Východisko: Společnost všeobecného lékařství ČLS JEP periodicky monitoruje názory občanů na vybrané aspekty problematiky zdravotnictví a zdravého způsobu života. Tato publikace navazuje na předchozí výstupy průzkumů provedených v letech 2015 až 2024. Cíl a metody: Cílem výzkumu bylo zjistit, jaké jsou názory občanů na vybrané součásti práce všeobecných praktických lékařů (VPL) a na zdravotní systém a jejich úlohu v něm. K provedení reprezentativního sociologického výzkumu názorů občanů byla v ČR zvolena metoda řízeného rozhovoru tazatele s respondentem (face-to-face), realizovaná profesionální agenturou. Statistické zpracování dat bylo provedeno programem SASD 1.5.8 (Statistická analýza sociálních dat). Závěry výzkumu jsou reprezentativní pro občany ČR z hlediska jejich pohlaví, věku a regionu. Výsledky: Občané ČR jsou ve většině případů s péčí a časem, který jim věnuje v průběhu jejich návštěvy praktický lékař, spokojeni, negativní stanovisko zaujímá jen malá část (6,8 %) z nich. Největší spokojenost s péčí praktického lékaře a časem, který jim věnuje, se vrátila na úroveň let 2018–2020, tj. na úroveň před pandemií covid-19. Lze rovněž konstatovat, že občané ČR jsou s prací zdravotní sestry v ordinaci jejich praktického lékaře spokojeni, negativní stanovisko zaujímá též jen malá část (5,4 %) z nich. Občané vnímají týmové praxe pozitivně, i když (56,9 %) preferuje, aby je vždy ošetřoval jen „jejich“ praktický lékař, což lze zabezpečit v rámci objednávkového systému. V oblasti preventivní péče jsou stále v ČR významné rezervy a jen cca 50 % občanů na ní aktivně participuje. Silnou se ukazuje do budoucna kombinace aktivit VPL a vlastní motivace občanů na zlepšení zdraví. Prevenci jako významnou ke zlepšení svého zdraví hodnotí 80 % respondentů a 75,4 % respondentů by respektovalo rady na změnu životního stylu od VPL nebo lékaře specialisty v rámci preventivní péče. Jen necelá 1/3 (30,8 %) občanů míní, že zdravým životním stylem žije, téměř ½ (48,0 %) občanů se domnívá, že zdravým životním stylem žije občas. Občané se domnívají, že největším rizikem, které je ohrožuje, je nedostatek pohybu (27,0 %), dalších 23,7 % respondentů označilo jako největší riziko špatné stravování, 20,0 % občanů považuje za největší riziko stres na pracovišti a 19,8 % nedostatek spánku. Nejmenším rizikem je dle mínění dotázaných stres doma (označilo 9,5 % respondentů). Výsledky budou využity v rámci připravovaných plánovaných změn v preventivní péči u VPL v ČR.
