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Pediatric solid central nervous system (CNS) tumors are rarely detected at an early stage. The reasons for this include the tumor site, acute intracranial bleeding, unavailable imaging tests, inconsistent conduct of clinical diagnostic procedures, etc (1). CNS tumors account for 20% of all childhood cancers, and their incidence rates are rising (2). Treatment results are better if the disease is detected early, which requires sufficiently sensitive and specific diagnostic methods. This is why new biomarkers indicating the presence of CNS tumors are needed. One of the biological materials used for biomarker testing is cerebrospinal fluid (CSF) (3). CSF washes the structures of the CNS including the tumors present there, enabling the detection of tumor proteins in the CSF. PChE has a role in tumorogenesis and oncogenesis and has been proven to be a good indicator of the presence of tumors (4-6). PChE in serum has already been recognized and confirmed as a good diagnostic and prognostic marker for head and neck tumors (7). Studies of PChE in tumor tissue showed that its concentration in some tumor samples was high, eg, in glioma tissue samples (4). In tissue samples, PChE has higher activity levels in astrocytomas than in meduloblastomas, neuromas, or meningeomas (4). It is included in the myelin metabolism of, eg, the corpus callosum, nervus opticus, and spinal cord. Subcortical white matter has much greater PChE activity than gray matter (8) and PChE activity decreases as we descend from the cerebrum toward the spinal cord. After blood removal, PChE activity is present in the vessels of the brain and it is higher in arteries than in veins (4) PChE is an enzyme (EC 3.1.1.8) synthesized in the liver and distributed to body tissue and fluids. Cholinesterases (acetylcholinesterase – AChE and PChE) activity changes in an abnormal tissue metabolism and/or they become part of the oncogenic process (7). Cholinesterase genes are amplified, aberrant, and mutated in numerous types of human tumors. The PChE and AChE found in these tumors contain the peptide motif S/T-P-X-Z found in many cdc2 gene-dependent protein kinase substrates (5). Phosphorylation of cdc2-dependent protein kinases is a possible molecular mechanism that connects cholinesterases with tumor proliferation. Moreover, the inhibition or reduction of AChE, PChE, and some other enzymes especially with organophosphorous and perhaps carbamate poisons used as insecticides in home and local environment may result in the formation of brain tumors in children partially depending on the genetic polymorphisms that affect insecticide metabolism (9,10). PChE activity in CSF in healthy people is rarely investigated, most often as a part of studies on specific diseases or anesthetics (11-13). Lumbar puncture is an invasive procedure and for ethical reasons the number of healthy participants in studies is always small, especially in case of children. For this reason the information about the normal values of PChE activity in CSF in relation to age at all ages is scarce. In adults, PChE activity in CSF ranges from 1/20 to 1/100 of the value of serum (13). In children, the values are age-dependent (14). PChE activity in serum is low at birth, which is followed by a sudden increase in activity over the next three weeks, with values exceeding those in adulthood. This remains unchanged until the age of three. Between three and six years, PChE activity is 30% above the adult level and it begins to slowly drop between the age of five and puberty, when it reaches the adulthood value, which remains relatively stable (14). In this study, we tested whether PChE could be used as a potential biomarker for solid CNS tumors in children.

The impact of physician burnout on the quality of patient care is unclear. This cross-sectional study aimed to investigate the prevalence of burnout in family physicians in Croatia and its association with physician and practice characteristics, and patient enablement as a consultation outcome measure.Hundred and twenty-five out of 350 family physicians responded to our invitation to participate in the study. They were asked to collect data from 50 consecutive consultations with their adult patients who had to provide information on patient enablement (Patient Enablement Instrument). Physicians themselves provided their demographic and professional data, including workload, job satisfaction, consultation length, and burnout [Maslach Burnout Inventory - Human Services Survey (MBI-HSS )]. MBI-HSS scores were analysed in three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA).Of the responding physicians, 42.4 % scored high for EE burnout, 16.0 % for DP, and 15.2 % for PA. Multiple regression analysis showed that low job satisfaction and more patients per day predicted high EE scores. Low job satisfaction, working more years at a current workplace, and younger age predicted high DP scores. Lack of engagement in education and academic work, shorter consultations, and working more years at current workplace predicted low PA scores, respectively (PBurnout is common among family physicians in Croatia yet burnout in our physicians was not associated with patient enablement, suggesting that it did not affect the quality of interpersonal care. Job satisfaction, participation in educational or academic activities and sufficient consultation time seem to reduce the likelihood of burnout.

Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record.We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years.First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation.Prevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41-3.15, P .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78-.61, P .001).Total yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.

Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record (EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients’ data using Wonca International Classification Committee (WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients (aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM’s assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p

AIM: To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. ----- METHODS: A multicenter prospective study was performed on 2467 participants of both sexes ≥40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. ----- RESULTS: Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P

OBJECTIVES: The effects of the Michigan splint on the change in disc displacement (DD) as well as the position of the condyles were determined by metrical analysis using magnetic resonance imaging (MRI). ----- METHODS: Twenty-five patients with clinical DD symptoms were treated by means of the Michigan splint, and an assessment of the effects of the splint was conducted or verified by MRI before and during the period of therapy, 5 months follow-up. The positions of the condyles and the disc were calculated from the MRI in the parasagittal plane. ----- RESULTS: There were no changes in the positions of the disc and condyles in the physiological joints of the patients (n=23) prior to and during the time the splint was in place (p>0.05). The splint achieved a DD decrease (p0.05). ----- CONCLUSIONS: The evaluation of the Michigan splint therapy showed that it has no influence in the repositioning of the DD joints without reduction, but the DD joints with reduction have a limited positive effect. In both forms of these displacements, conditions for the elimination of the clinical symptoms are created.

AIM: To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. ----- METHODS: A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. ----- RESULTS: In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P < 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P < 0.05 for each). ----- CONCLUSION: Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice.

The prevalence of respiratory abnormalities was studied in an elderly nursing home population. This study investigated 475 female and 147 male individuals living in five nursing homes in Zagreb, Croatia. Chronic respiratory symptoms were recorded using the British Medical Research Council questionnaire. Ventilatory capacity was measured with maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one-second forced expiratory volume (FEVI), maximum expiratory flow rate at 50% FVC (FEF50), and maximal expiratory flow rate at 25% FVC (FEF25) were measured. A high rate of chronic respiratory illness and symptoms was found ill both female and male nursing home residents. The highest rates were for asthma, chronic cough, and for chest tightness. Odds ratios (OR) showed that smoking and the length of employment were significant risk factors among men. Pulmonary function testing demonstrated a decrease in measured values compared to predicted (p < 0.01). This was particularly pronounced for FEF50 and FEF25, suggesting obstructive changes in smaller airways. Regression coefficients were significant for smoking and employment primarily for FEF50 and FEF25. Our data suggest that older individuals residing in nursing homes exhibit an excess of respiratory symptoms, and lung function abnormalities. Smoking and past employment are important risk factors for these respiratory findings. Medical surveillance and preventive strategies should be implemented for this high risk population.

