Unique contributions of specific neuropsychiatric symptoms to caregiver burden in informal caregivers family members of patients with dementia.

INTRODUCTION: We aimed to evaluate how the presence of individual neuropsychiatric symptoms in non-institutionalised patients with dementia is associated with caregiver burden of their informal caregivers, family members. METHODS: We performed a cross-sectional study on a total of 131 pairs of one informal caregiver family member and non-institutionalised patient with dementia in a family medicine practices in a city of Zagreb, Croatia. Caregiver measures included Zarit Burden Interview (ZBI) whereas patient measures included Mini mental state examination (MMSE), Barthel index and Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS: Total NPI-Q score explained 21% of overall burden. In order of strength of the association, after adjustments for age, sex, MMSE and Barthel index, overall burden was significantly associated with higher NPI-Q scores for agitation/aggression, apathy/indifference, irritability/lability, disinhibition, motor disturbance, appetite/eating, depression/dysphoria, anxiety, elation/euphoria and nighttime behaviours. When evaluating mutually independent contribution of unique NPI-Q symptoms to caregiver burden, agitation/aggression and apathy/indifference remained only two mutually independently associated symptoms, each explaining 5% of overall burden in this context. CONCLUSIONS: Informal caregivers who provide for family members with dementia suffering from agitation/aggression or apathy/indifference should be recognised as under special risk for the development of caregiver burden and considered as candidates for early targeted interventions.

Predictors of Health-Related Quality of Life in Informal Caregivers of Dementia Patients in Zagreb, Croatia, a Cross Sectional Study.

We aimed to estimate health-related quality of life (HRQoL) in family-member caregivers of patients with dementia in Croatia and to assess relevant predictors. A cross-sectional study in family medicine practices in Zagreb (Health Care Center Zagreb-West) was performed in period 10/2017-9/2018 and included 131 dyads consisting of a patient with dementia and one dominant informal caregiver. Patient measures included Mini-mental-state-examination (MMSE), Barthel-index and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver measures included 36-Item Short-Form-Health-Survey (SF-36), Zarit-Burden-Interview (ZBI) and structured questionnaire regarding general information on caregiver and patient. SF-36 is a reliable instrument to estimate HRQoL (Cronbach α ≥0.79 for all domains). Caregiver HRQoL was higher than reported in Croatian population in physical functioning (PF), role physical (RP), general health (GH), social functioning (SF) and role emotional (RE) domains. More pronounced neuropsychiatric symptoms in patient with dementia were associated with caregiver's lower HRQoL in vitality (VT) and mental health (MH) domains. Caregivers with higher caregiver burden assessed by ZBI had lower HRQoL in RP, bodily pain (BP), GH, VT, SF, RE and MH domains. In multivariate analyses, higher caregiver's burden was independent predictor of lower HRQoL in RP, VT, RE and MH domains. Neuropsychiatric symptoms and use of day-care service were recognized as independent predictors of lower HRQoL (in PF, BP and GH, SF, RE domains, respectively). Neuropsychiatric symptoms and caregiver burden are associated with HRQoL in caregivers of patients with dementia. Interventions including psychological support and learning of skills necessary to tackle individual problems may help in improvement of HRQoL.

SENSE OF COHERENCE AND SUBJECTIVE WELL-BEING AMONG ADOLESCENTS - THE POTENTIAL IMPACT OF LIVING IN A DORMITORY COMPARED TO LIVING WITH FAMILY.

The aim of the study was to analyze the relationship between the sense of coherence (SOC) and subjective well-being (SWB) as a health promoting resource among adolescents living with parents and those living in dormitories. There were 442 adolescent responders, yielding a response rate of 84.3%. The SOC was measured using the Orientation to Life Questionnaire, while SWB was obtained from the Personal Wellbeing Index. There were no significant differences between the group living with parents and the group living in dormitories in SOC (128.3 and 129.4, respectively; p=0.580) and SWB (78.0 and 78.9, respectively; p=0.537). A significant difference was found between the genders. Boys had a higher SOC, both those living with parents (131.7 and 124.9, respectively; p=0.014) and those living in dormitories (136.5 and 124.5, respectively; p=0.001), and a higher SWB when living in dormitories (83.4 and 75.8, respectively; p=0.001). Adolescents with better socioeconomic status had a significantly higher SWB if living with parents (76.7 and 85.5, respectively; p=0.003), whereas no difference was found in the dormitory group (78.5 vs. 83.4; p=0.241). The SOC was strongly and positively associated with SWB (correlation coefficient 0.63; p=0.001) and was a key predictor of adolescent SWB (R2=0.373). These findings may prove helpful in future planning and supportive work in schools and dormitories to improve student health.

A validation of the Croatian version of Zarit Burden Interview and clinical predictors of caregiver burden in informal caregivers of patients with dementia: a cross-sectional study.

AIM: To validate the Croatian version of the Zarit Burden Interview (ZBI) and to investigate the predictors of perceived burden. METHODS: This cross-sectional study involved 131 dyads of one informal caregiver family member and one patient with dementia visiting primary care practices (Health Care Center Zagreb-West; 10/2017-9/2018). Patient-related data were collected with the Mini-Mental-State-Examination, Barthel-index, and Neuropsychiatric-Inventory-Questionnaire (NPI-Q); caregiver-related data with the ZBI, and general information on caregivers and patients with a structured questionnaire. Principal-axis-factoring with varimax-rotation was used for factor analysis. RESULTS: The caregivers' mean age was 62.1±13 years. They were mostly women (67.9%) and patients' children (51.1%). Four dimensions of ZBI corresponding to personal strain, frustration, embarrassment, and guilt were assessed and explained 56% variance of burden. Internal consistency of ZBI (α=0.87) and its dimensions (α1=0.88, α2=0.83, α3=0.72, α4=0.75) was good. Stronger cognitive and functional impairment of patients was associated only with personal strain, whereas more pronounced neuropsychiatric symptoms and the need for daily care were associated with more dimensions. Longer caregiver education suppressed embarrassment and promoted guilt. Guilt was higher in younger caregivers, caregivers of female patients, patients' children, and non-retired caregivers. In multivariate analysis significant predictors of higher overall burden were male sex of the patient, higher NPI-Q, the need for daily-care services, shorter duration of caregiving, non-spouse relationship, higher number of hours caring per-week, and anxious-depressive symptoms in a caregiver. CONCLUSION: The Croatian version of ZBI is reliable and valid. Our data confirm that ZBI is a multidimensional construct. Caregivers may benefit from individually tailored interventions.

Changes in Nursing Students' Attitudes Towards Nursing During Undergraduate Study

The aim of this study was to determine the attitudes of nursing students towards nursing, and changes in their attitudes during the study. A quantitative study with pre-post survey was conducted among nursing students enrolled in first study year in the academic year 2012/2013 (N=115) and third study year in the academic year 2014/2015 (N=106). Students voluntarily and anonymously completed a questionnaire consisting of demographic information and the Nursing Image Questionnaire, which includes 30 items that assess how an individual looks at the roles and tasks, values, social stereotypes of nursing, professionalism and performance of nurses. The results indicated that students had positive attitude towards nursing at the beginning and during the study. During the study, there was a positive change in attitudes in the majority of items of the questionnaire, whereas at the end of the study lower attitude was expressed in only four items. The study conducted among nursing students indicated that students' attitudes changed during the study, influenced by the acquisition of knowledge and skills. During the study, students acquire a more realistic perception of nursing, and adoption of professional values emerges.

Compliance of menus with nutritional standards in state and private kindergartens in Croatia.

BACKGROUND: It is necessary to ensure a variety of nutrients in weekly menus in kindergartens according to the recommendations and standards currently in effect. It is also important to follow the energy value of macronutrients, which is usually carried out by the relevant institutions quarterly in every kindergarten. However, the quality of menus in relation to the representation of different types of food is not monitored. OBJECTIVE: The aim of this study was to estimate the quality of meals in relation to the representation of different types of food in state and privately owned kindergartens in one of Zagreb district in Croatia. MATERIAL AND METHODS: Weekly menu's daily meals served in kindergarten groups for children (4 - 6 years old) were ana- lysed and compared with the Croatian Health Care, Hygiene and Balanced Diet Programme for Children in Kindergartens and with Food Plan Standards for Children in Kindergartens - Menus and Standards. The studies were performed in state and privately owned kindergartens in Zagreb, district Maksimir. RESULTS: Except in the serving of dairy products, which were in comparison to the proscribed standard overrepresented, other foods such as grains, fruits, vegetables, meat, eggs, pulse were underrepresented. Grains, except in a smaller number of servings, were statistically underrepresented in state owned kindergartens in comparison to the privately owned ones. The largest discrepancy was shown in the low number of fish servings, equally so in the state and privately owned kindergartens. CONCLUSIONS: In recent years strides have been made to harmonise menus provided by kindergartens with standards based on scientific research on the prevention of obesity. However, further harmonisation of "old" and "new" foods intended to achieve a more substantial balance of the consumption of certain foods and the adequate amounts of their nutritional values is necessary.

Growth charts for Croatian school children and secular trends in past twenty years.

The aim of this study was to construct new Croatian growth charts for body height and weight of boys and girls aged 6.5 to 18.5 years and to investigate differences between our and pre-existing studies. Analysis was based on a multistage stratified sample representative for school children aged 6.5 to 18.5, 6046 boys and 5656 girls. Growth reference was constructed using LMS method. Present results demonstrated an increment of body height and weight during the last two decades. Highest increase of body height is in boys aged 13-14 years 6.5 cm, in girls aged 12 years is 5.0 cm. Highest increase of body weight is in 16 year age group of boys 8.7 kg and in 11-12 year age group of girls 5.2 kg. In conclusion, regarding presence of secular trend because previously used growth charts in Croatia are obsolete.

Elevated blood pressure in school children and adolescents--prevalence and associated risk factors.

Elevated blood pressure (BP) in children and adolescents is determined on normative distribution of BP in healthy children. The aim of this study was to determine prevalence of high normal and elevated BP among school children and to assess associated risk factors. The study comprised 965 children (48.7% girls) in 8th grade of primary school. Data were obtained from questionnaire and anthropometric measurements. The prevalence of high normal BP was 28.5% in girls, 36.8% in boys, and elevated BP 7.9% in girls and 5.3% in boys. Overweight was present in 19.4% of girls and 9.3% boys with high normal, and 29.7% of girls and 30.8% boys with elevated BP. Hypertension in family history was the most common associated factor reported by boys and girls with high normal and elevated BP. Follow-up of children throughout school age makes possible taking of preventative measures and promotion of healthy life style.

Behavioral pattern of overweight and obese school children.

The aim of this study was to determine socio economic, health status, nutritional and behavioral differences in obese, overweight and normal weight children attending first grade elementary school. In overweight group there is 13.8% of boys and 12.6% of girls, in obese group 8.3% of boys and 6.9% of girls. In factor analysis 12 factors was excluded with cumulative loading of 60% variability. Discriminant analysis was performed with 12 factors as predictive variables and discriminant variables were three BMI groups: normal weight, overweight and obese. Function 1 discriminate well normal weight group from overweight and obese group. Overweight and obese groups is described with lower number of children in the family and lower order of birth, higher education of parents, they eat less vegetables and fruits, spend more time playing computer games, have less physical activity, drink more alcohol with their meals, exactly opposite to normal weight group.

The CroHort study: cardiovascular behavioral risk factors in adults, school children and adolescents, hospitalized coronary heart disease patients, and cardio rehabilitation groups in Croatia.

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

Current status of iodine intake in Croatia--the results of 2009 survey.

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program for monitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 microg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7-10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N = 101) and the village of Rude (N = 56). In the time period 2002-2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 microg/L. Median UIC in pregnant women was 159 microg/L, with 50% of samples below and under 150 microg/L. Median UIC in women of child-bearing age was 136 microg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn't corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of "silent prophylaxis" in order to avoid iodine excess.

[Community health course--student's evaluation]. / Evaluacija predmeta "zdravlje u zajednici" studenata medicine.

