Prevalence of malnutrition risk among institutionalized elderly from North Bohemia is higher than among those in the Capital City of Prague, Czech Republic.

OBJECTIVE: The aim of the study is to assess the risk of malnutrition among institutionalized elderly individuals in North Bohemia and compare it to the risk of malnutrition in the capital city of Prague, Czech Republic. In the Czech Republic, very few studies have been conducted with the goal of describing and evaluating the nutritional status of the institutionalized elderly. METHODS: In this study, data was collected from 254 elderly individuals (aged ≥ 65) residing in retirement homes in North Bohemia and then compared with similar data for the elderly living in retirement homes in Prague (the data from Prague were previously published in 2013). The data included an Mini-Nutritional Assessment (MNA) test; anthropometric measurements - Body Mass Index (BMI), waist circumference, triceps skinfold thickness; and biochemical parameters - albumin, prealbumin, transferrin, urea, and creatinine. RESULTS: Mean BMI values were 27.4 kg/m2 for females and 26.3 kg/m2 for males. According to the MNA questionnaire, 10.4% of all tested elderly were malnourished and 50.8% were at risk of malnutrition; lager proportion of females were found to be malnourished than males. Biochemical indicators supported the MNA results. MNA categories correlated positively with independence (r = 0.56; p < 0.001), mental status (r = 0.54; p < 0.001), mobility (r = 0.46; p < 0.001), calf circumference (r = 0.42; p < 0.001), BMI, and the ability to self-feed (both r = 0.37; p < 0.001). The percentage of institutionalized elderly with malnutrition living in North Bohemia and Prague were about the same; however, the percentage of those at risk of malnutrition was higher in North Bohemia (p = 0.006). CONCLUSION: Study results confirmed that the institutionalized elderly face issues that lower their nutritional status and put them at increased risk; clearly these issues need urgent attention.

Correction: MeltMan: Optimization, Evaluation, and Universal Application of a qPCR System Integrating the TaqMan qPCR and Melting Analysis into a Single Assay.

[This corrects the article DOI: 10.1371/journal.pone.0151204.].

Alpha-2-HS-glycoprotein plasma level decrease correlates with age in patients with myelodysplastic syndromes.

BACKGOUND: It has been indicated in plasma proteomic studies on different myelodysplastic syndrome (MDS) cohorts that alpha-2-HS-glycoprotein could be a promising MDS biomarker candidate. OBJECTIVE: The goal of this work was to estimate alpha-2-HS-glycoprotein (AHSG) plasma levels and its biomarker value in the low- and high-risk subgroups of MDS patients. METHODS: The level of AHSG was estimated for 115 plasma samples using ELISA. RESULTS: The AHSG plasma level was found to be decreased significantly (p= 2.59 × 10-7) in MDS patients (515 ± 58 µg/ml) when compared to healthy controls (579 ± 64 µg/ml). Pearson and Spearman correlation analyses showed that age is the principal factor affecting the AHSG plasma level, rather than risk/diagnosis in MDS. CONCLUSIONS: In this work we demonstrate that although the total plasma level of AHSG is decreased in myelodysplastic syndrome patients, in particular in advanced MDS, that decrease correlates more strongly with age than with diagnosis within our studied cohort. Thus, according to the AHSG data gathered so far, AHSG total plasma level does not seem to be a suitable MDS biomarker, but its particular proteoforms should be considered for the next steps in MDS research.

Estimating the Baseline Incidence of a Seasonal Disease Independently of Epidemic Outbreaks.

In epidemiology, it is very important to estimate the baseline incidence of infectious diseases, but the available data are often subject to outliers due to epidemic outbreaks. Consequently, the estimate of the baseline incidence is biased and so is the predicted epidemic threshold which is a crucial reference indicator used to suspect and detect an epidemic outbreak. Another problem is that the "usual" incidence varies in a season dependent manner, i.e. it may not be constant throughout the year, is often periodic, and may also show a trend between years. To take account of these factors, more complicated models adjusted for outliers are used. If not adjusted for outliers, the baseline incidence estimate is biased. As a result, the epidemic threshold can be overestimated and thus can make the detection of an epidemic outbreak more difficult. Classical Serfling's model is based on the sine function with a phase shift and amplitude. Multiple approaches are applied to model the long-term and seasonal trends. Nevertheless, none of them controls for the effect of epidemic outbreaks. The present article deals with the adjustment of the data biased by epidemic outbreaks. Some models adjusted for outliers, i.e. for the effect of epidemic outbreaks, are presented. A possible option is to remove the epidemic weeks from the analysis, but consequently, in some calendar weeks, data will only be available for a small number of years. Furthermore, the detection of an epidemic outbreak by experts (epidemiologists and microbiologists) will be compared with that in various models.

