Bartonella schoenbuchensis causes bacteremia in ruminants and is transmitted by deer keds. Here, we report the complete genome sequences of three B. schoenbuchensis strains (L2, L19, and L24) recently isolated from deer keds (Lipoptena fortisetosa) in Czechia.

• Klíčová slova
• Bartonella, Czech Republic, Lipoptena, genomes, schoenbuchensis,
• Publikační typ
• časopisecké články MeSH

The shift in fertility to higher ages over the last few decades represents one of the most distinctive features of reproductive behaviour in Czechia. The aim of this article is to provide an overview of the process of fertility postponement in the European context and assessment of the Czech situation. While the fertility postponement is a universal trend in developed countries, significant differences are evident between European countries in terms of both the commencement and speed of postponement concerning the mean age of mothers at first birth. The article also discusses the main factors that influence the fertility postponement. While at the beginning of the 1990s Czech first-time mothers were among the youngest in the worlds developed countries, during the 1990s Czech women experienced one of the most rapid increases in the mean age of first birth. Nevertheless, in the European context Czechia continues to have slightly younger first-time mothers (28.2 years in 2016, 0.8 years younger than the EU average). It also appears that currently no direct correlation is evident with concern to the mean age of mothers at first birth and the total fertility rate.

• Klíčová slova
• Czechia, Europe, fertility postponement, mother’s age at first birth,
• MeSH
• fertilita * MeSH
• lidé MeSH
• populační dynamika MeSH
• porodnost * MeSH
• stárnutí * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH
• Evropa MeSH

This analysis of the Czech health system reviews developments in governance, organization, financing and delivery of care, health reforms and health system performance. Czechs have enjoyed a statutory health insurance system with a high level of financial protection, a broad benefits package and universal membership for over 30 years. The central level of the state, mostly represented through the Ministry of Health and its subordinated bodies, takes on the various roles of legislator, steward and even owner of various providers of care, while also making insurance contributions for the sizeable part of the population classified as economically inactive. Health insurance funds are responsible for contracting sufficient care provision for their members. The Czech health system has traditionally derived a majority of its financing from public sources, which stood at 81.5% of current health expenditure in 2019, as the latest available year of reference, with the rest coming from private sources. While health spending in Czechia is below the European Union (EU) average, the densities of acute care beds and primary care physicians are above respective EU averages. Ageing and a lack of qualified staff (for example, nurses in hospitals) are already putting pressure on the Czech health workforce, a bottleneck further exposed by the COVID-19 pandemic. Additionally, Czechia has embarked on a reform process to modernize and centralize specialized tertiary care and psychiatric care. Patients enjoy free choice of primary and specialized outpatient providers, though there are signs that accessibility is limited in some regions and for some specialties. Overall, health outcomes in terms of life expectancy, mortality and survival rates of stroke and cancer have improved in recent years, though these improvements have been slower in Czechia than in other countries. However, life expectancy dropped considerably due to heightened mortality resulting from the COVID-19 pandemic in 2020 and 2021. There remains considerable room for improvement in strengthening disease prevention and health promotion, particularly for dietary habits and health literacy. Various efforts to advance evidence-based interventions in the health system, such as the initiation of health care quality monitoring and health system performance assessment, will assist in further analysing Czechia's health outcomes.

• MeSH
• COVID-19 * epidemiologie   MeSH
• kvalita zdravotní péče MeSH
• lidé MeSH
• pandemie MeSH
• reforma zdravotní péče MeSH
• výdaje na zdravotnictví MeSH
• zdravotní pojištění MeSH
• zdravotní politika * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. RESULTS: Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001). CONCLUSIONS: The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

• Klíčová slova
• Breech delivery, Cesarean section (CS), Czechia, Fertility, Fertility postponement, Health status,
• MeSH
• císařský řez * škodlivé účinky   MeSH
• fertilita * MeSH
• lidé MeSH
• matky MeSH
• těhotenství mnohočetné MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The rapid increase in the proportion of women using hormonal contraception in the 1990s was positively reflected in a rapid decline in the number of abortions. Czechia was unique not only among Eastern European countries, but also worldwide. At the same time the decline in the prevalence of hormonal contraception from a peak of almost 50 % in 2007 to 30 % in 2021 meant a slowing and gradual halt in the further decline in abortions. The results of the GGP 2020-2022 survey in Czechia showed that the lower use of hormonal contraception among women was only partly offset by the increased use of other reliable methods of protection against unintended pregnancy (e.g. condom use). The largest decline in the use of hormonal contraceptives in the form of the pill occurred among the youngest women aged 18-27 years, from 76 to 37 %, which was partly reflected in the more intensive use of condoms (an increase from 21 to 35% in the 18-27 age group), but is worrying, that this age group saw the largest increase in the use of less reliable methods (withdrawal from 11 to 22 % and an increase in the use of the barren days method from 1 to 6 %) and also the largest increase in the proportion of women using neither method (from 7 to 17 %). The lowest proportion of female hormonal pill users was found among female with higher education. However an important finding is that when less reliable methods are used, there is an effort to combine at least two methods. Women have a more important role in determining how to protect themselves from unintended pregnancy.

• Klíčová slova
• contraception, fertility, abortion,
• MeSH
• antikoncepce metody   statistika a číselné údaje   MeSH
• antikoncepční chování * statistika a číselné údaje   MeSH
• dospělí MeSH
• indukovaný potrat statistika a číselné údaje   MeSH
• kondomy statistika a číselné údaje   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: The decrease in the number of healthcare workers and the resulting deterioration in healthcare quality and availability have been subjected to intensive discussion in Czechia in recent years. Estimating future healthcare worker capacities requires a detailed analysis of their "movement" within the healthcare system. This study focuses on exits of the primary care physicians from the healthcare system in Czechia. METHODS: Using anonymised data obtained from the largest Czech health insurance company (2012-2022), we constructed working life tables and calculated working life expectancy, which indicates the expected average number of remaining years of work at the exact age of the physician. The study focuses on primary care physicians, who are crucial for the effective functioning of the healthcare system. RESULTS: At age 50, working life expectancy was 20 years for female physicians and approximately 21 years for male physicians. Over the monitored period, working life expectancy decreased by 1 year for both genders. Gynaecologists had the longest working life expectancy, while dentists had the shortest. CONCLUSIONS: The decrease in the working life expectancy and the length of tenure indicates the need to create favourable conditions for the extension of the working lives of physicians to avoid early exits from the system.

• Klíčová slova
• Czechia, Healthcare system, Life tables, Primary care physicians, Working life expectancy,
• MeSH
• dospělí MeSH
• lékaři primární péče * MeSH
• lidé středního věku MeSH
• lidé MeSH
• naděje dožití * MeSH
• primární zdravotní péče MeSH
• zaměstnanost statistika a číselné údaje   MeSH
• zubní lékaři statistika a číselné údaje   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

OBJECTIVE: The aim was to analyse the mortality trends in Czechia and Slovakia through detailed anonymized primary data on deaths in 2010-2020 and in particular to identify various aspects of the impact of the 2020 pandemic year in their context. METHODS: Using the DeRaS application, complete life tables by sex for 2010-2020 were constructed for Czechia and Slovakia, and changes in life expectancy at birth and at the exact age of 65 years were analysed. Using Pressat's univariate decomposition, the effect of different age groups on the change in life expectancy at birth for men and women between 2019 and 2020 was identified. Subsequently, age group contributions to the decline in temporary life expectancy between the exact ages of 65 and 110 were also determined. Trends in mortality rates for each of the major cause of death groups were analysed using directly standardized mortality rates, with a detailed focus on selected groups of cardiovascular disease. The contributions of the major cause of death groups to the decline in life expectancy at birth between 2019 and 2020 were empirically identified by applying bivariate decomposition according to the Pollard method. RESULTS: In 2020, the life expectancy of newly born men in Czechia decreased by 1.05 years and that of women by 0.76 years. In Slovakia, the decrease was 0.67 years for men and 0.64 years for women. An even greater reduction was found for both countries at the exact age of 65. The main reason for this was the worsening of the mortality rates between the ages of 65 and 89 years, especially from COVID-19 and some diseases of the circulatory system. CONCLUSION: The study identified a significant reduction in life expectancy at birth for both men and women in Czechia and Slovakia between 2019 and 2020. The main reason for this phenomenon was the increase in mortality rates at senior ages, up to around age 90. However, the increase in mortality did not affect all age groups, but contributions at younger ages could not significantly compensate for the negative impact of older ages. The study confirmed mortality from COVID-19 as a major factor in declining life expectancy at birth but also noted a non-negligible effect of the worsened mortality rates from circulatory diseases. The negative impact of both groups of causes of death was particularly pronounced at the age of 65 and over.

• Klíčová slova
• COVID-19, Czechia, Life expectancy, Slovakia, causes of death, mortality, secular trends,
• MeSH
• COVID-19 * MeSH
• lidé MeSH
• novorozenec MeSH
• pandemie * MeSH
• příčina smrti MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Slovenská republika epidemiologie   MeSH

Objectives: Although people use health services throughout their lives, there are important differences in timing, location, and frequency of utilization. The aim of this article is to identify and explain these differences in terms of healthcare accessibility. Methods: Outpatient health services-diabetology, cardiology, and psychiatry-are analysed using anonymized data from the General Health Insurance Company (GHIC) in Czechia for 2019. Healthcare utilization is studied in relation to selected geodemographic characteristics-patient's age, sex, place of permanent residence, and location of healthcare provision. Results: The analysis found significant differences in the utilization of the selected health services in terms of age, sex, and size of the patient's municipality of residence. Generally, men tended to travel outside their municipality for healthcare more than women. Young patients were more likely (and also further) to travel outside their municipality for healthcare than older patients. Conclusion: The reasons for this were the location of the health service provider (mostly concentrated in local/regional centres), the patient's ability and willingness to travel for healthcare, and differences in the patient's permanent and ordinary place of residence.

• Klíčová slova
• Czechia, accessibility, cardiology, diabetology, health services, psychiatry, utilization,
• MeSH
• ambulantní péče * MeSH
• cestování MeSH
• dostupnost zdravotnických služeb * MeSH
• lidé MeSH
• pacientův souhlas se zdravotní péčí MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

This article explores medical students' career preferences in the context of the 2017 reform to medical specialty training in Czechia, which aimed to stabilise the physician workforce. One of the changes introduced by the reform was the merging of specialty training for both primary-care and hospital-based paediatrics, facilitating easier transitions of physicians between hospital and outpatient settings. This article presents findings from a survey, conducted by the authors in 2020-2022, of over 3000 students from all medical schools in Czechia. A particular focus was placed on respondents interested in paediatrics. Key findings include: (i) training experience plays a critical role in students' career decisions; however, (ii) students report limited exposure to primary-care paediatrics during their studies; (iii) up to one-third of students who prefer paediatrics intend to leverage the flexibility facilitated by the reform and combine careers in primary-care and hospital-based paediatrics; (iv) family-work balance is a key consideration for students who prefer paediatrics; (v) support from employers during training and the quality of supervision are pivotal for choosing a medical facility. These insights into medical students' career preferences are valuable for policy-makers internationally and underline the importance of aligning health workforce reforms with the preferences of medical graduates' and young physicians' to ensure an impact.

• Klíčová slova
• Czechia, Medical specialty training, Medical student career preferences, Paediatrics, Primary care,
• Publikační typ
• časopisecké články MeSH

The assessment of the development of fertility and abortion rates over the last three decades shows that Czechia has reached the top position in Europe with a total fertility rate of 1.83 children per woman in 2021. The postponement of fertility to women's older age, which was behind the sharp drop in fertility to 1.1, has been gradually slowed down and halted between 2015 and 2021. In recent years, there has been an increase in fertility rates for women aged 30 and older as well as a balanced increase for women under 30. In the European context Czechia has maintained its position as a country with lower rates of reproductive ageing. The favourable demographic position of Czechia among European countries is also illustrated by the relatively low level of the abortion rate. The postponement of female fertility to older ages has not been accompanied by an increase in the abortion rate among young women, but on the contrary a decline in fertility has been accompanied by a decline in the abortion rate. Given the year-on-year increase in total fertility (from 1.71 in 2020 to 1.83 in 2021), the initial effect of the COVID-19 pandemic on fertility can be assessed positively. However, the subsequent decline to 1.62 in 2022 is already the result of a combination of adverse effects stemming from the consequences of antipandemic measures and worsening economic conditions, to which new security risks associated with the war in Ukraine have subsequently been added. This has created the conditions for a further postponement of fertility until women are older.

• Klíčová slova
• fertility, abortion, reproductive ageing, fertility postponement,
• MeSH
• COVID-19 epidemiologie   MeSH
• dospělí MeSH
• fertilita MeSH
• indukovaný potrat * statistika a číselné údaje   trendy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• porodnost * trendy   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH