Tracing anthropogenic mercury in soils from Fe-Hg mining/smelting area: Isotopic and speciation insights.

Mercury (Hg) stable isotope ratios supplemented by Hg solid speciation data were determined in soils in a former Fe-Hg mining/smelting area (Jedová hora, Czech Republic, Central Europe). The dominant Hg phase in the studied soils was found to be cinnabar (HgS). A secondary form of soil Hg(II) was represented by Hg weakly and strongly bound to mineral (micro)particles, as revealed by thermo-desorption analysis. These Hg species probably play a key role in local soil Hg processes and biogeochemical cycling. The Hg isotopic data generally showed small differences between HgS (-1.1 to -0.8‰; δ202Hg) and the soil samples (-1.4 to -0.9‰; δ202Hg), as well as limited isotopic variability within the two studied soil profiles. On the other hand, the detected negative δ202Hg shift (∼0.4‰) in organic horizons compared to mineral soils in the highly contaminated profile suggests the presence of secondary post-depositional Hg processes, such as sorption or redox changes. For the less contaminated profile, the observed Hg isotopic variation (∼0.3‰; δ202Hg) in the subsurface mineral soil compared to both overlying and underlying horizons is likely due to cyclic redox reactions associated with Hg isotopic fractionation. We assume that the adsorption of Hg(II) to secondary Fe(III)/Mn(III,IV)-oxides could be of major importance in such cases.

Implementation of virtual music therapy in the practice of Czech music therapists: a best practice implementation project.

INTRODUCTION AND AIMS: Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT. METHODS: The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. RESULTS: Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed. CONCLUSIONS: The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic.

BACKGROUND: Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS: Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS: The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION: Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.

Prevalence of iodine deficiency among vegan compared to vegetarian and omnivore children in the Czech Republic: cross-sectional study.

BACKGROUND: The intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic. METHODS: We gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0-18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0-5 years and 6-18 years. RESULTS: Our study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 µg/l, p < 0.001). Notably, the lowest (5.99 µg/l) and highest (991.80 µg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 µg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 µg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups. CONCLUSION: We have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 µg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.

Cross sectional study of vitamin B12 supplementation in Slovak and Czech vegans.

Background: The number of vegans in the world is growing and in Slovakia and the Czech Republic they make up 1% of the population. Vegan diet excludes all foods of animal origin and vegans who do not use vitamin B12 supplements are at risk of the vitamin B12 deficiency. Objective: The aim of this study was to determine what proportion of Czech and Slovak vegans use vitamin B12 supplements regularly, irregularly or not at all and what is their supplemental cobalamin intake. Materials and methods: The research involved 1337 self-identified vegans from Slovakia and the Czech Republic who were interviewed using the CAWI (Computer-Assisted Web Interview) method. Participants were recruited by posts in veganism-themed social media groups. Results: Out of 1337 vegans 55.5% supplemented cobalamin regularly, 32.54% irregularly and 11.97% were not supplementing. Rate of not supplementing individuals was 5.04% higher in Slovaks than in Czechs. Short-term vegans had a significantly higher rate of not supplementing individuals (17.99%) compared to medium-term (8.37%) and long-term vegans (7.50%). Mean weekly cobalamin intake from supplements was 2938.34±2566.60 µg in regularly supplementing vegans compared to 1630.31±1949.27 µg in irregularly supplementing vegans, particularly due to the lower weekly supplementation frequency among irregularly (2.93) compared to regularly supplementing vegans (5.27). Conclusions: The rate of supplementation in Slovak and particularly Czech vegans was higher than in other countries. The number of not supplementing individuals was significantly higher among short-term vegans, indicating that there is still a need for education on the importance of adequate and regular cobalamin supplementation, especially in new vegans. Our results support the hypothesis that the reason for higher rate of cobalamin deficiency in irregularly compared to regularly supplementing vegans is the lower cobalamin intake caused by lower supplementation frequency.

