Telemedicine is a way to improve healthcare outcomes with greater efficiency for both patients and care providers. The great potential of digital technologies also lies in strengthening the patient-centered approach. The early successes and benefits of telemedicine in the Czech Republic, amplified by the COVID-19, have contributed to the fact that wider implementation of telemedicine is already generally supported at the expert and public levels. Our research focuses on the identification of key issues in the implementation of telemedicine and the challenges of telemedicine in the future, from the perspective of patients and other stakeholders. The study is based on a qualitative research approach, combining focus groups with key stakeholders, patient panels and expert panels (2021-2022). The lack of rules and uncoordinated development of various activities proved to be the main barriers to the integration of telemedicine in the health system. This regulatory uncertainty can generate a number of problems in the patient-doctor relationship in practice, including ethical ones, and can also lead to inequalities in access to healthcare and affect the overall quality of care provided. Furthermore, it has been shown that patients' interests in the implementation of telemedicine are: 1. a predictable and reliable framework that guarantees them certainty and security in the provision of telemedicine services, 2. telemedicine solutions that increase the availability and efficiency of the care provided while bringing comfort, and 3. user-friendly and simple solutions. At the same time, patients want to understand the new environment and be active participants in the process of digital innovation, including the practical implementation of telemedicine. The research team has developed recommendations for further developments in the implementation of telemedicine that reflect the patient's interest and can be implemented at three levels - the health system, institutional, and community level. In countries with a well-developed and institutionalized patient movement, the community level can be represented by patient organizations, thus becoming the link between telemedicine policy making and implementation at the individual level of healthcare provision. For the further development of telemedicine, the development of a national strategy involving all key stakeholders, including patients, in the implementation has proven essential.

• Keywords
• community, development of telemedicine, patient and public involvement, patient interest, patient organizations, stakeholders, telehealth,
• MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Patients MeSH
• Delivery of Health Care MeSH
• Telemedicine * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Nijmegen breakage syndrome (NBS) is an autosomal-recessive chromosome instability disorder characterized by, among others, hypersensitivity to X-irradiation and an exceptionally high risk for lymphoid malignancy. The vast majority of NBS patients is homozygous for a common Slavic founder mutation, c.657del5, of the NBN gene, which is involved in the repair of DNA double-strand breaks (DSBs). The founder mutation also predisposes heterozygous carriers to cancer, apparently however, with a higher risk in the Czech Republic/Slovakia (CS) than in Poland. AIM: To examine whether the age of cancer manifestation and cancer death of NBN homozygotes is different between probands from CS and Poland. METHODS: The study is restricted to probands born until 1989, before replacement of the communist regime by a democratic system in CS and Poland, and a substantial transition of the health care systems. Moreover, all patients were recruited without knowledge of their genetic status since the NBN gene was not identified until 1998. RESULTS: Here, we show that cancer manifestation of NBN homozygotes is at a significantly earlier age in probands from CS than from Poland. This is explained by the difference in natural and medical radiation exposure, though within the permissible dosage. CONCLUSION: It is reasonable to assume that this finding also sheds light on the higher cancer risk of NBN heterozygotes in CS than in Poland. This has implications for genetic counseling and individualized medicine also of probands with other DNA repair defects.

• Keywords
• NBS, age of cancer manifestation, cancer risk of heterozygotes, environmental and medical exposure to ionizing radiation,
• MeSH
• Heterozygote MeSH
• Nuclear Proteins genetics   MeSH
• Humans MeSH
• Mutation MeSH
• Neoplasms * MeSH
• Cell Cycle Proteins genetics   MeSH
• Nijmegen Breakage Syndrome * genetics   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Nuclear Proteins MeSH
• NBN protein, human MeSH Browser
• Cell Cycle Proteins MeSH

BACKGROUND There is a high prevalence of cognitive and socioemotional dysfunction in very low birth weight (VLBW <1500 g) and extremely low birth weight (ELBW <1000 g) children. This study from the Czech Republic aimed to compare the cognitive and socioemotional development at 5 and 9 years of age of children born with VLBW/ELBW with children born with normal birth weight (NBW ≥2500 g). MATERIAL AND METHODS The clinical group consisted of 118 VLBW/ELBW children and the control group consisted of 101 children with NBW at ages 5 to 9 years. The research battery included selected subscales from the Intelligence and Development Scales (IDS), A Developmental Neuropsychological Assessment - second edition (NEPSY-II), and the Behavior Rating Inventory of Executive Function (BRIEF). Data were analyzed using STATA IC v. 15 software and G*Power (descriptive statistic, analysis of variance (ANOVA), correlations, multivariate analysis of variance - MANOVA, post hoc power analysis). RESULTS We found a statistically significant difference in cognitive and socioemotional development between children with VLBW/ELBW and those with NBW. The average intelligence quotient (IQ) of VLBW/ELBW children was 96.38, while that of NBW children was 12.98 points higher (P<0.001). NBW children achieved better results on all subtests of the IDS (P<0.001) as well as in affect recognition (P<0.001). All results for both groups were within normal range. Parents of VLBW/ELBW children did not recognize impaired executive functioning (P=0.494). CONCLUSIONS This study has shown significant cognitive and socioemotional deficit in children born with VLBW and ELBW when evaluated at 5 and 9 years of age.

• MeSH
• Analysis of Variance MeSH
• Child MeSH
• Cognition MeSH
• Humans MeSH
• Infant, Extremely Low Birth Weight * MeSH
• Infant, Very Low Birth Weight * MeSH
• Infant, Newborn MeSH
• Birth Weight MeSH
• Child, Preschool MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students' oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students' views and attitudes.

• Keywords
• Czech Republic, HU-DBI, Hiroshima University Dental Behavioural Inventory, Slovakia, attitudes and practices, dental education, dental students, health-related knowledge, oral health, oral hygiene,
• MeSH
• Humans MeSH
• Oral Hygiene MeSH
• Oral Health * MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Students, Dental * MeSH
• Health Behavior MeSH
• Health Knowledge, Attitudes, Practice MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH
• Slovakia MeSH

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area.

• Keywords
• Czechia, Hungary, Poland, Slovakia, care coordination, chronic disease, integrated care, multi-morbidity,
• MeSH
• Chronic Disease MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Multimorbidity * MeSH
• Pandemics MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Hungary epidemiology   MeSH
• Poland epidemiology   MeSH
• Slovakia epidemiology   MeSH

BACKGROUND: An analysis of the regional distribution of health resources is one of the tools for evaluating equal geographic access to health care. The usual analytical approach to an assessment of regional differences is to evaluate each health resource separately. This is a sensible approach, because there may be systematic reasons for any differences, for example, higher salaries in urban areas. However, a separate evaluation of the regional distribution of health resource capacities may be misleading. We should evaluate all health resource capacities as a whole and consider the substitutability of resources. OBJECTIVE: This study aims to measure regional inequalities in the Czech Republic with the help of alternative approaches to the evaluation of regional inequalities in the case of several substitutable health resources. METHODS: Five alternative evaluation methods (models) are described and applied: the separate evaluation, expert model, market model, common weights model, and production frontier model. RESULTS: The regional distribution of physicians and nurses in the Czech Republic in 2017 was evaluated. In spite of many regulations at the national and regional levels, we have found inequalities in regional resource distribution. The models that consider all health resources and the possibility of a resource substitution show lower inequalities between regional health resource capacities. CONCLUSION: Both researchers and policy-makers should always consider the possibility of resource substitutions in the assessment of regional inequalities.

• Keywords
• Common weights model, Czech Republic, Data envelopment analysis, Inequality measures, Production frontier model, Regional inequality,
• MeSH
• Humans MeSH
• Delivery of Health Care * MeSH
• Health Resources * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

In contrast to the decreasing burden related to cardiovascular disease (CVD), the burden related to dysglycemia and adiposity complications is increasing in Czechia, and local drivers must be identified. A comprehensive literature review was performed to evaluate biological, behavioral, and environmental drivers of dysglycemia and abnormal adiposity in Czechia. Additionally, the structure of the Czech healthcare system was described. The prevalence of obesity in men and diabetes in both sexes has been increasing over the past 30 years. Possible reasons include the Eastern European eating pattern, high prevalence of physical inactivity and health illiteracy, education, and income-related health inequalities. Despite the advanced healthcare system based on the compulsory insurance model with free-for-service healthcare and a wide range of health-promoting initiatives, more effective strategies to tackle the adiposity/dysglycemia are needed. In conclusion, the disease burden related to dysglycemia and adiposity in Czechia remains high but is not translated into greater CVD. This discordant relationship likely depends more on other factors, such as improvements in dyslipidemia and hypertension control. A reconceptualization of abnormal adiposity and dysglycemia into a more actionable cardiometabolic-based chronic disease model is needed to improve the approach to these conditions. This review can serve as a platform to investigate causal mechanisms and secure effective management of cardiometabolic-based chronic disease.

• Keywords
• adiposity, cardiometabolic risk, cardiovascular disease, chronic disease, dysglycemia, insulin resistance, nutrition, obesity, type 2 diabetes,
• MeSH
• Adiposity ethnology   MeSH
• White People statistics & numerical data   MeSH
• Chronic Disease epidemiology   ethnology   MeSH
• Diabetes Mellitus, Type 2 epidemiology   ethnology   MeSH
• Diet adverse effects   ethnology   MeSH
• Health Status Disparities MeSH
• Adult MeSH
• Dyslipidemias epidemiology   ethnology   MeSH
• Hypertension epidemiology   ethnology   MeSH
• Cardiometabolic Risk Factors MeSH
• Cardiovascular Diseases epidemiology   etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Metabolic Syndrome epidemiology   ethnology   MeSH
• Obesity epidemiology   ethnology   MeSH
• Glucose Intolerance epidemiology   ethnology   MeSH
• Prediabetic State epidemiology   ethnology   MeSH
• Prevalence MeSH
• Sedentary Behavior ethnology   MeSH
• Social Determinants of Health ethnology   MeSH
• Feeding Behavior ethnology   MeSH
• Health Literacy MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

BACKGROUND AND AIMS: Since cardiometabolic diseases (CMD) are a frequent cause of death worldwide, preventive strategies are needed. Recruiting adults for a health check could facilitate the identification of individuals at risk for CMD. For successful results, participation is crucial. We aimed to identify factors related to unwillingness to participate in CMD health checks. METHODS: We performed a cross-sectional study in the Czech Republic, Denmark, Greece, the Netherlands, and Sweden. A questionnaire was distributed among persons without known CMD consulting general practice between January and July 2017 within the framework of the SPIMEU study. RESULTS: In total, 1354 persons responded. Nine percent was unwilling to participate in a CMD health check. Male gender, smoking, higher self-rated health, never been invited before, and not willing to pay were related to unwillingness to participate. The most mentioned reason for unwillingness to participate was "I think that I am healthy" (57%). Among the respondents who were willing to participate, 94% preferred an invitation by the general practitioner and 66% was willing to pay. CONCLUSION: A minority of the respondents was unwilling to participate in a CMD health check with consistent results within the five countries. This provides a promising starting point to increase participation in CMD health checks in primary care.

• Keywords
• cardiometabolic disease, cardiovascular disease, health check, prevention, willingness to participate,
• Publication type
• Journal Article MeSH

(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012-2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.

• Keywords
• Czech Republic, DRG, hospital economy,
• MeSH
• Reimbursement Mechanisms * MeSH
• Diagnosis-Related Groups * MeSH
• Humans MeSH
• Hospitals MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH
• Europe MeSH

BACKGROUND: Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany. METHODS: Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A two-part model with a logit model in the first part and a generalised linear model in the second part is applied. RESULTS: The diseases increasing the burden in the observed countries are heart attacks, high blood pressure, cancer, emotional disorders, rheumatoid arthritis and osteoarthritis. Reflecting country differences Parkinson's disease and its drug burden is relevant in Belgium, the drugs burden related to heart attack and outpatient care burden to chronic kidney disease in the Czech Republic and the outpatient care burden of cancer and chronic lung disease in Germany. In addition, we confirm the regressive character of out-of-pocket payments. CONCLUSIONS: We conclude that the burden is not equitably distributed among older adults with chronic diseases. Identification of chronic diseases with a high burden can serve as a supplementary protective feature.

• Keywords
• Belgium, Chronic diseases, Czech Republic, Germany, Older adults, Out-of-pocket burden,
• MeSH
• Chronic Disease * MeSH
• Humans MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Belgium MeSH
• Czech Republic epidemiology   MeSH
• Europe MeSH
• Germany epidemiology   MeSH