Stress among Anesthesiology Nurses/Technicians Working in the Intensive Care Unit (ICU): Experiences and Comparisons.

BACKGROUND: The International Labour Organization (ILO, 2000) has defined stress and exhaustion from working shifts and night work, and psychological and organizational stressors conditions that create health risks for surgical nurses. Among the OR nurses/ technicians 41.9% reported that causes of their stress included inadequate teamwork, ineffective communication, and especially surgeons' negative attitudes. SUBJECTS AND METHODS: The stuudie has been held in Clinical Hospital Centre Split, the sample consists of a total of 62 out of 109 possible respondents participated in the study. A total of 23 (37%) anesthesiology technicians and 39 (63%) ICU nurses / technicians participated in the survey. In the empirical part of this research, the importance of selected stressors was tested using quantitative methods in biomedicine. The existence of stress was tested by the Wilcoxon test. Stress level in the ICU was tested by T-test The analysis was elaborated in the statistical software STATISTICA 12. Conclusions were made at a significance level of 5%. The research was conducted through the questionnaire taken from the paper Milan Milosevic entitled: "Development of a measuring instrument of stress in the workplace hospital health professionals and an assessment of its use value" (2010). RESULTS: Based on the empirical t value of 3.42 at 59 degrees of freedom the conclusion is that there was found a statistically significant difference in the level of stressors in the workplace between nurses / technicians in the ICU and anesthesiology technicians. The conclusion was reached at an empirical level of significance <0.001. CONCLUSION: The highest level of stress among medical staff is caused by the factor of insufficient number of employees, followed by work overload, inadequate material resources for work (financial constraints), poor organization at work, and the factor of poor communication with superiors.

Drop-Out - Inadequate Response of Seafareres to Stress.

BACKGROUND: Seafarers are usually exposed to many stressors that are related to different duties on board. Several notable researchers have argued that stress is a transactional phenomenon between the individual and the environment that is largely dependent on the meaning given to the stimulus by the perceiver. One of the many causes of stress are poor communication skills. SUBJECTS AND METHODS: The aim of the study was to xplain why respondents drop out of research. The project was originally supposed to take place over a period of two years and involve a minimum of 30 respondents per group (30 skippers and 30 seafarers) who would take part in the research for at least four weeks while on board, or during the skipper season. Activity was to be measured with the Polar A370 fitness tracker, worn as a wrist-watch or bracelet and used for 24-hour heart rate, bodily activity and sleep pattern tracking for every respondent. The other device used is TANITA MC780MA, which is a segmental body composition analyser. RESULTS: We contacted overall 146 seafarers, of whom: 40 (27.4%) skippers, 43 (29.5%) deck officers and 63 (43.1%) engine officers. Participation was refused by 18 (12.3% of all contacted) individuals and 108 (74.0%) respondents dropped out during the research. Due to group dispersal and a low number of respondents who reached the end of the research, the project will have to be prolonged. CONCLUSION: We believe that the reasons behind respondent dispersal can be found in their inability to recognize the state they are in and in poor communication skills, while at the same time being exposed to extreme and possibly precarious work conditions. This forms a closed loop that only continues to generate even higher stress levels. Further research is needed to look into this phenomenon.

[EPIDEMIOLOGICAL CHARACTERISTICS OF TETANUS IN THE REPUBLIC OF CROATIA]. / EPIDEMIOLOSKE KARAKTERISTIKE TETANUSA U HRVATSKOJ.

The aim of the study was to determine the epidemiological characteristics of tetanus in Croatia and to determine changes in the age and sex structure, morbidity and mortality after the introduction of mandatory immunization and after the introduction of additional immunization for persons aged ≥ 60. The retrospective study was undertaken and the data on the number of patients and deaths from tetanus in the period 1946­2014 in Croatia were analyzed. The data considering age, gender and geographical location of disease occurrence were also analyzed. The study confirmed the reduction of morbidity, mortality and fatality rate from tetanus after the introduction of mandatory immunization. In the last twenty years the average morbidity rate was 1.68/1 000 000 population. A higher incidence of tetanus was observed in female patients. During the last ten years all patients were in the age group of 60 and above. The distribution of patients according to the geographical location showed a higher incidence of tetanus in continental Croatia (26/31; 84%) than in coastal area. The less reported number occurred during the winter months. This preventive measure is very effective and economically justified.

