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.     

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.     

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.     

Salmonelloses in the Czech Republic 1989-1998

In the Czech Republic in 1989 a triple increase of the incidence of salmonelloses was recorded: 34,435 cases. Since that year the morbidity trend varies between 400 and 500 cases per 100,000 population. The dominating agent (95% and more) is Salmonella Enteritidis PT8. The epidemic incidence was recorded on the whole territory of the Czech Republic mainly in Moravia and in the East Bohemian region. The specific morbidity is highest in 0 and 1-4 year-old children. The seasonal incidence has two peaks with the exception of 1997. During the period between 1989 and 1996 there was a significant increase of epidemics of salmonellosis in conjunction with food production incl. private confectionery shops, restaurants and the sale of foods in the streets. The most important vehicle are eggs and egg products, in particular confectionery. Salmonella Typhimurium DT104 is found only rarely in the Czech Republic. The first epidemic (15 cases) developed in 1998.     

Regional AIDS center activities in the Czech Republic

Conclusions The epidemic of AIDS is just beginning in the Czech Republic; only several dozens of patients with AIDS or anti-HIV positive individuals have been recorded. It is urgent to start an intensive preventive campaign. The AIDS Center of the Masaryk Hospital, Usti nad Labem, has embarked on a preventive campaign for the Northern Bohemia Region. The effort focuses on improving the diagnosis and treatment of AIDS, as well as educational activities presented in the media targeting primarily young people and population groups at high risk for HIV infection. International cooperation is an important factor in the success of this campaign, especially in large cities and border regions.     

Social costs of obesity in the Czech Republic

The European Journal of Health Economics - Increasing prevalence of obesity (BMI &gt; 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1...     

Drug Information System in the Czech Republic.

The Drug Information System (DIS) enables to monitor: incidence (the numbers of newly registered problem drug users); prevalence (the numbers of existing problem users visiting treatment/contact centres in a certain time period or as of a certain date); types of used drugs, manner of their application, frequency of use, their availability, purity; health (but also social consequences) of drug use (hepatitis, HIV; social and economic consequences); demographic profile of affected persons (age, sex, employment, education, etc.); time trends showing potential changes of the above specified indicators, including changes in the geographic distribution. Hygienic Service was mandated to create and operate the DIS in the Czech Republic. The system has been in operation since 1 January 1995 and it is based on the monitoring of basic health indicators.     

Pornography and sex crimes in the Czech Republic

Pornography continues to be a contentious matter with those on the one side arguing it detrimental to society while others argue it is pleasurable to many and a feature of free speech. The advent of the Internet with the ready availability of sexually explicit materials thereon particularly has seemed to raise questions of its influence. Following the effects of a new law in the Czech Republic that allowed pornography to a society previously having forbidden it allowed us to monitor the change in sex related crime that followed the change. As found in all other countries in which the phenomenon has been studied, rape and other sex crimes did not increase. Of particular note is that this country, like Denmark and Japan, had a prolonged interval during which possession of child pornography was not illegal and, like those other countries, showed a significant decrease in the incidence of child sex abuse.     

Breastfeeding promotion and protection in the Czech Republic

The purpose of the article is to present the National Breastfeeding Promotion Programme in the Czech Republic in the course of the last decade. It summarizes the main strategies, education and training activities of the National Breastfeeding Committee, its collaboration with the Government, Parliament, IBFAN and UNICEF. The article reviews the relevant studies on infant feeding which illustrate the increase of the prevalence of breastfeeding in the course of the 1990's and reflect the effect of the programme. Recent negotiations with the Ministry of Health have outlined the implementation of the WHO global strategy for infant and young child feeding in the Czech Republic.     

Biomonitoring of lead exposure in the Czech Republic

The systematic and long-term efforts to protect the environment may be successful also in the country in the period of transition from centrally planned to free market economies. The basic requirement is to disseminate reliable information on the exposure levels and expected health effects. The need for high quality information underscores the importance of the quality assurance and quality control systems in the context of good laboratory as well as epidemiologic practices. Each monitoring study should be planned in the way facilitating its use for the evaluation of long-term trends. Besides scientific issues, the communication of risks is of crucial importance. According to our experience, only an involvement of formal as well as informal local authorities and co-operation between all relevant stakeholders can ensure the success.     

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.