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P Velebil

Publications and source records attributed to P Velebil.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Reproductive health in women in the Czech Republic 1993-1997. I. Study methodology and characteristics of the sample groups].

AIM OF THE STUDY: To identify changes in reproductive health status as a consequence of changes in the system of health care and social affairs. THE AIM OF THIS PART OF STUDY: To prepare the methodology of data collection and to identify changes of demographic characteristics. TYPE OF THE STUDY: Retrospective comparative epidemiological study. INSTITUTION: Institute for the Care of Mother and Child, Praha 4-Podolí. METHODS: Two nation-wide surveys on reproductive health of representative three-stage cluster samples in 1993 and 1997. After selection of residential sites from all districts the households were selected for interview. One hundred and fifty trained interviewers asked selected women of reproductive age (4,497 in 1993 and 1,735 in 1997) questions according to a special questionnaire. The basic demographic characteristics of the two samples were compared with the 1991 Census data. The 1993 Czech Republic Reproductive Health Survey was funded by the United States Agency for international Development via a WHO agreement; the 1997 Survey was funded by the Czech Statistical Office and Ministry of Health. RESULTS: The age structure is very similar in the 1993 sample and in the 1991 Census data, however, there is a remarkably lower proportion of women 15-19 years of age in the 1997 sample. According to the marital status, the 1997 sample has a higher proportion of women living in partner-strip and divorced women. The 1997 sample has a higher proportion of women with only one child and there were fewer women with 4 and more children. Also the proportion of women with secondary education with higher school certificate was higher in the later sample. CONCLUSION: This part of the study evaluate a changes in four demographic characteristics of women of reproductive age, because these changes could influence the reproductive health indicators (contraception, induced abortions), which are the subject of further analysis.

Adolescent↗
PubMed2000

[Reproductive health in women in the Czech Republic 1993-97. II. Contraception].

THE AIM OF THE STUDY: To identify changes in reproductive health status as consequence of changes in the system of health care and social affairs. THE AIM OF THIS PART OF STUDY: To identify changes in use of different contraceptive methods among women of reproductive age in the Czech Republic. TYPE OF THE STUDY: Retrospective comparative epidemiological study. NAME AND ADDRESS OF THE INSTITUTION: Institute for the Care of Mother and Child Praha 4--Podolí. METHODS: Comparison of data on contraceptive use among women of reproductive age from two representative national surveys (see the first part of the study). Analysis was done by demographic characteristics using programs developed by the Centers for Disease Control, Atlanta, Georgia, U.S.A. RESULTS: There was no difference in proportion of women using one of four methods of contraception in 1993 sample and in 1997 sample (60%), however, there was change in their order. While the most frequently used method in 1993 sample was withdrawal (18.6% out of 60% of contraceptive users) and the pills were the last used method (7.7%), the order in 1997 sample was just opposite (pills 23.9%, withdrawal 6.7%). The proportion of condom and IUD users remained practically unchanged. With decline of withdrawal users, the proportion of other three methods increased from 37% to 52% (out of 60% of contraceptive users). The hormonal contraception was preferred method among women with higher education, while condom was the most popular among women with occasional intercourse or women with different partners (single women, women without children, divorced women). CONCLUSION: The withdrawal and condom users were the more frequent methods of contraception in 1993 sample versus two other methods (ratio 2:1), while this has changed in 1997 sample in favor of IUD and hormonal contraception users (ratio 3:2). We could conclude that the responsibility for contraception has been transferred from men to women.

Adolescent↗
PubMed2000

[An innovation in the Report on the Parturient].

Introduction of the form "Report on Parturient" in 1991 as a part of National Health Information System and annual national analyses of the data contributed to the improvement of obstetrical care. Such improvement impacted on decrease of maternal and perinatal mortality. Advances in obstetrical diagnostic procedures during last 8 years and new WHO form Basic Information Sheet (BIS), recommended for use in Europe for unified recording of selected indicators of perinatal care, created need to innovate the "Report on Parturient". The 5-year development of the WHO BIS under the international WHO Project OBSQID (two workers from the WHO Collaborating Center of the Institute for the Care of Mother and Child contributed to that activity) is described. Also, the collaboration with the Office of Health Statistics and Information, which resulted in innovation of "Report on Parturient" is mentioned. The new form "Report on Parturient" compatible with the WHO BIS will come to use the 1st of January 2000.

