BACKGROUND: Personal cancer risk assessments enable stratified care, for example, offering preventive surgical measures such as risk-reducing mastectomy (RRM) to women at high risk for breast cancer. In scenario-based experiments, we investigated whether different benefit-harm ratios of RRM influence women's consideration of this, whether this consideration is influenced by women's perception of and desire to know their personal cancer risk, or by their intention to take a novel cancer risk-predictive test, and whether consideration varies across different countries. METHOD: In January 2017, 1,675 women 40 to 75 years of age from five European countries-Czech Republic, Germany, UK, Italy, and Sweden-took part in an online scenario-based experiment. Six different scenarios of hypothetical benefit-harm ratios of RRM were presented in accessible fact box formats: Baseline risk/risk reduction pairings were 20/16, 20/4, 10/8, 10/2, 5/4, and 5/1 out of 1,000 women dying from breast cancer. RESULTS: Varying the baseline risk of dying from breast cancer and the extent of risk reduction influenced the decision to consider RRM for 23% of women. Decisions varied by country, risk perception, and the intention to take a cancer risk-predictive test. Women who expressed a stronger intention to take such a test were more likely to consider having RRM. The desire to know one's risk of developing any female cancer in general moderated women's decisions, whereas the specific desire to know the risk of breast cancer did not. CONCLUSIONS: In this hypothetical scenario-based study, only for a minority of women did the change in benefit-harm ratio inform their consideration of RRM. Because this consideration is influenced by risk perception and the intention to learn one's cancer risks via a cancer risk-predictive test, careful disclosure of different potential preventive measures and their benefit-harm ratios is necessary before testing for individual risk. Furthermore, information on risk testing should acknowledge country-specific sensitivities for benefit-harm ratios.

• MeSH
• chování snižující riziko MeSH
• dospělí MeSH
• genetická predispozice k nemoci * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mastektomie psychologie   MeSH
• nádory prsu genetika   patologie   psychologie   chirurgie   MeSH
• prognóza MeSH
• průzkumy a dotazníky MeSH
• riziko MeSH
• rozhodování * MeSH
• senioři MeSH
• úmysl * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Itálie MeSH
• Německo MeSH
• Spojené království MeSH
• Švédsko MeSH

Identifying children at risk of developing childhood sarcopenic obesity often requires specialized equipment and costly testing procedures, so cheaper and quicker methods would be advantageous, especially in field-based settings. The purpose of this study was to determine the relationships between the muscle-to-fat ratio (MFR) and relative handgrip strength, and to determine the ability of handgrip strength relative to body mass index (grip-to-BMI) to identify children who are at risk of developing sarcopenic obesity. Grip-to-BMI was measured in 730 Czech children (4 to 14 yrs). Bioelectrical impedance was used to estimate body fat mass and skeletal muscle mass, from which the MFR was calculated. The area under the curve (AUC) was 0.791 (95% CI 0.692-0.890, p ˂ 0.001) in girls 4-9; 0.789 (95% CI 0.688-0.890, p ˂ 0.001) in girls 10-14 years old; 0.719 (95% CI 0.607-0.831, p = 0.001) in boys 4-9; and 0.896 (95% CI 0.823-0.969, p ˂ 0.001) in boys 10-14 years old. Calculated using the grip-to-BMI ratio, the OR (95% CI) for girls to be at risk of sarcopenic obesity identified by MFR was 9.918 (4.243-23.186, p ˂ 0.001) and was 11.515 (4.280-30.982, p ˂ 0.001) for boys. The grip-to-BMI ratio can be used to predict the presence of sarcopenic obesity in children, which can play a role in pediatric health interventions.

• MeSH
• dítě MeSH
• elektrická impedance MeSH
• hodnocení rizik MeSH
• index tělesné hmotnosti MeSH
• kosterní svaly MeSH
• lidé MeSH
• mladiství MeSH
• obezita diagnóza   patofyziologie   MeSH
• plocha pod křivkou MeSH
• předškolní dítě MeSH
• ROC křivka MeSH
• sarkopenie diagnóza   patofyziologie   MeSH
• sexuální faktory MeSH
• síla ruky * MeSH
• složení těla MeSH
• tuková tkáň MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints. RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

• MeSH
• dospělí MeSH
• hypertenze * prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• riziko MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• senioři MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: The autosomal recessive chromosomal instability disorder Nijmegen breakage syndrome (NBS) is associated with increased risk of lymphoid malignancies and other cancers. Cells from NBS patients contain many double-stranded DNA breaks. More than 90% of NBS patients are homozygous for a founder mutation, 657del5, in the NBN gene. We investigated the 657del5 carrier status of cancer patients among blood relatives (i.e., first-, through fourth-degree relatives) of NBS patients in the Czech Republic and Slovakia to test the hypothesis that NBN heterozygotes have an increased cancer risk. METHODS: Medical information was compiled from 344 blood relatives of NBS patients in 24 different NBS families from January 1, 1998, through December 31, 2003. The 657del5 carrier status of subjects was unknown at the time of their recruitment but was later determined from blood samples collected at the time of the interview. Medical records and death certificates were used to confirm a diagnosis of cancer. For the relatives with cancer who are not obligate heterozygotes (such as parents and two grandparents in consanguineous families), the observed and expected number of mutation carriers were compared by use of the index-test method, which estimated the risk of cancer associated with carrying the mutation. All P values were two-sided. RESULTS: Thirteen of the 344 blood relatives had confirmed cases of any type of cancer; 11 of these 13 cancer patients carried the NBN 657del5 mutation, compared with 6.0 expected (P = .005). Among the 56 grandparents with complete data from 14 NBS families, 10 of the 28 carriers of 657del5, but only one of the 28 noncarriers, developed cancer (odds ratio = 10.7, 95% CI = 1.4 to 81.5; P<.004). CONCLUSIONS: The NBN 657del5 mutation appears to be associated with an elevated risk of cancer in heterozygotes.

• MeSH
• delece genu MeSH
• detekce genetických nosičů MeSH
• dospělí MeSH
• efekt zakladatele MeSH
• financování organizované MeSH
• genetická predispozice k nemoci MeSH
• heterozygot MeSH
• kolorektální nádory epidemiologie   genetika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutační analýza DNA MeSH
• nádory prsu epidemiologie   genetika   MeSH
• nádory ženských pohlavních orgánů epidemiologie   genetika   MeSH
• odds ratio MeSH
• proteiny buněčného cyklu genetika   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zárodečné mutace MeSH
• zlomy chromozomů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND/AIMS: We intended to compare the risk and prevalence of hypertension in patients undergoing renal biopsy with those of the general population and to investigate the possible effects of various independent factors (age, sex and degree of renal insufficiency) on the prevalence of hypertension.

