[Smoking and breast cancer]. / Kourení a rakovina prsu.

BACKGROUND: Investigation of the relationship between smoking and breast cancer risk did not show a consensus in results - some studies described smoking as a risk factor, while others found its effects protective. PURPOSE: The newest studies explain these differences by the genetic polymorphism. Cigarette smoke contains at least 20 chemical carcinogens, which are deposited and metabolically activated in the breast and surrounding adipose tissues. The substances are further detected in the nipple discharge or as smoking  specific DNA adducts in breast tissue. Several studies postulate significantly higher risk of breast cancer among women who started smoking at an early age and/ or before their first delivery. Some studies from Japan, China, California have shown that longterm exposure to passive smoking could significantly increase the risk of breast cancer in never smokers, while other scientist reject the evidence of this association as inconsistent. A possible protective effect of smoking on the incidence of breast cancer is explained by antiestrogenic activity of smoking, namely nicotine. CONCLUSION: Smoking may play a role in the breast cancer incidence. Due to a wide spectrum of harmful effects of smoking, and with regards to the worse prognosis of breast cancer among smoking patients, the common recommendations for cancer prevention are similarly plausible in case of breast cancer - no  smoking, no alcohol, fruit and vegetable consumption, physical activity and body weight control.

[Wound healing complications in smokers]. / Komplikace hojení ran u kuráku.

Smoking iniciates many different harmful effects on human health, including the wound healing complications. This statement is supported both by many epidemiological studies and by understanding of nicotine and other chemicals in cigarette smoke mechanisms of action. Smoking cessation can lower rates of postoperative complications and increase the chance of long-term abstinence. Thus preoperative anti-smoking intervention is an important part of the surgical treatment.

[Risk of smoking for the cardiovascular diseases starts even before the birth]. / Riziko kourení pro vznik kardiovaskulárních nemocí zacíná uz pred narozením.

Many proofs have confirmed that prenatal exposure to cigarette smoke is the important risk for the development of cardiovascular diseases (CVD) in later life. Such exposure influences on many CVD' determinants: obesity and adiposity, disturbances in glucose and blood lipids metabolism, hypertension, hypokinesis, blood vessel structure and heart reactivity. Expectant mothers have high moral motivation for the changes of their life style. They can substantially protect their babies' healthy development against risk factors if they will know and fully understand them. Our system of prenatal cure offers repeated and essential chance for active participations of physicians and midwifes in teaching both active and passive smoking pregnant women about risks of smoking and in motivation and consulting for smoking cessation.

[Secondary dyslipidaemia after oral contraceptives]. / Sekundární dyslipidemie navozená soucasnými perorálními kontraceptivy.

THE AIM OF THE STUDY: To examine changes to blood lipid and lipoprotein levels following introduction of modern oral hormonal contraception agents and to evaluate atherogenic character of this dyslipidemia. METHODS, PATIENT SAMPLE: Forty four women of the mean age of 22.7 +/- 3.5 years, BMI 21.4 +/- 2.5 kg/sqm, waste line 71.9 +/- 7.1 cm and BP 115.7 +/- 12.2/70.1 +/- 8.3 mm Hg were included. Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apolipoprotein A1 and apolipoprotein B levels were assessed before the introduction of contraception and 3 months into the treatment. RESULTS: Following 3 months of treatment, increase in the total cholesterol (4.19 +/- 0.80 vs 4.75 +/- 0.79 mmol/l; p < 0.001), LDL-cholesterol (2.10 +/- 0.64 vs 2.32 +/- 0.66 mmol/l; p = 0.23), HDL-cholesterol (1.71 +/- 0.42 vs 1.90 +/- 0.45 mmol/l; p < 0.001), triglycerides (0.85 +/- 0.36 vs 1.18 +/- 0.50 mmol/l; p < 0.001), apolipoprotein A1 (1.55 +/- 0.33 vs 1.88 +/- 0.44g/l; p < 0.001) and apolipoprotein B (0.58 +/- 0.15 vs 0.69 +/- 0.19 g/l; p < 0.001) levels was observed. The total cholesterol/HDL cholesterol and apolipoprotein B/apolipoprotein A1 ratios have not changed significantly between the two assessments. CONCLUSION: Three-month treatment with combined hormonal contraception resulted in statistically significantly increased concentrations of triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, apolipoprotein A1 and apolipoprotein B. At the same time, total cholesterol/HDL cholesterol and apolipoprotein B/apolipoprotein A1 ratios have not changed significantly and thus hormonal contraception-induced dyslipidemia should not be regarded as proatherogenic.

[Lifestyle of cancer patients--how and when to change it?]. / Zpusob zivota u onkologických pacientu--jak a kdy ho menit?

The increase in the rate of cancer survivors following diagnosis and treatment of malignant tumours is one of the most important successes in modern medicine. There is also increasing interest from specialists in how lifestyle changes contribute to this beneficial trend. The intervention is focused namely on nutrition, physical activity and smoking.The effects of intervention may be influenced by the optimal timing of patients' motivation to adopt such changes.

[Trends in respiratory morbidity of children in relation to their passive smoking exposure]. / Vývoj respiracní morbidity detí ve vztahu k jejich expozici pasivnímu kourení.

BACKGROUND: The exposure of children to passive smoking has shown significant associations to respiratory morbidity. The youngest children between 0 to 2 years of age are usually seriously affected. With increasing age of the child a decrease in respiratory illness incidence together with a decrease of the effects of passive smoking were observed. The aim of the study was to assess by repeated investigations the morbidity among children exposed to environmental tobacco smoke (at the age of 6, 18 months and 5 years) and the differences in morbidity in the groups with different exposure in children involved in the ELSPAC study (European Longitudinal Study of Pregnancy and Childhood). METHODS AND RESULTS: The data about health indicators and exposure were obtained from standardized questionnaire filled by mothers and physicians in the age of 6 and 18 month and in the 5th year of age. Results were assessed for 4 groups of children with different smoking habits of their mothers. The differences were statistically evaluated in the SPSS statistical program. The children of smoking mothers were more often exposed to environmental tobacco smoke; the children of middle and heavy smokers more than the children of light smokers. In the age of six months the children were slightly more often protected from passive smoking exposure than in the age of 18 months and 5 years: the differences were statistically significant (p < 0.01). The attendance in kindergarten represents an important protective factor: the children were exposed less during the week-days than during weekends (p < 0.001, resp. p < 0.01). The respiration symptomatology and morbidity were significantly increased in the earlier periods of life of those children, whose mothers smoked. In the age of 5 years the smoking household environment influences only the higher incidence of asthmatic symptomatology (wheeze breathing, apnoe) and more frequent allergies to household dust and pollen with symptoms of dyspnoe and wheezing (p < 0.05). CONCLUSION: The ELSPAC study has provided evidence of the significant influence of the mother's smoking on the child exposure to passive smoking. The consequences of such exposure are manifested especially as increased respiratory and allergic morbidity, more so in the first 18 months of life than at five years of age.

[Suicidal attempts within the set of young adult parents of children observed in ELSPAC study]. / Sebevrazedné pokusy v souboru mladých dospelých--výsledky studie ELSPAC.

BACKGROUND: Though effective medications for the treatment of mood disorders have been developed, panic anxiety, major depression and other psychiatric diseases, only small reduction in suicide rates has been achieved during last four decades. Further epidemiological, clinical and experimental studies are initiated to support both prevention and treatment of suicidal behaviour. METHODS AND RESULTS: In ELSPAC study, the data of 3148 men and 3637 women--parents of children aged 3 years--were analysed with the aim to detect possible determinants of psychiatric disorders. These data included both information about the parents' events and health after the child's delivery and about parents' history during their own childhood. According to their self-reported suicidal attempts during last 18 months, parents were divided into groups A (with positive history) and B (no attempt). Statistical significance was evaluated by the SPSS programme (Pearson's chi-square test, linear-by-linear associations, ANOVA). 23 persons (0,3%) overall self-reported the suicidal attempt during last 18 months: 18 men (0,6%) and 5 women (0,1%). Among them, 2 men and 4 women repeated the attempt. In the same cohort, the frequency of suicidal attempts dropped by 50% among women and rose by 125% among men compared to the previous observation. In the personal history, the information both about emotional and physical deprivation during childhood was more frequent among persons with suicidal attempts. On the other hand, partners' characteristics as possible sources of daily stress situations were not different between groups. Men with suicidal attempts were significantly more often heavy smokers (smoking more that 20 cigarettes daily) and alcohol abusers. Surprisingly, the level of satisfaction with family life was significantly higher in both sex groups with suicidal attempts. CONCLUSIONS: Although majority of respondents in all groups reported their health status as good, more detailed questions showed significantly higher frequency of different psychiatric disorders and moods in the groups of persons with suicidal attempts: irritation, exhaustion among men, anxiety, depression, dejection among women. Also subjective evaluation of parents' good health is not in correspondence with the relative high number of hospitalization (10% men and 40% women with suicidal attempts) and frequent using of psychoactive drugs. The psychic health of ELSPAC parents will be assessed in further prospective measurements.

