Dietary pattern longitudinality during 8 years in children: results from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ).

OBJECTIVE: Dietary pattern analysis constitutes a suitable method for identifying complex food preferences as well as a useful tool for comparing dietary behaviour across individual populations. In addition to a lack of information on Central European dietary patterns, dietary data featuring a longitudinal aspect are likewise largely unavailable for the region. Our study thus strives to address this gap by analysing children's dietary patterns, their stability and possible changes at 7, 11 and 15 years in the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). DESIGN: We analysed dietary data based on the self-reported semi-quantitative FFQ obtained in 1998, 2002 and 2006. Dietary patterns were derived using factor analysis for each period, followed by the determination of dietary pattern stability across the individual periods. SETTING: The analysis of dietary patterns was based on longitudinal children's dietary data from the geographical region that was undergoing massive socio-economic changes at the time of birth of the study subjects. PARTICIPANTS: All participants were children. At 7 years the analysis included 3220 children, at 11 years the analysis included 2509 children and at 15 years the analysis included 1589 children. RESULTS: Two stable children's dietary patterns labelled as 'prudent' and 'junk food' were identified across all three time points (7, 11 and 15 years). CONCLUSIONS: This study identifies stable longitudinal trends in the dietary behaviour of children enrolled in the ELSPAC-CZ study.

Adolescent body image: results of Czech ELSPAC study.

OBJECTIVES: The study examined appearance and body satisfaction in adolescents. For these purposes, data from the European Longitudinal Study of Pregnancy and Childhood in the Czech Republic were used. METHODS: The data were collected in 2010 and the sample comprised 3,105 18-year-old respondents. RESULTS: The research found that the respondents who wished to reduce their weight were mostly women with BMI in the normal range. Based on the body cathexis scale, we found that women compared to men are more critical of stomach, hips, buttocks, and thighs, as well as overall weight and figure. The results showed that criticism of their weight from their immediate environment is unpleasant to both female and male adolescents to such an extent that it makes them try to reduce it. However, it is clear that girls are altogether less satisfied with their bodies than boys. CONCLUSION: For both genders, body dissatisfaction is most likely enhanced by critical comments from peers and parents about appearance, body weight etc.

Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study.

Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma-COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma-COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.

Mother's education and offspring asthma risk in 10 European cohort studies.

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study.

BACKGROUND: In the postpartum period, certain groups of women are at a higher risk for developing depressive episodes. Several studies have described risk factors for developing postpartum depression (PPD). However, these studies have used limited numbers of participants, and therefore the estimated prevalence of PPD varies greatly. METHODS: The objective of this study is to identify the main risk factors for developing PPD by using data collected via the Czech version of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). This database provides a representative sample (n = 7589) observed prospectively and a large amount of data on depressive symptoms and on biological, socioeconomic, and environmental factors. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for incidence of PPD. The affective pathology was examined at three time points: before delivery, 6 weeks after delivery, and 6 months after delivery. RESULTS: The prevalence of depressive symptoms before delivery was 12.8%, 6 weeks after delivery 11.8%, and 6 months after delivery 10.1%. The prevalence rates are based on women who completed questionnaires at all three time-points (N = 3233). At all three time points, the main risk factors for developing PPD identified as significant by both univariate and multivariate analysis were personal history of depressive episodes and mothers experiencing psychosocial stressors. Other risk factors occurring in both types of analysis were: family history of depression from expectant mother's paternal side (prenatal), mothers living without partners (6 weeks postpartum) and feelings of unhappiness about being pregnant (6 months postpartum). Several protective factors were also observed: male child gender (prenatal), primiparous mothers (6 months postpartum), and secondary education (prenatal, only by multivariate analysis). Significant risk factors found solely by univariate analysis were family history of depression in both parents of the expectant mother (prenatal and 6 weeks postpartum), family history of depression from subject's maternal side (6 months postpartum), unintentional pregnancy (prenatal and 6 weeks postpartum), feelings of unhappiness about being pregnant (prenatal and 6 weeks postpartum), primary education (prenatal and 6 weeks postpartum), mothers who opted not to breastfeed (6 months postpartum) and mothers living without partners (prenatal and 6 months postpartum). Family savings were identified as protective factor (prenatal and 6 months postpartum). CONCLUSIONS: We identified significant predictors of PPD. These predictors can be easily detected in clinical practice, and systematic screening can lead to identifying potentially at risk mothers. Since the risk is linked with experience of psychosocial stressors it seems that they might benefit from increased psychosocial support to prevent affective pathology.

