Introduction: Individuals living in socially excluded localities (SEL) generally have worse health compared to the control group. This is caused by a combination of various risk factors. Goal: The aim of this study was to compare specific health parameters collected during field research focused on a population facing social exclusion. Methods: The group of 937 individuals consisted of 67% (n = 630) from SEL and 33% (n = 307) from a control area in the Moravian-Silesian Region. During the field work, volunteers filled out a questionnaire and had their blood pressure, body measurements, and total cholesterol levels checked. The data were analysed using non-parametric tests (alpha = 5%) and a binomial regression model with Stata v. 18 software. Results: The average age of the subjects was 45.4 +/- 16.0; 67% were women. Subjective assessment of health status as "very poor" was reported by 6.7% of individuals from SEL compared to 0.7% of controls. Approximately 65% of individuals from SEL suffered from one or more chronic diseases, primarily CVD (35%), musculoskeletal system diseases (25%), and respiratory system diseases (17%). Compared to the control group, individuals from SEL had elevated cholesterol, 27% versus 7% (p < 0.001), and 54% of individuals smoked compared to 20% of controls (p < 0.001). Statistically significant differences between SEL and the control group were found in education, unemployment, and healthcare accessibility. Conclusion: Among inhabitants of SEL, there is a higher risk of developing metabolic and cardiovascular diseases due to the more frequent occurrence of risk factors.

The highest concentrations of PM (particulate matter) in the Czech Republic are in the region of Ostrava and Karvina. One of the objectives of the project is to analyze the impact of ambient fine particles (PM1) on total and specific mortality for cardiovascular and respiratory causes in Ostrava. In the period 2018–2019, there were total (excluding S00-T98 and V01-Y98 according to ICD-10) of 7191 deaths, from these 3035 were cardiovascular (I00-99) and 536 respiratory causes (J00-99) of deaths in Ostrava (around 320,000 inhabitants). The daily PM1 concentrations were measured at three measurement stations. The generalized additive model (GAM) for Poisson distribution was used for the analyses; the “thin plate regression spline” was applied to smooth the pressure, relative humidity and an air temperature. The model was adjusted for meteorological conditions, incidence of acute respiratory infections, days off, the order of a day in a week. The calculations were done for lag0 to lag3 days. The results are presented as a

Particulate Matter (PM) air pollution is a serious concern in the northern Moravia region of the Czech Republic. This study aimed to evaluate the association between the risk of acute hospital admissions for cardiovascular (CVD) and respiratory diseases and PM2.5 concentrations using a geographic information system (GIS). The data on acute hospital admissions for cardiovascular (I00-99 according to ICD-10) and respiratory (J00-99) diseases was assigned to 77 geographical units (population of 601,299) based on the residence. The annual concentrations of PM2.5 in the period from 2013–2019 were assigned to these units according to the respective concentration iso-shapes. The Incidence Rate Ratio (IRR) and 95% confidence interval (CI) were calculated for each concentration category and then compared with the reference category. Statistical analyses were performed using SW STATA v.15. In 2013, approx. half of the population (56%) belonged to the PM2.5 category 34–35 µg·m−3, and 4% lived in PM2.5 concentrations ≥ 38 µg·m−3. During the analysed period, the average concentrations decreased from 30.8 to 21.4 µg·m−3. A statistically significant risk of acute hospitalization for CVD causes was identified in categories ≥ 36 µg·m−3, and for respiratory causes from 34–35 µg·m−3. With increasing concentrations, the risk of both acute cardiovascular and respiratory hospitalizations increased.

