Associations between migraine and possible risk factors in the Czech Republic.

Introduction: Migraine is a widespread neurological disorder, growing increasingly common. However, the pathogenesis of the disease is often unclear and the evidence for the role of various risk factors is limited. This study aimed to identify risk factors associated with migraine and to contribute towards a better understanding of this disease. Methods: Data from 3,247 questionnaires were analyzed for associations between migraine and sex, age, BMI, degree of education, and air pollution, along with other factors such as contact with friends, physical condition, health, anxiety, and depression. A cross-sectional study was conducted with an approximately equal distribution of the sample by age, gender and two analysed regions. Data were presented using basic descriptive statistics using the chi-square test. The model output was presented using a crude odds ratio (OR) and a fully adjusted OR. Three hundred and eight-six individuals (12%) suffered from migraine. Results: In an adjusted model, the presented study found associations between the prevalence of migraine and sex, age, and level of education. Individuals with migraine statistically significantly more often suffered from depression, anxiety and other selected factors. However, the assumed significant association between the occurrence of migraine and pollution in the region has not been found.

Extended high-frequency audiometry: hearing thresholds in adults.

PURPOSE: This study aimed to determine hearing thresholds in an otologically normal population without occupational noise exposure aged 18 to 64 years using extended high-frequency audiometry (EHFA). METHODS: Individuals from the general population who have never had hearing problems and whose job was not associated with noise exposure were included in the study and classified by age into 5 categories: 18-24 and, further, by 10 years of age. Each of these groups was further divided according to gender. All subjects underwent tympanometry, conventional pure-tone audiometry within the 0.125-8 kHz range, and extended high-frequency audiometry within the 9-16 kHz range, performed according to the standards. The significance level for statistical testing was set at 5%. RESULTS: Here, we established hearing thresholds in an otologically healthy population within the extended high-frequency (EHF) range (9-16 kHz). We found the EHFA to be a highly sensitive method for early detection of hearing loss, with hearing thresholds decreasing as soon as 35 years of age. In males, the hearing thresholds grew with age more rapidly than in women. The ability to respond at EHF gradually decreased with age and increasing frequency. CONCLUSION: Our results can help improve the knowledge of EHF hearing thresholds for individual sexes and age groups. So far, the standard 7029:2017 is not binding and, moreover, it only reaches up to the frequency of 12.5 kHz. EHFA is a highly sensitive method for the evaluation of hearing loss depending on age and sex.

Self-Reported Mental Health and Lifestyle Behaviour During the COVID-19 Pandemic in the Czech Population: Evidence From Two Cross-Sectional Surveys.

Objectives: Evidence of the impact of COVID-19 pandemic on mental and physical health behaviours is limited. This study presents results of two cross-sectional surveys on mental health changes and its consequences on healthy and unhealthy lifestyle behaviours. Methods: An online survey was distributed during Spring 2020 (N = 9,168) and Autumn 2020 (N = 1,042) in the Czech Republic. Differences in mental health observed in both surveys were evaluated using Mann-Whitney test and logistic regressions were used to examine demographic and socio-economic determinants of COVID-19-related mental health issues and resulting healthy and unhealthy lifestyle behaviours. Results: In multivariable models, the youngest individuals, females, people with increased work demands and participants with a reduced personal income due to the COVID-19 pandemic were all negatively associated with self-reported mental health issues (p < 0.05). A worsened quality of sleep, dietary habits, physical activity and unhealthy behaviours were highly associated with affected mental health in the models adjusted for potential covariates (p < 0.05). Conclusion: Taken together, these findings suggest that health promotion strategies directed to individuals who are at risk should be encouraged to adopt and/or maintain positive health-related behaviours.

Analysis of Histopathological Findings of Lung Carcinoma in Czech Black Coal Miners in Association with Coal Workers' Pneumoconiosis.

