Trends in health indicators in the urban middle-aged population in the Czech Republic in 1998-2010.

OBJECTIVES: To track the trends in general health indicators and the prevalence of cardiovascular diseases (CVD), high blood pressure and elevated blood cholesterol in the middle-aged urban population in the Czech Republic in 1998-2010. STUDY DESIGN: Cross-sectional study. METHODS: The following data from the three-phase HELEN (HEalth - Lifestyle - ENvironment) study, a prevalence questionnaire survey, were analysed: data collected from 8214 subjects in phase I, 6107 subjects in phase II, and 4389 subjects in phase III. The study subjects were aged 45-54 years and the study period spanned from 1998 to 2010. The differences in the indicators between phases were evaluated by binary and ordinal logistic regression models at a significance level of 0.01. RESULTS: Over the study period, a significant increase was observed in the proportion of respondents who self-rated their health as very good or good: from 46.6% to 51.0% in males (P = 0.006) and from 45.5% to 49.9% in females (P < 0.001). At the same time, the rates of respondents under long-term medical follow-up rose significantly from 36.3% to 44.3% (P < 0.001) and from 46.4% to 56.2% (P < 0.001), respectively. CVD prevalence did not change although the percentage of males and females with high blood pressure (from 29.3% to 36.6% and from 26.0% to 31.2%, respectively) and elevated total cholesterol (from 29.0% to 36.6% and from 27.3% to 32.4%, respectively) increased significantly. CONCLUSIONS: Self-rated health among the middle-aged population in the Czech Republic improved during the 1998-2010 period, but, at the same time, more people needed to be followed up for a disease. The proportions of respondents with hypertension and elevated blood cholesterol increased while the CVD rates did not vary significantly.

Increase in plasma free haemoglobin during cardiopulmonary bypass in heart valve surgery: assessment of renal dysfunction by RIFLE classification.

Heart valve surgery carries a high risk of renal insufficiency as an independent risk factor due to prolonged cardiopulmonary bypass. Multiple causes of cardiopulmonary bypass-associated renal damage have been described, and haemoglobin-induced renal injury is presently being investigated. Forty-three patients scheduled for heart valve surgery (mostly combined) were enrolled in the prospective study. Plasma free haemoglobin (PFH) levels were evaluated by photocolorimetric measurement at the start of procedures (t(0)) and before the end of extracorporeal circulation (t(1)). A statistically significant increase in PFH levels during cardiopulmonary bypass was detected [median values (interquartile range) - t(0): 62.0 (53.4) mg/L, t(1): 320.4 (352.2) mg/L], P < 0.001. A significant regression relationship between the duration of cardiopulmonary bypass and the increased PFH was found (Spearman's correlation coefficient 0.628, P < 0.001). In some elderly patients, the tendency towards a high release of PFH during cardiopulmonary bypass was more pronounced, but the overall association between age and PFH levels was of borderline significance (P = 0.077). The correlation between PFH and post-operative serum creatinine was low and non-significant, but the latter correlated highly with the pre-operative serum creatinine values (Spearman's correlation coefficient reached values of 0.6-0.7, P < 0.001). Patients were classified according to the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal failure (RIFLE) classification for acute renal dysfunction during post-operative days 1 - 4; the influence of PFH levels at t(1) on the consequent RIFLE classification was not proven (P=0.648), but 4 patients in the Injury category had shown a higher median value of PFH (433.6 mg/L) in comparison with the others (29 patients with no acute renal dysfunction - 313.7 mg/L, 10 patients at Risk - 330.1 mg/L).

Generic versus disease-specific instruments in quality-of-life assessment of chronic obstructive pulmonary disease.