[Conduct disorders in seven-year-old children--results of ELSPAC study. 3. Postnatal development]. / Poruchy chování u sedmiletých detí-- výsledky studie ELSPAC. 3. Vývoj v období po narození.

BACKGROUND: In the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), the pediatric observation of the cohort of 6100 7-year-old children described 4.4% of them as having conduct disorders. METHODS AND RESULTS: The predominant markers such as strong negativism, aggressivity, attention deficit, non-adequate reactions, hyperactivity, disorders of psychomotoric development, school maturation delay, poorer school results and social adaptation described children behavioral problems. The first signs of conduct disorders were often discovered already at the 18th month and the 3rd year of children's age. The acceptance of standardized criteria of possible conduct disorders in the routine pediatric practice, and the special psychologic and/or psychiatric care for children with the confirmed diagnosis should be recommended as soon as in their toddler age. CONCLUSIONS: Possible causal associations between prenatal exposure to nicotine and conduct disorders in childhood are another strong reason for the primary prevention and smoking cessation in antenatal clinics.

[Conduct disorders in seven-year-old children--results of ELSPAC study 1. Co-morbidity]. / Poruchy chování u sedmiletých detí-- výsledky studie ELSPAC 1. Komorbidita.

BACKGROUND: The interest of experts in conduct disorders (CD) research is growing during the last two decades. The research areas include the diagnostics, ethiopathogenesis and treatment and also the comorbidity, especially with the hyperkinetic syndrome incidence (Attention Deficit Hyperactivity Disorder--ADHD). This paper intends to describe the conduct disorder occurrence and its other manifestations of divergence found during the investigation of children followed in the prospective longitudinal study ELSPAC in seven, respectively eight years of their age. METHODS AND RESULTS: Data of 6100 seven-year-old children characterizing their behaviour was collected from mothers and attending physicians. In the school year during which this investigation phase took place 2518 of the children reached eight years of age and their behaviour, temperament and school results were also evaluated by their teachers. The children were divided into three groups according to the presence or absence of the symptoms, which characterize conduct disorders (found by physicians): "stubborn negativistic behaviour", "inability to pay attention", "aggressiveness" and "inadequacy of reactions". The presence of two of these symptoms was found in 3%, presence of all four symptoms in additional 1.4% of children. Parents and teachers more often indicated various symptoms of hyperactivity in children with conduct disorders. CONCLUSIONS: In almost 5% of the ELSPAC cohort children in seven years of their age those symptoms were diagnosed, which match the Conduct Disorder criteria and Attention Deficit Hyperactivity Disorder (ADHD) criteria. In agreement with similar studies these frequent comorbidities were found: sleep disorders, psychomotor development disorders and laterality changes. The cognitive abilities evaluated by mothers and also teachers based on schoolwork results were more often worsened in children with conduct disorders. Various data indicating their worse social adaptability (which significantly disturbed the class) occurred more frequently in these children.

[Conduct disorders in seven-year-old children--results of ELSPAC study. 2. Risk factors]. / Poruchy chováiní u sedmiletých detí--výsledky studie ELSPAC 2. cást: Rizikové faktory.