POPs and PAHs in fish oil-based food supplements at the Czech market.

The objectives of this study were to assess concentrations of three groups of persistent organic pollutants (POPs) and polycyclic aromatic hydrocarbons (PAHs) in 44 fish oil-based food supplements, to estimate their daily intake by consumers and, to evaluate the compliance of the oil samples with the oil origin declarations (cod liver oil or fish oil). The concentrations of ∑PCBs (7 congeners), OCPs (19 compounds, represented mainly by ∑DDTs), ∑PBDEs (10 congeners), and ∑PAHs (16 compounds) found in samples ranged between 0.15-55.7 µg kg-1, 0.93-72.8 µg kg-1, 0.28-27.5 µg kg-1, and 0.32-51.9 µg kg-1, respectively. Besides, the authenticity of the oils was assessed based on the fingerprints obtained by DART-HRMS, an ambient mass spectrometry technique. Four samples declared as fish oil were probably prepared from cod liver oil, which is much cheaper. Furthermore, these samples contained elevated concentrations of halogenated POPs when compared to supplements produced from fish oil.

Trends in spa and balneology in postcovid era, outcomes, and perspectives.

The COVID-19 pandemic has dramatically affected spa and balneology not only in the Czech Republic. Generally, almost two years without spa patients and clients led to a dramatic outflow of labor. The article main purpose is to analyze pandemic impact on the structure of spa patients and clients, to identify main current spa problems to be overcome, and to summarize possible future trends in modern spa and balneology for current and future spa clients. Spa will remain an important medical solution for treatment of some diagnoses using healing mineral-medical waters and natural sources, but they must innovate their services and treating programs to answer current questions and clients 'demands. It will be a complex patient care combining body and mental treatment and care with the use of so-called therapeutic landscape, a unique landscape surrounding spa towns and places, as well as wellness aspects. Modern spa must be an integral part of health care systems in Europe.

[First Experience with Diaphragm Pacing System in the Czech Republic]. / První zkusenosti se stimulacním systémem bránice v Ceské republice.

Patients with impaired diaphragm function are dependent on long-term mechanical ventilation. It is associated with numerous health complications as well as significant economic burden. Intramuscular diaphragm stimulation through laparoscopic implantation of pacing electrodes is a safe method which enables restoring breathing using diaphragm in a considerable number of patients. The first implantation of diaphragm pacing system in the Czech Republic was performed in a thirty-four-year-old patient suffering from a high-level cervical spinal cord lesion. After eight years of mechanical ventilation support, just five months from initiation of stimulation, the patient is able to breathe spontaneously for ten hours per day on average, with expected total weaning. Once the insurance companies decide to reimburse the pacing system, a widespread use of the method even in patients with other diagnoses, including children, is expected. Key words: electrical stimulation, diaphragm, spinal cord injury, laparoscopic surgery.

Common snowdrop as a climate change bioindicator in Czechia.

The phenological response to climate change differs among species. We examined the beginning of flowering of the common snowdrop (Galanthus nivalis) in connection with meteorological variables in Czechia in the period 1923-2021. The long-term series were analyzed from phenological and meteorological stations of the Czech Hydrometeorological Institute (CHMI). Temporal and spatial evaluation (using Geographic Information System) in timing of beginning of flowering (BBCH 61) of G. nivalis was investigated under urban and rural settings. Furthermore, the detailed analysis of selected meteorological variables to onset of G. nivalis flowering was performed. Moreover, the trends (using Mann-Kendall test) and Pearson's correlation coefficients between phenological phase and meteorological variable were calculated. The main finding of this study was that the trend of the beginning of flowering of the common snowdrop during the studied period (1923-2021) is negative, and it varies in urban and rural environments. The results showed most significant acceleration of the beginning of flowering of G. nivalis by - 0.20 day year-1 in urban area and by - 0.11 day year-1 in rural area. Above that, a major turning point occurred between 1987 and 1988 (both, in phenological observations and meteorological variables), and the variability of the beginning of flowering is significantly higher in the second period 1988-2021. On top of, the study proved that the beginning of flowering of G. nivalis closely correlated with number of days with snow cover above 1 cm (December-March) at both types of stations (urban and rural), and with mean air temperature in February, maximum air temperature in January, and minimum air temperature in March. The Mann-Kendall test showed a reduction in the number of days with snow cover above 1 cm (December-March) during 99 years period at Klatovy station (a long-term time series) by - 0.06 day year-1, i.e., by - 5.94 days per the whole period. Conversely, air temperatures increase (maximum and minimum air temperature by 0.03 °C year-1 (2.97 °C per the whole period) and average air temperature by 0.02 °C year-1 (1.98 °C per the whole period)). Thus, our results indicate significant changes in the beginning of flowering of G. nivalis in Czechia as a consequence of climate change.

