Trends of cervical tumours amongst women from perspectives of demographic, socioeconomic and geographic indicators: retrospective ecological study in Czechia.

Introduction: For many infectious diseases, women are at higher risk and have a more severe disease course than men for many reasons, including biological differences, social inequalities, and restrictive cultural norms. The study focuses on infections with human papillomaviruses (HPV) in the form of cervical cancer as a gender-specific disease. The main goal is to evaluate cervical tumour incidence trends in the Czech female population in the HPV vaccination period 2012-2020 in relation to selected demographic, socioeconomic, and geographic indicators. Methods: This is a retrospective ecological study. Data from publicly available databases about the incidence and mortality of cervical tumours (C53 Malignant neoplasm of cervix uteri, D06 Carcinoma in situ of cervix uteri according to ICD 10) and HPV vaccination rate were analysed and compared with demographic, socioeconomic and territorial data. Associations were searched using correlation analysis. Results: There was a decreasing trend in the incidence of cervical cancer in the observed period. Regarding cervical tumours (C53, D06) and malignant neoplasm of cervix uteri incidence (C53), the decrease was approximately 11 and 20%, respectively. Differences between regions were observed in incidences and vaccination rates. Based on correlation analysis, indicators connected with urban/rural aspects, such as a share of urban population and population density, were statistically significant. The indicators related to higher cervical cancer incidence are the high unemployment rate of women, the high number of divorces, the high number of abortions, the high share of the urban population, the high number of students, and the high number of women with only primary education. On the other hand, the indicators related to lower cervical cancer incidence are the high gross domestic product (GDP), the high average gross monthly wage per employee, the high employment rate of women, the higher average age of mothers at birth, and the high number of women with tertiary education. Conclusion: Results underline the problem of economically disadvantaged regions and families. Increasing vaccination rates, promoting regular screening for cervical cancer, and supporting awareness in the population, especially in regions with higher incidence rates, should be priorities for public health efforts.

The relationship between atherosclerosis and dementia.

OBJECTIVE: The main objective is to confirm a hypothesis that atherosclerosis, through various mechanisms, considerably influences cognitive impairment and significantly increases the risk for developing dementia. Complete sample should be 920 individuals. The present study aimed to analyse epidemiological data from a questionnaire survey. METHODS: The work was carried out in the form of an epidemiological case control study. Subjects are enrolled in the study based on results of the following examinations carried out in neurology departments and outpatient centres during the project NU20-09-00119 from 2020 to 2023. Respondents were divided into four research groups according to the results of clinical examination for the presence of atherosclerosis and dementia. The survey was mainly concerned with risk factors for both atherosclerosis and dementia. It contained questions on lifestyle factors, cardiovascular risk factors, leisure activities, and hobbies. RESULTS: Analysis of the as yet incomplete sample of 877 subjects has yielded the following selected results: on average, 16% of subjects without dementia had primary education while the proportion was 45.2% in the group with both dementia and atherosclerosis. Subjects with dementia did mainly physical work. Low physical activity was more frequently noted in dementia groups (Group 2 - 54.4% and Group 3 - 47.2%) than in subjects without dementia (Group 1 - 19.6% and Group 4 - 25.8%). Coronary heart disease was more frequently reported by dementia patients (33.95%) than those without dementia (16.05%). CONCLUSION: Cognitively impaired individuals, in particular those with vascular cognitive impairment, have poorer quality of life and shorter survival. Risk factors contributing to such impairment are similar to those for ischaemic or haemorrhagic stroke. It may be concluded that most of the analysed risk factors play a role in the development of both atherosclerosis and dementia.

Nurses job satisfaction identified by personal preferences and perceived saturation divergence: a comparative cross-sectional study in Czech hospitals between 2011 and 2021.

BACKGROUND: The perception of the quality of care provided by the medical institution to patients is directly affected by the job satisfaction of nurses. The feeling of job satisfaction is caused besides other things by the subjective expectations of employees about what their work should provide them with in return. The aim of the study is to evaluate and compare job satisfaction of hospital nurses in the Czech Republic in 2011 and 2021 by identifying differences between their personal preferences and perceived saturation. METHODS: The respondents are hospital nurses in the Czech Republic in 2011 and 2021. A developed questionnaire was used to determine the job satisfaction factors. The order of factors of personal preferences, perceived saturation and differences between them was compiled. For evaluation was used the Euclidean distance model that enables to capture the order and determine the significance given by the distance in which the factors are located. RESULTS: At the top of personal preferences of hospital nurses, the factors salary and patient care are in the first two places with a similar distance. The salary factor is the most preferred by hospital nurses in both evaluated periods, and at the same time there is the greatest discrepancy between personal preferences and perceived saturation. By contrast, image of profession and working conditions were sufficiently saturated by the employer in both periods, but nurses do not significantly prefer these factors. CONCLUSIONS: The salary and patient care (i.e. the mission of the nurse's work itself) are at the top of personal preferences of hospital nurses, with an exclusive position among other factors. We consider it important that the hospital management emphasizes them in the management of hospital nurses. At the same time, the patient care is perceived by the hospital nurses as one of the most saturated factors - in contrast to salary, which is located at the complete opposite pole as the least saturated factor and therefore emerges from the mutual comparison as the factor with the greatest degree of divergence. The stated conclusions are valid for both compared periods. New method of data evaluation was successfully tested.