BACKGROUND: Conduct disorders related to hyperactivity and significant attention deficit are caused by several types of risk factors-genetic, biological, environmental and psychosocial. A cohort of children was followed longitudinally in a prospective study during the pregnancy and childhood (ELSPAC). In the age of 7 years, marked behavioural divergences were described in 4,4% of children by their attending physicians. These children were also more often afflicted by other pathological symptoms (hyperactivity, sleep and psychomotor disorders). From the data collected from parents and physicians in the previous phases of investigation we selected possible risk factors which affect the prenatal and postnatal periods: prenatal exposure of children to smoking, alcohol, chemical substances, prenatal development complications, the level of education of parents, family dysfunction, alcoholism of both parents, conflicts with the police, mother's disturbed mental health. METHODS AND RESULTS: In the sample of 3752 children from the city of Brno, no behavioural divergence was found in 96.5% of cases. The presence of one or two of the four observed divergences occurred in 3.2% and 3 to 4 conduct disorder symptoms occurred in 0.3% children, significantly more often in boys. The children with conduct disorders compared to the children with no symptoms had significantly lower average birthweight, lower head circumference, their mothers had more often lower education, smoked and had psychological problems in childhood and as adults and the fathers had more often conflicts with the law. CONCLUSIONS: The ELSPAC study did not have the methodological possibility of studying the genetic-environmental interactions; nevertheless it contributes to the evidence supporting that some factors can negatively effect the foetal development and the unfavourable family environment can participate in the development of conduct disorders which can progress during lifetime.

Prevalence of active infection with Chlamydia pneumoniae and human cytomegalovirus in patients with type II diabetes mellitus.

By promoting the inflammatory process in the arterial wall, Chlamydia pneumoniae (CPN) and human cytomegalovirus (CMV) participate in the pathogenesis of cardiovascular disease (CVD). Since patients with diabetes mellitus (DM) are at high risk of CVD, we studied markers of CMV and CPN infection in DM patients as possible predictors of cardiovascular complications. The seroprevalence rates of CMV in 44 DM patients and matched controls were 74 and 88%, respectively. Compared with controls, patients showed lower titers of IgG against CMV (p < 0.001) and higher titers of genus-specific IgA against CPN (p = 0.006). The titers of genus-specific IgG and prevalence rates of type-specific anti-CPN IgA, IgG or IgM were similar in both DM patients and controls. Serological markers of either active or recent CPN infection were detected in 54% of patients and 59% of controls. However, CPN DNA was not detected in the blood of any DM patient. CMV DNA was found in the blood of 1 (2.3%) patient. The results do not indicate an increased rate of CMV or CPN infection in patients with type II DM.

Is environmental cadmium a serious hazard to Czech population?

The main objective of the study was to asses whether the environmental cadmium exposure in the Czech Republic is high enough to be able to affect significantly the human reproduction. Cadmium levels were measured in the blood and follicular fluid of 220 women in in vitro fertilization (IVF) therapy, using atomic absorption spectrometry. The mean value of cadmium in venous blood was 0.85 ng x ml(-1) with significantly higher values among smokers (1.18 ng x ml(-1), SD = 1.6, 95%CI: 0.6-1.1) as compared to non-smokers (0.46 ng x ml(-1), SD = 0.4, 95%CI: 0.4-0.6) (p < 0.0001). In all, 1518 blood-free follicles were assessed to determine cadmium residues in follicular fluid. The mean cadmium value was 0.34 ng x ml(-1) (SD = 0.45, 95%CI: 0.28-0.41). No association was found between the cadmium levels in blood and follicular fluid, and similar cadmium levels were observed in the follicular fluid of women with different smoking habits. The calculated dietary cadmium intake was similar in all our patients and had no relation to either blood or follicular cadmium levels. The follicular cadmium levels were approximately 20 times lower as compared to those found in the group of Canadian women. Our study confirmed the previous findings on the low exposure of the Czech population to environmental cadmium.

Influence of maternal active and passive smoking during pregnancy on birthweight in newborns.