Coal miners with coal workers' pneumoconiosis (CWP, J60 according to ICD-10) were previously found to have a significantly higher risk of lung carcinoma compared to the general male population. The presented study aimed to analyze the (i) incidence of lung carcinoma in miners, (ii) histopathological findings in cohorts with and without CWP, and (iii) effect of smoking cessation on the histopathological profile. Analyzed cohorts consisted of miners with (n = 3476) and without (n = 6687) CWP. Data on personal and working history obtained from the medical records were combined with information on lung cancer from the Czech Oncological Register and histopathological findings. Statistical analysis was performed using non-parametric tests and the incidence risk ratio at the significance level of 5%. In 1992-2015, 180 miners (2.7%) without CWP and 169 (4.9%) with CWP, respectively, were diagnosed with lung carcinoma. The risk of lung cancer in miners with CWP was 1.82 (95% CI: 1.48-2.25) times higher than in those without CWP. Squamous cell carcinoma (37%) was the most common histopathological type, followed by adenocarcinoma (22%) and small cell carcinoma (21%). A statistically significant difference between the cohorts (p = 0.003) was found in the histopathological subtypes, with the incidence of small cell carcinoma being 2 times higher in miners without CWP than in those with CWP. Only a few individuals with lung carcinoma were non-smokers. The incidence of small cell carcinoma, which is strongly associated with smoking, is significantly higher in miners without CWP. Smoking constitutes the most important risk factor for developing lung carcinoma even in that cohort. However, CWP remains a very important risk factor.

Risk of chronic diseases limiting longevity and healthy aging by lifestyle and socio-economic factors during the life-course - a narrative review.

The review provides a comprehensive summary of existing literature focusing on the most serious risk factors of non-communicable diseases and collects current knowledge on their distribution, determinants, clusters, psychological and socio-economic consequences. Especially, the life-course approach is stressed, early life consequences of the later onset of chronic diseases, the risk behavior and its social, socio-economic and psychosocial determination is reviewed. Potential of preventing these harmful consequences has a lifelong approach. The aim is to demonstrate the opportunity for future health system transformation in terms of public health prevention regarding the non-communicable diseases. It is concluded that personalized lifestyle medicine should address a patient's health by empowering them with the information they need to regain control of their health. Preventive methods should be tailored for each patient, considering such patient's specific genes, environment, lifestyle, early life factors and social patterns of risk factors to avoid burden of health in later age. Intervention and preventive measures should target not only to individual factors but should reflect wider social, psychosocial and socio-economic consequences. It is also crucial from the point of view of public health to consider data on exposome, which are not included in epidemiological studies as well as its impact on health in the context of non-communicable diseases. Med Pr. 2021;72(5):535-48.

Evaluation of Fine and Ultrafine Particles Proportion in Airborne Dust in an Industrial Area.

The health impacts of suspended particulate matter (SPM) are significantly associated with size-the smaller the aerosol particles, the stronger the biological effect. Quantitative evaluation of fine and ultrafine particles (FP and UFP) is, therefore, an integral part of ongoing epidemiological studies. The mass concentrations of SPM fractions (especially PM2.5, PM1.0, PM0.25) were measured in an industrial area using cascade personal samplers and a gravimetric method, and their mass ratio was determined. The results of PM2.5, PM1.0 were also compared with the reference measurement at stationary stations. The mean ratios PM2.5/SPM, PM1.0/SPM, and PM1.0/PM2.5 were 0.76, 0.65, and 0.86, respectively. Surprisingly, a mass dominance of UFP with an aerodynamic diameter <0.25 µm (PM0.25) was found with mean ratios of 0.43, 0.57, 0.67 in SPM, PM2.5 and PM1.0. The method used showed satisfactory agreement in comparison with reference measurements. The respirable fraction may consist predominantly of UFP. Despite the measures currently being taken to improve air quality, the most biologically efficient UFP can escape and remain in the air. UFP are currently determined primarily as particle number as opposed to the mass concentration used for conventional fractions. This complicates their mutual comparison and determination of individual fraction ratios.

An assessment of PM1 levels based on indicative PM1 measurements and relationships with PM10 and PM2.5 concentrations, for the analysis of hospital admissions and mortality in the Moravian region.

