INTRODUCTION: Upper limb (UL) impairment is common in people with multiple sclerosis (pwMS), and functional recovery of the UL is a key rehabilitation goal. Technology-based approaches, like virtual reality (VR), are increasingly promising. While most VR environments are task-oriented, our clinical approach integrates neuroproprioceptive 'facilitation and inhibition' (NFI) principles. To advance this, we developed immersive VR software based on NFI principles targeting UL function and sit-to-stand ability. This study aims to evaluate the effectiveness of this VR therapy compared with conventional NFI-based physical therapy in pwMS. Our study uniquely applies advanced imaging techniques, along with biological molecular assessments, to explore adaptive processes induced by VR rehabilitation. METHODS AND ANALYSIS: This double-arm, randomised, assessor-blinded, controlled trial runs over 2 months (1 hour, 2 times per week). PwMS with mild to severe disability will receive either VR therapy or real-world physical therapy. Primary outcomes include the nine-hole peg test, box and block test, handgrip strength, tremor and five times sit-to-stand test. Secondary measures include the Multiple Sclerosis Impact Scale, the 5-level EQ-5D questionnaire and kinematic analysis. Adaptive processes will be monitored using imaging techniques (functional MRI and tractography), molecular genetic methods (long non-coding RNAs) and immune system markers (leukocytes, dendritic cells). The International Classification of Functioning, Disability and Health brief set for MS will map the bio-psycho-social context of participants. ETHICS AND DISSEMINATION: This project and its amendments were approved by the Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital (1983/21+4772/21 (G-21-02) and the Ethics Committee of Kralovske Vinohrady University Hospital (EK-VP/38/0/2021) in Prague, Czechia (with single enrolment). The findings of this project will be disseminated through scientific publications, conferences, professional networks, public engagement, educational materials and stakeholder briefings to ensure a broad impact across clinical, academic and public domains. TRIAL REGISTRATION NUMBER: clinicaltrials.gov (NCT04807738).
- MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- horní končetina * patofyziologie MeSH
- kvalita života * MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- postura těla MeSH
- randomizované kontrolované studie jako téma MeSH
- roztroušená skleróza * diagnostické zobrazování MeSH
- síla ruky MeSH
- techniky fyzikální terapie * MeSH
- terapie pomocí virtuální reality metody MeSH
- virtuální realita MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
- MeSH
- lidé MeSH
- migréna * ekonomika farmakoterapie psychologie MeSH
- vzdělávání odborné * MeSH
- vzdělávání pacientů jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
OBJECTIVES: The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices. METHODS: We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology. RESULTS: We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs). CONCLUSIONS: Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
- MeSH
- časná detekce nádoru * statistika a číselné údaje MeSH
- COVID-19 * epidemiologie prevence a kontrola MeSH
- diabetes mellitus * epidemiologie MeSH
- kolorektální nádory * diagnóza epidemiologie MeSH
- lékařská praxe - způsoby provádění * statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- odborná praxe - umístění statistika a číselné údaje MeSH
- pandemie prevence a kontrola MeSH
- praktičtí lékaři statistika a číselné údaje MeSH
- primární zdravotní péče MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- ambulantní péče MeSH
- centra terciární péče MeSH
- lázně MeSH
- lidé MeSH
- následná péče MeSH
- rehabilitace * organizace a řízení zákonodárství a právo MeSH
- úhradový mechanismus MeSH
- zdravotní pojištění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
SARS-CoV-2 infection, which causes the respiratory disease COVID-19, has spread rapidly from Wuhan, China, since 2019, causing nearly 7 million deaths worldwide in three years. In addition to clinical risk factors such as diabetes, hypertension, and obesity, genetic variability is an important predictor of disease severity and susceptibility. We analyzed common polymorphisms within the LZTFL1 (rs11385942) and ABCA3 (rs13332514) genes in 519 SARS-CoV-2-positive subjects (164 asymptomatic, 246 symptomatic, and 109 hospitalized COVID-19 survivors) and a population-based control group (N?=?2,592; COVID-19 status unknown). Rare ABCA3 AA homozygotes (but not A allele carriers) may be at a significantly increased risk of SARS-CoV-2 infection [P?=?0.003; OR (95 % CI); 3.66 (1.47-9.15)]. We also observed a borderline significant difference in the genotype distribution of the LZTFL1 rs11385942 polymorphism (P?=?0.04) between the population sample and SARS-CoV-2-positive subjects. In agreement with previous studies, a nonsignificantly higher frequency of minor allele carriers was detected among hospitalized COVID-19 subjects. We conclude that a common polymorphism in the ABCA3 gene may be a significant predictor of susceptibility to SARS-CoV-2 infection.
- MeSH
- ABC transportéry genetika MeSH
- COVID-19 * diagnóza epidemiologie genetika MeSH
- genotyp MeSH
- lidé MeSH
- polymorfismus genetický MeSH
- SARS-CoV-2 MeSH
- transkripční faktory genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Úvod: Správně dimenzovaná síť školitelů je klíčová pro přípravu mladých lékařů v primární péči, kde umístění praxe školitele ovlivňuje mladé lékaře v úvahách o lokaci vlastní praxe. Tato práce popisuje počty školitelů podle krajů Česka, zahrnuje i jejich prostorovou charakteristiku a vývojové trendy. Metody: Na základě dat největší zdravotní pojišťovny v Česku jsme analyzovali školící praxe všeobecných praktických lékařů v letech 2017–2021, jak dle krajů, tak i prostorové lokace, pro kterou jsme použili vlastní typologii, aplikovanou opakovaně v předchozím výzkumu. Výsledky: Nejvyšší relativní počet školitelů působil ve Středočeském kraji, největšího nadhodnocení dosahovala školící činnost v Praze. Naopak nejnižší relativní počty školitelů vykazoval Ústecký kraj, nejrychlejší pokles Liberecký kraj. Kraje s nejnižší hustotou sítě školitelů měly zároveň nejnižší podíl venkovských školitelů. Závěry: Síť školitelů v Česku není rovnoměrná a ve sledovaném období vykazovala řadu odlišných trendů. Domníváme se, že v některých regionech je nedostatečná, a nelze sem proto alokovat potřebnou výši prostředků na vzdělávání.
Objectives: A properly sized network of trainers is crucial for the training of young doctors in primary care, where the location of the trainer’s practice influences young doctors’ considerations about the location of their own practice. This paper describes the number of trainers by region of the country, and includes their spatial characteristics and trends. Methods: Based on data from the largest health insurance company in Czechia, we analysed the training practices of general practitioners in 2017–2021, both by region and by spatial location, for which we used our own typology, applied repeatedly in previous research. Results: The highest relative number of trainers was in the Central Bohemia Region, with the highest overestimation of training activity in Prague. On the other hand, the lowest relative number of trainers was in the Ústí Region, while the fastest decline was in the Liberec Region. The regions with the lowest density of trainers also had the lowest proportion of rural trainers. Conclusions: The network of trainers in Czechia is not uniform and showed a number of different trends in the period under review. We believe that in some regions it is insufficient and therefore the necessary amount of resources for training cannot be allocated here.
- MeSH
- dostupnost zdravotnických služeb MeSH
- lidé MeSH
- primární zdravotní péče * MeSH
- školitelé MeSH
- zdravotnické služby pro venkov MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
A 2021 in silico study highlighted an association between the CD14 polymorphism rs2569190 and increased susceptibility to SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19). The aim of our study was to confirm this finding. We analysed the CD14 polymorphism (C→T; rs2569190) in 516 individuals who tested positive for SARS-CoV-2, with differing disease severity (164 asymptomatic, 245 symptomatic, and 107 hospitalized). We then compared these patients with a sample from the general population consisting of 3,037 individuals using a case-control study design. In comparison with carriers of the C allele, TT homozygotes accounted for 21.7 % of controls and 20.5 % in SARS-CoV-2-positive individuals (P = 0.48; OR; 95 % CI - 0.92; 0.73-1.16). No significant differences in the distribution of genotypes were found when considering co-dominant and recessive genetic models or various between-group comparisons. The CD14 polymorphism is unlikely to be an important predictor of COVID-19 in the Caucasian population in Central Europe.
- MeSH
- COVID-19 * genetika MeSH
- genetická predispozice k nemoci MeSH
- jednonukleotidový polymorfismus * genetika MeSH
- lidé MeSH
- SARS-CoV-2 genetika MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