Many studies have documented a strong association of active smoking during pregnancy with fetal growth retardation. Increasing interest has also been focused on whether there is an association between exposure of pregnant women to environmental tobacco smoke (ETS) and low birthweight of their babies. In the intervention controlled study "Healthy Pregnancy--Healthy Child", mothers after delivery were interviewed by medical students who collected data about their smoking and nutrition. Students were also trained to stimulate non-smoking behaviour and to explain the risks related to smoking and exposure to ETS. Data from 1147 mothers after delivery were collected but only single births were included in the analysis of birthweight. In our study, 63.4% women never smoked and 32.2% women reported they had stopped smoking either before pregnancy or during the first trimester. Only 4.4% of mothers (n = 50) smoked during the whole pregnancy. Women with the history of smoking were exposed to ETS more often than mothers who never smoked (51.6% vs 17.4%; p < 0.001). The number of heavily exposed both at home and workplaces was more than twice higher among former smokers compared with never smokers (22.4% versus 9.4%, p < 0.01). The average birthweight of babies born to women who had stopped smoking was higher than that born to never smokers. The average birthweight of babies born to women who smoked during pregnancy was lower by 119 g and 171 g than that of the babies born to never smokers and former smokers, respectively. When pre-term neonates were excluded, differences in birthweight between babies born to never smokers and either formerly smoking or still smoking mothers were slightly lower. The greatest effect of ETS exposure on birthweight was recorded in never smoking mothers; an average reduction in birthweight was 88 g. A strong dose-effect was observed; in mothers heavily exposed to ETS both at home and at work, the babies' birthweight was lower by 189 g in comparison with the group of non-exposed, never smoking mothers and even by 70 g compared with mothers smoking during pregnancy.

Influence of prenatal and postnatal exposure to passive smoking on infants' health during the first six months of their life.

On the Czech set of European Longitudinal Study of Pregnancy and Childhood (ELSPAC), we tried to verify whether it is possible to confirm the results of foreign studies which found out that the both prenatal and postnatal exposure of newborns to chemicals on cigarette smoke could influence the newborns' morbidity in the first six months of their life. Mothers, who served as sources of data about their smoking behaviour during the pregnancy and after the birth as well as information about the health status of the children after the birth (N=3,871) were divided into four groups: 1. women who never smoked (74.3%), 2. women who stopped smoking in pregnancy and started to smoke after delivery (18.3%), 3. women who smoked both during pregnancy and after delivery (7.2%), 4. women who smoked during pregnancy and stopped after delivery. Unfortunatelly, the last group was very small (only seven mothers) and did not allow assessment of exclusively prenatal exposition. Sucklings from Czech ELSPAC set exposed to chemicals in cigarette smoke either only after the birth or also during the prenatal period, showed significantly higher occurence of different symptoms of respiratory tract damages and their complications (like otitis media) when compared to children of non smoking mothers. Due to illnesses during the first six months after the birth, their parents had to look more often for the consultations of physician, including hospitalization. Our results, as well as results of foreign studies, confirm, that smoking of mothers during the pregnancy and after the birth represents significant risk for the first months of life. Illnesses of children in this early period can cause longitudinal consequences which emerge during the childhood as well as in adulthood. They also represent a strong stressogenic factor. Children's health consequences of exposure to cigarette smoke request very often intensive and expensive care within health system. Our results are the same as those of foreign studies and confirm that both prenatal and postnatal exposure to chemicals of cigarette smoke is significant risk factor which negatively influences the health status on the early periods life.

Cadmium and zinc concentrations in human placentas.

Cadmium and zinc levels in placentae of 688 women who delivered their children in two university hospitals in Brno and in the regional hospital in Znojmo during January-June 1992 were determined using AAS analytical method. Average value of zinc (54.6 micrograms/g) and cadmium (18.02 ng/g) concentrations found out in our file are in accord with those ones reported in literature. Individual differences in zinc contained in placentae occur uniformly. Very low concentrations prevail for cadmium; values exceeding 100 ng/g of dry basis are sporadic only. Zinc vs. cadmium concentrations values in placenta are mutually positively correlated [correlation coefficient (factor) r = +0.13, p < 0.001]. Cadmium content in placenta depends on mothers' age and it is significantly higher in older women. No changes in zinc contained in the placental tissue depending on mothers' age were found out. The mutual ratio of zinc vs. cadmium content in a placental tissue is significantly decreased in older mother (23.8 in older women, 41.2 in younger women, p < 0.01).

Smoking and damages of reproduction: evidence of ELSPAC.