Female↗
PubMed2000

[Development of reproductive health in women in the Czech Republic 1993-1997. III. Induced abortion].

OBJECTIVE: To analyze the effect of changes in system of health and social care on reproductive health of women. In particular to analyze the changes in frequency of induced abortions as a basis for evaluation of changes in contraceptive use. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4--Podolí. METHODS: The database of the Czech Office of Health Statistics and Information was used. Besides comparison of absolute numbers of induced abortions we used international criteria "Abortion rate" and "Abortion ratio". These parameters were compared with maternal age, marital status, level of education, and number of children. RESULTS: Since the legislature on induced abortions came into effect till 1991 the annual variations of the number of induced abortions in the Czech Republic were inverse to changes in number of births due to current fertility. However, since then the number of abortions has been decreasing while the number of births was also decreasing. Using the abortion ratio as a measure, we were able to observe the decrease from 34.3 to 29.1% during 1993-1997, however the later value is still higher than in developed world. According to the selected social-demographic parameters of women we have seen the highest decrease of absolute number of abortions among married women, women with two children, and women with secondary education. According to the number of abortions per 1000 women of reproductive age there has also been decrease among married women, however also among women 15-19 year and among women with university education. The smallest decrease of abortion rate has been observed among single women. CONCLUSIONS: In this part of the study we analyzed the decrease of induced abortions during 1993-1997 related to four selected social-demographic characteristics of women of reproductive age. Our results will be used for further analyses of relationship of contraception and induced abortions during the specified period. Such analysis is a subject of separate study.

Abortion, Induced↗
PubMed2000

[Development of reproductive health in women in the Czech Republic 1993-1997. IV. Relation between contraception and induced abortion].

OBJECTIVE: Overall objective is to detect changes in reproductive health of women due to changes in the system of social and health care. The particular objective of this part of the study (part IV) is to identify the changes in the relationship of decreasing number of induced abortions and increased use of contraception in 1997 compared to 1993. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4--Podolí. METHODS: Input data for the comparison of number of induced abortions and extent of contraceptive use came from the results of two previous parts of the study (parts II and III). The relationship of contraceptive use and induced abortions was analyzed with regard to possible effect of concurrent development of selected social-demographic factors. RESULTS: The highest decrease of absolute number of induced abortions, together with higher-than-average decrease of absolute number of women not using one of three effective methods of contraception, was among married women, women with two children and women with secondary education without exam. On the opposite, the highest relative decrease of women not using one of the three contraceptive methods was among women 20-24 year of age, women without children and women with university education, although such change was not reflected in relative decrease of number of induced abortions in these groups. Furthermore, their relative decrease was even smaller than the national average. Similarly, the highest relative decrease of number of induced abortions among divorced women and women 25-29 year of age was linked with less-than-average decrease of number of women not using one of three effective methods of contraception. CONCLUSIONS: Different values of changing relationship of contraception and induced abortions in relation to analyzed social-demographic factors during period of observation document the influence of these factors without dispute. Due to complex influence of these factors on the relationship of contraception and induced abortions, the particular contribution of each of them is difficult to asses during simple analysis one-by-one.

Abortion, Induced↗
PubMed2000

[Trends in the reproductive health of women in the Czech Republic 1993-1997. V. International comparisons].

OBJECTIVE: 1) Overall objective is to detect changes in reproductive health of women due to changes in the system of social and health care. 2) The particular objective of this part of the study (part V) is to compare the incidence of induced abortions and contraceptive use in the Czech Republic and selected developed countries during last 20 years. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4-Podolí. METHODS: Input data for the Czech Republic use came from the results of the four previous parts of the study. The data from similar studies in selected countries were divided into two groups. Seven countries of Central Europe formed the first group, the second group consisted of 14 countries of Western and Northern Europe and 4 developed countries over-the-ocean. The both groups were ordered according to the reliability of reported data. RESULTS: The cause of higher number of induced abortions and lower number of women using effective contraception in the Czech Republic compared to other developed countries falls into sixties when different social approach towards induced abortion legislation and concurrent development of planned parenthood began. This is being documented by comparisons of data on use of induced abortions and contraceptive use among women of different age groups, while using internationally accepted indicators. Although the number of induced abortions did not change substantially in western countries during last 20 years (there has been even slight increase in some of them since 1993), the number of induced abortions in the Czech Republic decreased markedly, and this fact, together with increased use of contraception since 1993 led to decrease of difference in between these two variables, compared to western countries. CONCLUSIONS: The 2-3 fold higher number of induced abortions in the Czech Republic than in countries of the second group before 1993 decreased substantially; there were only 19.3 induced abortions per 1000 women in the Czech Republic in 1997 compared to average of 14.1 induced abortions in developed countries. Use of effective contraceptive methods is lower in the Czech Republic due to low use of sterilization.

Abortion, Induced↗
PubMed2000

[Occurrence of congenital defects in the Czech Republic from 1996 to 1999 in the offspring of mothers taking medications during the 1st trimester of pregnancy].

OBJECTIVE OF STUDY: Elaborate the results of recorded inborn defects in mothers taking drugs during the first trimester of pregnancy. TYPE OF STUDY: Retrospective analysis of data from register of inborn defects in the Czech Republic. METHOD: Elaboration of the incidence of selected types of inborn defects assessed in children born to mothers taking drugs during the first trimester of pregnancy. Data from the nationwide register of inborn defects kept in the Institute for Health Information and Statistics of the Czech Republic in 1996-1999 were used. From this total number 519 cases were recorded in born infants and 31 in foetuses. In born infants there were 215 affected girls and 304 affected boys. Some of the inborn defects were recorded more frequently in our material than in the remaining population. RESULTS: In 1996-1999 in our retrospective analysis a total of 550 cases of inborn defects were recorded in women taking medication during the first trimester of pregnancy. CONCLUSION: The paper presents recent results of the incidence of nationwide registration of inborn defects during a four-year period.

Abnormalities, Drug-Induced↗
PubMed2000

[Analysis of stillbirths in the Czech Republic in 1998].

OBJECTIVE: To identify the reasons for stagnation of stillbirth rate in the Czech Republic and to evaluate possibilities how to avoid some cases of stillbirth. SETTING: Institute for the Care of Mother and Child, Prague 4. DESIGN: Retrospective analysis of individual cases of stillbirth. METHODS: Retrospective analysis of all cases of stillbirth without congenital malformations in the Czech Republic during 1998 was performed by regional perinatologists according to unified guidelines. The analysis targeted the evaluation of perinatal management with respect to possible flaws in care and with respect to avoidability of stillbirth. We prepared a questionnaire to collect data with special attention to birthweight and type of the facility (level of care) where death occurred. The data collected were analyzed in the Institute for the Care of Mother and Child. RESULTS: Out of 252 cases of stillbirth (contribution to total perinatal mortality of 2.8 per 1000) only 0.2 per 1000 were among multiple pregnancies; 0.13 per 1000 were deaths during labor. We found mistakes in the content of care among 40% of cases, problems in organization of care were in every second case of stillbirth, and combination of both was frequent. Every sixth case of death had insufficient prenatal care due to pregnant women. Probable avoidability was higher among foetuses with birthweight of 2000 grams and higher. Cases of mistakes in care and avoidability was higher in terrain (out of hospital) in absolute terms, however, related to number of cared population, the mistakes and avoidability were higher in hospitals. This is related to higher concentration of complicated pregnancies in these facilities. CONCLUSIONS: Based on the final evaluation of possible avoidability of some cases of stillbirth we can conclude that even in the case of ultimate success of prenatal care the contribution of stillbirth to decrease of total perinatal mortality would not exceed 0.6 per 1000; the cost of such care would increase substantially.

Czech Republic↗
PubMed1999

[Perinatal care in the Czech Republic in 1997 and prospects for the near future--I. Nationwide analysis].

From an analysis of the four main components of perinatal mortality, participating in its gradual decline to the value of 5.1/1000 in 1997 ensued that the ratio of three of them, i.e. inborn defects incompatible with life, stillborn neonates with a birth weight of 2000 g or more and neonates with birth weight of 1000 g or more who die after delivery, declined in recent years only minimally despite the use of expensive diagnostic and therapeutic procedures, incl. the increased rate of Caesarean sections. A continual decline of morbidity was noted only in neonates weighing less than 1000 g due to the high percentage taken before delivery to perinatological centres and due to the marked decline of specific early neonatal mortality of these neonates in some of these centres. Improvement of this care in other centres is a reserve for a further decline of the perinatal mortality but only of the order of tenths pro mille. Therefore in future it will be necessary to change priorities and focus them on the effectiveness but also usefulness of expansive diagnostic and preventive and therapeutic procedures and on the long-term follow up of all risk neonates with the objective of early assessment and subsequent prevention of their perinatal morbidity.

Czech Republic↗
PubMed1999

[Perinatal care in the Czech Republic in 1997 and prospects for the near future--II. Regional analysis].

In interregional comparisons of different indicators of quality of perinatal care from the aspect of the importance of revealed differences, it is due to errors of small numbers (number of births per year) better to use instead of frequency analysis the developmental trend of these indicators in the course of several years. From a thus conducted analysis ensues that along with the continual decline of the general perinatal mortality in the majority of regions a marked interregional difference persists in the frequency of very low birth weight neonates as well as in the quality devoted to these neonates. The advantage of regional analyses, as compared with nationwide analyses, is the possibility to assess interrelations between some indicators, e.g. between general early mortality, the frequency of very low birthweight infants and their specific early neonatal mortality which reflects the quality of care of these neonates in the perinatological centre of the catchment area. In the region one of the important tasks of the centre are annual interinstitutional comparisons of quality of care, using selected indicators.

Congenital Abnormalities↗
PubMed1999

Proportion of caesarean sections and main causes of maternal mortality during 1978-1997 in the Czech Republic.

OBJECTIVE: To analyze changes in frequency of caesarean section in the Czech Republic during period 1978-1997. DESIGN: Descriptive epidemiology. METHODS, RESULTS, DISCUSSION, CONCLUSION: The total cohort of all maternal deaths was analyzed regarding the main causes of death and the mode of delivery. Since 1978, a systematic analysis of individual cases of maternal deaths has been performed, in terms of their causes, course and avertabiliy (446 direct, specific and indirect, unspecific deaths). Thromboemboly, which was the main cause of maternal mortality until 1993, factually ceased to occur in the last four years. Currently, hemorrhage is rated as the 2nd cause, followed by cardiovascular--and further post-surgical complications, toxicosis, infections etc. In 34% of all cases in the period beginning from 1978, we strictly stated inadequate medical procedures. These cases are analyzed at medical fora and, subsequently, disclosed and published, anonymously. The increase in the number of caesarean sections from 3.5% to 11.9% in the course of years 1978 to 1997 presents a remarkable share of maternal mortality in the CR. While the share of intra- and postnatal deaths in connection with CS was 44% in 1978-1990, in the years 1991-1997 it increased to 61%. Out of which, the number of deaths in direct relation with surgery increased from 22 to 29%. By means of nation-wide enforced prophylactics of tromboembolia and DIC, the lethality in direct relation with CS was reduced from 0.44% in the years 1988-90 down to 0.24% in the years 1991-97. Total lethality 0.49% in the last five years is 4.4 times higher than after a total number of deliveries, which is the main argument against further unreasonable growth of CS, and for improvement of general surgical conditions in the nation wide perspective.

Cause of Death↗
PubMed1998

[Prediction of pregnancy-induced hypertension in women with risk factors].

UNLABELLED: The objective of the presented work was to find possible predictive factors of pregnancy-induced hypertension (PIH) in women with the risk of gestational diabetes (GDM) during pregnancy. A group of women with the risk of development of gestational diabetes was selected because it is known that in women with GDM a hypertension is encountered 2-4 times more frequently than in women without disorders of glucose tolerance during pregnancy. The patients were divided into four groups with regard to the risk of development of hypertension. The examinations were made once during the 20th week of gestation. PIH is manifested in the great majority of patients only after the 20th week of pregnancy. All patients were normotensive at the time of examination. During the subsequent course of pregnancy in all patients the diagnosis of gestational diabetes and pregnancy-induced hypertension was investigated. The investigated parameters were fasting insulin levels during the 20th week of gestation, coagulation factors--antithrombin III (AT III), D-dimer, number of thrombocytes. The authors investigated also anamnestic data on the presence of type II diabetes and hypertension in close relatives of the patients. RESULTS: No differences were found in the insulin, antithrombin III and D-dimer levels nor in the number of thrombocytes. A significant relationship was revealed between the incidence of hypertension during pregnancy and the family history of the patient. In women where there was diabetes type 2 and hypertension in the family, there was a markedly more frequent incidence of pregnancy-induced hypertension after the 20th week of pregnancy (p > 0.0002) than in the other investigated groups.

Antithrombin III↗
PubMed1998

[Importance of anticardiolipin antibody screening in pregnancy].

We performed 1698 examinations of anticardiolipin antibodies (ACLA) among pregnant women with gestational age from 16 to 37 weeks of pregnancy during eleven months of 1996. The ACLA levels above normal range were found in patients with pregnancy induced hypertension, preeclampsia, gestational diabetes, diabetes mellitus type I, venous thrombosis, thrombocytopenia and rheumatological diseases. The following results show the possible relations between high ACLA levels and pregnancy induced hypertension and gestational diabetes. The screening test for ACLA is recommended as a supportive method for prenatal follow-up of pregnant patients.

Antibodies, Anticardiolipin↗
PubMed1997

Trends in hospitalizations for abnormal uterine bleeding in the United States: 1980-1992.

We examined trends in hospital discharges, length of hospital stay, and procedures performed for abnormal uterine bleeding from 1980 through 1992. We used data from the National Hospital Discharge Survey. Discharges involving patients with reproductive tract cancers or pregnancy-related diagnoses were excluded. The overall discharge rate for abnormal uterine bleeding decreased 66% during the study period, from 56 discharges per 10,000 women in 1980 to 19 per 10,000 in 1992. The discharge rate declined significantly for hospitalizations during which hysterectomy was not performed and remained relatively stable for hospitalizations with hysterectomy. Discharge rates decreased among all age and race groups and in all geographic regions. The percentages of discharges following hysterectomy steadily increased from 25% in 1980 to 72% in 1992. The average length of stay decreased significantly only for discharges for stays during which hysterectomy was performed, from 7.6 days in 1980 to 3.7 days in 1992. During the study period, abnormal uterine bleeding contributed to more than 5 million hospitalizations, 2 million hysterectomies, and 20 million hospital days. Our findings are consistent with a decreased likelihood of hospitalization for abnormal uterine bleeding if hysterectomy was not performed and shorter hospital stays for women undergoing hysterectomy for bleeding. These findings highlight the impact of abnormal uterine bleeding on the U.S. health care system.

Adult↗
PubMed1996

Pregnancy, abortion, and birth rates among US adolescents--1980, 1985, and 1990.

OBJECTIVE: To analyze pregnancy, abortion, and birth rates among US adolescent girls in 1980, 1985, and 1990. DESIGN: Retrospective analysis of trends in data on pregnancies, abortions, and births. POPULATION: US adolescent girls aged 13 to 19 years. MAIN OUTCOME MEASURES: Pregnancy, abortion, and birth rates (with and without adjustment for sexual experience) among teenaged girls aged 15 to 19 years and girls under 15 years. RESULTS: Although pregnancy rates among all teenaged girls 15 to 19 years old remained fairly stable from 1980 to 1985, they increased by 9% during the last half of the decade, totaling 95.9 pregnancies per 1000 teenaged girls 15 to 19 years old by 1990. Because rates of sexual experience increased even faster, pregnancy rates among sexually experienced teens aged 15 to 19 actually declined between 1980 and 1990 by approximately 8%. Abortion rates among these teens remained stable during the 1980s, with 35.8 and 36.0 abortions per 1000 in 1980 and 1990, respectively. As with overall pregnancy rates, abortion rates among these sexually experienced teenaged girls declined during the 1980s. Between 1980 and 1985, birth rates among teenaged girls aged 15 to 19 years declined by 4%, but they increased by 18% during the latter half of the decade, totaling 59.9 births per 1000 in 1990. Among these sexually experienced teenagers, birth rates also declined between 1980 and 1985 and then increased over the next 5 years. In 1990, pregnancies and abortions among girls younger than 15 years accounted for only 3% of all adolescent pregnancies and abortions. However, the number of births among these younger adolescents increased by 15% over the decade. In that age group, trends in pregnancy, abortion and birth rates over the decade were similar to those for older teens. However, during the late 1980s, the abortion rate declined and the pregnancy rate remained stable, resulting in a 26% increase in the birth rate. CONCLUSIONS: Despite efforts to reduce adolescent pregnancy in the United States, pregnancy and birth rates for that group continue to be the highest among developed countries. Considering that 95% of adolescent pregnancies are unintended, increased efforts to prevent these pregnancies are warranted.

Abortion, Induced↗
PubMed1996

[Results of reproduction and health research, the Czech Republic 1993: Part 1].

This article "deals with two basic spheres: natality (abortion rate) and family planning. Natality was evaluated by current indicators such as specific female birth rate, by age, aggregate fertility, and/or median age at birth of the first child." Women were also asked about contraceptive use, knowledge of contraceptive methods, and reasons for use or nonuse. (SUMMARY IN ENG)

Abortion, Induced↗
PubMed1995

Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States.

OBJECTIVE: To analyze reproductive-tract disorders that resulted in hospitalization of reproductive-age women in the United States. METHODS: Data from the National Hospital Discharge Survey for 1988, 1989, and 1990 were used to study women 15-44 years old who had any gynecologic diagnoses noted in their discharge summaries. RESULTS: Based on average annual discharge rates per 10,000 women, the five most frequent diagnostic groups were pelvic inflammatory disease (PID) (average annual rate 49.3, 95% confidence interval [CI] 43.6-55.0), benign cysts of the ovary (average annual rate 32.7, 95% CI 28.8-36.6), endometriosis (average annual rate 32.4, 95% CI 28.5-36.3), menstrual disorders (average annual rate 31.4, 95% CI 27.6-35.2), and uterine leiomyomas (average annual rate 30.4, 95% CI 26.7-34.1). The highest rates for PID were among women 25-39 years old and for women of races other than white. Highest rates for uterine leiomyomas were among women 40-44 years old and for women of races other than white. Highest rates for endometriosis were among women 40-44 years old and white women. Racial difference existed among all ages in the uterine leiomyoma and endometriosis groups. Average annual rates of benign cysts and menstrual disorders increased with age, but there were no statistically significant differences according to race in these two diagnostic groups. CONCLUSIONS: Our findings confirmed the importance of PID as a common cause of hospitalization among reproductive-age women and identified additional gynecologic conditions as causes for hospitalization as well. We found significant age and racial differences not only among women with discharge diagnoses of PID but also among those with discharge diagnoses of uterine leiomyomas and endometriosis.

Adolescent↗