Risk Factors in Ischemic Stroke Subtypes: A Community-Based Study in Brno, Czech Republic

BACKGROUND

It is not known if risk factors differ between ischemic stroke (IS) subtypes in Central and Eastern Europe.

AIMS

We performed a community-based analysis of risk factors in patients admitted with IS over a 1 year period in Brno, the second largest city in the Czech Republic (CR).

METHODS

Based on the National Register of Hospitalized Patients, all patients with IS admitted in Brno in 2011 were identified. Comprehensive discharge summaries from hospital admissions were collected and reviewed. IS subtype and relevant risk factors were ascertained for all patients. The age- and sex-adjusted association of risk factors with IS subtypes was determined.

RESULTS

Overall, 682 patients with IS were admitted in 2011 to Brno hospitals. The distribution of IS subtypes was: 35% cardioembolism, 28% large-artery atherosclerosis, 23% small-artery occlusion, 7% stroke of undetermined etiology, 7% stroke of other determined etiology. Several of the risk factors showed high prevalence in the overall sample - e.g. hypertension (84%) and hyperlipidemia (61%). Cardioembolism as compared to other subtypes was positively associated with a history of myocardial infarction, cardiac failure, and atrial fibrillation. Small-artery occlusion was positively associated with history of dementia. No significant association was found between IS subtypes and history of IS, hypertension, diabetes, obesity, alcohol abuse or smoking.

CONCLUSIONS

We found high frequency of stroke risk factors in all IS subtypes. These findings have implications for stroke prevention strategies in the CR and across Central Europe.

Molecular Epidemiology of Hantaviruses in the Czech Republic

During 2008–2018, we collected samples from rodents and patients throughout the Czech Republic and characterized hantavirus isolates. We detected Dobrava-Belgrade and Puumala orthohantaviruses in patients and Dobrava-Belgrade, Tula, and Seewis orthohantaviruses in rodents. Increased knowledge of eco-epidemiology of hantaviruses will improve awareness among physicians and better outcomes of patients.

Decreasing litterfall mercury deposition in central European coniferous forests and effects of bark beetle infestation

We evaluated a 14-year trend (2003-2017) in mercury (Hg) concentrations and fluxes in six litterfall categories (needles, bark, twigs, cones, lichen, and a mixture of unidentified fragments) at six research plots situated in two central European unmanaged mountain forest stands, dominated by mature Norway spruce. One of the stands (catchment of Plešné Lake, PL) was infested by bark beetle and all mature spruces died at three of four research plots during the study. One PL plot and two plots in the second stand (catchment of Čertovo Lake, CT) were intact and used as a control. At the intact plots, the litterfall Hg deposition averaged 45 and 32 μg/m²/year in the PL and CT catchments, respectively, while bulk precipitation Hg deposition was an order of magnitude lower (2.6 μg/m²/year). In the individual litter categories, Hg concentrations averaged 223, 195, 126, 81, 79 and 30 μg/kg in lichen, unidentified fragments, bark, twigs, needles and cones, respectively. As a result of decreasing European Hg emissions, Hg concentrations in most litter categories decreased from 2003 to 2017. Consequently, the litter-associated Hg flux to the forest floor decreased from 66 to 23 μg/m²/year during 2003-2017. The litterfall mass fluxes exhibited no trends at the intact plots. In contrast, the litter-associated Hg flux increased 5-fold after tree dieback due to elevated litterfall, averaging 218 μg/m²/year Hg at the PL infested plots during 2004-2009. The relative contribution of individual litter categories to the total Hg flux shifted from needle to bark and twig dominance. Starting in 2010, Hg flux decreased to pre-disturbance levels for the following decade. The tree mortality in the PL catchment provided a unique opportunity to evaluate changes in litter-associated Hg fluxes to the forest floor during and after natural tree dieback.

Situating biologies of traditional Chinese medicine in Central Europe

Since the concept of 'local biologies' was proposed in the 1990s, it has been used to examine biosocial processes that transform human bodies in similar and different ways around the globe. This paper explores understandings of biosocial differentiation and convergence in the case of Traditional Chinese Medicine (TCM) in the Czech Republic. Specifically, it examines how Czech TCM practitioners view TCM as universally applicable while fine-tuning it to situated biosocial conditions, experimenting with the compatibilities of various human and plant bodies as part of their generalised, clinical practice. Drawing upon ethnographic research among TCM practitioners in the Czech Republic, it suggests that in addition to the individualization of TCM therapeutics to suit particular patients, Czech TCM is characterised by collective particularization, shaped by local concerns over ethnic, environmental and cultural differences. By looking critically at TCM practitioners' sensitivities to localised biological similarities and differences it aims to contribute to understandings of the expansion of TCM in Central Europe, as well as more broadly to current social science debates over the risks and opportunities inherent in abandoning the assumption of a universal human body and biology.