BACKGROUND: Particulate matter (PM) air pollution is a serious concern in the city of Ostrava. Thus, in 2018, a project entitled "Validation of the relationships between PM10, PM2.5 and PM1 concentrations, and morbidity and mortality, in the heavily polluted region in the Czech Republic," was launched. The relationship between hospital admissions and mortality in the said region is based primarily on short-term PM10 and PM2.5 concentrations and indicative PM1 measurement. The analysis of spatiotemporal variations and the relationship between PM10, PM2.5 and PM1 data from 3 measurement sites within the city of Ostrava is presented. MATERIAL AND METHODS: The analysis was based on the daily average PM concentrations for 5 and 6 months at 2 sites, and on the annual average values (2018-2019) at the baseline station. The correlations of and variability between PM fractions, seasonal differences and explanation of the differences found were the objectives of a detailed analysis. Especially, the potential PM1 variability and its causes were analyzed with respect to the location of the site. RESULTS: The study findings confirmed good correlations between the PM fractions. Compared to PM10, PM2.5 concentrations were more predictive for PM1 concentrations. The annual means of PM10, PM2.5 and PM1 reached 37.5, 29.9 and 27.1 µg/m3 in 2018, respectively, and 25.8, 19.9 and 17.9 µg/m3 in 2019, respectively. The concentration levels in the non-heating season were significantly lower than in the heating season in the 2 years under consideration. The levels of PM10, PM2.5 and PM1 were significantly correlated (the correlation coefficient, r > 0.96). The levels of PM2.5 represented about 0.82-0.86 of PM10, and the levels of PM1 about 0.92-0.93 of PM2.5. These ratios were found to differ in the heating and non-heating seasons, with the PM2.5-PM10 ratio ranging 0.61-0.63 in the non-heating seasons. CONCLUSIONS: The correlations found will be used for indicative PM1 measurements in other areas of the region. Seasonal variability should be taken into account as well. Med Pr. 2021;72(3):249-58.

Perception of health risk and compliance with preventive measures related to COVID-19 in the Czech population: preliminary results of a rapid questionnaire survey.

OBJECTIVES: In the Czech Republic, an outbreak of the coronavirus disease (COVID­19) has been decelerated by quickly adopting strict and strongly limiting government measures. In this study, the authors present the preliminary results (April 1-5, 2020) of a public risk perception study of COVID­19. MATERIAL AND METHODS: The online questionnaire survey was announced in the national TV and radio stations with the nationwide coverage. Respondents were recruited through the website of the University of Ostrava during the first 5 days of the survey (N = 7966). The data covered risk perception with a focus on physical and psychological aspects, the current socio-economic situation and adaptation to the lockdown. The authors used Mann-Whitney and Kruskal-Wallis tests, as well as ordered logistic regression, with a significance level of 5% using STATA version 15. RESULTS: From the total sample of the respondents aged 40 years on average (a range of 15-87 years), the present study shows that women (p < 0.001) and elderly people (p < 0.001) perceived the health risk related to COVID­19 as significantly worse than others. Older people (>60 years) perceived their mental health as significantly better than younger participants (p < 0.001). Most of the respondents assessed the adopted measures as adequate (71%) and believed in their effectiveness (69.7%). CONCLUSIONS: This study contributes to understanding the risk perception as a public response to the COVID­19 pandemic. Int J Occup Med Environ Health. 2021;34(2):165-76.

Comparison of lung cancer risk in black-coal miners based on mortality and incidence.

BACKGROUND: Cancer risk (especially as regards lung cancer) in black-coal miners is mainly analyzed on the basis of mortality. The risk calculated based on mortality may differ from the values based on incidence. The aim of the study was to compare cancer risk in black-coal miners with and without coal workers' pneumoconiosis (CWP), based on data on mortality and the incidence of lung cancer in the Czech Republic in 1992-2013. MATERIAL AND METHODS: The cohort without CWP was composed of 6687 miners, and the cohort with CWP of 3476 miners. Information on the incidence of lung cancer was obtained from the Czech National Oncological Register (NOR), and information on mortality from the National Population Register. The risk of lung cancer incidence was compared with the general male population in the Czech Republic using the standardized incidence ratio (SIR), and the risk of lung cancer mortality using the standardized mortality ratio (SMR), with the 95% CI. RESULTS: In miners with CWP, a lower SMR value was found, SMR = 1.70 (95% CI: 1.41-2.04), compared with the SIR value, SIR = 2.01 (95% CI: 1.70-2.36). In miners without CWP, this was opposite, the value of SIR = 0.81 (95% CI: 0.69-0.94) was lower than the value of SMR = 0.83 (95% CI: 0.70-0.98). In miners without CWP, 17 cases of lung cancer (out of 176 cases in total) were not registered in NOR. In miners with CWP, the share of not registered cases was significantly lower (p = 0.018), and it was represented by 3% of not registered lung cancer cases, out of 156 cases with the diagnosis of lung cancer. CONCLUSIONS: In spite of the difference between SIR and SMR, the results of both indicators were consistent with the resulting relationship between the lung cancer risk and CWP. Med Pr. 2020;71(5):513-8.

A response to the Comment on Tomaskova et al. Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013. Int. J. Environ. Res. Public Health, 2017, 14, 269 by the Author Mei Yong.

At first, we would like to thank Mei Yong for the comments on our article Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013 [...].

Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013.

While working underground, miners are exposed to a number of risk factors that have a negative impact on their health and may be a cause of an increased mortality in miners. The aim of the study was to compare total and specific mortality in black coal miners with acknowledged coal-workers' pneumoconiosis (CWP) and without CWP, and the mortality of the general male population in the Czech Republic in the period 1992-2013. The sample consisted of 3476 coal miners with CWP and 6687 ex-coal miners without CWP, who were removed after achieving the maximum permissible exposure (MPE). The mortality risk differences were analyzed with the use of the standardized mortality ratio (SMR) and 95% confidence interval. Significantly higher total mortality (SMR = 1.10; 95% CI: 1.02-1.17), and mortality from malignant neoplasm (SMR = 1.16; 95% CI: 1.03-1.30), lung cancers (SMR = 1.70; 95% CI: 1.41-2.04), and non-malignant respiratory diseases (SMR = 2.78; 95% CI: 2.32-3.31) were found in the sample of coal miners with CWP. In this sample, the severity of CWP was assessed, and the SMR increased with the severity of CWP. The total (SMR = 0.86; 95% CI: 0.82-0.91) and specific mortality of miners without CWP were not higher compared with the general population. In the case where the miners were removed from underground work after achieving the MPE (without CWP), their mortality was not higher than that of the general population, but the mortality of miners with CWP was higher compared to the general population. This mortality was affected by malignant and non-malignant respiratory diseases.

Environmental and Socioeconomic Health Inequalities: a Review and an Example of the Industrial Ostrava Region.

BACKGROUND AND AIM: According to the World Health Organization (WHO) more than 2 million premature deaths and 7 million of total deaths each year can be attributed to the effects of air pollution. The contribution of air pollution to the health status of population is estimated to be about 20%. Health is largely determined by factors outside the reach of healthcare sector, including low income, unemployment, poor environment, poor education, and substandard housing. The aim of the paper was to review a current knowledge of relationships among air pollution, socioeconomic health inequalities, socio-spatial differentiation, and environmental inequity. The relationships were demonstrated on an example of the Ostrava region. Also basic approaches to health valuation were reviewed. RESULTS: Social differences are reasons both for health inequalities and spatial patterns of unprivileged area housing. In urban environments with poor air quality there is also a large concentration of low income residents. Less affluent population groups are more often affected by inadequate housing conditions including second-hand smoking and higher environmental burden in their residential neighbourhoods. Environmental injustice is highly correlated with other factors that link poverty with poor health, including inadequate access to medical and preventive care, lack of availability of healthful food, lack of safe play spaces for children, absence of good jobs, crime, and violence. CONCLUSIONS: The theoretical background and also results of the studies brought evidence that population health is affected by both socioeconomic and environmental inequalities. Air pollution is unevenly distributed in Ostrava and is related to distribution of socially disadvantaged environment and social exclusion as well.

PM10 Air Pollution and Acute Hospital Admissions for Cardiovascular and Respiratory Causes in Ostrava.

