Social networks and cognitive function in older adults: findings from the HAPIEE study

BACKGROUND

Social networks are associated with better cognitive health in older people, but the role of specific aspects of the social network remains unclear. This is especially the case in Central and Eastern Europe. This study examined associations between three aspects of the social network (network size of friends and relatives, contact frequency with friends and relatives, and social activity participation) with cognitive functions (verbal memory, learning ability, verbal fluency, processing speed, and global cognitive function) in older Czech, Polish, and Russian adults.

METHODS

Linear regression estimated associations between baseline social networks and cognitive domains measured at both baseline and follow-up (mean duration of follow-up, 3.5 ± 0.7 years) in 6691 participants (mean age, 62.2 ± 6.0 years; 53.7% women) from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study.

RESULTS

Cross-sectional analyses, adjusted for country, age, and sex, showed positive associations of global cognitive function with social activity participation and network size of friends and relatives, but not with contact frequency in either network. Further adjustment for sociodemographic, behavioural, and health characteristics attenuated the associations with network size of relatives (P-trend = 0.074) but not with network size of friends (P-trend = 0.036) or social activities (P-trend< 0.001). In prospective analyses, network size and social activity participation were also linked with better cognition in simple models, but the associations were much stronger for social activities (P-trend< 0.001) than for network size of friends (P-trend = 0.095) and relatives (P-trend = 0.425). Adjustment for baseline cognition largely explained the prospective associations with network size of friends (P-trend = 0.787) and relatives (P-trend = 0.815), but it only slightly attenuated the association with social activities (P-trend< 0.001). The prospective effect of social activities was largely explained by sociodemographic, health behavioural, and health covariates (P-trend = 0.233). Analyses of specific cognitive domains generally replicated the cross-sectional and prospective findings for global cognitive function.

CONCLUSIONS

Older Central and Eastern European adults with larger social networks and greater social activities participation had better cognitive function, but these associations were stronger at baseline than over the short-term follow-up.

Side Effects of mRNA-Based COVID-19 Vaccines among Young Adults (18-30 Years Old): An Independent Post-Marketing Study

Young adults had been widely perceived as a low-risk group for COVID-19 severity; therefore, they were deprioritised within the mass vaccination strategies as their prognosis of COVID-19 infection is relatively more favourable than older age groups. On the other hand, vaccination of this demographic group is indispensable to achieve herd immunity. A cross-sectional survey-based study was used to evaluate the side effects of mRNA-based COVID-19 vaccines among university students in the Czech Republic. The validated questionnaire was delivered in a digital form, and it consisted of demographic data; COVID-19 vaccine-related anamnesis; and local, systemic, orofacial, and skin-related side effects' prevalence, onset, and duration. Out of the 539 included participants, 70.1% were females and 45.8% were <23 years old. The vast majority (95.2%) reported at least one side effect. The most common side effect was injection site pain (91.8%), followed by fatigue (62.5%), headache (36.4%), and muscle pain (34.9%). The majority of local side effects occurred after both doses (74.4%), while most systemic side effects occurred after the second dose only (56.2%). Most local (94.2%) and systemic (93.3%) side effects resolved within three days after vaccination. Females participants' adjusted odds ratio (AOR) showed they were 2.566 (CI 95%: 1.103-5.970) times more likely to experience post-vaccination side effects, and the participants who received two doses reported an increased AOR of 1.896 (0.708-5.077) for experiencing side effects. The results of this study imply that mRNA-based COVID-19 vaccines are highly probably safe for young adults, and further studies are required to investigate the role of medical anamnesis, prior COVID-19 infection, and gender in side effects incidence.

Safe environment management in acute psychiatric wards in the Czech Republic, foundation for recommendations for preventive practice

OBJECTIVES

Suicides of hospitalized patients present rare but very serious adverse events in healthcare settings. The aim of this article is to describe and analyse the facilities and material equipment of acute psychiatric settings in the Czech Republic and contrast these with recommendations for effective prevention of suicidal behaviour. Since there are currently no universally accepted protocols for risk assessment and prevention of suicides in hospital settings in the Czech Republic, these recommendations draw on international guidelines. Based on the outcomes of our study we provide recommendations for risk management and effective prevention of suicidal behaviour of patients hospitalized in acute care settings.

