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[Crohn's disease in the adult population in Slovakia].

The requirement of preparing a fundamental epidemiological study concerning the incidence of Crohn's disease in Slovakia became very important after the splitting of Czecho-Slovakia. The authors in cooperation with the regional gastroenterologists present the study concerning the incidence of this inflammatory bowel disease in the Slovak Republic up to 30th April 1994. The multidimensional Kruskal-Wallis test for analyzing statistical differences in incidence of Crohn's disease according to age, sex, and regions was used. Cluster analysis was used for investigation of the regional differences. This study has shown that there is 6.75 cases of Crohn's disease per 100 000 inhabitants in Slovakia. There are no differences in incidence rate of Crohn's disease between the regions. There are differences between the districts: some of districts have both, absolutely and relatively high number of cases, and in another districts, young people are more involved in the analysed disease. The highest age specific incidence rate of Crohn's disease was between 30-49 years. (Tab. 1, Fig. 7, Ref. 14.)

Adult↗

[Amputation of the lower extremities for non-traumatic causes in Slovakia in 1995].

The authors submit a questionnaire-based epidemiological study from 61 surgical departments in Slovakia, focused on the problem of amputation of the lower extremities. The objective of the study was to evaluate indirectly the standard of care of diabetic feet in Slovakia. In the study 61 surgical departments participated with a catchment area comprising 4,814,000 insured persons, i.e. 85% of the Slovak population. In these patients a total of 2116 amputations on account of non-traumatic causes were performed (44/100000 population). This number included 1578 diabetic patients (74.6%). Minor amputations were performed 1044 times, incl. 92.2% in diabetic subjects. Major amputations were made 1072 times, incl. 57.3% in diabetics. The prevalence of major amputations in 1995 was 21.8/100000 population. The authors recorded a 2.65 fold increase of the total number of amputations since 1985. They recorded dissatisfaction with the small number of revascularization operations-total 294 (13.9%) which is only one quarter of the desirable number. The authors submit their study as the basis for a systemic solution of care of the diabetic foot in Slovakia and as a challenge for its improvement.

Amputation, Surgical↗

[Trends in alcohol consumption in relation to liver diseases in Slovakia 1973-1994].

The World Health Organisation warns before the increase in alcohol consumption and the proportional increase in ethyltoxic diseases which have taken place in past decades. Slovakia is included into the countries with the highest consumption of alcohol in Europe. The authors present a retrospective analysis of alcohol consumption from 1973 to 1994 in Slovakia according to the kinds of alcohol beverages, in a selected district and according to profession and family status. The epidemiologic analysis of the situation of alcohol consumption that is currently present in Slovakia is based on the data from wholesale and retail sale in relation to the prevalence and the mortality due to hepatic cirrhosis. The presented data was investigated by the Slovak Statistical Institute and the Institute of Medical Statistics of the Slovak Republic. Mortality due to hepatic cirrhosis has increased during the past 40 years 10-fold in men, and 4-fold in women. A severely increasing trend in alcohol consumption which had taken place prior to 1990 was succeeded by an abrupt decrease in pure alcohol consumption after 1990 (as much as by 21.2%). This decrease corresponds with the proportional decrease in the prevalence of chronic hepatopathies (by 35%) and with the decrease in mortality due to hepatic cirrhosis (by 20%). This phenomenon may be explained by the proportional increase in prices of alcoholic beverages. According to average yearly consumption of pure alcohol (p.a.) per capita, the consumption of spirits dominates when compared with the consumption of beer and wine. It is desirable to continue in the begun decreasing trend in alcohol consumption which is crucial in the procurement of primary, secondary as well as of tertiary preventions on both individual and population levels. (Tab. 1, Fig. 6, Ref. 19.)

Alcohol Drinking↗

Genetic studies in Medzev, an isolate in south-eastern Slovakia. 2. Distribution of blood group genetic markers.

Phenotype and gene frequencies of three blood group, four serum protein and seven red cell enzyme polymorphisms were examined in 105 individuals from the population of Medzev, South-Eastern Slovakia. Locus and allele specific tests of homogeneity were calculated in order to obtain the pattern of variation. The results indicate considerable genetic differences between this population and another local population of this region (Chmelnica) as well as between the Medzev population and the total population of Slovakia. The possible reasons of the genetic heterogeneity within Slovakia are discussed.

Analysis of Variance↗

[Epidemiologic and microbiologic aspects of mycobacteriosis in Slovakia--M. xenopi].

The first mycobacterioses caused by M. xenopi in Slovakia were discovered in the year 1979. Gradually they became the most often occurring mycobacterioses caused by facultative pathogenic mycobacteria. The purpose of investigation is to describe epidemiological situation of diseases caused by M. xenopi in Slovakia and to confront it with the situation in chosen developed countries. The methodology of this paper is based upon surveillance of tuberculosis as applied on mycobacterioses. During the period of last 10 years 960 isolations of M. xenopi from 622 persons were registered in Slovakia. Pulmonary mycobacterioses caused by M. xenopi was discovered in 58 persons until the end of the year 1966, 48 of them are men and 10 are women. The most often transmission factor is water in water supply mainly in city-habitation and hospital environment. The occurrence has endemic character. (Ref. 31.)

Female↗

"Clusters" of CJD in Slovakia: the first laboratory evidence of scrapie.

Epidemic-like occurrence of Creutzfeldt-Jakob disease was observed in 1987 in Slovakia (Orava). Search for the cause of CJD focus indicated a coincidence of genetic and environmental risks in clustering patients. Since Spongiform Encephalopathies might be transmitted orally, (Bovine Spongiform Encephalopathy), the possibility of zoonotic source of CJD cases in Orava was also considered. A deficient knowledge about the occurrence of scrapie in Slovakia stimulated an examination of sheep with signs of CNS disorders in two flocks of Valasky breed in Orava. In one flock, neurohistopathological examination revealed in sheep brains lesions characteristic for scrapie. Frozen brain tissue of these animals were used for the detection of scrapie associated fibrils. They were found in 2 animals from the same flock. This is the first laboratory confirmation of scrapie in Czecho-Slovakia. The possible epidemiological and economical implications are emphasized.

Animals↗

Extensive examination of different tick species for infestation with Coxiella burnetii in Slovakia.

Between 1987-1989 almost 7000 adult Ixodes ricinus, Dermacentor reticulatus, Dermacentor marginatus, Haemaphysalis concinna, Haemaphysalis punctata and Haemaphysalis inermis ticks collected in all 38 districts of Slovakia were screened for the presence of Coxiella burnettii. The proportion of ticks containing C. burnetii as indicated by the haemocyte test was less than 3%. Attempts to recover C. burnetii by inoculation of yolk sacs of embryonated hen eggs from pools of 1-6 specimens of haemocyte test positive ticks resulted in the isolation of 10 rickettsial strains. Six strains were recovered from I. ricinus, the remaining ones from single pools of D. reticulatus, D. marginatus. H. concinna and H. inermis ticks. In addition to the previous recovery of C. burnetii from H. punctata ticks, the agent was thus isolated from all important ticks living in Slovakia. The agent was found in tick habitats regardless of the latitude and altitude in the entire country. These results are not consistent with the negligible number of Q fever cases occurring in past years in Slovakia.

Animals↗

[Occurrence, diagnosis and therapy of beta thalassemia in Slovakia].

The authors draw attention to the prevalence of beta-thalassaemia in Slovakia, the rising trend of the disease, the occurrence of new cases of the disease in eastern Slovakia where the disease was not described previously. They draw attention to pitfalls of the diagnosis and treatment of beta-thalassaemia in Slovakia, the importance of molecular analysis of DNA globin chains of haemoglobin in the diagnosis of this serious condition. The authors paid major attention to the importance of prenatal diagnosis.

Adult↗

Recent trends in uterine cervix cancer in Slovakia, 1968-1987.

The temporal trends in the incidence and mortality of uterine cervix cancer in Slovakia were evaluated. Only highly reliable and complete data from 1968-1987 derived from the National Cancer Registry of Slovakia were used. Incidence rates have fallen in the first part of the period studied, but this trend has reversed and the incidence rates of this cancer site have risen since about 1976. The mortality rates showed continuous and unchanged increase over the whole mentioned period. The analysis of the age specific incidence rates indicated the responsibility of the youngest age groups of women for the overall recent increase of the uterine cervix cancer incidence in this country, while the age specific mortality rates increased in nearly all age groups. The relatively high incidence and mortality rates of uterine cervix cancer in Slovakia in comparison with the same rates in other countries as well as the recent increase of both indicators, together with low proportion of the in situ forms could be attributed mainly to the deficiencies in the organization and performance of the cervical screening.

Adult↗

[Genetic polymorphism in sparteine oxidation--occurrence in healthy volunteers in Slovakia].

The aim of this study was to estimate the occurrence of the phenotype of poor metabolizers of sparteine (in the frame of sparteine-debrisoquine-dextromethorphane polymorphism) in Slovakia. The authors examined a group of 216 of healthy volunteers (73 women and 143 men, average age of the group 24, 9 +/- 0.4 years), university students coming from various regions of Slovakia. The test substance-sparteine (1 x 100 mg tbl.) was administered perorally to all probands, in the evening after fasting. A 12-hour gathering of urine was subsequently performed. A sample of urine was subdued to examination. Isolation, separation, identification and assessment of the concentration of sparteine and its metabolites (2- and 5-dehydrosparteine) were performed by the method of gas chromatography. The metabolic MR ratio calculated from the ratio of the detected concentrations of sparteine and (2- and 5-dehydrosparteine) served for the assessment of the phenotype of poor (MR > 20), or rapid (MR < 20) metabolizers of sparteine in 8 authors found the poor metabolizer phenotype of 216 examined probands (i.e. in 3.75%). Its prevalence of the presented phenotype was lower than that anticipated on the basis of epidemiologic studies performed in other European countries. Study represents the first data on the phenotype of poor sparteine metabolizers in Slovakia. (Tab. 4, Fig. 1, Ref. 24.)

Adult↗

Improving survival for childhood cancer in Slovakia.

Data from the National Cancer Registry of Slovakia were used to evaluate survival for 2,958 childhood cancer patients registered between 1968 and 1987 and aged 0-14 years at diagnosis. Actuarial survival rates were computed for children diagnosed in 4 successive 5-year periods and compared. Overall 5-year survival rose from 20% for the period 1968-1972 to 46% for the period 1983-1987. The increase was statistically significant in age groups 1-4, 5-9 and 10-14 years. Survival for children aged less than l year also increased slightly, but this was not statistically significant. In most of the major diagnostic groups, survival increased markedly. Five-year survival rose significantly for leukaemias, lymphomas, CNS neoplasms, Wilms' tumours, bone tumours, soft-tissue sarcomas and germ-cell tumours. Despite this progress, survival in Slovakia remains lower than the corresponding figures from registries in Western Europe and the United States.

Adolescent↗

Oral and pharyngeal cancer incidence in Slovakia 1968-1989.

Slovakia currently has one of the highest incidence rates of oral cancer in Europe. Incidence data from the Slovakian Cancer Registry relating to oropharyngeal cancer are analyzed for the period 1968-1989 to examine trends in the incidence of these malignancies, representing the first such reported time-series from Central Europe. Over this period, rates in males have increased from 4.5 per 100,000 in 1968-1970 to 17.9 per 100,000 in 1987-1989, with more marked increases noted amongst middle-aged males (35 to 64 years), among whom rates have increased from 6.8 to 47.9 per 100,000 over the same period. Rates in women have been relatively low and stable. Changes in rates in men follow a period during the 1950s and 1960s when there was a marked increase in alcohol and tobacco consumption. The magnitude of the increases have resulted in oropharyngeal cancer becoming an important public health problem in Slovakia and emphasizes the importance of measures to prevent further increases in the consumption of tobacco and alcohol.

Adult↗

Prevalence of ticks infected with Francisella tularensis in natural foci of tularemia in western Slovakia.

The prevalence of ticks infected with F. tularensis was followed during a systematic surveillance in endemic area of tularemia in western Slovakia over the years 1984-93. Ticks were collected from vegetation in localities of Podunajské Biskupice, in the vicinity of the capital of Slovakia, Bratislava, near the river Danube. In total 6033 ticks, mostly adults of Dermacentor reticulatus and Ixodes ricinus (4994 and 1004, respectively) and 35 nymphs of Haemaphysalis concinna, were examined for the presence of F. tularensis. Out of 4542 starving ticks, 34 F. tularensis strains were isolated predominantly from D. reticulatus (30), and to a smaller extent also from I. ricinus (3) and H. concinna (1). Natural infection with F. tularensis was further proved from 1491 adults of D. reticulatus fed on laboratory animals, rabbits and white mice, together in 27 cases. From that, 21 times it was by positive isolation either from suspensions of partly or fully engorged ticks and their feaces, or from spleens of animals dead after the feeding of ticks. In addition, solely the development of antibodies against the agent was confirmed in 6 rabbit hosts. The presence of F. tularensis in all the above mentioned tick species and namely the relatively high and permanent infestation of D. reticulatus adults, ranging between 0.5-2% during the followed time period, demonstrated the maintenance of active natural focus of tularemia in the area under study. The present paper also emphasizes the epidemiologic consequence of various species of ticks in endemic foci of tularemia and the aspect of possible ways of transmission of the agent to humans.

Adult↗

The virulence markers of Salmonella enterica serovar Typhimurium. Different phage-type strains isolated in Slovakia.

Phage-typing determination of cell-surface hydrophobicity, motility, and serovar-specific virulence plasmid was performed in a collection of 154 clinical isolates of S. enterica serovar Typhimurium (SeT) isolated in Slovakia. All isolates were also examined in PCR for the presence of both stn (enterotoxin) and iroB (siderophore) genes. The DT104 was the definitive phage type most frequently identified (37.7 %), the second most frequently isolated phage type was DT41 (5.8 %); the occurrence of other phage types was not epidemiologically significant. On the basis of virulence-marker investigation, 46.1 % of isolates were hydrophobic in the assay of bacterial adherence to xylene, and 97.4 % were hydrophobic in salt-aggregation test. Motility of more than 50 mm was expressed by 20.8 % isolates. The serovar-specific 90-kb virulence plasmid was contained in 138 (89.6 %) of isolates. All SeT isolates were found (according to PCR) to carry the Salmonella-enterotoxin (stn) gene and the siderophore (iroB) gene. The increasing incidence of SeT DT104 human strains in Slovakia requires continuous attention; this can be markedly improved by surveillance efficiency and made possible by determining relationships between sporadic isolates.

Animals↗

Environmental exposure to PCBs and cancer incidence in eastern Slovakia.

In a population-based cross-sectional study, we compared serum levels of 15 polychlorinated biphenyl (PCB) congeners and three organochlorine pesticides in residents of two districts in eastern Slovakia, one with extensive environmental contamination from a former PCB production site (Michalovce) and the other matched on geography but with low (background) levels (Svidnik). The age-adjusted geometric means for sum of 15 measured PCB congeners were statistically significantly higher in subjects from the Michalovce district for both sexes: 3327.6 versus 1331.4 ng/g of lipid in males, 2751.8 versus 992.2 ng/g of lipid in females. Levels of DDE and DDT were also significantly higher, although the absolute differences were less pronounced. There was no substantial difference in HCB levels between the districts. We also conducted an ecologic study to compare cancer incidence occurring in these same two districts from 1985 through 1994. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals for each district using indirect standardization and rates from eastern Slovakia. Among males from Michalovce (exposed), but not Svidnik (unexposed), there was an excess of cancer of the tongue (SIR=1.46; 1.06-1.96), stomach (SIR=1.15; 1.00-1.32), lung (SIR=1.14; 1.04-1.24), testis (SIR=1.40; 0.97-1.97), and kidney (SIR=1.23; 0.98-1.52), and lower than expected incidence of prostate cancer (SIR=0.83; 0.69-0.97); in contrast, there was an excess of peritoneal (SIR=3.05; 1.11-6.63) and laryngeal cancer (SIR=1.43; 0.99-1.98) in Svidnik not observed Michalovce. Among females from Michalovce, but not Svidnik, there was an excess of cancer of the lip (SIR=2.54; 1.53-3.96), stomach (SIR=1.22; 1.02-1.44), and lung (SIR=1.17; 0.94-1.45); in contrast, there was an excess of kidney (SIR=1.61; 1.03-2.40) and thyroid (SIR=1.97; 1.12-3.20) cancer in Svidnik not observed in Michalovce. Taken together, these results raise the possibility that high environmental exposure to organochlorines in the Michalovce district may be associated with higher rates of certain cancers, particularly stomach and lung cancer.

Age Factors↗

Health status among young people in Slovakia: comparisons on the basis of age, gender and education.

This study examines the health status of young people in Slovakia. Six subjective health indicators (self-rated health, long-standing illness, vitality, mental health, long-term well-being over the last year and occurrence of health complaints during the previous month) were used to assess the health status of three age groups: first grade secondary school students (mean age 15.9 years), third grade students (mean age 17.8 years) and secondary school leavers (mean age 19.6 years). Females rated their health worse than males on all six indicators (most of these differences were statistically significant). For males, younger age was associated with better self-rated health, less long-standing illness and higher levels of long-term well-being during the previous year. For females, the age differences were more complicated: third grade females reported significantly worse health status in terms of vitality, long-standing illness and number of health complaints than the other two age groups. An analysis of health status by educational level (attendance at or completion of grammar, technical or apprentice school), revealed that grammar school third grade females reported worse health than all other respondents on all six indicators. The third grade of grammar school in Slovakia puts particular stresses on students and, since it has been suggested that females may react more negatively than males to stressful events, this may contribute to their more negative self reports.

Adolescent↗

High frequency of alkaptonuria in Slovakia: evidence for the appearance of multiple mutations in HGO involving different mutational hot spots.

Alkaptonuria (AKU) is an autosomal recessive disorder caused by the deficiency of homogentisate 1,2 dioxygenase (HGO) activity. AKU shows a very low prevalence (1:100,000-250,000) in most ethnic groups. One notable exception is in Slovakia, where the incidence of AKU rises to 1:19,000. This high incidence is difficult to explain by a classical founder effect, because as many as 10 different AKU mutations have been identified in this relatively small country. We have determined the allelic associations of 11 HGO intragenic polymorphisms for 44 AKU chromosomes from 20 Slovak pedigrees. These data were compared to the HGO haplotype data available in our laboratory for >80 AKU chromosomes from different European and non-European countries. The results show that common European AKU chromosomes have had only a marginal contribution to the Slovak AKU gene pool. Six of the ten Slovak AKU mutations, including the prevalent G152fs, G161R, G270R, and P370fs mutations, most likely originated in Slovakia. Data available for 17 Slovak AKU pedigrees indicate that most of the AKU chromosomes have their origins in a single very small region in the Carpathian mountains, in the northwestern part of the country. Since all six Slovak AKU mutations are associated with HGO mutational hot spots, we suggest that an increased mutation rate at the HGO gene is responsible for the clustering of AKU mutations in such a small geographical region.

Alkaptonuria↗

Report from Working Group 3 (the Czech Republic, Denmark, Finland, Norway, The Netherlands, Slovakia, Sweden and the UK).

The Czech Republic, Denmark, Finland, Norway, the Netherlands, Slovakia, Sweden and the UK all have very low HBsAg carrier rates; in the Scandinavian countries, for instance, carrier rates are on the order of 0.05%. Most countries in this group are unconvinced that the carrier rates and the burden of disease caused by new hepatitis infections warrant the expense of universal childhood immunization. In Scandinavia and the UK hepatitis B prevention programmes are based on immunization of high-risk groups. In Scandinavia (excepting Denmark), the UK and the Netherlands, pregnant women are screened and newborns of carrier mothers vaccinated. Only the Czech Republic and Slovakia--both of which now employ high-risk group strategies of hepatitis B prevention--have expressed interest in implementing programmes of universal hepatitis B vaccination of infants and/or adolescents.

Czech Republic↗