The aim of this study is to investigate the characteristics of the Internet users in Croatia related to seeking health information, which information they seek, the reasons, and the outcomes of that information on them. We surveyed the users of the Internet health portal 'Cybermed', in spring 2003 and autumn 2004. Responses were collected from a pop-up questionnaire, which appeared at every website visit. There were 369 respondents in 2003 and 580 respondents in 2004. Most respondents were women (82% in 2003 and 80% in 2004). While more than half of the respondents (55%) in 2003 had a college or university degree, this changed in 2004, when only 40% of respondents had a college or university degree (P < 0.001). Also, we recorded a significant age-related change, suggesting that the average age of the respondents increased in 2004 (P < 0.001). The leading motivation for seeking medical information was 'unanswered questions after visiting a physician'. Most respondents (90% in 2003, 87% in 2004) went online to seek information on a specific illness or condition. Women sought information for friends and colleagues more often than men (42% vs. 28%, P = 0.031) in 2003, while these differences were diluted in 2004. Approximately half of all respondents discussed the information they found online with their physicians. Patients who feel they were given insufficient information, or simply seek more information than the physician provided, turn to using online health information, which no longer seems to be reserved to those with the highest education degrees. Health-care providers should consider creating health-related Internet portals, supplementing the information they provide.

Gas chromatography (GC) was used to differentiate 100 isolates of Candida species (Candida parapsilosis, Candida albicans, Candida tropicalis, Candida famata and Candida glabrata) from 22 of 509 diabetic patients in whom the same species had been isolated from ulcer and interdigital spaces of the same and/or the other foot. All clinical isolates were identified by quantitative differences in the composition of six cell fatty acids (CFA). The values of the coefficients of variability (CV) of CFA show that the isolates from foot ulcers and interdigital spaces of the same diabetic patient probably belong to different chemotypes of the same Candida species.

The goal of this study is to identify and describe variables contributing to the efficiency of health promotion interventions, and to assess whether these variables can serve as reliable and early indicators of the success of such interventions. The study sample includes 44 interventions selected through a network of key informants from five cities--Liverpool, Sandwell, Vienna, Pula, and Rijeka--by using a chain technique. Data on each intervention are collected through an in-depth interview with a program leader, the collection of project-related documents, and on-site observation. Qualitative analysis of data performed with content analysis and computer-assisted free-text analysis reveals different characteristics of interventions depending on whether they are initiated by the city government sector, health-care system, or citizens sector (independent of the city or country). The assessment of the efficiency of these three groups of interventions also differs because of varying features, scope (activity potentials) and impact they are able to accomplish. We have identified ways in which the efficiency of all three groups of interventions can be improved. The efficiency of the interventions within the city sector can be increased through an improved process of delegation to other sectors, higher involvement of user groups, and higher receptivity and organizational flexibility. The efficiency of the interventions within the citizens sector can be improved through professional, organizational, and financial support. Support from the professional community is important for citizens sector interventions in confirming the importance of the problem they address and legitimizing the actions they propose and undertake.

The objective was to determine the quantitative relationship between the condyle and disc position in the glenoid fossa between two different slices of the same temporomandibular joints (TMJs) with partial anterior disc displacement (DD). The study was conducted on 40 patients with DD of TMJs (mean age, 35.5 years). The clinical diagnosis of DD was confirmed by magnetic resonance imaging. Joints from the patient groups were analyzed according to the laterality and depending on disc displacement (a total of 80 joints). Comparison was made between two different slices of 9 joints with partial DD with reduction: partial DD was analyzed in the representative centrolateral or centromedial parasagittal slice of the TMJ (TMJ partial DD--slice DD). The contralateral slice of the same joint was without DD (TMJ partial DD--slice NDD). The analysis also included 34 healthy joints without DD (TMJ NDD) of the same patients. The position of the condyle and disc was calculated using the Kurita et al. method on the parasagittal view of the TMJ. A statistically significant difference was recorded for different slices of the same TMJs with partial DD (TMJ partial DD--slice DD and TMJ partial DD--slice NDD) (p0.01), but no difference was found in condyle positions depending on the existence of partial DD (p0.05). The compared values between slice TMJ partial DD--slice NDD with the group of TMJ NDD showed no significant difference in either disc position or condyle position (p0.05). There were differences of disc position in various slices of the same joint with visually confirmed partial DD. The dorsocranial condyle position could not indicate partial anterior DD.

Clinical and radiological findings were compared between the patients with osteoarthritis (OA) of temporomandibularjoint (TMJ) with or without disc displacement (DD), and asymptomatic volunteers. This study included 30 patients with OA of TMJs (mean age 52.6). All the patients were examined clinically by manual functional analysis and using magnetic resonance imaging. The inclusion criteria for patients comprised: pain referred to the TMJ and/or crepitation in the TMJ. A second group consisted of 20 asymptomatic dental school students (mean age 23.5). There is a statistically significant difference between degenerative changes of the condyle of TMJs with and without clinical signs of OA of patients (p=0.009). In 28% of osteoarthritic joints, flattening of condylar joint surfaces was observed and 17.4% of the joints were without clinical signs of OA. Osteophyte formations were found in 8% of asymptomatic and 25.7% of osteoarthritic patients' joints. There is a statistically significant difference between patients' TMJs with and without OA (p=0.0003): pronounced shape loss and severe sclerosation of the articular eminence were found in 12% of the joints without OA, and 42.9% of joints with OA. There is no difference between students' joints and patients' TMJs without OA (p=0.804). The most common imaging findings of osteoarthritic TMJs were sclerosis of the condyle and osteophyte formation.

The results of the recording of respiratory symptoms and the measurement of lung function in 136 male postal workers employed as mail carriers were studied. In addition, the prevalence of chronic respiratory symptoms in 87 male noexposed control workers was also examined. There was a significantly higher prevalence of chronic bronchitis (25.0%) and sinusitis (38.9%) in mail carriers than in control workers (13.8%; P

Karelia air-pollution. Malodorous sulfur-compounds. Lung-function. Pulmonary-function. Mill workers. Occupational asthma. New-hampshire. Pulp-mills. Dust. Mortality. The respiratory function and Immunological status of workers employed in the paper recycling industry were studied. The mean age of the 101 studied workers was 41 years, and the mean duration of their exposure was 17 years. A group of 87 unexposed workers of similar age, duration of employment, and smoking history was studied for the prevalence of chronic respiratory symptoms. Lung function in the paper workers was measured by recording maximum expiratory flow volume (MEFV) curves and recording forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum expiratory flow rates at 50% and the last 25 % of the FVC (FEF50, FEF25). Immunological studies were performed in all 101 paper workers and in 37 control workers (volunteers). These included skin-prick tests with paper-dust extracts and other nonoccupational allergens, as well as the measurement of total serum immunoglobulin E. Significantly higher prevalences of all chronic respiratory symptoms were found in paper compared with control workers (P < 0.01). The highest prevalences were found for chronic cough (36.6%), chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnea (18.8%). Occupational asthma was diagnosed in four(4.0%) of the paper workers. A logistic regression analysis performed on chronic respiratory symptoms of paper workers indicated significant effects of smoking and exposure, with the smoking effect bring the most important. Multivariate analysis of lung-function parameters indicate significant effects of exposure. For paper workers, the measured FEF50 and FEF25 were significantly decreased, compared with predicted values, suggesting obstructive changes located primarily in smaller airways. Among 101 tested paper workers, 16 (15.8%) had positive shin-prick tests to at least one of the paper extracts ; none of the control workers reacted to these extracts. increased serum IgE levels were found in 21% of the paper workers and in 5 % of control workers (P < 0.05). Paper workers with positive skin-prick tests to any of the paper and/or other tested extracts had higher prevalences of chronic respiratory symptoms and lower measured lung-function tests compared with predicted than did those with negative skin-prick tests, but the differences were not statistically significant. The measured concentrations of total and respirable dust in this industry were higher than those recommended by Croatian standards. Our study suggests that work in the paper-recycling industry is associated with respiratory impairment and that sensitive workers employed in this industry may be at particular risk of developing chronic respiratory abnormalities

We studied 233 male workers employed in two brick-manufacturing plants and 149 matched control workers. The mean age of the brick workers was 35 years, with a mean duration of employment in this industry of 16 years. The prevalence of chronic respiratory symptoms as well as acute symptoms during the work shift were recorded. Lung function was measured on Monday during the work shift by recording maximum expiratory flow-volume (MEFV) curves, from which the forced vital capacity (FVC), the one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 75% of the FVC (FEF50, FEF75) were measured. The results of periodic chest roentgenograms were reviewed. There was a significantly higher prevalence of chronic cough (31.8%), chronic phlegm (26.2%), and chest tightness (24.0%) in exposed workers, compared with control workers (20.1%; 18.1%; 0%) (P < 0.05). This increased symptom frequency was also documented among nonsmokers studied by age and by length of employment, suggesting a work-related effect. Among work shift-related symptoms, high prevalences were noted for upper respiratory tract symptoms (e.g., dry throat, eye irritation, throat irritation). The measured FVC and FEV1 were significantly lower than predicted for brick workers and suggested a restrictive pattern. The mean FVC (as a percent of predicted) was 78.1% and FEV1 was 88.1%. The FEF50 and FEF25 were not significantly decreased. A multiple regression analysis with age, exposure, and smoking as predictors and lung function parameters as response variables showed a significant effect between exposure and FVC. Significant chest roentgenographic abnormalities were not documented. These findings of a restrictive lung function pattern in brick workers with normal chest roentgenograms may suggest early interstitial disease. Additionally, a bronchitic component, as suggested by the respiratory symptoms, may also be present.

A group of 174 male vineyard and orchard workers was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. In addition, 115 male control workers were studied for the prevalence of chronic respiratory symptoms. There was a significantly higher prevalence of dyspnea and chest tightness in exposed compared to control workers. In particular, exposed nonsmokers had significantly higher prevalences of dyspnea and chest tightness than controls this was found for exposed nonsmokers with both short (or = 10 years) and long (10 years) exposure. Smokers exposed for more than 10 years had significantly higher prevalences of chronic cough, chronic phlegm, chronic bronchitis, and chest tightness than smokers with shorter exposures (p0.01 or p0.05). Workers employed for more than 10 years had higher prevalences of most of the acute (shipt-related) symptoms than those workers with shorter employment; however, the differences were significant only for cough in smokers (p0.05). Significantly lower than predicted FVC values were measured in smokers and nonsmokers after both short and long duration of employment. Differences between measured and predicted FEV1, FEF50, and FEF25 were significant for workers employed for more than 10 years. A separate analysis of individual data as a percent of predicted values demonstrated that many workers had FVC (5.2%), FEV1 (6.3%), FEF50 (27.6%), and FEF25 (40.2%) lower than 70% of predicted values. These data suggest that vineyard and orchard workers may develop acute and chronic respiratory symptoms and lung function changes which are, in part, related to environmental factors and to cigarette consumption.

The socioeconomic inequality in pupils' risk behaviors has been the topic of many studies with quite contradictory findings. Furthermore, the role of socioeconomic environment has been analyzed much less often than the role of individual socioeconomic status (SES). This study examined the association between school/area-level socioeconomic environment and Croatian pupils' risk behaviors (tobacco use, drunkenness, cannabis use, early sexual initiation and fighting). Data from the WHO-Collaborative 'Health Behavior in School-aged Children' study conducted in Croatia in 2006 (1601 secondary schools' pupils, aged 15) and census data were used. Multilevel logistic regression analyses, adjusted by gender, were performed. The individual level of SES explained the majority of differences in all risk behaviors among adolescents. Differences in tobacco use, early sexual initiation and fighting were more closely attributed to school level than area level, which was more closely associated with differences in adolescent drunkenness and cannabis use. At the individual level, high individual SES was associated with higher probability for tobacco use and drunkenness compared to low individual SES. Furthermore, school heterogeneity (compared to school homogeneity) and medium school-level SES (compared to low school-level SES) were associated with higher probability for cannabis use. Compared to the most advanced schools (gymnasiums), attending the least advanced schools (industrial and crafts schools) was associated with higher probability for fighting. Compared to low area-level SES, medium area-level SES was associated with higher probability for cannabis use and fighting. Conclusively, it was found that low SES at individual, school and area levels, school homogeneity and advanced school attendance play a protective role against risk behaviors. To reduce inequalities in pupils' risk behaviors, there is a need for community and school-based programs that take into consideration not only individual SES but also school- and area-level socioeconomic circumstances.

The purpose of this study was to evaluate the difference between disc and condyle position between temporomandi- bular joints (TMJs) without disc displacement (DD) in asymptomatic volunteers, and patients who have DD in contra- lateral joints, respectively unilateral DD. Secondly, there were two TMJ groups which consisted of measurements from patients’ symptomatic DD and volunteers with asymptomatic DD. The study included 79 TMJs of 40 patients with uni- lateral DD. In the group of 25 asymptomatic volunteers, 20 volunteers were without DD bilaterally (40 joints), while five had DD in at least one TMJ. All subjects were examined clinically and DD was confirmed by magnetic resonance imag- ing. Left and right TMJs were analysed independently for each participant based on their DD status (symptomatic, asymptomatic, and without DD). All asymptomatic TMJs did not have any clinical signs of TMJ functional abnormali- ties. There was a significant statistical difference between disc position among TMJs without DD in asymptomatic vol- unteers and TMJs without DD in patients (p=0.016). Moreover, no significant differences were found between condyle position in the same groups of joints (p=0.706). There were no significant differences in the DD position (p=0.918) or condyle position (p=0.453) between the group with asymptomatic volunteers’ joints and the group with symptomatic pa- tients’ joints. There was a significant difference between patient and volunteers’ joints without DD: the disc was posi- tioned more anteriorly in patients’ joints without DD than in joints of asymptomatic volunteers without DD.

The prevalence of acute and chronic respiratory symptoms and lung-function changes was studied in a group of 81 municipal sanitation workers. In addition, the prevalence of chronic respiratory symptoms and lung function was studied in 65 control workers. There were significantly higher prevalences of all chronic respiratory symptoms among the sanitation workers than among the control workers. Sanitation workers (smokers and nonsmokers) 40 years of age or older had higher prevalences of all chronic respiratory symptoms than younger workers. In addition, sanitation workers (both smokers and nonsmokers) employed for 10 years or longer had significantly higher prevalences of chronic respiratory symptoms than control workers. There was also a high prevalence of acute symptoms, which developed among the sanitation workers during work shifts. Of these symptoms, prevalences were highest for dryness of the nose and throat, followed by throat and eye irritation. Lung-function testing demonstrated significantly diminished forced vital capacity (FVC) and 1-second forced expiratory volume (FEV 1 ) for the 81 sanitation workers compared with control values. These differences only become significant after 10 or more years of employment in the sanitation industry and were not entirely explained by smoking. These differences were smaller and not statistically significant for maximum flow rates at 50% and the last 25% of the vital capacity. Our data suggest that sanitation workers-particularly those with long periods of work exposure-may develop acute and/or chronic respiratory symptoms accompanied by decreases in lung function (primarily FVC and FEV 1 ).

The aim of this study was to explore how the association of 5-year cumulative incidence of arterial hypertension (further 5-CIAH) and education varies according to body weight, age and sex. The study was conducted on cohort of 1383 subjects aged 18+ with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication). Data were collected in 2003 and repeated in 2008. Methods of descriptive statistics, chi2 test and logistic regression were used. No association between education level and hypertension development was recorded in the group of men and in the group of woman aged 65+. In the group of women with normal body weight, younger than 65 years, significantly higher 5-CIAH values were recorded in those with less than 12 years of education (32.5% [22.0 to 42.9]) compared to those with 12 or more years of education (9.6% [6.1 to 13.1]).

The aim of this study was to establish a five-year cumulative incidence of arterial hypertension (hereinafter 5-CIAH) and its dependence on initial prehypertension, body weight, age and gender. " Croatian Adult Health Cohort Study (CroHort)" data collected during 2003 and 2008 for the 1383 subjects aged 18 + with initially normal blood pressure (systolic

This prospective study of 1277 participants investigated patient risk self-assessment, motivation for changes in main determinants of the metabolic syndrome and the impact of community nursing intervention on cardiovascular risk reduction. Observed values of metabolic syndrome determinants indicated an elevated cardiovascular risk. Participants showed greatest motivation for positive changes regarding blood pressure, (3.70 +/- 1.26) then hyperglycemia (3.55 +/- 1.28), hyperlipidemia (3.46 +/- 1.30), overweight and obesity (3.43 +/- 1.28), and physical activity habits (3.29 +/- 1.31). Changes in physical activity and nutritional habits were not related to self-reported motivation regardless of the age and sex (p0.05). The most pronounced median improvements were observed in cholesterol (men 4.43%, women 4.89%) and triglycerides (men 3.41%, women 1.49%), with only slight changes in BMI (men 1.08%, women 1.18%) and no change in waist-to-hip ratio and glucose. This study revealed that, although aware and motivated, patients often do not succeed in changing habits. Concomitant changes of the environment and multisectoral prevention approach is necessary.

To compare characteristics in older patients in a sample of the general population of those with temporomandibular joint disorder (TMJD).A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0-10).There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months).In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients' groups, regardless of shorter pain experience in the older patients.

AIM: To investigate the association between environmental factors (perceived availability of marijuana, perceived use among friends and siblings, use of alcohol and tobacco, family structure, parental control, school performance) and lifetime prevalence and frequent and early marijuana use in high school students. ----- METHODS: We used self-reported data from 15-16 years old participants of the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 11 countries: Denmark, Estonia, Norway, Croatia, Slovenia, Germany, Switzerland, Bulgaria, Czech Republic, Russian Federation, and Ukraine. Multivariate logistic regression was used for data analysis. ----- RESULTS: Countries varied according to lifetime prevalence (8.7%-47.8%) and frequent (8.7%-23.9%) and early (3.0%-13.0%) marijuana use. Daily tobacco smoking was most strongly associated with lifetime marijuana use for boys in 7 and for girls in 5 countries, with highest odds ratio (OR, 95% and confidence interval - CI) for boys in Denmark (OR, 13.52; 95% CI, 8.16-22.4), and for girls in the Czech Republic (OR, 21.21; 95% CI, 12.99-34.62). Perceived marijuana availability was most strongly associated with frequent marijuana use for boys in 4 countries (highest in Slovenia: OR, 19.28; 95% CI, 6.52-57.02) and girls in 5 (highest in Slovenia: OR, 19.05; 95% CI, 5.18-70.04). Perceived use of marijuana among friends was most strongly associated with frequent marijuana use in 5 countries, both for boys (highest in Norway: OR, 23.91; 95% CI, 4.16-137.48) and girls (highest in Denmark: OR, 75.42; 95% CI, 13.11-433.90). Perceived use of marijuana among friends was most strongly associated with early marijuana use in 8 countries for boys (highest in Norway: OR, 54.03; 95% CI, 3.34-875.19) and 3 countries for girls (highest in Denmark: OR, 7.29; 95%CI, 1.77-30.12). ----- CONCLUSION: In each country, marijuana use was associated with similar factors, regardless of marijuana use prevalence in that country.The influence of peer group and perceived availability of marijuana seemed more important than parental control and family structure.

AIM: To assess the efficacy of the procedural consolidation concept (PCC) at reducing the number of sessions of general anesthesia necessary for treating children with epidermolysis bullosa (EB). ----- METHODS: We examined the records of children treated at Children's Hospital of Zagreb between April 1999 and December 2007. Children treated before the introduction of PCC in January 2005 (n=39) and after (n=48) were analyzed in order to determine the effect of PCC on the occurrence of complications, days of hospitalization, and number of hospitalizations. ----- RESULTS: During the study period, 53 patients underwent 220 sessions of general anesthesia for a total of 743 surgical interventions per session. Before the introduction of PCC (n=39 patients, 83 sessions), the median number of interventions per session was 2 (range 1-5), and after the introduction of PCC (n=48 patients, 137 sessions) it was 4 (range 3-7, P

To investigate dietary habits and assess pertinent regional differences observed in different parts of the Republic of Croatia. Based on these results, to identify the geographical regions where inhabitants are at the highest risk of developing hypertension.The study was carried out in 2003, using a modified food consumption questionnaire (Croatian Health Survey, CHS 2003), and included a total of 9070 adults agedor =18. The following six regions were investigated: mountainous, eastern, littoral, northern and central Croatia, and the City of Zagreb. The criterion used to establish diet-associated risk was the presence of at least one of the following variables: salting the food without tasting it first, regular consumption of dried meat products, and significant bread consumption (or =4 slices). The results pertinent to qualitative variables were expressed as frequencies.The analysis of dietary habits of the Croatian population revealed differences in the nutrition patterns customary for the investigated regions. The greatest number of subjects (12.3%) adding salt to food without tasting it first were recorded in the mountainous and eastern regions, followed by the City of Zagreb (10.3%), while the lowest number of subjects with such a dietary pattern were found in northern region. The highest incidence of smoked meat product consumption was recorded in the mountainous (30.7%) and eastern (26.5%) regions, and lowest in the northern region (15.6%). The most common type of bread was wheat bread with the frequency of consumption ranging from 65% (City of Zagreb) to 90.5% (mountainous region). The highest daily consumption of bread (4 slices) was recorded in the littoral (58.7% of men and 28.3% of women). All major foodstuffs contain a substantial amount of salt, i.e., sodium, thus posing a risk for hypertension. Grouping of these foodstuffs according to the respective cardiovascular risk level revealed the population in east Croatia to be at the highest risk of developing hypertension, followed by the mountainous region population, whereas the population of northern Croatia and the City of Zagreb were at the lowest risk of hypertension. In addition, the subjects from the mountainous region and in particular those from the eastern region reported other unhealthy dietary patterns in terms of more common animal fat consumption, rare or only sporadic vegetable and fruit intake, more common use of cakes and sweets, and considerably greater coffee intake as compared with other study areas.Substantial consumption of salt and sodium-rich foodstuffs, typical of the nutrition traditionally used by the Croatian population, calls for continuous promotion of healthy diet, healthy lifestyle and respective education of the population at large.

