OBJECTIVE: ANCA-associated vasculitis (AAV) is a relapsing-remitting disease, resulting in incremental tissue injury. The gold-standard relapse definition (Birmingham Vasculitis Activity Score, BVAS>0) is often missing or inaccurate in registry settings, leading to errors in ascertainment of this key outcome. We sought to create a computable phenotype (CP) to automate retrospective identification of relapse using real-world data in the research setting. METHODS: We studied 536 patients with AAV and >6 months follow-up recruited to the Rare Kidney Disease registry (a national longitudinal, multicentre cohort study). We followed five steps: (1) independent encounter adjudication using primary medical records to assign the ground truth, (2) selection of data elements (DEs), (3) CP development using multilevel regression modelling, (4) internal validation and (5) development of additional models to handle missingness. Cut-points were determined by maximising the F1-score. We developed a web application for CP implementation, which outputs an individualised probability of relapse. RESULTS: Development and validation datasets comprised 1209 and 377 encounters, respectively. After classifying encounters with diagnostic histopathology as relapse, we identified five key DEs; DE1: change in ANCA level, DE2: suggestive blood/urine tests, DE3: suggestive imaging, DE4: immunosuppression status, DE5: immunosuppression change. F1-score, sensitivity and specificity were 0.85 (95% CI 0.77 to 0.92), 0.89 (95% CI 0.80 to 0.99) and 0.96 (95% CI 0.93 to 0.99), respectively. Where DE5 was missing, DE2 plus either DE1/DE3 were required to match the accuracy of BVAS. CONCLUSIONS: This CP accurately quantifies the individualised probability of relapse in AAV retrospectively, using objective, readily accessible registry data. This framework could be leveraged for other outcomes and relapsing diseases.

• MeSH
• ANCA-asociované vaskulitidy * diagnóza   MeSH
• dospělí MeSH
• fenotyp * MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• recidiva * MeSH
• registrace MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Cíl: Popisujeme případ pacienta, u něhož byla stanovena diagnóza cystické degenerace adventicie popliteální tepny jako vzácného onemocnění; zároveň představujeme diagnostický algoritmus a proces rozhodování. Metody: Popisujeme případ 51leté zdravotní sestry, která si stěžovala na rychle progredující bolest v pravém lýtku během cvičení. Nejdříve jí byla stanovena chybná diagnóza a byl u ní indikován endovaskulární výkon. Až po vyšetření metodami CT a MR byla stanovena správná diagnóza a byl proveden otevřený chirurgický výkon. Po odstranění cysty z adventicie zůstala adventicie otevřená. Díky zdravé a nejspíše pevné stěně tepny nebyla nutná žádná další rekonstrukce. Výsledky: Pacientka byla propuštěna dva dny po výkonu s hmatným distálním pulsem a beze známek ischemie pravé dolní končetiny. Pooperační průběh byl nekomplikovaný. Histologicky se cysta podobala ganglionu. Závěr: Domníváme se, že diagnosticky náročné případy, jako byl tento, vyžadují multidisciplinární přístup, aby bylo možno správně určit zdroj ischemie u poměrně zdravého pacienta bez známek aterosklerózy postihující několik úrovní organismu. Jako léčbu první linie je nutno vždycky zvážit, zda se lze vyhnout rekonstrukci tepen, zvláště u pacienta bez vhodné žilní spojky.

Aim: We want to present a case of a patient who was diagnosed with the rare condition of popliteal adventitial cystic disease and to describe the diagnostic algorithm and the decision making process. Methods: We report a case of a 51-year-old female nurse complaining of rapidly progressing claudication involving the right calf during exercise. She was misdiagnosed at the beginning and endovascular procedure was scheduled. Only by performing CT-scan and MRI the right diagnosis was made and open surgery was performed. The adventitial cyst was excised and the adventitia was left open. No further reconstruction was needed due to healthy and presumably strong arterial wall. Results: The patient was discharged 2 days after the intervention with palpable distal pulse and no signs of right lower limb ischemia. Postoperative course was uneventful. The cyst was histologically similar to a ganglion. Conclusion: We believe that in challenging diagnostic cases like this multidisciplinary approach is important to correctly identify the source of ischemia in a relatively healthy patient with no signs of multilevel atherosclerosis. Avoiding arterial reconstructions especially in a patient without appropriate venous conduit must be always considered a first line treatment.

