[Anxiety and depression in elderly - prevalence and association with health care]. / Anksioznost i depresivnost u starijih osoba - pojavnost i povezanost s koristenjem zdravstvene zastite.

OBJECTIVE: To investigate the prevalence of anxiety and depression in the elderly inhabiting Koprivnica-Kri evci, Istria and Dubrovnik-Neretva Counties and their association with socio-demographic characteristics and healthcare utilisation. METHODS: A cross-sectional cluster survey carried out in 2006, encompassing a total of 1,469 examinees aged 70+. The Hospital Anxiety and Depression (HAD) Scale was used to screen for self-reported symptoms of anxiety and depression, which were further associated with socio-demographic characteristics and healthcare utilisation. RESULTS: The elderly have shown a high prevalence of borderline and probable anxiety (43%) and depression (53%), and regional differences (p<0.001). The level of anxiety was higher in women than men (p<0.001); as for depression, no statistically significant gender-based differences were found. The prevalence of probable depression increases (p=0.034) and that of probable anxiety decreases (p=0.028) with age. Anxiety and depression are associated with increased use of specialist health care and more frequent hospitalizations. CONCLUSION: High prevalence of anxiety and depression in elderly is associated with sociodemographic characteristics and frequent use of health care.

Differences in healthcare service utilisation in elderly, registered in eight districts of five European countries.

AIMS: The aim of the study was to compare and analyse the differences in self-reported frequencies of visits paid to physicians and hospitalisation rates, as well as their association with socio-demographic factors and health status self-rated by elderly. METHODS: A cross-sectional study was performed in eight districts of five European countries (Finland, Sweden, Ireland, Croatia, and Greece). A total of 3540 persons aged 70 or more were interviewed by trained interviewers. Healthcare service utilisation and its association with demographic characteristics and self-rated health were analysed using descriptive statistical methods, chi-square test, and logistic regression. RESULTS: Almost 90% of elderly visited a physician in the past year; 50% visited a specialist, while 24% were hospitalised. A visit to a specialist was paid by 70% of the Greek, 50% to 60% of the Croatian, and around 40% of the Irish, the Finnish, and the Swedish elderly. The highest proportion of hospitalisations (32%) was encountered in Greece and the lowest one (20%) in Sweden. Self-rated poor health appears to be the only common denominator associated with increased healthcare utilisation. Younger age stood out as a statistically significant predictor of the likelihood of specialist consults, while older age, male gender, and the synergy of male gender and current single life were disclosed as the predictors of hospitalisation frequency. CONCLUSIONS: Healthcare service utilisation exercised by the elderly across European districts was found to be highly variable and showed a clear distinction between north-western and south-eastern Europe; this is in line with differences in self-rated health.

[Monitoring of nitrate content in drinking water in Koprivnica-Krizevci County]. / Nadziranje nitrata u vodi za pice na podrucju Koprivnihko-Krizevacke Upanije.

AIMS: The aim of the study was to establish nitrate concentrations in drinking water originating from shallow wells across Koprivnica-Krizevci County, to assess the influence of agricultural point sources on nitrate water contamination, and to explore the correlations between water nitrate concentrations and agro-ecologic factors. METHODS: During the 2002-2007 period, a total of 1170 potable water samples were taken from 104 shallow wells across Koprivnica-Krizevci County. Given the geographical and developmental determinants, the investigated area was divided into three sections: Koprivnica, Krizevci and Durdevac areas. Potable water was sampled throughout the 6-year, all season-period conformant to the HRN ISO 5667-3 standard. Nitrate concentrations in potable water samples were established using ion chromatography (HRN EN ISO 10304-1:1998). The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service. Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations (MAC) stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive. The X2-test produced statistically significant differences. RESULTS: In 25% (n=294) of water samples, nitrate concentration exceeded MAC. The majority of unsafe samples were recovered in Krizevci area (38%; n=382), followed by Koprivnica (23%; n=613) and Durdevac area (6%; n=175). The mean range spanned from 0.1 to 279.0 mg/L, while the total mean nitrate concentration was 41.7 mg/L. The highest mean nitrate concentration of 53.9 mg/L was measured in Krizevci area, followed by 38.8 mg/L in Koprivnica and the lowest 24.9 mg/L in Durdevac area. Out of 75% of safe water samples, the measured nitrate concentration was below 25 mg/L limit value recommended under the Directive in as much as 52% of samples. Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory. The influence of point sources was assessed based on their distance. In roughly 50% of samples taken from occasionally or definitely unsatisfactory wells, point sources were located up to 10 meters away, while in as much as 93% of samples taken from satisfactory wells the point sources were situated over 20 meters away (p<0.01). For some of the wells, statistically significant positive (r=0.45 to 0.87) or negative (r=-0.30 to -0.66) correlations between the amount of downfalls and nitrate concentrations were established, while in the third well group this correlation (r=-0.14 to -0.24) was lacking. DISCUSSION AND CONCLUSIONS: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile. Across the Koprivnica-Krizevci County, differences in the underground water quality may arise as a consequence of water contamination due to distinctive agricultural activities. The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high (41.7 mg/L). The distribution of relative concentrations revealed 25% of samples to have nitrate concentrations higher than MAC under the Ordinance. Spatial distribution revealed the majority of unsafe water samples to stem from Krizevci area (38%), consistent with the majority of large husbandries situated therein. Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water. Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established.

Platinum, palladium, rhodium, molybdenum and strontium in blood of urban women in nine countries.