Five generations of second year students at the Zagreb University School of Medicine were interviewed through an anonymous questionnaire on their use of personal computers, Internet, computer laboratories and computer-assisted education in general. Results show an advance in students' usage of information and communication technology during the period from 1998/99 to 2002/03. However, their positive opinion about computer laboratory depends on installed capacities: the better the computer laboratory technology, the better the students' acceptance and use of it.

Efforts aimed at primary and secondary prevention of cardiovascular diseases, the major killer of contemporary adult populations, largely rely on modification of risk behaviours related to smoking, physical activity, dietary intake, and alcohol consumption, and also control of obesity and hypertension, the interim risk states between health and disease. We propose that the extent to which the gene x 'obesogenic' environment interaction depends on associations between particular single nucleotide polymorphisms (SNPs) and behavioural risk factors for overweight or obesity determines opportunities for novel, personalised preventive interventions. We systematically searched for SNPs that might be of interest for this postulate, and we present various SNPs that have been shown to be associated with overweight or obesity and behavioural risk factors for developing these traits, and thus hold promise for future design of personalised preventive interventions.

Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients' joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders.

The aim of the study was to follow and analyze patient referrals from general practice (GP) to diagnostic procedures and specialist consultations. Data on the kinds of diagnostic procedures, specialist consultations and requests for referrals were collected. Specific aim was to assess the contribution of referring for definitive diagnosis and to compare the frequency and contribution of first and repeat consultations.This prospective study was conducted in the course of one month at six GP practices (three urban and one rural practice in inland area, and one urban and one rural practice in coastal area of Croatia). Patient sociodemographic data (age and sex), referral request (by patient, GP, GP and specialist in agreement, specialist only) and kind of visit (first, follow-up) were collected. The contribution of referrals was assessed by GPs using modified Likert's scale (1-markedly significant, 2-significant, 3-undetermined, 4-small and 5-insignificant). On comparison of frequencies chi square test was used. Statistical analyses were done by use of licensed software (SAS Institute Inc, Cary, NC, USA).During one month, 1815 patients were referred, 979 for diagnostic procedures and 836 for specialist consultation (mean age 55.25 +/- 19.70; male 56.30 +/- 19.10, female 54.50 +/- 20.30). Most frequent diagnostic procedures requested were biochemical laboratory in primary health care setting (n = 331; 33.41%) and secondary care (n =1 18; 12.05%), basic radiology (n=106; 10.83%), ultrasonography (n=87; 8.80%) and microbiological laboratory (n = 68; 6.95%). The contribution of diagnostic procedures was mostly assessed as significant (54.84%). When GP and specialist indicated diagnostic procedure concordantly, its contribution was mostly assessed as significant (61.90%) and markedly significant (10.12%). Specialist consultations were used as follows: physical medicine in 131 (19%), surgeon in 90 (13%) and psychiatrist in 69 (10%) patients from inland area, cardiologist in 53 (37%), psychiatrist in 17 (12%) and oncologist in 12 (8%) patients from coastal area. Both in rural and urban practices in inland and coastal area surgeon consultations were assessed as markedly significant. Urban GPs assessed the contribution of first and follow-up check ups as undetermined or small more often than rural GPs (first check ups Xchi =21.66; P0.0001; follow-up check ups chi2 = 196.38; P0.0001). Rural GPs assessed the contribution of first check ups more often as undetermined or small than significant (chi2 = 12.02; P = 0.0005), with the same tendency recorded for follow-up check ups (Xchi =32.01; P0.0001).GP should maintain the gatekeeping role to assure good quality of care and rationality in using available resources. Cooperation between GPs and specialists is essential to achieve good quality of care. GPs should restore role in indicating follow-up check ups.

The objective was to estimate the proportion of cases developed interim risk factors (INTF: overweight, excess abdominal fat, high blood pressure) in relation with behavioral risk factors (BEHF: smoking, heavy alcohol intake, unhealthy diet, physical inactivity). NOBIR group was defined as cases with no BEHF and BIR as those with them. Both groups show higher proportions of INTF in older age. The increase by age varies of twofold (overweight: 13.2-29.2 for men, 18.1-42.6 for women) to six fold (high blood pressure: 4.6-26.5 for men, 6.6-40.8 for women) in proportions. Women show higher proportions of INTF than men in both groups, but BIR group shows higher proportions than NOBIR in all the age groups taking the both gender together. As a BEHF the physical inactivity has a markedly increase with age (from 4% to more than 25%). Smoking is the only BEHF decreasing in oldest for all the INTF.

The aim of this paper was to analyze the regional pattern of physical inactivity in Croatia based on the Croatian Adult Health Survey 2003 data. A total of 9,070 adult respondents were included in this study. In men, the highest prevalence of physical inactivity was recorded in the City of Zagreb (39.6%), and it was significantly higher than in Central (25.6%), Coastal (25.6%) and Mountainous region (14.1%). Mountainous region had significantly lower prevalence of physical inactivity compared to any other region, except the Central region. The highest prevalence of physical inactivity in women was also recorded in the City of Zagreb (43.6%), and it was also significantly higher than in all other regions. The lowest prevalence of physical inactivity was recorded in Eastern Region (24.7%). The highest levels of physical inactivity in both in both genders were recorded in urban regions, suggesting that intervention measures in terms of health promotion should be undertaken, with strong emphasis on the people living in urban settings.

The objective of this study was to investigate the prevalence of anterior disk displacement and condyle position in volunteers free from clinical symptoms and signs of temporomandibular disorders.Bilateral parasagittal T1-weighted magnetic resonance images of temporomandibular joints (TMJ) in 25 asymptomatic volunteers (age range 21-27, mean 23.4 years; 18 (72%) female and 7 (28%) male) were analyzed and metric measurements of disk and condyle position were investigated. Metric analysis of the position and relationship between the disk and the condyles were described using Kurita et al. method of measuring relative and absolute distances of reference points. On statistical data analysis, the left and right TMJs of each person were presented as two separate entities. The methods of nonparametric statistics were used.Anterior disk displacement was found in 5 (20%) asymptomatic volunteers (four of them female). Anterior displacement with unilateral reduction and anterior displacement without reduction unilaterally was present in two subjects each, whereas one volunteer had anterior displacement without reduction bilaterally. There was no difference in the calculated position of condyle between joints with and without disk displacement (Kruskal-Wallis test, p0.05).This study evaluated the prevalence of asymptomatic anterior disk displacement in symptom-free healthy volunteers and the condyle position in the glenoid fossa. Displaced disk is the main cause of temporomandibular pain; however, studies in asymptomatic volunteers also suggest it to be an anatomic variant. The relationship between dorsocranially positioned condyle and anteriorly displaced temporomandibular joint disk is a controversial issue. Metric analyses were only made in parasagittal plane.There was difference in the calculated disk position between joints with and without disk displacement, but this study found no difference in the calculated condyle positions according to the presence or absence of disk displacement.

This paper analyzes the Croatian Adult Health Survey data, collected in 2003 with a total of 9,070 respondents aged 18+. Based on an average of two measurements, respondents with the mean systolic arterial pressureor = 140 mmHg or mean diastolic pressureor = 90 mmHg were classified as hypertensive. The data for men and women were analyzed separately, according to regions. Prevalence of hypertension in men was 40.5% (95% confidence interval CI 37.9-43.01; coefficient of variability CV = 3.2), women 34.9% (95% CI 33.2-36.7; CV 2.5). There were no significant differences in regional prevalence in men, except in the Northern and Eastern region. In women we did not detect any significant regional difference. Non-controlled arterial hypertension is an important public health problem in all monitored regions of Croatia. Raising awareness about the problem, early detection and encouraging the population to adhere to the therapy for elevated arterial pressure, in addition to a healthy life style, are important for successful control and harm reduction.

OBJECTIVE: To identify the health-risk behaviour of various homogeneous clusters of individuals. ----- STUDY DESIGN: The study was conducted in 13 of the 20 Croatian counties and in Zagreb, the Croatian capital. In the first stage, general practices were selected in each county. The second-stage sample was created by drawing a random subsample of 10% of the patients registered at each selected general practice. ----- METHODS: The sample was divided into seven homogenous clusters using statistical methodology, combining multiple factor analysis with a hybrid clustering method. ----- RESULTS: Seven homogeneous clusters were identified, three composed of males and four composed of females, based on statistically significant differences between selected characteristics (P

Objective: Pesticide aerosols are frequently toxic irritants associated with respiratory symptoms and lung function impairment. Methods: A cross-sectional study examined the prevalence of acute and chronic respiratory symptoms and lung function abnormalities in 82 workers employed in processing pesticides and in 60 control workers not exposed to irritants and employed in a soft drink bottling plant. Results: The prevalence of almost all chronic respiratory symptoms was greater among pesticide workers than among controls. A logistic regression analysis shows differences between men and women. There was a high prevalence of acute symptoms during the work shift in pesticide workers. The data on ventilatory capacity indicates significant reductions in all tests compared to predicted. Multivariate analysis of lung function showed differences in smoking and work exposure effects in men and women. Conclusion: Our data indicate that duration of work exposure in the pesticide processing industry may be associated with the development of acute and chronic respiratory symptoms and lung function changes. These effects appear to be aggravated by smoking. (J Occup Environ Med. 2008;50:1299–1305)

INTRODUCTION: The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents' rural versus urban origin. ----- METHODS: Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression. ----- RESULTS: One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake. ----- CONCLUSIONS: Opportunistic cancer screening uptake is low in the Croatian adult population, with existing socio-economic differences in breast and prostate screening, and their absence in colon cancer screening. Rural origin was significantly associated with breast screening, even after adjustment to socioeconomic status and problems in access to health care. Lack of rural origin significance in the other screening sites could be related to small sample sizes of people who reported opportunistic utilization. Overall, access to health care is the strongest cancer screening predictor, and this should have a prominent role in the development of a systematic cancer screening program on a national level.

To estimate the regional prevalence of metabolic syndrome, and potential implication of socioeconomic characteristics to it.Assessment was performed in a sample representative of the Croatian population (N=9070). The metabolic syndrome was defined as "waist circumference greater than 102 cm for male and 88 cm for female, and at least two of the following criteria: arterial blood pressureor =140/90 mm Hg (regulated hypertonic was considered as normal blood pressure person), elevated blood lipids, and elevated blood sugar (self reported). Statistically, the prevalence and confidence intervals, and comparative figure for the prevalence of metabolic syndrome (according to Julious et al. 2001) were applied.The prevalence of metabolic syndrome in young adults (agedor =34) was less than 1%. In older population groups the prevalence was greater. In theor =65 age group, the prevalence (male 7.7, 95%CI 8.6-9.2; female 9.9, 95%CI 8.6. 11.1) was twofold that recorded in the 35-64 age group (male 15.2, 95%CI 12.4-17.9; female 22.5, 95%CI 20.1-24.8). The prevalence of metabolic syndrome was higher in female population in all age groups. There were no regional statistically significant differences. Socioeconomically, the metabolic syndrome population showed lower economic status, lower education level, and unfavorable health perception. As socioeconomic characteristics are not independent of age and sex, adjustment was made by calculating comparative figure for the prevalence of metabolic syndrome. Results showed no statistically significant differences between different socioeconomic groups, however, the groups with poor health perception showed a higher rate of metabolic syndrome than other groups. Comparative prevalence of the metabolic syndrome was 126.5, 95%CI 121.7-131.5 in the group with poor health perception, and 70.7, 95%CI 70.6-70.9 in well being groups.The prevalence of metabolic syndrome in the Croatian population is not region dependent. Socioeconomic status does not cause significant differences in the prevalence of metabolic syndrome, whereas poor health perception is associated with a higher prevalence of the syndrome.

To investigate the possibilities of diagnosing metabolic syndrome (MS) based on the data collected from patient records at the level of family health care, and to assess possible sex differences in MS prevalence as well as differences between individuals with and without MS.Data on age, sex, body mass index (BMI), systolic and diastolic blood pressure, and laboratory findings (blood sugar, triglycerides, total cholesterol and HDL cholesterol) were collected during a one-year period (June 2004 - June 2005) from standardized existing records of all patients covered by three general practitioners in Zagreb. MS was defined according to WHO criteria. Statistical analysis was performed with chi2-test for qualitative and t-test for quantitative variables.The data recorded showed that general practitioners either did not practice some activities or did not take notes of what they did. The overall incidence of MS was 6.64% (6.01% in men and 6.78% in women). Men and women with MS showed statistically significant differences in BMI (p=0.033) and age (p0.001). Men with MS showed a statistically significant increase in fasting glucose (p0.001), triglycerides (p=0.005), systolic blood pressure (p0.001), diastolic blood pressure (p=0.0020), and lower HDL cholesterol (p=0.021). MS men were older than men without MS (p0.001). Women with MS had a statistically significantly higher level of fasting glucose (p0.001), triglycerides (p0.001), BMI (p=0.035), systolic blood pressure (p0.001), and diastolic blood pressure (p0.001), and lower HDL cholesterol (p0.001) than women without MS. MS women were by 18.6 years older (p0.001).The data recorded by general practitioners in medical documentation are sufficient for MS diagnosis. However, the low prevalence of MS shows inadequate awareness of the role of MS in cardiovascular disease.

The aim of this study was to evaluate oral health of Croatian army recruits, and subsequently, by DMFT index and FST index, to point to dental status of each recruit and to make the diagnosis and treatment plan accordingly.A total of 248 randomly chosen Croatian Army recruits aged 19-29 underwent examination at a dental office in Koprivnica barracks. Their oral health status was clinically observed and evaluated by use of DMFT and FST indexes. The quality of dental treatment and number of restorations were estimated according to the formula: FTx100/DFT. The study included recruits who had no decayed teeth (DMFT=0), and all teeth, apart from wisdom teeth, were examined. The subjects were divided according to age and place of residence (urban, rural), all of them living in central Croatian counties. They were also interviewed about their dietary habits, and personal oral and dental care. The methods of nonparameter statistics were used due to abnormal data distribution.Healthy teeth were found in 4% of study subjects. The median value of DMFT was 6, and of FST index 25. There were no statistically significant differences in the indices according to either residence or age of recruits. A statistically significant difference was recorded between DT and FST index (p0.05) according to educational level and understanding of the dietary role of carbohydrates reflected in caries development. Restorations were present in 18.6% of the recruits, i. e. their teeth were well treated, without any further carious lesions.The results of epidemiological studies, carried out in many countries, have revealed a decreased number of caries resulting from overall preventive measures that were taken from early childhood. Specific socioeconomic factors play an important role in Croatia as well as in other transition countries.The values of DMFT indexes recorded in recruits from other countries tend to be considerably lower than those in Croatian Army recruits. In populations with a high caries incidence it is more appropriate to use FST index. The study of caries in heterogeneous populations such as recruits points to the need of taking more effective preventive measures in childhood and adolescence.

The aim was to assess the incidence of isolation of individual fungal species and interpret the meaning of fungal isolates from foot ulcers of 509 diabetic outpatients using mycologic and histopathologic methods. Another aim was to explore risk factors for the development of fungal infections in foot ulcer.Fungus isolation was made on selective media and their identification by standard mycologic methods. Histopathologic diagnosis of fungal ulcer infections was made on PAS-stained histopathologic preparations and imprint preparations (PAS and Papanicolaou staining) of foot wound biopsy specimens.Fungal and mixed foot ulcer infections were found in 14.9% of diabetic patients. In 33.8% of patients, these infections were confirmed by a finding of fungal elements in histopathologic preparations of ulcer biopsy specimens, as follows: in 16.9% of patients, by finding fungal elements in imprint preparations of ulcer biopsy specimens and by isolation fungus from the swab of the same ulcer; in 2.3% by fungus isolation from ulcer biopsy specimens; in 36.9% by fungus isolation from ulcer swabs in pure culture and/or in a large number of colonies and/or from several ulcers on the foot of the same patient. More than 89% of patients had a single foot ulcer with fungal or mixed infection, big toe and the plantar-metatarsal region in one foot or both feet being the most common sites of ulcer. Fifteen species from the genera Candida, Cryptococcus, Trichosporon and Rhodotorula were the causative agents of fungal and mixed foot ulcer infections. C. parapsilosis (in 61.5% of patients), and C. albicans and C. tropicalis (in 10.8% of patients each) were the most common causes of these infections. The presence of yeasts and/or dermatophytes in the toe web of the same or other foot, or of both feet, did not influence the incidence of fungal and mixed foot ulcer infections. Patient sex and age, type and length of diabetes, or clinical picture of diabetic foot did not affect it either. In IDDM patients, the risk factor for the development of fungal and mixed foot ulcer infections was ulcer infection lasting for more than 13 weeks, whereas in NIDDM patients the length of ulcer infection did not contribute to the incidence of fungal and mixed foot ulcer infection.Our results and other reports suggest that Candida species are the most common fungal isolates (between 93.2% and 100% of all fungal isolates) from diabetic foot ulcer, with C. parapsilosis being the most common causative agent of fungal and mixed infection. From diabetic foot ulcer, bacterial isolation was 5 times as common as that of yeasts (327 vs. 65 patients). Nevertheless, this investigation showed fungal isolates, originating not only from a primarily sterile ulcer sample (biopsy specimen) but also from foot ulcer swabs to be the causative agents (not ulcer colonizers or contaminants) of the foot ulcer infection. The pathogen c effect of yeasts in foot ulcer is indicated by the severity of clinical finding, chronic course of infection, and infection progression despite antibiotic therapy. Equally indicative are microbiologic diagnostic parameters (isolation in pure culture, and/or isolation in a large number of colonies, and/or isolation from several ulcers in the foot of the same patient).In diabetic patients at highest risk of developing fungal and mixed foot ulcer infections (IDDM patients with ulcer infection persisting for more than 13 weeks, and NIDDM patients with the clinical picture of deep ulcer and abscess in the plantar region, irrespective of the duration of ulcer infection), routine bacteriologic diagnosis should be supplemented with targeted mycologic and histopathologic methods.

To define trends in age-adjusted acute myocardial infarction mortality and morbidity in women and men in the city of Zagreb, Croatia, in the period 1979-2001.Acute myocardial infarctions occurring in both men and women at ages between 25 and 74 years were analyzed by using 1979-2001 data from the Acute Myocardial Infarction Population-based Register for the City of Zagreb, Croatia. The patients with myocardial infarction were identified retrospectively from the hospital discharge reports and death certificates in Zagreb hospitals and the Croatian Statistical Bureau.Over the period of 23 years, a total of 25,359 cases of acute myocardial infarction were registered in the city of Zagreb (18,345 men and 7,014 women). The age-adjusted attack rate for men was the lowest in 1981 (170 per 100,000 population) and the highest in 1993 (274 per 100,000 population), with a decreasing trend toward 2001. The rate for women was between 49 per 100,000 population in 1979 and 86 per 100,000 population in 1993, with a decreasing trend afterwards. Between 1993 and 2001, the rate for men decreased by 68.6% and for women by 62.8% (P=0.370). The age-adjusted mortality rate showed more pronounced changes and was much higher for men then for women. The rates per 100,000 population among men varied between 80 and 140, and among women between 20 and 40. Between 1993 and 2001, the age-adjusted myocardial infarction mortality rates decreased by 56.3% and 52.5% in men and women, respectively (P=0.670). The age-adjusted prehospital mortality rate for men was much higher than the hospital mortality rate and had an obvious decreasing trend since 1993. Both rates were much lower for women. Twenty-eight-day case-fatality rate for men ranged from 38.5% to 49.1%, and from 39.0% to 64.0% for women. It did not change much in men during the observed period. Women younger than 45 years had a significantly greater risk of a fatal heart attack, whereas the risk was greater for men in the older age groups (55-74 years).The age-adjusted attack rates, mortality rates, prehospital death rates, and case-fatality rates showed a definite decline since the early 1990s for both men and women, but the decline was greater for men.

To examine the differences in the morbidity among 325 native inhabitants, 231 immigrants, and 145 returned refugees in Komarevo, Croatia.The data on patients older than 45 years and their chronic diseases classified according to the 10th revision of International Classification of Diseases and Related Health Problems were collected from the medical files in a family practice in Komarevo. The patients were grouped according to their status (natives, immigrants, and returned refugees) and age (45-64 andor =65 years). The differences in diagnoses between the groups of the same age were analyzed by descriptive statistics, Kruskal-Wallis test, and chi2 test.In the 45-64 age group, hypertension was diagnosed in 67 out of 183 (36.6%) natives, 22 out of 108 (20.4%) immigrants, and 12 out of 50 (24%) returned refugees (chi2(2)=9.48; P=0.008). In the same age group, ischemic heart disease was found in 21 out of 183 (11.4%) natives, 3 out of 108 (2.8%) immigrants, and 3 out of 50 (6.4%) returned refugees (chi2(2)=7.34, P=0.025). In those agedor =65, intervertebral disc disorders, dorsalgia, and dorsopathy were found in 61 out of 169 (36.1%) natives, 26 out of 123 (21.1%) immigrants, and 15 out of 90 (15.8%) returned refugees (chi2(2)=15.44, P0.001). Ischemic heart disease was found in 20 out of 169 (11.8%) natives, 4 out of 123 (3.3%) immigrants, and 16 out of 90 (16.8%) returned refugees (chi2(2)=11.40, P=0.003). Five (56%) and six (67%) out of nine groups of diagnoses had the lowest prevalence in immigrants aged 45-64 andor =65, respectively.Native inhabitants had the highest prevalence of observed chronic diseases, whereas the immigrant adult population had the lowest. Such differences should be kept in mind in the approach to war-affected populations.

The diagnosis of acute myocardial infarction (AMI) and unstable angina is based on typical clinical signs, electrocardiogram (ECG) changes, and serial measurements of characteristic serum enzymes, especially troponins. Today, newer biochemical markers are used in assessing these conditions, as well as minor myocardial damage (MMD).The aim of this study was to determine the existence of MMD by the analysis of new biochemical markers including cardiac troponin T (c-TnT), troponin I (c-TnI), CK-MB activity (CK-MBact), CK-MB mass (CK-MBmass), a conventional marker of total creatine kinase (CK), and 12-lead ECG monitoring in two groups of critically ill patients admitted to the intensive care unit (ICU). Group 1 (n=52) consisted of the patients with heart failure, unexplainable hypotension, chronic obstructive pulmonary disease in acute exacerbation, acute severe pancreatitis, sepsis, pulmonary embolism, diabetes with complications, liver cirrhosis, and tachycardia120/min who suffered chest discomfort without evident ECG signs of AMI. Group 2 consisted of patients (n=73) with acute gastrointestinal bleeding, poisoning, and miscellaneous conditions without chest discomfort or ECG signs of AMI.Of the 52 critically ill patients, 21.2% were positive for troponin T and 11.5% for troponin I. Group 1 patients showed a prevalence of elevated total CK (28.8%), CK-MBact (7.7%), and CK-MBmass (32.7%). In group 2, positive troponin I was found in 19.7% of patients, troponin T was negative (0.00%), with elevated total CK (23.9%), CKMBact (7.0%), and CK-MBmass (2.3%). The mean concentrations of c-TnT, c-TnI, total CK, CK-MBact, CK-MBmass were higher in group 1 than in group 2, however, without statistical significance. The best positive correlation was recorded between CK-MBact and CK-MBmass (r=0.63). The c-TnI showed best discrimination and accuracy in the assessment of MMD under the ROC curves surface (0.84), while the accuracy was low for all other markers analyzed. Discrimination and accuracy were moderate for all markers analyzed.CK-MBact (92.3%) showed the highest specificity, followed by c-TnI (88.5%) and c-TnT (75.6%). The sensitivity was low for all markers analyzed. Concerning specificity, CK-MBact proved to be the best biologic marker for the assessment of MMD, followed by c-TnI and c-TnT. Correct clinical assessment according to marker accuracy and discrimination can be achieved by use of c-TnI, however, with a moderate degree of accuracy and discrimination for the detection of MMD in critically ill patients admitted to ICU.

INTRODUCTION: The urban road traffic accident (RTA) risks for the city of Zagreb, Croatia, from 1999 through 2000 were analyzed with the aim of reducing the increasing injury incidence. - - - - - METHOD: Simple and bivariate analysis using chi(2), odds ratio, and confidence interval of 95% was used to determine risks in three outcome groups: killed, severely, and mildly injured. - - - - - RESULTS: There were 528 RTA victims consisting of 260 severely, 213 mildly injured, and 55 killed at the scene of an accident and during transportation. More fatal accidents occurred during night hours (OR=3.78; 95% CI, 2.08-6.85), on urban road links (OR=2.33; 95% CI, 1.30-4.19), and at exceeding speed limit (OR=2.56; 95% CI, 1.43-4.61). More people were injured than killed on urban junctions (OR=5.27; 95% CI, 2.21-12.57). The highest combined risk of dying or being severely injured was found in males, driving at excessive speed, on urban links, and during bad visibility (OR=16.15; 95% CI, 3.901-66.881). - - - - - CONCLUSION: These results will influence the urban traffic police enforcement measures, which will change inappropriate behavior of drivers and protect the least experienced road users.

Background Pharmaceutical workers may be at risk for the development of respiratory problems as a result of their work environment. Methods This study investigated 163 female and 35 male workers, employed in a pharmaceutical plant processing different types of medication, primarily antibiotics, in order to characterize the risk of this environment. Chronic respiratory symptoms were recorded by using the British Medical Research Council questionnaire. Acute symptoms, which developed during the work shift, were also recorded. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves on which FVC, FEV1, FEF50, and FEF25 were measured. Controls (113) were selected from a food packing facility. Results A significantly higher prevalence of chronic respiratory symptoms was recorded among workers (compared to controls), the highest being for sinusitis, nasal catarrh, and dyspnea. There was also a high prevalence of acute symptoms recorded during the workshift. Odds ratio showed that the most significant risk factors for these respiratory findings were smoking and length of time worked in the pharmaceutical industry, particularly in men. Pulmonary function testing demonstrated significantly decreased measured values in comparison to predicted European pulmonary function measurements (P

The effects of organic dusts on the respiratory system of workers employed in food processing, in textile workers, as well as in agricultural and livestock farmers are reported. Deposition and elimination of particles from the lung as well as the possible mechanisms of the organic dust effects on respiratory system are described. Separately are presented results of our investigations on the prevalence of respiratory symptoms and diseases as well as lung function tests as indicators of the condition of the respiratory system. Data on the experimental studies with aqueous extracts of organic dusts on smooth muscle of isolated guinea pig trachea suggest that the bronchoconstrictive effects in humans can be reproduced in nonsensitized guinea pigs. The preventive measures in the development of respiratory impairments in subjects occupationally exposed to organic dusts are described.

To present the epidemiology of fatal bicyclist injuries in traffic accidents in Croatia.Between January 1, 1997 and December 31, 2000, there were 253 bicyclist fatalities in Croatia. The data were collected from the police reports of the Department of Traffic Police, Ministry of the Interior, written at the place of the accident. The data were processed by descriptive epidemiology and compared by tests of significance.The percentage of bicyclist fatalities among total road fatalities showed a decreasing trend over the years, from 11.6% in 1998 to 8.2% in 2000. The most frequent type of accident involving bicyclist fatalities were accidents in car-bicycle collisions (lowest: 74.7% in 1998; and highest: 81.3% in 1997). Most accidents occurred at the beginning and at the end of the bicycle season--months of April and October. Elderly people were involved in accidents occurring mainly in the morning hours--from 6 to 12 a.m., whereas the youngest and the middle-aged got injured or killed mainly in the evening - 6 to 9 p.m. This association between the age and the part of day when the accident happened was statistically significant (chi square=36.51, p0.0001).Bicycle-related fatal injuries as a part of total road fatalities showed a gradual decrease. Regulation of bicycle traffic, more stringent protection measures and their implementation, as well as preventive measures regarding the time of day are needed to further decrease bicyclist fatalities in traffic.

To compare ventilatory capacity of Croatian population with the ventilatory function values predicted by conventional equations based on measurements among European populations.Ventilatory capacity and respiratory symptoms were determined in a group of 2,482 healthy non-smokers (1,162 men and 1,320 women). The measurements were performed with a pneumotach spirometer. Maximum expiratory flow volume curves (MEFV) were registered, and forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and flow rates at 50% (MEF50) and the last 25% of the vital capacity (MEF25) were recorded. Anthropometric data were also noted. Reference values were calculated using multiple linear regressions.Comparisons of our values with the prediction summary equations issued by the European Community for Steel and Coal (ECSC) and the European Respiratory Society (ERS) showed that healthy Croatians had consistently lower values of FVC (92.1-/+14.0% of the predicted volume for men and 86.2-/+11.7% for women) and FEV1 (93.7-/+14.8% of the predicted values for men and 95.3-/+13.1% for women), but higher values of MEF50 (107.8-/+30.1% of the predicted values for men and 103.4-/+22.8% for women) and MEF25 (117.3-/+41.0% of the predicted values for men and 117.9-/+34.0% for women) than the ECSC/ERS recommendations. The comparison was also made with the most commonly used North American reference standards based on populations of European origin, with similar findings. On the basis of the results of multiple linear regressions, we constructed prediction equations for ventilatory function in Croatian population.The ECSC/ERS recommendations are not satisfactory for the Croatian population.