BACKGROUND AND AIM: The city of Ostrava and its surroundings belong to the most long-therm polluted areas in the Czech Republic and Europe. For identification of health risk, the World Health Organization recommends a theoretical estimation of increased short-term PM10 concentrations effect on hospital admissions for cardiac complaints based on a 0.6% increase per 10 µg.m-3 PM10 and 1.14% increase for respiratory causes. The goal of the present study is to verify the percentage increase of morbidity due to cardiovascular and respiratory causes, as per WHO recommendations for health risk assessment, in the population of Ostrava. METHOD: The input data include data on PM10 air pollution, meteorological data, the absolute number of hospital admissions for acute cardiovascular and respiratory diseases in the period 2010-2012. To examine the association between air pollution and health outcomes the time series Poisson regression adjusted for covariates was used. RESULTS: A significant relationship was found between the cardiovascular hospital admissions (percentage increase of 1.24% per 10 µg.m-3) and values of PM10 less than 150 µg.m-3 in the basic model, although after adjustment for other factors, this relationship was no longer significant. A significant relationship was also observed for respiratory causes of hospital admissions in the basic model. Contrary to cardiovascular hospitalization, the relationship between respiratory hospital admissions and PM10 values below 150 µg.m-3 (percentage increase of 1.52%) remained statistically significant after adjustment for other factors. CONCLUSIONS: The observed significant relationship between hospital admissions for respiratory causes was consistent with the results of large European and American studies.

Air Pollution and Potential Health Risk in Ostrava Region - a Review.

AIM: The aim of this review was to collect all available data about air pollution in Ostrava, which is one of the most polluted area in central Europe and to make a concise assessment of health risks resulting from historical exposures of air pollutants since the beginning of the monitoring, i.e. since 1970 to the present time. METHODS: All available information sources (the Czech Hydrometeorological Institute, the Institute of Public Health in Ostrava or publications) were used. To evaluate the exposures both short-term (hourly and daily) data and long term (yearly) data during 45 years were analysed. For health risk assessment the relationship between exposure and biological effects of pollutants published by the WHO and the US EPA were employed. RESULTS: During the studied period annual average concentrations of PM10 ranged from 25 to 96 µg/m3; PM2.5 from 24 to 45 µg/m3; SO2 from 3.4 to 101.5 µg/m3; NO2 from 17.76 to 51.17 µg/m3; benzene from 0.24 to 9.2 µg/m3; benzo[a]pyrene from 2.1 to 14 ng/m3; arsenic from 1.2 to 9.5 ng/m3. Since the turn of the 80s and 90s of the 20th century trend of air pollutant concentrations has been decreasing until the turn of millennium, when it stopped, and it has been constant until present time. However, presented results demonstrate that the citizens of Ostrava have been exposed to relatively high concentrations of pollutants in comparison to other similar cities. The most significant pollutants contributing to health risks are airborne dust (PM10, PM2.5), benzene and benzo[a]pyrene. The long-term average health risk of PM10 has increased in case of postneonatal infant mortality up to 30%; prevalence of bronchitis in children up to 61%; and incidence of chronic bronchitis in adults up to 89%. The long-term average health risk of PM2.5 increased for all-cause mortality in persons aged 30+ years up to 22%; cardiopulmonary related mortality up to 25%; and lung cancer related mortality up to 39%. The highest carcinogenic risk is observed in benzo[a]pyrene, when the range of individual lifetime carcinogenic risk is up to 1.25*10-3. This assessment is valid according to the strict carcinogenic risk by the WHO, while the maximum carcinogenic risk according the US EPA is 7.2*10-5. CONCLUSIONS: A significant reduction of the pollutants' concentrations in Ostrava in the nineties of the last century does not mean a required improvement of outdoor air quality to the desired level. Persisting episodes with a very strong short-term increase of the concentration of PM10 and PM2.5, as well as long-term load of these substances on the population is very high. Health risks from such burdens are likely to lead to a higher mortality and morbidity especially from specific diseases.

A Summary of Environmental Health Studies in the City of Ostrava and the Surrounding Region in the Czech Republic.

AIM: This study is concerned with environmental health studies conducted in Ostrava (Czech Republic) and the surrounding region since the early nineties. METHODS: Various databases, journals and reports, including internal or unpublished reports, were reviewed to assess the individual publications. A brief description of the studies and main results were collated. RESULTS: The city of Ostrava and the surrounding region is an important industrial centre in the Czech Republic with a long-term heavy environmental and occupational disease burden. In spite of the theoretically assessed decline of health risks related to decreasing concentrations of compounds in the environment in recent years, it still poses a disproportionally high risk for the city residents. There are a number of studies suggesting supportive evidence, but they are highly variable in their approach to this topic resulting in a high uncertainty of observed associations and consistency of results. Most of the studies were focused on specific contexts, without any relation to environmental factors. CONCLUSIONS: A more systematic approach is needed to assess environmental health burden of diseases especially in relation to air pollution, based on the prospective cohort study, that would lead to sufficient new evidence for accurate and updated description of the environmental health burden in Ostrava.

PM10, and children's respiratory symptoms and lung function in the PATY study.

Studies of the impact of long-term exposure to outdoor air pollution on the prevalence of respiratory symptoms and lung function in children have yielded mixed results, partly related to differences in study design, exposure assessment, confounder selection and data analysis. We assembled respiratory health and exposure data for >45,000 children from comparable cross-sectional studies in 12 countries. 11 respiratory symptoms were selected, for which comparable questions were asked. Spirometry was performed in about half of the children. Exposure to air pollution was mainly characterised by annual average concentrations of particulate matter with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)) measured at fixed sites within the study areas. Positive associations were found between the average PM(10) concentration and the prevalence of phlegm (OR per 10 µg · m(-3) 1.15, 95% CI 1.02-1.30), hay fever (OR 1.20, 95% CI 0.99-1.46), bronchitis (OR 1.08, 95% CI 0.98-1.19), morning cough (OR 1.15, 95% CI 1.02-1.29) and nocturnal cough (OR 1.13, 95% CI 0.98-1.29). There were no associations with diagnosed asthma or asthma symptoms. PM(10) was not associated with lung function across all studies combined. Our study adds to the evidence that long-term exposure to outdoor air pollution, characterised by the concentration of PM(10), is associated with increased respiratory symptoms.

Attitudes of the medical students from two Czech universities to pandemic flu A (H1N1) 2009 and to influenza vaccination.

OBJECTIVES: The aim of the study was to find out the approach of students to vaccination against seasonal influenza, how they perceived risk associated with influenza pandemic, and whether the pandemic influenced their approach to vaccination against seasonal flu. METHODS: Data collection was conducted through an anonymous questionnaire survey. Distribution and collection of questionnaires took place from November to December 2010 at the medical faculties of two universities. Out of the total 360 distributed questionnaires, 343 were filled. The qualitative data were analysed using chi2 test and Fisher's exact test. The analysis of variance (ANOVA) and two-sample t-test were used for the evaluation of quantitative data. Statistical tests were performed at a significance level of 5% in STATA 10. RESULTS: The proportion of students regularly vaccinated against seasonal flu was low (4%). Students rated the risk of pandemic influenza A (H1N1) in 2009 as relatively low and an interest in vaccination did not increase even during the pandemic and consequently only 5% expressed their interest to get vaccinated during the pandemic. However, only 3% of respondents were vaccinated at the time of vaccine availability. In the following year, only 5% of respondents planned to get vaccinated against seasonal influenza. CONCLUSION: The results of the questionnaire study indicate that young people have not perceived vaccination against influenza as an important anti-epidemic measure and their opinion have not changed even during the outbreak of pandemic influenza A (H1N1) in 2009.

Parental education and lung function of children in the PATY study.

Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East-West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from -2.80 to -1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (<75% of predicted) was 1.34 (95% CI 1.06-1.70) after all adjustments. Although social gradients were attenuated after adjusting for known risk factors, these risk factors could not completely explain the social gradient in lung function.

Czech socio-economic deprivation index and its correlation with mortality data.

OBJECTIVES: The aim of the study was to create an index of socio-economic deprivation (SESDI) and to analyse correlation between SESDI and mortality data. METHODS: The SESDI components were selected from the census data (2001) at enumeration district and district level. Two methods were used for creating the SESDI: 1/ a sum of Z-scores of specific components (INDEX1); and 2/ standardized score - average values of specific components were divided by a maximum value of the specific component at the corresponding geographical level (INDEX2). Pearson's correlation coefficient was used for assessing the relationship between indices, and between indices and mortality data (SMR). RESULTS: The final indices were applied to districts in the Czech Republic (N = 77). The correlation of INDEX1 and INDEX2 was high (r = 0.99). Analysis of relationships between degree of deprivation and total and selected specific SMR in the Czech Republic confirmed that mortality was associated with degree of deprivation. CONCLUSION: The use of socio-economic deprivation indices in analysis of routinely collected mortality data in public health might help to explain health inequalities.

Parental smoking and lung function in children: an international study.

RATIONALE: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear. OBJECTIVE: To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America. METHODS: Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools. MAIN RESULTS: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50). CONCLUSIONS: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.