INTRODUCTION: Since 1952, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, has provided a community health course, based on the medical education approach that the main fields of physicians' action are human settlements and not only consulting rooms and clinics. AIM: The aim of the study was to compare community health course students' evaluations immediately after attending the course at the 4th and 6th study years. SUBJECTS AND METHODS: The survey included 224 4th year medical students attending the community course during the academic year 2007-2008 and 192 same-generation 6th year students (85.7%) during the academic year 2009-2010. Students were required to fill out an evaluation questionnaire about the activities during the community health course using grades from 1-poor to 5-excellent, and to write personal remarks and essay. RESULTS: The academic year 2007-2008 students (n=224) were very satisfied (grades 5 and 4) with preparatory seminar (98% of students), final seminar (97%), course organization (90%) and course contents (89%). The same grades were allocated by 98% of students to public health field research, 94% to work in community nurse service, 93% to work in family practice and health promotion in school and kindergarten, and 87% to water sampling. Satisfaction with the community health course was very emotionally described in final essays: "... work with community nurse service in the poorest part of Croatia has changed my life. I have learned in only few hours to wish less and to give more. Every physician should experience it, because that is real life". Results of the same-generation students (n=192) in the academic year 2009-2010, now at 6th study year, showed them to be still very satisfied (grades 5 and 4) with the activities in the community health course: 94% with health promotion, 92% with work in the community nurse service and family medicine, 86% with course contents, 82% with course organization, 78% with final seminar, 64% with preparatory seminar, 63% with field research, and 49% with water sampling. DISCUSSION: At some medical schools, there are similar attempts to bring students more closely to life conditions, especially to rural communities. Different schools of medicine in the world have attempted to improve and adapt current curricula towards community-oriented education of medical students during undergraduate study and residency. In some countries, there is also the need of improvement of health care in rural areas. CONCLUSION: Results of the course evaluation showed that students had recognized the exceptional value of community health course as a whole. They perceived it as the most valuable and most useful experience in their medical study. By participating in local health care and social care activities in rural area, they got an insight into both the health care system and socio-medical determinants of health.

[Preventive work in family medicine--proactive approach]. / Proaktivni pristup preventivnom radu u obiteljskoj medicini.

The role of general practitioner/family physician (GP/FP) in disease prevention and health promotion is strongly supported by research and health policies. The position of GPs/FPs in the health care system and their close, sustained contact with their patients and local community makes preventive care an integral part of GP/FP routine work. The spectrum of caring for patients in general practice/family medicine is actually very large, going from intervention on health care determinants to palliative care. The prevention-related activities are more or less present at each step of this "healthcare continuum". The significant gaps between GP/FP knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention. We describe the role of GP/FP in preventive care and report data on preventive care activities in the Croatian Family Medicine Service. More objective evidence is needed to see what GPs/FPs actually do in practice. For this reason, it is critical that GPs/FPs systematically record the most relevant preventive and health promotion activities that they perform. Furthermore, their performance of the preventive program should be regularly monitored, evaluated and professionally and financially validated. We present the preventive program based on these principles in Family Medicine Service proposed by the Ministry of Health and Social Welfare Working Group on Reform of Primary Health Care.

[Guidelines for diagnostics and treatment of arterial hypertension. Practical recommendations of the Croatian Working Group for Hypertension. Consideration on the ESH-ESC 2007 guidelines]. / Smjernice za dijagnosticiranje i lijecenje arterijske hipertenzije. Prakticne preporuke hrvatske radne skupine i osvrt na smjernice ESH/ESC 2007.

ESH/ECS guidelines for diagnostics and treatment of arterial hypertension 2007 is a basic paper for all physicians who treat hypertensive patients. Since publishing, this article has been the most cited medical paper. According to ESH/ECS guidelines some local peculiarities in each country should be considered when diagnosing and treating hypertensive patients. Practical recommendations of the Croatian working group for the diagnostics and treatment of hypertension are in agreement with ESH/ECS guidelines. However, few additional issues are added and further discussed in this paper (hypertensive crisis, treatment of hypertension in patients undergoing dialysis and in renal transplanted patients, role of family physicians, role of nurse). We believe that this paper will contribute better control of hypertension in Croatia. All medical societies and institutions that took part in writing this document, have to consider this paper as an official statement.