METHODS

In order to describe and analyse the environment of acute psychiatric wards in the Czech Republic we have developed a questionnaire based on international recommendations for risk management and prevention of suicidal behaviour. We also collected data on the prevalence of attempted and completed suicides and their respective methods in these hospitals.

RESULTS

We have established that acute psychiatric wards in the Czech Republic operate within insufficient safety regimes, especially with respect to the prevention of suicide by hanging and the accessibility of objects for cutting. Our findings demonstrate that only 75% of the wards are equipped with safety glass, and only 50% of the wards with safety mirrors. Only just over 40% of hospitals have safety door handles and shower heads.

CONCLUSION

While it is impossible to entirely eliminate the risk of suicidal behaviour it is possible to manage it. The risk reduction is attainable by providing a safe-proofed environment and minimizing opportunities of suicide attempts by hanging and cutting. In order to effectively prevent suicides, it is essential to increase the awareness of the possibilities of safe proofing of the environment as well as standardization of risk assessment of potential suicidal behaviour of patients.

Respiratory syncytial virus acute respiratory infections in ≥ 65-year-old adults in long-term care facilities in the Czech Republic

OBJECTIVES

Due to immunosenescence and presence of comorbidities, respiratory syncytial virus (RSV) disease burden is a major health concern in older adults, which is expected to increase with the life expectancy rise. Data on RSV burden are scarce in older adults residing in long-term care facilities, a vulnerable population living in crowded settings. Therefore, two independent prospective studies were conducted during the 2003-2004 and 2004-2005 RSV seasons to assess RSV acute respiratory illnesses (ARIs) and lower respiratory tract infections (LRTIs) in ≥ 65-year-old adults residing in long-term care facilities in the Czech Republic.

METHODS

RSV ARI episodes were confirmed by polymerase chain reaction in nasal swabs collected within 3 days of symptoms onset. The mortality and morbidity of RSV-confirmed ARIs, as well as the risk factors associated with RSV-confirmed ARIs were evaluated.

RESULTS

Among 1,251 participants in the 2003-2004 season (ARI surveillance between October and March), there were no RSV-positive cases in 255 ARI and 105 LRTI episodes. Among 1,280 participants in the 2004-2005 season (ARI surveillance between October and April), there were 39 and 26 RSV-positive cases in 335 ARI and 217 LRTI episodes, respectively, and RSV-positive ARI and LRTI episode incidence rates were 45.82 and 30.40 per 1,000 person-years. Among 290 RSV-negative and 39 RSV-positive ARI cases in the 2004-2005 season, 15 and 4 hospitalizations, 188 and 26 LRTIs, and 11 and 3 deaths were reported. Risk factors associated with RSV-positive ARI were female gender (odds ratio: 4.98), chronic heart failure class II (odds ratio: 2.31) and diabetes requiring insulin treatment (odds ratio: 9.82).

CONCLUSIONS

These studies showed that RSV was an important cause of ARI in older adults living in long-term care facilities in the 2004-2005 season, with fluctuating yearly incidences.

Effect of environmental variables on incidence of tick-borne encephalitis, leptospirosis and tularaemia

OBJECTIVES

Potential effect of three environmental variables (population density of rodents, global weather in the form of the North Atlantic Oscillation (NAO) index, and acorn crop) on human morbidity rate of three zoonoses: tick-borne encephalitis (TBE), leptospirosis and tularaemia were analysed in the Czech Republic for the period 1970-1990.

METHODS

The Pearson's correlation analysis was used.

RESULTS

The correlation analysis revealed that the significant factor for explaining annual morbidity rates of these zoonoses was the abundance of common voles (Microtus arvalis) in the current year (for leptospirosis) or in the previous calendar year (for TBE and tularaemia).

CONCLUSIONS

The two other environmental variables tested (NAO index and acorn production) do not seem to play a significant role in these zoonoses in Central Europe.

