Scientific and research priority areas
Slovak Health for 2007-2010:
List of assisted areas 2007'

The draft material was adopted at the regular plenary session of the Scientific Council of the Ministry of Health of the Slovak Republic (hereinafter the CoR of the Slovak Republic) on 30 October 2006, published in accordance with the directive of the Slovak Republic No 26226/2005 of 10 October 2005 between 6 December 2006 and 6 January 2007 for public discussion on the website of the Slovak Republic, following receipt of proposals and discussion comments these were analysed in the relevant expert commissions of the CoR of the Slovak Republic and the CoR of the Slovak Republic. On 8 February 2007 the plenary session of the CoR of the Slovak Republic adopted the material.

On 26 February 2007 the material was approved by a german meeting of the Minister of Health of the Slovak Republic, making it binding.

I. DISEASES OF THE SLOVAK AND CIVE

Atherosclerosis is the most important pathological-anatomic substrate of heart and vascular diseases. Analyses of pilot epidemiological studies carried out so far in Slovakia showed an alarmingly high incidence of serious risk factors for atherosclerosis. It is therefore proposed to support research projects aimed at: (a) monitoring of genetic and environmental factors involved in the development of atherosclerosis, (b) monitoring of genetic and environmental factors involved in the development of pathomechanisms in the emergence and development of obesity, metabolic syndrome and type 2 diabetes, (c) carrying out a prospective randomised intervention study to monitor the pharmacological impact of risk factors and heterosclerosis; at the same time evaluating the pharmacoeconomic parameters of intensive and conventional care for patients with defined risk factors and teroclerosis; (d) monitoring of early myocardial injury markers.

In the field of pneumology, it is necessary to focus research on obstructive pulmonary diseases (COPD) and bronchial asthma: a) epidemiologically map the occurrence of chronic obstructive pulmonary diseases in Slovakia, b) monitor interactions between genetic factors and the environment in the progression of obstructive ventilation disorder, c) identify pathogenetic mechanisms that contribute to disease development. The incidence and complications of atherosclerosis in COPD patients are higher than in the non-obstructive ventilation disorder population. At the same time, the frequent co-incidence of COPD with respiratory disorders in sleep is - obstructive sleep apnoea, which is often associated with arterial hypertension and metabolic syndrome. It is therefore necessary to focus research also on monitoring diseases associated with COPD and its so-called systemic manifestations.

Summary of preferred areas:

II. ONOLOGICAL DISEASES

Tumour diseases are among the main causes of death in the population of industrialized countries. Slovakia is one of the leading cities on this list. The primary objective of the recovery of the cancer population will be to take measures that would reduce as much as possible the progression and recurrence of malignant diseases by improving diagnostic methods and therapeutic practices. All this with the use of the most protective and quality of life of patients as little as possible deteriorating treatment methods. Relevant scientific activities in the field of -oncology-- can be summarised under the title: -Quality and early diagnosis and targeted and safe treatment of cancers for the improvement of life in cancer patients-- The focus of the proposed scientific research area characteristics will be:

The output of the solution of each submitted and approved scientific-research project in the field of -Oncology- should be the effort to improve diagnostic algorithms, innovation of therapeutic protocols, increasing individualisation of therapy and achieving improved quality of life and survival of the cancer patient.

III. Diseases associated with the Motherhood and the Childhood Age

III.1.a. Birthplace

The absence of a national peri-natal programme for the care of the mother, fetus and newborn has already produced the first negative results. In addition to the significant, almost 50% decline in birth rate, we achieved almost twice as bad results in perinatal mortality and morbidity in the 13 years after the split of Czechoslovakia compared to the Czech Republic.

In view of the social needs of Slovak health, the primary task in 2007 is the approval and acceptance by the government of the guaranteed National Programme for the Care of Mother, Fetus and Newborn.

The national maternal, foetal and neonatal care programme, aimed primarily at prenatal diagnosis and in utero treatment of the foetus, will bring improvement in the quality of the statistical indicators of perinatal mortality and morbidity by improving the prenatal diagnosis of intrauterine threat to healthy foetuses by hypoxia and, at the same time, by improving the quality of the gene pool of the population by early diagnosis of genetically-related and treatment of congenital and metabolic foetal diseases.

An important part of the peri-natal programme - National programme for mother, foetus and newborn care is also an economic benefit in the form of reduced costs in health and social care of the physically or mentally affected individual, early prenatal diagnosis and effective intrauterine treatment of the endangered or affected foetus.

III.1.b. Gynaecology

Mini-invasive surgery is an operating technique that saves the patient while maintaining the full extent of surgery. Such a procedure allows intimate contact with the surgical field, selective access to lymphatic system-sparing tissues and vegetative nerves. The result is early recovery, return to full life in the postoperative period and after radical surgery of patients with cancer and endometriosis.

The focus of the proposed scientific activity is:

III. 2. Children age

The aim of the scientific programme is to stimulate activities aimed at promoting health and healthy lifestyles, reducing negative environmental impacts and increasing the efficiency and quality of health care provided in order to reduce the negative consequences of diseases. Academic research activities based on university institutions and applying newer biomedical knowledge, as well as multidisciplinary research networks in paediatric practice, are supported to study the health status of larger newborns, children and adolescents.

The programme shall concentrate on:

Specific scientific areas of the project include:

An important tool to identify the impact of environmental, genetic, nutritional, social and other factors on children's health, as well as to know the relationships between prenatal parameters and chronic childhood and adult age diseases is long-term monitoring of cohort parents - children.

Characteristics of the expected outcome of the solution:

IV. MOVEMENT SYSTEM DISEASES

Monitoring of autoimmune syndromes in chromosome aberrations

This is an interesting clinical problem from a rheumatological point of view. In these diseases, associated autoimmune diseases such as juvenile idiopathic arthritis, rheumatoid arthritis and systemic lupus erythematosus, or dermatomyositis/polymyositis, especially in Klinefelter syndrome, are common. Turner syndrome may have juvenile idiopathic arthritis or rheumatoid arthritis-like arthritis. Finally, in Down's syndrome, musculoskeletal disorders are common in the form of skeletal changes, atlantoaxial dislocation, early development of degenerative joint changes, especially coxarthritis, or arthropathy, which are very similar to juvenile idiopathic arthritis. Early diagnosis and treatment of musculoskeletal disorders with the chromosome and picks listed above will help to reduce the progression and improve the prognosis of these patients, especially in terms of improving quality of life.

It is appropriate to cooperate with the endocrinologist of adults and children, the SZU Down Syndrome Center, in the selection of patients. These patients will be clinically evaluated, the autoantibodies profile, hormonal analysis shall be determined and the presence of inflammatory rheumatic diseases or congenital or familial arthropathy, juvenile idiopathic arthritis or other abnormalities due to musculoskeletal disorders such as hypermobile syndrome, premature coxarthritis, atlantoaxial dislocation shall be confirmed or excluded according to applicable diagnostic criteria. It will be important to monitor the therapeutic procedures of basal therapy for the occurrence of autoimmune diseases in chromosome aberrations as well as special rehabilitation procedures.

Diagnostics, clinical image, etiopathogenesis and treatment of musculoskeletal disorders associated with infection including reactive arthritis

- immunopathogenesis
- serodiagnosis of diseases
- immunogenicity of the disease
- new therapeutic options

V. TRANSMISSION DISEASES AND IMMUNITY

In developed countries, infectious diseases are ranked third behind cancer and cardiovascular diseases as a cause of death in the human population. New types of infectious diseases, caused by unknown or new agents, appear and emerge as was the case with Lyme disease, Legionary disease, STSS, AIDS, avian influenza and others.

Current scientific knowledge provides evidence that infectious diseases and immune disorders are also involved in the development of cardiovascular, endocrine and musculoskeletal disorders. Recent evidence from cancer also suggests that micro-organisms play a significant role in cancer development of up to 70%.