Comparison of the miRNA profiles in HPV-positive and HPV-negative tonsillar tumors and a model system of human keratinocyte clones.

BACKGROUND: Better insights into the molecular changes involved in virus-associated and -independent head and neck cancer may advance our knowledge of HNC carcinogenesis and identify critical disease biomarkers. Here we aimed to characterize the expression profiles in a matched set of well-characterized HPV-dependent and HPV-independent tonsillar tumors and equivalent immortalized keratinocyte clones to define potential and clinically relevant biomarkers of HNC of different etiology. METHODS: Fresh frozen tonsillar cancer tissues were analyzed together with non-malignant tonsillar tissues and compared with cervical tumors and normal cervical tissues. Furthermore, relative miRNAs abundance levels of primary and immortalized human keratinocyte clones were evaluated. The global quantitation of miRNA gene abundance was performed using a TaqMan Low Density Array system. The confirmation of differentially expressed miRNAs was performed on a set of formalin-fixed paraffin-embedded tumor samples enriched for the tumor cell fraction by macrodissection. RESULTS: We defined 46 upregulated and 31 downregulated miRNAs characteristic for the HPV-positive tonsillar tumors and 42 upregulated miRNAs and 42 downregulated miRNAs characteristic for HPV-independent tumors. In comparison with the expression profiles in cervical tumors, we defined miR-141-3p, miR-15b-5p, miR-200a-3p, miR-302c-3p, and miR-9-5p as specific for HPV induced malignancies. MiR-335-5p, miR-579-3p, and miR-126-5p were shared by the expression profiles of HPV-positive tonsillar tumors and of the HPV immortalized keratinocyte clones, whereas miR-328-3p, miR-34c-3p, and miR-885-5p were shared by the miRNA profiles of HPV-negative tonsillar tumors and the HPV-negative keratinocytes. CONCLUSIONS: We identified the miRNAs characteristic for HPV-induced tumors and tonsillar tumors of different etiology, and the results were compared with those of the model system. Our report presents the basis for further investigations leading to the identification of clinically relevant diagnostic and/or therapeutic biomarkers for tumors of viral and non-viral etiology.

MeltMan: Optimization, Evaluation, and Universal Application of a qPCR System Integrating the TaqMan qPCR and Melting Analysis into a Single Assay.

In the present work, we optimised and evaluated a qPCR system integrating 6-FAM (6-carboxyfluorescein)-labelled TaqMan probes and melting analysis using the SYTO 82 (S82) DNA binding dye in a single reaction. We investigated the influence of the S82 on various TaqMan and melting analysis parameters and defined its optimal concentration. In the next step, the method was evaluated in 36 different TaqMan assays with a total of 729 paired reactions using various DNA and RNA templates, including field specimens. In addition, the melting profiles of interest were correlated with the electrophoretic patterns. We proved that the S82 is fully compatible with the FAM-TaqMan system. Further, the advantages of this approach in routine diagnostic TaqMan qPCR were illustrated with practical examples. These included solving problems with flat or other atypical amplification curves or even false negativity as a result of probe binding failure. Our data clearly show that the integration of the TaqMan qPCR and melting analysis into a single assay provides an additional control option as well as the opportunity to perform more complex analyses, get more data from the reactions, and obtain analysis results with higher confidence.

Early MRD response as a prognostic factor in adult patients with acute lymphoblastic leukemia.

OBJECTIVE: To evaluate the prognostic power of minimal residual disease (MRD) monitored by polymerase chain reaction at defined time points during early treatment in adult patients with acute lymphoblastic leukemia (ALL). METHODS: Seventy-one patients were treated according to the GMALL 07/2003 protocol and evaluated for MRD in bone marrow by specific clonal rearrangements of Ig/TCR in BCR-ABL negative ALL or fusion gene transcript in BCR-ABL positive ALL. RESULTS: Three-year overall survival (OS) was 94% in patients with BCR-ABL negative ALL reaching complete molecular response (CMR) after the first course of chemotherapy (vs. 32% if MRD >10(-4) ; P = 0.001). Patients with CMR prior to the start of consolidation chemotherapy at week 11 had 3-yr OS 82% (vs. 18% if MRD >10(-4) ; P = 0.001). Patients with BCR-ABL positive ALL showed slower MRD dynamics. There was a trend to better OS in patients with ≥ 4 log reduction of BCR-ABL transcript prior to HSCT (92% vs. 50%; P = 0.065). None of the patients with detectable MRD (both BCR-ABL positive and negative) after HSCT survived 3 yr. CONCLUSION: Early MRD kinetics is an important tool for new prognostication models with direct clinical impact irrespective of standard prognostic factors in patients with BCR-ABL negative ALL.

Estimating the Baseline and Threshold for the Incidence of Diseases with Seasonal and Long-Term Trends.

In epidemiology, it is very important to estimate the baseline incidence of infectious diseases. From this baseline, the epidemic threshold can be derived as a clue to recognize an excess incidence, i.e. to detect an epidemic by mathematical methods. Nevertheless, a problem is posed by the fact that the incidence may vary during the year, as a rule, in a season dependent manner. To model the incidence of a disease, some authors use seasonal trend models. For instance, Serfling applies the sine function with a phase shift and amplitude. A similar model based on the analysis of variance with kernel smoothing and Serfling's higher order models, i.e. models composed of multiple sine-cosine function pairs with a variably long period, will be presented below. Serfling's model uses a long-term linear trend, but the linearity may not be always acceptable. Therefore, a more complex, long-term trend estimation will also be addressed, using different smoothing methods. In addition, the issue of the time unit (mostly a week) used in describing the incidence is discussed.

The effect of different doses and different routes of acetylsalicylic acid administration on platelet aggregation in healthy volunteers and ischemic stroke patients.

The purpose was to assess the effect of different doses and different routes of acetylsalicylic acid (ASA) administration on platelet aggregation and the comparison between platelet aggregation after the single and the repetitive administration of ASA in healthy individuals and in patients after ischemic stroke. The study group consists of 22 healthy individuals and 30 patients with documented ischemic stroke. Platelet aggregation was measured in healthy individuals: (a) twice before ASA and (b) 2 h after different single doses and different routes of ASA administration-(b1) 500 mg orally, (b2) 500 mg intravenously, and (b3) 100 mg orally. We measured aggregability in healthy individuals after five consecutive days of 100 mg of ASA q.d. and in patients on chronic ASA 100 mg q.d. The VerifyNow was used with results expressed in aspirin reaction units (ARU). In healthy individuals, the dose-(b1) 500 mg orally-reduced the aggregability to mean (SD) 392 (36) ARU (p < 0.001), (b2) 500 mg intravenously to 428 (46) (p < 0.001) and (b3) 100 mg orally to 460 (76) (p < 0.001). The suppression of aggregation after 500 mg was (p = 0.029) higher after the oral compared to intravenous administration, and the same is true for the suppression after single dose of 500 mg orally and 100 mg orally (p = 0.011). Oral dose 100 mg for 5 days in healthy individuals reduced aggregation to 405 (37) and in post-stroke patients to 433 (54). All doses of ASA, both orally and intravenously, have produced a significant reduction of platelet aggregation. Preference of the parenteral to oral application has not been established.

[Effect of the liquid milk nutritional supplement with enhanced content of whey protein on the nutritional status of the elderly]. / Vliv podávání tekutého mlécného nutricního doplnku se zvýseným obsahem syrovátkových bílkovin na nutricní stav senioru

AIM: The aim of this study was to evaluate the effect of long-term administration of liquid nutritional supplement with increased amounts of whey protein and reduced amounts of lactose, produced in accordance with a new recipe "Nutrisen" on the elderly living in institutionalized care. METHODS: The study was carried out from May to July, 2013, on 47 retirement home residents, living in Prague, all of which were 65 years or older. Supplemented group (n = 23) consumed (200 ml) milk drinks with three different flavours on a daily basis for eight weeks. The reference group was on a normal diet. There was no significant difference in baseline characteristics between participants in both groups. Anthropometric and biochemical indicators of nutritional status and tolerance of the nutritional supplement during long-term use were evaluated. RESULTS: Both compliance (daily intake program) and tolerance of the nutritionally defined supplement were very good. For the supplemented group, there was an average weight increased of 700 grams after the 8 week nutritional supplement test period. Average levels of albumin and prealbumin increased significantly (from the beginning to the end of the program), 35.5 ± 4.52 g/l vs 36.19 ± 4.1 g/l and 0.160 ± 0.05 vs 0.174 ± 0.04 g/l (p < 0.05), vitamin D levels increased from 31.2 ± 16.4 nmol/l to 36.8 ± 17.7 nmol/l (p < 0.001) and HDL-cholesterol levels increased from 1.29 ± 0.33 mmol/l to 1.35 ± 0.35 mmol/l (p < 0.001). CONCLUSION: The specific nutritionally defined milk drink (Nutrisen), used in this study, was well tolerated by the elderly study participants, over the eight-week clinical study. We observed a positive effect on the participants weight, serum albumin, prealbumin, vitamin D and HDL-cholesterol.

