BACKGROUND: Generic drugs and generic substitution belong to the tools by which healthcare costs may be reduced. However, low awareness and reluctance among healthcare professionals towards generic drugs may negatively affect the rational use of generic substitution. METHODS: The study aimed to analyze opinions and attitudes towards generic drugs and generic substitution among Czech physicians including their understanding of generic substitution legislative rules and the physicians´ previous experience in this field. Using random allocation, 1551 physicians practicing in the Czech Republic were asked to participate in the sociological representative survey conducted from November to December 2016, through face-to-face structured interviews comprising 19 items. Factor analysis as well as reliability analysis of items focused on legal rules in the context of physicians' awareness were applied with p-value of < 0.05 as statistically significant. RESULTS: Of a total of 1237 (79.8%) physicians (43.7% males; mean age 47.5 ± 11.6 years, 46.3% general practitioners) 24.8% considered generic drugs to be less safe, especially those with specialized qualification (p < 0.01). However, only 4.4% of the physicians noticed any drug-related problems, including adverse drug reactions associated with generic substitution. The majority of physicians felt neutrally about performing generic substitution in pharmacies, nor they expressed any opinion on characteristics of generics, even though a better understanding of the legislation and higher need of accordance of substituted drugs were associated with more positive attitudes towards generic substitution (p < 0.05). Physicians showed low knowledge score of legislative rules (mean 3.9 ± 1.6 from maximum 9), nevertheless they overestimated the law, as they considered some rules valid, even if the law does not require them. Cronbach alpha of all legislative rules that regulate generic substitution increased from 0.318 to 0.553 if two optional rules (physician consent and strength equivalence) would be taken into account. CONCLUSIONS: There is no sufficient awareness of generic drugs and generic substitution related issues among Czech physicians, although a deeper knowledge of legislation improves their perception about providing generic substitution.

• Klíčová slova
• Czech Republic, Generic drugs, Generic substitution, Physician, Representative survey,
• MeSH
• dospělí MeSH
• generika * ekonomika   MeSH
• lékaři psychologie   statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada léků * MeSH
• průzkumy a dotazníky MeSH
• zákonodárství lékové MeSH
• zdraví - znalosti, postoje, praxe * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• generika * MeSH

OBJECTIVES: A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence. STUDY DESIGN: The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment. METHODS: We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians' self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians' counselling skills measured on ordinal scale. RESULTS: Of the 37 residents trained, 75% were female, 89% aged 20-29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications. CONCLUSIONS: Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations.

• MeSH
• dospělí MeSH
• hodnocení programu MeSH
• kontinuální vzdělávání lékařů metody   organizace a řízení   statistika a číselné údaje   MeSH
• kuřáci psychologie   MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• odvykání kouření metody   MeSH
• osoby simulující pacienta ve výuce MeSH
• poradenství výchova   statistika a číselné údaje   MeSH
• poruchy vyvolané užíváním tabáku diagnóza   terapie   MeSH
• problémově orientovaná výuka metody   organizace a řízení   statistika a číselné údaje   MeSH
• průzkumy a dotazníky statistika a číselné údaje   MeSH
• studie proveditelnosti MeSH
• vzdělávací modely MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Arménie MeSH

We provide a new assessment of the effect of hospital proximity in an emergency situation-road-traffic accidents-exploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital on the basis of their population size. Our instrumental variable results show that a one-standard-deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both ordinary least squares and difference-in-differences estimates, common approaches in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards.

• Klíčová slova
• access to care, difference in differences, hospital proximity, instrumental variables, road-traffic accidents,
• MeSH
• dopravní nehody mortalita   MeSH
• hustota populace MeSH
• lékaři statistika a číselné údaje   MeSH
• letecká záchranná služba statistika a číselné údaje   MeSH
• lidé MeSH
• prostorová analýza MeSH
• sanitky statistika a číselné údaje   MeSH
• socioekonomické faktory MeSH
• urgentní služby nemocnice statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Itálie epidemiologie   MeSH

BACKGROUND: The organization of long-term care is one of the main challenges of public health and health policies in Europe and worldwide, especially in terms of care concepts for people with dementia. In Austria and the Czech Republic the majority of elderly institutionalized persons with dementia are cared for in nursing homes. It is however unclear, how many persons living in nursing homes in Austria and in the Czech Republic are suffering from cognitive impairment and dementia. In addition, basic information on the nutritional status, the status of mobility and the medication prescription patterns are often missing. To facilitate new effective and evidenced based care concepts, basic epidemiological data are in urgent need. Thus, DEMDATA was initiated to provide important basic data on persons living in nursing homes in Austria and the Czech Republic for future care planning. METHODS: DEMDATA is a multicentre mixed methods cross-sectional study. Stratified and randomly drawn nursing homes in Austria and the Czech Republic are surveyed. The study protocol used in both study centres assesses four different domains: a) Resident, b) Care team, c) Relative and d) Environmental Factors. Resident's data include among others health status, cognition, dementia, mobility, nutrition, behavioural symptoms, pain intensity and quality of life. A minimum of 500 residents per country are included into the study (N = 1000 residents). The care team is asked about the use of the person-centred care and their burden. The relatives are asked about the number of visits and proxy-rate the quality of life of their family member. All staff employed in the nursing homes, all residents and relatives can voluntary take part in the study. The environmental factors include among others the organisational category of the nursing home, number of residents, number of rooms, social activities and the care concept. The project started in March 2016 and will be concluded in February 2018. DISCUSSION: DEMDATA will provide important epidemiological data on four different nursing home domains in Austria and the Czech Republic, with a focus on the prevalence of dementia in this population. Thereby supplying decision and policy makers with important foundation for future care planning.

• Klíčová slova
• Database, Health parameters, Nursing homes, dementia,
• MeSH
• behaviorální symptomy psychologie   terapie   MeSH
• demence epidemiologie   psychologie   terapie   MeSH
• dlouhodobá péče organizace a řízení   MeSH
• domovy pro seniory statistika a číselné údaje   MeSH
• institucionalizace MeSH
• kognitivní poruchy psychologie   terapie   MeSH
• kvalita života MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé MeSH
• péče orientovaná na pacienta MeSH
• pečovatelské domovy statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• rodina psychologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Rakousko epidemiologie   MeSH

OBJECTIVE: Cardiovascular diseases are the most common cause of deaths. Cardiovascular mortality is influenced by several factors that can be changed by our behaviour. The goal of this study was to survey the opinions of physicians and nurses on the topic of preventative cardiovascular risk factors. METHODS: The inquiry was carried out using a standardized structured interviewer-respondent interview (face-to-face). The final form of the interview was based on the results of a pre-investigation. The study was anonymous, participation was voluntary, and the actual interview did not contain any controversial ethical questions. To meet these goals, a non-standardized questionnaire for nurses and physicians was developed. The questions evaluated the interest, coping difficulties, and efficiency of multimodal interventions in practice. The study sample included 1000 physicians and 1000 nurses. The results were statistically evaluated. RESULTS: The survey of physician and nurse opinions showed that patients were primarily interested in interventions in the area of nutrition, weight loss, and coping with pharmacotherapy; however, the overall lack of interest in smoking cessation was a surprising result. Physicians and nurses viewed smoking cessation as the most difficult risk factors to influence, followed by nutrition changes, and weight loss. It was noteworthy that more than half of the interviewed physicians and nurses were of the opinion that behavioral interventions were only sometimes or rarely effective. CONCLUSION: The results of our study show that nurses and physicians largely agree on behavioral risk factors and how to influence them. Nurses and physicians in Czech health care generally agree that patients are interested in influencing the above risk factors, being least interested in exercise and smoking cessation. Nurses and physicians also consider smoking reduction and weight loss as particularly difficult risk factors to manage. Results from this study will contributed to the overall goal of preparing and implementing short-term and long-term interventions in preventive cardiology.

• MeSH
• chování snižující riziko * MeSH
• hmotnostní úbytek MeSH
• kardiovaskulární nemoci prevence a kontrola   MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé MeSH
• odvykání kouření statistika a číselné údaje   MeSH
• pacientův souhlas se zdravotní péčí statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• zdravotní sestry statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: The goal of this article was to assess the delivery of patient health-education, relative to cardiovascular disease from the perspective of physicians and nurses, as well as from the perspective of citizens living in the Czech Republic. METHODS: The article is based on data acquired from the "Intervention procedures in preventive cardiology" grant project. To evaluate patient health education, non-standardized questionnaires intended for physicians (n = 1000) and nurses (n = 1000) were used. A combination of a non-standardized questionnaire and a standardized questionnaire (SF-36) was used to assess citizen (n = 1992) viewpoints. The actual investigation took place from April 1 to April 20, 2016 and was implemented over the entirety of the Czech Republic. Data were analyzed using the SASD v. 1.4.12 program. Both first and second degree sorting was used. The degree of dependence of selected characteristics was established based on the Chi-square test and the T-test. RESULTS: A bit more than half (53.1%) of the physicians indicated that nurses carried out patient education regarding influenceable risk factors associated with cardiovascular diseases, while 71.6% of nurses reported carrying out this duty. The overwhelming majority of physicians (97.1%) and nurses (92.3%) report informing patients about how to improve their health condition. Citizen respondents reported that topics such as nutrition, exercise, smoking cessation, stress reduction, and the drug side effects use were discussed with them more frequently by physicians than by nurses. Citizen respondents reported that nutrition was discussed most frequently with them, while the issue of smoking cessation was discussed the least frequently. CONCLUSION: Our analysis showed that physicians engage in patient education more frequently than nurses. At the same time, results suggest that a relatively significant number of physicians and nurses rarely or never educate regarding risk factors associated with cardiovascular diseases.

• MeSH
• dospělí MeSH
• kardiovaskulární nemoci * MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé MeSH
• vzdělávání pacientů jako téma statistika a číselné údaje   MeSH
• zdraví - znalosti, postoje, praxe * MeSH
• zdravotní sestry statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: The electrocardiogram (ECG) is the most commonly used diagnostic procedure for assessing the cardiovascular system. The aim of this study was to compare ECG diagnostic skill among fellows of cardiology and of other internal medicine specialties (non-cardiology fellows). METHODS: A total of 2900 ECG interpretations were collected. A set of 100 clinical 12-lead ECG tracings were selected and classified into 12 diagnostic categories. The ECGs were evaluated by 15 cardiology fellows and of 14 non-cardiology fellows. Diagnostic interpretations were classified as (1) correct, (2) almost correct, (3) incorrect, and (4) dangerously incorrect. Multivariate logistic regression was used to assess confounding factors and to determine the odds ratios for the months of experience, age, sex, and the distinction between cardiology and non-cardiology fellows. RESULTS: The mean rate of correct diagnoses by cardiology vs. non-cardiology fellows was 48.9±8.9% vs. 35.9±8.0% (p=0.001; 70.1% vs. 55.0% for the aggregate of 'correct' and 'almost correct' diagnoses). There were 10.2±5.6% of interpretations classified as 'dangerously incorrect' by cardiology fellows vs. 16.3±5.0% by non-cardiology fellows (p=0.008). The cardiology fellows achieved statistically significantly greater diagnostic accuracy in 7 out of the 12 diagnostic classes. In multivariable logistic regression, the distinction between cardiology and non-cardiology fellows was the only independent statistically significant (p<0.001) predictor of whether the reader is likely correct or incorrect. Being a non-cardiology fellow reduced the probability of correct classification by 42% (odds ratio [95% confidence interval]: 0.58 [0.50; 0.68]). CONCLUSIONS: Although cardiology fellows out-performed the others, skills in ECG interpretation were found not adequately proficient. A comprehensive approach to ECG education is necessary. Further studies are needed to evaluate proper methods of training, testing, and continuous medical education in ECG interpretation.

• Klíčová slova
• Diagnostic accuracy, Electrocardiogram interpretation, Fellows, Training,
• MeSH
• chybná diagnóza statistika a číselné údaje   MeSH
• dospělí MeSH
• elektrokardiografie statistika a číselné údaje   MeSH
• klinické kompetence statistika a číselné údaje   MeSH
• lékaři statistika a číselné údaje   MeSH
• lidé MeSH
• odchylka pozorovatele MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• srdeční arytmie diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees. METHODS: One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire. RESULTS: The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean)=0.92, SD=1.44, range=0-12) and most in Portugal (M=19.06, SD=17.44, range=0-100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M=3.30, SD=1.26 vs. M=2.39, SD=1.06 on a 5-point Likert scale: 1 "completely disagree" to 5 "completely agree"). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio)=1.21, 95%CI=1.12-1.30 and OR=1.18, 95%CI=1.02-1.37). CONCLUSIONS: There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.

• Klíčová slova
• Conflict of interest, EFPT, European Federation of Psychiatric Trainees, Industry interactions, Pharmaceutical industry, Psychiatric training,
• MeSH
• dospělí MeSH
• farmaceutický průmysl * MeSH
• interprofesionální vztahy * MeSH
• lékaři statistika a číselné údaje   MeSH
• lékařská praxe - způsoby provádění * MeSH
• lidé MeSH
• postoj zdravotnického personálu MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• psychiatrie výchova   MeSH
• studium lékařství specializační postgraduální * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

There are few studies from East and Central European countries on health-status, lifestyle and social circumstances of medical professionals. We evaluated data of a cohort of physicians who had graduated 30 years ago in Hungary and compared the data of their professional carrier, life style, health outcomes, and medical specialties. Questionnaires compiled by an expert group and filled in by 208 physicians (83 men and 125 women) were analysed. Men mostly work as surgeons, women were mostly employed as primary care specialists. Women changed their specialty and/or place of work more often than men. Male primary care physicians had more children than women and others specialists. At graduation, most of them had a normal BMI. Since then, a significant increase in weight and BMI was observed in both genders and across all specialty groups. The largest increase in body weight and BMI (mean 5.27) was recorded among female primary care physicians. Recorded physical activity was low in general, with male primary care specialists being most active and female primary care physicians the least. Female doctors in surgical specialties had longer resting time. Male physicians rarely participated in regular health screenings. The incidence of hypertension was higher than the Hungarian national average for that age. About 5% of primary care physicians identified themselves as regular smokers. Abstinence and regular daily alcohol consumption were reported in equal ratio. Burn-out symptoms were rarely experienced. This generation had started its medical profession before the significant progressive changes in the medicine occurred in the last decades. While physicians do not always follow their own professional advices, their lifestyle proved a little bit healthier than that of the population at large, especially for women and their health outcomes, except hypertension, were also better. In general, they were not satisfied with the financial and working conditions of the recent Hungarian healthcare system.

• MeSH
• cvičení MeSH
• demografie statistika a číselné údaje   MeSH
• index tělesné hmotnosti MeSH
• lékaři statistika a číselné údaje   MeSH
• lékařství statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidita * MeSH
• pracovní uspokojení MeSH
• stárnutí MeSH
• zdravé chování MeSH
• zdravotní stav MeSH
• životní styl * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Maďarsko MeSH

The paper presents the results of a questionnaire poll carried out in the workers in pharmacies in the Slovak Republic in the year 2012. A number of 250 respondents (50.8%) were satisfied with their weight, 242 (49.2%) were not satisfied; 190 (38.6%) of them attempted to decrease the weight, 52 (10.6%) did not; 94 persons (49.5 %) attempted to decrease weight more than 3 times. 110 respondents (57.9%) actively searched for the possibilities of treatment of overweight and obesity. The most frequent source of information was the Internet (64; 57.7%). Only 43 (22.6%) participants decided to solve their problem of overweight/obesity in cooperation with an expert. As many as 127 (66.8%) respondents stated that the physician did not draw their attention to the need of decreasing their weight. The most widely used method of slimming in the workers in pharmacies was modification of eating habits (162, 84.4%). A number of 108 (56.8%) respondents reported that they were able to maintain the loss of weight.

• MeSH
• farmaceuti psychologie   statistika a číselné údaje   MeSH
• farmaceutický laborant psychologie   statistika a číselné údaje   MeSH
• lékaři statistika a číselné údaje   MeSH
• lékárny statistika a číselné údaje   MeSH
• lidé MeSH
• nadváha epidemiologie   psychologie   MeSH
• obezita epidemiologie   psychologie   MeSH
• percepce MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika epidemiologie   MeSH