Dissolution characteristics of uranium and lead in simulated lung fluid using fly ash samples from coal-fired power plants in the Czech Republic.

Samples of fly ash, slag and boiler scale containing elevated amounts of uranium or lead (210Pb) from several coal-fired power stations in the Czech Republic were collected for an assessment of their dissolution parameters - the dissolution rates and their respective fractions in vitro. The dissolution data were fitted either by a biexponential model or by a triexponential model. The uranium 234U and 238U in the fly ash sample are classified as M-type. Similarly, type M could be attributed for most of the materials containing 210Pb. A complementary measurement of the activity concentrations of 210Pb in relation to the grain size confirmed that the radionuclide is deposited mainly in fine particles (<25 µm).

Efficacy of switches within the class of IL-17 inhibitors: An analysis of data from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP).

The IL-17 cytokine family encompasses six different homodimers and heterodimers referred to as IL-17A-F. Due to some differences in the mechanism of IL-17 inhibition, aninsufficient effect of one IL-17 inhibitor does not necessarily imply lack of efficacy of the other agent of the same class. Aim of study was analysis of the success rate of switches among IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) in patients treated in the Czech Republic. Data were obtained from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP). Our analysis involved data of a total of 90 patients with severe chronic plaque psoriasis and baseline PASI scores >10 both prior to first-line biological therapy initiation and after switch to another agent of the class of IL-17 inhibitors. The most effective switch was that from secukinumab to brodalumab, with PASI 90 reached by 64.7% and 73.3% of patients at weeks 12 and 24. Among patients switched from secukinumab to ixekizumab target PASI 90 responses were achieved (at weeks 12 and 24) by 41.2% and 55.2% of patients. Among patients switched from ixekizumab to brodalumab target PASI 90 responses were achieved, at the above time points, by 30.8% and 38.5% of patients. Our analysis showed a high success rate of switches from secukinumab to ixekizumab and brodalumab, followed by the ixekizumab-to-brodalumab switch. Importantly, the therapeutic response and success rates of individual switches are independent of the patient's body weight and presence of psoriatis arthritis.

Health and economic impact of subcutaneous allergen immunotherapy in patients with pollen-induced allergic rhinoconjunctivitis: real-word evidence from the Czech Republic.

Background: The prevalence of allergic rhinoconjunctivitis (AR) has been increasing over the years, and allergen immunotherapy (AIT) remains the only disease-modifying treatment. However, cost-effectiveness data remain scarce. Methods: In this single-arm, noninterventional, prospective, multicenter study, we describe the effectiveness, safety and costs of subcutaneous AIT for pollen-induced allergic rhinoconjunctivitis. Results: Of 471 new AIT users, 317 completed three courses of treatment, and symptoms improved in 96%; no serious adverse reactions were reported. The cost of symptomatic medication decreased by 49% and the cost of unscheduled specialist visits decreased by 73%. Except for AIT administration, total healthcare costs decreased by 54% compared with the baseline pollen season without AIT. Conclusion: In clinical practice, subcutaneous AIT is an effective treatment generating savings on symptomatic medication and unscheduled consultations.

