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Abstract As with Northern European countries, Czechia experienced unexpected fertility developments during the Covid-19 pandemic. Fertility in Czechia increased between 2020 and 2021 from 1.76 children per woman to 1.83. However, between 2021 and 2022, fertility fell significantly to just 1.62 children per woman. The main change that occurred between 2020 and 2021, which is thought to have affected fertility one year later, comprised vaccination against Covid-19. This vaccination of the adult population was very specific in terms of both its scope and the timing of vaccination for each age group as organised by the state. The mass scale of the vaccination campaign and its implementation within a very short period of time were unprecedented. However, along with the significant degree of uncertainty concerning the appropriateness of vaccination for pregnant women, vaccination was seen as a factor that potentially acted to significantly change women’s reproductive plans in the short term and, as a consequence, potentially exerted a significant short-term impact on both birth rates and fertility indicators. This study models the maximum potential impact of vaccination on fertility levels under the assumption that all the vaccinated women chose to avoid conception in the month in which they were vaccinated. Applying the indirect standardisation principle, we calculated the expected monthly live births after excluding women who were vaccinated nine months earlier. The comparison of hypothetical and observed fertility revealed that the perceived potential impact of vaccination was largely consistent with the observed fertility decline in Czechia between 2021 and 2022.

Abstract Background Russia’s military aggression against Ukraine set in motion a large number of refugees. Considerable amount of them came and stayed in Czechia. Refugees represent special vulnerable individuals often affected by war physically and psychologically. Due to the national regulations not allowing most of Ukrainian men aged 18–60 to leave the country, nowadays Ukrainian forced migration is relatively young and strongly gendered. Evidence suggests the higher probability for searching the safe refuge abroad among Ukrainian women with small children as well as those with relatively higher economic and cultural capital. The aim of this study is to identify the structural features of systemic risks associated with war migration by examining determinants of self-rated health among forcibly displaced highly educated Ukrainian women of productive age residing in Czechia. Methods Data from one wave of the panel survey among Ukrainian refugees in Czechia conducted in September 2022 was used. Determinants of self-rated health including self-reported diseases and healthcare factors, lifestyle, human and social capital, economic factors, and migration characteristics were analysed using binary logistic regression. Results About 45% highly educated Ukrainian women refugees in Czechia assessed their health as poor. The poor self-rated health was mostly associated with the number of diseases and depressive symptoms, and by social capital and economic factors. Having four and more diseases (OR = 13.26; 95%-CI: 5.61–31.35), showing some severe depressive symptoms (OR = 7.20; 95%-CI: 3.95–13.13), experiencing difficulties to seek help from others (OR = 2.25; 95%-CI: 1.20–4.23), living alone in a household (OR = 2.67; 95%-CI: 1.37–5.27), having severe material deprivation (OR = 2.70; 95%-CI: 1.35–5.41) and coming originally from the eastern part of Ukraine (OR = 2.96; 95%-CI: 1.34–6.55) increased the chance of these refugees to assess their health as poor. Conclusion Social and economic determinants such as lack of social contacts for seeking help and material deprivation were found to be crucial for self-rated health and should be tackled via migration policies. Further, qualitative research is needed to better understand the mechanisms behind the factors affecting subjectively assessed health.

Abstract While the direct effects of the pandemic are well documented, less is known about the indirect ones, including changes in healthcare provision or human behavior. This paper aims to study the impact of indirect consequences on mortality, focusing on two leading causes (cardiovascular diseases, COVID-19) and places of death in Czechia, during the COVID-19 pandemic, one of the most severely affected European countries. The analysis was performed using data from the Czech Statistical Office and the Institute of Health Information and Statistics. The study compares annual mortality changes during three time periods: pre-pandemic (2018–2019), pandemic beginning and peaking (2020–2021), and pandemic fading (2022). Pandemic years were covered by the WHO public health emergency of international concern. Abridged life tables were computed, and Pollard's decomposition was used to calculate the contributions of causes and places of death on annual differences in life expectancy. Seasonal decomposition of monthly time series revealed an increase in cardiovascular mortality at home or in social care facilities corresponding to limitations in healthcare. While COVID-19 had a systemic negative effect on life expectancy during the pandemic, the impact of cardiovascular mortality according to place of death changed over time. This study contributes to the evidence base of systemic risks during health crises and emergency response.

Abstract When evaluating vaccine efficacy, the conventional measures include reduction of risk of hospitalization and death. The number of patients dying with or without vaccination is often in the public spotlight. However, when evaluating public health interventions or the burden of disease, it is more illustrative to use mortality metrics taking into account also prematurity of the deaths, such as years of life lost (YLL) or years of life saved (YLS) thanks to the vaccination. We develop this approach for evaluation of the difference in YLL and YLS between COVID-19 victims with or without completed vaccination in the autumn pandemic wave (2021, October–December) in Czechia. For the analysis, individual data about all COVID-19 deaths in the country (N = 5797, during the studied period) was used. While 40.6% of the deaths are in cohorts with completed vaccination, this corresponds to 35.1% of years of life lost. The role of vaccination is expressed using YLS and hypothetical numbers of deaths. The registered number of deaths is approximately 3.5 times lower than it would be expected without vaccination. The results illustrate that vaccination is more effective in saving lives than suggested by simplistic comparisons.

Objective: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. Method: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. Results: We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. Conclusions: Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders. Resumen: Objetivo: Analizar las desigualdades socioeconómicas en la mortalidad por todas las causas en hombres y mujeres de nueve áreas urbanas europeas durante la reciente crisis económica, y comparar los resultados con dos periodos previos a la crisis. Método: Estudio ecológico de tendencias basado en tres periodos (2000-2003, 2004-2008 y 2009-2014). Las unidades de análisis fueron las áreas pequeñas de nueve zonas urbanas europeas. Se utilizaron un índice compuesto de privación socioeconómica como indicador socioeconómico y otros indicadores simples. Como indicador de mortalidad se usó la razón de mortalidad estandarizada suavizada, calculada utilizando el modelo jerárquico bayesiano propuesto por Besag, York y Mollié. Para analizar la evolución de las desigualdades socioeconómicas se utilizó un modelo de regresión ecológico que incluía el indicador socioeconómico, el periodo y la interacción de ambos. Resultados: Se observaron desigualdades significativas en la mortalidad en los hombres para casi todos los indicadores socioeconómicos, periodos y áreas urbanas. Sin embargo, no hubo cambios significativos en las desigualdades en el periodo de crisis. Aunque las desigualdades entre las mujeres fueron menos comunes, hubo un incremento significativo en las desigualdades en mortalidad en el periodo de crisis en términos de desempleo y del índice de privación en Praga y Estocolmo, respectivamente. Conclusiones: Futuros análisis deberán tener en cuenta el tiempo transcurrido entre la crisis y su efecto en la mortalidad, así como diferentes causas de mortalidad y el efecto diferencial entre géneros.

Objectives: The automotive industry represents the most important industrial sector in Czechia. The objective of this study has been to analyze the occurrence of occupational diseases (OD) in the automotive industry during the period from 2001 till 2014. Material and Methods: Data on OD cases was retrieved from the National Registry of OD. Further, we conducted a survey in automotive companies with focus on occupational health services and positions of the companies in global production networks (GPNs). An analysis of OD distribution in the automotive industry was performed (age, gender, company size and its role in GPNs, regional distribution of studied companies, and regional unemployment rate), and was accompanied by assessment of the quality and range of occupational health services. Results: Employees older than 40 years old have nearly 2.5 times higher probability of OD occurrence as compared with employees younger than 40 years old (odds ratio (OR) = 2.41, 95% confidence interval (CI): 2.05–2.85). Occupational diseases occurrence probability was 3 times higher for women than for men (OR = 3.01, 95% CI: 2.55–3.55). Occupational diseases incidence rates increased with the size of the company (0 OD/10 000 employees in micro enterprises to 57 OD/10 000 employees in large enterprises). A particularly steep rise in OD incidents in the automotive industry was observed in the Plzeň Region between 2001 and 2011. An association between OD incidents and the unemployment rate was not statistically confirmed. Conclusions: A statistically significant increase in OD incidents dependent on company size may be arguably attributed to a higher quality of occupational medical services in bigger companies, which ensures better detection and diagnosis of OD. In the Plzeň Region, the rapid increase in OD incidents was mainly caused by a change in the production process of automobile textiles in one factory due to the introduction of a glue containing isocyanates, which are potent allergising agents. This led to an increase in occupational allergic diseases – bronchial asthma in particular. Int J Occup Med Environ Health 2017;30(3):455–468