Is Alzheimer's disease a type 3 diabetes? A review.

OBJECTIVES: This is a review article that deals with the question of whether type 2 diabetes is a risk factor for the development of Alzheimer's disease. METHODS: We searched the PubMed database and relevant publications were selected for review. The introduction, which describes the possibilities of how type 2 diabetes can affect the development of Alzheimer's disease, is followed by other questions related to this issue: May on the contrary Alzheimer's disease induce type 2 diabetes? What is a relative risk for type 2 diabetes to induce dementia? How type 2 diabetes influence conversion of mild cognitive impairment to Alzheimer's disease? What is the role of antidiabetic medication? Proposition of term "type 3 diabetes" for Alzheimer's disease. RESULTS: Type 2 diabetes mellitus has been shown to increase the risk for cognitive decline and dementia, such as Alzheimer's disease and vascular dementia. Despite extensive research and numerous publications, the mechanisms underlying these associations remain unclear. CONCLUSIONS: Because of similar molecular and cellular features among type 1 and type 2 diabetes and insulin resistance associated with memory deficit and cognitive decline, some researches proposed the term "type 3 diabetes" for Alzheimer's disease.

Neuropsychological tests and prediction of dementia in association with the degree of carotid stenosis.

This study constitutes a cross sectional analysis of the association between cognitive impairment defined by neuropsychological tests and carotid stenosis. The main objective was to compare the results of the Mini-Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination-Revised (ACE-R) with regard to the degree of carotid stenosis. The sample comprised 744 patients who underwent a carotid duplex ultrasound and cognitive function testing (by ACE-R and MMSE). A multivariable analysis of potential confounding factors was completed. The significance of the different number of positive (MMSE ≤ 27, ACE-R ≤ 88) and negative (MMSE ≥ 28, ACE-R ≥ 89) results of the neuropsychological tests was analysed with regard to the degree of carotid stenosis (50-99%). Neuropsychological test results were also compared between carotid stenosis of 50-69%, 70-89%, and 90-99%. For both the MMSE and ACE-R, a difference was observed between positive and negative test results when higher degrees of stenosis were present. However, for the ACE-R only, more severe stenosis (80-89%, 90-99%) was predominantly associated with positive test results (p-value < 0.017). The same dependence for ACE-R (although not statistically significant) was observed in the group of patients without an ischemic stroke (confounding factor). In the case of the MMSE and more severe stenosis, negative results predominated, regardless of the confounding factor. There were no statistically significant differences in test results between carotid stenosis of 50-69%, 70-89%, and 90-99%. The results suggest that for assessing the early risk of cognitive impairment in patients with carotid atherosclerosis, the ACE-R appears more suitable than the MMSE.

Evaluation of Fine and Ultrafine Particles Proportion in Airborne Dust in an Industrial Area.

The health impacts of suspended particulate matter (SPM) are significantly associated with size-the smaller the aerosol particles, the stronger the biological effect. Quantitative evaluation of fine and ultrafine particles (FP and UFP) is, therefore, an integral part of ongoing epidemiological studies. The mass concentrations of SPM fractions (especially PM2.5, PM1.0, PM0.25) were measured in an industrial area using cascade personal samplers and a gravimetric method, and their mass ratio was determined. The results of PM2.5, PM1.0 were also compared with the reference measurement at stationary stations. The mean ratios PM2.5/SPM, PM1.0/SPM, and PM1.0/PM2.5 were 0.76, 0.65, and 0.86, respectively. Surprisingly, a mass dominance of UFP with an aerodynamic diameter <0.25 µm (PM0.25) was found with mean ratios of 0.43, 0.57, 0.67 in SPM, PM2.5 and PM1.0. The method used showed satisfactory agreement in comparison with reference measurements. The respirable fraction may consist predominantly of UFP. Despite the measures currently being taken to improve air quality, the most biologically efficient UFP can escape and remain in the air. UFP are currently determined primarily as particle number as opposed to the mass concentration used for conventional fractions. This complicates their mutual comparison and determination of individual fraction ratios.

Risk Factors for Alzheimer's Disease: An Epidemiological Study.

