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This survey was performed to determine the relationship between the adherence to hypertension drug treatment and the perception of stress, depression, hypertension, and myocardial infarction. 300 patients with uncomplicated hyperten- sion from Rijeka, Croatia, were included (131 women, 169 men, mean age 53.5 years). Adherence to hypertension drug treatment as criterion, and the perception of stress, depression hypertension and myocardial infarction as prediclors were determined by self-assessment. Collected data were analysed using factor analysis, regression analysis, Kolmogorov-Smirnov test, chi2-test and t-test. The statistical significance was set at a probability rate of less than 5% (p < 0.05). 45.09% of women (p=0.479), and 64.08% of men (p = 0.032) were motivated to take antihypertensives. 55.79% of women (p = 0.382) and 64.78% of men (p = 0.028) had sufficient knowledge about drug treatment of hypertension. The positive predictors of motivation for taking antihypertensives were physiological disturbances and perceived potency of hypertension and the negative were perceived helplessness in stress control and negative thoughts and emotions. The positive predictors of knowledge about taking antihypertensives were perceived helplessness in stress control, perceived potency of hypertension and myocardial infarction and the negative predictors were perceived self-efficacy in stress control, physiological disturbances and evaluation of hypertension. Both the motivation as well as the knowledge about taking antihypertensives should be improved, especially in women. The perception of stress, depression, hypertension and myocardial infarction can be used to predict adherence to hypertension drug treatment.

The research aims were to test perception of arterial hypertension and myocardial infarction in hypertensive and normotensive men and women as well as to test perception of arterial hypertension and myocardial infarction as predictors of blood pressure control in hypertensives. In the research 470 subjects of 4 general practices from Rijeka, Croatia participated, hypertensive group from the list of hypertensive patients without cardiovascular complications and other major chronic conditions, normotensive group from the list of patients without chronic conditions. Each group had 235 subjects, 128 men and 107 women. Perception of hypertension and myocardial infarction was measured as the result on semantic differential questionnaire. Factor analysis extracted evaluation, potency and activity factor. Blood pressure control was interpreteted on the five degrees scale. Statistical significance was defined under 5% (p < 0.05). Hypertensive subjects perceived hypertension as less negative and more active, while myocardial infarction was perceived as more potent term than by normotensives. Women perceived myocardial infarction as less negative, and less potent term than men. Both groups perceived myocardial infarction as more negative, potent and active term than hypertension. Normotensive women evaluated hypertension as more negative, and perceived myocardial infarction as less potent than other subjects. Well-controlled hypertension was correlated with a lower potency of hypertension and lower activity of myocardial infarction. Both conditions are perceived as more "male" diseases. As perception of hypertension and myocardial infarction is correlated with blood pressure regulation in hypertensives, and hypertension is major risk factor for myocardial infarction, family doctors should put additional effort in changing perception of cardiovascular diseases in their patients, especially in women.

Objective: The aim of this review is to warn about the effects of methemoglobin and its catabolic products and the toxic effects caused by environmental oxidants that cause high-risk pregnancy and may later impair the health of newborns, children and adolescents., Methods: In our study of pregnant women (n = 36) whose methemoglobin level was >1.5 g/l, we took blood samples from their newborns to determine the frequency of sister chromatid exchange (SCE) by cultivating lymphocytes. The research took place at the Department of Biology and Medical Genetics of the School of Medicine in Rijeka (Croatia)., Results: The results have shown that no deviation in the SCE frequency was found in either case (1990). We examined data on the health of newborns collected at perinatal hospital departments in Rijeka (Croatia), the preschool office and school service at the Labin Health Center and continued until they were 18 years of age (2008). The statistics obtained by applying the chi-square test show that the incidences of neonatal jaundice (p = 0.034), heart murmur at a later age (p = 0.011) and dyslalia and learning/memory impairments (p = 0.002) were significantly higher than in children of control mothers (n = 19)., Conclusion: Depending on the mother's exposure to environmental oxidants, during its development the fetus is more likely to be affected by methemoglobin and hemolysis. Oxidants affect the vascular endothelium of kidneys, brain and other vital organs, because they have the capacity to cross the damaged fetomaternal placental barrier. 'Fetal preeclampsia' is an expected manifestation of the condition. Our research proves our thesis on the pathophysiological relationship between methemoglobinemia and unexplained jaundice and hyperbilirubinemia, heart murmur at a later age, dyslalia and learning and memory impairments that have not exactly been demonstrated yet.

Global heating and increased solar ultraviolet irradiance have caused an increase in number of many diseases, particularly skin malignant diseases. Aim of this study was to investigate the influence of climate changes on the health of the population of the Primorsko-goranska and Istria Counties. We gathered and analyzed data about the frequency of skin malignant melanoma in the period of eight years (1998-2005). The data were collected from the Croatian cancer registry. The incidence of malignant skin cancer was estimated overall, by age group and gender. We found that the incidence of the skin melanoma was approximately the same in both counties during the period 1998-2005. However, significant increase has been noted when compared to the situation in the period 1977-1996 (p = 4.95 E-13) The incidence of malignant skin melanoma has risen during the last ten years. It is differently distributed between gender and age groups in Primorsko-goranska and Istria County. It can be related to climate changes, but also to different ways way of life between these two counties.

Multiple sclerosis (MS) is an autoimmune disease triggered by a combination of genetic and environmental risk factors which are however individually insufficient to provoke the disease. Previous investigations studied the coexistence of cancer in MS patients, and only a few relations between the geographic distribution of MS and that of cancer. The aim of this research was to find an environmental link between the aetiology of MS and cancers in Croatia. Incidence and prevalence of MS in Croatia were compared with the incidence of the most frequent cancer sites: stomach cancer, cancer of the colon and the rectum, pancreatic cancer, lung cancer, cancer of the kidneys and brain cancer. Data for MS were collected from seven population-based epidemiologic studies which used Poser's diagnostic criteria and reported the number of cases and the magnitude of the studied population. Data for cancers were drawn from the Croatian National Cancer Registry. The analysis was done for single municipalities, grouped in their belonging regions or counties, and separately for the continental and the coastal area. For each rate a 95% confidence interval was calculated. The differences between rates were tested with the chi-square test as well. In addition, MS incidence or prevalence were correlated with the corresponding cancer incidence data. Pearson's correlation coefficients were used to measure the correlation between both diseases. Calculations were done with the statistical package Statistica V 7.1. and the Smith's Statistical Package freeware In the continental area of Croatia the mean annual incidence (per 100,000 inhabitants) of MS was nearly two folds higher than in the coastal area: 2.1 vs. 1.3 (p = 0.0029). The difference was lower when expressed by prevalence: 46.5 vs. 36.7 (p = 0.0601). Among the malignant neoplasms, in the continental area significantly higher incidence rates were found for stomach (32.9 vs. 20.8; p = 3.14E-14) and lung cancer (55.8 vs. 46.4; p = 1.21E-05), whilst colon cancer alone (20.4 vs. 15.7; p = 9.44E-05) or colorectal cancer (38.3 vs. 31.6; p = 8.18E-05) had a significantly higher incidence in the coastal area. The geographic distribution of MS expressed by incidence was significantly correlated with pancreatic (r = 0.62024, df=23, p = 0.00094) and lung cancer (r = 0.46380, df=23, p = 0.01953). This research adds further malignant neoplasms, possibly exposure-related, to the list of diseases with geographic distribution like MS. The similarity of MS distribution with the named malignancies is unlikely to be incidental. MS in Gorski Kotar and Slavonia seems to be associated with a diet rich in meat and fat. A diet rich in fat and meat and poor in vegetables is a risk factor for stomach, colorectum, pancreatic as well as lung cancers. Some authors have documented a possible protective role of the "Mediterranean diet" for the named cancers. Olive oil is the main source of fat in the "Mediterranean diet". Oleocanthal, aphenolic compound of the extra-virgin olive oil was found to inhibit the cyclooxigenase enzymes which are involved in demyelination and tumorigenesis. We hypothesize that the "Mediterranean diet", olive oil and particularly oleocanthal, to have a protective role in MS too.

Objectives: To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina., Patients and Methods: We analysed data from 81 MS patients (49 females, 32 males) on the prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994-2003 in the investigated area., Results: Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20-34). Prevalence was highest in the mountainous municipality of Posusje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0-3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0+/-11.6 years, and the mean age at disease onset was 31.0+/-7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients., Conclusions: Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.

Objective: The aim of this study was to evaluate the prevalence of multiple sclerosis (MS), and to determine the clinical characteristics and the occurrence of familial MS in the Gorski kotar-Kocevje region, which was previously considered to be a region of high prevalence of MS., Methods: All clinically and laboratory supported definite cases of MS according to Poser's criteria, living residents of the chosen area on June 1, 1999 were included in the study. The patients were ascertained through national case registers for MS at the University Medical Centers (Rijeka and Ljubljana), registries of the national associations of MS patients, as well as from the medical records of regional outpatient clinics., Results: The crude annual prevalence per 100,000 population was 151.9 (95% CI 123.2-187.4). 28.7% of patients had a history of MS among first-, second-, or third-degree relatives. The frequency of primary progressive course of disease was 23.5%. The sex ratio (F/M) was 1.41., Conclusion: A stable high prevalence of MS as well as a high number of familial MS cases was identified in the neighbouring regions of Slovenia and Croatia.

Aim: To investigate whether p53 expression and apoptosis play a role in the pathogenesis of discoid lupus erythematosus (DLE) and whether they are associated with a hyperproliferative state in the epidermis of DLE lesions and epidermal atrophy., Methods: A total of 70 skin biopsy specimens, 35 DLE and 35 normal, were used. Expression of protein p53 and Ki-67 was examined immunohistochemically. Apoptotic cells were identified by terminal deoxynucleotidyl transferase (TdT)-mediated nick end labeling (TUNEL). Histopathological examination of hematoxylin-eosin-stained sections of DLE included analysis and scoring of epidermal atrophy and other histopathological parameters., Results: p53 expression was greater in DLE than in normal skin (14.5 vs 0.6%, P<0.001). Ki-67 expression was also greater in DLE than in normal skin (8.0 vs 3.1%, P<0.001). A significant positive correlation between p53 and Ki-67 expression was found in both groups (normal skin, r=0.46, P<0.009; DLE, r=0.72, P<0.001). A significant negative correlation (r=-0.75, P<0.001) between Ki-67 expression and the intensity of epidermal atrophy was found. The degree of apoptosis in the epidermis of DLE lesions with higher Ki-67 and p-53 expression was higher than when the expression of these molecules was low (3.0+/-1.8 vs 1.6+/-1.5 on a scale from 0-5; P=0.048)., Conclusion: Aberrant p53 expression occurs in the keratinocytes of DLE and is associated with keratinocyte hyperproliferation and epidermal atrophy. Accumulation of p53 protein, together with an extensive apoptosis, suggests that the activation of a p53-induced apoptotic pathway may play a role in the pathogenesis of skin lesions in DLE.

Aim and Background: To establish the incidence of primary tumors of the central nervous system (CNS) in the resident population of the Coast and Gorski Kotar County, Croatia, in the period 1977-2000., Methods: A retrospective descriptive epidemiological study. Tumors were classified according to the World Health Organization's scheme. A total of 911 cases was identified. Information about patient gender and age at diagnosis, tumor location and histologic type was obtained from case histories, autopsy protocols and pathology reports. Age- and sex-adjusted incidence were determined by a direct standardization method., Results: Histologic confirmation was obtained in 84.5% of cases. The most frequent tumors were glioblastoma in men (30.2%) and meningioma in women (29.5%). The average annual crude and world-standardized incidence was 11.2 (95% CI, 10.1-12.3) and 8.2/100,000/year (95% CI, 7.4-9.0), respectively. The highest specific age incidence was detected in the seventh decade of life, 24.7/100,000/year (95% CI, 21.4-28.8). The tumors occurred equally in each sex. The lowest incidence was detected on the islands, 7.4/100,000/year (95% CI, 5.9-9.2) and the highest along the coast, 12.7/100,000/year (95% CI, 11.4-14.0). The survey showed the highest incidence of these neoplasms in the coastal municipality of Senj, 14.7/100,000/year (95% CI, 10.3-20.5)., Conclusion: The descriptive epidemiological incidence of primary CNS tumors in the Coast and Gorski Kotar County, Croatia, especially those of neuroepithelial and meningeal origin, correspond to the data reported in similar studies elsewhere in the world. The incidence of these neoplasms in the area investigated is uneven. Limitations in study design preclude definitive conclusions about the causes of these differences.

Aim: To establish the incidence of tumors of the central nervous system (CNS) in the population of Labin area in Istria, Croatia, characterized by very little population migration., Method: We retrospectively analyzed data on 175 patients (102 men and 73 women) diagnosed with CNS tumor according to the World Health Organization's diagnostic criteria in the period 1974-2001. Patient data were retrieved from multiple sources: files of general practitioners in Labin area; registers of admissions and discharges of the Pula General Hospital and Rijeka University Hospital Center; and medical records of the Hospital Departments of Neurology, Surgery, Neurosurgery, Oncology and Radiotherapy, and Pathology. Annual incidence, anatomic location, and pathohistological classification of CNS tumors were determined, as well as age at disease onset., Results: Out of 175 subjects, 95 had primary CNS tumors and 80 had metastases. Intracranial tumors were found in 88.4% of patients with primary CNS tumors (annual incidence, 11.8/100000 population) and intraspinal in 11.6% of patients (annual incidence, 1.6/100000). Similar distribution was observed for CNS metastases (70 intracranial vs 10 intraspinal), with annual incidence of 9.9 and 1.4/100000, respectively. The most frequent intracranial tumors were those of neuroepithelial tissue, accounting for 58.3% of all CNS neoplasms (annual incidence, 6.9/100000 population). The most frequent intraspinal tumors were tumors of the meninges (54.5%). There was no particular temporal clustering of CNS tumors. The age at disease onset corresponded with that reported in the literature: 50.5+/-17.0 years for primary intracranial tumors, and 59.7+/-12.2 years for primary intraspinal tumors., Conclusion: Primary CNS tumors showed high, but temporally stable incidence in population of Labin area over the last 27 years, indicating that the alleged increase in CNS tumors incidence was not true.

Aim: Clinical forms of Lyme disease in Gorski Kotar have occurred only sporadically, in contrast to the northwestern Croatia and the neighboring areas of Slovenia, which are well-known Lyme borreliosis endemic regions. Our aim was to assess the level of sero-prevalence of Borrelia burgdorferi sensu lato in a high-risk population of forestry workers in the mountainous region of Gorski Kotar, Croatia, and compare it with the sero-prevalence in the residents of that area and the neighboring littoral region., Methods: A sero-epidemiological study was conducted on 520 healthy subjects, divided in 3 groups: the first group included 234 forestry workers, residents of Gorski Kotar, the second 100 residents of various professions in the same region, and the third 186 subjects of various professions from the neighboring littoral region. The sera were collected during the winters of two successive years, 1997 and 1998. Lyme borreliosis serology was performed by indirect immunofluorescence assay. Sera from 10 hunting dogs from Gorski Kotar were also analyzed., Results: The IgG antibodies to B. burgdorferi sensu lato were found in 11 examinees (4.7%) from the group of forestry workers, in 3 (3%) from the second group, and in 5 (2.7%) from the third group. Four out of 10 dogs (40%) had IgG antibodies against B. burgdorferi., Conclusion: Our results show that the forest and mountainous area of Gorski Kotar, Croatia, has the characteristics of a low sero-prevalence area, in contrast to the endemic neighboring areas.

This research aims to establish the effect of working conditions on the appearance of varicose veins. The epidemiological study was carried out on 1,324 examinees, 530 males and 794 females, employed in 5 highly represented groups of professional activities in Rijeka (catering, trade, light industry, heavy industry and finances). The data were collected by survey and clinical examination. Varicose veins were more prevalent in the trade than in the office workers (odds ratio (OR) = 2.08; 95% confidence interval (CI) = 1.31-3.31), and more prevalent in catering industries than in the office workers (OR = 1.56; 95% CI = 1.001-2.43). chi 2-testing suggested that standing in the workplace (OR = 1.35; 95% CI = 0.95-1.92), weight handling while working (OR = 1.29; 95% CI = 1.01-1.64) and working indoors (OR = 1.61; 95% CI = 1.02-2.53) were risk factors for varicose veins. By multiple logistic regression, the following risk factors were isolated in the total population: female sex (OR = 1.92; 95% CI = 1.37-2.67), workplace (OR = 0.89; 95% CI = 0.78-0.99), age (OR = 1.05; 95% CI = 1.03-1.07), body mass index (OR = 1.04; 95% CI = 1.01-1.07) and family history of the disease (OR = 1.99; 95% CI = 1.55-2.57).

An injury might derange the protective function of the blood-brain barrier, and thus it represents one of the possible pathogenetic factors in the demyelination of the neural axis. However, the effect of injury on the occurrence or deterioration of multiple sclerosis is still controversial. According to most authors, the importance of injury in individual cases of multiple sclerosis is undeniable, as well as the fact that injuries are factors of progression and deterioration of the disease, but never its cause. Consequently, injuries can cause only temporary disability, and not permanent. Nevertheless, the incidence of multiple sclerosis increases proportionally to the severity of injury. The length of the period from the occurrence of injury to possible demyelination is still not established. Studies and clinical reports point to the fact that in the evaluation of injury as a precipitating factor for the vulnerability of the blood-brain barrier, the severity of the injury is of greater importance than its site.

Multiple sclerosis, original primary demyelination in the central nervous system, is a disease of as yet unknown cause. Epidemiologic research may contribute to the clarification of this problem. Migration studies have proven that susceptibility to multiple sclerosis is associated with ethnic origin and environment, and that the critical age for the disease development is till 15 years. In Croatia, emigrating inhabitants of Gorski Kotar, a region with high exposure to this disease, carry the risk of multiple sclerosis development, provided that have emigrated after adolescence.

An analysis was made of the possible influence of nutritional factors on the etiology of multiple sclerosis in Gorski Kotar (Croatia), a high-risk zone for this disease. A total of 46 MS patients and 92 controls, native-born residents of the area studied, participated in a case-control study. The questionnaire comprised 51 questions concerning dietary habits. An odds ratio (OR) estimate was obtained for all the factors which were more frequently found in the patients than in the controls. Large differences were found in the daily consumption of different quantities of full fat unskimmed milk (OR 21.7; chi 2 42.34; LL 7.12), potatoes with lard and fresh or smoked meat (OR 20.7; chi 2 15.52; LL 2.72), and new potatoes (OR 20.7; chi 2 15.52; LL 2.72). The consumption of unpasteurized milk, animal fat, smoked meat and potatoes are nutritional risk factors which could have an influence on the severity of primary demyelinization in a high-risk area for multiple sclerosis.

Almost all the neurological diseases can imitate multiple sclerosis. No strictly specific laboratory test has become as yet available for its diagnosis. Information obtained by clinical examination of the patient--dissemination of different symptoms at the same time and the same symptom in various periods--supplemented by neuroradiological, neurophysiological and biological supplementary tests allow making diagnosis of multiple sclerosis with about hundred percent certainty.

An epidemiological research of multiple sclerosis (MS) in Istria, Yugoslavia, was made in the period of 1980-1981. After examining all the sources of health care information, 125 potential MS patients were found in the investigated area. According to the diagnostic criteria by Schumacher et al., 47 affected were recognized and accepted as clinically definite MS patients. The MS prevalence rate in Istria on March 31st, 1981 amounted to 25.0/10(5) inhabitants (CI: 19.9-38.9). Such rates classify Istria in the middle between the medium and high risk zones for the disease in Europe and in the world. The onset age of MS in Istria was about 30 years, the female/male sex ratio was 2.13. The average duration of MS in Istria up to the prevalence day was 16.5 years. The average annual incidence rate was 1.5/10(5) inhabitants.

Epidemiologic study of Huntington's disease (HD) in the Rijeka district represents the first research of its kind carried out in Yugoslavia. After a detailed investigation of all available sources of health information, ten families, with a total number of 24 HD patients, were found. The prevalence rate of HD on March 31, 1981, was 4.46/100,000 population. Most of the patients involved were members from the second or third familial generation. The age at recognition of disease was 41.6 years, with earlier onset among the males. Involuntary movements frequently appeared as the initial symptomatology (45.8%). Duration of the disease from initial symptomatology to death averaged at 10.6 years. Six of nine patients who died had committed suicide. It took physicians of primary care, neurologists, and psychiatrists 5.3 years (1-12 years) to make a definite diagnosis. Nine of the affected families from Rijeka district were autochthonic households. Six of these families immigrated from Saxony, Slovakia and Upper Carinthia during the reign of the Habsburg dynasty (1619-1780).