The health risk behaviour (HRB) of teenagers, especially substance abuse, is one of the most serious problems of today’s public health arena. The aim of this paper is to assess the extent of the multiple health-risk behaviours within the teenage population and to analyse the role of the individual and family structure as well as educational and geographic factors in the combination of their risk behaviours (frequency of smoking, alcohol intoxication and lifetime cannabis use). The data for this paper come from an on-line survey among elementary school students in 19 selected schools in Prague and 18 other elementary schools throughout Czechia. Family composition and relationship with the adolescent’s mother were confirmed as significant variables associated with risk behaviours. Adolescents coming from two-parental families had a significantly lower prevalence rate of all three HRB than students living with only one parent or in zero-parent families. Respondents who declared the highest satisfaction with the relationship with their mother had the lowest prevalence of all three HRB characteristics. Regarding leisure time activities, going out with friends clearly increased the risk of HRB, and having specific hobbies reduced the risk of HRB’s. The strongest association revealed was the one between the co-occurrence of health risk behaviours and going out with friends. Significant associations with the aggregate municipality characteristics were confirmed only in the case of marijuana use. It is thus mainly the family and peer domain where the prevention and health policies have to focus. Víceúrovňová analýza zdravotně rizikového chování českých teenagerů Zdravotně rizikové chování teenagerů, především pak užívání návykových látek, je jedním z nejožehavějších problémů v rámci zdravotní problematiky. Cílem tohoto článku je popsat rozsah vícenásobného zdravotně rizikového chování v rámci náctileté populace a také analyzovat roli individuálních a rodinných faktorů, stejně tak jako školního prostředí a geografických faktorů na kombinace rizikového chování mladých lidí v Česku. Hodnocena je frekvence kouření, zkušenosti s opilostí a také užívání marihuany. Data pro tento výzkum byla získána v rámci šetření provedeného on- -line mezi žáky devátých ročníků 19 základních škol v Praze a 18 základních škol ve zbytku republiky. Výsledky ukazují, že složení rodiny a zejména pak kvalita vztahu s matkou byly potvrzeny jako významné proměnné spojené s rizikovým chováním v tomto věku. Adolescenti pocházející z úplných rodin (s oběma rodiči), měli signifikantně menší prevalenci všech tří rizikových chování oproti studentům, kteří žili v rodině pouze s jedním ze svých biologických rodičů, či zcela bez rodičů. Také respondenti, kteří deklarovali vysokou spokojenost se svým vztahem k matce, měli nejnižší prevalenci rizikových chování. Pokud jde o volnočasové aktivity, je to především „chození ven s kamarády a partou“, které očividně nejsilněji zvyšuje pravděpodobnost, že dojde k rizikovému chování. Naopak, specifické koníčky (v tomto případě různé kroužky a zájmová sdružení) redukovala toto riziko. Signifikantní asociace s agregátními veličinami (charakteristikami obcí) byly potvrzeny pouze v případě užívání marihuany, u ostatních druhů rizikového chování tedy geografické faktory neměly prokazatelný vliv. Je tedy jasné, že prevence a zdravotní politika v této oblasti rizikového chování adolescentů musí být zaměřena na první místě na rodinu a oblast vrstevnických vztahů.