The effectiveness of the treatment of infectious aetiology diseases is undermined by increasing resistance of micro-organisms to antibiotics and biocides.

The incidence of allergic diseases is a significantly increasing trend. Skin and respiratory allergies (bronchial asthma) are increasing in both adult and paediatric populations. It is therefore an absolute priority for every state, including our Republic, to enable the development of science - an exploratory activity that would contribute substantially to:

Scientific research activities in this area will be oriented as follows:

VI. NEUROPOLOGICAL AND PSYCHIATRIC DISEASES

Cerebrovascular diseases are still a serious medical and socio-economic problem in Slovakia, as, unlike other developed states, mortality and morbidity have not only fallen, but have increased in some population groups. Although the main risk factors and underlying pathophysiological mechanisms of cerebrovascular disease are common to other cardiovascular diseases, there are demonstrably specifics that require special access to vascular strokes. Research projects should focus on:

- The role of genetic factors in the pathogenesis of vascular diseases of the brain.
- The role of hemoreological factors and changes in endothelial function in the pathogenesis of cerebral circulation disorders.
- Cerebral oedema mechanisms for intracerebral bleeding.
- The role of microembolism of detectable USD in the pathogenesis of cerebral circulation disorders.
- The relationship between heart and vascular diseases in the brain.
- Epidemiologicals of brain vascular diseases in terms of their prevalence and occurrence of risk factors.

In the context of the general ageing population, ensuring decent old age is one of the key tasks of modern society. Dementia is one of the diseases that particularly reduce the quality of life of both the elderly and the part of the working age population (due to care responsibilities). Research projects should focus on:

- Mapping the incidence of genetic mutations associated with dementia in the Slovak population.
- Assessment of the options and effectiveness of modification of known risk factors for Alzheimer' s disease and vascular dementia, or mixed dementia.
- Identification of optimal diagnostic procedures under conditions of clinical practice in Slovakia

- Finding the real incidence and prevalence of dementias in the Slovak population as well as the current situation in dementia therapy.

Intervertebral disc disease and its consequences, i.e. spinal cord compression, in the cervical and chest regions, or spinal cord roots in the lumbar region, affect the majority of the population to varying degrees and are also one of the most common causes of incapacity for work and often lead to disability.

Research projects should focus on:

- identification of causes of development and progression of degenerative changes of intervertebral plates
- evaluation of relevant diagnostic procedures and indications of medical and/or surgical treatment
- drawing up scientifically justified recommendations for each type of operation and type of material used for implantation

In Slovakia, patients with mental disorders make up 11 percent of all sick, yet the scientific issue of mental disorders in Slovakia is marginal attention. It is necessary to focus on the following scientific tasks in the next period and to ensure implementation of the principles of the National Programme for the Development of Mental Health in scientific research programmes:

- Research on the incidence and prevalence of mental disorders (depressions, schizophrenia, anxiety disorders, alcohol and drug abuse, Alzheimer' s dementia).
- Determine the importance of individual specific factors (biological, psychological and social) to the development, development, course and prognosis of mental disorders.
- Research on the etiopathogenesis of mental disorders, in order to ensure early diagnosis and rational therapy taking into account also pharmacoeconomic indicators.
- Genetics and molecular biology: research of genetic predisposition to mental disorders, familial studies, research of the potential for genetics and molecular biology to be involved in ever more exact treatment and prevention of mental disorders.
- Psychoneuroendocrinology: gender differences in the incidence of psychiatric disorders, the specificity of the generation periods in women's life and their importance for the development and progression of psychiatric disorders.
- Introduction of modern imaging techniques into research, diagnosis and treatment of mental disorders: fMRI, MRI, PET, SPECT.
- Research of psychological factors, environmental impact and lifestyle changes on the incidence and prevalence of mental disorders.
- Mapping the frequency of morbidity of mental and somatic disorders.

- Perform thorough, independent pharmacoeconomic studies to treat the most serious psychiatric disorders, on their basis to prepare treatment standards and recommended therapeutic practices.