The Epidemiological Characteristics of Hepatitis B in Croatia: The Results of the Prevention.

This study shows epidemiological characteristics and preventive measures implemented for the prevention and control of hepatitis B infections in Croatia. We analyzed the data from obligatory infectious disease reports and notifications of death due to infectious diseases, data on the hepatitis B infections in Croatia, and data collected by survey of the population. The average prevalence of the disease is 3.67 per 100,000 annually. All age groups are affected, but still a higher rate of the disease is found in the age groups from 15-19 and 20-29 years of age. Hepatitis B disease is 1.4 times more likely in men than in women. For the past 18 years, the average rate of mortality was 0.2%. The incidence of HbsAg-positive donors of blood is within the range of 0.65% in 1992 to 0.012% in 2011. The largest part of preventive measures implemented in Croatia against hepatitis B is predicted and required by legislation. The registrations of acute and chronic carriers of the virus are obligatory. High-risk groups have started being vaccinated since 1992. The obligatory vaccination of infants was introduced in the mandatory vaccination program in 2007. Routine testing of blood exclusively from voluntary donors for HbsAg presence is obligatory. The non-governmental organization "Help" created for intravenous drug users, along with the "Harm reduction" program implemented hepatitis B, C, and HIV/AIDS prevention program in 1995. In order to gain a better understanding of epidemiological characteristics of hepatitis B in Croatia, the specifics of its dynamics in small communities are required since the research of Croatian public health officials and researchers have shown that hepatitis B is spread in different ways.

Bus water storage tank as a reservoir of Legionella pneumophila.

Health concerns associated with Legionnaires' disease have been identified as an area of the increasing public and professional interest. Any natural water or man-made water systems worldwide might be reservoirs of Legionellae. We presented a sporadic, community-acquired case of Legionnaires' disease caused by Legionellapneumophila serogroup 1 in a bus driver who used water for hand and face washing from a bus water storage tank. The history of any other usual place of exposure to Legionellae was negative. The water from the tank was dirty, filled with sediment and leaves, at the temperature of 22 degrees C. The water was heavily contaminated with Legionella pneumophila serogroup 1 isolated from each sample with the concentration of 66,000, 16,000, 42,000, 56,000 and 34,000 CFU/L. The disinfection of the bus water storage tank was made using hyperclorination with 50 mg/L of free residual chlorine. The control sampling one week after the disinfection yielded negative results. So far, there are no recommendations on regular management or disinfection of water in bus storage tanks, but it seems to be reasonable to assume that passengers as well as bus drivers may be exposed to Legionella and therefore at risk of acquiring the infection. These recommendations should include regular empting, rinsing and filling the tank with fresh tap water, at least once a week. Finally, we have to be aware that Legionella bacteria are ubiquitous and any potential mode of producing contaminated aerosol should not be overlooked during an epidemiological field investigation and proposed appropriate measures.

Risk factors for pulmonary tuberculosis in Croatia: a matched case-control study.

BACKGROUND: Mycobacterium tuberculosis is a necessary, but not sufficient, cause of tuberculosis. A number of studies have addressed the issue of risk factors for tuberculosis development. Croatia is a European country with an incidence rate of 14/100 000 which is slowly decreasing. The aim of this study is to evaluate the potential demographic, socioeconomic, behavioural and biological risk factors for tuberculosis in Croatia in comparison to other high-income, low-incidence European countries. METHODS: A total of 300 tuberculosis patients were matched for age, sex and county of residence to 300 controls randomly selected from general practitioners' registers. They were interviewed and their medical records were evaluated for variables broadly described as potential risk factors. RESULTS: In multiple logistic regression, the following factors were significant: parents born in a particular neighbouring county (Bosnia and Herzegovina) (OR = 3.90, 95% CI 2.01-7.58), the lowest level of education (OR = 3.44, 95% CI 1.39-8.50), poor household equipment (OR = 4.72, 95% CI 1.51-14.76), unemployment (OR = 2.69, 95% CI 1.18-6.16), contact with tuberculosis (OR = 2.19, 95% CI 1.27-3.77), former (OR = 2.27, 95% CI 1.19-4.33) and current smoking habits (OR = 2.35, 95% CI 1.27-4.36), diabetes (OR = 2.38, 95% CI 1.05-5.38), a malignant disease (OR = 5.79, 95% CI 1.49-22.42), being underweight in the previous year (OR = 13.57, 95% CI 1.21-152.38). CONCLUSION: In our study, the identified risk groups for tuberculosis reflect a complex interaction between socioeconomic conditions, lifestyle and non-communicable diseases. Interventions focused on poverty will undoubtedly be useful, but not sufficient. Tuberculosis control would benefit from a combination of broad public health activities aimed at the prevention and control of risky lifestyles and non-communicable diseases, interventions outside the health sector, and efforts to constantly improve the Croatian national tuberculosis programme.

Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study.

BACKGROUND: Delayed diagnosis and treatment of tuberculosis increase both the severity of the disease and the duration of infectivity. A number of studies have addressed the issue of health system delays in the treatment of tuberculosis, but mostly in countries with a high or low incidence of the disease. Our understanding of delay is quite limited in settings with an intermediate burden of tuberculosis. We explore the duration and factors associated with delays in the Croatian health system which has free health care and a sufficient network of health services providing tuberculosis diagnosis and care. METHODS: A total of 241 consecutive adults with culture-confirmed pulmonary tuberculosis were interviewed in seven randomly selected Croatian counties and their medical records were evaluated. A health system delay was defined as the number of days from the first consultation with a physician to the initiation of anti-tuberculosis treatment. A long delay was defined as a period exceeding the median delay, while an extreme delay was considered to be above the 75th percentile delay. RESULTS: The median health system delay was 15 days while the 75th percentile was 42 days (the 5th and 95th percentile being 1 and 105 days respectively). Almost 30% of tuberculosis patients remained undiagnosed for more than 30 days after the initial health care visit. Female patients (p = 0.005), patients with a negative sputum smear (p = 0.002) and patients having symptoms other than the usual ones (0.027) were found to be in significant correlation with a long delay. In a multivariate model, a long delay remained associated with the same variables (p = 0.008, p = 0.003, and p = 0.037, respectively).A significant association was demonstrated between both the female gender (p = 0.042) and a negative sputum smear (p < 0.001) and extreme delay, while only a negative sputum smear (p < 0.001) remained significant in the multivariate analysis. CONCLUSIONS: Our findings suggest that some groups of tuberculosis patients experienced a health system delay. In such a setting where tuberculosis incidence is decreasing, which leads to a lack of physician experience and expertise, training in tuberculosis is required. Such measure may be useful in reducing the number of missed opportunities for tuberculosis diagnosis.

Estimating global and regional morbidity from acute bacterial meningitis in children: assessment of the evidence.

AIM: To estimate global morbidity from acute bacterial meningitis in children. METHODS: We conducted a systematic review of the PubMed and Scopus databases to identify both community-based and hospital registry-based studies that could be useful in estimation of the global morbidity from bacterial meningitis in children. We were primarily interested in the availability and quality of the information on incidence rates and case-fatality rates. We assessed the impact of the year of study, study design, study setting, the duration of study, and sample size on reported incidence values, and also any association between incidence and case-fatality rate. We also categorized the studies by 6 World Health Organization regions and analyzed the plausibility of estimates derived from the current evidence using median and inter-quartile range of the available reports in each region. RESULTS: We found 71 studies that met the inclusion criteria. The only two significant associations between the reported incidence and studied covariates were the negative correlation between the incidence and sample size (P<0.001) and positive correlation between incidence and case-fatality rate (P<0.001). The median incidence per 100000 child-years was highest in the African region - 143.6 (interquartile range [IQR] 115.6-174.6), followed by Western Pacific region with 42.9 (12.4-83.4), the Eastern Mediterranean region with 34.3 (9.9-42.0), South East Asia with 26.8 (21.0-60.3), Europe with 20.8 (16.2-29.7), and American region with 16.6 (10.3-33.7). The median case-fatality rate was also highest in the African region (31.3%). Globally, the median incidence for all 71 studies was 34.0 (16.0-88.0) per 100000 child-years, with a median case-fatality rate of 14.4% (5.3%-26.2%). CONCLUSIONS: Our study showed that there was now sufficient evidence to generate improved and internally consistent estimates of the global burden of acute bacterial meningitis in children. Although some of our region-specific estimates are very uncertain due to scarcity of data from the corresponding regions, the estimates of morbidity and case-fatality from childhood bacterial meningitis derived from this study are consistent with mortality estimates derived from multi-cause mortality studies. Both lines of evidence imply that bacterial meningitis is a cause of 2% of all child deaths.

Longitudinal Study on the Effect of Onboard Service on Seafarers' Health Statuses.

Seafaring is considered one of the most stressful professions. Stressors in seafaring lead to typical symptoms of stress, such as insomnia, loss of concentration, anxiety, lower tolerance of frustration, changes in eating habits, psychosomatic symptoms and diseases, and overall reduced productivity, with the possibility of burnout and chronic responsibility syndrome. It has been previously determined that seafarers belong to high-risk occupations in terms of developing metabolic syndrome, and according to their BMIs, almost 50% of all seafarers belong to the overweight and obesity categories. This is the first longitudinal study conducted with the aim of using the BIA method to determine the anthropometrical changes that occur during several weeks of continuous onboard service. This study included an observed group consisting of 63 professional seafarers with 8 to 12 weeks of continuous onboard service and a control group of 36 respondents from unrelated occupations. It was determined that Croatian seafarers fit into the current world trends regarding overweight and obesity among the seafaring population, with the following percentages in the BMI categories: underweight, 0%; normal weight, 42.86%; overweight, 39.68%; and obesity, 17.46%. It was established that the anthropometric statuses of the seafarers significantly changed during several weeks of continuous onboard service. Seafarers who served on board for 11 weeks lost 0.41 kg of muscle mass, whereas their total fat mass increased by 1.93 kg. Changes in anthropometric parameters could indicate deterioration of seafarers' health statuses.

Does life along the sea carry greater risk of thyroid cancer?

Aim of this study was to determine whether there are any differences between coastal and inland Dalmatia in incidence rates and clinical characteristics of thyroid cancer. Data on 651 persons who suffer from and have undergone surgery for thyroid cancer have been analysed. All patients lived in Dalmatia between 1997 and 2006. Data were collected via surveys, insight into medical histories and results of histopathological analysis. In Dalmatia, in the overall sample, there are no statistically significant differences in incidence between coastal and inland areas (chi2=3.03; df=1; p=0.082). Somewhat higher overall incidence has been recorded in the inland (8.5%000) than in the coastal Dalmatia (7.3%000). In the overall sample, in Dalmatia, women make up 81.4% of patients and papillary cancer accounts for 80.0% of all thyroid cancers. The ratio of papillary to folicullar cancer is 7.8:1 in coastal and 4.2:1 in inland Dalmatia. Papillary and medullary types are more common in the coastal area and follicular and anaplastic cancer types in the inland area and the differences are statistically significant (p>0.033). Epidemiological characteristics of thyroid cancer in coastal Dalmatia are in accordance with the characteristics of this cancer as described in iodine-sufficient areas: the most common type is papillary cancer, and the ratio of papillary to follicular is 7.8:1. Sex-wise, the coastal area records a higher ratio of male patients (1:3.8) than the inland area (1:7.1). There are no statistically significant differences in thyroid cancer incidence rates between coastal and inland Dalmatia. Epidemiological characteristics of thyroid cancer in inland Dalmatia are in some ways more similar to those of continental Croatia. This result could be the consequence of previous iodine insufficiency in inland Dalmatia.

[Leprosy--today forgotten in Croatia?]. / Lepra--danas zaboravljena u Hrvatskoj?

Leprosy is an infectious skin disease caused by Mycobacterium leprae, which predominantly affects the skin, peripheral nerves and mucous membrane of the upper respiratory tract and oral cavity. In spite of today's efficient treatment, leprosy represents a public health problem in some countries of the world. It is estimated that 12 to 15 million patients are currently affected in the world. Leprosy ravaged across Europe, including Croatia, for centuries, so this paper provides a few historical facts on leprosy in Croatia. In 1956, the last case of leprosy was recorded in Blizna, a small village near Trogir, which was considered an endemic region in the Republic of Croatia. Although there is no indigenous leprosy nowadays in Croatia, there is a possibility of the disease re-emergence from tourists or crew members from large vessels, or from the infected persons returning to Croatia from abroad. Therefore, Croatian physicians, especially dermatovenereologists, must be familiar with the basics of the disease; therefore, this article points out the clinical picture, classification and basic principles of pathogenesis and treatment of the disease.

[Childhood tuberculosis: an ancient disease in the youngest generation in the 21st century from epidemiological point of view]. / Epidemioloski aspekti tuberkuloze--stare bolesti u djece 21. stoljeca danas.

Childhood tuberculosis (TB) has distinct epidemiological and clinical features. TB burden in children worldwide and in Croatia, the risk of infection and disease, as well as disease characteristics, sources of infection in children, diagnostic difficulties, impact of HIV on pediatric tuberculosis, limits of BCG-vaccine and program implications are discussed in this paper. Children younger than 15 years account for 15%-20% of global TB burden, which is often associated with severe TB-related morbidity and mortality. Childhood TB is rarely sputum-smear positive on microscopy. That is probably the reason for the lower priority traditionally given to children by TB control programs compared to that of adult disease. Young children are at a high risk of rapid progression from infection to disease, reflecting recent transmission rather than secondary reactivation. Therefore, the pediatric burden potentially provides a useful measure of current transmission within a community and it is a good indicator of the efficacy of TB control achieved in a particular community. Strict contact tracing and use of preventive chemotherapy is important to reduce TB-related suffering of children. Untreated latent TB infection in children provides the seed of the epidemic for the next generation. Evidence of an adult TB index case is a clue for diagnosis of childhood TB in low-endemic countries. Prognosis of early detected and properly treated TB is excellent. Consequently, new diagnostic methods and treatment options are an imperative. Among HIV-coinfected children, the optimal timing for highly active antiretroviral therapy initiation and drug combinations that have minimal interactions with anti-TB drugs need to be further explored. The most effective vaccine, suitable even for HIV-infected children, remains the need for successful prevention at the global level. The Stop TB Strategy, which builds on the previous Directly Observed Treatment Short-Course Strategy (DOTS) developed by the World Health Organization, has a critical role in reducing the worldwide burden of the disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. In addition to reducing the burden of adult TB, attention to childhood nutrition and improvement of socioeconomic conditions of communities is likely to have an impact on TB transmission to children.

[Epidemiological characteristics of thyroid cancer in Dalmatia, Croatia]. / Karcinom stitnjace u Dalmaciji: neke epidemioloske osobitosti.

OBJECTIVES: To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the incidence rate in Dalmatia with that in Croatia. STUDY DESIGN: Retrospective epidemiological study. SUBJECTS AND METHODS: Epidemiological indicators of thyroid carcinoma were compared between Dalmatia and Croatia as a whole, while some epidemiological indicators were compared with the characteristics of persons suffering from thyroid carcinoma in Croatia. The study included 651 persons suffering from and/or operated for thyroid carcinoma in Dalmatia between 1997 and 2006. Data were obtained from case histories, including the results of histopathologic analysis. The area of Dalmatia includes Zadar, Sibenik-Knin, Split-Dalmatia and Dubrovnik-Neretva counties (overall 861,060 inhabitants, surface 11,960 square kilometers). RESULTS: The incidence of thyroid carcinoma in Dalmatia ranged from 5.2 (1997) to 10.2 per 100,000 inhabitants (2006). The mean age adjusted incidence rate of thyroid cancer in the last 10 years was 8.1 in Croatia and 9.32 per 100,000 inhabitants in Dalmatia. All incidence rates observed (Europe and world-age standardized rates, crude incidence, incidence based on research) showed a rising trend and were significantly higher in Dalmatia than in Croatia. According to sex structure, in both study areas thyroid cancer affected predominantly women, who had four times more chances of falling ill. In Dalmatia, in the overall sample, women accounted for 81.4% of all patients. In Dalmatia, papillary thyroid carcinoma was diagnosed in 80.0% of the overall sample. The median age of newly diagnosed thyroid cancer patients was 50 in Dalmatia. There was no statistically significant sex difference in the prevalence of histologic types of thyroid carcinoma in Dalmatia (P=0.318). In both sexes, papillary carcinoma was the most common type, followed by follicular, medullary and anaplastic thyroid carcinomas. CONCLUSION: The incidence rate of thyroid cancer showed a rising trend and was significantly higher in Dalmatia than in Croatia. Epidemiological characteristics of thyroid gland carcinoma in Dalmatia were consistent with the reported characteristics of this carcinoma in iodine-sufficient areas: papillary carcinoma was prevalent and the papillary to follicular carcinoma ratio was 6.4:1.

[Tick-borne diseases in the Republic of Croatia]. / Bolesti koje se prenose krpeljima na podrucju Hrvatske.

This study analyses occurence, trendline, occurence by months and geographical distribution of tick-transmitted diseases: Lyme borreliosis, Tick-borne meningoencephalitis (TBM) and Mediterranean spotted fever in the Republic of Croatia in the period between 1999 and 2008. The vector for Lyme borreliosis and tick-borne meningoencephalitis is Ixodes ricinus, while Mediterranean spotted fever is transmitted by the Rhipicephalus sanguineus. Lyme disease is endemic in entire continental Croatia and Croatian littoral. Tick-borne meningoencephalitis is endemic in northern Croatia. Mediterranean spotted fever occurs only in Dalmatian counties and the average annual incidence rate increases from north to south of Dalmatia. All three diseases show extremely seasonal characteristics, which is conditioned by the biological cycle of ticks as their activity peaks in summer and spring. In terms of vaccines against the above diseases, the only one available in Croatia is the TBM vaccine and it is applied according to epidemiological indications. In preventing Lyme disease some authors have recommended a single 200-mg dose of doxycycline taken within 72 hours of being bitten by an infected tick.

Common variants in SLC17A3 gene affect intra-personal variation in serum uric acid levels in longitudinal time series.

AIM: To investigate whether intra-personal variation in serum uric acid concentration is influenced by genes that were described to be associated with serum uric acid levels in cross-sectional studies. METHODS: The study included 92 participants from the isolated community of the Croatian island of Vis. For each participant, two uric acid concentration measurements were available, one from 2002 and one from 2003. Changes in uric acid concentration were correlated with a set of 8 genes known to affect it: PDZK1, GCKR, SLC2A9, ABCG2, LRRC16A, SLC17A3, SLC16A9, and SLC22A12. RESULTS: Thirteen participants (14%) had uric acid concentration change greater than 130 micromol/L. Greater variability of uric acid concentration was recorded in women (coefficient of variation 49% vs 12% in men). Two SNPs belonging to SLC17A3 gene (rs9393672 and rs942379) yielded significant association with serum uric acid concentration changes in women. These two single-nucleotide polymorphisms (SNP) explained 0.2%-1.3% of variance for 2002 or 2003 uric acid measurement and 1.1%-1.8% of variance for the average value of these two measurements. CONCLUSIONS: Repeated measurements offer a possibility to enrich the percent of explained variance and contribute to the understanding of the "missing heritability" concept. Although a number of genes have been shown to affect serum uric acid concentration, SLC17A3 seems to have a major role in determination of serum uric acid repeated measurements variation.

Interactions between genetic variants in glucose transporter type 9 (SLC2A9) and dietary habits in serum uric acid regulation.

AIM: To investigate possible interactions between genetic variants in glucose transporter type 9 (SLC2A9) gene and dietary habits in serum uric acid regulation. METHODS: Participants for this study were recruited from two isolated Croatian island communities of Vis (n=918) and Korcula (n=898). Three single nucleotide polymorphisms (SNP) from the SLC2A9 gene (rs1014290, rs6449213, rs737267) were correlated with dietary habits and uric acid. RESULTS: A significant decrease in uric acid levels was recorded with increasing consumption of milk, sour cream, duck and turkey, and eggs. The only significant interaction was found between potato consumption and rs737267 and a near-significant interaction was found between soft drinks and rs1014290 (interaction P=0.068). Increased consumption of soft drinks interacting with the TT genotype at rs1014290 increased serum uric acid. No significant interactions were observed between food products consumption and rs6449213. CONCLUSION: There is a certain extent of interaction between SLC2A9 and dietary patterns in serum uric acid determination. The metabolic effect of soft drinks seems to be determined by the underlying genotype of rs1014290.

Q fever in Croatia: war-induced changes in epidemiological characteristics.

The article describes the epidemiological characteristics of Q fever in Croatia, during the period before and after the Homeland War. In the ten years prior to the Homeland War (1983-1992) 1053 cases of Q fever were recorded, 16.2% (171) of which on islands and in coastal areas. In the period after the Homeland War (1995-2008), a total of 654 cases was recorded, 59.9% (392) of which on islands and in coastal areas. In addition to reduced incidence, geographic distribution of the disease also changed. Before the war, the highest morbidity rate was recorded in the Sisak-Moslavina County. After the war, the Split-Dalmatia County recorded the highest morbidity rate because in the post-war period sheep from Bosnia and Herzegovina went to this county for winter grazing. The disease might be relevant to the Croatian Army and other armed forces that stay in Croatia as part of NATO forces.

Supplying ships with safe drinking-water.

BACKGROUND: Ships are supplied with water from various sources: directly from the public utility system at the port, from water supply vessels or barges, bottled water, ice or, if water production on board is possible,through processes such as desalination and reverse osmosis. All elements of a ship's water supply chain are exposed to the influence of different factors that may have a negative impact on water safety on board or on human health. Potable water standards are the same for vessels and for land-based facilities. In recognition of the importance of drinking water and the impact it can have on human health, stringent quality standards have been laid down in national and global regulations. The aim of the study was to describe the water supply system on ships and its weak points, as well as the health risks that the use of npolluted drinking water can entail. MATERIALS AND METHODS: The Medline Database has been searched using the following key words: ship, water supply, waterborne infections. Other available literature has also been used, as well as national and international regulations on drinking-water safety. RESULTS AND CONCLUSIONS: Drinking water on ships is managed in line with the hygienic and health standards applied along the entire supply chain, from the source to the point of consumption. Regardless of the sanitary control system used by the authorised institutions on the ground, ship officers must oversee the entire water supply and distribution system on board, as well the water production systems if these exist. That means that they must be well aware of all of the fundamental facts of the supervision system, as well as the weaknesses of the water supply system. Maritime studies students, future deck officers and engine officers, must all receive training on the weak points of the system and on water contamination prevention.

Historic, demographic, and genetic evidence for increased population frequencies of CCR5Delta32 mutation in Croatian Island isolates after lethal 15th century epidemics.

AIM: To assess the frequency of 32 base pair deletion in CCR5 (CCR5Delta32), which has been shown to confer resistance to HIV infection in a homozygous form, in 10 isolated island communities of Dalmatia, Croatia, with different histories of exposure to epidemics during and since the medieval period. METHODS: In 2002, DNA analysis of 100 randomly selected individuals from each of the 10 isolated communities of 5 Croatian islands (Susak, Rab, Vis, Lastovo, and Mljet) showed high levels of 3-generational endogamy, indicating limited gene flow. Five of the communities were decimated by epidemics of unknown cause between 1449-1456, while the other 5 villages remained unaffected. Genotyping of the CCR5 gene was performed using the polymerase chain reaction method with primers flanking the region containing 32-bp deletion. RESULTS: The frequency of CCR5Delta32 in the 5 villages affected by the epidemic was 6.1-10.0%, and 1.0-3.8% in the 5 unaffected villages. The Delta32 mutation was found in 71 of 916 alleles among the individuals from the affected villages (7.5%), and in 24 of 968 alleles in unaffected villages (2.5%, chi(2)=27.3, P<10-6). A previous study in 303 random Croatian blood donors showed the frequency of the CCR5 Delta32 of 7.1% in the general population. The difference remained significant after correcting for population structure using both STRAT and STRUCTURE software and the genomic control test, to ensure results do not arise from the background genetic differences. CONCLUSION: Our results and historical evidence, suggest that the mid-15th century epidemic could have acted as a selection pressure for the CCR5Delta32 mutation.

Occurence of visceral and cutaneous leishmaniasis in Croatia.

UNLABELLED: The purpose of this study was to show epidemiological characteristics and clinical manifestations of visceral and cutaneous leishmaniasis in Croatia. METHODS: Analysis of data on reported visceral and cutaneous leishmaniasis cases and description of the most common clinical manifestations of the disease was based on meta analysis of collected data. RESULTS: A total of 124 cases of visceral and cutaneous leishmaniasis were reported from 1954 until the end of 2006. During the 1994-2006 period, 35 people became infected: 23 with visceral and 12 with the cutaneous form of the disease. The diagnosis of cutaneous leismaniasis is based on the clinical picture, epidemiological data, and light microscopic histology. The clinical picture of visceral leishmaniasis was confirmed by detection of amastigotes in bone marrow aspirate (n=22; 95.7%) and liver (n=1; 4.3%) and by serology-indirect immunofluorescent assays (n=23; 100%). Age-specific morbidity is highest in the 0 to 4 age group (0.29%). None of the infected was human immunodeficiency virus positive. CONCLUSION: It is estimated that there have been some changes in epidemiological characteristics of the natural foci of leishmaniasis in Croatia.