OBJECTIVES: Chronic respiratory diseases may alter a patient's social life and well-being. Measures of health-related quality of life have been proven to bring complementary information to functional assessments. The aim of the study was to describe the questionnaires that are most frequently used to measure this subjective construct in patients with chronic obstructive pulmonary disease (COPD) and to compare the responses obtained via administering one generic (SF-36) and one disease-specific questionnaire (St. George's Respiratory Questionnaire; SGRQ) to patients with COPD. METHODS: One group of patients (46 individuals) was used to evaluate the questionnaire's performance in repeated administrations under unchanged conditions (reproducibility) and to study the correlations of corresponding domains of respective questionnaires. Responsiveness of both questionnaires was tested on another group of 129 patients measured before and after the therapeutic stay at the spa. Methods of correlational analysis (Spearman, intraclass, and canonical correlation coefficients) as well as the Wilcoxon rank test were used for statistical analysis. RESULTS: Both questionnaires seem to be comprehensive outcome measures for patients with COPD, but some particular areas may not be covered with the same intensity (e.g. emotional problems). Reproducibility of both questionnaires was good and only small non-significant shifts were seen, particularly in physical and social functioning domains. In repeated measurement, the SGRQ seemed to be slightly more responsive to change than the SF-36. CONCLUSIONS: The idea of using generic and disease-specific questionnaires together probably represents the best approach to this topic. It may improve our knowledge and explain better the relationship between disease-specific changes in patient status and both disease-specific treatment and general functional status.

[Assessment of speed of an anti-platelet effect after two different doses of acetylsalicylic acid by flocculation]. / Stanovení rychlosti nástupu úcinku protidestickového vlivu dvou ruzných dávek kyseliny acetylsalicylové agregometrickou metodou.

UNLABELLED: Acetylsalicylic acid inhibits aggregation of blood platelets through affecting arachidon acid metabolism--a precursor of thromboxan which is a strong platelet aggregation inhibitor. A standard method for measurement of aggregation activity blockade (in percents) of platelet rich plasma is turbidimetric aggregomethry based on spectrophotometric principle. According to results of recent studies administration of acetylsalicylic acid is one of the basic pillars of prevention of thrombotic complications in atherosclerotic arterial disease. Acetylsalicylic acid doses differ from study to study. An aim of our work was to measure speed of two different doses of acetylsalicylic acid. RESULTS: Level of aggregation activity blockade in samples of platelet rich plasma was measured by aggregometry in 26 healthy volunteers after administration of four inductors of thrombocyte aggregation (arachidon acid, adenosindiphosphate, collagen, and ristocetin). The samples were taken before administration and 120, 240, and 360 minutes after single peroral administration of 100 or 400 mg of acetylsalicylic acid. Samples of plasma were analysed immediately after sampling. Before drug administration there was no aggregation activity in 27.7% of the sample after arachidon acid administration, 28.3% after ADP administration, 21.5% after collagen administration and 25.3% after ristocetin administration. After administration of 400 mg of acetylsalicylic acid and administration of arachidon acid as an inductor 89.9% of the aggregation activity of the sample was blocked after 120 minutes, 89.6% after 240 minutes, and 90.6% after 360 minutes. After administration of adenosindiphosphate as an inductor 71.7% of the aggregation activity of the sample was blocked after 120 minutes, 68.3% after 240 minutes, and 69.9% after 360 minutes. And, after administration of ristocetin as an inductor 64% of the aggregation activity of the sample was blocked after 120 minutes, 66.4% after 240 minutes, and 54% after 360 minutes. Blockade of aggregation activity after collagen administration was not statistically significant. After administration of 100 mg of acetylsalicylic acid and administration of arachidon acid 83.8% of the aggregation activity of the sample was blocked after 120 minutes, 89.2% after 240 minutes, and 89.6% after 360 minutes. After adenosindiphosphate administration statistically significant blockade of aggregation activity was achieved after 360 minutes in the 56.7% of the sample. Also after collagen administration 42.5% of aggregation activity of the sample was blocked significantly after 360 minutes while ristocetin has not proved to influence aggregation in a statistically significant manner. CONCLUSION: Both doses of acetylsalicylic acid influenced aggregation activity of platelets in a statistically significant manner as soon as after 120 minutes following their peroral administration. However, they had different ability to influence platelets response to alternative ways of activation--by adenosindiphosphate, collagen, and ristocetin. 400 mg dose blocked these ways while 100 mg dose was efficient in blocking these ways after 360 minutes and in case of ristocetin--an inductor used to monitor platelet adhesion ability--100 mg dose has not led to statistically significant blockade at all.