Býma S, Javorská K, Halata D, Borský P. Citizens’ opinions on some aspects of the activities of general practitioners 2024 Background: The Czech Society of General Practitioners (CSPG) periodically monitors citizens’ opinions on selected aspects of healthcare and healthy lifestyle issues. This publication follows up on previous results of surveys conducted in 2015–2024. Aim and methods: The aim of the research was to find out what citizens’ opinions are on selected parts of the work of general practitioners (GPs) and on the healthcare system and their role in it. To conduct a representative sociological survey of citizens’ opinions in the Czech Republic, the method of controlled interview between the interviewer and the respondent (face-to-face), implemented by a professional agency, was chosen. Statistical data processing was performed using the SASD 1.5.8 program (Statistical Analysis of Social Data). The conclusions of the research are representative of citizens of the Czech Republic in terms of their gender, age and region. Results: Citizens of the Czech Republic are in most cases satisfied with the care and time that a general practitioner devotes to them during their visit, and only a small part (6.8%) of them have a negative opinion. The highest satisfaction with the care of a general practitioner and the time they devote to them has returned to the level of 2018–2020, i.e. to the level before the covid-19 pandemic. It can also be stated that citizens of the Czech Republic are satisfied with the work of a nurse in their general practitioner’s office, and only a small part (5.4%) of them also have a negative opinion. Citizens perceive team practices positively, although (56.9%) prefer that they are always treated only by“their” general practitioner, which can be ensured within the framework of an ordering system. There are still significant reserves in the Czech Republic in the area of preventive care and only about 50% of citizens actively participate in it. The combination of VPL activities and citizens’ own motivation to improve their health is proving to be strong in the future. 80% of respondents rate prevention as important for improving their health and 75.4% of respondents would respect advice on lifestyle changes from a VPL or a specialist doctor as part of preventive care. Just under 1/3 (30.8%) of citizens believe that they live a healthy lifestyle, almost ½ (48.0%) of citizens believe that they live a healthy lifestyle occasionally. Citizens believe that the greatest risk that threatens them is lack of exercise (27.0%), another 23.7% of respondents identified poor nutrition as the greatest risk, 20.0% of citizens consider stress at work to be the greatest risk, and 19.8% lack of sleep. According to the respondents, the least risk is stress at home (indicated by 9.5% of respondents). The results will be used within the framework of the planned changes in preventive care for primary health care in the Czech Republic.
- MeSH
- Humans MeSH
- Attitude to Health MeSH
- General Practice MeSH
- Primary Prevention MeSH
- Primary Health Care * MeSH
- Data Collection MeSH
- Patient Satisfaction * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Chart MeSH
- Geographicals
- Czech Republic MeSH
Spinal cord injury (SCI) induces the upregulation of chondroitin sulfate proteoglycans (CSPGs) at the glial scar and inhibits neuroregeneration. Under normal physiological condition, CSPGs interact with hyaluronan (HA) and other extracellular matrix on the neuronal surface forming a macromolecular structure called perineuronal nets (PNNs) which regulate neuroplasticity. 4-methylumbelliferone (4-MU) is a known inhibitor for HA synthesis but has not been tested in SCI. We first tested the effect of 4-MU in HA reduction in uninjured rats. After 8 weeks of 4-MU administration at a dose of 1.2 g/kg/day, we have not only observed a reduction of HA in the uninjured spinal cords but also a down-regulation of CS glycosaminoglycans (CS-GAGs). In order to assess the effect of 4-MU in chronic SCI, six weeks after Th8 spinal contusion injury, rats were fed with 4-MU or placebo for 8 weeks in combination with daily treadmill rehabilitation for 16 weeks to promote neuroplasticity. 4-MU treatment reduced the HA synthesis by astrocytes around the lesion site and increased sprouting of 5-hydroxytryptamine fibres into ventral horns. However, the current dose was not sufficient to suppress CS-GAG up-regulation induced by SCI. Further adjustment on the dosage will be required to benefit functional recovery after SCI.
- MeSH
- Chondroitin Sulfate Proteoglycans MeSH
- Gliosis * pathology MeSH
- Hymecromone therapeutic use MeSH
- Rats MeSH
- Hyaluronic Acid MeSH
- Spinal Cord pathology MeSH
- Spinal Cord Injuries * MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Spinal cord injuries (SCI), for which there are limited effective treatments, result in enduring paralysis and hypoesthesia, in part because of the inhibitory microenvironment that develops and limits regeneration/sprouting, especially during chronic stages. Recently, we discovered that targeted enzymatic removal of the inhibitory chondroitin sulfate proteoglycan (CSPG) component of the extracellular and perineuronal net (PNN) matrix via Chondroitinase ABC (ChABC) rapidly restored robust respiratory function to the previously paralyzed hemi-diaphragm after remarkably long times post-injury (up to 1.5 years) following a cervical level 2 lateral hemi-transection. Importantly, ChABC treatment at cervical level 4 in this chronic model also elicited improvements in gross upper arm function. In the present study, we focused on arm and hand function, seeking to highlight and optimize crude as well as fine motor control of the forearm and digits at lengthy chronic stages post-injury. However, instead of using ChABC, we utilized a novel and more clinically relevant systemic combinatorial treatment strategy designed to simultaneously reduce and overcome inhibitory CSPGs. Following a 3-month upper cervical spinal hemi-lesion using adult female Sprague Dawley rats, we show that the combined treatment had a profound effect on functional recovery of the chronically paralyzed forelimb and paw, as well as on precision movements of the digits. The regenerative and immune system related events that we describe deepen our basic understanding of the crucial role of CSPG-mediated inhibition via the PTPσ receptor in constraining functional synaptic plasticity at lengthy time points following SCI, hopefully leading to clinically relevant translational benefits.
- MeSH
- Chondroitin ABC Lyase pharmacology MeSH
- Chondroitin Sulfate Proteoglycans * pharmacology MeSH
- Rats MeSH
- Spinal Cord MeSH
- Spinal Cord Injuries * MeSH
- Rats, Sprague-Dawley MeSH
- Forelimb MeSH
- Nerve Regeneration physiology MeSH
- Receptor-Like Protein Tyrosine Phosphatases, Class 2 MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
All components of the CNS are surrounded by a diffuse extracellular matrix (ECM) containing chondroitin sulphate proteoglycans (CSPGs), heparan sulphate proteoglycans (HSPGs), hyaluronan, various glycoproteins including tenascins and thrombospondin, and many other molecules that are secreted into the ECM and bind to ECM components. In addition, some neurons, particularly inhibitory GABAergic parvalbumin-positive (PV) interneurons, are surrounded by a more condensed cartilage-like ECM called perineuronal nets (PNNs). PNNs surround the soma and proximal dendrites as net-like structures that surround the synapses. Attention has focused on the role of PNNs in the control of plasticity, but it is now clear that PNNs also play an important part in the modulation of memory. In this review we summarize the role of the ECM, particularly the PNNs, in the control of various types of memory and their participation in memory pathology. PNNs are now being considered as a target for the treatment of impaired memory. There are many potential treatment targets in PNNs, mainly through modulation of the sulphation, binding, and production of the various CSPGs that they contain or through digestion of their sulphated glycosaminoglycans.
- MeSH
- Chondroitin Sulfate Proteoglycans * metabolism MeSH
- Dendrites metabolism MeSH
- Extracellular Matrix * metabolism MeSH
- Neurons metabolism MeSH
- Neuronal Plasticity physiology MeSH
- Synapses metabolism MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Research Support, N.I.H., Extramural MeSH
Chondroitin sulphate and heparan sulphate proteoglycans (CSPGS and HSPGs) are found throughout the central nervous system (CNS). CSPGs are ubiquitous in the diffuse extracellular matrix (ECM) between cells and are a major component of perineuronal nets (PNNs), the condensed ECM present around some neurons. HSPGs are more associated with the surface of neurons and glia, with synapses and in the PNNs. Both CSPGs and HSPGs consist of a protein core to which are attached repeating disaccharide chains modified by sulphation at various positions. The sequence of sulphation gives the chains a unique structure and local charge density. These sulphation codes govern the binding properties and biological effects of the proteoglycans. CSPGs are sulphated along their length, the main forms being 6- and 4-sulphated. In general, the chondroitin 4-sulphates are inhibitory to cell attachment and migration, while chondroitin 6-sulphates are more permissive. HSPGs tend to be sulphated in isolated motifs with un-sulphated regions in between. The sulphation patterns of HS motifs and of CS glycan chains govern their binding to the PTPsigma receptor and binding of many effector molecules to the proteoglycans, such as growth factors, morphogens, and molecules involved in neurodegenerative disease. Sulphation patterns change as a result of injury, inflammation and ageing. For CSPGs, attention has focussed on PNNs and their role in the control of plasticity and memory, and on the soluble CSPGs upregulated in glial scar tissue that can inhibit axon regeneration. HSPGs have key roles in development, regulating cell migration and axon growth. In the adult CNS, they have been associated with tau aggregation and amyloid-beta processing, synaptogenesis, growth factor signalling and as a component of the stem cell niche. These functions of CSPGs and HSPGs are strongly influenced by the pattern of sulphation of the glycan chains, the sulphation code. This review focuses on these sulphation patterns and their effects on the function of the mature CNS.
- Publication type
- Journal Article MeSH
- Review MeSH
The perineuronal net (PNN) is a specialized extracellular matrix structure that surrounds subpopulations of neurons in the central nervous system (CNS). The appearance of PNNs on the cell surface marks the closure of the critical period during development and has been observed to reduce synaptic plasticity. Perineuronal nets comprise hyaluronan, chondroitin sulfate proteoglycans (CSPGs), link proteins, tenascin-R, and other components, some of which are substrates for a disintegrin-like and metalloprotease domain with thrombospondin type 1 motifs (ADAMTS) proteases. There is a high heterogeneity of PNNs in the CNS. Depending on which part of the CNS is studied, the PNNs may be observed surrounding the soma, or both the soma and proximal dendrites. The most robust marker for PNN is a lectin called Wisteria floribunda agglutinin. Here, we describe a method for preparing tissue for visualization of PNNs in CNS.
Axon regeneration in the CNS is inhibited by many extrinsic and intrinsic factors. Because these act in parallel, no single intervention has been sufficient to enable full regeneration of damaged axons in the adult mammalian CNS. In the external environment, NogoA and CSPGs are strongly inhibitory to the regeneration of adult axons. CNS neurons lose intrinsic regenerative ability as they mature: embryonic but not mature neurons can grow axons for long distances when transplanted into the adult CNS, and regeneration fails with maturity in in vitro axotomy models. The causes of this loss of regeneration include partitioning of neurons into axonal and dendritic fields with many growth-related molecules directed specifically to dendrites and excluded from axons, changes in axonal signalling due to changes in expression and localization of receptors and their ligands, changes in local translation of proteins in axons, and changes in cytoskeletal dynamics after injury. Also with neuronal maturation come epigenetic changes in neurons, with many of the transcription factor binding sites that drive axon growth-related genes becoming inaccessible. The overall aim for successful regeneration is to ensure that the right molecules are expressed after axotomy and to arrange for them to be transported to the right place in the neuron, including the damaged axon tip.
- MeSH
- Axonal Transport physiology MeSH
- Axons physiology MeSH
- Central Nervous System cytology physiology MeSH
- Humans MeSH
- Neural Inhibition physiology MeSH
- Neurogenesis physiology MeSH
- Protein Biosynthesis physiology MeSH
- Nerve Regeneration physiology MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Schwann cell grafts support axonal growth following spinal cord injury, but a boundary forms between the implanted cells and host astrocytes. Axons are reluctant to exit the graft tissue in large part due to the surrounding inhibitory environment containing chondroitin sulphate proteoglycans (CSPGs). We use a lentiviral chondroitinase ABC, capable of being secreted from mammalian cells (mChABC), to examine the repercussions of CSPG digestion upon Schwann cell behaviour in vitro. We show that mChABC transduced Schwann cells robustly secrete substantial quantities of the enzyme causing large-scale CSPG digestion, facilitating the migration and adhesion of Schwann cells on inhibitory aggrecan and astrocytic substrates. Importantly, we show that secretion of the engineered enzyme can aid the intermingling of cells at the Schwann cell-astrocyte boundary, enabling growth of neurites over the putative graft/host interface. These data were echoed in vivo. This study demonstrates the profound effect of the enzyme on cellular motility, growth and migration. This provides a cellular mechanism for mChABC induced functional and behavioural recovery shown in in vivo studies. Importantly, we provide in vitro evidence that mChABC gene therapy is equally or more effective at producing these effects as a one-time application of commercially available ChABC.
- MeSH
- Astrocytes metabolism MeSH
- Axons metabolism MeSH
- Cell Adhesion MeSH
- Central Nervous System metabolism MeSH
- Chondroitin ABC Lyase metabolism MeSH
- Chondroitin Sulfate Proteoglycans metabolism MeSH
- Genetic Therapy MeSH
- Integrins metabolism MeSH
- Rats MeSH
- Cells, Cultured MeSH
- Lentivirus enzymology MeSH
- Neurites metabolism MeSH
- Neuroglia metabolism MeSH
- Neurons metabolism MeSH
- Peripheral Nervous System metabolism MeSH
- Cell Movement MeSH
- Spinal Cord Injuries physiopathology MeSH
- Rats, Sprague-Dawley MeSH
- Nerve Regeneration drug effects MeSH
- Schwann Cells metabolism MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Perineuronal nets (PNNs) are extracellular matrix (ECM) chondroitin sulfate proteoglycan (CSPG)-containing structures that surround the soma and dendrites of various mammalian neuronal cell types. PNNs appear during development around the time that the critical periods for developmental plasticity end and are important for both their onset and closure. A similar structure - the perinodal ECM - surrounds the axonal nodes of Ranvier and appears as myelination is completed, acting as an ion-diffusion barrier that affects axonal conduction speed. Recent work has revealed the importance of PNNs in controlling plasticity in the CNS. Digestion, blocking or removal of PNNs influences functional recovery after a variety of CNS lesions. PNNs have further been shown to be involved in the regulation of memory and have been implicated in a number of psychiatric disorders.
- MeSH
- Mental Disorders physiopathology MeSH
- Extracellular Matrix physiology MeSH
- Humans MeSH
- Models, Neurological MeSH
- Central Nervous System Diseases physiopathology MeSH
- Neurons physiology MeSH
- Neuronal Plasticity physiology MeSH
- Memory physiology MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Perineuronal nets (PNNs) are extracellular matrix structures surrounding neuronal sub-populations throughout the central nervous system, regulating plasticity. Enzymatically removing PNNs successfully enhances plasticity and thus functional recovery, particularly in spinal cord injury models. While PNNs within various brain regions are well studied, much of the composition and associated populations in the spinal cord is yet unknown. We aim to investigate the populations of PNN neurones involved in this functional motor recovery. Immunohistochemistry for choline acetyltransferase (labelling motoneurones), PNNs using Wisteria floribunda agglutinin (WFA) and chondroitin sulphate proteoglycans (CSPGs), including aggrecan, was performed to characterise the molecular heterogeneity of PNNs in rat spinal motoneurones (Mns). CSPG-positive PNNs surrounded ~70-80% of Mns. Using WFA, only ~60% of the CSPG-positive PNNs co-localised with WFA in the spinal Mns, while ~15-30% of Mns showed CSPG-positive but WFA-negative PNNs. Selective labelling revealed that aggrecan encircled ~90% of alpha Mns. The results indicate that (1) aggrecan labels spinal PNNs better than WFA, and (2) there are differences in PNN composition and their associated neuronal populations between the spinal cord and cortex. Insights into the role of PNNs and their molecular heterogeneity in the spinal motor pools could aid in designing targeted strategies to enhance functional recovery post-injury.
- MeSH
- Choline O-Acetyltransferase metabolism MeSH
- Chondroitin Sulfate Proteoglycans metabolism MeSH
- Extracellular Matrix Proteins metabolism MeSH
- Extracellular Matrix metabolism MeSH
- Rats MeSH
- Spinal Cord cytology metabolism MeSH
- Motor Neurons cytology metabolism MeSH
- Neuronal Plasticity MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
