Primary health care in the Czech Republic: brief history and current issues.

The objective of this paper is to describe the recent history, current situation and perspectives for further development of the integrated system of primary care in the Czech Republic. The role of primary care in the whole health care system is discussed and new initiatives aimed at strengthening and integrating primary care are outlined. Changes brought about by the recent reform processes are generally seen as favourable, however, a lack of integration of health services under the current system is causing various kinds of problems.

The use of regression models for medians when observed outcomes may be modified by interventions.

Some outcomes used in epidemiological studies and clinical trials are prone to modification by interventions, for example, individuals with high blood pressure are likely to receive antihypertensive medication. Often the scientific interest is in the relationship of covariates (exposures or randomized treatment) to the outcomes that would have been observed in the absence of intervention. We compare three approaches to the analysis of such data: ignoring the intervention; excluding individuals who receive the intervention, and assuming that individuals who receive the intervention have underlying outcomes above the median.

[A deadly pandemic is still spreading. The harmful effects of smoking are a serious warning for all].

The author draw attention to the serious character of the pandemic caused by smoking which on a worldwide scale is responsible for the premature death of 4.2 million people every year. In the Czech Republic every year 22,000 people die from the sequelae of smoking.

Neonatal mortality in the Czech Republic during the transition.

"This paper examines how neonatal mortality has changed in the Czech Republic during the [1990s], examining trends in the distribution of birth weights and in birth weight specific neonatal mortality. It examines how these have varied in different parts of the country and, to ascertain the scope for further improvement, it compares them with corresponding values from Sweden, a country with one of the lowest neonatal mortality rates in Europe."

The increase in very-low-birthweight infants in Germany: artefact or reality?

Earlier findings have shown that after unification with the Federal Republic of Germany (FRG) in October 1990 the proportion of very-low-birthweight infants in the former German Democratic Republic (GDR) increased. This study seeks to explore this observation in more detail at the regional level. The analysis of aggregate data of live births in Germany between 1991 and 1997 shows an increasing proportion of very-low-birthweight infants as well as a general trend towards heavier babies in both east and west.

Temporal and spatial pattern of infant mortality in Germany after unification.

Objectives: After unification in 1990 the two parts of Germany underwent a complex process that has led to convergence of infant mortality. The pattern of change did, however, differ in east and west. This study investigates whether these differences conceal a complex pattern of heterogeneity at the regional level.

Health needs of the Roma population in the Czech and Slovak Republics.

In the growing literature on the human rights of Roma people in Central Europe, their relatively poor health status is often mentioned. However, little concrete information exists about the contemporary health status of the Roma in this region. We sought information on the health of the Roma in two of countries with significant Roma minorities, the Czech and Slovak Republics, by means of systematic searches for literature on the health of Roma people published in Czech or Slovak or by authors from the two countries.

[Social determinants of health. Basic facts and recommendations for practice within the context of the Health City Program].

Paper provides some basic information on selected social determinants of health that had been summarised in the process of creating, detailing, implementing and evaluating the European health policy led by WHO. The social areas discussed are: social gradient, stress, early life experiences, social exclusion, job control at work, unemployment, social support, addiction, food, and transport. We also present a brief summary of policy recommendations related to social determinants of health.

Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

The burden of disease due to injuries has elicited virtually no public health response in the countries of central and eastern Europe, even though injuries have long been a much greater problem in the east of Europe than in the west, with children especially affected. This paper seeks to identify factors that have inhibited policy development on this topic and to draw lessons for health policy development in this region more generally. Several factors emerge.

Maternal socioeconomic characteristics and infant mortality from injuries in the Czech Republic 1989-92.

Objectives: Infant and childhood mortality from injuries in Central and Eastern Europe is high but little is known about its determinants. This study examined whether maternal socioeconomic characteristics predict infant mortality from injuries in the Czech Republic.

Methods: Data on all live births registered in the Czech Republic 1989-91 (n=387 496) were linked with the national death register, 1989-92, using the unique national identification number.

[Health care needs and their assessment. Part 1. The role of health needs in the development, regulation and evaluation of the health care system].

The authors draw attention to the fact that higher spending on health care will not necessarily translate into better health. They advocate the importance of theoretical conceptual work and research in the field of health care and health services management. The needs-based approach is recommended as an alternative to the current models based on patient-physician interactions.

Social determinants of birthweight and length of gestation in Estonia during the transition to democracy.

Background: To investigate social variation in birthweight and length of gestation in Estonia in the period of transition to a democracy and market economy.

Methods: All live births resulting from singleton pregnancies reported to the Estonian Medical Birth Registry in 1992-1997 (n = 84, 629) were studied with respect to social variation in birthweight and preterm delivery (<37 weeks gestation). The results were adjusted for maternal age, parity, education, nationality, marital status, smoking in pregnancy, sex of the infant (and gestational age).

Neonatal and postneonatal mortality in Germany since unification.

Background: After unification, the gap in infant mortality rates between the two parts of Germany widened until 1996 before converging. The reasons for these changes have not, so far, been apparent.