BACKGROUND: There is little reliable information on human exposure to the metals platinum (Pt), palladium (Pd) and rhodium (Rh), despite their use in enormous quantities in catalytic converters for automobile exhaust systems. OBJECTIVES: To evaluate blood concentrations of Pt (B-Pt), Pd (B-Pd) and Rh (B-Rh) in women from six European and three non-European countries, and to identify potentially influential factors. In addition, molybdenum (Mo) and strontium (Sr) were analysed. METHODS: Blood from 248 women aged 47-61 was analysed by high resolution inductively coupled plasma mass spectrometry under strict quality control. RESULTS: The medians were: B-Pt 0.8 (range <0.6-5.2), B-Pd <5 (<5-9.3), B-Rh <0.4 (<0.4-3.6)ng/L and B-Mo 2.0 (0.2-16) and B-Sr 16.6 (3.5-49) µg/L. Two women with highly elevated B-Pt (242 and 60ng/L), previously cancer treated with cis-platinum, were not included in the data analysis. All elements varied geographically (2-3 times) (B-Pd P=0.05; all other elements P<0.001); variations within each area were generally 5-10 times. Traffic was not associated with increased concentrations. CONCLUSIONS: General population blood concentrations of Pt, Pd and Rh are within or below the single digit ng/L range, much lower than in most previous reports. This is probably due to improved analytical performance, allowing for more reliable information at ultra-trace levels. In general, Mo and Sr agreed with previously reported concentrations. All elements showed geographical and inter-individual variations, but no convincing relationships with self-reported traffic intensity were found. Pt from the antineoplastic drug cis-platinum is retained in the body for years.

[Study of accidents in the Koprivnica area]. / Istrazivanje nesreca na koprivnickom podrucju.

The aim of this paper is to present injury incidence, risky population groups, circumstances and activities before the accident and injury mechanism in Koprivnica district (715 km2, 61,052 inhabitants). Data were taken from the Register which includes all population who were injured in this area. Register was located in surgical unit, general hospital in Koprivnica. During study period Jan 1, 1998-Jun 30, 2000 there were 4833 injured persons registered. Males had significantly higher injury incidence (40.9/1000) than females (23.8/1000) (P < 0.01). The highest incidence among male population was in the age 15-24 yrs. (66.3/1000) and among females in the age 0-14 yrs. (35.6/1000). The most risky time for accidents was on Saturday (18.7%) and at 12-18 p.m. (53.2%). The highest road traffic accident mortality was in older age (65 and over) (110.3/100,000) and the highest injury incidence was in younger age (15-24 yrs.) (3200.6/100,000). Regarding other accidents, the most risky place was around the house, in garden (26.6%). The most frequent injury mechanism for both genders is slipping (16.5%); in men follow cuts (12.8%) and being hit from the moving object (12.3%) and in women follow fall on (from) stairs (12.5%) and cuts (10.7%). The most frequent activity before an accident appears is unpaid work with tools, machines and other (15.7%). More detailed investigation on the local level makes possible suggesting more efficient injury prevention programs.

[The Mediterranean diet and occurrence of malignant tumors of the digestive system in the Croatian islands]. / Mediteranski nacin prehrane i ucestalost zlocudnih tumora probavnog sustava na hrvatskim otocima.

The aim of this study was to compare the age-standardised incidence rates of gastric bowel and pancreatic cancer between two regions of the Republic of Croatia: (1) five middle Dalmatian islands (Brac, Hvar, Korcula, Vis and Lastovo) with "Mediterranean" nutrition; (2) the control population of Koprivnicko-krizevacka County (KKC) with "continental" nutrition. The characterisation of nutrition habits in the two study regions revealed very significant differences. The newly registered cases of gastric, bowel and pancreatic cancer between 1986 and 1995 were retrieved from the Cancer Registry of Croatia. The resulting incidence rates were standardised to the standard world population using the method of direct standardisation. Age-standardised incidence rates in the islands in comparison to the control KKC population per 100,000 inhabitants were 17.2 vs. 39.4 (p < 0.001) in males with gastric cancer, 9.1 vs. 16.5 (p < 0.01) in females with gastric cancer, 34.5 vs. 31.4 (p > 0.05) in males with bowel cancer, 18.3 vs. 20.3 (p > 0.05) in females with bowel cancer, 5.5 vs. 9.0 (p < 0.05) in males with pancreatic cancer and 2.7 vs. 5.0 in females with pancreatic cancer (p < 0.05). Standardised incidence rates of gastric and pancreatic cancer in the island populations were significantly lower from the standardized Croatian average. The study showed that "Mediterranean" type of diet could have a protective effect against gastric and pancreatic cancer.

Cadmium, mercury and lead in the blood of urban women in Croatia, the Czech Republic, Poland, Slovakia, Slovenia, Sweden, China, Ecuador and Morocco.

OBJECTIVES: The aim of the study was to make an international comparison of blood levels of cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) of women in seven European, and three non-European cities, and to identify determinants. MATERIALS AND METHODS: About 50 women (age: 46-62) from each city were recruited (totally 480) in 2006-2009. Interview and questionnaire data were obtained. Blood samples were analysed in one laboratory to avoid interlaboratory variation. RESULTS: Between the European cities, the B-Pb and B-Cd results vary little (range of geometric means: 13.5-27.0 µg/l and 0.25-0.65 µg/l, respectively); the variation of B-Hg was larger (0.40-1.38 µg/l). Between the non-European cities the results for B-Pb, B-Cd and B-Hg were 19.2-68.0, 0.39-0.99 and 1.01-2.73 µg/l, respectively. Smoking was a statistically significant determinant for B-Cd, while fish and shellfish intakes contributed to B-Hg and B-Pb, amalgam fillings also contributed to B-Hg. CONCLUSIONS: The present results confirm the previous results from children; the exposure to lead and cadmium varies only little between different European cities suggesting that other factors than the living area are more important. The study also confirms the previous findings of higher cadmium and lead levels in some non-European cities. The geographical variation for mercury is significant.