Testing Positive for SARS-CoV-2 in Two Countries 105 Days Apart

Recovered COVID-19 patients may test positive for SARS-CoV-2 for a long time from intermittent shedding of viral fragments. A 36-year-old man who tested positive for SARS-CoV-2 in the Czech Republic and recovered tested positive again in Bhutan, 105 days beyond his first positive test. He experienced minimal symptoms and recovered without complications. Although no virological test was conducted to rule out reinfection, the repeat positive test after initial recovery likely resulted from prolonged shedding of dead viral particles than a reinfection.

New Perspective on the Geographic Distribution and Evolution of Lymphocytic Choriomeningitis Virus, Central Europe

Lymphocytic choriomeningitis virus (LCMV) is an Old World mammarenavirus found worldwide because of its association with the house mouse. When LCMV spills over to immunocompetent humans, the virus can cause aseptic meningitis; in immunocompromised persons, systemic infection and death can occur. Central Europe is a strategic location for the study of LCMV evolutionary history and host specificity because of the presence of a hybrid zone (genetic barrier) between 2 house mouse subspecies, Mus musculus musculus and M. musculus domesticus. We report LCMV prevalence in natural mouse populations from a Czech Republic–Germany transect and genomic characterization of 2 new LCMV variants from the Czech Republic. We demonstrate that the main division in the LCMV phylogenetic tree corresponds to mouse host subspecies and, when the virus is found in human hosts, the mouse subspecies found at the spillover location. Therefore, LCMV strains infecting humans can be predicted by the genetic structure of house mice.

Impacts of COVID-19 Pandemic on the Mental Health of Working Adults in the Czech Republic: Analysis of Self-Report Psychological Data in a One Year Perspective

The article presents research evidence on psychological impacts of the COVID-19 pandemic on the economically active Czech population aged 18–64 (n = 1603; 365 men and 1238 women) within a one year perspective. The aim is to describe the differences in the reported mental health indicators (anxiety, depression, and distress) for women and men in the four age groups, two groups with different working statuses (continuation of work/interrupted working status), and between two phases of the epidemic (March to May 2020 and September 2020 to February 2021). The results point to elevated scores of negative mental health indicators (anxiety, depression, and distress) in different subgroups. More negative experiences in a pandemic situation were found, especially in groups of women, people under the age of 35, and among people with interrupted working status. The results also indicate a deterioration of symptoms over time during the epidemic.

Exoskeletal and eye repair in Dalmanitina socialis (Trilobita): An example of blastemal regeneration in the Ordovician?

OBJECTIVE

To analyze anomalies of a biomineralized exoskeleton of a trilobite.

MATERIALS

A specimen of Dalmanitina socialis from the Upper Ordovician Letná Formation at Veselá near Beroun, Czechoslovakia, curated at the Czech Geological Survey in Prague.

METHODS

The internal mold and external mold and latex casts were coated with ammonium chloride sublimate and photographed.

RESULTS

A substantial reduction of the eye surface associated with changes in morphology and surface structure was noted.

CONCLUSIONS

The anomaly is believed to be the result of a healed injury after an unsuccessful predatory attack. Based on the presumed mechanism of injury, a 'large arthropod' is proposed to be the potential attacker.

SIGNIFICANCE

The low incidence of sublethal attack to cephala in collections of Cambrian to Carboniferous trilobites implies that most such attacks were fatal, rendering this specimen unique and capable of providing insight into healing processes.

LIMITATIONS

Post-mortem damage rendered analysis difficult.

SUGGESTIONSFOR FURTHER RESEARCH

Exploration of other cases of healed trauma in order to understand Ordovician ecosystems.

Educational Program Improved Senior Preparedness to Call 911 as a Response to Stroke

OBJECTIVES

Stroke predominantly affects the elderly. Universities of the Third Age (U3A) are presented with an opportunity to target them. The goal of our study was to improve older adults' preparedness to call 911 as a response to symptoms of stroke.

MATERIALS AND METHODS

Participants were recruited from U3A in Brno, Czech Republic in year 2018. The program included an educational movie about stroke and testing with pretest posttest design. Stroke awareness was measured by Stroke Action Test and video-clips portraying stroke and stroke mimicking symptoms. Respondents had to answer close-ended questions. Composite scores were compared using paired t-test.