• MeSH
• dospělí MeSH
• financování organizované MeSH
• hypertenze epidemiologie   komplikace   MeSH
• kreatin krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin epidemiologie   komplikace   MeSH
• odds ratio MeSH
• prevalence MeSH
• proteinurie MeSH
• registrace MeSH
• riziko MeSH
• senioři MeSH
• sexuální faktory MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Prediction of susceptibility to multiple sclerosis (MS) might have important clinical applications, either as part of a diagnostic algorithm or as a means to identify high-risk individuals for prospective studies. We investigated the usefulness of an aggregate measure of risk of MS that is based on genetic susceptibility loci. We also assessed the added effect of environmental risk factors that are associated with susceptibility for MS. METHODS: We created a weighted genetic risk score (wGRS) that includes 16 MS susceptibility loci. We tested our model with data from 2215 individuals with MS and 2189 controls (derivation samples), a validation set of 1340 individuals with MS and 1109 controls taken from several MS therapeutic trials (TT cohort), and a second validation set of 143 individuals with MS and 281 controls from the US Nurses' Health Studies I and II (NHS/NHS II), for whom we also have data on smoking and immune response to Epstein-Barr virus (EBV). FINDINGS: Individuals with a wGRS that was more than 1.25 SD from the mean had a significantly higher odds of MS in all datasets. In the derivation sample, the mean (SD) wGRS was 3.5 (0.7) for individuals with MS and 3.0 (0.6) for controls (p<0.0001); in the TT validation sample, the mean wGRS was 3.4 (0.7) for individuals with MS versus 3.1 (0.7) for controls (p<0.0001); and in the NHS/NHS II dataset, the mean wGRS was 3.4 (0.8) for individuals with MS versus 3.0 (0.7) for controls (p<0.0001). In the derivation cohort, the area under the receiver operating characteristic curve (C statistic; a measure of the ability of a model to discriminate between individuals with MS and controls) for the genetic-only model was 0.70 and for the genetics plus sex model was 0.74 (p<0.0001). In the TT and NHS cohorts, the C statistics for the genetic-only model were both 0.64; adding sex to the TT model increased the C statistic to 0.72 (p<0.0001), whereas adding smoking and immune response to EBV to the NHS model increased the C statistic to 0.68 (p=0.02). However, the wGRS does not seem to be correlated with the conversion of clinically isolated syndrome to MS. INTERPRETATION: The inclusion of 16 susceptibility alleles into a wGRS can modestly predict MS risk, shows consistent discriminatory ability in independent samples, and is enhanced by the inclusion of non-genetic risk factors into the algorithm. Future iterations of the wGRS might therefore make a contribution to algorithms that can predict a diagnosis of MS in a clinical or research setting.

• MeSH
• alely MeSH
• algoritmy * MeSH
• dítě MeSH
• dospělí MeSH
• genotyp MeSH
• hodnocení rizik MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokus kvantitativního znaku MeSH
• mladiství MeSH
• odds ratio MeSH
• prediktivní hodnota testů MeSH
• předškolní dítě MeSH
• rizikové faktory MeSH
• roztroušená skleróza * epidemiologie   genetika   MeSH
• senioři MeSH
• životní prostředí MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

V červenci roku 2011 byla publikována metaanalýza, která demonstrovala asociaci vysokodávkové statinové terapie se zvýšeným rizikem rozvoje diabetu mellitu (DM). Cílem metaanalýzy bylo zhodnotit, zda jsou vysoké dávky statinů spojeny s rozvojem nově vzniklého DM v porovnání s nízkodávkovou statinovou terapií. Do metaanalýzy bylo zařazeno pět prací, které zahrnuly celkem 32 752 pacientů bez DM na začátku sledování. Při vysokodávkové statinové terapii bylo v přepočtu na 1000 pacientoroků zjištěno o 2 případy nově vzniklého DM více a o 6,5 případu kardiovaskulárních příhod méně oproti skupině léčené nízkými dávkami statinů.

A meta-analysis published in July 2011 has shown an association between high-dose statin therapy and diabetes mellitus (DM) risk. The goal of the meta-analysis was to compare high-dose and low-dose statjin therapies for their potential of causing new DM cases. The meta-analySis covered five studies including 32 752 patients who had been DM free at baseline. The high-dose statin therapy was associated with two additional DM cases per 1000 patient years and with 6.5 fewer cases of cardiovascular events in comparison with low-dose statin therapy.

• Klíčová slova
• dávkování,
• MeSH
• diabetes mellitus epidemiologie   chemicky indukované   MeSH
• hodnocení rizik MeSH
• kardiovaskulární nemoci epidemiologie   prevence a kontrola   MeSH
• lidé MeSH
• odds ratio MeSH
• randomizované kontrolované studie jako téma MeSH
• statiny aplikace a dávkování   škodlivé účinky   MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• metaanalýza MeSH

