[Failures to comply with the routine childhood immunization schedule due to contraindications and the use of alternative vaccines in children aged 0-4 years in the Czech Republic]. / Príciny vynecáni pravidelného ockování z duvodu kontraindikace a pouzití alternativních vakcín u detí ve veku 0-4 roky v Ceské republice.

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.

The role of socioeconomic circumstances in differences in height of pre-school children within and between the Czech Republic and southern Brazil.

Children's height is an important indicator of nutritional status and health of populations. Little is known about the role of individual socioeconomic factors and whether socioeconomic differences within countries can help explaining differences in children's height between countries. This paper examines the effect of socioeconomic factors on children's height in two population with different social environments. Two separate cross-sectional studies of children 36-59 months old from Southern Brazil and the Czech Republic collected data on height and socioeconomic and demographic variables. Height was converted into height-for-age Z-scores (HAZ) based on one growth standard, and the effect of socioeconomic and demographic factors on children's heights was studied by multiple regression. First, these effects were estimated separately for each country, and secondly, it was assessed whether some of the difference in height between the two countries could be explained by these factors. Czech children were 0.61 HAZ (approximately 2.6 cm) taller than Brazilian children. In Brazil, income, dwelling conditions, birth order, birth weight and maternal age were independently and significantly associated with height (multiple R-squared 0.27). In the Czech Republic, maternal education, birth order, birth weight and maternal age predicted height in a multivariate analysis (multiple R-squared 0.11). Maternal education alone explained 30% of the difference in children's height between Brazil and the Czech Republic; further adjustment for education of the father, birth weight, number of siblings and birth order slightly increased the proportion of explained difference to 41%. Our results suggest that although socioeconomic and demographic factors predicted children's growth in both countries, the role of individual factors differed and the associations were stronger in South Brazil. The finding that these factors explained a large part of the between-population difference further illustrates the importance of social environment for children's growth.

Outdoor sulphur dioxide and respiratory symptoms in Czech and Polish school children: a small-area study (SAVIAH). Small-Area Variation in Air Pollution and Health.

OBJECTIVES: Air pollution has been linked to respiratory outcomes but controversy persists about its long-term effects. We used a novel technique to estimate the outdoor concentrations of sulphur dioxide (SO2) at small-area level to study the long-term effects on respiratory symptoms and disease in children. METHODS: As part of the international SAVIAH study, parents of 8,013 children aged 7-10 studied in Prague (Czech Republic) and Poznan (Poland) completed a questionnaire covering respiratory health, demographic and socio-economic factors and health behaviours (response rate 91%). This report is based on 6,959 children with complete data. Outdoor SO2 was measured by passive samplers at 80 sites in Poznan and 50 sites in Prague during 2-week campaigns. Concentrations of SO2 at each point (location) in the study areas were estimated from these data by modelling in a geographical information system. The mean of the estimated SO2 concentrations at children's homes and schools was used as an indicator of exposure to outdoor SO2. RESULTS: The prevalence of respiratory outcomes was similar in both cities. In the pooled data, 12% of children had experienced wheezing/whistling in the past 12 months; 28% had a lifetime prevalence of wheezing/whistling; 14% had a dry cough at night; and 3% had had asthma diagnosed by a doctor. The estimated mean exposure to outdoor SO2 was 80 (range 44-140) microg/m3 in Poznan and 84 (66-97) microg/m3 in Prague. After socio-economic characteristics and other covariates were controlled for, SO2 was associated with wheezing/whistling in the past 12 months (adjusted OR per 50 microg/m3 1.32, 95% CI 1.10-1.57), lifetime prevalence of wheezing/whistling (OR 1.13, 95% CI 0.99-1.30), and lifetime prevalence of asthma diagnosed by a doctor (OR 1.39, 95% CI 1.01-1.92). The association with dry cough at night did not reach statistical significance. CONCLUSIONS: In these two Central European cities with relatively high levels of air pollution, small-area based indicators of long-term outdoor winter concentrations of SO2 were associated with wheezing/whistling and with asthma diagnosed by a doctor.

Outdoor air concentrations of nitrogen dioxide and sulfur dioxide and prevalence of wheezing in school children.

