Biomedical subjects
Publications and source records attributed to J Holcík.
Article presents the necessity of systematic enhancement of Public Health in the Czech Republic. Theoretical outlines of the basic development of medicine and health care are given, definition of Public Health and thesis of the EUPHA document (European Public Health Association) which concern developmental priorities of Public Health in Europe are presented.
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Paper responds to financial difficulties of the Czech health care system. Benefits and limitations of economics are presented together with the concept and role of quality, the significance of starting and target values of the health care system, necessity of excellent administration including definition of its critical domains. Based on partial and generally presented experience with the hitherto transformation of health care the necessity of permanent evaluation of efficiency of the introduced changes and significance of overall quality of the integrated health care system are discussed. As solutions for present difficulties author suggests broader use of material of the World Health Organization and modification of recommended policy in particular political, economical, cultural and social situation in the Czech Republic.
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. The authors refer to work which contributed to the evidence of the harmful impact of smoking on health. The World Health Organization contributes markedly to efforts to control smoking. The authors present brief information on the conference in Warsaw held in February 2002, they mention briefly data on smoking in Europe and the Czech Republic. They draw attention to the new strategy of the tobacco industry and appeal for joint and coordinated activities the objective of which would be to prevent health problems caused by smoking.
The pattern-reversal (P-VEPs) and the motion-onset (M-VEPs) of visual evoked potentials were modeled by means of three damped oscillators (O1, O2, O3) of identical construction. The O1, assumed to simulate the response of primary visual area (V1), was driven by the firing density of the lateral geniculate nuclei. 01 contributed mainly to the N75 and P100 peaks of the P-VEPs. The O2, driven by the O1 output, mimics the activity of V2, V3a, and MT. It contributed to the negative peak N145 of the P-VEPs or to the N160 in the M-VEPs. The O3 was suggested to model late slow processes probably of an attentive origin. The model parameters were set by optimization to follow the P-VEPs and M-VEPs obtained as a grand average of four young volunteers (Pz - A2 lead). The evoked potentials were described with normalized root mean square error lower than 13%.
The paper deals with evaluating quality of some orthogonal and pseudoorthogonal electrocardiographic lead systems as Frank lead system, signals derived from standard electrocardiographic leads by Levkov's transform and some signals of the standard 12 lead system that roughly fulfill condition of geometrical orthogonality. The signals of the lead systems were assessed by means of a mathematical criterion of two vector orthogonality which was originally proposed for purposes of electrocardiography and proved by Netusil. Experiments done with signals of the CSE database of short-time rest ECG records have revealed that the best ECG lead orthogonality has been found for signal sets of I-aVF-V2, and I-III-V2 leads, resp. Unfortunately nearly the worst results were obtained for the widely used Frank orthogonal lead system. It means that this lead system can lead (under some specific conditions) to missing diagnostically important information.
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. This information is relevant both for the development of the health services system and the system of health care and policy in a broader sense.
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. Published research on health of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. What limited evidence exists indicates that the health needs of the Roma population are considerable. With very few exceptions, the health status of Roma is worse than that of non-Roma population in both countries. The burden of communicable disease among Roma is high and diseases associated with poor hygiene seem to be particularly important. Evidence on health care suggests poor communication between Roma and health workers and low uptake of preventative care. The health needs of Roma lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf. Since 1989, Czech and Slovak researchers have largely turned away from health research on particular ethnic groups. This probably reflects a growing sensitivity about stigmatising Roma, but it also makes it difficult to know how their circumstances might be improved. There is a need for further research into the health of Roma people with particular emphasis on non-communicable disease and for interventions that would improve their health.
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.
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. The relationships between health needs, demands and health services provided should be further explored and their potential role as a basis for health policy in the Czech Republic should be addressed.
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. This usually takes a form of an assessment of symptoms and physical functioning, measurement of psychological well-being, life satisfaction, or coping and adjustment. Numerous scales of psychological health, physical health status and physical functioning have been developed for use in the assessment of health outcomes and a wide range of instruments for measurement of health-related quality of life is available. These fall into two broad categories of generic and disease-specific instruments. The selection of an instrument depends upon its measurement properties but also upon the specific context in which the instrument is going to be used. Adequate attention needs to be paid to the translation and validation of instruments for use across countries and cultural contexts.
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 < 0.001). The mean difference in birthweight between children of mothers with primary and university education was 197 g [95% CI 190, 205] in the Czech and 136 g [95% CI 128, 144] in the Swedish population, adjusted for maternal age, parity and sex of the infant. Mean birthweight was significantly higher in mothers who were married or lived with partners in both countries; the difference was 167 g [95% CI 161, 173] in the Czech Republic (CR) and 86 g [95% CI 78, 94] in Sweden, adjusted for age, parity and sex. The extent of social variation in ponderal index and frequency of preterm birth was also greater in the CR. Between 1989 and 1991, mean birthweight in the CR fell from 3323 g to 3292 g (P < 0.001) and the social differences increased, largely as a result of more rapid worsening in the lower socio-economic groups. There did not appear to be such a decline in birthweight in Sweden. We suggest that the fall in mean birthweight and the increasing social variation in birth outcome in the CR is related to decline and divergence in living standards in 1989-91.
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. SUBJECTS: All singleton births occurring in the Czech Republic in 1989-1991 and 1994-1995, with a comparison group of all singleton births in Sweden in 1989-1991. MAIN OUTCOME MEASURES: Neonatal mortality rate. RESULTS: Despite a slight worsening in the birth weight distribution, the neonatal mortality rate in the Czech Republic fell from 5.6 to 3.8 per thousand live births. This was due to an improvement in the survival of infants at all birth weights but especially amongst the lightest. Eighty percent of the overall improvement was due to greater survival among those under 2500 g. Comparison with Swedish birth weight specific rates indicates that, for the country as a whole, only small additional gains are likely as a result of improved survival at a given birth weight but, instead, a reduction in the proportion of low birth weight babies would have a much greater effect. Regional analysis indicates that the improvements have been much greater in Prague than in the rest of the country. CONCLUSIONS: An effective strategy to reduce neonatal mortality in the Czech Republic should have two elements. The first is to address the socio-economic determinants of low birth weight. The second is to reduce regional inequalities in the quality of neonatal care. This should, however, be supplemented by more detailed investigation to identify specific amenable factors.
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 = -0.062). A close correlation with expenditure of health insurance companies was found with the number of doctors (r = 0.894), the number of nurses (r = 0.842) and the number of hospital beds (r = 0.679). The number of population per general practitioner correlated only weakly with the expenditure of health insurance companies (r = 0.012). A marked correlation (r = -0.676) was found between the percentage of general practitioners from the total number of doctors in the district and expenditures of the health insurance companies. CONCLUSIONS: The authors recommend that the role of general practitioners in the system of health care should be appreciated and that primary care should be conceived as the basis of effective, economical and high standard health care. It is desirable that HSI data should become the baseline of systematic operational research into health services.
Health, similarly as most health services, cannot be considered a common market commodity, to which apply laws governing industrial spheres. The baseline for selection and suitable application of economic mechanisms in health care must be a modern purposeful health policy and an information system, training and research, associated with it. The contribution made by provisions in health economics is also conditioned by the culture of management, the degree of democracy, the standard of professional training, respect of human values and sensitive control of ethical problems.
The author characterizes briefly the contemporary baseline situation of social medicine. He explains its three aspects--the methodical and cognitive approach, the orientation on values and attitudes and the formative and action component. The author emphasizes the integral concept and the necessity of a purposeful development of the mentioned discipline. The purpose of the article is to provide basic orientation in social medicine for discussion and creative work.
The authors describe the procedure, suggested by Kendall for evaluation of the concordance of several sequences. Kendall's coefficient, called also coefficient of concordance, can be used when it is possible to assess the sequence of investigated variables. The calculation procedure and interpretation of the coefficient is explained on a simple example. For evaluation of significance tables of critical values are presented for 1% and 5% levels of significance.
The submitted paper terminates the series of eight articles on the application of non-parametric methods in medicine, which were published in this journal in 1990-1991. Attention is drawn, on the one hand, to the urgent need of knowledge of mathematical and statistical methods, on the other hand, to the fact that proper processing of experimental data is not guaranteed by the use of computer technique alone, the complexity and numerical correctness of calculations but by interpretation of results and their plausibility which depends above all on the correctness of the reflections of the research worker. On a general level attention is paid to the description, comparison and evaluation of correlations, in particular the possibility to conclude from statistical correlation that a causal relationship exists. In the present as well as in previous articles the authors emphasize repeatedly that statistics are only one of the important tools of the doctor, but they cannot replace his responsibility, nor his professional experience.