Data of a sub-analysis of the DEMDATA study: characteristics of Austrian and Czech nursing homes residents

Objectives

The aim of this data paper is to provide the data set of a sub-analysis of the DEMDATA study data. In the DEMDATA study, epidemiological data on the prevalence and severity of dementia, as well as functioning, behavioral problems and other health related factors in residents living in Austrian and Czech nursing homes were collected. The DEMDATA project further provides information on relatives’ perception of the life Quality of residents, care team burden as well as environmental factors. Participating nursing homes were randomly drawn and stratified. Inclusion criteria for participation were that the resident was living permanently in the institution and that he/she and/or a legal representative (where relevant) had signed an informed consent.

Data description

This paper provides data of cognitive, functional and behavioral assessments as well as other health related information of 1085 residents living in Austrian and Czech nursing homes. For each resident, several measurements on his or her cognitive, functional, and behavioral status are available. Also further health-related factors such as quality of life, pain, numbers of falls and hospital stays are provided.

Psychology in the Czech lands: Bohemia, Czechoslovakia, and the Czech Republic

The article provides a comprehensive review of Czech psychology-its history and its current state. It enumerates significant psychologists who were Czech, born in Bohemia or who were instrumental for the development of psychology in the region. The article also enumerates Czech psychological associations along with their main representatives, journals, and academic facilities involved in education and research in psychology. It is pointed out that the origins of psychology as a science are in the Central Europe-the first laboratory of W. Wundt was in Leipzig, Germany; S. Freud was born in Bohemia, in the Moravian city of Příbor and he practiced in Vienna, Austria. The Czech capital Prague will also become the capital of the psychological science in 2020 when it will be hosting the 32nd International Congress of Psychology (ICP 2020).

Chronic hepatitis C in the Czech Republic: Forecasting the disease burden

OBJECTIVE

Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown.

METHODS

Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets.

RESULTS

The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liver-related deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030.

CONCLUSIONS

Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.

Epidemiology of rare diseases detected by newborn screening in the Czech Republic

OBJECTIVES

Presymptomatic detection of patients with rare diseases (RD), defined by a population frequency less than 1 : 2,000, is the task of newborn screening (NBS). In the Czech Republic (CZ), currently eighteen RD are screened: phenylketonuria/hyperphenylalaninemia (PKU/HPA), congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), medium chain acyl-CoA dehydrogenase deficiency (MCADD), long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD), very long chain acyl-CoA dehydrogenase deficiency (VLCADD), carnitine palmitoyl transferase I and II deficiency (CPTID, CPTIID), carnitine-acylcarnitine translocase deficiency (CACTD), maple syrup urine disease (MSUD), glutaric aciduria type I (GA I), isovaleryl-CoA dehydrogenase deficiency (IVA), argininemia (ARG), citrullinemia (CIT), biotinidase deficiency (BTD), cystathionine beta-synthase-deficient homocystinuria (CBSD HCU), and methylenetetrahydrofolate reductase deficiency homocystinuria (MTHFRD HCU). The aim was to analyze the prevalence of RD screened by NBS in CZ.

METHODS

We examined the NBS programme in CZ from 1 January 2010 to 31 December 2017, which covered 888,891 neonates. Dried blood spots were primarily analyzed using fluorescence immuno-assay, tandem mass spectrometry and fluorimetry.

RESULTS

The overall prevalence of RD among the neonate cohort was 1 : 1,043. Individually, 1 : 2,877 for CH, 1 : 5,521 for PKU/HPA, 1 : 6,536 for CF (1 : 5,887 including false negative patients), 1 : 12,520 for CAH, 1 : 22,222 for MCADD, 1 : 80,808 for LCHADD, 1 : 177,778 for GA I, 1 : 177,778 for IVA, 1 : 222,223 for VLCADD, 1 : 296,297 for MSUD, 1 : 8,638 for BTD, and 1 : 181,396 for CBSD HCU.

CONCLUSIONS

The observed prevalence of RD, based on NBS, corresponds to that expected, more precisely it was higher for BTD and lower for MSUD, IVA, CBSD HCU, MCADD and VLCADD. Early detection of rare diseases by means of NBS is an effective secondary prevention tool.

Comparison of oral health in children aged 5-6 years in the Czech Republic and Yemen

OBJECTIVE

Dental caries is the most widespread oral disease in the world, with multifactorial aetiology. It hinders not only the ability to eat good food, but also affects perfect speech and well-being. As the disease is almost completely preventable, and at its early stage well treatable, the prevalence of dental caries expresses the lack of public health literacy and skills in dental hygiene, and availability of adequate dental care. Children are especially vulnerable to dental caries, hence the WHO recommends regular monitoring of children's oral health and also appropriate controls for its continual improvement. We describe the part of the study targeted on dental health of Czech (CR) and Yemeni (YE) school children and its association with basic anthropometric markers of their nutrition.

METHODS

Total of 190 children aged 5-6 years (100 from CR and 90 from YE, 111 males, 79 females - 22.5% of the wider study on 5-15 years old children) were involved (after obtaining informed consent from their parents). The sample is not representative. All dental examinations were performed in accordance with the WHO criteria by the same examiner. Each individual tooth, whether primary or permanent, was identified as intact, untreated decayed, extracted or filled. Also, dmft/DMFT indexes for individual children were calculated. Anthropometric measurements were performed by standardized methods and the body mass index (BMI-for-age) was calculated. For the statistical evaluation of differences, the program MedCalc Software Inc., Belgium, was used, especially t-test, Pearson's correlation (rho with 95% confidence interval (CI) and Spearmen's rank correlation coefficient; p-values less than 0.05 were considered significant.

RESULTS

Dental caries prevalence and dmft scores (2.12-4.31) were found to be rather high among this age group of children, with no significant differences in relation to gender and country; only 30.0% or less of children were caries free. The decayed component was the major part of the dmft scores, and the evaluation of restorative index (ri%) indicates a high percentage of untreated caries and a high treatment need. Especially in Yemeni children dental caries is wholly untreated (ri 0.0 %), but also in the CR the dental care is rather poor (ri 38-41%). The levels of association(s) between oral health markers (dmft/DMFT) and BMI were inconsistent (both positive and negative), but without statistical significance.

CONCLUSIONS

The high prevalence of poor dental health in these groups of Czech and Yemeni children and low or even no treatment urge effort to include WHO recommendations for practice into the national health policies. Prevention and control of dental caries can be promoted not only by dentists, targeting children and the whole family and their dental habits and lifestyle, with the cooperation of schools, paediatricians, general practitioners and with gynaecologists targeting new and expectant mothers, to increase their knowledge and skills.

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

INTRODUCTION

Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic.

METHODS

A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS

IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained.

CONCLUSION

The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic.

FUNDING

Novo Nordisk. Plain language summary is available for this article.

Web-Based Communication of Socially Responsible Activities by Gambling Operators

Application of the concept of corporate social responsibility (CSR) is of fundamental importance for the future existence and success of gambling operators, the activity of which is linked to a risk of addiction to gambling together with the negative impacts of this on the health and wellbeing of gamblers, families and society as a whole. Gambling operators must apply and effectively communicate socially responsible activities in the economic, environmental, ethical, social and philanthropic fields and in particular in the field of responsible gambling. Nowadays, it is necessary to ensure communication via modern channels in the form of corporate websites and social networks. This study evaluates the level of web-based CSR communication by gambling operators which operate in one of the post-communist countries-the Czech Republic (114 companies). It at the same time provides an alternative method of evaluating the level of CSR communication by gambling operators which makes it possible to uncover weaknesses and room for improvement on the part of the gambling operator's CSR communication practices. The results of the study show that the level of web-based CSR communication of gambling operators operating in the Czech Republic is low, both in comparison with controversial companies and also with non-controversial companies. Economic responsibility activities, responsible gambling and philanthropic responsibility activities are communicated to the greatest extent. On the contrary, ethical responsibility activities are communicated the least.

Circulation of influenza A and B in the Czech Republic from 2000-2001 to 2015-2016

Background

To improve national influenza vaccination recommendations, additional data on influenza A and B virus circulation are needed. Here, we describe the circulation of influenza A and B in the Czech Republic during 16 seasons.

Methods

This was a retrospective analysis of data collected from the 2000–2001 to 2015–2016 influenza seasons by the Czech Republic national influenza surveillance network. Influenza was confirmed and viral isolates subtyped by virological assays followed by antigen detection or by reverse transcriptase-polymerase chain reaction.

Results

Of 16,940 samples collected, 5144 (30.4%) were influenza-positive. Influenza A represented 78.6% of positive cases overall and accounted for more than 55.0% of all influenza cases in every season, except for 2005–2006 (6.0%). Both A/H1N1 and A/H3N2 were detected in most seasons, except for 2001–2002 and 2003–2004 (only A/H3N2), and 2007–2008 and 2009–2010 (only A/H1N1). Influenza B represented 21.4% of positive cases overall (range, 0.0–94.0% per season). Both influenza B lineages were detected in three seasons, a single B lineage in 11, and no B strain in two. For the 11 seasons where influenza B accounted for ≥20% of positive cases, the dominant lineage was Yamagata in six and Victoria in four. In the remaining season, the two lineages co-circulated. For two seasons (2005–2006 and 2007–2008), the B lineage in the trivalent influenza vaccine did not match the dominant circulating B lineage.

Conclusions

In the Czech Republic, during the 2000–2001 to 2015–2016 influenza seasons, influenza virus circulation varied considerably. Although influenza A accounted for the most cases in almost all seasons, influenza B made a substantial, sometimes dominant, contribution to influenza disease.

Assessment of geogenic input into Bilina stream sediments (Czech Republic)

Over the past 100 years, the area along the River Bílina has been influenced by open-cast brown-coal mining, coal processing, petroleum refineries, and chemical plants. As a result, the extensive industrial activity has changed the overall character as well as the morphology of the landscape. A survey was underway to investigate the occurrence and distribution of various elements in the sediments of the River Bílina-a tributary of the River Elbe, a watercourse running through the Czech Republic and Germany-in order to discern the natural background from anthropogenic pollution. The study evaluated the content of selected elements (As, Zn, Pb, Cr, Ni, V, and Cu) in stream sediments of the River Bílina. Samples were taken at 20 sampling sites throughout the 82-km-long watercourse. For all the samples, the content of the elements was determined using ICP-MS after each of the sample was digested using HF and HNO₃. The results of analyses of elemental composition of stream sediments were compared with those found through such analyses made within the surrounding geological units-more specifically, Proterozoic crystalline, Tertiary volcanic, Quaternary loess, Neogene sediments, and Neogene coal. All the samples of the stream sediments examined revealed increased amounts of As, V, Ni, Cr, and Pb. Using the enrichment factor established on the basis of the regional geological background values proved that elevated levels of elements in stream sediments are not always the result of industrial contamination.

Assessment of vitamin D status in Czech children

OBJECTIVE

Vitamin D deficiency is a global health problem. The aim of this study was to determine the proportion of Czech children with vitamin D deficiency and examine related factors.

METHODS

The study subjects were 419 healthy children aged 5 and 9 years. Severe vitamin D deficiency was defined as a serum 25(OH)D level of < 25 nmol/L (3% of children), deficiency as that of 25-50 nmol/L (24% of children), insufficiency as that of 50-75 nmol/L (40% of children) and sufficiency as that of > 75 nmol/L (34% of children).

RESULTS

Serum 25(OH)D levels varied mainly with season. The highest levels of 25(OH)D were reached in autumn (median: 79.0 nmol/L), followed by summer (median: 67.8 nmol/L) and winter (median: 56.0 nmol/L). The lowest median value (49.8 nmol/L) was detected in spring.

CONCLUSION

Children with sufficiency 25(OH)D levels were more frequently exposed to the sun and exposed a larger part of their body to the sun while spending time outdoors. Levels of 25(OH)D were also associated with using vitamin D supplements within six weeks before sampling.

Detection of Francisella tularensis in three vole species in Central Europe

Francisella tularensis is a zoonotic, gram-negative bacterium that causes tularemia in humans. Depending on its subspecies and the route of transmission, mild to lethal courses have been reported. F. tularensis subsp. holarctica is the only subspecies found in Europe and affects a plenitude of vertebrates including lagomorphs and rodents. Population outbreaks of certain rodent species are likely to be involved in the transmission of this pathogen. This molecular survey aims to evaluate the presence of F. tularensis in small mammals from three Central European countries. Using a real-time polymerase chain reaction, F. tularensis DNA was detected in common voles (Microtus arvalis) from Switzerland and in field voles (Microtus agrestis) and a bank vole (Myodes glareolus) from Germany, but not in any other small mammal species. All common voles from the Czech Republic were negative for F. tularensis DNA. The prevalence in the three vole species varied between 1.3% and 3.0%. In conclusion, Francisella tularensis DNA was detected in three vole species in two of three countries investigated. The observed low prevalence raises questions on the role of voles for the transmission of Francisella tularensis in Central Europe.

Two Different Causes of Paediatric Hypercalcaemia

Paediatric hypercalcaemia is a rare condition which can be easily overlooked or misdiagnosed. We report two paediatric patients who presented to the Department of Paediatrics, Pardubice Hospital, Pardubice, Czech Republic, in 2009 and 2010, respectively. Each patient was diagnosed with hypercalcaemia due to a different cause. The first case involved a seven-month-old infant who presented with failure to thrive, vomiting and psychomotor retardation. Fluorescent in situ hybridisation revealed Williams-Beuren syndrome. The second patient was a 16-year-old girl with abdominal pain and renal colic due to hypercalcaemia-induced urolithiasis. High parathyroid hormone serum levels suggested primary hyperparathyroidism. An adenoma of the left upper parathyroid gland was diagnosed via technetium-99m-labelled methoxyisobutyl isonitrile single photon emission computed tomography and removed surgically. Hypercalcaemia should be considered in the differential diagnosis of various disease states, particularly among infants who fail to thrive or children with abdominal pain.

HCV genotype shift occurred over the 15 years in PWIDs in the Czech Republic

OBJECTIVES

To follow on the epidemiology of HCV, especially genotypes spreading among people who inject drugs (PWID) in Prague and surrounding Central Bohemia, Czech Republic.

METHODS

546 patients who reported past and/or recent injecting of drugs were recruited in the years 2010-2012. They were initially tested for anti-HCV. Real-time PCR was used for quantification and genotyping of hepatitis C virus. Obtained data from the years 2010-2012 were compared with historical controls from periods of 1998-2000 and 2005-2007.

RESULTS

Of 546 initially recruited and tested patients were 393 (72%) anti-HCV seropositive and of them 269 (68.4%) had detectable HCV PCR RNA. The most prevalent subtype was 3a in 97 patients (36.1%), 1a was detected in 85 patients (31.6%) and 1b in 57 patients (21.2%). These three genotypes were responsible for nearly 89% of infections.

CONCLUSION

Significant increase in both genotypes 1a and 3a over the 15 years was apparent and significant, followed by the decrease in genotype 1b. In the genotype 1b and genotype 3a the significance has risen with the years of data collection. Described genotypic shift reflects the evolution of HCV epidemics and corresponds with the mode of transmission.

Tuberculosis in elderly in the Czech Republic

INTRODUCTION

The incidence of tuberculosis (TB) in the Czech Republic (CR) is decreasing since 1960s. (1965: 76.9; 1975: 60.4; 1985: 45.2; 1995: 17.7; 2005: 9.9; 2015: 4.9 per 100, 000 population). In 2017 men accounted for over than 70% of cases. People aged over 75 years are most frequently affected. Elderly patients tend to develop more of extrapulmonary and atypical manifestation of the disease, the diagnosis of TB can be difficult and consequently overlooked. Multimorbid seniors are suffering from chronic illnesses, malignancies and autoimmune diseases, which translate into higher degree of immunosuppression and add to the generally described process of immunosenescence. Furthermore, therapy of TB in the elderly is challenging because of the increased drug resistance and higher incidence of adverse drug reactions. This article reviews the epidemiology of TB in the CR, immunological aspects, clinical characteristics, diagnosis, management, prevention of TB infection and presents two clinical cases in hospitalized aging adults in the CR.

CASE PRESENTATION

We present a case of a 79 year old female suffering from chronic obstructive pulmonary disease (COPD), who was repeatedly hospitalized for acute exacerbations of COPD and was consequently diagnosed with TB. Patient developed manifestation of treatment toxicity and drug interactions due to comorbidities and other medications. Secondly, we present a case of a 70 year old male, a lifelong smoker, who was initially admitted for collapsing. TB developed via the endogenic route from a Ghons complex in association with a slowly progressing bronchogenic carcinoma.

CONCLUSION

Diagnosis and management of TB in the elderly person can be challenging. Age-related factors increase the risk of TB reactivation as well as enhance susceptibility to TB infection. In elderly population we find accumulation of risk factors for developing TB (malnutrition, low socio economic status, smoking and alcoholism). The people most at risk among elderly include fragile institutionalized seniors whose incidence of TB is 2-3 times higher than those living at home. Because the number of seniors is growing and the incidence of TB in this subpopulation is increasing, detailed knowledge of the epidemiological features of TB in this group is needed to optimize healthcare services.

A high prevalence of viral hepatitis C in a socially excluded Roma community in Brno

OBJECTIVES

To conduct a pilot study to assess the prevalence of blood-borne and sexually transmitted diseases (STDs) in a social-ly excluded Roma community engaging in risky behaviours in Brno, Czech Republic.

METHODS

Fifty subjects engaging in risky behaviours, of whom 35 self-reported to belong to the Roma ethnicity, were recruited while receiving treatment in a newly established addiction centre in Brno between March and December 2017. All subjects were tested for blood-borne diseases and STDs. Epidemiological and demographic data were collected by means of assisted interview at the time of the first contact.

RESULTS

Forty-three (86%) of 50 participants were anti-HCV positive. Of 35 subjects from the Roma subgroup, 32 (91.5%) tested anti-HCV positive. Among the 43 anti-HCV positive subjects, 35 (81.4%) also showed HCV RNA positivity. Of the 32 anti-HCV positive in the Roma subgroup, 26 (81.3%) were HCV RNA PCR positive. Only HCV (hepatitis C virus) genotypes 1 (a,b) and 3 were detected in the study group. Nine Roma subjects (25.9%)were newly diagnosed with syphilis of which none of them was aware. All study patients were negative for anti-HIV 1,2.

CONCLUSION

As a proof of concept, this pilot study showed the importance of targeting epidemiological research and preventive care at excluded communities engaging in risky behaviours. The high anti-HCV seroprevalence in the Roma population in Brno who self-admitted intravenous drug use as well as the nine newly diagnosed cases of syphilis illustrate not only a high prevalence of risky behaviours in this excluded community but also the absence of systematic health care coverage in this population.  A positive point is that when an appropriate model of care is used, even the Roma clients are willing and able to comply with the therapy. This is true of both viral hepatitis C and syphilis: thanks to close cooperation with addictology services and opiate substitution treatment, all nine patients successfully completed 2 weeks of anti-treponemal antibiotic treatment. More systematic work with socially excluded communities including specific models of care tailored to the needs of poorly compliant patients is an essential prerequisite for controlling HCV epidemics in the Czech Republic. An additional effect in the surveillance of other infectious diseases linked to risky behaviours can be considered as an added value.

OTC market - comparing Czech Republic and Greece

Medicines for self-medication (over-the-counter, OTC) are available through pharmacies, in some countries they are also available in supermarkets and other outlets. The use of OTC in European Union countries shows some differences at national level, in pharmacies and in patients preference. This study aimed to completing the lists of marketed OTC in Czech Republic and Greece. Next topics are: finding out the real range of OTC products offered by pharmacies, finding and evaluating number of packages sold in pharmacies in 20 particular common OTC in 2016, and indentification of factors influencing the sales. Web pages of national drug authorities (Czech Republic, Greece) were searched to complete lists of marketed OTC in each country. Data on range of OTC drugs and sales of them were extracted from computer systems (Czech Republic) and other types of documents (Greece) kept in pharmacies. The percentage of the real range of OTC products in pharmacies was calculated as the ratio to the number of OTC in national lists. Numbers of sold packages were compared among pharmacies. Classification system ATC (anatomical/therapeutical/chemical) was employed to present findings in all parts of the research. The Czech list contained 1,160 of marketed OTC in 10 ATC (1st level), with the maximum in ATC R (243 drugs). The Greek list contained 1,254 OTC in 13 ATC (1st level), with the maximum in ATC D (272 drugs). In lists of both countries, there were detected 86 drugs identical in 9 ATC (1st level). At least one OTC in each of 10 listed ATC was found in Czech pharmacies as a part of range of products, the range of OTC in Greek pharmacies comprised 11 ATC. The highest sales (year 2016) were found in ATC R (drug ACC long tbl eff) in CR and in ATC A (drug: Imodium cps) in Greece. The differences in the range of OTC drugs and in their sales were found between Czech Republic and Greece, and between types of pharmacies inside each country. Factors influencing them were detected: ownership of the pharmacy, locality (number of inhabitants). OTC drugs pharmacy Czech Republic Greece.

Congenital anomalies in children born in the Czech Republic in 1994-2015

ÚVOD Populace je v sou&#269;asné vystavena r&#367;zným zevním vliv&#367;m, ze kterých mohou vyplývat i r&#367;zná zdravotní rizika. Jedním z mo&#382;ných je i riziko vzniku vrozené vady (VV). Z hlediska studia zdravotního stavu populace je d&#367;le&#382;itá znalost nejen pr&#367;m&#283;rných celkových incidencí VV, ale i p&#345;ípadných zm&#283;n t&#283;chto incidencí v pr&#367;b&#283;hu &#269;asu. Incidence VV je pova&#382;ována za jeden ze základních kvalitativních ukazatel&#367; popula&#269;ních i medicínských (1). Nelze opomenout ani hledání potenciálních rizik vedoucích ke zvý&#353;ené pravd&#283;podobnosti výskytu VV. T&#283;mito riziky mohou být ne&#382;ádoucí vlivy zevního prost&#345;edí nebo faktory biologicko-sociální (v&#283;k &#382;en, jejich onemocn&#283;ní aj). Podíl jednotlivých typ&#367; VV u narozených d&#283;tí se v &#269;ase m&#283;ní, obdobn&#283; jako struktura p&#345;í&#269;in úmrtí. Z hlediska epidemiologického je nutné hodnotit incidence VV a jejich zm&#283;ny p&#345;edev&#353;ím z pohledu jednotlivých diagnóz. B&#283;hem posledních let se intenzita VV v &#268;esku m&#283;nila. U n&#283;kterých typ&#367; se &#269;etnost v novorozenecké populaci sni&#382;uje díky úsp&#283;&#353;né prenatální diagnostice, u jiných diagnóz naopak &#269;etnost u narozených d&#283;tí stoupá (2). Krom&#283; prenatální diagnostiky se v&#353;ak na výsledné &#269;etnosti VV v populaci mohou uplat&#328;ovat i dal&#353;í vlivy. Jedním z nich m&#367;&#382;e být i zlep&#353;ení, zrychlení a zkvalitn&#283;ní postnatálních diagnostických mo&#382;ností - p&#345;edev&#353;ím zavedení a rozvoj ultrazvukové diagnostiky (3). Úsp&#283;&#353;nost prenatální diagnostiky a &#269;etnost VV u narozených jsou rovn&#283;&#382; významným ukazatelem prenatální a perinatální pé&#269;e, p&#345;e&#382;ívání d&#283;tí narozených s VV pak ukazatelem pé&#269;e postnatální (p&#345;edev&#353;ím neonatální a chirurgické). Registrace vrozených vad má v &#268;eské republice dlouhou tradici - Národní registr vrozených vad zahájil svou &#269;innost ji&#382; p&#345;ed více ne&#382; p&#367;lstoletím, v roce 1964 (4).   METODIKA Retrospektivní epidemiologická studie vyu&#382;ívá oficiální data z Národního registru vrozených vad vedeného v rámci Registru reproduk&#269;ního zdraví v Ústavu zdravotnických informací a statistiky &#268;R (ÚZIS). Analyzovány byly incidence jednotlivých diagnóz vrozených vad (kódy Q00-Q99) u narozených d&#283;tí z celého území &#268;eské republiky za &#269;asové období 1994-2015. Incidence VV byly analyzovány pro ob&#283; pohlaví, a to jak celkov&#283; (pro celou skupinu diagnóz VV), tak i dle základních diagnostických skupin Mezinárodní klasifikace nemocí (MKN).   VÝSLEDKY V období 1994-2015 se dle údaj&#367; ÚZIS &#268;R narodilo v &#268;eské republice celkem 87 359 d&#283;tí s vrozenou vadou zji&#353;t&#283;nou do 1 roku &#382;ivota. Z tohoto celkového po&#269;tu bylo 51 315 chlapc&#367; a 36 030 dívek. U 14 p&#345;ípad&#367; nebylo pohlaví známé / zji&#353;t&#283;no. Vývoj po&#269;tu diagnostikovaných p&#345;ípad&#367; ukazují p&#345;ehledn&#283; první t&#345;i grafy (obr. 1-3), zvlá&#353;&#357; pro chlapce, dívky a celkov&#283;. V relativních po&#269;tech to bylo za celé sledované období pr&#367;m&#283;rn&#283; 385,4 na 10 000 &#382;iv&#283; narozených d&#283;tí: nejmén&#283; 242,5 v roce 1994, nejvíce pak 448,3 v roce 2011. V p&#345;ípad&#283; &#382;iv&#283; narozených chlapc&#367; to bylo nejmén&#283; 263,6 v roce 1994, nejvíce pak 533,3 v roce 2011; pr&#367;m&#283;rná hodnota &#269;inila 440,6 na 10 000. U &#382;iv&#283; narozených dívek byla pr&#367;m&#283;rná hodnota za sledované období 327,1 na 10 000 ; nejni&#382;&#353;í hodnota 220,1 byla zaznamenána op&#283;t v roce 1994, nejvy&#353;&#353;í hodnota 380,9 v roce 2003. Grafy na obr. 4-6 ukazují relativní po&#269;ty na 10 000 &#382;iv&#283; narozených v pr&#367;b&#283;hu sledovaného období, op&#283;t zvlá&#353;&#357; pro chlapce, dívky a celkov&#283;. Dal&#353;í &#269;ást na&#353;í analýzy se v&#283;novala zm&#283;nám v pr&#367;b&#283;hu sledovaného období pro jednotlivé skupiny diagnóz dle rozd&#283;lení v Mezinárodní klasifikaci nemocí, 10. verze (tab. 1). various types of congenital anomalies are changing during the time according to different factors. Three main factors are methodical changes of the registration process, improvement of prenatal diagnostics and the real changes of incidences of selected diagnoses. While in the previous time period (till 1993) the registry included only selected diagnoses of congenital anomalies, in the new period (starting 1994) the registry includes all diagnoses of congenital anomalies from the ICD-10 classification. We can also see the difference in the incidences from 1994-1999 and 2000-2015 time period. The reason for this difference is the methodical change of registration, the Registry of congenital anomalies also receives the notifications about possible anomalies from the report of newborn (even when the report of congenital anomaly was not sent). As for the prenatal diagnostics - we may analyse possible changes of incidences - if the specific defect can be diagnosed prenatally.

Incidence and analysis of campylobacteriosis cases in the Czech Republic in 1997-2017

AIM

The aim of our study was to conduct analysis of reported epidemiological data on human campylobacteriosis in the Czech Republic (CZ) from 1997 to 2017 and to summarize the current knowledge about the disease.

METHODS

We conducted a descriptive epidemiological analysis of data on campylobacteriosis cases reported to the national surveillance system of infectious diseases in the CZ (EpiDat) from 1997 to 2017. MS Excel 2010 and statistical program R were used for data management and analysis. The incidence maps were created using the ECDC Map Maker tool (EMMa).

RESULTS

Overall, 411 699 campylobacteriosis cases (average annual incidence of 188.9/ 100 000) were reported in the CZ from 1997 to 2017. Between 1997 and 2005, the annual incidence of campylobacteriosis was increasing sharply, but it showed a fairly stable trend over the last decade. The highest average age-specific incidence of 1 068.5/100 000 was observed in the age group 1-4 years followed by 99% of cases). The most common etiologic agent of campylobacteriosis is Campylobacter jejuni.

CONCLUSIONS

Since 2007, campylobacteriosis is the most common food- and water-borne disease in the CZ. Given the high number of cases, this infectious disease is a rising public health concern. The prevention should be focused on the main risk groups, i.e. children under 5 years of age, who are the most affected, and those older than 80 years, who have more complications and a higher hospitalization rate.

The efficacy of selected bariatric surgery methods on lipid and glucose metabolism: a retrospective 12-month study

OBJECTIVE

Approximately 25% of the Czech population is currently obese. Obesity rates are expected to increase in the future. Obesity not only raises the risk of health complications for individuals, but increasing rates also represent a significant and steadily growing economic burden for healthcare systems and society as a whole. The aim of this study was to evaluate the therapeutic efficacy of three methods of bariatric surgery: laparoscopic greater curve plication (LGCP), laparoscopic sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYBG) in patients with type 2 diabetes mellitus (DM). This study examined the influence of bariatric surgery on body weight and BMI, changes in serum glucose and markers of lipid metabolism.

METHODS

This study evaluated outcomes in 74 patients with type 2 DM who underwent LGCP, LSG or RYGB. Patient selection followed guidelines of the International Federation for the Surgery of Obesity, i.e. BMI≥40 kg/m² or BMI≥35 kg/m² with associated comorbidities or BMI<35 kg/m². For each of the procedures, the hypotheses were tested with the Bonferroni method.

RESULTS

Statistically significant weight loss, 20.2±9.3 kg on average, occurred by 12 months after surgery, with maximum weight reduction of 38 kg. Over the 12-month period, average fasting glycaemia decreased by 2.58 mmol/L after LGCP, by 2.01 mmol/L after LSG, and by 4.64 mmol/L after RYGB. Triacylglycerol (TGC) values decreased significantly with all procedures. The mean decrease was 1.35 mmol/L after LGCP and 1.06 mmol/L after LSG. The greatest TGC concentration decrease, 1.92 mmol/L, occurred after RYGB. Average concentrations decreased below 1.7 mmol/L. There was a statistically significant difference in body weight and BMI reduction between LGCP and LSG groups, as well as between LGCP and RYGB groups. A significant difference in the glucose decrease was observed between the LSG and RYGB groups, which can be explained by the fact that glycaemia and HbA1c levels were different between these groups prior to surgery.

CONCLUSIONS

The best results from the carbohydrate metabolism point reached the malabsorption method RYGB. However, the other two restrictive methods also achieved very good results. In particular, the LGCP method has not only the effect on weight reduction but also on metabolic functions and consequently points to potential healthcare expenditure savings.

Terrestrial isopods (Oniscidea) of the White Carpathians (Czech Republic and Slovakia)

This paper summarizes data regarding the terrestrial isopods of the White Carpathians range in the Western Outer Carpathians based on field research undertaken during the past several decades in natural meadow pasture and forest localities. Using a combination of four collection methods 19 species belonging to nine families were recorded. The most common representatives were ProtracheoniscuspolitusTrachelipusrathkii and Ligidiumhypnorum. In general the biodiversity of isopod communities in the studied area was considerable with half of the localities explored inhabited by six to ten species. The composition of the isopod assemblages was determined by the character of the biotope and its geographical location. Forest habitats were considerably richer in species than the meadow and pasture ecosystems. Some xerotermic localities in the Slovak part of the area were inhabited by Trachelipusnodulosus and Orthometoponplanum thermophilic species typically associated with warmer parts of Europe. Two relic species (Hyloniscusmariae and Ligidiumgermanicum) were confirmed for this area. Except for only one finding of Porcellioscaber no other evidently introduced or synanthropic species were recorded. Based on the data analyzed the high nature conservancy value of the given area is emphasised.