisible, requirs holistic approach throughout the individual's life. Healthy outcome at one point in the life cycle, provides a positive determinant for health elsewhere in the cycle. Health and development of the 0-19 age group links intimately, at both ends of the range, with reproductive health. Health during childhood is in part determined by the health of the mother, and affected also by factors such as the nutrition of adolescent girls and the avoidance of early pregnancy. These factors, in turn, are influenced by healthy growth and development in childhood.
The paper presents main environmental and socio-cultural challenges for each of the stages of child and adolescent life. Main challenge described are: unsafe abortion, malnutrition, anaemia, malformations, and infections during pregnancy; low birth weight, asphyxia, hypothermia, infection, failure to initiate early and full breastfeeding in the neonatal period; poor nutrition, growth and development, frequent illnesses, injury, abuse and neglect in the early childhood; poor nutrition, growth and development, injury, abuse, neglect, and helminth infections in the early school age; poor nutrition, poor development, chronic conditions, mental disorders, injury, drug abuse, and violence in the adolescence.
Both, prevention of ill health and care for illnesses are important at all times but the balance between them shifts over time during the childhood and adolescence. Main actions needed to meet the child and adolescent needs are presented as well.

In Slovak Republic and the region of Central and Eastern Europe the viper is the only species of venomous snake living in wild. During the last nine observed years (1993-2002) the Toxicological Information Center (TIC) was consulted in 81 cases of individuals attacked by snakes. 51 of these cases were by viper, rattlesnake 6, and green mamba once. 23 cases were by non-venomous snakes; adder 22 times and royal snake once. The viper and adder attacks occurred in the wild and the other cases with snake keepers. None of affected individuals died.
Our contribution contains the new recommended therapy procedures for viper attack.

Mining for coal and its utilization have various impacts on the surrounding environment. Huge volumes of waste materials which are by-products of both the underground and open cast coal mining, pose one of the major environmental hazards in addition to air pollution caused by coal burning in power plants in the Czech Republic. Some of these risks could be reduced when having accurate and comprehensive data on coal quality. Statistical data processing of almost 35,000 coal samples from Late Paleozoic and Tertiary coal basins of the Czech Republic provided a unique information on the quality of lignite, sub-bituminous and bituminous coals and anthracites including the content of toxic trace elements (As, Be, Hg, Pb and Se). In this context related environment and health risks and protection implications are discussed.

The aim of the study was to assess stress on the basis of the excretion rates of stress hormones in occupational groups under mental stress. The investigation includes 293 persons, working in power engineering, education, public health and information sector. The stress hormones adrenaline, noradrenaline and 11-oxycorticosteroids (11-OCS) were followed during the working day using spectrofluorimetric methods. Very high excretion rates of adrenaline, noradrenaline and/or 11-OCS were found with leading radio editors, responsible engineers and operators in nuclear power station (NPS), teachers in secondary schools, designing engineers. In conclusion our data indicate high stress in occupational groups working under high psychological demands, high responsibility, making important managing decisions, low job control and are discussed with regard to the health risk.

To determine whether there is a relationship between trichomoniasis and bacterial vaginosis (BV), cervicovaginal smears obtained from 600 women were stained with the Papanicolaou technique and examined cytologically. Thirty-six (6%) of 600 women were diagnosed as having Trichomonas vaginalis [TV(+)]. Sixteen (44.4%) of 36 TV(+) cases were observed as having BV [BV(+)]. Thirty-one of 564 TV(-) vaginal smears were also positive for BV (5.5%).There was a statistically significant correlation between trichomoniasis and bacterial vaginosis (p < 0.05).
It is possible that TV might create an anaerobic environment, thereby changing the vaginal flora. This flora becomes a more suitable milieu for growing of anaerobic microorganisms. It can be postulated that TV might be the most important protozoan that contributes to the overgrowth of BV-related microorganisms.

Objectives: To genetically characterize and compare Mycobacterium tuberculosis isolates among culture-confirmed TB cases in two regions in the Czech Republic in 1998.
Methods: Consecutive M. tuberculosis isolates from 111 TB patients in Prague and 120 patients in the South Moravia region were genotyped using the standardized IS6110 Southern blot hybridization method and by spoligotyping.
Results: Eighty of the Prague patients (72.1%) had isolates with unique RFLP patterns, while 31 (27.9%) had isolates which belonged to 10 clusters. Seventy-eight (64.7%) of the South Moravia strains displayed unique RFLP pattern and 42 (35.3%) were assigned into 15 clusters. The spoligotype profiles previously identified in the U.S. were found in 69 (33%) samples and newly identified Czech spoligotypes in 24 (11.4%) of the total number of examined strains.
Conclusions: The present population-based molecular epidemiological study performed in two regions of the Czech Republic in 1998 demonstrated the distribution of individual genotypes as well as clustered strains of M. tuberculosis isolated from TB patients, and confirmed the similarity between the Czech strain collection and the European Community TB Database, that includes countries with low TB rate. The sporadic import of TB cases from foreign countries and recent transmission events probably do not play significant roles in the epidemiological situation in the Czech Republic.

Objective: The aim of the present study was to investigate influence of oxidative stress on newborn organism, in terms of the dynamics of malondialdehyde (MDA) concentration changes and of the activities of selected antioxidants in asphyxial newborns on the 1st and 5th day of life. Method: In the group of 62 preterm and term asphyxial newborns, characterized by the presence of asphyxial criteria and admitted within 24 hours of life, the plasma concentration of MDA and level of total antioxidant status (TAS) were followed. Results: Dynamic changes of MDA signalized active process of lipoperoxidation (LP) and values of TAS were decreased in comparison with the capacity of adult patients.

Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there.

The article describes the exposure pathways of cadmium in the Czech urban population. The data on Cd concentrations originated from the Environmental Health Monitoring System, which has been realized in 30 cities since 1994. The data on cadmium content in particular exposure pathways - diet, drinking water, ambient air and soil - were processed for the period 1994-2003. The estimate of the daily dietary intake for an average adult population amounted to 11-19 µg/d, i.e. 0.17-0.30 µg/kg bw/d, which represents 17%-30% of the PTWI (provisional tolerable weekly intake). The contribution from drinking water to the oral exposure is low; on average 0.5 µg/d. Potential exposure to airborne Cd was estimated at about 0.02 µg/d. The additional Cd intake from urban soil ingestion probable in small children was found to be insignificant based on Cd concentrations in the soil of kindergarten playgrounds.
Biomonitoring outputs characterize the recent and life-long cadmium burden of the Czech population from general environment. In 1994-2003, the median blood Cd levels ranged in the interval 0.9-0.4 µg/l blood, in smokers being more than double that in non-smokers. Blood Cd levels detected indicate slightly decreasing trend as well as urine Cd levels (range of median values 0.44-0.28 µg/g creatinine). Since 1996 the levels in children have been found in more than 50% cases below the detection limit of the methods used.
The estimated total cadmium intake in the Czech urban population does not signalize any increased risk of health impairment considering non-carcinogenic effects.

The German health care system has been based on the Hospital Financing Act, which the German government introduced in 1972. According to that, the federal states plan hospitals and make investments. The health insurance funds finance the operating costs. But now the Hospital Financing Act is obsolete, because both the health insurance funds and the federal states are in financial trouble and try to avoid the costs, which are nevertheless rising. In order to freeze costs, the legislators have introduced a new remuneration system, called DRGs (Diagnosis Related Groups), which will be mandatory from 2007 onwards. In this system, the treatment provided will be coded and remunerated on the basis of the primary diagnosis. Periods of hospitalisation and different remuneration systems will no longer be relevant. Transparency and quality will thus be promoted, and the upshot will be more competition among the hospitals. Hospitals that cannot meet quality standards will lose patients and will ultimately have to close. Other participants in the health care system, such as, for example, nursing staff, physicians, pharmacies, rehabilitaion centres and patients, will also be concerned in many ways. The consequences of the DRGs for the health care system, its future development and possible alternatives are discussed in this article.

Pharmacological pretreatment and antidotal treatment on tabun-induced neurotoxicity were studied in male albino rats that were poisoned with a lethal dose of tabun (280 µg/kg i.m.; 100% of LD50 value) and observed at 24 hours and 7 days following tabun challenge. The neurotoxicity of tabun was evaluated using a Functional observational battery and an automatic measurement of motor activity.
Pharmacological pretreatment as well as antidotal treatment were able to reverse most of tabun-induced neurotoxic signs observed at 24 hours following tabun poisoning. However, there was not significant difference between the efficacy of profylaxis and antidotal treatment to eliminate tabun-induced neurotoxicity. The combination of profylactic pretreatment and antidotal treatment seems to be slightly more effective in the elimination of tabun-induced neurotoxicity in rats at 24 hours following tabun challenge in comparison with the administration of profylactic pretreatment or antidotal treatment alone. At 7 days following tabun poisoning, very few neurotoxic signs in tabun-poisoned rats were observed regardless of administration of pharmacological pretreatment or antidotal treatment.
Thus, our findings confirm that the combination of pharmacological pretreatment and antidotal treatment is not only able to protect the experimental animals from the lethal effects of tabun but also to eliminate most of tabun-induced signs of neurotoxicity in tabun-poisoned rats.