The cross-cultural (transcultural) adaptation and validation of the nursing image questionnaire.

Education of nurses in the Republic of Croatia is being developed as a result of compliance with education in the European Union and the implementation of nursing research that leads to the growth of the whole profession. However, prejudice against the nursing profession is still present and therefore it is necessary to explore the attitudes of the general population and the population of nurses in the nursing profession in order to discover the causes of such prejudices and act on them. Therefore, the aim of this paper was to present transcultural adaptation and validation of the Nursing Image Questionnaire, which was created by Toth and associates (1998). The questionnaire, which includes 30 items and measures how an individual looks at the roles, values, and professional activities of nurses, was conducted as part of a preliminary study and was culturally adapted. The final study included 905 students who in 2011 and 2012 enrolled in the first year of full-time and part-time nursing study; the questionnaire was completed by 725 students. Toth and associates assumed that the attitude toward nursing is expressed as the sum of the responses of all the items, which would mean a factor structure with high item intercorrelation, but they also split the questionnaire into five thematic units. Results showed that, contrary to expectations, intercorrelations of items were extremely low and that following the completion of factor analysis, no satisfactory construct validity was established. From the obtained results, it can be concluded that it is not justified to create a latent dimension as established by research of Toth and associates, and the items, although there is a correlation between some of them, should be interpreted and analysed as independent constructs.

The role of school medicine doctors in health education in Croatia--past, present and future.

Croatia never had a separate vocation (occupation) of a health educator. Health education is one of the main tasks in the long tradition of preventive work of doctors-school medicine specialists. Additionally, in the school curriculum in the Republic of Croatia the health-educational contents are integrated into various subjects, and are conducted by teachers. However, there are requests to introduce a new subject into schools called Health Education. We asked physicians of school medicine their opinion on the introduction of this new subject. 30% of the physicians were dissatisfied with the current condition, 10% were satisfied, while there were no very satisfied school medicine doctors. They believe that health education goals are oriented solely to passing on knowledge (facts), while efforts are not done to change habits and attitudes of young people. They recognize themselves as persons mostly involved in health education in schools. Half of the school medicine doctors believe that the school curriculum should contain both a separate subject as well as integration of health education into other subjects. Before introducing any changes into healthcare or education system, it is necessary to examine the attitudes of students and parents, to direct the changes towards the promotion of the cooperation between the healthcare system, education, civil society, school and community where investing into the health of young people is done through comprehensive and holistic programmes.

Do we need the "adolescent crisis" diagnosis?

The aim of the study was to examine patients in adolescent crisis at the beginning of treatment and after a period of 12 months in order to evaluate the relative diagnostic and therapeutic validity. The study included 153 Split University students in adolescent crisis; 90 of them were treated by counseling and 63 served as controls. For diagnosis, Hampstead index and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) multiaxial evaluation were used, allowing a wider insight into personal functioning. The study sample was split in 7 significantly different diagnostic subgroups. The counseling-treated examinees had better personality functioning after 12 months, but did not differ significantly from the control group. Some of their single functions were more severely disturbed at the very beginning. Counseling is a valuable therapeutic and diagnostic tool for adolescent crisis. The assessment must evaluate the entire person, because looking at only one aspect, due to different development and its place, a wrong conclusion may be reached. The "adolescents crisis" entity is clinically relevant.

SUFFICIENT IODINE INTAKE IN SCHOOLCHILDREN FROM THE ZAGREB AREA: ASSESSMENT WITH DRIED BLOD SPOT THYROGLOBULIN AS A NEW FUNCTIONAL BIOMARKER FOR IODINE DEFICIENCY.

Current methods for assessment of iodine intake in a population comprise measurements of urinary iodine concentration (UIC), thyroid volume by ultrasound (US-Tvol), and newborn TSH. Serum or dried blood spot thyroglobulin (DBS-Tg) is a new promising functional iodine status biomarker in children. In 1996, a new act on universal salt iodination was introduced in Croatia with 25 mg of potassium iodideper kg of salt. In 2002, Croatia finally reached iodine sufficiency. However, in 2009, median UIC in 101 schoolchildren from Zagreb, the capital of Croatia, was 288 µg/L, posing to be excessive. The aim of the study was to assess iodine intake in schoolchildren from the Zagreb area and to evaluate the value of DBS-Tg in schoolchildren as a new functional biomarker of iodine deficiency (and iodine excess). The study was part of a large international study in 6- to 12-year-old children supported by UNICEF, the Swiss Federal Institute of Technology (ETH Zurich) and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD). According to international study results, the median cut-off Tg < 13 µg/L and/or < 3% Tg values > 40 µg/L indicate iodine sufficiency. The study included 159 schoolchildren (median age 9.1 ± 1.4 years) from Zagreb and a nearby small town of Jastrebarsko with measurements of UIC, US-Tvol, DBS-Tg, T4, TSH and iodine content in salt from households of schoolchildren (KI/kg of salt). Overall median UIC was 205 µg/L (range 1-505 µg/L). Thyroid volumes in schoolchildren measured by US were within the normal range according to reference values. Median DBS-Tg in schoolchildren was 12.1 µg/L with 3% of Tg values > 40 µg/L. High Tg values were in the UIC range < 50 µg/L and > 300 µg/L (U-shaped curve of Tg plotted against UIC). All children were euthyroid with geometric mean TSH 0.7 ± 0.3 mU/L and arithmetic mean T4 62 ± 12.5 nmol/L. The mean KI content per kg of salt was 24.9 ± 3.1 mg/kg (range 19-36 mg/kg). Study results indicated iodine sufficiency in schoolchildren from the Zagreb area. Thyroglobulin proved to be a sensitive indicator of both iodine deficiency and iodine excess in children. Iodine content in salt from households of schoolchildren was in good compliance with the Croatian act (20-30 mg KI/kg of salt).

Ultrasound bone measurement in children and adolescents. Correlation with nutrition, puberty, anthropometry, and physical activity.

Ultrasound bone measurement in healthy Croatian children and adolescents has been evaluated. Relationships between pubertal status, anthropometry, nutrition, and physical activity with ultrasound bone parameter were analyzed. A total number of 501 children and adolescents of both sexes participated in the study. There were 244 prepubertal children (120 boys and 122 girls) and 259 postpubertal adolescents (112 boys and 147 girls). Anthropometric measurements included height, weight, percent of fat tissue, and body mass index. Quantitative ultrasound measurements of the heel (nondominant side) were performed using "Sahara" sonometer and included speed of sound (SOS), broad-band ultrasound attenuation (BUA), and calculated bone stiffness (QUI). Dietary data were assessed using specially designed semiquantitative food frequency questionnaire calculations based on the daily intakes of calcium, carbohydrates, fats, and proteins. Quantitative ultrasound bone measurements (BUA, SOS, and QUI) were similar in prepubertal boys and girls. Adolescent boys had significantly higher BUA (P<.01) than girls. The percentage of children and adolescents who consumed more than 1,000 mg of calcium per day were 54.8% and 48.7%, respectively. Body weight and pubertal status and activity were significantly correlated with bone stiffness but not the calcium intake. In this study, bone stiffness in children and adolescents is determined by pubertal status and body weight, rather than by calcium intake.

Anxiety and defense styles in eating disorders.

This study investigates anxiety and defense styles in eating disorders. Seventy eating disorder (ED) patients and fifty-one female matched control subjects completed State and Trait Anxiety Inventory (STAI) and 88-items Defense Style Questionnaire (DSQ). ED patients were more anxious in actual situations and more anxiety prone in general. They relied on maladaptive action and Image distorting defense style. Bulimic anorexic (BAN) patients and bulimia nervosa (BN) patients differed in defense styles from restrictive anorexic (RAN) patients who displayed no significant difference in either state and trait anxiety or in defense styles when compared to healthy patients. Different levels of anxiety and ego defense maturity are present in ED patients. The almost normal ego functioning of RAN patients could be explained by pseudomaturity, tendency to control external and internal environment and the unconscious efforts to imitate normality to avoid conflicts.