Hay fever has become more frequent over the years, and allergen immunotherapy (AIT) remains the only treatment able to reduce both symptoms and the root cause of this condition. However, it is not clear whether the benefits outweigh the price of the therapy. In this study, we observed patients in the common practice and described the effectiveness, safety and costs of injected AIT for pollen-induced hay fever. Of 471 new AIT users, 317 completed three courses of treatment in 3 consecutive years. Symptoms improved in 96% of them; no serious adverse reactions were reported. The cost of symptom-relieving medication decreased by 49% and the cost of unscheduled physician visits decreased by 73%. Except for costs related to AIT administration, total healthcare costs decreased by 54% compared with the years before AIT. In clinical practice, injected AIT is an effective treatment which generates savings on other medication and unscheduled physician consultations.

The Associations of Experiencing the COVID-19 Pandemic With Religiosity and Spirituality: A Cross-Sectional Study in Czech Adults.

Objectives: We investigated the associations between religiosity/spirituality and respondents' changes in their relationships, feelings, thinking, and behaviour during the first wave of the COVID-19 pandemic in the Czech Republic. Methods: A sample of Czech adults (n = 1,434; 48.3 ± 16.4 years; 49.65% women) participated in the online survey. We measured spirituality, religiosity, self-reported changes in relationships, disrupted feelings, and changes in behaviour during the pandemic. Results: Spiritual respondents were more likely to report increased physical activity, sex, reading and self-education, with odds ratios (ORs) ranging from 1.26 (95% confidence interval 1.09-1.46) to 1.56 (1.31-1.86). The combination of spirituality and religiosity led to an increase in the range of ORs to 1.57-2.69. Spiritual and religious participants were less likely to feel the decrease of hope by 70%, while mere spirituality significantly reduced the decrease of hope by only 30%. Religiosity itself led to a lower risk of reporting a disrupted day structure with an OR = 0.74 (0.58-0.95). Conclusion: Religiosity and spirituality separately help people during a pandemic in some areas. Especially their combination has a more positive impact on relationships, feelings, and behaviour.

Social Capital as a Predictor of Quality of Life: The Czech Experience.

In the paper, we understand social capital as a variable that affects the quality of life. A variable whose change affects another variable is called a predictor. The paper is based on Putnam's understanding of social capital with the dimensions of trust, norms and networks. Trust is considered the most important dimension, and for the purposes of the paper social capital is identified with trust. Quality of life is a holistic concept with two dimensions expressing an assessment of satisfaction with life. After society became richer-in the 1960's in the West and, after the collapse of the bipolar world, also in Central and Eastern Europe-the need for quantity was replaced by the need for quality. The paper is focused on Czechia, with social capital as a predictor of quality of life being investigated geographically at the level of districts. According to the research hypothesis, social capital will have a strong influence on the quality of life of residents in Czechia, i.e., it will be its predictor. To test the validity of the research hypothesis, research was conducted. The aim of the paper is to outline the epistemology of social capital from the aspect of quality of life, description of quality of life and then to test the validity of the research hypothesis by measurements. The result of the quantification of social capital and quality of life at the level of districts and their correlation is important from an epistemological point of view for two reasons. The first is to question the generally accepted premise of the position of social capital as a strong predictor of quality of life. The second is the recognition that the premise of the position of social capital as a strong predictor of quality of life applies in the districts with the highest quality of life.

The Relationship Between Religious/Spiritual Beliefs and Subjective Well-Being: A Case-Based Comparative Cross-National Study.