Non-invasive evaluation of proximal vertebral artery stenosis using color Doppler sonography and CT angiography.

BACKGROUND AND PURPOSE: A reliable and safe diagnostic procedure for vertebral artery (VA) stenosis is needed, but none is generally accepted yet. In our study, we evaluated symptomatic VA stenoses using color Doppler sonography (CDS). CT angiography (CTA) has been employed as a non-invasive reference method. Next, we tested the accuracy for medium to high degree stenoses by digital subtraction angiography (DSA). MATERIALS AND METHODS: Sixty-two symptomatic patients with a proximal VA stenosis were examined prospectively with CDS and CTA. The VA diameters by both methods were correlated. The stenotic peak systolic velocity (PSV1) and its ratio to the post-stenotic segment (PSVr) were analysed using receiver operating characteristic curve (ROC). Cut-off values for PSV1 and PSVr defining moderate and severe stenosis were assessed. In stenoses≥50%, an additional search for correlation with DSA was carried out. RESULTS: Mean VA diameter was 3.561mm (95% CI 3.361-3.760) by CDS and 4.180 (95% CI, 3.950-4.411) by CTA, accompanied with significant similarity in Pearson' correlation (0.847, P<0.001). The PSV1 and PSVr appeared to be equally accurate for VA stenoses of 50% or more (PSV 1-AUC 0.814, P<0.001, cut-off velocity≥1.35m/s, PSVr-AUC 0.819, P<0.001 with a cut-off value≥2.2). Final Spearman' correlation of CTA results vs DSA was highly significant (0.823, P<0.001). CONCLUSION: Our results endorse the non-invasive combination of CDS with CTA in the evaluation of VA stenosis as a reliable diagnostic algorithm, tightly correlating with DSA.

Transportation to primary percutaneous coronary intervention, compared with on-site fibrinolysis, is a strong independent predictor of functional status after myocardial infarction: 5-year follow-up of the PRAGUE-2 trial.

AIMS: Subjective symptoms represent significant criteria of a patient's health condition; therefore, we focused on the long-term prevalence of heart failure symptoms and angina pectoris after myocardial infarction between two groups of patients in which two different therapeutic strategies were used during the acute phase of ST-elevation myocardial infarction (STEMI). METHODS: The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention (PCI) centre (n=429) vs. fibrinolysis in community hospitals (n=421). The data were collected from either primary hospitals or PCI centres, as well as via questionnaires. RESULTS: The mean follow-up was 58 months. At 5 years, 45.4% of patients were in New York Heart Association class I following primary PCI vs. 31.8% of those treated with fibrinolysis (OR 2.02, 95% CI 1.37-2.97, p<0.002). At 5 years, 83.6% of patients had no symptoms of angina pectoris following invasive therapy vs. 58% of patients treated with fibrinolysis (OR 4.47, 95% CI 2.79-7.18, p<0.001). CONCLUSIONS: The symptoms of angina pectoris and heart failure were significantly lower in patients assigned to primary PCI in the acute stage of myocardial infarction compared with patients treated with fibrinolysis at the 5-year follow up.

Nutritional status assessment of institutionalized elderly in Prague, Czech Republic.

BACKGROUND: There are few studies in the Czech Republic describing and evaluating the nutritional status of institutionalized elderly. METHODS: Data were collected from 659 women and 156 men aged 65 years and older and living in retirement homes in and around Prague. Data included: a Mini-Nutritional Assessment (MNA questionnaire), anthropometric measurements and biochemical evaluations. RESULTS: According to the MNA questionnaire, 10.2% of these elderly individuals were malnourished and 39.4% were at risk of malnutrition. More women than men were malnourished (OR = 0.59 and 95% CI 0.42-0.86). Mean BMI values were 25.5 for females and 27.5 for males. MNA was positively correlated mostly with immobility (r = 0.63; p < 0.001), BMI (r = 0.57; p < 0.001) and mid-arm circumference (r = 0.56; p < 0.001). Serum albumin levels were <28 g/l in 1.3% (1.3% of the women and 1.36% of the men) and between 29.0 - 34.0 g/l in 21% (22.5% of the women and 14.4% of the men). Statistically significant differences between groups according to MNA scores were found for albumin, prealbumin, transferrin and creatinine. Prevalence of smoking was significantly higher among males. CONCLUSION: The study results confirmed that institutionalized elderly, especially women, should be considered a nutritionally vulnerable population group that needs attention.

