Casopis lekaru ceskych最新文献

Microvascular diabetes complications are linked to inadequate long-term diabetes control, as indicated by glycated haemoglobin (HbA1c) levels. Fluctuations in glucose levels are connected to oxidative stress, endothelial dysfunction, and inflammation, all of which are traditionally linked to the development of vascular damage. While some studies have linked glucose variability to macrovascular disease, its association with microvascular disease is still debated. The major question is whether short-term glucose variability should be regarded as an independent risk factor for microvascular complications in diabetes. This summary reviews research on glucose variability and its potential connections to diabetic retinopathy, nephropathy, and neuropathy. Current data indicate the need for further research into the parameters of both short-term and long-term glucose variability. These variability parameters may be important for selecting optimal treatment strategies and for estimating the risk of chronic diabetic complications.

Analysis of data from the representative "GGP - Contemporary Czech Family Survey" (2020-2022) on the population of women aged 40-69 years showed that the age of onset of menopause is associated with a low age at the birth of the first child. Women who had their first child before their 20th birthday, a pattern of reproductive behaviour common among generations of women before 1989, have an earlier onset of menopause than older first-time mothers. Conversely, the effect of higher age at first birth (35 years or more) on the delay of menopause has not been proved. However, this issue requires further investigation, as the sample analysed suggests certain tendencies. A larger sample size would be needed to make a conclusive finding.

Automated insulin delivery systems (AID) represent a major advance in the treatment of type 1 diabetes. These systems automate insulin delivery by integrating continuous glucose monitoring, control algorithms and insulin pump actions. Despite their advances, there is a need to adjust the settings in specific situations, either by using special features or even by manually adjusting the dose. The article provides an overview of the possibilities of adjustments in the insulin dosing for intercurrent disease, alcohol consumption and increased physical activity for four certified automatic insulin delivery systems available in the Czech Republic.

The article focuses on short-term (up to three years) and long-term (three years and beyond) reproductive intentions of women aged 18-49 living in the Czechia. Reproductive plans are predominantly formulated at the threshold of adulthood and only 11 % of women under 25 are unsure of their reproductive plans. In the short term, childbearing is planned with the greatest intensity at the ages of 25-29 and 30-34 (when 47 and 33 % of women plan to have a child, respectively), while for childless women the intensity of planning peaks slightly later, at the ages of 30-34 and 35-39 (planning rates of 54 and 50 %, respectively). Older women are not giving up their desire to pursue their reproductive plans. Despite the health risks associated with motherhood at an older age, 20 % of childless women aged 40-44 plan to have their first child in the next three years or later. In addition to age and the current number of children, short- and long-term reproductive plans also differ by women's education, with college graduates more likely to plan to have (another) child in the short and long term than women with less education. At the same time, short-term plans are influenced by women's partnership status, and in the case of long-term reproductive plans, the influence of perceptions of the long-term impact of the COVID-19 pandemic was observed.

The assessment of the development of fertility and abortion rates over the last three decades shows that Czechia has reached the top position in Europe with a total fertility rate of 1.83 children per woman in 2021. The postponement of fertility to women's older age, which was behind the sharp drop in fertility to 1.1, has been gradually slowed down and halted between 2015 and 2021. In recent years, there has been an increase in fertility rates for women aged 30 and older as well as a balanced increase for women under 30. In the European context Czechia has maintained its position as a country with lower rates of reproductive ageing. The favourable demographic position of Czechia among European countries is also illustrated by the relatively low level of the abortion rate. The postponement of female fertility to older ages has not been accompanied by an increase in the abortion rate among young women, but on the contrary a decline in fertility has been accompanied by a decline in the abortion rate. Given the year-on-year increase in total fertility (from 1.71 in 2020 to 1.83 in 2021), the initial effect of the COVID-19 pandemic on fertility can be assessed positively. However, the subsequent decline to 1.62 in 2022 is already the result of a combination of adverse effects stemming from the consequences of antipandemic measures and worsening economic conditions, to which new security risks associated with the war in Ukraine have subsequently been added. This has created the conditions for a further postponement of fertility until women are older.

The objective of this paper is to evaluate the long-term development of main health system inputs and outputs and to evaluate the development of the efficiency of the Czech health system. We evaluate the health system efficiency by two indices of efficiency, which contain 4 inputs and 2, respectively 3 outputs of the health system. The weights of inputs and outputs were obtained by a questionnaire survey among experts. The developed efficiency indices show that the efficiency of the Czech health system has a downward trend.

Emergency departments in the Czech Republic have been established in recent years. Seniors are typical patients of these departments. Emergency medicine´s approach is based on symptoms' evaluation and on deciding about the priority of the care needed. The approach to older patients is specific both in diagnostics and in therapy. The triage of geriatric patients is more accurate when we also evaluate patient´s cognition, when we use geriatric frailty scales and screening tools for detection of delirium. Comprehensive geriatric evaluation is a time demanding process and thus inadequate for emergency department however we must maintain its basic components. The therapeutical approach must be complex, and it must include biological, psychological, and social aspects and environmental risk analysis. Trauma management in seniors requires evaluation of different vital function´s values compared to common triage criteria, the influence of medication on adaptive mechanisms and the risk of low energy trauma mechanisms. Therapy of trauma must be timely and complex and the continuity of care between intensive and standard level and then rehabilitation must be ensured. Palliative approach is appropriate for terminally ill patients.

SARS-CoV-2 is a virus which infects the respiratory tract and may cause severe, occasionally life-threatening disease COVID-19. In more than 5% of symptomatic patients the infection is associated with post-acute symptoms. The initial contact of the virus with the immune system of the nasopharynx and oropharynx induces a mucosal immune response manifested by the production of secretory IgA (sIgA) antibodies which may contribute to the restriction of the infection to the upper respiratory tract and an asymptomatic or clinically mild disease. The current systemically administered vaccines protected against the severe COVID-19 infection and its post-acute sequelae. However, they do not induce antibodies in mucosal secretions in SARS-CoV-2-naive individuals. In contrast, in those who previously experienced mucosal infection, systemically administered vaccines may stimulate sIgA production. The clinical benefit of systemic vaccination convincingly documented in tens of millions of individuals overshadows the rare, sometimes controversial reports of complications encountered after vaccination. The inability of current SARS-CoV-2 vaccines to induce mucosal immune responses and to prevent the spreading of the virus by external secretions demonstrates the mutual independence of mucosal and systemic compartments of the immune system, and thus emphasizes need for the development of vaccines inducing protective immune responses in both compartments.

Diabetic foot attack is an acute manifestation of diabetic foot syndrome that requires rapid diagnosis and early initiation of complex therapy based on multidisciplinary team cooperation to save the affected limb. The term "attack" evokes the need for a rapid reaction as for "heart attack". Patients with diabetes mellitus and acute manifestations of diabetic foot syndrome have high risk for amputation of the lower limb, which is associated with higher morbidity and mortality. Complex therapy includes systemic antibiotic therapy, surgical debridement of ulceration, revascularization in the case of proven lower limb ischemia and an individualized offloading. Without the subsequent outpatient podiatric follow-up, the risk of recurrence increases significantly.