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Featured researches published by Ales Kubena.


Journal of Infection in Developing Countries | 2014

Antibiotic use and knowledge in the community of Yemen, Saudi Arabia, and Uzbekistan

Tatyana Belkina; Abdullah Al Warafi; Elhassan Hussein Eltom; Nigora Tadjieva; Ales Kubena; Jiri Vlcek

INTRODUCTION Inappropriate use of antibiotics has resulted in a dramatic increase of antimicrobial resistance in developing countries. We examined knowledge, attitudes, and practices of antibiotic use in three Asian countries. METHODOLOGY A nationwide cross-sectional study of teachers in large cities of Yemen, Saudi Arabia, and Uzbekistan was conducted. A random sample of 1,200 teachers was selected in each country. Data were collected through a questionnaire-based survey and then analyzed using descriptive and multivariate statistical methods. RESULTS The prevalence of non-prescription antibiotic use ranged from 48% in Saudi Arabia to 78% in Yemen and Uzbekistan. Pharmacies were the main source of non-prescribed antibiotics. The most common reasons for antibiotic use were cough (40%) and influenza (34%). Forty-nine percent of respondents discontinued antibiotics when they felt better. Although awareness of the dangers of antibiotic use correlated inversely with self-medication, understanding of the appropriate use of antibiotics was limited. CONCLUSIONS The prevalence of antibiotic self-medication in the educated adult population in the studied countries was found to be alarmingly high. Effective strategies involving regulatory enforcement prohibiting sales of antibiotics without prescription should be implemented along with educational interventions for health professionals and the public.


European Journal of Endocrinology | 2011

The effect of timing of teriparatide treatment on the circadian rhythm of bone turnover in postmenopausal osteoporosis

Maria Luchavova; Vit Zikan; Dana Michalska; Ivan Raška; Ales Kubena; Jan J. Stepan

BACKGROUND We hypothesized that with the administration of teriparatide (TPTD) treatment at different times, we would be able to modify the physiological circadian rhythm of bone turnover. METHODS The concentration of serum C-terminal telopeptide of collagen type I (βCTX), serum N-terminal propeptide of procollagen type I (P1NP), serum ionized calcium (iCa), and plasma PTH were measured every 3 h over a 24 h period in 14 postmenopausal osteoporotic women (aged 72.4±9.3 years) treated with 20 μg TPTD for long term, given at different times of the day. General linear model-repeated measurements (GLM RM) were performed to analyze the circadian rhythms as well as intergroup comparisons. RESULTS GLM-RM for both related groups showed a significant influence of time of day on all measured variables except P1NP. The analysis for each group separately provided a powerful model for βCTX (P<0.001, η(2)=0.496), serum iCa (P<0.001, η(2)=0.423), plasma PTH (P<0.001, η(2)=0.283), and serum PINP (P<0.001, η(2)=0.248). While the evening TPTD treatment showed a marked circadian rhythm for serum βCTX, the morning TPTD treatment rather suggested circasemidian rhythm. The P1NP rhythm followed a much smaller amplitude of the rhythm than βCTX. Changes in serum iCa were positively related to changes in serum βCTX (P<0.001) and negatively related to changes in PTH (P<0.001). CONCLUSION Timing of TPTD administration may significantly change the 24 h variation in bone turnover markers as well as calcium-parathyroid axis in postmenopausal osteoporotic women.


Pharmacy World & Science | 2007

Impact of a multidisciplinary approach on antibiotic consumption, cost and microbial resistance in a Czech hospital