Psychometric properties of the Czech version of the Beck Anxiety Inventory - comparison between diagnostic groups.

OBJECTIVE: Beck anxiety inventory (BAI) is widely used self-rating questionnaire evaluating the severity of anxiety symptoms. The aim of our study was to confirm validity and reliability of Czech version of BAI, identify cut-off points and prove sensitivity to measure improvement after therapy. METHODS: The patients selected for the study were treated in the department of psychiatry, University Hospital Olomouc between January 2008 and 2014. Patients meeting criteria for anxiety, or depressive disorder were involved. RESULTS: 789 patients and 284 healthy controls agreed to participate in the study. Czech version of Beck anxiety inventory proved high internal consistency (α=0.92) and good test-retest reliability over one week (BAI seems to be independent of other used scales - Beck depression inventory and the Clinical Global Impression. BAI is also sensitive to measure change after therapy. CONCLUSION: Czech version of BAI was found to have enough internal stability and test-retest reliability same as the original version. It may also be useful to detect improvement after therapy.

Association of Picky Eating with Weight and Height-The European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ).

OBJECTIVE: This study aimed to evaluate whether preschool children identified as picky eaters showed differences in anthropometric characteristics (weight and height) from their non-picky peers at 15 years of age. DESIGN: This study was performed among the cohort members of the EL- SPAC-CZ study, a longitudinal study of pregnancy and childhood. The analysis included 2068 children (997 girls and 1071 boys) followed between births and 15 years of age. Picky eaters were identified at 1.5, 3, and 5 years of age. Anthropometric characteristics were measured at 15 years of age (15 years). RESULTS: Picky eaters (n = 346; 16.7%) had a lower weight and height than non-picky eaters (n = 1722; 83.3%) at 15 years. This difference in weight and height was maintained after controlling for sex of the child, birth weight, birth length, maternal education, family structure at 15 years, and maternal age at childbirth. The picky children were on average 2.3 kg lighter and 0.8 cm shorter than non- picky children at 15 years. CONCLUSIONS: Persistent picky eating in preschool children is related to lower weight and height at 15 years of age in ELSPAC-CZ study.

Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-Control Study in a Czech Tertiary University Hospital.

Background: More than 50% of patients worldwide die in hospitals and end-of-life care is costly. We aimed to explore whether support from the palliative team can influence end-of-life costs. Methods: This was a descriptive retrospective case-control study conducted at a Czech tertiary hospital. We explored the difference in daily hospital costs between patients who died with and without the support of the hospital palliative care team from January 2019 to April 2020. Big data from registries of routine visits were used for case-control matching. As secondary outcomes, we compared the groups over the duration of the terminal hospitalization, intensive care unit (ICU) days, intravenous antibiotics, magnetic resonance imaging/computed tomography scans, oncological treatment in the last month of life, and documentation of the dying phase. Standard descriptive statistics were used to describe the data, and differences between the case and control groups were tested using Fisher's exact test for categorical variables and the Mann-Whitney U test for numerical data. Results: In total, 213 dyads were identified. The average daily costs were three times lower in the palliative group (4392.4 CZK per day = 171.3 EUR) than in the nonpalliative group (13992.8 CZK per day = 545.8 EUR), and the difference was probably associated with the shorter time spent in the ICU (16% vs. 33% of hospital days). Conclusions: We showed that the integration of the palliative care team in the dying phase can be cost saving. These data could support the implementation of hospital palliative care in developing countries.

