Links between alcohol and external causes of deaths in males: an autopsy study.

OBJECTIVES: This study aimed to analyse deaths due to external causes in males in northwest Slovakia. STUDY DESIGN: This was a cross-sectional autopsy study. METHODS: The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. RESULTS: From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5-1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. CONCLUSIONS: Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations.

Decline in alcohol use among adolescents in Slovakia: a reason for optimism?

OBJECTIVES: To analyze selected indicators of alcohol use (lifetime use, initiation of drinking at ≤13 years of age, weekly use, beverage preferences, initiation of drunkenness at ≤13 years of age and lifetime drunkenness) in adolescents in Slovakia from 2006 to 2014. STUDY DESIGN: The Health Behaviour in School Aged Children (HBSC) study is a cross-sectional questionnaire study. METHODS: A standardized uniform questionnaire was used in representative samples of 11-, 13- and 15-year-old adolescents. In Slovakia, the HBSC study was undertaken in 2006 (n = 3972), 2010 (n = 5089) and 2014 (n = 4369). RESULTS: Over the study period, decreases were observed in weekly drinking (from 34.3% to 21.0% in 15-year-old boys and from 22.1% to 11.9% in 15-year-old girls), lifetime drinking and initiation of drinking at ≤13 years of age. In terms of beverage preferences, the reduction in beer consumption was most notable. Approximately one-third of respondents got drunk for the first time at ≤13 years of age, and this remained consistent throughout the study period. CONCLUSIONS: The declining trend in alcohol use among adolescents in Slovakia may reflect a progressive change in the social environment and is attributable, at least in part, to policy improvements such as pricing and stricter legislation and enforcement.

Structure of deaths associated with heavy alcohol use and their contribution to general mortality in Northwest Slovakia.

OBJECTIVES: The article analyses death cases with detected blood alcohol level ≥2 g/kg. Their contribution to general mortality is calculated. METHODS: Death cases from 2005 to 2012 with detected blood alcohol concentration ≥2 g/kg (975 cases) were selected from autopsy records at the Department of Forensic Medicine and Medical Expertises of the Jessenius Faculty of Medicine in Martin. The selected cases were analysed by age and causes of death (pathological, fatal alcohol intoxication, other external causes). Their contribution to general mortality was calculated using official demographic data. RESULTS: Deaths associated with heavy alcohol use comprised 2.2 % of general mortality in males and 0.3 % in females and showed declining trend. The proportion was highest in males aged up to 39 years (10.3 %). External causes dominated among death cases associated with heavy alcohol use (90.8 % in males, 83.7 % in females). CONCLUSIONS: Deaths associated with heavy alcohol use significantly contribute to general mortality, particularly in younger males. In spite of the trend indicating slight improvement of the situation, this specific part of alcohol-related problems still constitutes a significant public health issue.

[Knowledge about cervical cancer among respondents in Slovakia and the Czech Republic - Aurora Project]. / Vedomosti respondentov na Slovensku a v Cechách o karcinóme cervixu - projekt Aurora.

OBJECTIVE: The Aurora Project, aimed at promotion of cervical cancer prevention, was realised with the support of the European Commission. The project included 14 partners from 11 EU countries. The objective of this contribution was to analyse the level of knowledge on cervical cancer among respondents in the project partner countries and to compare the situations in Slovakia and the Czech Republic. Data were obtained within one of the project outputs: Work Package 2 (WP2) Dissemination of Aurora Project Objectives and Results. METHODS: The questionnaire used included 10 questions (available at the project website www.aurora-project.eu) and has been translated into 11 languages of the project partners. In total, 2111 questionnaires were analysed (91.7% response rate), among them 246 were from Slovakia and 305 from the Czech Republic. Descriptive statistical methods and the χ2 test were used to analyse data. RESULTS: The level of knowledge in Slovak and Czech respondents was comparable in answers to seven questions. Statistically significant differences were observed in answers to questions about anatomy and cervical cancer therapy. Answers to the question, 'What are the symptoms of cervical cancer in the early stages?', should be considered as crucial to understand attitudes of the lay population towards prevention. There were 7% of women in the Czech Republic and 16% in Slovakia with the opinion that there is some clinical manifestation of such a condition. This means that women with such an opinion have no reason to visit a gynaecologist while no signs of a disease are present. The period during which they do not attend a preventive check-up is sufficient for the development of precancerous lesions or even cancer. CONCLUSION: Recommendations of doctors play a key role in primary and secondary prevention of the disease. An important part of interventions includes information campaigns and educational programmes. The internet is another important source of information, especially for younger generations. Together, these can contribute to increased participation in preventive check-ups by education of the general public. Thus, the disease can be detected early and the development of cervical cancer prevented.

Socioeconomic predictors of smoking behaviour among school-aged children, in the Slovakia.

