Evaluation of ultrafiltration cartridges for a water sampling apparatus.

AIMS: To determine the efficiency of various ultrafiltration cartridges (UFC) in concentrating test micro-organisms from drinking water. METHODS AND RESULTS: Replicate drinking water samples from three potable water supplies were dosed with Bacillus anthracis Sterne, Francisella tularensis LVS, Yersinia pestis CO92, bacteriophages MS2 and phi-X174, and Cryptosporidium parvum. The test micro-organisms were dosed together in 100 l of water, which was then recirculated through one of five different UFC until the retentate volume was reduced to c. 500 ml. The micro-organisms were assayed before and after ultrafiltration concentration and per cent recoveries were calculated. There were nine statistically significant differences among pairs of filters out of a possible 180 different combinations of UFC, test micro-organisms, and water types. CONCLUSIONS: No filter consistently performed better or worse than the others for each test micro-organism in all water samples tested. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides performance data on the ability of several different UFC to concentrate a panel of test micro-organisms from three sources of potable water. Water utilities and first responders may use these data when selecting UFC for use in emergency response protocols. This study also provides additional data as to the efficacy of ultrafiltration for recovering bacteria, virus-like particles, and protozoan oocysts from water samples.

[Epidemiological characteristics of diabetes mellitus in Slovakia, 1992-2002]. / Epidemiologicke charakteristiky diabetes mellitus na Slovensku v rokoch 1992 az 2002.

UNLABELLED: Diabetes mellitus (DM) is one of the most important public health concerns and its consequences represent a considerable social and health burden. The study analyses the occurrence of DM in Slovakia in 1992-2002. MATERIAL AND METHODS: Age standardised incidence and prevalence rates of DM were calculated from the data published by the Institute of Health Information and Statistics for 1992, 1997 and 2002. Disease length and the incidence of selected complications in 1997 and 2002 were also analysed. RESULTS: In 1992-2002, DM prevalence in Slovakia increased from 4261.3 to 5065.8 cases per 100,000 population and appeared to be positively associated with age, while the DM incidence rates rose from 329.6 to 423.7 cases per 100,000 population. In most patients, DM length was 5 years or less, showing an upward trend over the studied period. From 1997 to 2002, the rates of selected diabetic complications slightly increased (from 18.7 % to 20.3 % for peripheral neuropathy, from 16.8 % to 18.0 % for retinopathy, from 7.1 % to 8.0 % for nephropathy and from 1.2 % to 1.3 % for amputations). DISCUSSION AND CONCLUSIONS: Comparing with the world data, Slovakia ranks among the countries with relatively high prevalence of DM, mainly due to the rising incidence. These results are consistent with the global upward trend in DM. However, taking into account underreporting, the actual DM prevalence in Slovakia could be considerably higher. Besides primary prevention, risk reduction measures should be focused particularly on early diagnosis and better implementation of secondary prevention.

Pneumococcal vaccination--current situation and perspectives.

The authors carried out a survey in outpatient and hospitalised patients with risk factors for invasive pneumococcal disease in a tertiary-care medical faculty affiliated hospital. Data were collected by individual interviews and verified against the medical records of all addressed patients. The authors also attempted to discover the attitude of general practitioners (GPs) from 2 Slovak districts towards the pneumococcal vaccine by means of an anonymous questionnaire. Out of the total of 154 addressed patients, 128 (83.1%) had at least one risk factor for acquiring invasive pneumococcal disease. However, only 8 (6.3%) of them had ever been administered pneumococcal vaccine. Out of 34 hospitalised patients with at least one risk factor 82.4 % had not received any pneumococcal vaccination in the past. When subdivided according to age and risk factors (chronic respiratory, cardiovascular, uropoetic, metabolic, immunne system disorders, asplenia), vaccination coverage in all groups was very low, ranging between --9.3%. In an anonymous questionnaire 74 (94.9%) out of 77 surveyed GPs referred to a lack of information on the polysaccharide pneumococcal vaccine and 22 (28.2%) expressed their general distrust towards vaccination of any kind. The main role in increasing the disturbingly low pneumococcal vaccination coverage lies in the hands of medical professionals, especially GPs who should inform their patients about the possibility of a free vaccine and who should make an effort to explain to their patients the benefit of pneumococcal vaccination. (Tab. 4, Reft 9.)

Effectiveness of school programs in tobacco control.