Association between Stress Urinary Incontinence and Depressive Symptoms after Birth: the Czech ELSPAC Study.

The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02-2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91-2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.

Effects of Early and Systematic Integration of Specialist Palliative Care in Patients with Advanced Cancer: Randomized Controlled Trial PALINT.

Background: A broad consensus on the optimal structure, intensity, and timing of early specialist palliative care (SPC) intervention is lacking. Objective: To evaluate the benefit of an early and systematic palliative intervention alongside standard oncology care compared with standard oncology care alone in patients with advanced solid tumors. Design: PALINT, a single-center RCT, conducted at the Masaryk Memorial Cancer Institute, the largest comprehensive cancer center in the Czech Republic (CR). Setting/Subjects/Measurements: Patients with newly diagnosed advanced cancer within six weeks from the start of the palliative systemic therapy were randomly assigned to the integration of SPC (intervention; a consultation with a PC physician every six to eight weeks) or to the standard oncology care (control). The primary endpoint was the quality of life (QOL) assessed by EORTC QLQ C30 and Hospital Anxiety and Depression Scale (HADS) at three and six months. Results: From 2015 to 2017, a total of 126 patients were randomly assigned to intervention (60) or to control (66) arm. At baseline, at three and six months, the global QOL scores (mean, 95% CI) in the intervention and control arm were 58.6 (53.9-63.3), 61.9 (56.4-67.4) and 66.7 (60.2-73.2) versus 54.2 (49.4-58.9), 59.0 (53.7-64.3), and 62.8 (56.7-68.9), respectively. The prevalence of anxiety (HADS-A; value >7) was 36.7%, 27.5%, and 18.9% versus 34.8%, 23.5%, and 16.3% and the prevalence of depression (HADS-D; value >7) was 28.3%, 25.4%, and 29.7% versus 28.8%, 29.4%, and 27.9%, respectively. There was no significant difference between the two arms. The overall survival was similar in both arms (347 vs. 310 days; p = 0.203). Conclusions: A model of early integration of SPC consisting of a consultation with a PC physician alone every six to eight weeks did not increase the QOL of patients with advanced cancer compared with routine oncology care in a center with widely available supportive services. These negative results underline the importance of the multidisciplinary patient centered approach in the early SPC.

Early-life exposure to household chemicals and wheezing in children.

The prevalence of the asthmatic symptoms among children increases globally over the time. Reduced exposure to pathogens in early childhood and increased exposure to anthropogenic irritants result in increased risk of wheezing in children, and all of this may be related to the usage of household chemicals. Objective of this analysis thus was to study the potential effects of overall exposure to home chemicals in the early life on the phenotypes of wheezing from birth until five years of age. 3411 mother-infant pairs from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ) participated in the study. The exposure was estimated by the composite household chemical score from 18 chemical-based products. Social, medical and environmental factors were taken into account as covariates in multivariable multinomial logistic regression using phenotypes of wheezing as a study outcome. We were able to determine the association between several wheezing childhood phenotypes and the frequent usage of household chemicals in the fully adjusted model. Statistically significant odds ratios (OR) for increasing exposures per 1 SD of exposure score were obtained for the intermediate onset transient (OR 1.27, 95% CI 1.10-1.47), intermediated onset persistent (OR 1.23, 95% CI 1.03-1.46), and early onset persistent phenotypes (OR 1.36, 95% CI 1.04-1.77) in comparison to never wheezing children. Moreover, the persistent phenotypes were significantly associated with school age asthma. Our study has shown the negative role of the increased household chemicals usage on the respiratory outcomes in children up to five years of age. Overall evaluation of the household chemical exposure may be useful tool for any large epidemiological studies.

Perinatal Maternal Stress and Susceptibility to Infectious Diseases in Later Childhood: An Early Life Programming Perspective.