OBJECTIVE: The aim of this study was to describe the relationship between smoking habits and socioeconomic determinants among adolescents. BACKGROUND: Tobacco use among young people is a formidable social health concern. The aim of this paper is to describe the situation in selected localities surveyed, and to elucidate the relations among experiments with tobacco in adolescent youth and behaviour of parents, friends and teachers and media influence. Thd objectives of this study are to describe patterns of self-reported smoking and to describe the association of trying smoking with other variables, such as social, or socio-demographics among a sample of young students. METHODS: Global Youth Tobacco Survey to track tobacco use among youth across countries using a common methodology and core questionnaire. In Slovakia, GYTS was carried out at the turn of 2002 to 2003. A total of 4.594 students participated in the study. RESULTS: The results indicate that the majority of the students (74.3%) have tried smoking where both parents are smokers. We found that gender, parents', friends' and teachers' smoking had a significant influence on whether the children ever tried smoking. A parent who smokes was found as a strong significant predictor for trying smoking in the group of students [OR = 1.6 (1.39-1.92)]. CONCLUSION: Predictors of smoking behaviour include parents', teachers' and friends' smoking. Public health interventions aim at conducting effective health promotion programs tailored to specific population groups and known predictors should be central to the design of such endeavours (Tab. 5, Ref. 18).

Pneumococcal meningitis--comparison of therapy and vaccination costs.

The authors analysed the direct cost associated with treatment of IPI in 156 patients hospitalised with the diagnosis of pneumococcal meningitis at the terciary care Teaching Hospital. The total direct cost for 156 patients was 22,180,080 CZK (Czech Crowns). The average length of hospital stay for the patient with invasive pneumococcal meningitis (IPM) was 23 days. It was possible to conclude, that the direct financial expenses in 156 patients with pneumococcal meningitis would enable 88,337 people to be vaccinated. This is 6.2 % of all people in 65+ age group living in the Czech Republic, 54.8 % of all people in 65+ age group living in the Morava-Silesia Region with 1,250,800 inhabitants, or all inhabitants below 14 and above 65 years in Ostrava city (total population 312,000). The cost of pneumococcal polysacharide vaccine and its administration was 566 times lower compared to the average cost of treatment for one IPM case (Ref.21). Full Text (Free, PDF) www.bmj.sk.

[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.

[Telephone hotlines as a part of complex services for tobacco dependence treatment]. / Telefonní linky jako soucást komplexní nabídky sluzeb pro odvykání kourení.

Telephone quitlines for smoking cessation should be included into the available tobacco dependence treatment and should be included into smoking cessation guidelines. Telephone quitlines does not mean only the help to the calling smoker, but also can increase the number of quit attempts in the general population. Especially minorities that not so often take part in the classic smoking cessation treatment, use quitlines more often (e.g. pregnant women). Quitlines are economically effective, although the most expensive form - individual counselling - should be reserved for those really willing to stop. Quitlines should be given governmental financial support (compared to other medical interventions, any smoking cessation treatment is economically more cost effective).

Lung cancer in relation to occupational and environmental chromium exposure and smoking.

The increased occurrence of lung cancer in residents of Dolny Kubin, the North-Slovakia district with ferrochromium industry, compared to the general population of Slovakia, led us to the study assessing influence of the occupational and environmantal exposure to chromium on the lung cancer incidence, respecting also the risk coming from cigarette smoking. Residents of Dolny Kubin district with the diagnosed lung cancer in 1984-1999 were involved in the study. The occurrence of lung cancer was significantly higher in people working in ferrochromium industry. The age at the onset of the disease in people exposed to chromium was by 5.5 years lower than in non-exposed. Smoking was an important risk factor, which has been proved particularly in non-exposed group where 62% were smokers and the onset of the lung cancer in them occured about 3.4 years earlier than in non-smokers. In exposed groups, no significant effect of smoking was found. We can conclude, that occupational exposure to chromium was identified as the main risk factor of lung cancer in Dolny Kubin district even overlaying effect of smoking.

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.)

The role of non-critical health-care tools in the transmission of nosocomial infections.

The authors performed the cultivation of swabs taken from membranes of 110 stethoscopes of physicians, medical students and shared stethoscopes from ward consultant rooms. In addition to that, 24 random samples from other non-invasive health-care tools and the hospital environment were taken. In order to find out about the disinfection habits and knowledge of medical students, 97 of them were addressed in an anonymous questionnaire. Out of 110 stethoscopes, microbial colonisation was not present only in nine cases (8 %). Staphylococcus sp. was present on 94 stethoscopes (85 %), out of which 19 (20 %) were methicillin-resistant staphylococci of various species. S. aureus was found in 16 cases (14 %), out of which MRSA made 12 % (two cases). Cultivation of 24 additional samples discovered methicillin-resistant staphylococci in four cases--two of them were MRSA present on the esmarch and a blood-presure cuff. The questionnaire revealed that only six (6 %) addressed medical students have ever disinfected their stethoscopes in the past. Disinfection of non-critical tools should become an integral part of under-graduate and postgraduate education (Tab. 1, Fig. 2, Ref. 7).

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.

Lifestyle of a women--mother and health of members of the family.

OBJECTIVE: The goal of the study was to evaluate the efficacy of prevention of cardiovascular diseases. METHODS: The follow-up study included a sample of 206 intervened pregnant women. They were given an information booklet about risk factors and prevention. During the postpartum period they were contacted again and 111 of them completed a questionnaire. Control sample consisted from 200 women inthe postpartum period not intervened, who filled in the same questionnaire. RESULTS AND CONCLUSIONS: Such intervention positively influences both attitudes towards lifestyle and knowledge level and can be considered as an appropriate preventive measure in pregnant women. The question is, if the achieved changes last for a longer time and if they are passed an to members of families of the intervened women (Fig. 1, Ref. 8).

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.)

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.