The authors reviewed published data dealing with the effectiveness of school programs in tobacco control. Most of the evaluated school programs showed at least partial effect including namely improved knowledge level, decreased prevalence of smoking initiation and continuation. Less successful was achieving of behavioural changes and social resistance. Effect of the school programs can be significantly amplified by combination with other interventions such as mass media campaigns, parent involvement and extracurricular activities. The main problem of the studies in this field is a relatively short follow-up time not allowing considering findings as relevant evidences for long-term effects of school programs. However, even assuming only time limited decrease of prevalence of smoking among intervened students, such temporary effect leads to the decrease of a lifetime cigarette exposure having beneficial health effects. Considering social, demographic and cultural aspects of the epidemiology of smoking habit, evidence based data in this field, relevant for Central and Eastern Countries, are required. Such situation calls for authentic trials and studies respecting specific conditions in these countries.

Analysis of unusual accumulation of Creutzfeldt-Jakob disease cases in Orava and Liptov regions (northern Slovak focus) 1983-2000.

While familial cases of Creutzfeldt-Jakob disease are extremely rare all over the world, 3 familial clusters were observed between 1983-2000 in a relatively small area situated in the North of Slovakia. Prevalence of CJD in this area exceeded the overall prevalence in Slovakia more than 8 times. The majority of CJD patients admitted consuming sheep brain. Most patients lived in small secluded villages with rather common familial intermarriage. CJD affected both sexes equally. All patients were prior to the disease mentally normal individuals. Shortly after the onset of CJD their mental status deteriorated remarkably with an average survival rate of 3.6 months.

Influenza vaccination--knowledge, attitudes, coverage--can they be improved?

The reasons for low rate of influenza vaccination in Slovakia have been analyzed in selected target groups. In our questionnaire study we focused on the level of knowledge about this vaccination and the attitudes towards it. We selected three target groups: medical students, nurses and printing company workers. The authors as well tried to identify the ways how the flu vaccination coverage could be increased in the future. The questionnaire survey revealed several surprising facts. Though almost all the respondents knew about the existence of influenza vaccine, less than one quarter of them have ever received influenza shot. Despite our expectations that the main source of information about influenza prevention in medical students and nurses would be from their medical and nursing studies, it was shown to be from mass media instead. Even more staggering was the distrust towards the vaccination as a reason for not being vaccinated in a high proportion of both the medical students and the nurses. The majority of medical students would not even want to get a vaccination, even if it were to be provided for free. These results suggest that if we want to improve the low influenza vaccination coverage within the general population of our country, we will have to focus our attention primarily on the professional groups of medical workers and medical and nursing students who should be able to provide the public with the competent advice. Therefore, changing the current negative approach and improving the deficit in knowledge concerning vaccination are the key tasks for all under- as well as postgraduate teachers of medicine and nursing in Slovakia, especially, but not exclusively, of those specialised in public health.(Tab. 3, Fig. 2, Ref. 8).

Detection of antibodies in saliva--an effective auxiliary method in surveillance of infectious diseases.

Saliva is a body fluid containing antibodies of diagnostic significance. Unlike venipuncture, saliva collection (by brushing the teeth and rubbing the gums) is painless, non-invasive, inexpensive, simple and rapid. By using sensitive immunoassays in salivary specimens it is possible to diagnose immunoglobulins against a wide range of infectious diseases e.g. hepatitis A, B and C, measles, mumps, rubella, human immunodeficiency virus, Epstein-Barr virus, parvovirus B 19, human herpesvirus 6 and Helicobacter pylori infections. Salivary antibody testing may provide better access to epidemic outbreaks, children, large populations, hard-to-reach risk groups and may thus play a major role in the surveillance and control of infectious diseases. (Tab. 2, Ref. 34.)

Cost effectiveness and cost benefit of viral hepatitis B vaccination in the Slovak Republic.

In our work we tried to evaluate the cost effectiveness (CEA) and cost benefit (CBA) of the vaccination strategy of viral hepatitis B (VHB) vaccination in Slovakia. Retrospectively we analysed the incidence of VHB before and after the vaccination against VHB. From the calculated yearly cost (direct and indirect)--treatment costs and vaccination costs--we tried to calculate the estimated financial costs of vaccination strategy in 2000 (89.4 mil. SK), the saved costs (92 mil. SK), cost effectiveness (201 642 SK) and cost benefit (2.70 SK). First a decrease of the incidence (after introduction of measures to prevent nosocomial transmission) had been achieved by vaccination of selected risk groups of the population. A significant positive impact on the incidence of VHB is expected from mass preventive vaccination of infants, introduced in Slovakia in 1998.

Pharmacotherapy in smoking cessation.

The authors reviewed literature on nicotine replacement therapy and bupropion in smoking cessation. Nicotine replacement therapy increases the quit rate in smoking cessation; however, its efficacy is influenced by numerous factors. Bupropion, particularly combined with nicotine replacement therapy, reaches even higher efficacy. Behavioural therapy as well as individualized approach during the cessation process are beneficial. Beside from this, these agents help to avoid excessive weight gain after quitting. If properly used, they have minimal side effects, and, if not contraindicated, they should be included into standard smoking cessation programs. (Ref. 74.)