There is evidence of transmission of stress-related dysregulation from parents to offspring during early developmental stages, leading to adverse health outcomes. This study investigates whether perinatal stress is linked to the risk of infectious diseases in children aged 7-11 years. We hypothesize that stress exposure during pregnancy and the first 6 months after birth independently predict common infectious diseases. Data are obtained from ELSPAC-CZ, a prospective birth cohort. Maternal stress, operationalized as the number of life events, is examined for pregnancy and the first 6 months postpartum. Children's diseases include eye infection, ear infection, bronchitis/lung infection, laryngitis, strep throat, cold sores, and flu/flu-like infection. More prenatal and postnatal life events are both independently linked to a higher number of infectious diseases between the ages of 7-11 years. The effect is larger for postnatal vs. prenatal events, and the effect of prenatal events is attenuated after maternal health in pregnancy is controlled. The results suggest that perinatal stress is linked to susceptibility to infectious diseases in school-age children. Interventions to address stress in pregnant and postpartum women may benefit long-term children's health.

Role of combined prenatal and postnatal paracetamol exposure on asthma development: the Czech ELSPAC study.

BACKGROUND: Prenatal and postnatal paracetamol exposure has been previously associated with asthma development in childhood in Western populations. We explore the association between prenatal and postnatal paracetamol exposure and asthma development in a Central European sample of Czech children, suggesting possible additive effect of the both exposures. Furthermore, since aspirin had been used more widely during study data collection in Central Europe, we also compared asthma development for those exposed to paracetamol and aspirin. METHODS: We used data from 3329 children born in the 1990s as members of the prospective Czech European Longitudinal Study of Pregnancy and Childhood. Data about prenatal and postnatal paracetamol and aspirin exposure, and potential covariates were obtained from questionnaires completed by mothers. Data about incident asthma were obtained from paediatrician health records. RESULTS: 60.9% of children received paracetamol only postnatally, 1.5% only prenatally and 4.9% of children were exposed both during pregnancy and infancy. Prevalence of asthma in following population was 5% at 11 years. Being exposed to paracetamol both in prenatal and postnatal period was associated with asthma development (unadjusted OR 1.98, 95% CI 1.02 to 3.87). Being exposed only in the postnatal period was also significantly associated with increased risk of asthma. No association between prenatal exposure only and outcome was found. A higher but non-significant risk of asthma was observed for those whose mothers used paracetamol during pregnancy compared with those who used aspirin. CONCLUSIONS: The main findings of this prospective birth cohort study add to previous observations linking prenatal and early postnatal paracetamol exposure to asthma development. However, the magnitude of effect is relatively modest, and therefore, we recommend paracetamol to remain the analgesic and antipyretic of choice throughout pregnancy and early childhood.

A Comparative Study of Conservative Functional Treatment versus Acute Ligamentous Repair in Simple Dislocation of the Elbow in Adults.

BACKGROUND: Elbow dislocation is the second most frequent type of large joint dislocations in adults. Standard treatment of simple elbow dislocation (SED) without manifestation of instability includes closed reduction, short-term immobilization of the elbow followed by functional aftercare. This study evaluates SED treatment, comparing outcomes of conservative functional treatment and surgical therapy. MATERIALS AND METHODS: 54 adult patients with SED without manifest instability treated in tertiary hospital between January 2008 and June 2015 were analyzed in this retrospective study. 28 patients were treated conservatively. Closed elbow reduction was followed by short-term plaster splint and active rehabilitation. Twenty six patients underwent closed elbow reduction and subsequent reconstruction of torn collateral ligaments. Postoperatively, plaster splint was applied followed by rehabilitation. RESULTS: Patients who were treated conservatively reached statistically significant better scores in Quick Disability Arm Shoulder Hand, Oxford Elbow Score, and Mayo Elbow Performance Score. Functional conservative treatment resulted in a higher range of motion. The complication rate was higher in the group of surgically treated patients. CONCLUSIONS: Careful examination of elbow stability after closed reduction of SED is crucial for further therapy. Patients with stable SED should be treated with functional conservative therapy. Surgical collateral ligaments revision and reconstruction are indicated only for patients with manifestation of elbow instability.