VII. TRANSPLANTATION OF BODIES AND TANKS

The trend of transplant development was partly captured by Slovakia, which is mainly evidenced by kidney, bone marrow, heart, fewer organs (liver, pancreas, lungs) that are performed in addition to Bratislava in Košice, Banská Bystrica and Martin. The development of transplantology continues in terms of research, both practical and organisational. Slovakia cannot afford to lag behind in this dynamically developing medical area, especially now that it has already become a member of the European Union and is trying to get into its transplant companies. In particular, transplant research should focus on the following issues:

Cell therapy for vascular insufficiency

VIII. GENOMICA AND PROTEOMICS

The sequencing of the human genome has opened a new era in human biology and offers huge opportunities to improve human health. Genetic predisposition, environmental factors including nutrition, lifestyle and interaction between genetic factors and the environment play a role in the development of the disease. The medicine of the future will be gene-oriented, from prevention to diagnosis to therapy. Early knowledge of susceptibility to a certain disease will offer wider therapeutic options when using traditional screening, observation methods and gene therapy.

In Slovakia, research in the field of medical genomics and proteomics of the Slovak population should be encouraged so that we do not depend on the import of technologies and scientific knowledge in the future. Development of molecular medicine is one of the European Commission's priorities. As part of the 7th Framework Programme under preparation, a new sector was established in the European Commission in 2005 "Innovative medicine"" Its aim is to build strong infrastructure and support the application of molecular medicine knowledge to prevention, diagnosis and therapy for building the foundations of personnel medicine. The importance of supporting this field of research is also demonstrated by the fact that genomics and biotechnology for health are the first thematic priority in the EU's 6th Framework Programme where research activities are targeted in these areas.

Specific themes

IX. PUBLIC HEALTH

The main health problems in the population to which WHO has drawn attention and which are also relevant for Slovakia are: neuropsychological disorders, cardiovascular diseases, malignant neoplasms, accidental injuries, respiratory diseases, diabetes and obesity. Health determinants whose effects must be monitored by scientific approaches include in particular: social, economic and cultural environment, education, lifestyle and health promotion, birth and hereditary factors, diet and nutrition, infectious diseases in relation to climate change and the environment, poverty and health care, uncontrolled urbanisation, human behaviour, globalisation (travel, trade), possible transmission of animal diseases to humans, environmental health (life conditions and health), health care (preventive and curative medicine, palliative care). The EU's public health programme 2003 - 2008 highlights the importance of primary prevention, i.e. identifying and eliminating or reducing health risks arising from the environment or human behaviour.

In the coming period we recommend focusing research on three main areas: environmental health, epidemiology of infectious and non-infectious diseases, health at work.

1. Environmental health

Due to
□ past inherited environmental pollution of Slovakia,
□ the lifestyle of the Slovak population containing many unhealthy elements and
□ morbidity associated with a particular ethnic group,

the study should be based on the latest knowledge of pathogenesis of a wide range of diseases, where interaction between the individual's genes and environmental factors plays a major role. At the same time, environmental factors are considered in the broadest sense and thus including both chemical and physical components and lifestyle elements. According to this idea, which is increasingly supportive of scientific evidence, this interaction leads to the emergence of most chronic degenerative diseases. In order to characterise these interactions, scientific knowledge activities shall be encouraged:

□ mutagenic, carcinogenic and immunomodulatory properties of xenobiotics, their ability to induce allergies and atopics and their properties as endocrine disruptors,
□ the radiation and chemical characteristics of the environmental components, namely the issues of radon and chlorinated organic polutants and their neurotoxic and ototoxic properties,
□ role of free oxygen radicals in pathogenesis of chronic degenerative diseases,
□ DNA damage and repair mechanisms related to pathogenesis and disease prevention,
□ the pharmacodynamic and pharmacokinetic properties of the substances,
□ participation of lifestyle factors in the development of chronic degenerative diseases.