Smoking and some life-style changes in medical students--Slovakia, 1995-1999.

INTRODUCTION: The main goal of a questionnaire cross-sectional study was to compare the changes of smoking habits in medical students between 1995 and 1999. Beside this, other factors of life-style such as alcohol consumption, nutritional status [studied through body mass index (BMI)] and citrus consumption were studied. METHODS: Cross-sectional questionnaire study in 453 medical students of 1st to 5th academic years of the Jessenius Faculty of Medicine, Comenius University in Martin, Slovakia, carried out in October and November 1999. Data on smoking habit were compared with a similar study carried out in 1995. RESULTS: Prevalence of regular smoking (min. 1 cig/day) was 13.6% in men and 8.9% in women and did not change significantly in comparison with 1995. In women, prevalence of occasional smokers increased from 7.3% in 1995 to 19.8% in 1999 and almost reached men in the same year (21.8%). During this period significantly decreased proportion of respondents who have never smoked both in men (from 43.0 to 23.3%) and women (from 61.9% to 18.2%). Excessive drinking dominates in men, overweight (BMI > or = 25) had 16.0% of males and 2.0% of females and excessive underweight (BMI < or = 17.5) 1.0% of men and 2.8% of women. More than one half of respondents consumed less than 1 piece of citrus fruit per day. CONCLUSIONS: Smoking of men still predominates, however, the most apparent changes of smoking habit in regard to increasing proportion of smoking women, particularly occasional smokers. This indicates increasing social tolerance of smoking. In female a possibility of eating disorders deserve attention and a need for the improvement of diet is felt in both sexes.

[Intestinal parasites in children from the Turiec region in long-term monitoring. How should we proceed with further preventive parasitologic examinations?]. / Crevné parazity u detí regiónu Turiec v dlhodobom priereze. Ako d'alej s preventívnymi parazitologickými vysetreniami?

The results of preventive parasitological examinations for intestinal parasites in preschool and school children of the Turiec Region (Central Slovakia) in 1970-1999 are submitted. The study is divided into three cross-sections in the following decades (1970-1979; 1980-1989; 1990-1999). An acute decrease in geohelminths virtually to zero values has been found, as well as a significant decrease in intestinal protozoans. The occurrence of Enterobius vermicularis, despite its significant decrease in the recent decade, remains on a relatively high level. In the conclusion the authors discuss continuation of parasitological field examinations, and, on the basis of their 30-year experience, they submit their recommendations for the simplest and most effective way of such examinations.

[Health and economic benefits of mandatory regular vaccination in Slovakia. IV. Measles, rubella and mumps]. / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. IV. Morbilli, rubeola a parotitis.

The epidemiological situation as regards measles, rubella and mumps in Slovakia before vaccination and after its introduction in 1996, is analysed. On the basis of model costs of treatment of these diseases before vaccination and costs of treatment in 1996 including costs of vaccination, the authors calculated the total saved costs (549.7 mil. Sk), cost-effectiveness (10,680 Sk), as well as the cost-benefit.

Non-pharmacological approach to smoking cessation.

Literary data on non-pharmacological approach in smoking cessation have been reviewed. The used methods are depending on particular target groups: patients visiting general practitioners, clients of smoking cessation clinics, pregnant women, hospitalised patients, and adolescents. Community based intervention represents a specific approach. The existing data on non-pharmacological smoking cessation show certain differences with a wide range of the reported cessation rates. Important role of primary health care providers in smoking cessation is evident, however, frequently underestimated. Specific situation in Central and Eastern Europe (CEE) requires evidence based data in this field, taking into consideration also psychological, social and cultural aspects. Only guidelines based upon authentic studies carried out in CEE can be of value for long-term tobacco control programmes. (Ref. 70.)

Hippocrates' humoral pathology in nowaday's reflections.

Ancient medicine integrated three components: experience (empirical observation), religion/magic and speculations of natural philosophers. The Greek medicine out-achieved medicine of other ancient nations in starting to investigate the true causes of health and diseases and thus laying foundations for the diagnosis, prognosis and treatment. Hippocrates, the most famous physician of the ancient times, made a synthesis of existing philosophical opinions from the point of view of a physician. His 58 writings were preserved in the collection "Corpus Hippocraticum". The most relevant writing in it--"Peri fyseos anthropu" (On the nature of man)--is ascribed to Hippocrates' son-in-law Polybos to whom we are grateful for the ancient humoral-pathological theory. In explaining human organism and its processes the author integrated ancient teachings on 4 basic humors (humoral theory), elements and qualities with observations of manifestations of health and disease. Normal condition (health) was defined as balance between the body fluids (eukrasia) and external environment. If this balance is disturbed, the result is dyskrasia, i.e. disease studied by pathology. According to Hippocrates disease causes can be understood only through empirical study. A man has a power to overcome disease, but to achieve it the right diet is necessary to keep harmony in body fluids of an organism. The role of a physician was just to support the nature. "Prognosis", another writing included in "Corpus Hippocraticum", reflects Hippocrates' understanding of prognosis as a necessary development of diagnosis based on past knowledge (anamnesis) and present observation. Ideas of Hippocrates and his medical school are still valuable and inspiring especially for today's very sophisticated medicine--concept of fighting diseases by natural means: maintaining healthy lifestyle and harmony within the organism, or an effort for perfect understanding of human creature and for humanization of medicine. (Fig. 3, Ref. 14.)

