Changes in Alcohol Consumption and Determinants of Excessive Drinking During the COVID-19 Lockdown in the Slovak Republic.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, countries have been forced to adopt strong restrictions, such as lockdown, which can lead to serious consequences for public health, including the problematic use of addictive substances. The aim of this cross-sectional study was to examine changes in alcohol consumption and to identify determinants against the background of excessive drinking during the COVID-19 lockdown in the Slovak Republic. The research included 445 respondents (33% males and 67% females), and the data collection through the questionnaire took place from April 29, 2020 to July 1, 2020. Measures such as drinking frequency, amount of alcohol and excessive drinking were used to examine alcohol consumption. Descriptive analysis and binary logistic regression were used to meet the main aim. The findings provide a closer look at the situation in the Slovak Republic and contribute to comprehensive international knowledge. The frequency of excessive drinking did not change in about half of respondents (53% of males and 69% of females). More respondents decreased their excessive drinking than increased, both among males (31 and 16%, respectively) and females (25 and 6%, respectively). Similar results were found for drinking frequency and amount of alcohol. Amongst Slovak respondents, an increase in excessive drinking was more common among males, younger people, smokers, and smokers who increased smoking during the lockdown. Especially in the case of vulnerable populations, public policies should consider a response to impending problems. The findings of this study encourage the implementation of effective and evidence-based prevention programs, which are more than necessary in the Slovak Republic.

Interaction of Socioeconomic Status with Risky Internet Use, Gambling and Substance Use in Adolescents from a Structurally Disadvantaged Region in Central Europe.

BACKGROUND AND AIMS: The current level of knowledge concerning the effect of socioeconomic status (SES) on internet use, gambling, and substance use in structurally disadvantaged regions is scarce. The objective of this study was an investigation of the relationship between SES and risky internet use, gambling and substance use in a structurally disadvantaged region in Central Europe. METHODS: A cross-sectional survey was conducted among high school students (n = 1063) in a Czech structurally disadvantaged region in autumn 2017. Binary Logistic Regression models were applied to data from the modified Excessive Internet Use scale (mEIUS), a standard tool for measuring the risk of addictive behavior on the internet and the risk of excessive gaming. Other data were collected using the Lie/Bet (problematic gambling), CAGE (acronym of the key words: cut, angry, guilty and eye-opener), and the Cannabis Abuse Screening Test (CAST) (problematic alcohol/cannabis use) tools. RESULTS: There were statistically significant differences between at-risk and not-at-risk groups in addictive behavior on the internet and gaming, while none were found in problematic gambling. Individual dimensions of SES showed significant effects on substance use. Regarding parenting styles, significant differences were found only in the risk of addictive behavior on the internet or gaming between the authoritarian and authoritative styles. Being engaged in behavioral addictions with one´s parents increased the odds of the behavioral addiction risk and decreased the odds of the substance addiction risk. Engagement with one´s parents in substance addictions decreased the odds of the behavioral addiction risk and increased the odds of the substance addiction risk. DISCUSSION AND CONCLUSIONS: The results point at specific relations between SES and the risk of addictive behaviors on the internet and gaming within structurally disadvantaged regions. The results of SES and/or structurally disadvantaged region measures obtained in research, policy-making, and care-provision may improve the focus of actions taken.

Competition in Public Procurement in the Czech and Slovak Public Health Care Sectors.

Sustainability of health financing is a critical issue for all countries, especially now in the COVID-19 period. The final level of achievements of critical public health goals is connected not only with the efforts of the people involved, but also with the availability of funding to cover the costs of the actions needed. One of the "internal sources" providing more resources to cover public health care costs is effective public procurement in the health care sector. According to existing scientific literature, a low rate of competition represents one important factor that has a direct negative impact on the efficiency of public procurement. The aim of our article is to examine the degree of competitiveness of public procurement in the Czech and Slovak health care systems and its impact on the final price of a contract. The research fully attested the findings of those studies carried out so far - the higher the number of tenderers, the lower the final price, even in the Czech and Slovak health sectors. However, the average number of tenderers is only around two and in the Czech Republic for more than half of the tenders only one bid was submitted.

Economic Value Estimation of the Natural Heritage of the Tatra National Park.

The aim of the study is to determine the economic value of the Tatra National Park. The willingness to pay approximation was used. Additionally, a questionnaire survey was applied in order to collect data. It contained a hypothetical event, and respondents expressed their willingness to pay an annual entry fee to the Tatra National Park in exchange for a guarantee of stopping the interference to its integrity. The total number of respondents was 921. The results show that the income level has a positive impact on respondents' willingness to pay for entry to the Tatra National Park. With the increase of fee, the willingness to pay for entry to the Tatra National Park decreased by 2.2% for every additional price increase. The resulting value of the Tatra National Park, with the limits of the presented research mentioned in the paper, is approximately 17.5 million €.