We report analysis of data on outdoor air pollution and respiratory symptoms in children collected in the Czech part of the international Small Area Variations in Air pollution and Health (SAVIAH) Project, a methodological study designed to test the use of geographical information systems (GIS) in studies of environmental exposures and health at small area level. We collected the following data in two districts of Prague: (1) individual data on 3,680 children (response rate 88%) by questionnaires; (2) census-based socio-demographic data for small geographical units; (3) concentrations of nitrogen dioxide (NO2) and sulfur dioxide (SO2) measured by passive samplers in three 2-week surveys at 80 and 50 locations, respectively. We integrated all data into a geographical information system. Modeling of NO2 and SO2 allowed estimation of exposure to outdoor NO2 and SO2 at school and at home for each child. We examined the associations between air pollution and prevalence of wheezing or whistling in the chest in the last 12 months by logistic regression at individual level, weighted least squares regression at small area (ecological) level and multilevel modeling. The results varied by the level of analysis and method of exposure estimation. In multilevel analyses using individual data, odds ratios per 10 microg/m3 increase in concentrations were 1.16 (95% CI = 0.95-1.42) for NO2, and 1.08 (95% CI = 0.97-1.21) for SO2. While mapping of spatial distribution of NO2 and SO2 in the study area appeared valid, the interpolation from outdoor to personal exposures requires consideration.

[Malignant prostatic neoplasms in the Czech Republic. Hospital case-control study]. / Zhoubný novotvar prostaty v Ceské republice. Nemocnicní analytická studie prípadu a kontrol.

In a hospital-based analytical case-control study of prostate cancer conducted during 1996-1997 at the Urological clinics of FNKV Prague 10,181 cases of prostate cancer and 277 controls of males with non cancerous urological disease were analysed. Mean age of newly diagnosed cases of prostate cancer was 70.8 years, mean age of death (83) from this cancer was 72.8 years. At the time of diagnosis 44.2% cases had already remote metastases in bones. Five-year cumulative survival rate of the cases was in this study 53.4%. Statistically significant differences were observed in examination of prostatic specific antigene (PSA) and alkaline phosphatase. Results of other biochemical examinations, digital rectal examination or sonography of the prostate did not show statistically significant differences between cases and controls. Implementation of both digital rectal examination and PSA examination into the scheme of preventive medical examination of males over 50 years of age represents the only possibility how to increase the proportion of the prostatic cancer diagnosed in early latent stage and thus therapeutically and prognostically more favourable.

Association between ambient air concentrations of nitrogen dioxide and respiratory symptoms in children in Prague, Czech Republic. Preliminary results from the Czech part of the SAVIAH Study. Small Area Variation in Air Pollution and Health.

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.

Socioeconomic factors and height of preschool children in the Czech Republic.

The effect of socioeconomic factors on growth was investigated among 2275 children 3 to 6 years old attending nurseries in the Czech Republic. Measured heights of children were converted into height-for-age z scores. After adjustment for birthweight, parental height, and other socioeconomic variables, only mother's education was independently and significantly associated with children's height; adjusted differences in z scores between children of secondary- and university-educated mothers and children of mothers with only primary education were 0.12 and 0.31, respectively. This is equivalent to 0.5 and 1.5 cm, respectively, for children 5 years old.

Socio-economic factors and growth of preschool children attending nurseries in Prague, Czech Republic.

Association between socio-economic circumstances and children's growth was investigated in a cross-sectional study in preschool children attending nurseries in one district in Prague. Data on socio-economic variables and growth were available for 352 children. In presented analysis, height-for-age percentiles are used as the outcome. Education of mothers was most strongly related to growth in unadjusted analysis. Independent contribution of individual factors was then assessed by logistic regression. After adjustment for birth length, parental height, frequency of illness, housing and car ownership, children of mothers with secondary or lower education had about twice the risk of being in lowest tertile of height-for-age (odds ratio 1.91, 95% CI 0.98-3.70) compared with children of mothers with university education. Paradoxically, children from families without a car had lower risk of delayed growth than those from families with a car (odds ratio 0.52, 95% CI 0.28-0.95). Our results suggest that social environment and behaviour rather than material conditions determine the physical growth of preschool children in Prague 10.