If a vaccine against COVID-19 was available, would you like to be vaccinated? And are you vaccinated against flu and other diseases? A survey among university students during state of emergency

AIM

Achieving sufficient vaccination rate (and herd immunity respectively) is considered to be the most promising strategy for prevention of outbreaks of novel coronavirus disease in future. The main aim of this work was to compare willingness of university students to receive vaccine against COVID-19 with vaccines for adults against other well-known diseases. Another aim was to assess students´ opinion on growing trend of parents refusing to vaccinate children.

METHODS

The online questionnaire shared with students consisted of 12 questions. It was distributed via university bulk emails and social media.

RESULTS

3,133 students responded to our questionnaire. Overall university response rate was 15.9%. Students of our university showed significantly much stronger interest in receiving vaccine against COVID-19 than vaccine against other diseases (p < 0.0001). Students also showed strong pro-vaccination attitude to vaccination of children.

CONCLUSION

The study showed very well sudden change of attitude of university students to vaccination of adults at the time of strong restrictive regulations. Most of university students had pro-vaccination attitude to vaccination of children.

Strengthening core competences of medical and public health students for public health emergencies

Background

The importance of public health capacity development with a focus on public health emergencies and humanitarian assistance is continuously increasing at the global scale. In the time of Public Health Emergencies of International Concern is crucial to provide basic training in core public health competences to all health professionals, including students. Faculty of Medicine & Dentistry, Palacký University Olomouc, Czech Republic (full ASPHER member), implemented in medical as well as public health curricula new topics focused on core competences of health professionals in the area of public health emergencies and humanitarian assistance.

Objectives

To strengthen competences and skills of medical as well as public health students to prepare them better for public health emergencies and humanitarian assistance in the time of increasing risk of global public health emergencies. New modules were proposed and tested in all education programmes at our Faculty of Medicine & Dentistry, Palacký University Olomouc (CZ): General Medicine (Czech and English programmes), Dentistry (Czech and English programmes) and Public Health (Czech programme).

Results

New modules on Public Health Emergencies, including preparedness, responses, risk management and risk communication were successfully tested in all education programmes during the academic year 2018/19 and fully implemented for the academic year 2019/20. New module has blended learning structure based on combination of face-to-face seminars and exercises with e-learning parts, including self-assessment. New module is presented in details.

Conclusions

This new education module fully supports international recommendations to strengthen public health competences and skills of medical as well as public health students to be ready for any unexpected public health emergencies at all levels, in particular at the local community level. COVID-19 pandemic confirmed.

Supported by university project CZ.02.69/0.0/16_015/0002337

Key messages

Medical and public health students with competences and skills on public health emergencies and humanitarian assistance will be an asset for any public health emergency of international concern.

New education module on public health emergencies will support both medical and public health students to be prepared for risk communication, advocacy and action if needed and called to action.

Associations Between Homeostasis Model Assessment (HOMA) and Routinely Examined Parameters in Individuals With Metabolic Syndrome

The aim of the study was to investigate whether routine clinical parameters, including visceral adiposity index (VAI) and atherogenic index of plasma (AIP), could become widely applicable predictors of insulin resistance (IR), evaluated using homeostasis model assessment (HOMA-IR, HOMA-β), with regard to presence of metabolic syndrome (MS). The study comprised 188 individuals identified to meet the MS criteria during regular health examinations and an equal number of age, sex-matched controls without MS. The strongest correlations were noted between HOMA-IR and waist circumference (WC) in the MS group (r=0.57) as well as between HOMA-IR and alanine aminotransferase (ALT, r=0.57) or aspartate aminotransferase (r=0.56) in the controls, with a statistical significance of p<0.001. In a multivariate linear regression model, the predictors of HOMA-IR were WC (linear coefficient β=0.1, p<0.001), ALT (β=2.28, p<0.001) and systolic blood pressure (β=0.04, p<0.001). HOMA-β was determined by WC (β=1.97, p=0.032) and ALT (β=99.49, p=0.004) and inversely associated with age (β=-1.31, p=0.004). Neither VAI nor AIP were significant predictors. The presence of MS was significantly associated with both HOMA-IR and HOMA-β. These results indicate that WC and ALT appear to be reliable predictors of IR. Comprehensive assessment of these parameters may serve for estimating the level of IR.

Epidemiology of hepatitis E virus infection

Hepatitis E is a major concern to public health, it is estimated that 44,000 people die annually due to hepatitis E. Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. HEV has been found with 7 genotypes, only 4 can infect humans. Genotypes 1 and 2 are major causes of the epidemic and endemic acute hepatitis in developing countries. In the poor hygienic conditions, these genotypes are obligate human pathogens transmitted between humans by the fecal-oral route and via contaminated water. On the contrary, in developed countries, genotypes 3 and 4 are of zoonotic origin and they are transmitted by alimentary route and via direct contact with the infected animal. Transmission by blood, blood products and tissues from infected persons or animals and even mother-to-infant transmission is also possible. Hepatitis E clinical course varies from self-limiting disease to fulminant hepatic failure, and extrahepatic manifestations have occurred. Management to control and prevent this infection is mainly hygienic measures. The provision of clean drinking water and ameliorating the sanitation of human wastes are the most effective preventive approaches as in any infection outbreak transmitted through the fecal-oral route. Nevertheless, dietary habits, distribution of different zoonotic reservoirs and the hygienic level play a crucial role in limiting and preventing the spread of hepatitis E in the developed countries. Although HEV vaccine was developed, it is still available only in China. It protects against genotype 4 with no clear evidence of protection against other genotypes.

[The common bed bug (Cimex lectularius) - biology, medical relevance, possibilities for the detection and control]

Bed bugs have become a major concern worldwide in the 21st century and are therefore intensively investigated. The new findings not only extend the knowledge of their biology, medical relevance, and causes of the resurgence, but also can be used in bed bug management. A brief overview is provided of some of the most important research results and opinions, published in the last few years in prestigious international journals.

Evaluation of Dietary Habits in the Study of Pancreatic Cancer

BACKGROUND

Pancreatic cancer is serious and rapidly progressing condition. Little is known about the role of diet in etiology of pancreatic cancer. The study focused on the role of selected dietary factors related to pancreatic cancer.

MATERIAL AND METHODS

The case-control study was performed in the Czech Republic in 2006- 2009, involving three centers in Olomouc, Ostrava and Ceske Budejovice. It comprised a total of 530 persons, of whom 310 had pancreatic cancer and 220 were controls. Data were obtained directly from each participant in an interview with a trained interviewer and entered into a standardized questionnaire. The data were analyzed using a crude odds ratio (OR) and multivariate logistic regression with an adjusted OR and 95% CI. The statistical analysis was performed with the STATA v. 10 software.

RESULTS

A very strong protective effect was found in pickled cabbage (OR 0.32; 95% CI 0.19- 0.55), broccoli (OR 0.37; 95% CI 0.25- 0.53), cooked onion (OR 0.14; 95% CI 0.08- 0.27), tomatoes (OR 0.28; 95% CI 0.13- 0.60), raw carrot (OR 0.33; 95% CI 0.20- 0.56), cooked carrot (OR 0.35; 95% CI 0.19- 0.62). In logistic regression model, statistically significant protective associations were found in consumption of more than three portions of cooked vegetables per week (OR 0.16; 95% CI 0.05- 0.55) and high consumption of citrus fruit (OR 0.46; 95% CI 0.23- 0.90).

CONCLUSION

The study found statistically significant protective effect of consumption of more than three portions of cooked vegetables per week and high consumption of citrus fruit.

[Epidemiological significance of the metabolic syndrome]

From an epidemiological point of view, the metabolic syndrome is a group of risk factors causally, rather than coincidentally, related to insulin resistance. The metabolic syndrome is a condition with relatively high prevalence rates in both the Czech Republic and in other developed countries. There is a clear trend of increasing prevalence in both sexes depending on age. In the Czech Republic, the syndrome is less common in females (25.5%) than in males (37.6%). Epidemiological studies found white (Europoid race) males to be at higher risk due to abdominal obesity. The definition of the metabolic syndrome has evolved over time and helps to identify individuals at high risk of developing cardiovascular disease and type 2 diabetes, hence the use of the term cardiometabolic syndrome. Early detection of metabolic syndrome symptoms including insulin resistance should be performed mainly by general practitioners as part of regular check-ups.

The speciation and genotyping of Cronobacter isolates from hospitalised patients

The World Health Organization (WHO) has recognised all Cronobacter species as human pathogens. Among premature neonates and immunocompromised infants, these infections can be life-threatening, with clinical presentations of septicaemia, meningitis and necrotising enterocolitis. The neurological sequelae can be permanent and the mortality rate as high as 40-80%. Despite the highlighted issues of neonatal infections, the majority of Cronobacter infections are in the elderly population suffering from serious underlying disease or malignancy and include wound and urinary tract infections, osteomyelitis, bacteraemia and septicaemia. However, no age profiling studies have speciated or genotyped the Cronobacter isolates. A clinical collection of 51 Cronobacter strains from two hospitals were speciated and genotyped using 7-loci multilocus sequence typing (MLST), rpoB gene sequence analysis, O-antigen typing and pulsed-field gel electrophoresis (PFGE). The isolates were predominated by C. sakazakii sequence type 4 (63%, 32/51) and C. malonaticus sequence type 7 (33%, 17/51). These had been isolated from throat and sputum samples of all age groups, as well as recal and faecal swabs. There was no apparent relatedness between the age of the patient and the Cronobacter species isolated. Despite the high clonality of Cronobacter, PFGE profiles differentiated strains across the sequence types into 15 pulsotypes. There was almost complete agreement between O-antigen typing and rpoB gene sequence analysis and MLST profiling. This study shows the value of applying MLST to bacterial population studies with strains from two patient cohorts, combined with PFGE for further discrimination of strains.

[Pancreatic cancer and lifestyle factors]

BACKGROUND

Pancreatic cancer is a serious cancer with unfavorable prognosis. Due to differences in the incidence of pancreatic cancer in different regions, it is clear that factors associated with lifestyle play an important role in the etiology. The aim of this study was to evaluate the impact of selected lifestyle factors in relation to pancreatic cancer.

MATERIALS AND METHODS

The study included a total of 529 subjects, including 309 cases and 220 control subjects. Cases of newly diagnosed patients with pancreatic cancer who lived in the region were selected in hospitals in three centers (University Hospital Olomouc, University Hospital Ostrava, Hospital Ceske Budejovice). The control group was obtained in cooperation with selected general practitioners for adults, and it is a population control group.

RESULTS

Analyses compared persons who reported consuming alcohol with those who do not consume alcohol. Results showed a statistically significant inverse association, even after adjustment for the other studied factors (OR = 0.57, 95% CI 0.36 to 0.89). When assessing leisure time physical activity, results showed statistically significant inverse association and 35% decrease in the risk (crude OR = 0.65, 95% CI 0.45 to 0.93), and this inverse association was confirmed after adjustment for other studied factors although the result is on the border of statistical significance (adjusted OR = 0.68, 95% CI 0.44 to 1.04). Drinking coffee and tea has only a marginal impact on the occurrence of pancreatic cancer, although the medium and high consumption of black tea was found increased risk by 90 or 44%, respectively. Smoking is considered a causal risk factor for pancreatic cancer, but in this study, a positive association was not found. The study found no statistically significant association between overweight and obesity.

CONCLUSION

Physical activity, dietary measures that will lead to weight loss and education to non-smoking can have a significant impact on the primary prevention of cancer.

[West Nile virus transmission risk in the Czech Republic]

West Nile Virus (WNV) belongs to the family Flaviviridae. It is transmitted to humans by mosquitoes, capable of sucking blood on birds and mammals, most often by mosquitoes of the genus Culex. In humans, the virus was first identified in 1937 in the West Nile region, Uganda, Africa. Later, the virus spread and caused more or less severe epidemics of West Nile fever in North Africa, Europe, Asia, and North and South America. During the last two decades, WNV has been on the rise and is currently ranked as one of the most prevalent arboviruses in the world. In humans, WNV infection mostly occurs as asymptomatic, but may have a more severe or even fatal course in older and weakened patients. Humans may become infected not only by mosquitoes that acquire the virus from infected birds, but also through a blood transfusion, organ transplant, breast milk and transplacental transmission, or contact with infected animals, their blood, and tissues. The first autochthonous human case of West Nile fever in the Czech Republic was reported from South Moravia in 1997. In 2013, another case of West Nile fever emerged in this country, in the Ostrava area. The issue of WNV has recently been studied from many different perspectives, as evidenced by many original and review papers. This article briefly reviews the essential knowledge about this virus and its spread.

[A multifactor epidemiological analysis of risk factors for pancreatic cancer in women]

STUDY OBJECTIVE

A multifactor analysis of risk factors for pancreas cancer in women.

MATERIAL AND METHODS

A case-control study was conducted in three centres in the Czech Republic (Olomouc, Ostrava, and České Budějovice) in 2006-2009. In total, 226 women (129 pancreas cancer cases, 97 controls) were included in the study. Statistical analysis was performed, the crude odds ratio (OR) was calculated, and logistic regression analysis was used at a 5% level of statistical significance.

RESULTS

A statistically significant inverse association was found between pancreatic cancer and oral contraceptives (OR 0.21; 95% CI: 0.07-0.69). Pregnancy and number of pregnancies or gynecological surgical procedures did not show any association with pancreatic cancer. No significant difference in the first menstrual period was found between pancreatic cancer patients and controls.

CONCLUSIONS

The study results showed inverse association between pancreatic cancer and oral contraceptives (OR 0.21; 95% CI: 0.07-0.69), controlled alcohol consumption (OR 0.26; 95% CI: 0.12-0.55), and anti-inflamatory drug use (OR 0.10; 95% CI: 0.02-0.41).

[Prevention of tick-borne meningoencephalitis--summary report]

Tick-borne meningoencephalitis is a zoonosis that shows an upward trend. The causative agent is an RNA virus of the family Flaviviridae whose vector in Central Europe is the castor bean tick (Ixodes ricinus). The infection is most often transmitted via tick bite or, less commonly, by the alimentary route, through the consumption of unpasteurized milk of infected animals. Preventive measures consist in personal protection from ticks, exceptionally in blanket treatment with contact insecticides, in preventing consumption of unpasteurized milk and dairy products from areas with a high incidence of tick-borne encephalitis, and particularly in vaccination of the susceptible population.

Occupation and renal cell cancer in Central and Eastern Europe

OBJECTIVE

Central and Eastern Europe has among the highest rates of renal cell cancer worldwide. Few studies have been conducted in these areas to investigate the possible role of occupational exposures in renal cell cancer aetiology. The purpose of this study was to examine the association of renal cell cancer with employment in specific occupations and industries.

METHODS

From 1999 to 2003, we conducted a hospital-based case-control study in seven areas of the Czech Republic, Poland, Romania and Russia. A detailed occupational history was collected from renal cell cancer cases and controls, together with information on potential confounders. Odds ratios (ORs) and 95% CI of cancer risk were calculated for having ever been employed in selected jobs and industries, with follow-up analyses examining duration of employment.

RESULTS

A total of 992 histologically confirmed incident renal cell cancer cases and 1459 controls were included in the analysis. An increased risk of renal cell cancer was observed for workers in agricultural labour and animal husbandry (OR 1.43; 95% CI 1.05 to 1.93), particularly among women employed as general farm workers (OR 2.73; 95% CI 1.05 to 7.13). Risk gradients for agricultural work increased with longer employment. An overall increased risk of renal cell cancer was seen among architects and engineers (OR 1.89; 95% CI 1.35 to 2.65), and mechanical engineers (OR 1.71; 95% CI 1.03 to 2.84).

CONCLUSIONS

Our data suggest an association between renal cell cancer and agricultural work, particularly among female workers.

[Pancreas cancer epidemiology]

Pancreas cancer is characterized by a rapid and fatal outcome. It is a non-communicable disease showing increasing incidence mainly in Europe, North America and Japan. In the Czech Republic, the incidence of pancreas cancer has more than tripled over the last 50 years. The pancreas cancer incidence and mortality rates are practically identical in this country. The standardized incidence rates (world standard) are 10.4 in men and 7.1 in women, with the Czech Republic ranking the sixth and fourth in the world, respectively. The standardized mortality rates are 10.4 and 7.2, respectively, with the Czech Republic ranking the fourth and sixth to seventh in the world, respectively. Very rapid fatality is also indicative of the seriousness of the disease whose median survival ranges from three to six months.

Epidemiology of colorectal cancer

This review article presents colorectal cancer epidemiology, describing main epidemiologic characteristics and the influence of environmental and life style risk factors. The most important ideas for primary prevention are listed at the end of the article.

[Pathogenesis, prevention and detection of cardiotoxicity of anthracycline cytostatic agents]

BACKGROUND

Anthracycline antibiotics represent a part of therapeutic schemes in the treatment of a wide spectrum of malignancies. Precisely due to their cytostatic effectiveness they are being applied in spite of the risk of cardiac damage of patients. Anthracycline cardiotoxicity may culminate in potentially irreversible heart failure and fatal arrhythmias. Consequences of cardiotoxicity can complicate and shorten the lives of patients with formerly favourable prognosis of the malignant disease, and even of those that have been cured.

OBJECTIVES

The aim of the presented study was to provide a review on current opinions concerning the pathophysiological mechanisms of cardiotoxicity due to anthracycline antibiotics, as well as the possibilities of cardiotoxicity prevention and detection. The procedure of cardiac monitoring of anthracycline effects is performed in order to detect the initial stage of myocardial impairment which is on the level of microstructural alterations. This requirement is mostly fulfilled by the invasive method of endomyocardial biopsy. Also the noninvasive method of high-resolution electrocardiography may reflect anatomic-electrophysiological abnormalities on the level of cardiomyocytes and interstitium. We decided to verify the usefulness of this method in the sense of the ability to detect the risk of the cardiotoxicity origin following anthracycline application.

METHODS

We have repeatedly observed 34 hospitalized patients with cancer before or during chemotherapy. On the basis of high-resolution electrocardiography we have analysed the ECG signal in regard to time, frequency and time-frequency relation.

RESULTS

In this study we present our initial experience with this method in combination with electrocardiographic and echocardiographic findings. In regard to the fact that the observations were of short term character we interpret our results of high-resolution electrocardiography as being preliminary. We report 4 illustrative cases of patients who independent of the dosage, yielded distinct responses toward the applied potentially cardiotoxic therapy.

CONCLUSIONS

We consider the high-resolution electrocardiography in regard to its noninvasive character and low demand of time and finance to represent a perspective method of cardiac monitoring of the negative anthracycline effect. Not only ours but also the first experience in the world confirm this presupposition. By means of this method we have been able to detect initial alterations due to already low cumulative doses of anthracyclines (120 mg/m2 in a patient with ischemic heart disease and 260 mg/m2 in a patient with unimpaired myocardium prior to treatment). Our results also confirm the fact that the problem of cardiotoxicity must be necessarily strictly individualized. (Fig. 19, Ref. 80.)

The antihypertensive treatment and high-resolution electrocardiography

After six months of antihypertensive treatment the regression of the initially present myocardial hypertrophy was observed: The decrease in blood pressure values is in correlation with the regression of the left ventricular hypertrophy. No correlation with parameters of high-resolution electrocardiography was noted. In one patient, a deterioration of late potentials was observed. It became more pronounced following the treatment. The monitoring of antihypertensive treatment effects by echocardiography and high-resolution electrocardiography may be therefore considered useful, especially in expected regression of the left ventricular hypertrophy. In individual cases of very outstanding regression, there exists the potential possibility of the process, resulting in the risk of arrhythmogenic substrate formation and subsequent generation of dysrhythmias.