The international longitudinal prospective ELSPAC study also includes women from the Czech Republic: the results sum up data from 4530 women from City of Brno and District of Znojmo who had different exposure to active and passive smoking. Anamnestic data were collected by fulfilling the internationally unified questionnaires during pregnancy and at the 2nd month after delivery. Gynaecologists, obstetricians and pediatricians, using the unified procedures, were collecting objective data in the course of the pregnancy, delivery, monitoring health status of women and newborns. Significant differences were found between smoking and non-smoking women in the prevalence of alcohol and marihuana consumers both before and during pregnancy and after delivery. In personal health history, smoking women more often reported their self-perceived poor health, panic and loss of self-control during the delivery. In the current pregnancies, smoking women suffer more often with placenta praevia, placental abnormalities, fetal growth retardation and fetal malformations. On the other hand, the prevalence of preeclampsia was decreased among smokers. The children of mothers who were moderate/heavy smokers during pregnancy, had on average by 245 g lower birth weight, 1.22 cm shorter body length and by 0.66 cm smaller head circumference than those of non-smokers. These measures were on average also decreased in the groups of newborns whose mothers were light smokers or non-smokers heavy exposed to environmental tobacco smoke. On the contrary, the average gestational age was similar both in case of active smoking, passive smoking, and non-smoking women. In spite of the fact that most of smokers would give up smoking after getting pregnant, it is necessary to place the antismoking interventions and nutrition advisory service within the routine duty of physicians.

Occupational risks for human reproduction: ELSPAC Study. European Longitudinal Study of Pregnancy and Childhood.

Pregnant women living in Brno who were contacted for the first time at 18th week of their pregnancies during the period from February 1990 to January 1992 were involved into the ELSPAC group. Among others, the exposure to different occupational factors in the three periods was obtained by the self-reported questionnaire: 1. the last 9 months before pregnancy, 2. the first, and 3. second trimester periods. The women's health status during pregnancy, the history of delivery and the developmental and health status of newborns were described in details by obstetrics and pediatrics according to another internationally unified questionnaire. All data obtained from 3,897 pregnant women living in Brno were computered. Smoking women were significantly more often than non-smokers occupationally exposed to ergonomic stressors associated with the monotony work, and to chemical substances. In the whole group, the intrauterine growth retardation has been positively associated with shifting (OR 1.59, p < 0.05) and occupational exposure to permanent noise (OR 1.92, < 0.05). Newborns of such exposed women had in average lower parameters of head cimcumstances (p < 0.01). Non-physiologic, non-spontaneous deliveries have been more often observed among VDTs users (OR 1.20-1.28, p < 0.05). Women exposed to organic solvents during 2nd trimester of pregnancy delivered more often babies with some congenital malformations (OR 2.31, p < 0.05). On the other hand, the different occupational factors seemed to be protective for several markers of the women health status, as the prevalence of reproductive damages was significantly lower among exposed women than in the non-exposed group. After the standardization of the smoking habit, more significant associations have occurred in the group of smokers occupationally exposed to: shift work (low-birth-weight babies: OR 1.98, p < 0.05), chemicals (bleeding during pregnancy: OR 2.00, p < 0.05), sedentary work (placental abnormalities and congenital malformations: OR 1.59, p < 0.05). Non-smoking women using VDTs had more often babies with intrauterine growth retardation (OR 2.29, p < 0.05). Newborns with different malformations were more often born to non-smoking women occupationally exposed to chemicals (OR 2.33, p > 0.05).

Dietary guidelines in the Czech Republic III.: Challenge for the 3rd millennium.

In developed countries, dietary guidelines are more and more often used as a source of binding information not only in public health, food production, nutrition and agricultural policy, but in ecology and economy as well. In view of that, it is imperative to formulate such guidelines that would be supported by relevant population studies and correspond to the European model of WHO/CINDI guidelines. At the turn of the millennium, the Czech guidelines were updated in order that serving sizes of 5 basic food groups were brought closer to contemporary trends emphasizing lower protein intakes and at the same time, by setting limit ranges, they were able to meet specific need of people of different age group, sex, physiological status, physical activity, etc. The conversion of recommended servings to nutrients was compared with the results of the actual food basket of the Czech population and specific recommendations for amendments in proportions of individual food items in food groups and subgroups were given. On the basis of diet guidelines, conclusions describing tasks for the beginning of the third millennium were made. Besides them the most important are: production or health information systems with special emphasis to food intake and nutritional status report, policies to increase the access to vegetables and fruit for vulnerable groups, legislation to curb advertising high-fat energy-dense foods to children, policy to strengthen the operational targets of Innocenti Declaration and to increase the number of Baby Friendly Hospitals, legislation regarding food control systems based on international standards, sustainable campaigns to promote safe healthy diet, policies to ensure sustainable food production.