The most unique aspect of religiosity/spirituality (R/S), supernatural beliefs, and their relationship with SWB has hardly been examined. This study explores the relationship between six R/S supernatural beliefs and SWB, in a case-based comparative cross-national design including two religious and two secular nations. Data were obtained from the International Social Survey Programme (ISSP) Religion IV module from the religious countries of the USA (n = 1060) and Turkey (n = 1353) and the secular countries of Denmark (n = 1281) and Czech Republic (n = 1112). SWB was measured as happiness and self-rated health. Statistical analyses were performed using binary logistic regression models replicated across countries. Results indicated that the American sample showed no evidence of relationships between R/S and SWB outcomes capable of improving the model over demographic and service attendance covariates. In Turkey, some R/S beliefs were found to be statistically significantly related to SWB, with positive and negative associations with happiness. No associations were found in the secular countries. Findings were discussed in the light of previous research and interpreted from a terror management theory perspective.

Cross-Sectional Study of the Prevalence of Cobalamin Deficiency and Vitamin B12 Supplementation Habits among Vegetarian and Vegan Children in the Czech Republic.

Vegetarian (VG) and vegan (VN) diets in childhood are of growing interest due to their perceived health and environmental benefits. Concerns remain due to the possible disruption of healthy growth and development of children because of the scarcity of evidence-based studies. Among the nutrients of special concern is vitamin B12. Therefore, the Czech Vegan Children Study (CAROTS) decided to examine the relationship between B12 metabolism parameters and B12 intake through diet and supplementation. We analyzed laboratory parameters within n = 79 VG, n = 69 VN, and n = 52 omnivores (OM) children (0−18 years old). There were no significant differences in levels of holotranscobalamin (aB12), folate, homocysteine (hcys), or mean corpuscular volume. However, there was a significant difference in levels of cyanocobalamin (B12) (p = 0.018), even though we identified only n = 1 VG and n = 2 VN children as B12 deficient. On the other hand, we identified n = 35 VG, n = 28 VN, and n = 9 OM children with vitamin B12 hypervitaminosis (p = 0.004). This finding was related to a high prevalence of over-supplementation in the group (mean dose for VG 178.19 ± 238.5 µg per day; VN 278.35 ± 394.63 µg per day). Additionally, we found a significant (p < 0.05) difference between B12, aB12, and hcys levels of supplemented vs. non-supplemented VG/VN children. This can show that the intake of vitamin B12 via diet in the VG group might not be sufficient. Secondly, we analyzed a relation between supplement use in pregnancy and breastfeeding and its impact on vitamin B12 levels of children aged 0−3 years. Out of n = 46 mothers, only n = 3 (e.g., 6.5%) were not supplemented at all. We have not identified any clinical manifestation of B12 deficiency and only n = 1 child with low serum cobalamin, a child who did not receive vitamin B12 supplementation and whose mother took only low doses of vitamin B12 (25/µg/day).To conclude, we did not observe any life-threatening or severe consequences of laboratory-stated vitamin B12 deficiency; thus, our group was well supplemented. On the other hand, we have identified many subjects with vitamin B12 hypervitaminosis of unknown impact on their health. Further research and new guidelines for B12 supplementation among VG and VN children are needed.

Perlite is a suitable model material for experiments investigating breathing in high density snow.

Outdoor breathing trials with simulated avalanche snow are fundamental for the research of the gas exchange under avalanche snow, which supports the development of the international resuscitation guidelines. However, these studies have to face numerous problems, including unstable weather and variable snow properties. This pilot study examines a mineral material perlite as a potential snow model for studies of ventilation and gas exchange parameters. Thirteen male subjects underwent three breathing phases-into snow, wet perlite and dry perlite. The resulting trends of gas exchange parameters in all tested materials were similar and when there was a significant difference observed, the trends in the parameters for high density snow used in the study lay in between the trends in dry and wet perlite. These findings, together with its stability and accessibility year-round, make perlite a potential avalanche snow model material. Perlite seems suitable especially for simulation and preparation of breathing trials assessing gas exchange under avalanche snow, and potentially for testing of new avalanche safety equipment before their validation in real snow.The study was registered in ClinicalTrials.gov on January 22, 2018; the registration number is NCT03413878.

Remediation of the uranium industry in the Czech Republic: regulation aspects and main technologies.

There is a long history of uranium mining and milling in what is now the Czech Republic, with the main exploitation beginning in the second half of the 19th century. The greatest expansion was during the Cold War, which was then reduced after political changes in eastern Europe in the 1990s. Thereafter, almost all uranium work was stopped, the mines and mills were closed, and plans for decommissioning and remediation of sites and facilities were initiated. The paper describes the application of the regulatory framework for the decommissioning and remediation of the uranium waste sites and facilities in the Czech Republic, illustrated by examples of deep and surface mining,in-situleaching sites, and ore processing facilities. It builds on information provided as a case study for the Nuclear Energy Agency's Expert Group on Legacy Management. Some practical experience and lessons learned are presented. The sharing of the lessons and experience is noted as an important mechanism for avoiding the creation of future legacies.

Lung and extrathoracic cancer incidence among underground uranium miners exposed to radon progeny in the Príbram region of the Czech Republic: a case-cohort study.

OBJECTIVES: Radon is carcinogenic, but more studies are needed to understand relationships with lung cancer and extrathoracic cancers at low exposures. There are few studies evaluating associations with cancer incidence or assessing the modifying effects of smoking. METHODS: We conducted a case-cohort study with 16 434 underground uranium miners in the Czech Republic with cancer incidence follow-up 1977-1996. Associations between radon exposure and lung cancer, and extrathoracic cancer, were estimated with linear excess relative rate (ERR) models. We examined potential modifying effects of smoking, time since exposure and exposure rate. RESULTS: Under a simple ERR model, assuming a 5-year exposure lag, the estimated ERR of lung cancer per 100 working level months (WLM) was 0.54 (95% CI 0.33 to 0.83) and the estimated ERR of extrathoracic cancer per 100 WLM was 0.07 (95% CI -0.17 to 0.72). Most lung cancer cases were observed among smokers (82%), and the estimated ERR of lung cancer per 100 WLM was larger among smokers (ERR/100 WLM=1.35; 95% CI 0.84 to 2.15) than among never smokers (ERR/100 WLM=0.12; 95% CI -0.05 to 0.49). Among smokers, the estimated ERR of lung cancer per 100 WLM decreased with time since exposure from 3.07 (95% CI -0.04 to 10.32) in the period 5-14 years after exposure to 1.05 (95% CI 0.49 to 1.87) in the period 25+ years after exposure. CONCLUSIONS: We observed positive associations between cumulative radon exposure and lung cancer, consistent with prior studies. We observed a positive association between cumulative radon exposure and extrathoracic cancers, although the estimates were small. There was evidence that the association between radon and lung cancer was modified by smoking in a multiplicative or super-multiplicative fashion.

Quarter of a century of work of the Intersectoral Commission on Iodine Deficiency Solution.

World Summit for Children held in 1990 in its final declaration called for removal of iodine deficiency to the year 2000. Urgency of iodine deficiency in the Czech Republic was highlighted by the studies of the Institute of Endocrinology in Prague in the early 90's. The Intersectoral Commission on Iodine Deficiency Solution arising from the initiative of endocrinologists, hygienists and paediatricians was then established in 1995. Representants from selected ministries, non-governmental organizations and food and pharmaceutical industry also participated in its work. Activities initiated by the Intersectoral Commission succeeded significantly improve the iodine status of population and supressed the deficit until 2000. In next years the Intersectoral Commission continuously evaluated results of monitoring of iodine status of population, held national conferences and annual Iodine Days that gave the opportunity to revive public interest in iodine. This Intersectoral Commission although deserved for the reduction of excessive levels of iodine in cows milk after 2000 and will address iodine deficiency in pregnant and breastfeeding women. The Intersectoral Commission will pay attention on expected decrease of kitchen salt consumption and subsequent reduction of iodine offer, will deal food supplements containing an excessive amount of iodine and will constantly monitor iodine status of the population.