Ulnar nerve at the elbow - normative nerve conduction study.

INTRODUCTION: A goal of our work was to perform nerve conduction studies (NCSs) of the ulnar nerve focused on the nerve conduction across the elbow on a sufficiently large cohort of healthy subjects in order to generate reliable reference data. METHODS: We examined the ulnar nerve in a position with the elbow flexion of 90o from horizontal. Motor response was recorded from the abductor digiti minimi muscle (ADM) and the first dorsal interosseous muscle (FDI). RESULTS: In our sample of 227 healthy volunteers we have examined 380 upper arms with the following results: amplitude (Amp)-CMAP(wrist) for ADM 9.6 ± 2.3 mV, MNCV at the forearm 60.4 ± 5.2 m/s, MNCV across the elbow 57.1 ± 5.9 m/s. DISCUSSION: Our study showed that motor NCSs of the ulnar nerve above elbow (AE) and below elbow (BE) in a sufficiently large cohort using methodology recommended by AANEM gave results well comparable for registration from FDI and ADM.

Trace elements in the blood of institutionalized elderly in the Czech Republic.

Whole blood selenium, copper, zinc and manganese concentrations of 197 institutionalized senior citizens (46 males, 151 females) aged 61-100 years (mean age 83.6 years) were determined using atomic absorption spectrometry and inductively coupled plasma mass spectrometry from two localities in the Czech Republic (Prague and Teplice) from 2009 through 2011. Geometric means (GM) of whole blood selenium (B-Se), copper (B-Cu), zinc (B-Zn) and manganese (B-Mn) levels were 74.0 µg/l, 941.0 µg/l, 5898.0 µg/l and 10.9 µg/l, respectively. Gender-related differences were found with significantly higher B-Cu levels in women and significantly higher B-Zn levels in men. The percentage of seniors with B-Se levels lower than 56 µg/l (which is equivalent to the critical value of 45 µg/l of Se in serum (S-Se)) was 8.6%. A negative correlation between age and B-Se levels was found. B-Zn positively correlated with serum albumin and prealbumin whereas a negative correlation between age and B-Zn was observed. Seniors with diabetes mellitus and atherosclerosis had higher B-Cu and B-Mn levels, respectively, than those without these diagnoses. The elderly from Prague had significantly higher B-Mn concentrations than those from Teplice. We found no evidence of serious essential elements deficiencies or excesses in the seniors who participated in this study.

Alcohol consumption and marijuana use in young adult Czechs.

OBJECTIVES: The main objective of the study is to explore associations between alcohol consumption and marijuana use in young adults and to discuss the opportunities for brief intervention. METHODS: Face to face structured interviews were carried out with 2,221 young adult Czechs (mean age 29.9, sd. 5.8 years). 51.4% were males. Alcohol consumption was calculated using beverage specific quantity frequency method. Alcohol-related problems were assessed using the Czech version of the AUDIT. Frequency of marijuana use in the last twelve months was asked as well. RESULTS: The overall alcohol consumption was 9.2 litres of pure alcohol per person and year. The last year prevalence of marijuana use was 21.8%. The use of marijuana positively correlated with the frequency of beer drinking (r = 0.27), frequency of heavy episodic drinking [HED] (r = 0.32) and with the summary score in AUDIT (r = 0.39). Harmful or problem drinkers (AUDIT score > or = 16) reported marijuana use more frequently than moderate drinkers (60% compared to 18.8%; OR = 6.54; 95% CI = 4.7; 9.1). OR for marihuana use in heavy episodic drinkers was 4.3 (95% CI = 3.3; 5.6). DISCUSSION: The results suggest that frequent HED and harmful drinking are closely associated with marijuana use in younger adults. Since marijuana use (including heavy use) is rather common in the Czech Republic, it would be recommendable to also extend screening and brief intervention to reduce the use of cannabis. The existing guidelines for brief intervention should be modified in order to cover marijuana consumption as well.

HPV involvement in tonsillar cancer: prognostic significance and clinically relevant markers.