INTRODUCTION: Dementia becomes a major public health challenge in both the Czech Republic and worldwide. The most common form of dementia is Alzheimer's disease (AD). OBJECTIVE: We conducted two successive epidemiological projects in 2012-2015 and 2016-2019. Their aim was to study the effect of selected potential genetic, vascular and psychosocial risk factors on the development of AD by comparing their frequencies in AD patients and controls. METHODS: Epidemiological case-control studies were conducted. In total, data from 2106 participants (1096 cases, 1010 controls) were analyzed. RESULTS: Three times more females than males suffered from AD. The highest proportion of cases were those with primary education, unlike controls. There were statistically significantly more manual workers among cases than among controls. Of selected vascular risk factors, coronary heart disease was found to be statistically significantly more frequent in cases than in controls. The onset of hypertension and diabetes mellitus was earlier in controls than in cases. As for hobbies and interests, there were statistically significant differences in physical activity, reading and solving crosswords between the groups, with these activities being more common in controls. CONCLUSION: The prevalence of chronic neurodegenerative diseases, in particular AD, is currently increasing. Given the aging of the population, these conditions may be expected to rise in prevalence. Potential risk of AD needs to be studied, analyzed and confirmed; a detailed knowledge of the risks of AD and early detection of the pathology may therefore be very beneficial for prevention and early treatment of this condition.

Assessment of toe brachial index validity in diabetic patients - interim results.

INTRODUCTION: The toe brachial index (TBI) is recommended for the detection of lower extremity arterial disease (LEAD) in case of reduced efficacy of the ankle brachial index (ABI), which most often occurs in diabetics. In this case, TBI is expected to give more accurate results. There are not many studies dealing with the use of TBI specifically in diabetics and the results are different. OBJECTIVE: The purpose of this work is to present the interim results of the study, whose main objective is to assess the validity of TBI in diabetics and to determine whether this method provides improvements over the ABI. METHODS: In the first phase of the study, 42 limbs were examined in 21 patients with type 2 diabetes. ABI was measured using the automatic oscillometric method (ABI OSC) and the manual method using the pencil doppler (ABI DPP). TBI was determined using an automatic plethysmographic method. The reference examination of the arteries of the lower limbs was performed using duplex ultrasonography (DUS). A paired t-test was used to compare the individual TBI and ABI methods. Cut-off points ABI < 0.9; TBI < 0.7; and DUS stenosis > 50 % were used to evaluate validity parameters. RESULTS: The individual ABI and TBI methods gave different results (p < 0.05). In eight limbs of the total number, LEAD was demonstrated using DUS. The best validity parameters were demonstrated by the TBI - sensitivity 0.88; specificity 0.88; positive predictive value 0.64; negative predictive value 0.97, positive likelihood ratio 7.44; negative likelihood ratio 0.14. The ABI method of calculation, that uses lower systolic blood pressure determined from two measurement sites on the ankle as a numerator, had a higher validity parameters. The ABI OSC did not correctly detect a single limb with stenosis > 50 % in this cohort. CONCLUSION: According to the interim results of this work, the TBI was more suitable for the detection of LEAD in diabetics in comparison with ABI.

Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients.

BACKGROUND: Ankle brachial index (ABI) is the principal screening method for peripheral arterial disease (PAD). In this study, we compare various types of Doppler-derived and oscillometric ABIs with results obtained through duplex ultrasonography. METHODS: 62 patients were enrolled in the study. For each limb, blood pressures for both ankle arteries and the arm were measured using Doppler and an automated oscillometric device. Duplex ultrasound was performed for all limbs and occlusions >50% were considered PAD-positive. ABI was calculated using both higher (HABP) and lower (LABP) arterial blood pressure on the individual limbs and the ability to predict duplex-detected stenoses was evaluated. RESULTS: LABP calculation provided results superior to the guideline-recommended HABP. Considering patients with ABI >1.4 or measurement failure as PAD-positive further enhanced the test parameters. The higher ABI cut-off of 1.0 resulted in somewhat better sensitivities (max 92%) and negative predictive values (max 87%) at the expense of a substantial increase in the number of false positives. Oscillometric method yielded poor sensitivities but very good specificities (max 94%) and positive predictive values (max 90%). CONCLUSIONS: Doppler-based LABP provides better results than the guideline-recommended HABP in diabetic patients, nevertheless even this method is not perfect. Increasing the cut-off value to 1.0 in these patients does not bring a substantial improvement of the test performance. Patients with high ABI should be automatically considered PAD-positive and referred for further investigation using imaging techniques.

Associations between air pollution in the industrial and suburban parts of Ostrava city and their use.