Suspendované částice (PM) se významně podílí na znečištění ovzduší, představují epidemiologickými studiemi potvrzené významné riziko onemocnění nebo předčasného úmrtí a zároveň jsou spojeny s ekonomickými ztrátami z celospolečenského pohledu. Přehledový článek přináší ucelený pohled na fyzikálně-chemické charakteristiky PM, mechanizmus jejich působení na lidský organizmus, shrnuje aktuální informace z expozičních studií, experimentálních studií na zvířatech i epidemiologických studií. Zároveň článek shrnuje současné možnosti a přístupy nadnárodních i národních institucí k ochraně zdraví obyvatel před účinky znečištění PM s očekávaným dalším snižováním zdravotně zdůvodnitelných referenčních hodnot, na které bude navázáno následné snižování limitů v legislativě národních států. Klíčová slova: prašné částice (PM), nemocnost, mortalita, rizika zdravotní, hospitalizace ZDRAVOTNÍ RIZIKA KRÁTKODOBÝCH EXPOZIC SUSPENDOVANÝM ČÁSTICÍM

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).

The number of HIV-positive people in the Czech Republic has trebled over the last decade. An educational programme aimed at the prevention of HIV and STDs in adolescents between 13 and 19 years of age is underway in the Moravian-Silesian Region in the Czech Republic. All schools in the region have been offered the chance to participate in the programme (on a voluntary basis). The programme consists of an educational lecture and a game with interactive elements; the students perform various tasks in groups. An anonymous paired questionnaire (input/output) was used to assess the efficacy of the programme. In order to evaluate the programme efficacy, descriptive statistics, non-parametric Wilcoxon paired test at the level of significance of 5%, and a model of logistic regression for a dichotomous variable were used. A total of 1210 students took part in the programme. The students’ knowledge improved, on average, by 15.5%. The highest efficacy was observed in the age group of 13–14-year-olds, where the improvement reached 17.9%. The educational programme was effective in raising awareness about STDs. Due to the observed increase in knowledge especially among the youngest participants (13–14 years old), we recommend aiming further interventions at the youngest age groups.

OBJECTIVES:The aim of the serological survey of measles was to obtain information on the prevalence of antibodies against measles and to verify the effectiveness of vaccination in the Czech population in order to protect public health.METHODS:The serological survey was carried out in the Czech Republic in 2013. Antibodies against measles were tested in 3,111 serum samples of participants aged 1-64 years. Serum samples were tested for the presence of immunoglobulin G (IgG) antibodies by enzyme immunoassay (EIA). The vaccination status assessment was based on the medical documentation. Seroprevalence differences were evaluated by sex and age using the Pearson's χ2 test at 5% significance level.RESULTS:The overall seroprevalence reached 93.0% (2,893/3,111) (95% CI 92.0-93.9). No statistically significant difference was found between men and women (p=0.724). A lower seroprevalence was identified in the first age group (1-year old children) 62% (62/100), as the vaccination has not yet been completed in this age group. The second lowest seroprevalence 80.4% (160/199) was identified in the age group of 35-44 years. The highest seroprevalence 97.7% (387/396) (95% CI 95.7-99.0) was in the population with naturally-induced immunity (age above 45 years). In the individuals with two doses seroprevalence reached 94.1% (2,081/2,212) (95% CI 93.0-95.0). The level of IgG antibodies decreased in persons above 7 years of age.CONCLUSIONS:Based on the results of the serological survey carried out in 2013 in the Czech Republic, it has been decided to postpone the second MMR (measles, mumps and rubella) dose to the age of 5-6 years.

BACKGROUND AND AIMThe 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.METHODThe 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.RESULTSA 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.CONCLUSIONSThe observed significant relationship between hospital admissions for respiratory causes was consistent with the results of large European and American studies.

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.

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.

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.

