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All livebirths resulting from singleton pregnancies reported to the Czech (n = 380,633) and Swedish (n = 351,775) birth registries in 1989-91 were studied with respect to social variation in birthweight, ponderal index (weight/length at birth3) and preterm delivery. The mean birthweight was significantly lower in the Czech population (3310 g vs. 3522 g, P < 0.001). The mean difference in birthweight between children of mothers with primary and university education was 197 g [95% CI 190, 205] in the Czech and 136 g [95% CI 128, 144] in the Swedish population, adjusted for maternal age, parity and sex of the infant. Mean birthweight was significantly higher in mothers who were married or lived with partners in both countries; the difference was 167 g [95% CI 161, 173] in the Czech Republic (CR) and 86 g [95% CI 78, 94] in Sweden, adjusted for age, parity and sex. The extent of social variation in ponderal index and frequency of preterm birth was also greater in the CR. Between 1989 and 1991, mean birthweight in the CR fell from 3323 g to 3292 g (P < 0.001) and the social differences increased, largely as a result of more rapid worsening in the lower socio-economic groups. There did not appear to be such a decline in birthweight in Sweden. We suggest that the fall in mean birthweight and the increasing social variation in birth outcome in the CR is related to decline and divergence in living standards in 1989-91. [ABSTRACT FROM AUTHOR]

A systematic investigation of an outbreak of postoperative sepsis in nine patients following surgery in the operating rooms of a primary-type hospital between November 26 and 28, 2018 was conducted to determine the extent of the outbreak, the vehicle, and the route of transmission. The comprehensive investigation included epidemiological, microbiological, molecular biological, and environmental methods. A retrospective cohort study was used to find associations between individual exposure factors and outcomes, the respective septic conditions. Nine of 24 surgery patients were infected (AR 37.5 %). An identical strain of Acinetobacter calcoaceticus was found in biological specimens of two infected patients. The combined investigation did not reveal the vector or route of transmission. Immediate infection prevention and control measures avoided new cases of postoperative sepsis.

We compared neighbouring regions of the Czech Republic (CZ) and Poland (PL) situated within 100 km of the country border, in order to compare surveillance systems performance in measuring the burden of tick-borne diseases in both countries. We used routine surveillance notifications from 1999-2008 on tick-borne encephalitis (TBE) and Lyme borreliosis (LB). We assessed the crude risk ratio (RR) across the country border, and its estimates adjusted for both population density and the expected epidemiological gradient across the region, using negative binomial regression. The crude RR between CZ and PL was 7.43 (95% Cl 6.20-8.90) for TBE, and 1.80 (1.76-1.83) for LB. The adjusted RR for TBE increased from 4.47 in 1999-2001 to 10.01 in 2005-2008, but for LB decreased from 9.30 to 2.51 during the respective periods. Those results reflect possible differences in surveillance systems performance between the two countries, as the administrative boundaries cannot constitute a barrier for zoonotic diseases and no biological processes alone can explain such large differences in disease occurrence.

The study objective was to determine the rate of failures to present for routine childhood immunization due to either parental vaccine refusal, failure to comply with the immunization schedule and real or false contraindications. The rate of use of alternative vaccines which can be provided within the routine immunization schedule either on parental request or when recommended by the physician was also determined. We analyzed records of 5,038 children born between January 1, 2000 and December 31, 2004 and registered with a sample of general practitioners. We identified 1,284 cases (25.5 %) of no, incomplete or alternative vaccination. Failure to present for immunization with at least one vaccine as scheduled due to contraindication was stated in 291 (5.8 %) children; a total of 436 contraindications were reported (more than 1 contraindication in some children). The most common contraindication was a CNS disorder (171 cases) such as encephalopathy, epilepsy or unspecified conditions. Sixty-nine children (1.4 %) remained nonvaccinated against at least one disease (due to parental vaccine refusal or failure to comply with the immunization schedule). Alternative vaccines were administered to 936 (18.5 %) children for the following reasons: contraindication in 275 (5.5 %) children and on parental request in 716 (14.2 %) children (cost incurred by parents), with 55 (1.1 %) children given alternative vaccines for both reasons. These results suggest that contraindications and the use of alternative vaccines are quite common and need to be monitored.

With respect to the fact that acute respiratory infections (hereafter ARI) are a world-wide serious social and economic problem, more and more attention is being paid to the development and application of oral bacterial immunomodulators. The preventive effect of GS Imunostim has been evaluated during the respiratory season 2005. The study took place at 10 outpatient sites of general practitioners and lung specialists in Prague, Pilsen and Brno in the respiratory season from January to April 2005. The comparison with the ARI morbidity reports in the studied period revealed statistically significant morbidity reduction in the study participants compared to the ARI morbidity in the Czech population in the studied period from January to April 2005. The morbidity rate in the studied group was 7%, whereas ARI morbidity 15.1% was reported in the general population. The morbidity in the study group was significantly lower that in the general population.

Background: Surgery results in chronic pain in 7-80 percent. One of the most studied is chronic post-mastectomy pain. The prevalence was 40-50 percent in studies performed abroad. As this problem has not yet been studied in the Czech Republic, a retrospective prevalence study was performed to asses the extent of the problem and risk factors for development of chronic post-mastectomy pain., Methods and Results: After ethic committee approval an anonymous questionnaire was developed and distributed in various oncology department and patients'organisations. Response rate was 100 percent, 330 questionnaires were processed. Chronic post-mastectomy pain (lasting longer than 3 months after surgery) was described by 69 (20.9 per cent) women. The pain was permanent in 17 and transient in 46 cases, not specified in 6 cases. The pain intensity was predominantly mild or moderate. Risk factors were younger age (below 55-60 years, p=0.0098), less extensive surgery (tumourectomy vs. mastectomy, p=0.0017), intensive post operative pain (p=0.0002) and radiotherapy (p=0.0174). Trend in chemotherapy (p=0.0778) was observed., Conclusions: The prevalence of chronic post-mastectomy pain was lower in our study comparing to studies in other countries. The reason remains obscure in spite of detailed analysis.

Salmonellosis and campylobacteriosis are the most frequently reported acute enteric diseases of infectious origin in the Czech Republic. Epidemiological data on salmonellosis and campylobacteriosis have been reportable in this country since 1951 and 1984, respectively. In 2003, 53,486 cases of acute enteric infections were reported: 26,899 (52%) diagnosed as salmonellosis and 20,063 (almost 40%) diagnosed as campylobacteriosis. In 1989, the annual incidence of salmonellosis was three times as high as in the previous year, the upward trend continued until 1995 (528/100,000) and since 1998 the salmonellosis incidence rates have been declining. The incidence of campylobacteriosis showed a progressive increase since 1984 to peak in 2002 with a following slight decline in 2003. Morbidity from salmonellosis and campylobacteriosis is highest in the age group 0-4-year-olds. The most frequent causative agents are Salmonella Enteritidis (96%) and Campylobacter jejuni, respectively. Both infections are foodborne. Ready-to-eat meals, poultry, confectionery and eggs seem to be most frequently implicated in outbreaks of salmonellosis in public catering and families. Sporadic cases of campylobacteriosis are mostly associated with ingestion of poultry and chopped meat. The incidence rates of these two infections are positively correlated with the average daily temperatures.

In recent decades an increase in the number of fractures of the proximal femur was recorded in this country and world-wide. The majority of patients with this diagnosis is above 70 years of age and their treatment comprises in addition to the medical aspect also economic and social problems. The objective of the present work is to summarize briefly the results achieved during the five-year trial focused on socio-economic problems of treatment of patients with fractures of the proximal femur. The investigated group comprised 244 patients hospitalized at the Orthopaedic Department of the Third Faculty of Medicine Charles University in 1997 with 248 fractures of the proximal femur. Thirty-nine fractures were treated conservatively, 116 by internal fixation and in 93 cases an arthroplasty was implanted. In the course of the first year of treatment 85 patients died. The therapeutic results after one year were evaluated in 159 patients. The total annual costs of the investigated group were 15.9 million crowns. The mean annual costs of treatment of one fracture of the proximal femur was 64,000 crowns. The ratio of deaths rose with age (p = 0.003), it did not depend on the social background of the patient (p = 0.16) and the quality of locomotor activity before the injury (p = 0.16). No type of fracture was associated with a higher or lower mortality (p = 0.09). A statistically significant higher mortality was recorded in patients included in the higher class of the ASA score (p < 0.001) and in conservatively treated patients (p < 0.001). The type of anaesthesia did not affect the mortality. The functional results were significantly worse in patients living before the injury in a dependent position (0.01 < p < 0.05) and with restricted physical activity (p < 0.01). The type of fractures did not affect significantly the functional results (p > 0.05). Poorer functional results were recorded in patients with ischaemic heart disease (p < 0.001) and neurological disease in their history (p < 0.001). Also inclusion into a higher class of surgical risk according to the ASA score was associated with poorer functional results (p < 0.001). Different types of anaesthesia and different methods of surgical treatment did not affect the quality of functional results. However the functional results were better in operated patients as compared with conservatively treated patients (p < 0.001).

Background: Multidrug-resistant (MDR) tuberculosis, defined as a disease caused by Mycobacterium tuberculosis strains, which are resistant to more antituberculous drugs (at least to isoniazid and rifampicin), is a problem frequently discussed in the Czech Republic. Cases of specific disease refractive to causal antituberculous therapy are associated with the risk of the spread of the causative agent among the population., Methods and Results: The National Reference Laboratory for Mycobacteria collected 2813 Mycobacterium tuberculosis strains isolated by Czech mycobacteriological laboratories in 1999 to 2001. All strains were tested for susceptibility to basic antituberculous drugs and then the MDR strains were further tested for susceptibility/resistance to other antituberculous and antibacterial drugs. The MDR strains were studied by DNA analysis (DNA fingerprinting restriction analysis, RFLP-Restriction Fragment Length Polymorphism) as well. Thirty-nine patients who had MDR tuberculosis were excretors of 56 Mycobacterium tuberculosis strains. In average, MDR tuberculosis accounted for 1.96% (1.7-2.4) of all cases of bacillary tuberculosis. The most frequent type of the multidrug resistance was that resistant to four basic antituberculous drugs (isoniazid, rifampicin, ethambutol and streptomycin). It was confirmed in 48.2% multidrug resistant strains., Conclusions: Isepamicin, clofazimin, capreomycin and amikacin are considered to be the most promising antituberculosis drugs. Based on RFLP profiles, 61.5% of strains were placed into 8 clusters while the other strains remained unclustered. No significant differences in geographical distribution and population structure were found between the excretors of clustered strains and those of unclustered strains. Preliminary comparison with restriction profiles of the MDR Mycobacterium tuberculosis strains in the international database suggests the uniqueness of Czech strains showing the profiles not found elsewhere to date.

Purpose of the Study: The authors present an overview of mortality of patients with proximal femur fractures treated at the authors' Department in 1997 in dependence on different factors relating to the preinjury condition and the treatment itself. The aim of the work was to determine the impact of these factors on the risk of mortality and compare the findings with the data published by other authors dealing with the same issue., Material: In the given year 244 patients with 248 proximal femur fractures, 58 men (24%), 186 women (76%), average age 77 years were treated. There were 115 (47%) fractures of femoral neck, 117 (47%) pertrochanteric fractures and 16 (6%) intertrochanteric (high subtrochanteric) fractures. Thirty-nine fractures (16%) were treated conservatively, internal fixation was performed in 116 fractures (47%), i.e. 6 times by a plate, 94 times by a DHS, 16 times by the Gamma nail, and 93 fractures (37%) were treated by arthroplasty (62 times by hemiarthroplasty and 31 times by total hip arthroplasty)., Methods: The following data was recorded in all patients of the monitored group: age, sex, social environment and physical activities of the patient prior to the injury, mechanism of the injury, type of fracture, surgical risk expressed by the respective class of the ASA score, therapeutic procedure, type of anesthesia and interval between the injury and operation. Recorded was also the number of mortality in the course of primary hospitalisation and one year after the injury or operation. At the end of the one-year monitoring statistical evaluation was made of the relation between mortality and the above mentioned monitored factors and the results were compared with those published in similar types of study., Results: In the period of one year after the injury or operation 85 patients died of the total number of 244 (56 women and 29 men). The number of decreased patients was increasing in individual age decades and the highest number was recorded in case of men in 9th decade (80%) and 10th decade (100%). The lowest number of mortality related to patients who lived with their families prior to the injury (26.5%) and the highest number was in patients from social care institutes (43.8%). Patients with impaired mobility already prior to the injury and not leaving their homes accounted for 46.7% of mortality. In the course of one year after the injury 33.0% died of fracture of femoral neck, 30.7% of pertrochanteric and 35.7% of intertrochanteric (high subtrochanteric) fracture. Dependence of mortality on ASA score was as follows: ASA I-0%, ASA II-4.3%, ASA III-21.3%, ASA IV-42.1%, ASA V-68.9%. The highest number of mortality of operated on patients was in the group treated by hemiarthroplasty (41.1%). After spinal anesthesia 26.6% of patients died within one year and after general anesthesia 26.7% of them. There was an evident increase in the number of mortality in patients operated on in the interval longer than 3 days after the injury., Discussion: The mortality in the followed up group was statistically significantly influenced by the age (p = 0.003), sex (p < 0.01) and ASA score (p < 0.001). This corresponds to the results of other studies. The dependence of mortality on environment and mobility prior to the injury, type of the fracture, type of surgical treatment and type of anesthesia has not been proved., Conclusion: Based on the evaluation of the data monitored in the group a conclusion was made that absolute mortality risk in the first year after the injury related to patients with pathological fractures due to metastasis. A higher risk related to male patients older than 80 years with the surgical risk of ASA IV and higher and this risk rate was the highest in the time interval within 3 months after the injury or operation.

In a pilot study Double Repetitive Element-Polymerase Chain Reaction 20 clinical isolates of Mycobacterium tuberculosis from Guatemala and 49 strains from Prague were typed. This technique is based on direct evidence of repetitive elements IS6110 or PGRS and does not require DNA purification, digestion by endonuclease nor Southern blot hybridization. Preliminary examination of Guatemalian strains revealed a striking identity or similarity of DRE-PCR profiles while the Prague strains were characterized by conspicuous polymorphism. The Prague strains were examined in a total number of 13 series of electrophoreograms and subsequently subjected to automated analysis with GelCompar software. The DRE-PCR method is suitable for screening of a major number of clinical isolates of M. tuberculosis in laboratories equipped with a minimum of technical facilities for the PCR method, furthermore it requires facilities for synthesis of the necessary primers and at least basic knowledge of molecular biology.

In a group of student volunteers vaccinated at the age of 13-17 years with vaccine produced by SmithKline Beecham Biologicals which contains the live attenuated strain of the Oka virus of varicella zoster the period of the protective effect of vaccination was assessed. In the course of 310,000 man-days of detailed investigation the authors revealed in 55 vaccinated subjects close exposure to a patient with varicella, and six of the vaccinated subjects contracted the disease after exposure. In the course of the subsequent three years no further case of varicella was recorded. Subjects vaccinated only by a single dose of the vaccine with low post-vaccination levels of specific antibodies contracted the disease.

There are probably several causes why steady decrease of tuberculosis incidence stopped. The aim of our work was to investigate a possible relation of tuberculosis incidence in smaller administrative areas with several social and economic characteristics. The individual data were taken from the Information System of Bacillary Tuberculosis, based on laboratory reporting network. Tuberculosis incidence dropped to 19.8/100,000 in 1987 and since then it fluctuates around that level. The levels in districts ranged from 1.9 to 45.6 in 1997. The social status, overcrowding, air pollution and unemployment rates are weakly correlated with tuberculosis incidence. These unfavourable values of social, economical and ecological indicators are linked with more industrialised parts of the country. Age and gender analysis shows that male population aged from 40-60 is the most affected population with higher rates of smear positive pulmonary TB. These rates are positively linked with a size of the municipality, in larger towns higher number of those cases are detected. Contrary to that, relatively higher rates of pulmonary tuberculosis are in elderly women in smaller municipalities. There is a suspicion about important role of relative poverty in the epidemiology of tuberculosis in the Czech Republic. The results indicate that we should concentrate our effort to reduce the incidence of tuberculosis mainly in economically active male population.

The Central Europe forms a buffer zone between the countries of the European West reporting tuberculosis notification rates lower than 20 per 100,000, the cut-off set between low and high incidence areas, and the Eastern European countries including the republics of the former USSR, Russia and the Baltic States. The Czech Republic holds an intermediate place between these two territories with the total notification rate of tuberculosis cases 18.8, 9.7 bacteriologically verified and 5.7 positive in direct smear per 100,000 in 1996. Data on drug resistance obtained from the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance were available from the Czech Republic, the only Central European country participating in the Project. The prevalence of resistant cases was here low: 2% primary and 13% acquired, and MDR cases were recorded in 1% of untreated and in 6% of repeatedly treated patients. The first microepidemic of MDR cases comprising 21 individuals was characterized by DNA fingerprinting. This outbreak pointed out the MDR tuberculosis as a new, extremely serious phenomenon in the epidemiology of tuberculosis. Corresponding data from Estonia and Latvia showed incomparably higher values in the drug resistance pattern: from 28 to 34% primary and 46 to 74% acquired resistance. MDR strains were reported in 9 to 14% of untreated and in 19 to 54% of repeatedly treated patients.

The primary objective of the SAVIAH, a multi-centre study funded by European Union, was to assess new methodology for study of small area health statistics and to implement it in epidemiological health statistics and geography. In Prague, the study has been conducted in two city districts with large variation in air pollution. Data at individual level (health symptoms and socio-economic circumstances of the family) were collected by questionnaires completed by parents of 3680 children aged 7-10 both resident and attending schools within the area (response rate 88%). Aggregated data for geographical areas were available from census and urban planning sources for 692 enumeration districts in the study area which were aggregated into 75 medium sized areas. Outdoor concentrations of nitrogen dioxide (NO2) were monitored by passive samplers. All these data were integrated into a geographic information system (GIS). Spatial distribution of air pollution was estimated by kriging and multiple regression modelling. These models explained about 80% of the variation in air pollution measured by passive samplers. GIS was then used to assign to individuals an exposure based on place of residence and school in order to conduct individual based analyses. Association between NO2 and life-time prevalence of wheezing and/or whistling, and wheezing/whistling in the last 12 months was studied by logistic regression. For both outcomes, school levels of NO2 were positively related to symptoms but home levels of NO2 showed a negative association. Logistic regression at individual level gives similar results as ecological analysis and multilevel modelling. Hierarchical model yielded somewhat wider confidence limits. Adjustment for parental behavioural and socio-economic factors did not affect these estimates substantially. This study demonstrated the power of the GIS methodology in studying the effects of complex environmental factors on respiratory health of children.

Background: Socioeconomic factors have been identified as important determinants of morbidity and mortality in many populations but only few studies examined their importance in the Czech population. The objective of this study was to analyse the relationship between socioeconomic characteristics and mortality in districts of the Czech Republic in 1989-1993., Methods and Results: The association between age-standardised mortality (for men and women separately) from all causes, all cancers, lung cancer, cardiovascular and ischaemic heart disease in the age group 35-64 and socioeconomic characteristics of districts reported from the 1991 Census was studied in multiple linear regression. In principle, associations between socioeconomic factors and mortality were similar for all causes of death. Mortality was inversely related to percentage of population with secondary and university education and to proportion of population with any religious denomination. After controlling for other factors, correlation coefficients (r) between all cause mortality and proportion of population with primary education were 0.69 in men and 0.64 in women; for the proportion of population with any religious denomination the r were -0.42 and -0.72, respectively. Relation of mortality to mean of persons per room was stronger in women (r = 0.29) than in men (r = 0.10). Population density was most closely correlated with ischemic heart disease (r = 0.41) in men and 0.43 in women). Available socioeconomic factors explained over 60% of geographical variation in mortality from all causes, more than 50% of variation in cancers and about 40% of variation in ischaemic heart disease., Conclusions: Although ecological studies do not allow firm identification of causal factors, our results agree well with other studies, and confirm the important effect of socioeconomic factors on health in the Czech population.

In 200 3-7-year-old children in two localities of Bratislava-city with different concentrations of NO2, SO2, dustiness with different bioclimatic factors and a different epidemiological position the authors investigated their effect on the frequency, incidence and types of relapsing respiratory diseases during different months in 1991. The different concentrations of the above substances in the atmosphere of the two localities did not affect the number of respiratory diseases nor their annual or monthly incidence. In the place with the increased NO2 concentration a significantly higher number of serious forms of respiratory diseases was found in the investigated group. In the locality with a more favourable oecological and epidemiological situation the adverse effect of monthly NO2 concentrations was manifested when it was potentiated by the SO2 concentration and combined with dustiness and dust fall-out. The authors found a significant correlation between the incidence of relapsing respiratory diseases and the atmospheric temperature and its relative humidity in the course of different months of the year.

R plasmids have been demonstrated in several group of strains of enterobacteriaceae from hospital environment. R + enteropathogenic strains of Escherichia coli were isolated from several items of baby-care as well as from the pre-prepared baby food in a newborn unit. Strains from environmental samples are thought to be identical with those causing nosocomial gastroenteritis of babies. From hospital waste waters of another larger country hospital we could isolate R + strains of Salmonella typhimurium and R + protei, both associated with occurence of gastrointestinal or urological hospital infections. R-factor-carrying strains of E. coli have been isolated also from surface water samples from the area surrounding the hospital monitored.