Selecting the locations and numbers of air quality monitoring stations is challenging as these are expensive to operate. Representative concentrations of pollutants in certain areas are usually determined by measuring. If there are significant correlations with concentrations of other pollutants or with other monitoring sites, however, concentrations could also be computed, partly reducing the costs. The aim of this study is to provide an overview of such possible relationships using data on concentrations of ambient air pollutants obtained in different areas of a larger city. Presented are associations between industrial (IP) and suburban parts (SP) as well as correlations between concentrations of various pollutants at the same site. Results of air pollutant monitoring come from Ostrava, an industrial city in Central Europe with a population of over 300,000. The study showed that certain pollutants were strongly correlated, especially particulate matter (r = 0.940) and ozone (r = 0.923) between the IP and SP. Statistically significant correlations were also found between different pollutants at the same site. The highest correlations were between PM10 and NO2 (r IP = 0.728; r SP = 0.734), NO2 and benzo(a)pyrene (r IP = 0.787; r SP = 0.697), and NO2 and ozone (r IP = -0.706; r SP = -0.686). This could contribute to more cost-effective solutions for air pollution monitoring in cities and their surroundings by using computational models based on the correlations, optimization of the network of monitoring stations, and the best selection of measuring devices.

Air Pollution and Potential Health Risk in Ostrava Region - a Review.

AIM: The aim of this review was to collect all available data about air pollution in Ostrava, which is one of the most polluted area in central Europe and to make a concise assessment of health risks resulting from historical exposures of air pollutants since the beginning of the monitoring, i.e. since 1970 to the present time. METHODS: All available information sources (the Czech Hydrometeorological Institute, the Institute of Public Health in Ostrava or publications) were used. To evaluate the exposures both short-term (hourly and daily) data and long term (yearly) data during 45 years were analysed. For health risk assessment the relationship between exposure and biological effects of pollutants published by the WHO and the US EPA were employed. RESULTS: During the studied period annual average concentrations of PM10 ranged from 25 to 96 µg/m3; PM2.5 from 24 to 45 µg/m3; SO2 from 3.4 to 101.5 µg/m3; NO2 from 17.76 to 51.17 µg/m3; benzene from 0.24 to 9.2 µg/m3; benzo[a]pyrene from 2.1 to 14 ng/m3; arsenic from 1.2 to 9.5 ng/m3. Since the turn of the 80s and 90s of the 20th century trend of air pollutant concentrations has been decreasing until the turn of millennium, when it stopped, and it has been constant until present time. However, presented results demonstrate that the citizens of Ostrava have been exposed to relatively high concentrations of pollutants in comparison to other similar cities. The most significant pollutants contributing to health risks are airborne dust (PM10, PM2.5), benzene and benzo[a]pyrene. The long-term average health risk of PM10 has increased in case of postneonatal infant mortality up to 30%; prevalence of bronchitis in children up to 61%; and incidence of chronic bronchitis in adults up to 89%. The long-term average health risk of PM2.5 increased for all-cause mortality in persons aged 30+ years up to 22%; cardiopulmonary related mortality up to 25%; and lung cancer related mortality up to 39%. The highest carcinogenic risk is observed in benzo[a]pyrene, when the range of individual lifetime carcinogenic risk is up to 1.25*10-3. This assessment is valid according to the strict carcinogenic risk by the WHO, while the maximum carcinogenic risk according the US EPA is 7.2*10-5. CONCLUSIONS: A significant reduction of the pollutants' concentrations in Ostrava in the nineties of the last century does not mean a required improvement of outdoor air quality to the desired level. Persisting episodes with a very strong short-term increase of the concentration of PM10 and PM2.5, as well as long-term load of these substances on the population is very high. Health risks from such burdens are likely to lead to a higher mortality and morbidity especially from specific diseases.

Bioaerosols in the Suburbs of Ostrava during a One Year Period.

AIM: The aim of this paper is to provide information about the concentrations of airborne bioaerosols (airborne bacteria, fungi and endotoxins) in outdoor suburban environments in Ostrava, Moravian-Silesian region, Czech Republic. METHODS: The methods were based on systematic bioaerosol monitoring during one calendar year, subsequent analysis of the samples and statistical processing. The regression, correlation analysis and analysis of variance for one factor and pairwise comparisons were performed on bioaerosol data to determine their dependence on season, daytime, temperature, humidity and dew point. RESULTS: The results show higher fungi concentrations especially in summer (corrected mean 365 colony forming units - CFU per m3) compared to other seasons (75-209 CFU/m3) and higher concentrations of bacteria in the evening (380 CFU/m3) compared to other parts of the day and seasons (in summer 206-252 CFU/m3 and in winter 81-87 CFU/m3). Concentrations of endotoxins were relatively low throughout the year, on average 0,056 endotoxin units (EU) per m3. CONCLUSIONS: The concentration of bioaerosol (bacteria, fungi and endotoxins) were found in ambient air at substantially lower levels than in an indoor environment. Although the concentrations of this bioaerosol greatly fluctuate with temperature, dew point, season and daytime, they do not represent increased health risks.