Jan Švancara

Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts

Background A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries. Methods Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts. Results Mothers education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied. Conclusions This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe.

Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study

Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region. Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment. 3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma–COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma–COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes. The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes. Distinct phenotypes of COPD in Central and Eastern Europe have differences in symptoms, comorbidities and treatment http://ow.ly/oMZI307ndr5

Cohort Profile: The European Longitudinal Study of Pregnancy and Childhood (ELSPAC) in the Czech Republic

The Czech ELSPAC study was set up as a part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). ELSPAC was designed as a population-based prospective longitudinal birth cohort study to investigate the effects of biological, psychosocial, economic and environmental factors on pregnancy, delivery and subsequent child´s development and health. The study was initiated by the World Health Organization (WHO) Regional Office for Europe in 1985, with the aim to enrol 40 000 children across Europe. Seven independent centres—ALSPAC, Isle of Man, the Czech Republic, Slovakia, Ukraine, Greece and Russia—joined the project, coordinated by Professor Golding at Bristol University, UK. The coordination centre was also responsible for most of the protocol development, including follow-up planning and questionnaire design. Enrolment of the Czech participants started in 1991. In addition to the primary aims of ELSPAC, the Czech team was interested also in the effects of the profound socioeconomic changes related to the societal transformation after the fall of Communism in 1989.

Practical use of medical terminology in curriculum mapping

BACKGROUND Various information systems for medical curriculum mapping and harmonization have been developed and successfully applied to date. However, the methods for exploiting the datasets captured inside the systems are rather lacking. METHOD We reviewed the existing medical terminologies, nomenclatures, coding and classification systems in order to select the most suitable one and apply it in delivering visual analytic tools and reports for the benefit of medical curriculum designers and innovators. RESULTS A formal description of a particular curriculum of general medicine is based on 1347 learning units covering 7075 learning outcomes. Two data-analytical reports have been developed and discussed, showing how the curriculum is consistent with the MeSH thesaurus and how the MeSH thesaurus can be used to demonstrate interconnectivity of the curriculum through association analysis. CONCLUSION Although the MeSH thesaurus is designed mainly to index medical literature and support searching through bibliographic databases, we have proved its use in medical curriculum mapping as being beneficial for curriculum designers and innovators. The presented approach can be followed wherever needed to identify all the mandatory components used for transparent and comprehensive overview of medical curriculum data.

EMPIRE Registry, Czech Part: Impact of Demographics, Pulmonary Function and HRCT on Survival and Clinical Course in Idiopathic Pulmonary Fibrosis

Prognostic factors of idiopathic pulmonary fibrosis (IPF) currently recognized include changes in vital capacity and radiologic findings. However, most of the prognostic studies in IPF are based on clinical studies with preselected IPF populations. Therefore, we decided to analyze the factors influencing IPF prognosis based on the real‐practice data from our IPF registry.

Fasciotomy closure using negative pressure wound therapy in lower leg compartment syndrome.

BACKGROUND Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. OBJECTIVES To evaluate lower leg fasciotomy wound closure outcomes comparing treatment with combined dressing fabric (COM) and negative pressure wound therapy (NPWT) in combination with elastic dynamic ligature (EDL). METHODS Retrospective study of 63 patients who underwent lower leg fasciotomy due to injury treated from January 2008 to December 2015 at the Department of Trauma Surgery, University Hospital Brno. Of these fasciotomy wounds 42 received a NPWT treatment in combination with EDL, 21 were treated only with COM. Fasciotomy wounds were closed either with primary suture or in case of persisting oedema and skin retraction the defect was covered with split thickness skin graft. RESULTS There was statistically significantly higher rate of primary wound closure using the NPWT versus traditional dressing (p = 0.015). Median time to definitive wound closure or skin grafting was shorter in the NPWT group. Number of dressing changes was lower in the NPWT group (p=0.008). CONCLUSION NPWT combined with elastic dynamic ligature offers many advantages for fasciotomy wound closure in comparison with traditional techniques (Tab. 5, Fig. 3, Ref. 21).