Epidemiological features and economic evaluation of a potential chickenpox vaccination strategy in Slovak Republic.

Cost effectiveness and cost benefit of a potential chickenpox vaccination strategy in Slovakia have been evaluated. As a base for comparison with potential vaccination strategy, direct and indirect costs of chickenpox incidence in Slovakia in 1996 were evaluated, using the EPIS data (Epidemiological Information System in Slovak Republic), and official annual analyse of epidemiological situation in Slovakia. According to their estimates, the authors consider the potential chickenpox vaccination as highly cost effective. The results of their analysis show that as the saved costs mostly indirect costs participate. With respect to the prevailing social impact of chickenpox also the funding of the future chickenpox vaccination is supposed to be shared by social insurance system.

Smoking habits in university students in Slovakia.

INTRODUCTION: Cigarette smoking has reached the proportion of a global epidemic with particularly devastating consequences in countries of Central and Eastern Europe. Learning of epidemiological aspects of smoking in youngsters, especially university students, is of great importance for the whole community. Goals of the study were mapping smoking habits and identifying other factors of life style including body mass index, alcohol and citrus fruit consumption in non-medical university students in Slovakia. METHODS: A cross-sectional questionnaire study, including 2,419 respondents, was carried out in students of 5 non-medical faculties in Slovakia from October to December 1997. RESULTS: 19.6% of males and 12.3% of females were regular smokers (min 1 cig/day) and 16.1% of males and 15.1% of females were occasional smokers. From regular smokers 11.5% of males and 13.2% of females started to smoke at the University. Respondents from urban areas smoked more frequently than those from rural areas. Significant association was found between alcohol consumption and cigarette smoking in males. More than a half of respondents consumed less than 1 piece of citrus per day. 15.4% of males were overweight (BMI > or = 25) and 8.5% of females were very underweight (BMI < or = 17.5). CONCLUSIONS: In females social smoking prevails and an increasing rate of female-smoking can be expected in Slovakia. There is a need of improving dietary habits of youngsters in Slovakia in favour of the consumption of more fruit and vegetables in both sexes, and in females additional attention should be paid to eating disorders.

[Health and economic benefits of mandatory regular vaccination in the Slovak Republic. II. Poliomyelitis]. / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. II. Detská obrna.

The authors compared intervention strategy (vaccination) and non-intervention strategy (no vaccination). For the evaluation of health and financial effectiveness of regular polio vaccination the authors used the modelling of treatment of polio cases in 1957, and vaccination costs in 1996--the most recent year with available statistical data from the Slovak Republic. From these model years they calculated: the cost saving (11,919,106 Sk), cost-effectiveness ratio (79,944 Sk) and the net cost of vaccination (3,047,786 Sk). Simultaneously, they present a breakdown of cost-benefit analysis.

[Health and economic benefits of compulsory regular vaccination in the Slovak Republic. I. Methods]. / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. I. Metodika.

The authors will submit in their series of contributions under the common title of "Health and Economic Benefits of Compulsory Regular Vaccination in the Slovak Republic" estimates of benefits and effectiveness of particular vaccinations. In their first contribution they deal with the objectives and methods of this evaluation essential for the allocation of funds for the maintenance of existing preventive programmes and also for the implementation of new preventive measures. On the basis of literary data and their own experience they formulate modified methods of cost/effectiveness and cost/benefit and other parameters adjusted for the conditions of the vaccination programme in the Slovak Republic.

[Health and economic benefits of mandatory regular vaccination in the Slovak Republic. III. Diphtheria, tetanus and pertussis] . / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. III. Záskrt, tetanus a cierny kasel.

The authors tried to evaluate the cost-effectiveness and cost-benefit of regular vaccination of children against diphtheria, tetanus and pertussis in Slovakia. On the basis of model costs of treatment of these diseases before and after vaccination in 1996, the total saved expenditure (102.6 million Sk) and cost-effectiveness (31,619 Sk) were calculated, as well as the cost-benefit.