Objectives: To investigate trends in neonatal and postneonatal mortality in the eastern (the new Länder) and western (the old Länder) part of Germany after unification in 1990 and to identify the scope for further improvement.

Defining and assessing health-related quality of life.

In recent years, there has been an increasing interest in quality of life assessment in clinical research and practice, as well as in public health and policy analysis. Indicators of health-related quality of life are important not only for health professionals and their patients, but also for health administrators and health economists in health care planning and policy making. Most studies on the outcome of treatments and interventions now include some kind of a quality of life measure.

Time trends in incidence of hypertrophic scarring in children treated for burns.

Control of burn-scar hypertrophy remains a priority program in the care of burned children. We analysed data from 779 clinical notes of children aged from 0 to 15 years who were hospitalised at the Burn Centre in Brno between 1991 and 1996. The occurrence of hypertrophic scarring in burn-injured children was studied by monitoring two periods separately, the first period from 1991 to 1993 and the second period with better clinical advantages from 1994 to 1996 using outpatients' records.

[Health care needs and their assessment. Part 2. The need for health and health care].

Health needs assessment is primarily concerned with the benefits that can be expected from the provision of different kinds of health services. These are closely related to the levels of health risks and illness in the population and the expected effectiveness of the service in reducing health risks and the consequences of illness as indicated by results of evaluative research or by clinical consensus. Levels of disease and health risks in a population are commonly referred to as needs for health, and the levels of expected benefit are referred to as the needs for services or care.

Social determinants of birthweight, ponderal index and gestational age in Sweden in the 1920s and the 1980s.

This study compared the effect of social class and marital status on birth outcomes in Sweden, using (i) data on all births at the Akademiska Hospital in Uppsala from 1920 to 1924 with socioeconomic information from records at birth; and (ii) a linkage of the Medical Births Registry for all births in Sweden in November/December 1985 to the 1985 Census. Preterm births (<37 weeks) have become less common during the 20th century. Between 1920-24 and 1985, mean and median birthweight increased, as did mean ponderal index, indicating a shift to the right of the birthweight and ponderal index distributions.

Is the effect of low birth weight on cardiovascular mortality mediated through high blood pressure?

Objective: To explore whether the inverse association between birth weight and mortality from circulatory diseases is mediated through blood pressure in men aged 50-75 years.

Design: Cohort study with retrospectively collected data on size at birth.

Subjects And Setting: The study included 1334 men born during 1920-1924, living in Uppsala, Sweden, who were examined at the ages of 50 and 60 years, and followed-up to the end of 1995.

Increasing social variation in birth outcomes in the Czech Republic after 1989.

Objectives: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989.

Methods: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records.

Results: Mean birthweight fell from 3,323 g to 3,292 g (P < .

Neonatal mortality in the Czech Republic during the transition.

Objectives: To identify factors underlying the reduction in neonatal mortality in the Czech Republic during the 1990s and to identify scope for further improvements.

Design: Examination of trends in birth weight and birth weight specific neonatal mortality in the Czech Republic and comparison with figures from Sweden, which has one of the lowest neonatal mortality rates in Europe.

Setting: The Czech Republic.

Reduced fetal growth rate and increased risk of death from ischaemic heart disease: cohort study of 15 000 Swedish men and women born 1915-29.

Objective: To establish whether fetal growth rate (as distinct from size at birth) is associated with mortality from ischaemic heart disease.

Design: Cohort study based on uniquely detailed obstetric records with 97% follow up over the entire life course and linkage to census data in adult life.

Subjects: All 14 611 babies delivered at the Uppsala Academic Hospital, Sweden, during 1915-29 followed up to end of 1995.

[Assessment of health needs, their geographic distribution and association of health care indicators in Districts within the Czech Republic].

Background: The objective of the present study was to use available data provided by the programme Health Services Indicators (HSI) for partial analyses focused on the estimated health services needs in different districts of the Czech Republic (CR) and on evaluation of some intentions of the health policy.

Methods And Results: After evaluation of the standardized and gross mortality rates in different districts of the CR the authors evaluated relationships of selected indicators recorded in 1995. The correlation of the gross mortality as an orientational estimate of health services needs in different districts of the CR and expenditures of health insurance companies for health care per one insured subject was low and was not statistically significant (r = -0.

Social variation in size at birth and preterm delivery in the Czech Republic and Sweden, 1989-91.

All livebirths resulting from singleton pregnancies reported to the Czech (n = 380,633) and Swedish (n = 351,775) birth registries in 1989-91 were studied with respect to social variation in birthweight, ponderal index (weight/length at birth3) and preterm delivery. The mean birthweight was significantly lower in the Czech population (3310 g vs. 3522 g, P < 0.

Size at birth and hypertension in longitudinally followed 50-70-year-old men.

We investigated the relationship between weight at birth and the prevalence of hypertension (defined as treatment and/or systolic blood pressure > 160 mmHg) at ages 50, 60 and 70 years in a cohort of Swedish men followed longitudinally, in which we had previously found a strong inverse association of birthweight with blood pressure at age 50. In men of above median adult height (> 176 cm), a 1000 g decrease in birthweight was associated with an odds ratio for hypertension of 2.53 (95% CI 1.