Mortality Characteristics of Two Populations in the Northern Mediterranean (Croatia) in the Period 1960⁻2012: An Ecological Study.

In the second half of the 20th century, the town of Bakar (Primorje-Gorski Kotar County, Croatia), where a coking plant was operational 1978⁻1994, experienced intensive industrialisation. The town of Mali Losinj (Primorje-Gorski Kotar County, Croatia) in this period based its economy on non-industrial sectors. The study goal was comparing mortality characteristics of these populations in the northern Mediterranean for 1960⁻2012. An ecological study design was used. Data were analysed for 1960⁻2012 for the deceased with recorded place of residence in the study area. Data on the deceased for 1960⁻1993 were taken from death reports, for 1994⁻2012 from digital archives of the Teaching Institute of Public Health, Primorje-Gorski Kotar County. Data on causes of death for 1960⁻1994 were recoded to the three-digit code of underlying cause of death according to the International Classification of Diseases (ICD⁻10). Among studied populations significant difference was found among the causes of deaths coded within ICD⁻10 chapters: neoplasms (particularly stomach carcinoma), mental and behavioural disorders and diseases of the respiratory system (particularly chronic obstructive pulmonary disease, (COPD)). Increase in mortality from neoplasms, increase in respiratory diseases for the area exposed to industrial pollution, also stomach carcinoma and COPD particularly in the town Bakar require further research.

Attitudes and beliefs related to childhood vaccinations among parents of 6 years old children in Zagreb, Croatia.

The Croatian Immunization Programme is a mandatory prevention programme in which vaccines are offered free of charge and little is known about parental vaccine-related beliefs and attitudes. We aimed to describe beliefs and attitudes towards childhood vaccination of parents in Zagreb, estimate the proportion of parents with positive attitudes towards vaccination, and to identify the possible predictors of positive attitudes. Using a self-administered questionnaire, we performed a cluster sampling survey among parents of 6-years-old children in Zagreb. In total 542 questionnaires were collected, 80% (n = 430/542) of respondents were mothers. Even though 72.6% (n = 385/531; 95%CI: 69-76) respondents feel that childhood vaccination should remain mandatory, 36.3% (n = 192/528; 95%CI: 58.3-65.3) considered that simultaneous administration of vaccines can have negative effect to their child's health. In addition, 38% (n = 202/532; 95%CI: 33.2-43.1%) feared that vaccines may harm their child. Of total, parents mostly reported positive attitude towards vaccination (61.8%; 95% CI: 34.7-42). Parents with positive attitudes were more likely to state their child experienced mild or no adverse reaction after vaccination, report not delaying vaccination and provide additional non-mandatory vaccines to their child (p < 0.05). Gender, age, education and marital status of parent were not significantly associated with the positive attitude towards vaccination. Our results suggest the need for educational interventions and communication strategies that could foster better knowledge on immunization with a focus on parental misconceptions, perceived constraints and safety issues about vaccine.

Cumulative incidence of self-reported diabetes in Croatian adult population in relation to socioeconomic status and lifestyle habits.

The aim of this study was to determine the 5-year cumulative incidence of self-reported diabetes mellitus in relation to various socioeconomic and lifestyle factors in Croatian adult population. The analysis included 2909 participants of the Croatian Health Cohort Study (CroHort) aged 20-79 years (median 55, interquartile range 43-67; 69% women) with no history of diabetes. There were 163 new cases of diabetes (5-year cumulative incidence 5.6%), without significant differences according to sex. Significant predictors of diabetes were age, body mass index, waist and hip circumference in bivariate logistic regression, and being married or living in partnership (OR = 1.57, 95% CI 1.08-2.28; p = 0.018), body mass index (OR =1.11, 95% CI 1.07-1.14; p < 0.001) and age (OR = 1.02, 95% CI 1.01-1.03; p = 0.004) in multivariate model. Our results indicate that approximately 1% of the Croatian adult population develops diabetes each year. Association of living in partnership with higher diabetes incidence requires further investigation.

Vaccine regulations in Croatia.

In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian legislation concerning vaccine licensing, marketing authorisation and utilization is reviewed. The procedures for including a vaccine into the Mandatory Childhood Vaccination Programme are also discussed with focus on Human papillomavirus (HPV) vaccines. Non-obligatory vaccination recommendations are given when according to professional opinion; vaccination is beneficial for the vaccinee. There is little doubt that HPV vaccines should be recommended for preadolescent girls in Croatia. However, reaching a decision on its possible introduction into the Childhood Vaccination Programme will require careful consideration of the larger picture and a comparison of the cost-effectiveness of a mandatory vaccination against other competing public health priorities.

Cardiovascular diseases in Croatia and other transitional countries: comparative study of publications, clinical interventions, and burden of disease.

AIM: To determine the number of publications on cardiovascular diseases in the MEDLINE database, the rate of medical doctors and clinical interventions in cardiology, and health and socioeconomic indicators for Croatia, and to compare them with those for Slovenia, Hungary, the Czech Republic, and Austria. METHODS: PubMed was used in search for publications on cardiovascular diseases published in 1991-2004. Rates per million population and proportions of publications on cardiovascular diseases in the MEDLINE database were calculated. Gross domestic product (GDP) per capita was used as a socioeconomic indicator, whereas human resources in medicine were presented as the rate of medical doctors per million population. Standardized death rates from cardiovascular diseases and ischemic heart disease were used as indicators of cardiovascular health. Clinical interventions in cardiology, such as coronary angiograms, percutaneous transluminal coronary angioplasties (PTCA), and coronary bypass surgeries (CABG) were expressed per million population per year. RESULTS: Croatia had the lowest GDP per capita among the analyzed countries. The standardized death rate from cardiovascular diseases in Croatia was 91.7 per 100,000 population aged 0-64 in 2001, which was higher than that in Slovenia and Austria (P<0.001), similar to that in the Czech Republic, and lower than that in Hungary (P<0.001). Cardiovascular scientific output in Croatia was the lowest among investigated countries, ie, 1.1 per million population in 2003 (P<0.001). Despite a significantly lower number of medical doctors in comparison with Hungary and the Czech Republic (P<0.001), Croatia experienced a similar increment in the amount of clinical interventions in cardiology. CONCLUSION: In contrast to high cardiovascular mortality rates, cardiovascular scientific production in Croatia was significantly lower than in other investigated countries. A positive trend in cardiovascular medicine was recorded in clinical practice, but has yet to be followed by scientific production.