Dietary guidelines in the Czech Republic. I.: Theoretical background and development.

Setting dietary guidelines for the healthy population of the Czech Republic has respected the methodical steps suggested by authors as follows: consideration of dietary guidelines was preceded by the consensus on general goals and methods, e.g. health and well-being promotion at the population level. The guidelines cover a total diet, not only a part of it and have to be realistic, with respect to actual frequency of food in majority of population. The second step was the declaration of nutritional goals with respect to achieving the RDI. The third step was dividing the food into defined food groups according to the following criteria: the food contained in one food group had the same/similar nutritional characteristics with regard to achieving the adequate of decreased intake. Within the groups several sub-groups were set, associating foods with another specific nutrient content. The fourth step was the setting the serving sizes as an equivalent for each food group. These equivalents must reflect typical average consumed amount of food and always within the group the content of the main nutrient has to be same/similar. The fifth step was setting nutritional profile of each group and/or sub-group. This profile represented the content of energy, proteins, lipids, carbohydrates, vitamins and minerals. The sixth step was deciding the daily number of servings of each food group, which must allow the flexibility as much as possible--authors recommend the interval solution. The seventh step was decision about the form (textual and graphic), which presents the guidelines. The decision was preceded by the study focused on accepting suggested possibilities. The last, eighth step was working out the strategy of implementation in practise, which means the summarizing organizational, administrative and political arrangements with the aim to be positively accepted by the population who identify itself with the principles of the dietary guidelines. In the formulation of dietary guidelines in the Czech Republic, the authors accepted methods described above and each of the eight steps was supported by adequately focused population study.

Evaluation of the level of nicotine dependence among adolescent smokers.

The questionnaire containing ten items evaluated the degree of dependence in students-volunteers from Brno secondary and vocational schools (ages ranging from 15 to 17 years) and the anamnestic data were compared with the specific (urinary cotinine) and non-specific (CO in the air exhaled) biological tests of exposure to smoking. The sample of 147 students examined contained 42% non-smokers, 25% occasional smokers and almost 33% of those who smoked every day. Almost 10% children smoked more than 10 cigarettes a day, and more than 20% children stated that they smoked 60 and more cigarettes a week. In accordance with the pre-developed degrees of dependence, compiled by the scores of the individual responses, 59% of the respondents (including the non-smokers) were ranked among the non-dependent. The second most frequent group contained the "strongly dependent" (almost 17% of all persons, e.g. 30% of smokers), 3.4% of examined persons (6% of smokers) were ranked in the sub-group of persons with a very high degree of dependence. Highly positive correlations were found between the evaluation of the dependence degree according to the anamnestic data and the exposure bio-markers (urinary cotinine/creatinine and CO in the air exhaled): the values of correlation coefficients were 0.615 and 0.764, resp. Both bio-markers also correlated negatively with the time of the last exposure to both active and passive smoking. The individual items in the dependence questionnaire had positive correlations with the objective exposure indicators which had statistical significance. The strongest relationship was observed in the question about the first morning cigarette--the highest correlation coefficients, being followed by signs evaluating the smoking frequency and the usual number of cigarettes smoked per day and in a week. The lowest relationships concerned the occasions for smoking and the unpleasant symptoms associated with the withdrawal. The anamnestic questionnaire could explain 42.6% of urinary cotinine level variability (converted to the density measured by creatinine content) and 65.8% of variability of CO content in the air exhaled. It was demonstrated that regular adolescent smokers at the ages between 15 to 17 years inhaled the cigarette smoke and the young smokers' inner exposure to nicotine had been proved as well. In this age group, there are many individuals who have a strong or a very strong dependence on nicotine. As a result, it is necessary to promote smoking cessation and nicotine dependence treatment by recommending pharmaceuticals of substantial nicotine therapy.