Současná úroveň znečištění ovzduší prachovými částicemi do 10 μm (PM10) je spojována se zvýšením nemocnosti a úmrtnosti. Město Ostrava je jednou z oblastí se zhoršenou kvalitou ovzduší a s častými smogovými situacemi v zimních měsících. Pro zhodnocení teoretického dopadu smogové epizody 2010 na celkovou úmrtnost, hospitalizace z kardiálních a respiračních příčin, výskyt symptomů dolních cest dýchacích u zdravých dětí a dospělých s chronickým respiračním onemocněním a počtu dnů s omezenou aktivitou byla použita metodika výpočtu atributivních proporcí doporučená WHO. Atributivní proporce vyjadřuje proporci případů, ke kterým dojde vlivem krátkodobě zvýšených koncentrací PM10. Smogová situace z roku 2010 byla porovnána se smogovou epizodou v roce 2009. Výsledky ukázaly, že úroveň znečištění ovzduší PM10 při smogové situaci ve městě Ostravě v roce 2010 může být spojována s téměř dvojnásobně vyšší odhadovanou proporcí případů pro všechny hodnocené zdravotní ukazatele ve srovnání se smogovou situací v roce 2009. Kvantifi kace tzv. excesivní úmrtnosti a nemocnosti ve vztahu ke znečištění ovzduší může být významným nástrojem pro orgány státní správy z hlediska přijímání opatření ke zlepšení kvality ovzduší, a tím i snižování zdravotních rizik pro obyvatele. Klíčová slova: koncentrace PM10, úmrtnost, nemocnost, atributivní proporce, smogové epizody

Soucasna uroveň znecistěni ovzdusi prachovými casticemi do 10 μm (PM10) je spojovana se zvýsenim nemocnosti a umrtnosti. Město Ostrava je jednou z oblasti se zhorsenou kvalitou ovzdusi a s castými smogovými situacemi v zimnich měsicich. Pro zhodnoceni teoretickeho dopadu smogove epizody 2010 na celkovou umrtnost, hospitalizace z kardialnich a respiracnich přicin, výskyt symptomů dolnich cest dýchacich u zdravých děti a dospělých s chronickým respiracnim onemocněnim a poctu dnů s omezenou aktivitou byla použita metodika výpoctu atributivnich proporci doporucena WHO. Atributivni proporce vyjadřuje proporci připadů, ke kterým dojde vlivem kratkodobě zvýsených koncentraci PM10. Smogova situace z roku 2010 byla porovnana se smogovou epizodou v roce 2009. Výsledky ukazaly, že uroveň znecistěni ovzdusi PM10 při smogove situaci ve městě Ostravě v roce 2010 může být spojovana s teměř dvojnasobně vyssi odhadovanou proporci připadů pro vsechny hodnocene zdravotni ukazatele ve srovnani se smogovou situaci v roce 2009. Kvantifikace tzv. excesivni umrtnosti a nemocnosti ve vztahu ke znecistěni ovzdusi může být významným nastrojem pro organy statni spravy z hlediska přijimani opatřeni ke zlepseni kvality ovzdusi, a tim i snižovani zdravotnich rizik pro obyvatele.

ISEE-0042 Background and Objective: Lung cancer (ICD-C34) mortality risk was confirmed to be correlated with area socioeconomic deprivation in a previous study. Standardized mortality index (SMR) in geographical areas with a small numbers of inhabitants is not stable therefore Bayesian models were used for detailed exploration of spatial clustering and variation allowing also evaluation of socioeconomic deprivation effect on SMR. Methods: Lung cancer mortality risk (SMR) in men in 22 smaller geographical units (ORP) of the North-Moravian Region (total population 1.2 mil.) and census based socioeconomic deprivation index (SESDI) on ORP level entered into the analysis. Bayesian models for relative risk of lung cancer smoothed according average risk in the Czech Republic, in the North-Moravian Region and average risk in the neighbour ORPs were applied using software WinBugs v. 4. Convolution regression model was used for analysis of SESDI effect on SMR. ArcView v. 3 was used for visualisation of results. Results: SMR in specific ORPs varied in range from 0.40 to 2.25. Using Bayesian methods the relative risk varied in range from 0.82 to 1.25 for all models. ORPs were divided into 3 categories according the relative risk (<0.97; 0.97–1.03; >1.03) and also into 3 categories of deprivation according SESDI. The results of regression model confirmed effect of deprivation on lung cancer mortality risk in 20 ORPs; at least 9 % of SMR variability was explained by the level of area deprivation. Conclusion: Estimates of mortality or morbidity risk in areas with a small number of population are more precise using Bayesian methods than those without smoothing. Acknowledgement: This study was realized within the program EUREKA (E!3751 ISTAHIS). “New information tools for analysis of health data in managerial information systems (2007–2009)”.