The main focus of research should be to clarify the causal relationships between living conditions (i.e. environmental and lifestyle exposure of the population and its groups) and population health, to identify and quantify health risks for the population, to develop appropriate scientific interventions to reduce these risks and to evaluate their effectiveness. A combination of epidemiological and experimental methods for monitoring, clarifying and proposing solutions to the following themes is particularly useful and desirable:

□ Internationally usable population health indicators
□ Preventing childhood and youth obesity
□ Primary prevention of diabetes
□ Primary prevention of osteoporosis
□ Primary prevention of cardiovascular diseases
□ combined environmental effect of chemical agents on human health
□ late effects of chemicals on human health
□ monitoring population saturation by selected micro- and macronutrients
□ Improving the health information system to identify health determinants in the area of accidental injury and violence

□ drawing up programmes to evaluate the effectiveness of preventive activities and health risk reduction intervention programmes
□ Development of mental health criteria and programmes to promote and prevent burn-out syndrome
□ Prevention of suicides

Priority will be given to proposals addressing the specificities of the child population and the need to protect it. Therefore, the tasks of the above factors will be examined in the context of prenatal and early childhood development. Proposals on biomarkers of exposure, effect and sensitivity will be welcomed.

2. Epidemiologicals of infectious and non-infectious diseases

Based on the positive results of the existing system for the control of infectious diseases in our population as well as on the current and expected situation in the occurrence of infectious and non-infectious mass diseases, it is recommended to focus research on the following topics:

□ The effectiveness and side effects of vaccines
□ Risk factors in the occurrence of salmonella
□ tickborne epidemiology
□ Epidemiology of Ehrlichiosis
□ Epidemiology of aseptic meningitis
□ Epidemiology of rash infections not yet followed
□ Epidemiology of Coxsackie viral infections
□ Epidemiology of avian influenza
□ Epidemiology of accidents (transport, domestic, sports)
□ Epidemiology of hypertension
□ The effectiveness of interventions in individuals with an identified risk of hypertension, coronary heart disease and cerebral vascular disease
□ Epidemiology of depression
□ Prevention of nosocomial diseases, catheter sepsis
□ germ profile of the healthcare facility and resistance to disinfectants
□ stabbing injuries to medical staff and prevention of professional diseases
□ HELICS Þ EU project for hospital surveillance
□ single day surgery and the issue of nosocomial diseases.

Proposals for scientific projects must be designed in such a way that epidemiology is seen as detecting existing forms of disease information, risk factors for diseases and the distribution of diseases in the population by location and time, and designing optimal ways of collecting, analysing and using them in health policy. In this context, priority will be given to approaches based on a geographical information system

3. Health at work

Research and new knowledge gained by it should contribute to the protection and promotion of the health of the working population and thus to the development of the health of the whole population, to improving the ability to work and health skills, including in the context of the extension of the retirement age, to preventing early retirement for health reasons, to improving the quality of life of people of working but also after working age. Current problems requiring new scientific knowledge and groundwork for practical decision-making are:

□ AIDS, multi-resistant Tbc, hepatitis C as a professional disease
□ one-sided excessive long-term burden of disease,
□ Consequences and prevention of professional microtraum
□ Endotoxic reactions (OTS) and chemical susceptibility
□ combined effects of chemicals
□ Male infertility and its professional aspects
□ determination of principles and scientifically based limits of burden by factors in the working environment
□ Principles for ensuring and evaluating the psychosocial quality of work and working conditions
□ Sick building syndrome
□ Professional respiratory disorders
□ The mental health of workers, their indicators, criteria and their protection and support
□ Psychic stress when working with displays and preventing them
□ psychological stress and resistance to infectious diseases
□ Psychological stress and cancer
□ Burnout syndrome and prevention
□ Electromagnetic fields and cancer
□ Electromagnetic fields and their effects on reproduction
□ Electric eczema
□ new sources of hearing impairment
□ Psychosocial factors in the workplace
□ criteria and indicators of wellbeing in the workplace
□ combined effects of professional and environmental factors and lifestyles on the health of the working population
□ An ageing population and work – Optimization of working conditions, health criteria for inclusion in work in individual professions.

Cooperation and interconnection with projects to be addressed in Area 8.