The Intestinal Carriage of Plasmid-Mediated Colistin-Resistant Enterobacteriaceae in Tertiary Care Settings

Background: In order to estimate the prevalence of plasmid borne colistin resistance and to characterize in detail the mcr-positive isolates, we carried out a sentinel testing survey on the intestinal carriage of plasmid-mediated colistin-resistant Enterobacteriaceae in hospitalized patients. Methods: Between June 2018 and September 2019, 1922 faecal samples from hospitalised patients were analysed by selective culture in presence of colistin (3.5 mg/L), and in parallel by direct detection of the mcr-1 to mcr-8 genes by qPCR. The mcr-positive isolates were characterised by whole-genome sequencing. Results: The prevalence of the mcr-1 gene was 0.21% (n = 4/1922); the mcr-2 to 8 genes were not detected. The mcr-1 gene was found to be localised in the IncX4 (n = 3) and IncHI2 (n = 1) plasmid type. One Escherichia coli isolate was susceptible to colistin due to the inactivation of the mcr-1 gene through the insertion of the IS2 element; however, the colistin resistance was inducible by culture in low concentrations of colistin. One human mcr-1 positive E. coli isolate was related genetically to the mcr-1 E. coli isolate derived from turkey meat of Czech origin. Conclusions:mcr-mediated colistin resistance currently poses little threat to patients hospitalised in Czech healthcare settings. The presence of the mcr-1 gene in the human population has a possible link to domestically produced, retail meat.

How to improve access to health care for Roma living in social exclusion: a concept mapping study

Background

Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic.

Methods

We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation).

Results

Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies.

Conclusions

Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01396-4.

Occurrence and genetic diversity of Cryptosporidium spp. in wild foxes, wolves, jackals, and bears in central Europe

Parasites of the genus Cryptosporidium Tyzzer, 1910 are one of the most common protistan parasites of vertebrates. Faecal samples from 179 red foxes (Vulpes vulpes [Linnaeus]), 100 grey wolves (Canis lupus Linnaeus), 11 golden jackals (Canis aureus Linnaeus), and 63 brown bears (Ursus arctos Linnaeus) were collected in the Czech Republic, Poland and Slovakia. Samples were examined for the presence of Cryptosporidium spp. using microscopy and PCR/sequence analysis. Phylogenetic analysis based on the small subunit ribosomal RNA (SSU), actin and 60-kDa glycoprotein (gp60) genes using the maximum likelihood method revealed the presence of Cryptosporidium tyzzeri Ren, Zhao, Zhang, Ning, Jian et al., 2012 (n = 1) and C. andersoni Lindsay, Upton, Owens, Morgan, Mead et Blackburn, 2000 (n = 2) in red foxes, C. canis Fayer, Trout, Xiao, Morgan, Lai et Dubey, 2001 (n = 2) and C. ubiquitum Fayer, Santín et Macarisin, 2010 (n = 2) in grey wolves, and C. galli Pavlásek, 1999 in brown bears (n = 1) and red foxes (n = 1). Subtyping of isolates of C. ubiquitum and C. tyzzeri based on sequence analysis of gp60 showed that they belong to the XIId and IXa families, respectively. The presence of specific DNA of C. tyzzeri, C. andersoni and C. galli, which primarily infect the prey of carnivores, is probably the result of their passage through the gastrointestinal tract of the carnivores. Finding C. ubiquitum XIId in wolves may mean broadening the host spectrum of this subtype, but it remains possible this is the result of infected prey passing through the wolf - in this case deer, which is a common host of this parasite. The dog genotype of C. canis was reported for the first time in wolves.

Protozoan and Helminth Infections of Aviary-Reared Alectoris rufa (Galliformes: Phasianidae) before Releasing for Hunting in the Czech Republic: Infection Dynamics and Potential Risks

Age-related dynamics of protozoan and helminth infections in the red-legged partridge, Alectoris rufa, were studied in an intensive breeding aviary in the Czech Republic before releasing birds for hunting purposes. Pooled fecal samples (n = 900) were examined over 3 rearing seasons (2012-2014). A total of 4 protozoan species, Cryptosporidium baileyi, Cryptosporidium meleagridis, Eimeria kofoidi, and Eimeria legionensis, and 4 helminths, Capillaria phasianina, Eucoleus perforans, Heterakis gallinarum, and Syngamus trachea, was found. The most common parasite was S. trachea (prevalence 20-26%) in dead birds (n = 99), which represents a high risk for breeders. Co-occurrence of protozoans and helminths indicated similarities in infection dynamics throughout the 3 breeding seasons. Mixed infections of Cryptosporidium baileyi and C. meleagridis with other parasitic species are reported for the first time. Our findings provide new insights into breeding of A. rufa and may help to improve the efficacy of disease control strategies and prevention, especially with the potential for spreading of parasitic infections to wildlife through released birds into open areas.