RESULTS

Data were obtained from 206 attendees of the program, that is 2% of all students, from 4 of 5 U3A in Brno. The mean test score improved from 80% to 87% (paired p < 0.001). Participants with a lower baseline knowledge improved by 12% (95% CI 9% to 16%) and with a higher baseline knowledge by 0% (95% CI 3% to 4%). The score for calling 911 for stroke mimicking symptoms improved from 29% to 20% (paired p < 0.001).

CONCLUSIONS

Video-based educational program improved senior preparedness to call 911 as a response to stroke. The improvement was mild, which is at least partly due to a high baseline level of preparedness of seniors active in U3A. A lower baseline knowledge was however associated with a bigger improvement, which might be important for use in a less active/educated population. Educational intervention also decreased intention to call 911 for stroke mimicking symptoms, which could have important implications for decreasing unnecessary activation of pre-hospital services.

Prevalence and Drivers of COVID-19 Vaccine Hesitancy among Czech University Students: National Cross-Sectional Study

Background: university students are believed to retain the highest levels of health literacy. They are perceived as the opinion leaders within their communities; therefore, their health-related beliefs and attitudes are deemed important for public health campaigns. This study aimed to investigate the COVID-19 vaccine hesitancy drivers among university students in the Czech Republic. Methods: a cross-sectional study using a self-administered questionnaire was carried out in the weeks before the unrestricted vaccine deployment to Czech adults. The questionnaire had 21 multiple-choice items stratified in 4 categories; demographic characteristics, COVID-19-related anamnesis and influenza vaccine experience, attitudes towards COVID-19 vaccination, and the possible drivers of COVID-19 vaccine hesitancy suggested by the WHO-SAGE. Results: out of the 1351 included students, 66.8% were females, 84.5% were Czech nationals, and 40.6% enrolled in healthcare programs. The overall COVID-19 vaccine acceptance level was 73.3%, 19.3% of participants were vaccine-resistant, and only 7.4% were vaccine-hesitant. Trust in the pharmaceutical industry, trust in healthcare providers, and perceived knowledge sufficiency predicted higher odds of vaccine acceptance. In contrast, media and social media, personal beliefs, immunity misconception, previous COVID-19 infection, and suspicions about novel vaccines and the local availability predicted higher odds of vaccine hesitancy. Conclusions: The findings of this study predict a fair probability to achieve community immunity (herd immunity) among the target population group. The primary prevention strategies in the Czech Republic need to be culturally sensitive and inclusive for foreign nationals. As one-quarter of the participating students are dependent on vaccine safety data, this study findings support the call for independent studies evaluating the side effects of COVID-19 vaccines.

Trends in the treatment and survival of heart failure patients: a nationwide population-based study in the Czech Republic

Aims

A retrospective nationwide observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018.

Methods and results

Prevalence of heart failure (HF) patients increased from 176 496 (1679.4 per 100 000 population) in 2012 to 285 745 (2689.0 per 100 000 population) patients in 2018 (mean age 74.4 ± 12.8 years). In the last years, a stable incidence of HF patients was observed (544 per 100 000 population in 2016 vs. 551 per 100 000 population in 2018; P = 0.310). Mortality rate decreased from 20.55% in 2012 to 15.89% in 2018. The number of hospitalized patients remained similar (318.2 per 100 000 population in 2012 vs. 311.8 per 100 000 population in 2018; P = 0.479). The most used drugs were diuretics (173 295; 60.6%) and beta‐blockers (178 823; 62.6%), followed by angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (angiotensin‐converting enzyme inhibitors 120.581; 42.2%; angiotensin II receptor blockers 47 216; 16.5%). Even though the whole number of implanted devices in HF patients increased steadily (from 25 205 in 2012 to 45 363 in 2018), the prevalence of all devices (pacemakers and defibrillators) in the HF patients remained about the same (14.3% in 2012; 15.9% in 2018).