Sleeping habits of adolescents in relation to their physical activity and exercise output: results from the ELSPAC study.

BACKGROUND: Little is known about the effects of physical activity and fitness on sleep timing parameters in adolescence. METHODS: We investigated the development of sleep timing between age 8 and 15 and its association with physical fitness at age 15 in 787 adolescents (408 males, 379 females). Physical fitness was measured using the physical work capacity (PWC) protocol. Information on sport activity was collected at ages 11 and 15. Finally, the contribution of other covariates (sex, body mass index (BMI), parental education and occupational skill level) to the association between sleep parameters and physical fitness was evaluated. The correlation of BMI and physical fitness was assessed separately. RESULTS: Mild correlation of sleep duration at ages 8 and 15 was observed (r=0.08-0.16). Higher sport activity participation and physical fitness were found to be mildly associated with delayed bedtime and reduced sleep duration; the association with bedtime was significant after adjustment for all covariates. Sport activity at age 11 was not associated with sleep timing at age 15. Interestingly, higher BMI was linked to delayed bedtime and higher physical fitness. CONCLUSION: Our findings do not support existing hypotheses suggesting the association of low physical activity and fitness with shorter sleep duration and high BMI in a generally non-obese adolescent population without severe sleep restriction.

EMPIRE Registry, Czech Part: Impact of demographics, pulmonary function and HRCT on survival and clinical course in idiopathic pulmonary fibrosis.

INTRODUCTION: Prognostic factors of idiopathic pulmonary fibrosis (IPF) currently recognized include changes in vital capacity and radiologic findings. However, most of the prognostic studies in IPF are based on clinical studies with preselected IPF populations. Therefore, we decided to analyze the factors influencing IPF prognosis based on the real-practice data from our IPF registry. METHODS: Data of 514 subjects consecutively entered since 2012 into Czech EMPIRE IPF registry were analyzed. RESULTS: Median age of our patient cohort was 67 years (50-82). Median overall survival (OS) of the cohort was 63.1 months. The clinical course of IPF according to FVC (forced vital capacity) changes was stabilized in 32.8% of patients (29.7% according to DLCO [diffuse lung capacity] changes), slowly progressive in 39.5% (45%), rapidly progressive in 23.5% (20.7%); and 1.7% patients had at least one acute exacerbation during follow-up. Deterioration in FVC of ≥10% at month 12 and in DLCO of ≥15% at months 12, 18, and 24 influenced the OS significantly. The fast progressors defined by the DLCO decline rate had higher risk of death compared to those defined by the FVC change over time. In multivariate analysis, age ≥70 years, interstitial HRCT scores ≥3, and change in DLCO of ≥15% at month 12 were confirmed as factors negatively influencing OS. CONCLUSIONS: DLCO changes over time were shown as a better predictor of mortality compared with FVC changes in our study. In our opinion it is necessary to implement the DLCO analysis into clinical trials and routine practice.

Parental heights and maternal education as predictors of length/height of children at birth, age 3 and 19 years, independently on diet: the ELSPAC study.

BACKGROUND/OBJECTIVES: Little is currently known about the relationship between the parental diet during pregnancy and the growth of the child from early childhood until early adulthood. This study was designed to examine whether the dietary patterns of the parents during a pregnancy and of the respective child at 3 years are associated with the length/height-for-age z-score of child at birth, 3 years of age and at 19 years of age. SUBJECTS/METHODS: Dietary patterns of pregnant women and their partners, and offspring at 3 years that were enroled in the 1990-1991 period in the Czech part of the European Longitudinal Study of Pregnancy and Childhood. Multivariable linear regression models were used to estimate the relationship between the dietary patterns of parents (835 child-mother-father trios) during pregnancy and the length/height-for-age z-score of their offspring at birth, 3 years and 19 years. RESULTS: The maternal health-conscious food pattern was found to predict lower child height at 3 years, but not at birth nor at 19 years of age. An increase in the health-conscious pattern score of the maternal diet was associated with significantly lower height-for-age z-score at 3 years; however, the observed effect lost its significance after the adjustment for diet of the child at 3 years. CONCLUSIONS: After full adjustment, the only significant predictors of the height-for-age z-score of the child at 3 years were the heights of both parents and maternal education. More research into the association of maternal diet in pregnancy and height of child is necessary.