Different epidemiological pattern of canine dirofilariosis in two neighboring countries in Central Europe-the Czech Republic and Slovakia

The known data resulting from individual surveys of canine dirofilariosis point to the great differences in the epidemiological situation among countries where Dirofilaria parasites emerged approximately at the same time. In this regard, the Czech Republic and Slovakia, neighboring countries situated in Central Europe, could serve as an illustrative example of such a situation. The present study aimed to assess the prevalence of canine dirofilariosis in both countries and to discuss the reasons for potential differences shown. Between October and December 2019, 429 dogs from the Czech Republic and 644 from Slovakia were examined for canine dirofilariosis using the Knott test for microfilariae detection and conventional PCR for the species determination. The results' analyses showed notable differences. While in the Czech Republic autochthonous Dirofilaria repens cases are reported sporadically and Dirofilaria immitis infections have been confirmed only as imported so far, in Slovakia, both Dirofilaria species seem to have become endemic. Concretely, in the Czech Republic, microfilariae were detected in the peripheral blood of 8 dogs (1.86%): in seven, D. repens was confirmed, and in one dog, mixed infection with D. repens and D. immitis was diagnosed. Seven infected animals came from the eastern part of the country neighboring Slovakia. In Slovakia, microfilariae were detected in 68 (10.56%) dogs examined. DNA analysis confirmed D. repens mono-infection in 38 (5.90%) dogs, single D. immitis infection in 21 (3.26%) animals, and both Dirofilaria species were detected in 9 (1.40%) samples. Although we are unable to determine the cause of the differences, our study confirmed that the long-registered low number of canine dirofilariosis cases in the Czech Republic is not due to insufficient investigation (monitoring), but due to a low prevalence of the parasite in this area.

The risk of insect-borne diseases transmission in the Czech Republic and Slovakia

There are many species of arthropods in the Czech Republic and Slovakia that suck blood in humans and cause unpleasant skin reactions. The extent and type of local reaction depends on the number of previous exposures to the given ectoparasite species, which is also related to possible therapeutic interventions. The review summarizes the classes of arthropods that suck blood in humans in the Czech Republic and Slovakia. The most important families of ticks (Ixodidae) and mosquitoes (Culicidae) pose the risk of transmitting the infection to humans. The individual infectious diseases, especially the possibilities of diagnosis and treatment of stages not requiring hospital care, and the most common myths related to this issue are briefly described.

Listeriosis - an analysis of human cases in the Czech Republic in 2008-2018

AIM

The aim of our work was to summarize the most important knowledge about listeriosis in humans and to analyse available epidemiological data on this disease in the Czech Republic in 2008-2018.

METHODS

We conducted a literature search and descriptive epidemiological analysis of all human Listeria cases reported to the national surveillance system of infectious diseases (EpiDat until 2017, ISIN for 2018) in the Czech Republic in 2008-2018. For data management and analysis, MS Excel 2010 was used. The incidence maps were created using the ECDC Map Maker tool (EMMa).

RESULTS

In total, 380 cases of human listeriosis (mean annual incidence of 0.33/100 000 inhabitants) were reported in the Czech Republic in 2008-2018. The highest age specific incidence was detected in 0-year-olds (1.85/100 000) and then in persons over 60 years (mean incidence of 0.95/100 000). Altogether 222 cases were detected in men (mean incidence of 0.39/100 000) and 158 in women (mean incidence of 0.27/100 000). Geographically, the highest mean annual incidence was reported in the Moravian-Silesian Region (0.6/100 000) and Pilsen Region (0.57/100 000). As many as 96.3% of the reported cases required hospital admission. Of 81 deaths related to listeriosis, 50 were directly caused by listeriosis. The highest monthly incidence was observed in June through October and then in January.  The incidence of listeriosis in the CZ shows an oscillating trend over the last 11 years. Neither epidemics nor imported cases were reported to the national surveillance system during the study period.

CONCLUSIONS

Listeriosis cases have been on the rise in the European Union (EU) over the last years, while in the CZ, an oscillating and slightly increasing trend has been observed. Generally, cases are reported mostly in the population aged over 64 years (and especially after the age of 84). As there is no vaccine available yet against this disease, the only option is the prevention, i.e., health education of consumers in general and of the risk groups in particular, and compliance with food safety and hygiene standards in food production and handling.

The Bark Beetle Phloeotribus rhododactylus (Coleoptera: Curculionidae) Has a Stable Range in Europe

Simple Summary

The abundance of bark beetles is generally explained by resource-related parameters. The bark beetle Phloeotribus rhododactylus feeds mainly on the shrub Cytisus scoparius. Other host plants include Spartium junceum, Cytisus sp., Ulex europaeus, Calicotome sp., Coronilla emeroides, Genista florida, Adenocarpus complicatus, and Ficus carica. Phloeotribus rhododactylus seems to have a stable range that is centred in Western Europe and extends to Eastern Europe. Its abundance is highest in Western Europe and decreases to the east, which coincides with the distribution of the host tree, Cytisus scoparius. Even though Cytisus scoparius is an invasive plant in agricultural and natural ecosystems out of Europe, Phloeotribus rhododactylus has not been found in any of the areas invaded by Cytisus scoparius.

Abstract

The bark beetle Phloeotribus rhododactylus feeds mainly on the shrub Cytisus scoparius. The range of P. rhododactylus extends from Spain in the south to southern Sweden, Denmark, and Scotland in the north. Its range to the east extends to Poland, Slovakia, and Hungary, but single localities are known further east in Romania, Bulgaria, and Greece. It is clear that the range of the beetle matches that of its main host. C. scoparius is adapted to Mediterranean and coastal climates, and its range is limited by low winter temperatures. P. rhododactylus is, therefore, rare in Central Europe. It infests either individuals of C. scoparius that have been damaged by mammalian herbivores or snow or that are drought-stressed. Although C. scoparius is an invasive plant in agricultural and natural ecosystems, P. rhododactylus has not been found in any of the areas where C. scoparius has invaded.

Bulimia symptoms in Czech youth: prevalence and association with internalizing problems

OBJECTIVE

Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status.

METHOD

The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations.

RESULTS

The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems.

DISCUSSION

Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study (according to Oxford (UK) CEBM Levels of Evidence, 2011).

A very rare case of possible actinomycosis of the mandible from the Middle Ages

OBJECTIVE

Documented cases of actinomycosis in archaeological skeletons are very rare, especially from Central Europe. Our contribution will help facilitate the differential diagnosis of this disease for other paleopathologists.

MATERIAL

This paper describes a pathological finding of the skeleton of a 40-year-old male from a burial ground in Sady-Špitálky (Czech Republic) dated to the 10th-12th century.

METHODS

The affected skeleton was evaluated as a probable case of actinomycosis on the basis of a detailed macroscopic, X-ray and histological examination. The osteolytic foci examined were compared with similar changes caused by tuberculosis, syphilis and mycoses.

RESULTS

The character and location of the defect on the mandible is indicative of organ actinomycosis and is also reflected by the lytic lesion observed on a lumbar vertebra.

CONCLUSIONS

The described case can be considered one of the very rare paleopathological findings of possible actinomycosis in humans in Central Europe.

SIGNIFICANCE

Good evidence of bone actinomycosis findings may be beneficial for further paleopathological and epidemiological studies, especially for research focused on the diachronic development of actinomycosis in Europe. In doing so, all available factors, such as hygiene habits, nutrition, social structure and overall health of the population that could be causally related to its origin, course and treatment, can be taken into account.

LIMITATIONS

The mandible of the studied individual was damaged, especially in the area affected by the lesion, so the paleopathological analysis was difficult to perform.

SUGGESTION FOR THE FUTURE RESEARCH

In future, actinomycosis in this skeleton may be confirmed by bio-molecular analysis.

Changes in Cognitive Impairment in the Czech Republic

BACKGROUND

Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts.

OBJECTIVE

We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic.

METHODS

The study used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out.

RESULTS

The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education.

CONCLUSION

Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.

Spontaneous reports of adverse drug reactions related to oral anticoagulants in the Czech Republic

Background Oral anticoagulants are established drugs of choice for the prevention and treatment of thromboembolic events. However, monitoring their safety remains warranted. Objective The aim was to analyze spontaneous reports of adverse drug reactions related to oral anticoagulants in the Czech Republic. Setting Retrospective observational pharmacovigilance study. Methods Adverse drug reaction reports were obtained from the State Institute for Drug Control between January 2005 and November 2017. Reports related to warfarin, dabigatran, apixaban, and rivaroxaban received from healthcare professionals and patients were analyzed. Main outcome measure Frequency and nature of adverse drug reactions reported to oral anticoagulants. Results In total, 297 reports containing 672 adverse drug reactions were received; 269 reports were sent by healthcare professionals (85% by physicians). In 65% of all reports, reactions were due to direct oral anticoagulants. A higher total number of adverse drug reactions was associated with direct oral anticoagulants than with warfarin [reporting odds ratio (ROR): 10.76; confidence interval (CI): 8.70-13.32; p < 0.001]. Along with the increasing utilization of direct oral anticoagulants, the reporting rate gradually declined over time, especially for rivaroxaban and apixaban. Fatal outcomes were reported in 7%, mostly for dabigatran. Hemorrhagic reactions were the most frequently reported adverse drug reactions (37% associated with dabigatran, 28% with apixaban, 24% with warfarin, and 23% with rivaroxaban), and compared to warfarin, they were significantly more often associated with direct oral anticoagulants (ROR: 14.36; CI: 9.57-21.54; p < 0.001). Conclusion The number of adverse drug reaction reports related to oral anticoagulants in the Czech Republic was relatively low, compared to other studies, but 96% of the cases were serious. Data from spontaneous adverse drug reactions reporting should be further analyzed in order to obtain additional information on the safety profile of oral anticoagulants.

Childhood cancer epidemiology in the Czech Republic (1994-2016)

BACKGROUND

The knowledge of cancer burden in the population, its time trends and the possibility of international comparison is an important starting point for cancer control programmes. Our study aimed to evaluate trends in childhood cancer epidemiology of patients aged 0-14 years in the period 1994-2016 in the Czech Republic.

METHODS

Data on childhood cancers have been obtained from the Czech National Cancer Registry. These data were validated using the clinical database of childhood cancer patients and combined with data from death certificates. Incidence and mortality trends were assessed by the joinpoint regression method. The life tables method was used to calculate the overall age-standardised five-year survival.

RESULTS

The incidence trend was stable; the age-standardised (world) cancer incidence - ASR (W) - was 173.7 per 1 million children in the period 1994-2016. However, there was apparent significant decrease in mortality: ASR (W) dropped from 58.1 per 1 million children in 1994 to 21.4 per 1 million children in 2016. The overall five-year survival increased over time by 10 %. Statistically significant improvements in survival were observed in patients with lymphoid leukaemia, astrocytomas, neuroblastomas, osteosarcomas and rhabdomyosarcomas.

CONCLUSION

Such a relevant increase in survival rates, and therefore also a decrease in mortality rates in the Czech Republic, is most likely due to improvements in diagnostic and treatment methods since the 1990s, which were facilitated by the concentration of childhood cancer patients in children's cancer centres.

Current state and future directions of bioeconomy in the Czech Republic

This article presents the current status of the development of bioeconomy in the Czech Republic. Although the country has no unified strategy on bioeconomy, there are ambitious governmental innovation strategies and focused strategies for each region. Traditionally, the country has had a strong research performance in chemistry and biology, which together with developed agriculture, forestry and food industries, provides a good foundation for the development of locally based circular systems. Moreover, the government supports research on tools and applications of new plant breeding technologies, including genome editing, and there is a strong initiative from the research community calling to update EU regulatory policy in this area.

The Identification of Precursor Regulation Impact on the Methamphetamine Market and Public Health Indicators in the Czech Republic: Time Series Structural Break Analysis

BACKGROUND

This study provides insight into the impact of methamphetamine precursor regulation, which is considered to be one of the most important tools of supply reduction and a tool with potential public health impact.

METHODS

It is based on a longitudinal and quasi-experimental design and it investigates the changes of methamphetamine precursor regulation in Czech Republic, which is treated as a natural experiment. The statistical analysis uses features from the generalized fluctuation test framework as well as from the F test framework to estimate structural changes in the methamphetamine-related arrests and nonfatal intoxications time series.

RESULTS

The analysis identified structural breaks in the majority of the methamphetamine drug market-related time series in the period related to the tightening of regulation. The results of this study show that methamphetamine precursor regulation was associated with the proliferation of international and organized crime groups and with no change in the overall number of arrests and nonfatal intoxications.

CONCLUSIONS

The precursor regulation ceteris paribus plausibly leads to the change in drug supply towards more organized groups and to an increasing involvement of foreign nationals at the drug market and is not effective in suppressing the methamphetamine market and in reducing the public health indicator of nonfatal methamphetamine intoxications.

Anticipated Social and Healthcare Economic Burden of People with Alzheimer's Disease in Two Selected Regions of the Czech Republic

Increasing life expectancy in modern society is undoubtedly due to improved healthcare, scientific advances in medicine, and the overall healthy lifestyle of the general population. However, this positive trend has led to an increase in the number of older people with a growing need for a sustainable system for the long-term care of this part of the population, which includes social and health services that are essential for a high quality of life. Longevity also brings challenges in the form of a polymorbid geriatric population that places financial pressure on healthcare systems. Regardless, one disease dominates the debate about financial sustainability due to the increasing numbers of people diagnosed, and that is Alzheimer’s disease (AD). The presented paper aims to demonstrate the economic burden of social and healthcare services. Data from two regions in the Czech Republic were selected to demonstrate the potential scope of the problem. The future costs connected with AD are calculated by a prediction model, which is based on a population model for predicting the number of people with AD between 2020 and 2070. Based on the presented data from the two regions in the Czech Republic and the prediction model, several trends emerged. There appears to be a significant difference in the annual direct costs per person diagnosed with AD depending on the region in which they reside. This may lead to a significant inequality of the services a person can acquire followed by subsequent social issues that can manifest as a lower quality of life. Furthermore, given the prediction of the growing AD population, the costs expressed in constant prices based on the year 2020 will increase almost threefold during the period 2020–2070. The predicted threefold increase will place additional financial pressure on all stakeholders responsible for social and healthcare services, as the current situation is already challenging.

Conceptualization of Roma in Policy Documents Related to Social Inclusion and Health in the Czech Republic

In the Czech Republic, a number of strategy papers and policy documents are guiding the direction of Roma inclusion, including in the area of health. The conceptualization of Roma and how mainstream political and public discourse operate with the term “Roma” contribute to a mistakenly homogenous and harmful image of Roma that conforms to negative stereotypes. The aim of our study was to examine the conceptualization of Roma in policy documents related to social inclusion and health in the Czech Republic. Relevant political, strategic and project documents were selected for analysis. Emphasis is placed in them on individual responsibility in relation to health, while structural conditions and discrimination are mentioned less often. Roma are described in relation to health primarily as people who should be educated. More emphasis is placed on the economic benefits of eliminating health inequalities than on citizens’ rights and the importance of inclusion. When “participation” or “empowerment” is mentioned, it is done vaguely, usually in addition to references to completely non-participatory practices. The majority is the primary actor in the field of eliminating health inequalities, as it defines the “path” that Roma need to be shown or determines what is needed to “stimulate” citizens. Although the political discourse concerning Roma has shifted more towards human rights, equity and combating discrimination in the Czech Republic, subtle forms of anti-Gypsyism still seem to be present.

Understanding the crisis in harm reduction funding in Central and Eastern Europe

Background

The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region.

Methods

Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions.

Results

The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare.

Conclusion

The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.

Chronic hepatitis C virus infection in the Czech Republic and Slovakia: an analysis of patient and virus characteristics

OBJECTIVES

The MOSAIC study gathered data on chronic hepatitis C virus (HCV) infection and its treatment in various countries worldwide. Here we summarise patient and HCV characteristics in the Czech Republic and Slovakia.

METHODS

MOSAIC was an observational study that included patients with chronic HCV infection untreated at the time of enrolment. Study collected and descriptively analysed patient demographics, disease stage and viral characteristics. Data were collected between February 2014 to October 2014.

RESULTS

Among 220 patients enrolled, 51.4% were treatment-naïve. The most prevalent HCV genotype was G1 (78.4%), followed by G3 (19.7%). Higher prevalence of G1 was found in treatment-experienced patients (94.3%) compared to treatment-naïve (63.4%). Most participants (67.7%) presented viral RNA load of ≥ 800,000 IU/mL. Liver cirrhosis was reported in 24.5% of patients. Higher HCV RNA load and duration of HCV infection correlated with the degree of liver fibrosis. Anti-HCV interferon-based treatments were initiated in 88.2% of participants.

CONCLUSIONS

The study confirmed significant changes in the HCV genotypes partition with G3 genotype rapidly increasing in both countries, with possible impact on the WHO eradication initiative and treatment selection.

Czech and Slovak life scripts: the rare case of two countries that used to be one

In this study, we examined cultural life scripts in two countries, the Czech Republic and Slovakia. The cultural life script is semantic knowledge about culturally shared expectations regarding the order and timing of important life events during an idealised life course. For many decades, Slovakia and the Czech Republic were one country: Czechoslovakia. After a regime change in 1989 and the separation of the Czech Republic and Slovakia in 1993, their two cultures have been evolving and changing independently from one another, making these countries interesting for examining life scripts. We found that the cultural life scripts provided by Slovak and Czech participants shared 25 event categories, representing 89.3% of event categories in the Czech sample and 80.6% of event categories in the Slovak sample (including the category Other). However, participants also reported unique event categories to each culture (10.7% of unique event categories in the Czech sample and 19.4% in the Slovak sample), reflecting the specific cultural characteristics of these two separate countries. Reported events were listed in the same order they are expected to happen during the life span, were mostly positive, and showed a lifespan distribution consistent with the reminiscence bump. Participants showed higher agreement in the age estimates of positive events, compared to neutral and negative ones. Events were mostly social, in contrast to biological events. All these findings are consistent with the life script literature.

Landscape epidemiology of neglected tick-borne pathogens in central Europe

Studies of tick-borne diseases (TBDs) in Europe focus on pathogens with principal medical importance (e.g. Lyme disease and tick-borne encephalitis), but we have limited epidemiological information on the neglected pathogens, such as the members of the genera Anaplasma, Rickettsia, Babesia and Candidatus Neoehrlichia mikurensis. Here, we integrated an extensive field sampling, laboratory analysis and GIS models to provide first publicly available information on pathogen diversity, prevalence and infection risk for four overlooked zoonotic TBDs in the Czech Republic. In addition, we assessed the effect of landscape variables on the abundance of questing ticks at different spatial scales and examined whether pathogen prevalence increased with tick density. Our data from 13,340 ticks collected in 142 municipalities showed that A. phagocytophilum (MIR = 3.5%) and Ca. Neoehrlichia mikurensis (MIR = 4.0%) pose geographically uneven risks with localized hotspots, while Rickettsia (MIR = 4.9%) and Babesia (MIR = 1.1%) had relatively homogeneous spatial distribution. Landscape variables had significant effect on tick abundance up to the scale of 1 km around the sampling sites. Questing ticks responded positively to landscape diversity and configuration, especially to forest patch density that strongly correlates with the amount of woodland-grassland ecotones. For all four pathogens, we found higher prevalence in places with higher densities of ticks, confirming the hypothesis that tick abundance amplifies the risk of TB infection. Our findings highlight the importance of landscape parameters for tick vectors, likely due to their effect on small vertebrates as reservoir hosts. Future studies should explicitly investigate the combined effect of landscape parameters and the composition and population dynamics of hosts on the host-vector-pathogen system.

A Study on the Prevalence and Subtype Diversity of the Intestinal Protist Blastocystis sp. in a Gut-Healthy Human Population in the Czech Republic

Blastocystis sp. is a common intestinal protist colonizing the human intestine the prevalence of which varies across non-industrialized and industrialized countries. Its role in the human gut ecosystem remains unclear due to persisting gaps in knowledge of epidemiology and factors affecting gut colonization. Here, we aimed to expand the knowledge of the epidemiology of Blastocystis sp. in the gut-healthy humans in one of the industrialized European countries, including the distribution of its subtypes, the correlation between its occurrence and several factors such as lifestyle, contact with animals, age, and sex. A total of 288 stool samples were obtained from asymptomatic individuals over the entire age-range and 136 samples from animals with which the volunteers were in frequent contact. All samples were examined in parallel by PCR and xenic in vitro culture. Blastocystis sp. was detected in samples from both human and non-human hosts. In humans, the overall prevalence was 24% and eight subtypes were found; in animals, the prevalence was 10%, and only five subtypes were detected. A higher incidence of Blastocystis sp. was observed in individuals (i) traveling outside Europe, (ii) in frequent contact with livestock, and (iii) over 50 years of age. We found no effect on gender on Blastocystis sp. colonization.

Summary

This study provides data on the prevalence and diversity of the gut protist Blastocystis sp. and its subtypes in a gut-healthy human population with emphasis on several factors such as contact with animals, lifestyle, age, and gender.

Cadmium contents of vertically and horizontally deposited winter precipitation in Central Europe: Spatial distribution and long-term trends

Cadmium (Cd) and its forms has recently been a focus of attention due to its toxic effects on human health and the environment. We evaluated the atmospheric deposition of Cd during three consecutive winter seasons (2009-2011) at 10 mountain-top locations in the Czech Republic along the borders with Poland, Germany, Austria and Slovakia. Cadmium concentrations of soluble and insoluble forms in both horizontal (rime) and vertical (snow) deposition were determined using sector-field ICP-MS. Across the sites, 94% of the total winter Cd deposition occurred in the soluble (environmentally available) Cd form. Mean concentrations of soluble Cd in rime were six times higher than in snow (398 vs. 66 ng L^-1). Vertical deposition contributed as much as 41% to the total winter Cd input. Between-site variability in Cd deposition was large, ranging between 13 and 108 μg m^-2 winter^-1. Overall, Cd concentrations in winter deposition did not reach the drinking water limits and did not pose a direct threat for human health. Long-term trends (1996-2017) in winter Cd deposition were evaluated at six GEOMON sites (a monitoring network of small forested catchments). Since 1996, Cd input in winter atmospheric deposition decreased by 73-93%. Simultaneously, we found declines in between-site variability in winter Cd inputs. The highest recent winter Cd inputs were found at sites located in the northeast of the country. A north-south pollution gradient, which has frequently been mentioned in the literature, was not observed, with both northwestern sites and southern sites being among those with the lowest Cd pollution. Backward trajectories of the HYSPLIT model for fresh snow samples identified Poland and Germany as major transboundary Cd pollution sources for the Czech Republic.

Contrasts in alcohol-related mortality in Czechia and Lithuania: Analysis of time trends and educational differences

INTRODUCTION AND AIMS

Globally, Czechia and Lithuania are among the top-ranking countries in terms of high alcohol consumption. This study highlights notable contrasts in temporal trends in alcohol-related mortality and identifies country-specific patterns in educational differences.

DESIGN AND METHODS

The study uses harmonised cause-of-death series from the Human Cause of Death Database. Mortality disparities by education were assessed using census-linked mortality data. Directly standardised death rates were used to estimate levels of national and group-specific mortality. Relative and absolute mortality differences by education were assessed by range-type measures (Poisson regression mortality ratios and rate differences) and Gini-type measures.

RESULTS

Between 1994-1995 and 2016, the absolute difference between Czechia and Lithuania in terms of alcohol-related age-standardised death rates (per 1 000 000) decreased from 450 for males and 130 for females to 76 in males and 11 in females. In both countries, alcohol-related mortality was markedly higher among persons of lower education levels. Lithuanian males experienced the highest absolute inequalities measured by rate difference between the low and high educated (740 per million), while Lithuanian females showed the most pronounced relative inequalities (6.70-fold difference between low and high educated). The corresponding figures were less than half for Czechia.

DISCUSSION AND CONCLUSIONS

Reducing educational disparities in alcohol-related mortality within both countries would have a substantial impact on overall levels. Policies aimed at targeting the lowest priced and illegal alcohols and reducing levels of harmful drinking should be a priority, especially in Lithuania.