• Klíčová slova
• cystická degenerace adventicie popliteální tepny, otevřené chirurgické výkony,
• MeSH
• arteria poplitea * chirurgie   patologie   MeSH
• cysty chirurgie   diagnóza   patologie   MeSH
• diagnostické zobrazování metody   MeSH
• intermitentní klaudikace chirurgie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Příspěvek se zabývá přetížením urgentních příjmů a faktory, které k němu přispívají a opatřeními, kterými je možné přetížení snížit. Přetížení je definováno jako situace, kdy počet pacientů urgentního příjmu je za hranou aktuálně dostupné prostorové a/nebo personální kapacity. Prokazatelně snižuje bezpečnost a kvalitu péče, zvyšuje morbiditu a mortalitu během následné hospitalizace, způsobuje odklad potřebné léčby, prodloužení do stanovení diagnózy i prodloužení doby strávené na oddělení. Přetížení také negativně ovlivňuje spokojenost pacientů a zvyšuje riziko rozvoje syndromu vyhoření personálu. Zdroje přetížení i opatření k prevenci a snížení mají komponenty na vstupu, při průchodu i na výstupu z urgentního příjmu. Účinná řešení musí být systémová a na více úrovních a musí vycházet z analýzy dat z konkrétního oddělení.

The paper deals with overcrowding of emergency departments and discusses both factors leading to overcrowding and measures to reduce it. Overcrowding is defined as a situation when number of patients at emergency department exceeds either spacial and/or personnel capacity which is available at the moment. It decreases safety and quality of care significantly, increases morbidity and mortality during hospitlaization, leads to delay in necessary care and it prolongs time to diagnostics and the lenght of stay at the department. Overcrowding has a negative impact on patients ́ satisfaction and increases the risk of burnout syndrom development in personnel. The sources leading to overcrowding as well as measures to prevent and reduce it have input, throughput and output components of the emergency department. Effective solutions must include systematic and multilevel responses and they must be based on data analysis of a particular department.

• MeSH
• dostupnost zdravotnických služeb MeSH
• lidé MeSH
• předání pacienta do jiné péče MeSH
• urgentní služby nemocnice * organizace a řízení   MeSH
• zajištění kvality zdravotní péče MeSH
• Check Tag
• lidé MeSH

The student population has been highly vulnerable to the risk of mental health deterioration during the coronavirus disease (COVID-19) pandemic. This study aimed to reveal the prevalence and predictors of mental health among students in Poland, Slovenia, Czechia, Ukraine, Russia, Germany, Turkey, Israel, and Colombia in a socioeconomic context during the COVID-19 pandemic. The study was conducted among 2349 students (69% women) from May-July 2020. Data were collected by means of the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Perceived Stress Scale (PSS-10), Gender Inequality Index (GII), Standard & Poor's Global Ratings, the Oxford COVID-19 Government Response Tracker (OxCGRT), and a sociodemographic survey. Descriptive statistics and Bayesian multilevel skew-normal regression analyses were conducted. The prevalence of high stress, depression, and generalized anxiety symptoms in the total sample was 61.30%, 40.3%, and 30%, respectively. The multilevel Bayesian model showed that female sex was a credible predictor of PSS-10, GAD-7, and PHQ-8 scores. In addition, place of residence (town) and educational level (first-cycle studies) were risk factors for the PHQ-8. This study showed that mental health issues are alarming in the student population. Regular psychological support should be provided to students by universities.

• MeSH
• Bayesova věta MeSH
• COVID-19 epidemiologie   psychologie   MeSH
• deprese epidemiologie   psychologie   MeSH
• duševní zdraví * MeSH
• lidé MeSH
• pandemie * MeSH
• prevalence MeSH
• psychický stres epidemiologie   psychologie   MeSH
• regresní analýza MeSH
• studenti psychologie   MeSH
• univerzity * MeSH
• úzkostné poruchy epidemiologie   psychologie   MeSH
• víceúrovňová analýza MeSH
• zeměpis MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• biomedicínský výzkum MeSH
• epidemiologie MeSH
• klinické laboratorní techniky MeSH
• klinické zkoušky jako téma MeSH
• medicína založená na důkazech MeSH

• Konspekt
• Patologie. Klinická medicína
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• diagnostika
• epidemiologie
• NLK Publikační typ
• učebnice vysokých škol

Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which <30% were consumed in more than one country. Nine species were consumed in all countries and provided, on average, 61% of total energy intake and a significant contribution of micronutrients in the wet season. Compared with Simpson's index of diversity and functional diversity, species richness (SR) showed stronger associations and better diagnostic properties with micronutrient adequacy. For every additional species consumed, dietary nutrient adequacy increased by 0.03 (P < 0.001). Diets with higher nutrient adequacy were mostly obtained when both SR and DDS were maximal. Adding SR to the minimum cutoff for minimum diet diversity improved the ability to detect diets with higher micronutrient adequacy in women but not in children. Dietary SR is recommended as the most appropriate measure of food biodiversity in diets.

• MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mikroživiny * MeSH
• nutriční hodnota * MeSH
• předškolní dítě MeSH
• preference v jídle * MeSH
• přijímání potravy * MeSH
• venkovské obyvatelstvo * MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Although increasingly complex models have been proposed in mediation literature, there is no model nor software that incorporates the multiple possible generalizations of the simple mediation model jointly. We propose a flexible moderated mediation model allowing for (1) a hierarchical structure of clustered data, (2) more and possibly correlated mediators, and (3) an ordinal outcome. The motivating data set is obtained from a European study in nursing research. Patients' willingness to recommend their treating hospital was recorded in an ordinal way. The research question is whether such recommendation directly depends on system-level features in the organization of nursing care, or whether these associations are mediated by 2 measurements of nursing care left undone and possibly moderated by nurse education. We have developed a Bayesian approach and accompanying program that takes all the above generalizations into account.

• MeSH
• Bayesova věta * MeSH
• lidé MeSH
• personál sesterský nemocniční statistika a číselné údaje   MeSH
• počítačová simulace MeSH
• regresní analýza * MeSH
• spokojenost pacientů MeSH
• víceúrovňová analýza * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• centra terciární péče MeSH
• discitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• meziobratlový kloub diagnostické zobrazování   mikrobiologie   MeSH
• ortopedické výkony MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• stafylokokové infekce diagnostické zobrazování   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Sepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward. Many studies have evaluated the usefulness of various markers of infection, including C-reactive protein (CRP), which is the most accessible and widely used. CRP is of weak diagnostic value because of its low specificity; a better understanding of patterns of CRP levels associated with a particular form of infection may improve its usefulness as a sepsis marker. In the present article, we apply multilevel modeling techniques and mixed linear models to CRP-related data to assess the time course of CRP blood levels in association with clinical outcome in children with different septic conditions. METHODS: We performed a retrospective analysis of 99 patients with systemic inflammatory response syndrome, sepsis, or septic shock who were admitted to the Pediatric Critical Care Unit at the University Hospital, Brno. CRP blood levels were monitored for 10 days following the onset of the septic condition. The effect of different septic conditions and of the surgical or nonsurgical diagnosis on CRP blood levels was statistically analyzed using mixed linear models with a multilevel modeling approach. RESULTS: A significant effect of septic condition and diagnosis on the course of CRP levels was identified. In patients who did not progress to septic shock, CRP blood levels decreased rapidly after reaching peak values - in contrast to the values in patients with septic shock in whom CRP protein levels decreased slowly. Moreover, CRP levels in patients with a surgical diagnosis were higher than in patients with a nonsurgical condition. The magnitude of this additional elevation in surgical patients did not depend on the septic condition. CONCLUSION: Understanding the pattern of change in levels of CRP associated with a particular condition may improve its diagnostic and prognostic value in children with sepsis.

• MeSH
• analýza přežití MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• dítě MeSH
• financování organizované MeSH
• kojenec MeSH
• komorbidita MeSH
• lidé MeSH
• lineární modely MeSH
• mladiství MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• rány a poranění epidemiologie   MeSH
• retrospektivní studie MeSH
• sepse epidemiologie   krev   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany. METHODS: We combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates. RESULTS: Smoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02-1.66] in the Czech Republic and 1.60 [95% CI 1.29-1.98] in Germany. CONCLUSION: In this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.

• MeSH
• charakteristiky bydlení * MeSH
• chudé oblasti * MeSH
• cvičení fyziologie   MeSH
• hypertenze epidemiologie   MeSH
• kardiovaskulární nemoci ekonomika   epidemiologie   MeSH
• kouření škodlivé účinky   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nahuštění v prostoru MeSH
• nezaměstnanost statistika a číselné údaje   MeSH
• obezita MeSH
• prevalence MeSH
• regresní analýza MeSH
• rizikové faktory MeSH
• senioři MeSH
• společenská třída * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Česká republika MeSH
• Německo MeSH