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Simulation and predictive models of tb epidemiological trends in the Czech Socialist Republic (CSR) for the 1949-2000 period were devised taking into account several variants of tb control measures. AZUMA'S simulation model from Japan was used as the basis for the mathematical processing and adapted in different parts to satisfy the conditions prevailing in the CSR. The initial conditions and parameters to go into the equations of the model were determined or estimated from statistical data for the whole of CSR or from the results of some of the more detailed partial studies. An Olivetti P 6060 minicomputer was used for calculations. Statistical data were found in satisfactory agreement with trends estimated from model simulations. The simulation models revealed that the epidemiological trends were most influenced by the treatment, less by the BCG vaccination and the least by the active case finding. As suggested by the predictive simulations, discontinuation of the programme of tb control would result in a major deterioration of the epidemiological situation.

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The occurrence of non-tuberculous non-tumorous respiratory diseases in children and in adults was investigated in a population of approximately 28 300 inhabitants from selected health communities of a Prague industrial district between October 1, 1976 and December 31, 1978. In the course of this period such a disease occurred once at least in 31% of the population. Of a total of 17 133 respiratory disease cases, acute upper respiratory infections occurred in 72.0%, acute bronchitis in 12.2%, influenza in 12.5%, pneumonia in 1.3%, chronic bronchitis in 0.3%, bronchial asthma in 0.6% and other respiratory diseases in 0.5%. Repeated respiratory diseases with four or more episodes of a disease in the course of one year occurred in 6.0% of preschool-age children (0-5 years of age), in 2.8% of school-age children (6-14 years of age), and in 0.2% subjects from the age of 15. Differences in the morbidity rate among the three age groups were statistically significant. In most cases repeated respiratory diseases began to occur after the entry of children to collective institutions. The most frequent respiratory diseases as a cause of incapacity for work were acute upper respiratory infections and influenza with a predominance of incidence in persons younger than 40 years of age. By contrast, in chronic bronchitis as a cause of incapacity for work there was a significant predominance of affected subjects from 40 years of age. The mean duration of incapacity for work due to chronic bronchitis was longer than that due to acute respiratory diseases. In respiratory diseases chronic bronchitis was found to be the most frequent primary cause of death, while pneumonia was quite often an immediate cause of death in the subjects weakened by other diseases.

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To rationalize tuberculosis control in countries with low tuberculosis prevalence it is necessary to evaluate continuously some control measures and to propose suitable modifications. For years Czechoslovakia is taking part in the international research of methods of tuberculosis control; in compliance with the results of these studies its programme of tuberculosis control is being modified. Decision processes are more difficult, when measures till now applied should be limited or given up. In such cases it is necessary to evaluate not only the efficiency of defined health measures but also their possibilities of application, acceptability and influence on the tuberculosis situation in all. For the choice of appropriate models of tuberculosis control the application of experience from other countries should be regarded. However sometimes it is not possible to use this experience in the own country because there are obvious differences in other conditions. Mathematical simulation models may by of good help in the decision process answering the purpose of discerning the effect of different variants of the control measure on the epidemiological trends. For this purpose reliable statistic data should be available. To get such information a central tuberculosis register was established on CSR gathering data on new cases of tuberculosis, on relapses, on the further development of the cases of tuberculosis registered and on data concerning the quality of case-finding, diagnostics and therapy.

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The initial manifestation of atopic bronchial asthma belongs in diagnostics and therapy into the field of the allergologist. But the services of the specialty tuberculosis and respiratory diseases can assist especially with hospital treatment in this care because the services for allergology in the policlinical departments for internal medicine and pediatrics do not dispose of bed capacities of their own. The cooperation of the specialty tuberculosis and respiratory diseases is appropriate in the dispensaire care and hospital treatment of asthmatics especially in those cases, when there is an infect-induced asthma, if any other respiratory diseases exist as complications of bronchial asthma or if disturbances of pulmonary function supervene. Then the consultation with the specialist of clinical immunology and allergology may become necessary.

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The medical specialization of "phtisiology" was extended to the specialization of "tuberculosis and respiratory diseases" (corresponding to the demonination of "pneumology and phtisiology") in the Czechoslovak Socialist Republic in 1966. This branch is an additional specialization of the basic internal medicine. It provides preventive as well curative care for population of all age groups, as far as tuberculosis and increased risk of tuberculosis are concerned. This medical branch covers persons with non-tuberculous diseases of the respiratory system aged 18 years and over, especially cases having tendency to deterioration, those with complicated course or functional disorders. Comparison of statistical data on activities of phtisiologic institutions in 1965 and institutions for tuberculosis and respiratory diseases in 1978 (see table 1) reveal the following information: --BCG vaccination of newborns exceeded in both years 98%. --Utilization of radiophotography for screening of selected groups with increased risk of tuberculosis or malignant respiratory tumours or for examination of patients with symptoms has been increasing. --Number of beds decreased by 35%, but at the same time the number of cases hospitalized increased by 36%. The average duration of treatment of tuberculous patients was shortened and proportion of persons hospitalized for non-tuberculous respiratory diseases increased.

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In Czechoslovakia phtisiology was enlarged into the specialization of tuberculosis and respiratory diseases by a decree of the Ministry of Health in 1966. The dispensary care of pneumophtisiological institutions aims--besides tuberculosis control--especially at the following groups of patients suffering from non-tuberculous respiratory diseases: 1. cases having tendency to deterioration or with a complicated course, 2. cases with functional disorders of the respiratory system, 3. cases in conditions which may influence unfavourably the respiratory disease. When patients with non-tuberculous respiratory diseases are in the care of other physicians, the pneumophtisiologists render necessary consultations and decide which patients will be taken over into the dispensary care of pneumophtisiological department.

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In Czechoslovakia obligatory registration of all cases of cancer is introduced in 1953. In this paper are informed of the most important results of the analysis of indexes which were find out in the whole country, of the results of epidemic studies in Prag, and of the epidemic studies in the district of Kolín. From 1959 to 1975 the rate of bronchial carcinoma has increased in men from 47 to 86 of the male population, in women from 6 to 9 of the female population.

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