Health status in the Czech and Slovak Federal Republic

Health status in the Czech and Slovak Federal Republic (CSFR)since 1950 is reviewed and compared with health status in Austria,West Germany (as was) and Sweden. CSFR performance in childhealth and communicable disease control has been good overall,although infant and child mortality declines have fallen behindthose in Western European countries in recent years. Life expectancyat birth has stagnated and is now substantially lower than inWestern Europe, while life expectancy at 15 years for maleshas declined. Substantial excess adult mortality exists in theCSFR compared to Western European countries. This disparityis particulary marked in males, and is largely due to high ratesof cardiovascular disease and lung cancer. Public expenditurein the health sector is likely to decline in real terms overthe next few years. In this climate, it is essential that anadequate level of investment in public health is maintainedand that resources are allocated to only the most cost-effectiveprogrammes.     

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.     

The status of measles after five years of mass vaccination in the USSR

Mass vaccination of children from 10 months to 8 years old with the original live vaccine prepared from the Leningrad—16 strain has led to a sharp decline in measles morbidity and mortality, and changed its epidemic pattern. In 1972, after 5 years of mass vaccination, the morbidity rate was 117.5 per 100 000 persons, whereas before vaccination the average annual morbidity rate was about 827.0. The periodicity of increases in morbidity every 3 years was also broken, the last peak of measles morbidity occurring in 1965. Another result of vaccination is that the formerly much higher morbidity rate in urban areas is now lower than that in rural areas. The mortality rate decreased more than 3-fold compared with the period before vaccination, and recently no deaths were registered in a number of regions. The serologic examination of 7 585 vaccinated children from 10 different regions revealed antibodies with a mean geometric titre of 78.6±1.16 in 90% of individuals. The high antibody level was maintained for 7 years after vaccination. The effect of vaccination is both epidemiological and economical. The saving in the use of gamma-globulin alone covered the cost of the vaccine and the expenses involved during vaccination.     

Targeted vaccination with meningococcal polysaccharide vaccine in one district of the Czech Republic.

Vaccination against Neisseria meningitidis is not part of routine immunization schemes in any country; instead, targeted vaccination of groups at the highest risk is recommended during outbreaks and epidemics. After a long period of sporadic occurrence of meningococcal invasive disease, a new clone of Neisseria meningitidis C:2a:P1.2, ET-15/37, occurred in the Czech Republic, and caused local outbreaks in two neighbouring districts, Olomouc and Bruntal, in spring 1993. In Olomouc, a mass campaign was conducted during which 6191 students were vaccinated (5.6% of the total population of this locality and 96% of all students in the age group 15-19) within 2 weeks in June 1993. In Bruntal district, no such campaign was organized. In Olomouc, the incidence of invasive disease caused by Neisseria meningitidis C in the age group 10-24 decreased from 57 to 0 per 100,000 (P < 0.001) during the post-vaccination period (July 1993-August 1994), but no such decrease was observed in Bruntal. Although other factors can affect the frequency of disease, these results support the current recommendations of targeted vaccination in outbreaks of meningococcal disease.     

Caries experience, oral health status and urine fluoride excretion in children in some localities in the Czech Republic

Two studies on caries experience and oral health status in 12-year-old-children were conducted in a five year period (1993-1998). The examination was completed by analysing the urinary fluoride excretion of the examined children. The DMFT was recorded. The F-selective electrode was used for the analysis of the urinary fluoride concentration. The percentage of caries-free children decreased between 1993-1998. Caries experience rose in most of the localities. The highest caries experience expressed by DMFT was found in Tábor where it reached 5 per person. The urinary fluoride excretion ranged from the lowest level, found in Strakonice (0.478 mg/l), to the highest which was in Ostrava (0.660 mg/l) in 1998. F-concentrations in all other localities were between these extremes (both in 1993 and 1998). Oral health and fluoride exposure from the environment varied considerably which implies the necessity to implement individual precautions in oral care and prevention at a local level.     

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.     

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.     

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.     

Five years of the system of monitoring the environmental impact on population health of the Czech Republic

The data collected in the System of monitoring the environmental impact on population health of the Czech Republic in 1994-1998 were obtained routinely and in a stabilized manner in six subsystems: health consequences and risks related to air pollution, drinking water quality, noise, human dietary exposure, human exposure to toxic pollutants from the environment and monitoring of the health status and evaluation of selected indicators of demographic and health statistics. They represent a useful and comprehensive background for providing objective information on the health status of the Czech population and on pollution of different components of the environment in the Czech Republic. The results obtained in the period 1994-1998 show that no critical situation needing urgent countermeasures to be taken appeared in the localities monitored. However, some results are indicative of the necessity to take certain remedial measures to maintain all population exposure burdens as low as reasonably possible from the economical and social points of view. Generally, the admissible limit values and exposure limits are exceeded only sporadically in some localities while for most contaminants monitored only very low values compared to the limits can be found and such situations are mostly considered as non-systematic changes.     

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.

     

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.     

Increasing social variation in birth outcomes in the Czech Republic after 1989.

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.     

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.     

Poliomyelitis surveillance in the Czech Republic from the start of vaccination to the certification of eradication in the European Region

Poliomyelitis anterior acuta is an acute infectious disease caused by polioviruses of three antigenic types. First epidemics of poliomyelitis emerged at the end of the 19th century. The World Health Organization launched the poliomyelitis eradication program in 1988. The incidence of poliomyelitis in the world decreased from 350,000 cases in 1988 to 1918 cases in 2002 when poliomyelitis eradication was certified in three WHO regions, the European Region (2002), American Region (1994) and West Pacific Region (2000). Systematic clinico-virological surveillance of poliomyelitis has been carried in the Czech Republic since 1961, including annual vaccination campaigns with living OPV vaccine, clinical screening, virological screening of clinical specimens and sewage water (environmental) samples and sera screening within serological surveys mapping the vaccination immunological efficacy. From 1961 to 2003, 21,423 stool specimens of vaccinated healthy children, 62,440 stool specimens of patients, 6250 cerebrospinal fluid specimens and 2100 throat swab specimens were screened. Within the outdoor environment surveillance, 15,460 sewage water samples were analysed. From 1995 to 2003 129 cases of acute flaccid paresis were investigated in children under 15 years of age and 28 stool samples from their contacts were screened. Over the same period, 1280 sewage water samples from refugee camps were analysed. For serological surveys, about 60,000 sera from healthy individuals of all age categories were investigated. No case of paralytic poliomyelitis has been reported and no wild virus has been isolated in the Czech Republic since 1961.