Predictive value of self‐rated health in pregnancy for childbirth complications, adverse birth outcomes, and maternal health

To investigate whether self‐rated health (SRH) in pregnancy can predict childbirth complications, adverse birth outcomes, and maternal health problems up to 3 years after delivery.

Perinatal Maternal Stress and Susceptibility to Infectious Diseases in Later Childhood: An Early Life Programming Perspective

Abstract There is evidence of transmission of stress-related dysregulation from parents to offspring during early developmental stages, leading to adverse health outcomes. This study investigates whether perinatal stress is linked to the risk of infectious diseases in children aged 7–11 years. We hypothesize that stress exposure during pregnancy and the first 6 months after birth independently predict common infectious diseases. Data are obtained from ELSPAC-CZ, a prospective birth cohort. Maternal stress, operationalized as the number of life events, is examined for pregnancy and the first 6 months postpartum. Children’s diseases include eye infection, ear infection, bronchitis/lung infection, laryngitis, strep throat, cold sores, and flu/flu-like infection. More prenatal and postnatal life events are both independently linked to a higher number of infectious diseases between the ages of 7–11 years. The effect is larger for postnatal vs. prenatal events, and the effect of prenatal events is attenuated after maternal health in pregnancy is controlled. The results suggest that perinatal stress is linked to susceptibility to infectious diseases in school-age children. Interventions to address stress in pregnant and postpartum women may benefit long-term children’s health.

Role of combined prenatal and postnatal paracetamol exposure on asthma development: the Czech ELSPAC study

Background Prenatal and postnatal paracetamol exposure has been previously associated with asthma development in childhood in Western populations. We explore the association between prenatal and postnatal paracetamol exposure and asthma development in a Central European sample of Czech children, suggesting possible additive effect of the both exposures. Furthermore, since aspirin had been used more widely during study data collection in Central Europe, we also compared asthma development for those exposed to paracetamol and aspirin. Methods We used data from 3329 children born in the 1990s as members of the prospective Czech European Longitudinal Study of Pregnancy and Childhood. Data about prenatal and postnatal paracetamol and aspirin exposure, and potential covariates were obtained from questionnaires completed by mothers. Data about incident asthma were obtained from paediatrician health records. Results 60.9% of children received paracetamol only postnatally, 1.5% only prenatally and 4.9% of children were exposed both during pregnancy and infancy. Prevalence of asthma in following population was 5% at 11 years. Being exposed to paracetamol both in prenatal and postnatal period was associated with asthma development (unadjusted OR 1.98, 95% CI 1.02 to 3.87). Being exposed only in the postnatal period was also significantly associated with increased risk of asthma. No association between prenatal exposure only and outcome was found. A higher but non-significant risk of asthma was observed for those whose mothers used paracetamol during pregnancy compared with those who used aspirin. Conclusions The main findings of this prospective birth cohort study add to previous observations linking prenatal and early postnatal paracetamol exposure to asthma development. However, the magnitude of effect is relatively modest, and therefore, we recommend paracetamol to remain the analgesic and antipyretic of choice throughout pregnancy and early childhood.

Sleeping habits of adolescents in relation to their physical activity and exercise output: results from the ELSPAC study

Background Little is known about the effects of physical activity and fitness on sleep timing parameters in adolescence. Methods We investigated the development of sleep timing between age 8 and 15 and its association with physical fitness at age 15 in 787 adolescents (408 males, 379 females). Physical fitness was measured using the physical work capacity (PWC) protocol. Information on sport activity was collected at ages 11 and 15. Finally, the contribution of other covariates (sex, body mass index (BMI), parental education and occupational skill level) to the association between sleep parameters and physical fitness was evaluated. The correlation of BMI and physical fitness was assessed separately. Results Mild correlation of sleep duration at ages 8 and 15 was observed (r=0.08–0.16). Higher sport activity participation and physical fitness were found to be mildly associated with delayed bedtime and reduced sleep duration; the association with bedtime was significant after adjustment for all covariates. Sport activity at age 11 was not associated with sleep timing at age 15. Interestingly, higher BMI was linked to delayed bedtime and higher physical fitness. Conclusion Our findings do not support existing hypotheses suggesting the association of low physical activity and fitness with shorter sleep duration and high BMI in a generally non-obese adolescent population without severe sleep restriction.