René Mach; Jiri Vlcek; Miroslava Prusova; Petr Batka; Vladan Rysavy; Ales Kubena

ObjectiveThe study objective was to evaluate the impact of a restrictive antibiotic policy, efficacy of inpatient therapeutic and prophylactic antibiotic regimens and susceptibility patterns of infecting bacteria in 2000–2004.SettingA 500-bed general hospital in the Czech Republic.MethodA retrospective computerized survey of antibiotic prescribing practices over a five-year period 2000–2004, using medical records and laboratory data from the hospital information system (HIS).Main outcome measureConsumption of antibiotics expressed in defined daily doses (DDDs) and Euros per 1,000 bed days. Resistance to antibiotics, average length of hospital stay, rate of inpatients treated with antibiotics, number of nosocomial infections per 1,000 bed days, median length of hospital stay and total mortality.ResultsDue to a restrictive antibiotic policy implemented in 2002, the use of several antibiotics in 2003 was significantly reduced but the consumption of several other antibiotics rose in 2003. In comparison with 2001 the cost of antibiotic agents (in € per 1,000 inpatient days) fell significantly by 31% in 2003 (€ 969.07 vs. € 671.34). The hospital saved about € 29,288 after the first year of implementation of the new antibiotic policy. The use of restricted antibiotics increased by 8%; however, the expenditure decreased by 26%. For non-restricted antibiotics, the use and expenditure decreased by 71% and 41%, respectively. Consequently, a net reduction of 55% (€ 804.36 vs. € 359.36) was achieved.ConclusionThe intervention was effective in reducing the use and cost of antibiotics. The HIS is a helpful tool for observing and evaluating the impacts of the measures taken and can be used for assessment of pharmacotherapy outcomes.


Patient Preference and Adherence | 2013

Adherence in adults with type 1 diabetes mellitus correlates with treatment satisfaction but not with adverse events

Tereza Hendrychova; Magda Vytrisalova; Alena Smahelova; Jiri Vlcek; Ales Kubena

Purpose Diabetes self-care and self-monitoring adherence has a positive effect on the metabolic control of the disease. The aim of this study was to analyze the adherence to self-care recommendations and to identify its correlates in adults with type 1 diabetes mellitus. Patients and methods One hundred and eleven patients with type 1 diabetes were enrolled in an observational cross-sectional study conducted at the Diabetes Center of the University Hospital in Hradec Králové, Czech Republic. Diabetes self-care adherence was measured by the Self Care Inventory-Revised, and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire-status version. Additional data were collected from self-administered questionnaires and medical records. The Mann–Whitney test, Spearman correlations, and multiple linear regressions were used in the statistical analysis. Results The mean age of patients was 42.4 years; 59.5% of them were females and 53.2% of all patients used an insulin pump. The mean glycosylated hemoglobin (HbA1c) was 66.2 ± 15.3 mmol/mol and the mean insulin dosage was 0.6 ± 0.3 IU insulin/kg/day. The number of hypoglycemic episodes (including severe) that patients had in the last month before taking the survey was 3.6 ± 3.2. Self-care adherence was associated with treatment satisfaction (0.495; P = 0.004) along with frequency of self-monitoring of before meal blood glucose (0.267; P = 0.003). It was not associated with the incidence of hypoglycemic events or any other insulin therapy-related problems or with socio-demographic or clinical characteristics. Conclusion Treatment satisfaction is one of the key factors that need to be targeted to maximize benefits to patients. Self-care adherence in adults with type 1 diabetes did not correlate with socio-demographic and clinical characteristics, nor with adverse events.


Environmental Science & Technology | 2014

The Fate of Atmospherically Derived Pb in Central European Catchments: Insights from Spatial and Temporal Pollution Gradients and Pb Isotope Ratios

Leona Bohdalkova; Martin Novak; Marketa Stepanova; Daniela Fottova; Vladislav Chrastny; Jitka Mikova; Ales Kubena

Soils in polluted regions are generally regarded as a delayed, long-lasting source for Pb contamination of aquatic systems. Lead deposited on topsoil is slowly transported downward with particulate and colloidal organic matter, driven by infiltrating precipitation. Then, Pb is tightly retained in mineral soil. Lead export from catchments is extremely low and decoupled from the atmospheric input. We tested this hypothesis in 11 small catchments, differing in pollution levels. Input/ouput Pb fluxes were monitored for 14-15 years in an era of decreasing industrial Pb emission rates. Between 1996/1997 and 2010, Pb deposition fluxes decreased significantly, on average by 80%. At the beginning of the monitoring, Pb export constituted 2 to 58% of Pb input. At the end of the monitoring, Pb export constituted 2 to 95% of Pb input. Highly polluted sites in the northeast exported significantly more Pb than less polluted sites further south. The (206)Pb/(207)Pb isotope ratios of runoff (1.16) were identical to those of topsoil and present-day deposition, and different from mineral soil and bedrock. Lead isotope systematics and between-site flux comparisons indicated that a portion of the incoming Pb had a relatively short residence time in the catchments, on the order of decades.


Journal of Evaluation in Clinical Practice | 2010

Osteoporosis risk assessment and management in primary care: focus on quantity and quality

Sarka Blazkova; Magda Vytrisalova; Vladimir Palicka; Jan J. Stepan; Svatopluk Byma; Ales Kubena; Tomas Hala; Jiri Vlcek

INTRODUCTION AND HYPOTHESIS Early identification of high-risk patients by general practitioners (GPs) plays the key role in the management of osteoporosis (OP). METHODS We conducted a postal questionnaire survey among 1500 Czech GPs to examine their behaviour related to OP. RESULTS The overall questionnaire return rate was 38%. The respondents (mean age 52 years; 61.5% women) did not differ from non-respondents. OP knowledge correlated negatively with age (P<0.001). The most common reason for both suspicion of OP and referral for suspected OP is the patients complaints. When the initial skeletal examination for suspected OP is conducted on the GPs initiative, it is most often X-ray (76%) followed by osteodensitometry (61%). The respondents address five patients (median) per month about this issue. The number of referrals to a specialist for suspected OP during the last quarter was 5 (median). The most commonly reported barriers to OP management were financial limits set by the health insurance agency (71%) and lack of authorization to prescribe selected drugs (71%). CONCLUSIONS The GPs should pay greater attention to risk factors and be more active in the detection of at-risk patients. It is necessary to motivate the GPs and to overcome the barriers to effective clinical practice.


Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia | 2014

Incidence of intravenous drug incompatibilities in intensive care units

Ondrej Machotka; Jan Manak; Ales Kubena; Jiri Vlcek

AIMS Drug incompatibilities are relatively common in inpatients and this may result in increased morbidity/mortality as well as add to costs. The aim of this 12 month study was to identify real incidences of drug incompatibilities in intravenous lines in critically ill patients in two intensive care units (ICUs). METHODS A prospective cross sectional study of 82 patients in 2 ICUs, one medical and one surgical in a 1500-bed university hospital. One monitor carried out observations during busy hours with frequent drug administration. Patients included in both ICUs were those receiving at least two different intravenous drugs. RESULTS 6.82% and 2.16% of drug pairs were found to be incompatible in the two ICUs respectively. Among the most frequent incompatible drugs found were insulin, ranitidine and furosemide. CONCLUSIONS The study showed that a significant number of drug incompatibilities occur in both medical and surgical ICUs. It follows that the incidence of incompatibilities could be diminished by adhering to a few simple rules for medication administration, following by recommendations for multiple lumen catheter use. Future prospective studies should demonstrate the effect of applying these policies in practice.


Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia | 2012

Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

Veronika Krnacova; Ales Kubena; Karel Macek; Martin Bezdek; Alena Smahelova; Jiri Vlcek

AIMS To evaluate the incidence of severe hypoglycaemia (SH) requiring the assistance of Emergency Medical Services (EMS) in the general population of the Hradec Králové region, in a 1 year period; to describe the distribution of these events throughout the day, and to analyse the symptoms and causes. METHODS The outcome data were obtained from special forms which were filled in by EMS medical staff. Incidence of SH was calculated and the distribution of events throughout the day was analysed using contingency tables. The relationship between blood glucose levels and the presence or absence of causes and symptoms of hypoglycaemia was evaluated using a general linear model and the regression tree technique. RESULTS In all, a total of 338 events of SH were recorded in 262 patients. 150 episodes appeared in type 2 diabetic patients, 83 episodes in type 1 diabetic patients. 258 events were documented in insulin-treated patients. The incidence of SH was 2.4 and 0.4 episodes/100 patients/year for type 1 and type 2 diabetic patients, respectively. A significantly greater number of hypoglycaemic episodes was documented between 2 pm and 6 pm (P<0.001). Insulin therapy and alcohol consumption were the most dangerous causes of SH. CONCLUSIONS Hypoglycaemia requiring the assistance of EMS represents an essential problem, especially in type 1 diabetic patients. The percentage of SH is comparable to other frequent diagnoses requiring the assistance of EMS in the region. This study reflects the behaviour of diabetic patients and highlights information which is important in the prevention of SH.


Central European Journal of Medicine | 2014

Opinions of Czech general practitioners on generic drugs and substitution

Martin Dosedel; Josef Maly; Ales Kubena; Jiri Vlcek

The aim of the study was to map and analyze general practitioners` opinions of, attitudes towards and experiences with generic drugs and generic substitution (GS) in the Czech Republic. General practitioners (GPs) who took part in the annual and regional professional conferences of the Society of General Practice in the period from November 2008 until March 2009 were asked to complete the 28-item questionnaire concerning the issue of generic drugs and GS. Questions were organized in 5 sections aimed at assessing the attitude towards GS, understanding the legislation and opinions on statements related to GS. All data were analyzed using descriptive statistics and correlations were tested by selected parametric and non-parametric tests. Total of 263 completed questionnaires were returned (mean age of 52.2 years (SD=13.7), 177 (67.3%) females and 248 (94.3%) GPs having a practice specialization). 99 (37.6%) respondents have considered generic drugs to be bioequivalent to the respective brand name drugs. 121 (46.0%) respondents believed that generic drugs are of lower quality than brand name drugs. None of respondent showed acquaintance with all the legal rules for GS. Awareness of the legislation and attitude towards GS correlated with the age (p<0.001). In conclusion, distrust among GPs in generic drugs derives from poor knowledge and personal experiences.


Patient Preference and Adherence | 2013

An analysis of fat-related and fiber-related behavior in men and women with type 2 diabetes mellitus: key findings for clinical practice

Tereza Hendrychova; Magda Vytrisalova; Jiri Vlcek; Alena Smahelova; Ales Kubena

Background Despite the efforts of health care providers, adherence of patients with type 2 diabetes to the recommended diet is poor. The aim of this study was to describe the eating habits with emphasis on fat and fiber-related behavior (FFB) as well as the relationship between FFB behavior and parameters of diabetes control in men and women with type 2 diabetes mellitus. Methods The subjects in this observational cross-sectional study were 200 patients (54.5% male, mean age 66.2 ± 10.1 years, mean Diabetes Control and Complications Trial [DDCT] glycosylated hemoglobin [HbA1c] 7.6% ± 1.7%) recruited from diabetes outpatient clinics in the Czech Republic. The subjects filled out the Fat- and Fiber-related Diet Behavior Questionnaire. The most recent patient data on diabetes control and drug therapy were derived from patient medical records. Results Patients tend to modify the dishes they are used to, rather than remove them completely from their diet and replace them by other types of foods. It is easier to perform healthier fat-related behaviors than fiber-related ones. Women scored significantly better than men on the fat-related diet habits summary scale (P = 0.002), as well as on “modify meat” (P = 0.001) and “substitute specially manufactured low-fat foods” (P = 0.045) subscales. A better score on the fat-related diet habits summary scale was significantly associated with higher HbA1c (ρ = −0.248; P = 0.027) and higher waist circumference (ρ = −0.254; P = 0.024) in women. Conclusion Type 2 diabetes patients are likely to vary in their FFB behavior, and their dietary habits depend on gender. Health care professionals should pay attention to these facts when providing specific education. Emphasis should be placed on how to increase the fiber intake in diabetic patients.

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Jiri Vlcek

Charles University in Prague

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Martin Dosedel

Charles University in Prague

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Jana Nekvindová

Charles University in Prague

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Magda Vytrisalova

Charles University in Prague

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Petr Pavek

Charles University in Prague

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Tomáš Soukup

Charles University in Prague

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Ivan Barvík

Charles University in Prague

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Petr Bradna

Charles University in Prague

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Tereza Hendrychova

Charles University in Prague

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Jan J. Stepan

Charles University in Prague

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