Health aspects of the behaviour of the Czech population during the COVID-19 pandemic from a public health perspective.

The paper presents the outcomes of the WHO European Region research project, Ministry of Health of the Czech Republic and the First Faculty of Medicine, Charles University which concerned Czech population behaviour during the COVID-19 pandemic. In the Czech Republic the research was carried out in three waves on a representative sample of respondents using methodology of a questionnaire survey. The results showed that the risk perception in connection with the pandemic was low in the Czech environment, regardless of the growing number of infected and deceased. Optimism persisted about the perception of personal susceptibility to infection and self-efficacy. General wellbeing was above average after successfully coping with the first wave, but it decreased slightly in connection with the worsening of the pandemic situation. Compliance with preventive measures has been relatively low for a long time and the trend has been rather declining. By the time, it became increasingly difficult to understand the communication of state authorities regarding the measures being implemented, and trust in the media decreased. A positive finding was the increase in the proportion of those who tried to improve the lifestyle in connection with the pandemic.

Changes in the level of health literacy in Czechia between 2015 and 2020.

During the five years from 2015 to 2020, the proportion of people with limited health literacy decreased by 12%. This finding results from international research on the level of health literacy, which took place since 2019 till 2021 in 17 countries of the European region of the World Health Organization. In total, more than 42,000 respondents were interviewed, in Czechia there were 1,650 respondents. In 2020, however, we recorded a limited level of health literacy in 47% of the population over the age of 18. Respondents have the greatest problems with understanding health information from the media and with assessing different treatment options. Czechs (like Slovaks) have the biggest problem with following the instructions of a doctor or pharmacist. Health literacy is influenced by gender, age and education: women, older people and less educated people show higher levels of health literacy. The respondent's social gradient, primarily subjective social status has positive influence to health literacy while financial deprivation has negative influence. On the other hand, health literacy positively affects the physical activity of the respondent; subjectively perceived health and consumption of medical services are influenced as well. The Czech Health Literacy Institute is currently preparing monitoring in 2024-2025.

The HLS19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries.

BACKGROUND: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. METHODS: The HLS19-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach's alpha and Person separation index were considered for reliability. RESULTS: The 11-item version (HLS19-COM-P-Q11) and its short version of six items (HLS19-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. CONCLUSIONS: The HLS19-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.

Opinions and attitudes of experts to the digitization of the Czech healthcare: preliminary report on the implementation of the first wave of the DELPHI study.

The article provides an overview of the opinions and attitudes of a selected group of experts on the introduction of electronic healthcare in the Czech healthcare system. The research used the DELPHI method, the first wave of which took place in the first quarter of this year and the second wave is planned for the second half of this year. A total of forty respondents assessed the relevance of the individual steps of electronization and digitization, as well as the obstacles that need to be overcome in the implementation of the National eHealth Strategy. Respondents consider electronic information on health promotion and prevention programs (87%) and support for chronic patients (77%) to be the most appropriate or important, while the least supported is the publication of service level assessments of providers (27%) and on-line access to documentation of the authorizing person (30%), less support is also given to the optimization of waiting times with the help of digitization (35%) and electronic consultation with a doctor (35%). Respondents see the biggest obstacles to eHealth implementation in the resistance of providers (up to 70% for some measures) and in unsatisfactory or missing legislation (up to 85% for some steps). The survey was carried out as part of the project Structural Reform Support Service (SRSS) of the European Commission at the Ministry of Health and under coordination of National eHealth Centre (NeHC).

[Health literacy in Czech population results of the comparative representative research]. / Zdravotní gramotnost obyvatel CR výsledky komparativního reprezentativního setrení.

Health literacy survey was carried out at the end of 2014 in the context of preparation of implementation strategy of the Program Health 2020 in the Czech Republic. The survey was conducted by the National Institute of Public Health with financial support from the Ministry of Health and the Czech WHO office. Sociological survey replicated comparative research conducted in eight EU countries in the first half of this decade. Representative survey in 1037 respondents in the age over 16 years, selected in all regions of the country. The identical methodology as used in the original study was utilized. Health literacy was measured in the areas of health care, disease prevention and health promotion.We found that 59,4 % of respondents showed limited general health literacy; health literacy in health care is proved to be 49.5 % of the population, in the area of disease prevention it was 54.1 % respondents and in health promotion it was even even 64.3 % of respondents. Compared to the other countries surveyed, Czech Republic occupies the eighth, penultimate place. Health literacy is correlated negatively with age and positively with education. We found a strong social gradient of health literacy which rises with social status. Health literacy quite significantly influences the health status and health behaviors.Key words: health literacy, health behaviour, health promotion, social determinants of health.

Effects of alendronate and calcitonin on bone mineral density in postmenopausal osteoporotic women. An observational study.

OBJECTIVE: Alendronate and calcitonin are antiresorptive drugs that were used for the treatment of postmenopausal osteoporosis and were shown to increase bone mineral density (BMD). However, the effect of both drugs in daily clinical practice may differ from that observed in clinical trials. METHOD: About 50 postmenopausal osteoporotic women were observed during their first year of treatment. Among them, 32 patients used alendronate and 18 used calcitonin. Lumbar spine and femoral neck BMD were measured by dual energy X-ray absorptiometry (DXA) at baseline and after 1 year of therapy. Biochemical markers (B-ALP--bone-specific alkaline phosphatase, OTC--osteocalcin and DPD/UCr--deoxypyridinoline/creatinine ratio) of bone metabolism were measured at baseline and 6 months later. Patient compliance was assumed by tablet counting and verified at interview. Each patient was further questioned about her attitude towards the treatment, as well as her dairy product intake, physical activity, use of other medications, smoking and social status. MAIN OUTCOME MEASURE: (1) Annual percent change in BMD in lumbar spine and femoral neck after the one-year treatment with either alendronate or calcitonin. (2) The change in biochemical markers of bone turnover. RESULTS: The lumbar spine BMD significantly increased by 7.0% (P < 0.001), the femoral neck BMD by 4.3% (P < 0.01). OTC, B-ALP and DPD/UCr decreased significantly during the therapy with alendronate. Compliance with therapy was 79% (95% CI 68-90%). In the calcitonin-treated group, the lumbar spine BMD significantly increased by 3.1 % (P < 0.05), while the femoral neck BMD remained unchanged. OTC, B-ALP and DPD/UCr did not change significantly during the treatment with calcitonin. Compliance with calcitonin therapy was 87% (95% CI 63-110%). The annual change of BMD in both treatment groups was independent on all questioned factors. CONCLUSION: In daily practice, alendronate enhanced significantly BMD both in lumbar spine and femoral neck. Calcitonin showed increase only in the lumbar spine BMD.

Theoretical exposure of chronically treated patients to lipid lowering agents.

PURPOSE: The objective was to analyse the exposure to lipid lowering agents (LLA) using the databases of health insurance companies and to appraise its concordance with the findings of evidence based medicine. METHODS: Three health insurance companies' prescription based databases were analysed in the years 1997-2000. All inhabitants in the Czech Republic (CR) have to be insured. The insured person with a recorded prescription for LLA in the year of interest was defined as a patient, the insured person with a recorded prescription for LLA in the years bordering the year of interest was defined as a chronically treated patient. In the year of interest the percentage of chronically treated patients without LLA medication, with 'very low' (<122 defined daily doses (DDD)/year), 'low' (122-243 DDD/year) and 'adequate' (>243 DDD/year) consumption was determined. RESULTS: During the observed period the total consumption of LLA increased among 450 000 inhabitants twice (by 109.6%) to 24.8 DDD/1000 inhabitants/day. In 2000 the rate of the consumption of statins and fibrates represented 34.2 and 65.6% respectively. In 1998 33.5% and in 1999 41.0% of the chronically treated patients occurred in the 'adequate' consumption group. CONCLUSIONS: The signals of inappropriate drug treatment such as the preferred use of fibrates and low doses of LLA prescribed to the Czech population were identified. Conversely, the increasing proportion of the chronically treated patients belonging to the group with the 'adequate' consumption could be considered as a positive signal.