Nemocní schizofrenií mají 2–3× vyšší riziko mortality ve srovnání s obecnou populací. Většinou jsou jeho podkladem přirozené příčiny jako kardiometabolická a respirační onemocnění. Mezi rizikové faktory u pacientů se schizofrenií patří nezdravý životní styl, vysoká prevalence kouření, omezená zdravotní péče, tělesné příznaky (imunitní, kardiometabolické a endokrinní) spojené s nemocí samotnou nebo nežádoucí účinky antipsychotik. Antipsychotika mohou mít negativní vliv na řadu metabolických parametrů a přispívat ke zvý-šenému kardiovaskulárnímu riziku léčených pacientů. Kardiometabolické problémy u nemocných schizofrenií jsou stále nedostatečně diagnostikovány a léčeny. V článku popisujeme doporučené postupy monitorování tělesného zdraví u pacientů léčených antipsychotiky a léčebné postupy opřené o klinické studie.

A number of studies have demonstrated that patients with schizophrenia have an excess mortality, measured by a standardized mor-tality ratio that is two or three times that seen in the general population. Majority of this excess mortality is due to natural causes, such as cardiometabolic and respiratory diseases. The causes of increased cardiometabolic burden in schizophrenia include unhealthy life style, high prevalence of smoking, disparities in quality of medical care, somatic alteration (immune, cardiometabolic and endocrine) associated with the disease itself or side effects of antipsychotics. Antipsychotics can have a negative impact on various metabolic para-meters and further increase of cardiovascular risk in treated individuals. Both the diagnostics and treatment of cardiometabolic health problems is insufficient in patients with schizophrenia. We present the recommended monitoring of cardiometabolic risk factors in patients treated with antipsychotics, as well as the evidence based treatment options.

• MeSH
• antipsychotika klasifikace   škodlivé účinky   MeSH
• kardiometabolické riziko * MeSH
• lidé MeSH
• monitorování fyziologických funkcí klasifikace   MeSH
• nežádoucí účinky léčiv klasifikace   prevence a kontrola   MeSH
• riziko MeSH
• rizikové faktory MeSH
• schizofrenie * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVES: To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS: We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS: The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION: Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.

• MeSH
• arteria femoralis MeSH
• arteria radialis MeSH
• cévní mozková příhoda * epidemiologie   etiologie   prevence a kontrola   MeSH
• koronární angioplastika * metody   MeSH
• lidé MeSH
• periferní katetrizace * metody   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• srdeční katetrizace škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

BACKGROUND: In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and magnitude of the socioeconomic gradient in cardiovascular risk factors in a former communist country. As the relationship between material conditions and education has been much weaker than in the west, we have also attempted to separate their effects. METHODS: A cross-sectional survey examined a random sample of men and women resident in six Czech districts participating in the MONICA study in 1992. Participants completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided a blood sample. Two indicators of SES were used: education and material conditions, the indicator constructed from car ownership and crowding. Linear regression was employed to analyse the relation between SES and total and high-density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-hip ratio (WHR) and height. Logistic regression was used to assess the association between SES and smoking and hypertension. RESULTS: A total of 1141 men and 1212 women (overall response rate 75%) participated in the study. After controlling for age, all risk factors were associated with education, except HDL cholesterol in women and BMI in men; only smoking in both sexes and WHR in women and height in men were significantly related to material conditions. In mutually adjusted analyses, educational gradients persisted but associations with material conditions disappeared or became substantially weaker. The magnitude of the educational differences was similar to those found in western countries. CONCLUSIONS: Socioeconomic differences in cardiovascular risk factors in Czech Republic in 1992 had the same direction and similar magnitude as in Western Europe, and were strongly related to education rather than material conditions. Materialist explanations for the social differences seem unlikely in this population.

• MeSH
• antropometrie MeSH
• cholesterol krev   MeSH
• dospělí MeSH
• hypertenze epidemiologie   MeSH
• kardiovaskulární nemoci epidemiologie   prevence a kontrola   MeSH
• kouření škodlivé účinky   MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• multivariační analýza MeSH
• odds ratio MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• socioekonomické faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH