Smoking-attributable mortality in the Czech Republic

Objectives The main objective of this work is to quantify the contribution of smoking to mortality in the Czech Republic (CR) in 2002. Methods The estimate of the proportion by which smoking contributed to mortality in the CR was computed using the method of smoking-attributable fractions (SAF). The SAF was computed from relative risks established in the American Cancer Prevention Study II and from estimates of the prevalence of smoking from a nationwide study conducted in 2002. Results In 2002, there were 20,550 (95% confidence interval: 18,851–22,262) deaths in the CR that could be attributed to smoking (14,525 men and 6,025 women). Deaths caused by smoking represent 19% of the total nationwide mortality for 2002. Earlier estimates were published by Peto and Lopez for 1995 (22,300 deaths caused by smoking) and 2000 (17,746 deaths). The estimate arrived at using the SAF method for 2002 coincides with that reported by Peto and Lopez for 2000. Conclusions The high mortality rate related to smoking is the result of the high prevalence of smoking and an insignificant change of smoking habits in the adult population in recent years. An efficient tobacco control policy could contribute to the reduction of smoking and save lives and costs expended to treat diseases caused by smoking.     

The impact of obesity on cardiovascular disease mortality in the District Sumperk,Czech Republic

Summary Objective: The impact of obesity on cardiovascular mortality in the District Sumperk (C2) is assessed. Methods: A case-control design was selected to study the impact of obesity on cardiovascular mortality among the population of the District Sumperk, Czech Republic. Exposure to obesity was defined as body-mass index (BMI) higher or equal 30. Men and women with BMI lower than 30 were considered nonexposed. Odds ratios were calculated, comparing the probability of exposure among cases and controls. Cases were defined as persons from the studied population who died between 1987–2004, the cause of death being circulatory system diseases. Controls were persons from the studied population who had not died as to December 31, 2004. Results: Cases were more likely to be obese than controls (OR = 1.68; 95 % CI 1.56–1.80). In men OR was 1.56 (95 % CI 1.40–1.74), in women OR was 1.89 (95 % CI 1.72–2.06). The impact of obesity was decreasing with increasing age. Conclusions: An increased risk of cardiovascular mortality following exposure to obesity was observed. Younger age groups seem to be the important target population for preventive programmes focusing on treatment of obesity. Submitted: 6 June 2006; Revised: 9 March 2007; Accepted: 29 March 2007     

Neonatal mortality in the Czech Republic during the transition

OBJECTIVES: To identify factors underlying the reduction in neonatal mortality in the Czech Republic during the 1990s and to identify scope for further improvements. DESIGN: Examination of trends in birth weight and birth weight specific neonatal mortality in the Czech Republic and comparison with figures from Sweden, which has one of the lowest neonatal mortality rates in Europe. SETTING: The Czech Republic. SUBJECTS: All singleton births occurring in the Czech Republic in 1989-1991 and 1994-1995, with a comparison group of all singleton births in Sweden in 1989-1991. MAIN OUTCOME MEASURES: Neonatal mortality rate. RESULTS: Despite a slight worsening in the birth weight distribution, the neonatal mortality rate in the Czech Republic fell from 5.6 to 3.8 per thousand live births. This was due to an improvement in the survival of infants at all birth weights but especially amongst the lightest. Eighty percent of the overall improvement was due to greater survival among those under 2500 g. Comparison with Swedish birth weight specific rates indicates that, for the country as a whole, only small additional gains are likely as a result of improved survival at a given birth weight but, instead, a reduction in the proportion of low birth weight babies would have a much greater effect. Regional analysis indicates that the improvements have been much greater in Prague than in the rest of the country. CONCLUSIONS: An effective strategy to reduce neonatal mortality in the Czech Republic should have two elements. The first is to address the socio-economic determinants of low birth weight. The second is to reduce regional inequalities in the quality of neonatal care. This should, however, be supplemented by more detailed investigation to identify specific amenable factors.     

Socioeconomic status and cardiovascular risk factors in the Czech Republic

BACKGROUND: In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and magnitude of the socioeconomic gradient in cardiovascular risk factors in a former communist country. As the relationship between material conditions and education has been much weaker than in the west, we have also attempted to separate their effects. METHODS: A cross-sectional survey examined a random sample of men and women resident in six Czech districts participating in the MONICA study in 1992. Participants completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided a blood sample. Two indicators of SES were used: education and material conditions, the indicator constructed from car ownership and crowding. Linear regression was employed to analyse the relation between SES and total and high-density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height. Logistic regression was used to assess the association between SES and smoking and hypertension. RESULTS: A total of 1141 men and 1212 women (overall response rate 75%) participated in the study. After controlling for age, all risk factors were associated with education, except HDL cholesterol in women and BMI in men; only smoking in both sexes and WHR in women and height in men were significantly related to material conditions. In mutually adjusted analyses, educational gradients persisted but associations with material conditions disappeared or became substantially weaker. The magnitude of the educational differences was similar to those found in western countries. CONCLUSIONS: Socioeconomic differences in cardiovascular risk factors in Czech Republic in 1992 had the same direction and similar magnitude as in Western Europe, and were strongly related to education rather than material conditions. Materialist explanations for the social differences seem unlikely in this population.     

Excess mortality associated with antimicrobial drug-resistant Salmonella typhimurium

In a matched cohort study, we determined the death rates associated with drug resistance in Salmonella Typhimurium. We linked data from the Danish Surveillance Registry for Enteric Pathogens with the Civil Registration System and the Danish National Discharge Registry. By survival analysis, the 2-year death rates were compared with a matched sample of the general Danish population, after the data were adjusted for differences in comorbidity. In 2,047 patients with S. Typhimurium, 59 deaths were identified. Patients with pansusceptible strains of S. Typhimurium were 2.3 times more likely to die 2 years after infection than persons in the general Danish population. Patients infected with strains resistant to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline were 4.8 times (95% CI 2.2 to 10.2) more likely to die, whereas quinolone resistance was associated with a mortality rate 10.3 times higher than the general population.     

High summer temperatures and mortality in the Czech Republic 1982-2000

The heat-stress-related mortality, which is among main impacts of periods of high summer temperature on society, was reported in many European countries, but analyses focusing on central European population have been rare. Results of the analysis for the period of 1982-2000 in the Czech Republic indicate that heat stress leads to a considerably increased all-causes mortality and mortality due to cardiovascular diseases. Periods with the highest deviations of the daily number of deaths from a baseline (in all-year data) are influenza epidemics and heat waves; the distribution of days with the highest excess mortality in a year is clearly bimodal, showing a main peak in winter and a secondary one in summer. Summer days with a considerably increased mortality are almost entirely days with a positive temperature deviation from the seasonal course. Deviations of mortality from the baseline exceed 100 deaths daily (more than 30% relative increase) in heat wave peaks, and the excess total mortality during the severe 1994 heat waves was +456 deaths (+10.3%) for June 17 to 30, and 8 deaths (+12.3%) for July 24 to August 8. The relative increase in mortality due to cardiovascular diseases was even more pronounced. The mortality displacement effect played an important role, since it was estimated to account for as much as 52% of the total number of victims for the June 1994 heat wave and 48% for the July-August heat wave. People who would die soon without oppressive weather conditions make about half of the total number of deaths, which is a larger value compared to what other studies reported. The increased mortality is observed at maximum (average, minimum) daily temperatures higher than 25 degrees C (18 degrees C, 14 degrees C) and their anomalies from mean seasonal courses larger than 3 degrees C. The same values hold for both the total and cardiovascular mortality. The mortality response at high temperatures is more pronounced in females than males. Correlations between mortality and temperature variables (including heat index) are positive and statistically significant (P = 0.01), stronger for deviations of meteorological variables from seasonal courses than for raw values, in females than males, and for heat index than for any temperature variable and summer simmer index. The unlagged correlations are stronger than correlations with lags 1-3 days; positive values of correlation coefficients hold for lags 0 to 3 days only while at lags of 4 to 25 days, the link is negative (mostly statistically significant) which demonstrates the mortality displacement effect and its time extent.     

The impact of heat waves and cold spells on mortality rates in the Dutch population

We conducted the study described in this paper to investigate the impact of ambient temperature on mortality in the Netherlands during 1979-1997, the impact of heat waves and cold spells on mortality in particular, and the possibility of any heat wave- or cold spell-induced forward displacement of mortality. We found a V-like relationship between mortality and temperature, with an optimum temperature value (e.g., average temperature with lowest mortality rate) of 16.5 degrees C for total mortality, cardiovascular mortality, respiratory mortality, and mortality among those [Greater and equal to] 65 year of age. For mortality due to malignant neoplasms and mortality in the youngest age group, the optimum temperatures were 15.5 degrees C and 14.5 degrees C, respectively. For temperatures above the optimum, mortality increased by 0.47, 1.86, 12.82, and 2.72% for malignant neoplasms, cardiovascular disease, respiratory diseases, and total mortality, respectively, for each degree Celsius increase above the optimum in the preceding month. For temperatures below the optimum, mortality increased 0.22, 1.69, 5.15, and 1.37%, respectively, for each degree Celsius decrease below the optimum in the preceding month. Mortality increased significantly during all of the heat waves studied, and the elderly were most effected by extreme heat. The heat waves led to increases in mortality due to all of the selected causes, especially respiratory mortality. Average total excess mortality during the heat waves studied was 12.1%, or 39.8 deaths/day. The average excess mortality during the cold spells was 12.8% or 46.6 deaths/day, which was mostly attributable to the increase in cardiovascular mortality and mortality among the elderly. The results concerning the forward displacement of deaths due to heat waves were not conclusive. We found no cold-induced forward displacement of deaths.     

Health-care reforms in the Czech Republic

Health-care reform is everywhere. Although different countries are moving at different speeds, using somewhat different means and different routes, they are all trying to arrive at the same place. The place is called "better value for money in health care". Presents details of the health-care reforms taking place in the Czech Republic, identifying and discussing the main strands of Czech reforms: the dissolution of the regional health authorities; the reorientation of district health authorities; the move to a pluralistic semi-competitive insurance-based system; hospitals receiving funding by winning contracts with purchasers; contracts becoming more sophisticated and being based on cost, volume and quality factors; changes in the incentives and rewards for GPs; the drive towards a primary-care-led health-care system; and privatization.     

Tobacco control in the Czech Republic

Main points of tobacco control measures in the country are mentioned: smoking prevalence among population and health professionals (both about one third), smoking cessation availability (about 70 smoking cessation clinics), education of health professionals, both pre- and post-gradual, public-oriented actions, advertising, tobacco prices, legislation, cigarette consumption, mortality.     

Occupational respiratory diseases in the Czech Republic

This paper presents the profile of occupational respiratory diseases in the Czech Republic. In a retrospective study the author analyzes structure, causes, occurrence, and trends of occupational diseases. Between 1996 and 2000, a total of 2,127 new cases were recorded, of which 62.0% were pneumoconioses caused by dust containing free silica, 21.0% were occupational asthma or allergic rhinitis and the rest were divided between lung cancer (10.0%), asbestos-related disorders (4.4%) and variety of other respiratory diseases (2.7%). During the period of the investigations, the decreasing trend of occupational respiratory diseases, which began in 1992, has continued.     

Costs of dementia in the Czech Republic

Objective

The aim of this study was to estimate the cost of dementia in the Czech Republic.

Methods

One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables.

Results

The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p < 0.05) increased if patients were living with their primary caregiver, and if the severity of cognitive impairment was increased.

Conclusions

The indirect cost, which was represented mainly by informal care, comprised the main part of the total cost of care for patients with dementia in the Czech Republic. Both total and indirect care costs increased significantly the cognition declined.

     

Human biomonitoring system in the Czech Republic

The human biomonitoring (HBM) is an integral part of Environmental Health Monitoring System in the Czech Republic since 1994. Selected biomarkers of the internal dose (heavy metals, PCBs) and cytogenetic analysis of peripheral lymphocytes as a biomarker of the exposure/effect to/of environmental genotoxic factors are systematically followed up in the blood and urine of adults (blood donors), in children aged 8 to 10 years, and in the breast milk of nursing mothers. Selected outputs documented the declining trend of blood lead levels, with the recent reference value of 80 mg/l for men, and the rising trend of blood selenium levels in adults, but not in children. PCBs and chlorinated pesticides in human milk show a long-term downward trend, but still higher than in neighbouring countries. The frequency of aberrant cells revealed a downward trend, but the increase obtained in the last monitored period needs to be explained. Further HBM activities are required to demonstrate the corresponding trends and to reduce human exposure and health risks.     

Genetic, biochemical, and environmental factors associated with pregnancy outcomes in newborns from the Czech Republic

Background

Oxidative damage to placental DNA can result in negative pregnancy outcomes, including intrauterine growth restriction (IUGR) and low birth weight (LBW).

Objective

We investigated associations between the levels of 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG), a marker of oxidative DNA damage, in placental DNA, exposure to air pollutants during pregnancy, genetic polymorphisms in 94 selected genes, and pregnancy outcomes.

Methods

We studied 891 newborns who were IUGR- or LBW-affected or normal weight and were born between 1994 and 1999 in the Czech Republic in two districts with different levels of air pollution.

Results

We found nonsignificantly elevated 8-oxodG levels in the IUGR-affected group compared with the non-IUGR group (p = 0.055). Similarly, slightly elevated 8-oxodG levels were found in the LBW-affected group compared with the non-LBW group (p < 0.050). In univariate analyses, we identified single nucleotide polymorphisms associated with 8-oxodG levels, IUGR, and LBW. Exposure to particulate matter < 2.5 μm was associated with increased 8-oxodG levels in placental DNA and LBW. However, multivariate-adjusted logistic regression revealed that above-median 8-oxodG levels were the only factor significantly associated with IUGR [OR = 1.56; 95% confidence interval (CI), 1.07–2.37; p = 0.022]. Above-median levels of 8-oxodG were associated with LBW (OR = 1.88; 95% CI, 1.15–3.06; p = 0.011). Other variables associated with LBW included sex and gestational age of the newborn, maternal smoking, and haplotypes in the promoter region of the gene encoding mannose-binding lectin 2 (MBL2). The role of air pollutants in the risk of adverse pregnancy outcomes seemed to be less important.

Conclusions

Levels of 8-oxodG in placental DNA were associated with the risk of IUGR as well as LBW. Newborn’s sex, gestational age, maternal smoking, and genetic polymorphisms in the promoter region of the MBL2 gene were associated with LBW incidence.