Age-gender mortality study on alcohol-induced deaths in Slovakia.

OBJECTIVE: Alcohol use is one of the ten most common risk factors threatening global health that is avoidable (ranked fifth after smoking). It is involved in high rates of liver cirrhosis, epilepsy, hypertension, cerebrovascular and mental illness. Negative consequences of family and social drinking are also very significant. The aim of the study is to quantify the gender and age-differentiated disparities in alcohol-related mortality in the population over 16 years between the years 1996-2017 in Slovakia. METHODS: We used data from mortality reports within 1996-2017 provided by the National Health Information Centre in the Slovak Republic. We applied two-dimensional correspondence analysis where dimensions are age and chosen causes of deaths induced by use of alcohol and classified by the International Classification of Diseases. RESULTS: In case of males, we found that K74 - Fibrosis and cirrhosis of liver diagnosis almost perfectly corresponds to age 66-75 years, and we documented strong correspondence between K70 - Alcoholic liver disease and age 46-55 years. For females, the most robust finding is that K70 - Alcoholic liver disease corresponds relatively similarly with age groups 26-35, 36-45, 46-55. The results of the analysis allow us to obtain a detailed overview of the development of mortality in individual alcohol diagnoses and their intervention in individual age groups by gender. Mortality for some diagnoses affects the young female as well as male population. We observed that there are systematic differences in alcohol-induced mortality between males and females. CONCLUSIONS: In such development of the alcohol-related mortality structure, the priority remains the permanent provision of primary, secondary and tertiary prevention at the individual and population level. The results of our analysis represent a valuable platform for health and social policymakers to develop quality national and regional health strategies aimed at eliminating the consequences of alcohol use. Lessons learned from our analysis will be supported by our other geographically oriented analytical lines to link identified and quantified regional disparities in the mortality of alcohol diagnoses to the availability of health care to treat these diseases.

Spatial analysis of alcohol-related mortality in Slovakia.

OBJECTIVE: The aim of our study was to investigate the relationship between alcohol-related mortality in Slovak regions, as represented by Nomenclature of Territorial Units for Statistics (NUTS) III level. METHODS: We used data from mortality reports spanning 1996-2017 in the Slovak Republic. Data was provided by the National Health Information Centre in Slovakia. We applied two-dimensional correspondence analysis where the dimensions are regions and selected alcohol-related deaths diagnoses are classified by the International Classification of Diseases. RESULTS: Analysis revealed a relationship between the Presov region and diagnoses I42 - Cardiomyopathy and K29 - Alcoholic gastritis. Furthermore, the Banská Bystrica and Zilina regions correspond to G31 - Degeneration of nervous system due to alcohol and K86 - Alcohol-induced chronic pancreatitis. In the case of K70 - Alcoholic liver disease - the Banská Bystrica, Trencín and Nitra regions are identified as regions which have an intermediate relationship with this diagnosis. The Trnava region corresponds to F10 - Acute alcohol intoxication. The Trencín and Nitra regions correspond closely to G62 - Alcoholic polyneuropathy. Perfect correspondence can be seen between the Kosice region and K73 - Chronic hepatitis, not elsewhere classified. K74 - Fibrosis and cirrhosis of liver diagnosis also corresponds with the Kosice region. CONCLUSIONS: The results of this analysis provide valuable insights for national and regional health policymakers in the process of preparing high-quality health regional plans, as well as retrospectively assessing the success of existing health policies and interventions in this area. Facts presented in the study justify the need for specialised health care, which is part of the process of building an Integrated Health Care Centre in Slovakia.

On the Structure of Mortality among the Regions in the Slovak Republic.

AIM: The Slovak Republic consists of eight regions which may dispose a different structure of cause-specific mortality. The aim of this study is to reveal the regions with higher risk of dying from the main categories of diseases selected according to the chapters of the International Classification of Diseases (ICD-10). METHODS: Data were obtained from mortality reports throughout 1996-2014. We applied multinomial logistic regression analysis, where the dependent variable is death categories and the explanatory variables are regions, age, year and gender. The Bratislava region and Diseases of the circulatory system are set as the reference level. RESULTS: We propose a spatiotemporal analysis of the relative risk ratio of dying in the Slovak Republic for every significant group of diseases from the International Statistical Classification of Diseases and Related Health Problems maintained by the World Health Organization. Moreover, we propose gender and age analysis. CONCLUSIONS: These results could be useful for setting active prevention programs, as well as a hospital network specialising in high risk diagnoses in Slovakian regions.

Risk of Dying from Cancer by Socio-demographic Indicators in the Slovak Republic.

AIM: Cancer mortality distribution was investigated by detailed neoplasms groups, age, sex, marital status of deceased, and regions in the Slovak Republic, and examined how these determinants influence the odds of dying due to cancer. METHODS: A retrospective analysis of cancer mortality statistics registered in the Slovak Republic during the years 1996-2014. For this time period, data was available only on the underlying subgroups of cancer deaths, place of death, age, year, sex, and marital status. Binary logistic regression was applied for odds of dying calculation influenced by these socio-demographic factors. RESULTS: The most common are deaths from malignant neoplasms of digestive organs in males as well as females. The biggest difference among both genders is recognized in malignant neoplasms of lip, oral cavity and pharynx, where deaths among males are on average 7.9 times higher in comparison to females. As for place of death the Bratislava region reports the highest level of cancer mortality stated at 25.22% of all deaths, on the contrary the Banská Bystrica region reports only 21.40% of all deaths. Age has a negative influence on odds of dying due to neoplasms compared to all other causes of death by 1.7%. In all regions compared to the reference Bratislava region, the odds of dying from neoplasms are lower. Being female diminishes the odds of dying due to neoplasms by 25.7% compared to males. Yearly the relative ratio of dying from neoplasms increases with respect to all other causes of death. When single people are set as the reference category, the relation of the probability of death from cancer to the probability of death due to other causes of death is higher for married, divorced and widowed persons. CONCLUSIONS: The results should be taken into account when comparing risk of dying due to cancer among people with the mentioned sociodemographic characteristics. Health policy makers should consider place of death and cancer types while planning hospital care units.

Time Trend, Age and Sex Distribution of Deceased from Diabetes Mellitus at the Regional Level in the Slovak Republic.

AIM: To describe the time trends, age and sex distribution of death from diabetes mellitus (E10-E14) as a significant part of endocrine, nutritional and metabolic diseases (E00-E90), during 1996-2014 in the Slovak regions, and to estimate the influence of social characteristics on mortality. METHODS: Secondary data on deaths during 1996-2014 were gathered from the National Health Information Center in the Slovak Republic. The total crude death rate per 100,000 of the standard Slovak population and age-standardized death rate per 100,000 of the standard European population were calculated by direct standardization. Multilevel logistic regression analysis was performed. RESULTS: Deaths from diabetes mellitus account for 91.6% of deaths registered in the endocrine, nutritional and metabolic diseases Chapter. The age-standardized death rate per 100,000 of inhabitants decreased from 19.2 in 1996 to 15.3 in 2014 in the Slovak Republic, although a massive increase of up to 32.5 was reported in 1999. The highest age-standardized death rates per 100,000 inhabitants were typical for the Kosice, Nitra and Trencín regions. On the other hand, the lowest counts were recorded in the Bratislava region. Mortality from diabetes mellitus starts to be evident in the 45-49 year age-group in both sexes. The median age of death for women is lower in the 75-79 year age-group in comparison to men although the total crude death rate for men in lower age groups is higher. After age 80 the situation is reversed. The odds of dying due to endocrine, nutritional and metabolic diseases decreases by 0.4% each year. The odds of dying are lower by 17% and 12.3%, respectively, in the Zilina and Presov regions compared to Bratislava region. Women have a higher probability of dying by 38% in contrast to men, and married couples by 16.7% than singles. Age is proved to be an insignificant factor. CONCLUSIONS: In spite of the declining trend of mortality from diabetes mellitus, it is necessary to reduce the risk of its incidence by healthier food consumption and physical activity.

Impact of Selected Socio-demographic Factors on the Development of Mortality due to Circulatory System Diseases in the Slovak Republic.

AIM: We mapped the situation within a group of diseases of the circulatory system (I00-I99) in the Slovak Republic during 1996-2014. We focused mainly on spatiotemporal differences in mortality while controlling for age and sex. METHODS: We performed binary logistic regression aiming to reveal socio-demographic factors that influence the odds of dying due to diseases of the circulatory system (I00-I99). In our analysis, the dependent variable was death diagnosis and the independent variables were age, region, gender, and marital status. RESULTS: Our findings suggest that odds of dying due to diseases of the circulatory system (I00-I99) increased for every year of age by 5.4%. Within the period from 1996 to 2014, the risk of dying from diseases of the circulatory system decreased by 2% every year. We also documented the fact that being female raised the odds of dying due to diseases of the circulatory system (I00-I99) by 12.9% compared to males. Furthermore, it could be argued that serious differences in terms of regional distribution of deaths caused by diseases of the circulatory system (I00-I99) exist in the Slovak Republic. CONCLUSIONS: We present the development of diseases of the circulatory system (I00-I99) in the Slovak Republic. Differences in spatial distribution of deaths are documented as well as related gender differences. Our study can serve as a tool for policy makers and benchmark for professionals.