Predictive value of self-rated health in pregnancy for childbirth complications, adverse birth outcomes, and maternal health.

OBJECTIVE: To investigate whether self-rated health (SRH) in pregnancy can predict childbirth complications, adverse birth outcomes, and maternal health problems up to 3 years after delivery. METHODS: A retrospective analysis was performed of data obtained in a prospective longitudinal population-based birth cohort study. Pregnant women resident in the Brno or Znojmo regions in the Czech Republic were included if they were expected to deliver between March 1991 and June 1992. SRH data were collected between 1991 and 1995 via pen-and-paper questionnaires administered in mid-pregnancy, and at 6 months, 18 months, and 3 years after delivery. Medical records were reviewed for pregnancy complications, childbirth complications, and birth outcomes. Multivariate regression analysis was performed. RESULTS: Overall, 4811 women were included. Better SRH in pregnancy predicted fewer childbirth complications (b=-0.03; P=0.036); lower odds of cesarean delivery (odds ratio 0.81; P=0.003); and fewer maternal health problems at 6 months (b=-0.32; P<0.001), 18 months (b=-0.28; P<0.001), and 3 years after delivery (b=-0.30; P<0.001). The effects of SRH were independent of diagnosed complications and self-reported health problems in pregnancy. CONCLUSION: SRH in pregnancy has predictive value for subsequent health outcomes, and might be an additional tool for assessment of pregnant women's health.

Gender differences in the treatment of first-episode schizophrenia: Results from the European First Episode Schizophrenia Trial.

Gender differences in the response to antipsychotic treatment have been detected in the past, but not studied in great detail. The results of the European First-Episode Schizophrenia Trial (EUFEST) were analyzed with a focus on gender differences in the response to randomized treatment of first-episode schizophrenia. A total of 498 patients (298 men and 200 women) were randomly assigned by a web-based online system to open-label treatment with haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone. Treatment response was evaluated using the positive and negative syndrome scale (PANSS). Data were collected at baseline and then prospectively for one year. Baseline characteristics (age and proportion of patients assigned to individual antipsychotics) were the same between the male and female patients with the exception of ziprasidone: significantly fewer men, proportionately, were prescribed ziprasidone. There was no significant difference between genders between the initial total PANSS and subscale scores. A significant interaction between time and gender was found, with more robust PPANSS and TPANSS score improvement in women during the course of treatment. Of all of the antipsychotics used, only olanzapine led to significantly greater improvement in the total PANSS score in women during the follow-up period. Gender differences should be given more attention in research and clinical practice. Their causes require clarification, and future strategies for dealing with them may be considered in early intervention programs and guidelines.

Practical use of medical terminology in curriculum mapping.

BACKGROUND: Various information systems for medical curriculum mapping and harmonization have been developed and successfully applied to date. However, the methods for exploiting the datasets captured inside the systems are rather lacking. METHOD: We reviewed the existing medical terminologies, nomenclatures, coding and classification systems in order to select the most suitable one and apply it in delivering visual analytic tools and reports for the benefit of medical curriculum designers and innovators. RESULTS: A formal description of a particular curriculum of general medicine is based on 1347 learning units covering 7075 learning outcomes. Two data-analytical reports have been developed and discussed, showing how the curriculum is consistent with the MeSH thesaurus and how the MeSH thesaurus can be used to demonstrate interconnectivity of the curriculum through association analysis. CONCLUSION: Although the MeSH thesaurus is designed mainly to index medical literature and support searching through bibliographic databases, we have proved its use in medical curriculum mapping as being beneficial for curriculum designers and innovators. The presented approach can be followed wherever needed to identify all the mandatory components used for transparent and comprehensive overview of medical curriculum data.