The association of high-risk human papillomaviruses (HR HPVs) with tonsillar cancer (TC) has been documented. Because patients with HPV-associated tumors show better survival rates, modification of their treatment regimen is being considered. It is therefore crucial to find markers for the identification of patients whose tumors are linked to viral infection. A cohort of 109 patients with primary TC was screened for HPV DNA presence in the tumor tissues and HPV-specific antibodies in sera. Data regarding risk factors and clinical parameters were collected. Forty-five specimens were analyzed for the expression of viral E6 and E2-region mRNA, and the p16 and p53 protein expression status was assessed by immunohistochemistry. The overall prevalence of HPV DNA in TC tissues was 65.1%. Ninety-three percent of HR HPV DNA-positive samples expressed E6*I mRNA. E2-region mRNA expression was detected in 36% of positive samples, which implies that the virus is integrated in 64% of HPV DNA/RNA-positive tumors. p16 overexpression and the presence of antibodies specific to HPV16 E6/E7 oncoproteins correlated well with HPV DNA and RNA presence. The disease-specific survival rate of patients with HPV DNA-positive tumors was significantly higher than that of HPV DNA-negative patients. In addition to providing further evidence of the involvement of HPV infection in the etiopathogenesis of a proportion of TC cases, our study demonstrates that p16 immunostaining and anti-E6/E7 antibodies as surrogate markers of HPV involvement represent specific, sensitive and clinically accessible assays for the identification of TC patients who have a considerably better prognosis.

Clonal distribution of invasive pneumococci, Czech Republic, 1996-2003.

We conducted surveillance on invasive pneumococci isolated from adults in the Czech Republic during 1996-2003. The 7 most prevalent serotypes were characterized. Coverage with the 7-valent pneumococcal conjugate vaccine was low. Our observations confirm that detection methods may have modified the expected effect of this vaccine.

Acute bacterial meningitis in adults: predictors of outcome.

Case fatality ratio and permanent sequelae of acute bacterial meningitis remain high in recent decades. A prospective longitudinal study of adult patients admitted with community acquired acute bacterial meningitis at a tertiary infectious diseases unit aimed to identify predictors of unfavourable outcome - death and sequelae. Anamnestic, clinical and laboratory data and clinical outcome were recorded. From 1997 to 2006, 279 adults (122F, 157M) with a median age of 51 y were admitted with acute bacterial meningitis. Predisposing condition and comorbidity were recorded in 42% and 38% of patients, respectively. Time between symptoms onset and antibiotic treatment ranged from 6 to 160 h. An aetiological agent was identified in 77% of patients: Streptococcus pneumoniae (29%) and Neisseria meningitidis (27%) were the most frequent. 55 patients (20%) died and 63 (23%) had neurological sequelae 6 months after discharge. In multivariate analysis, 7 independent predictors of unfavourable outcome were identified: internal comorbidity, time to treatment >48 h, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology. The results suggest that acute bacterial meningitis remains associated with significant morbidity and mortality. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential for an optimal clinical outcome.

Health behaviors, nutritional status, and anthropometric parameters of Roma and non-Roma mothers and their infants in the Czech Republic.

OBJECTIVE: To compare maternal health behaviors, maternal nutritional status, and infant size at birth of Romas and non-Romas in the Czech Republic. DESIGN: Maternal interviews and food frequency questionnaire, maternal blood samples, physical measurements of mothers and infants. SETTING: Hospital, maternal/child care center; 2-4 days postpartum. PARTICIPANTS: 76 Roma mothers and 151 mothers from the majority population. MAIN OUTCOME MEASURES: Infant length/weight; maternal height/weight; weight gain during pregnancy; duration of pregnancy; maternal smoking habits; dietary intake; use of food supplements during pregnancy; and maternal blood levels of folate, beta-carotene, retinol, and alpha-tocopherol. ANALYSIS: Comparison of ethnic groups by 2-sample Wilcoxon test, chi-square, Fischer's exact test, relative risk, and analysis of variance (ANOVA). RESULTS: Pregnancy duration was about 1 week shorter in Roma women (P < .001), and their infants had lower birth weight (P < .001) and shorter length (P < .001). Prevalence of smoking was significantly higher among Roma mothers (P < .001). Roma women used food supplements less frequently than non-Roma women (P < .001) and had significantly lower mean blood concentrations of folate (P < .001), beta-carotene (P < .001), retinol (P < .02), and alpha-tocopherol (P < .02). CONCLUSIONS AND IMPLICATIONS: The nutritional status of Roma mothers is worse than that of mothers from the majority Czech population. The dietary and smoking habits of pregnant Roma women should be of special concern to family doctors, obstetricians, nutrition educators, and social workers.