Conclusions

The study included all patients with HF in the Czech Republic. These are the first nationwide data of HF epidemiology in the Eastern bloc. The incidence of HF remains stable in the last years. Due to aging of the population, the prevalence of HF significantly increased in the last 6 years. Despite a continuous increase in the prevalence of HF and a suboptimal utilization of its pharmacological therapy, mortality decreased, and the number of hospitalized patients remained the same.

RD, Bryndziar T, Jarkovsky J, Tomek A, Sramek M, Skoda O, Sramkova T, Littnerova S, Mikulik R. Treat COVID-19, but Not Only COVID-19: Stroke Matters as Well

INTRODUCTION

During the COVID-19 pandemic, studies reported less number of hospitalizations for acute stroke and reduction in the use of recanalization treatments. This study analyzes nationwide data on stroke admissions and management in the Czech Republic during the first wave of the COVID-19 pandemic.

METHODS

We compared the early COVID-19 pandemic (March-May 2020) with the pre-pandemic period (January-February 2020 and March-May 2019): (a) the National Register of Reimbursed Health Services provided volume of all admissions for subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS), and volume of recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]); (b) Registry of Stroke Care Quality provided door-to-needle time (DNT), onset-to-door time (ODT), and stroke severity at admission (National Institutes of Health Stroke Scale, NIHSS) for IS.

RESULTS

During the pandemic (March-May 2020), the peak number of COVID-19 patients treated in Czech hospitals was 39 per million. In March-May 2020 versus March-May 2019, hospital admissions decreased as follows: stroke overall by 14% (p < 0.001), IS by 14% (p < 0.001), SAH by 15% (p = 0.07), and ICH by 7% (p = 0.17). The mean age was 74 years versus 74 years (p = 0.33), and 52% versus 51% were men (p = 0.34). The volumes of IVT and MT decreased by 14% (p = 0.001) and 19% (p = 0.01), respectively. The proportions of all IS patients receiving IVT or MT remained unchanged, with, respectively, 17% versus 17% receiving IVT (p = 0.86) and 5% versus 5% receiving MT (p = 0.48). DNT and ODT were 24 versus 25 min (p = 0.58) and 168 versus 156 min (p = 0.23), respectively. NIHSS at admission did not differ (6 vs. 6; p = 0.54).

CONCLUSION

Even with a low burden of COVID-19 during the first wave and no change in organization and logistics of stroke services, stroke admissions and volume of recanalization treatments decreased. Public health communication campaigns should encourage people to seek emergency medical care for stroke symptoms during the COVID-19 pandemic.

SETAP: epidemiology and prevention of stroke and transient ischaemic attack in Czech patients with atrial fibrillation

AIMS

The aim of this study is to analyse the prevalence, epidemiology, and anticoagulation prevention of stroke or transient ischaemic attack (TIA) in Czech patients with atrial fibrillation (AF).

METHODS AND RESULTS

Retrospective observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Healthcare Services between 2015 and 2018. Prevalence of AF in 2018 was 4.3% of Czech population and the prevalence of stroke/TIA in AF patients was 22.3% with annual incidence of 181.62 cases per 100 000 inhabitants. In 2018, CHA2DS2-ASc score ≥4 was present in 98% AF patients in secondary and 59% in primary prevention, respectively, while the anticoagulation treatment was used by 71-81% of them. Between 2015 and 2018, the percentage of AF patients treated with warfarin monotherapy in primary prevention decreased from 35% to 31%, with acetylsalicylic acid (ASA) monotherapy from 18% to 16% and non-vitamin K antagonist oral anticoagulants (NOACs) monotherapy increased from 7% to 11%. In secondary prevention, the percentage of warfarin monotherapy treatment decreased from 35% to 32%, with ASA monotherapy from 20% to 18% and with NOACs monotherapy increased from 9% to 15%.

CONCLUSION

This study followed all Czech patients with AF. The unadjusted prevalence and incidence of AF was higher compared with other countries and 2019 European Society of Cardiology Statistics. The study identified several gaps in standard of reimbursed care. 20-30% of AF patients with other risk factors were without any prevention medication and the share of ASA monotherapy in treated patients was 16-18%.

Associations among Sexual Activity, Relationship Types, and Health in Mid and Later Life

Despite a growing amount of research on sexuality in mid and later life, relatively little is known about the associations among sexual activity, relationship types, and health. This paper analyzes data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for the subpopulation of respondents residing in the Czech Republic (N = 1304, 49% women; M_age = 69.1, SD_age = 8.0). Hierarchical ordinal regression models showed that persons who stayed in newly formed or less traditional relationship types, such as dating, Living-Apart-Together (LAT) relationships, and cohabitation, reported a higher frequency of sexual activity than married people. Overall, the dating and LAT relationship group displayed the highest sexual frequency and the lowest incidence of chronic diseases. People in marriages and cohabitation were comparable with respect to the number of chronic diseases. The findings suggest that sexual activity is intertwined with later-life relationships and sexual frequency may vary according to the relationship type. Future research may benefit from probing the extent to which partnered sex is important for maintaining bonds between older partners with separate households.

Long-Term Outcome After Midline Lumbar Fusion for the Treatment of Lumbar Spine Instability Due to Degenerative Disease

BACKGROUND

Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF.

METHODS

This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant.

RESULTS

The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded.

CONCLUSIONS

MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.

Regional inequalities and substitutability of health resources in the Czech Republic: a five methods of evaluation

BACKGROUND

An analysis of the regional distribution of health resources is one of the tools for evaluating equal geographic access to health care. The usual analytical approach to an assessment of regional differences is to evaluate each health resource separately. This is a sensible approach, because there may be systematic reasons for any differences, for example, higher salaries in urban areas. However, a separate evaluation of the regional distribution of health resource capacities may be misleading. We should evaluate all health resource capacities as a whole and consider the substitutability of resources.

OBJECTIVE

This study aims to measure regional inequalities in the Czech Republic with the help of alternative approaches to the evaluation of regional inequalities in the case of several substitutable health resources.

METHODS

Five alternative evaluation methods (models) are described and applied: the separate evaluation, expert model, market model, common weights model, and production frontier model.

RESULTS

The regional distribution of physicians and nurses in the Czech Republic in 2017 was evaluated. In spite of many regulations at the national and regional levels, we have found inequalities in regional resource distribution. The models that consider all health resources and the possibility of a resource substitution show lower inequalities between regional health resource capacities.

CONCLUSION

Both researchers and policy-makers should always consider the possibility of resource substitutions in the assessment of regional inequalities.

Cancer incidence trends in the Czech Republic

BACKGROUND

Evaluation of time trends is an integral part of a comprehensive analysis of cancer data. Our study aimed to assess trends in cancer incidence in the period 1977-2018 in the Czech Republic.

METHODS

Cancer data were obtained from the Czech National Cancer Registry. Incidence trends were evaluated using the joinpoint regression. The overall trend for the entire analysed period and the current trend for the last 10 years were determined using the average annual percentage change.

RESULTS

In the period 1977-2018, the age-standardised incidence (European standard) of malignant neoplasms excluding non-melanoma skin cancers increased from 518.2 to 681.9 cases per 100,000 population in men, and from 320.9 to 467.2 in women. The largest increase in trend in the analysed period was observed for melanoma, which showed an average annual increase of 4.0 % in men and 3.3 % in women. Over the last decade, a significant increase has been observed for head and neck cancer and oesophageal cancer, mainly in women. On the contrary, the largest decrease in trend in the analysed period was observed for stomach cancer, with an average decrease of 2.9 % in men and 2.8 % in women. Over the last 10 years, a highly significant decrease has also been observed for colorectal cancer: 3.2 % in men and 2.8 % in women. The largest difference in trend between the sexes was recorded in lung cancer: a steady decline of 1.3 % per year was observed for men, but an increase of 3.1 % per year was demonstrated for women. After the introduction of colorectal and cervical cancer screening programmes, a significant decrease of incidence rates for these diagnoses was observed.

CONCLUSIONS

Knowledge of the current cancer burden in the population and its time trends will help to prioritise targets and future resource allocation to cancer control.

The out-of-pocket medication burden: Which health problems impact the Czech population aged 50+?

Adults 50-years-old and greater form the group most vulnerable to a high burden from payments for medication. These Czech older adults devote around 60% of out-of-pocket payments for medication, which might influence their consumption patterns and access to health care. This paper extends the empirical evidence of the out-of-pocket burden and catastrophic payments by addressing the consumption of medication among the Czech population aged 50 and higher. Data from the Survey of Health, Ageing and Retirement in Europe, wave 6, is used. A generalised linear model is applied for estimating the out-of-pocket medication burden; a binary logistic regression is used for the investigation of catastrophic medication expenditure. The results showed that medications for pain, joint pain/joint inflammation, anxiety and depression, heart diseases and high blood pressure are robust predictors for the medication burden and risk factors for catastrophic payments. Special attention should also be paid to medications for suppressing inflammation and sleep problems. Despite universal coverage in the Czech Republic, taking medications for specific health problems, especially those related to the nervous system, influences the well-being of older individuals. Policy makers should revise the prescription practice and related reimbursement policies and reconsider current protection from the high medication burden.

Therapy of chronic hepatitis C in people who inject drugs: focus on adherence

Background

Intravenous drug use (IVDU) represents the major factor of HCV transmission, but the treatment uptake among people who inject drugs (PWID) remains low owing to a false presumption of low efficacy. The aim of our study was to assess treatment efficacy in PWID and factors determining adherence to therapy.

Methods

A total of 278 consecutive patients starting DAA (direct-acting antivirals) therapy were included, divided into two groups: individuals with a history of IVDU, PWID group (N = 101) and the control group (N = 177) without a history of IVDU.

Results

Sustained virological response 12 weeks after the end of therapy (SVR12) was achieved by 99/101 (98%) and 172/177 (98%) patients in the PWID and control group, respectively; in PWID group, two patients were lost to follow-up, and in the control group, four patients relapsed and one was lost to follow-up. PWID patients postponed appointments significantly more often, 29 (28.7%) in PWID versus 7 (4%) in the control group, p = 0.001. Thirteen of 101 (12.9%) and six of 177 (3.4%) patients in the PWID and in the control group, respectively, missed at least one visit (p < 0.01). However, postponing visits led to a lack of medication in only one PWID. In the PWID group, older age (p < 0.05; OR 1.07, 95% CI 1.00–1.20) and stable housing (p < 0.01; OR 9.70, 95% CI 2.10–56.20) were factors positively contributing to adherence. Contrarily, a stable job was a factor negatively influencing adherence (p < 0.05; OR 0.24, 95% CI 0.06–0.81). In the control group, none of the analyzed social and demographic factors had an impact on adherence to therapy.

Conclusions

In PWID, treatment efficacy was excellent and was comparable with SVR of the control group. Stable housing and older age contributed to a better adherence to therapy.

Safety of ChAdOx1 nCoV-19 Vaccine: Independent Evidence from Two EU States

Recent reports of thrombosis following AstraZeneca COVID-19 vaccine in young females (<55 years-old) led to temporary suspension and urgent investigation by the European Medicines Agency (EMA) that concluded that vaccine benefits still outweigh its side effects (SEs). Therefore, this study aims to provide early independent evidence on the vaccine SEs’ prevalence and their potential risk factors; a cross-sectional survey-based study was carried out between February and March 2021 in Germany and Czech Republic among healthcare workers who recently received the AstraZeneca COVID-19 vaccine. The study used a validated self-administered questionnaire composed of twenty-eight multiple-choice items covering demographic variables, medical anamneses, and local, systemic, oral, and skin related SEs of the vaccine. Out of the ninety-two included participants, 77.2% were females and 79.3% were from Germany. Their mean age was 35.37 ± 12.62 (19–64) years-old, 15.2% had chronic illnesses and 22.8% were receiving medical treatments. Overall, 94.6% of the participants reported at least one SE. The most common local SE was injection site pain (72.8%), and the most common systemic SEs were fatigue (73.9%), muscle pain (55.4%), chills (48.9%), feeling unwell (46.7%), nausea (45.7%), and headache (29.3%). The vast majority (91.9%) resolved within 1–3 days, and the below 35 years-old group was the least affected age group. The SEs’ frequency was insignificantly higher in females and previously infected participants; the vaccine safety for the elderly was supported by the early findings of this study. Chronic illnesses and medical treatments were not associated with an increased risk of SE incidence and frequency. No blood disorder SEs were reported in our sample. Further independent studies are highly required to evaluate the safety of the AstraZeneca vaccine and to explore whether gender or previous infection could be associated with the vaccine SEs.

Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution

Despite high vaccination coverage, pertussis is increasing in many industrialized countries, including the Czech Republic. To better understand Bordetella pertussis resurgence, we analyzed historic strains and recent clinical isolates by using a comparative omics approach. Whole-genome sequencing showed that historic and recent isolates of B. pertussis have substantial variation in genome organization and form separate phylogenetic clusters. Subsequent RNA sequence analysis and liquid chromatography with mass tandem spectrometry analyses showed that these variations translated into discretely separated transcriptomic and proteomic profiles. When compared with historic strains, recent isolates showed increased expression of flagellar genes and genes involved in lipopolysaccharide biosynthesis and decreased expression of polysaccharide capsule genes. Compared with reference strain Tohama I, all strains had increased expression and production of the type III secretion system apparatus. We detected the potential link between observed effects and insertion sequence element–induced changes in gene context only for a few genes.

The use of complementary and alternative medicine by adults with allergies: a Czech national representative survey

BACKGROUND

The prevalence rates of the use of Complementary and Alternative Medicine (CAM) in allergy patients range from 42% in the United States up to 50% in Europe. In the Czech Republic, no such data exists. Our aim was to examine patterns in CAM use in populations with self-reported allergies in the Czech Republic.

METHODS

A cross-sectional survey was conducted. A sample of citizens aged 15 years and older, sex, age, and region-stratified, was randomly selected from the 2014 voter registration lists (n = 8,395,132). Respondents with self-reported allergies were further analyzed.

RESULTS

Overall, 93% of the respondents with self-reported allergies reported the use of 1 or more CAM modalities during the past 30 days. Herbal teas, relaxation techniques, a detoxifying diet, dietary supplements (excluding vitamins and minerals), and reflexology were used in respondents with allergies. Females, under age 30, with higher education, higher income, and self-reported poor health, were significantly associated with the use of CAM among respondents with allergies.

CONCLUSIONS

The prevalence of CAM use among people with self-reported allergies in the Czech Republic is higher compared to other countries, with determinants of CAM varying across specific CAM categories. More attention to existing use is needed to promote the healthy adoption of CAM by raising awareness of its safe and effective use, both for CAM users as well as for health care providers.

Chiral separation of beta-blockers by high-performance liquid chromatography and determination of bisoprolol enantiomers in surface waters

Beta-blockers are chiral compounds with enantiomers that have different bioactivity, which means that while one is active, the other can be inactive or even harmful. Due to their high consumption and incomplete degradation in waste water, they may reach surface waters and affect aquatic organisms. To address this issue we developed a chromatographic method suitable for determining beta-blocker enantiomers in surface waters. It was tested on five beta-blockers (acebutolol, atenolol, bisoprolol, labetalol and metoprolol) and validated on bisoprolol enantiomers. Good enantioseparation of all analysed beta-blockers was achieved on the Chirobiotic V column with the mobile phase composed of methanol/acetic acid/triethylamine (100/0.20/0.15 v/v/v) at a flow rate of 0.5 mL/min and column temperature of 45 °C. Method proved to be linear in the concentration range from 0.075 µg/mL to 5 µg/mL, and showed good recovery. The limits of bisoprolol enantiomer detection were 0.025 µg/mL and 0.026 µg/mL and of quantification 0.075 µg/mL and 0.075 µg/mL. Despite its limitations, it seems to be a promising method for bisoprolol enantiomer analysis in surface water samples. Further research could focus on waste water analysis, where enantiomer concentrations may be high. Furthermore, transferring the method to a more sensitive one such as liquid chromatography coupled with tandem mass spectrometry and using ammonium acetate as the mobile phase additive instead of acetic acid and triethylamine would perhaps yield much lower limits of detection and quantification.

The Use of Diagnosis-Related Group-Based Reimbursement in the Czech Hospital Care System

(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012–2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.