The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia.

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18-98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0-24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007-2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (-8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (-35.1%), fish (-23.4%), white meat (-11.6%), cereals (-10.9%), and dairy products (-9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.

[Analysis of the results of mammography screening in Dubrovnik-Neretva County in the 2006-2009 period]. / Analiza rezultata mamografskog probira u Dubrovacko-Neretvanskoj Zupaniji 2006-2009 godine.

AIM: To analyze the results of the first cycle of mammography screening during implementation of the National Program for Early Breast Cancer Detection (National Program) for women aged 50-69 in the Dubrovnik-Neretva County (DNC) in the 2006-2009 period, and to present new cases of breast cancer among women undergoing screening. METHODS: Data were collected from the DNC Institute of Public Health database. Mammography results were classified according to the Breast Imaging Reporting and Data System (BI-RADS classification). Descriptive method was used to analyze the results of mammography screening. RESULTS: A total of 19,475 women aged 50-69 were invited to the first cycle of mammography screening for early breast cancer detection, conducted from October 2006 to October 2009 in DNC. The overall turnout in mammography screening was 59.5%; according to age groups, it was 61.8%, 60.6%, 58.5% and 56.8% for 50-54, 55-59, 60-64 and 65-69 age group, respectively. According to BI-RADS classification, BI-RADS 0 was recorded in 886 (10.0%), BI-RADS 1 in 2993 (33.8%), BI-RADS 2 in 4023 (45.4%), BI-RADS 3 in 864 (9.8%), BI-RADS 4 in 87 (1.0%) and BI-RADS 5 in eight (0.1%) women. Fifty-seven new cases of breast cancer were diagnosed in the first cycle of mammography screening. Among newly diagnosed cases of breast cancer, in the category of BI-RADS 0, 4 and 5 malignancy was confirmed in 55.6%, 13.9% and 30.6% within 45 days, 46-90 days and more than 3 months of mammography. DISCUSSION: Study results indicated a total turnout on mammography screening of 59.5%, which was below the goal set in the National Program of 70%, and also below the acceptable response rate of 70% or more according to the European guidelines for quality assurance in breast cancer screening. Comparison of our rate of newly diagnosed cancer cases (6.3/1000 screened women) with the rates from other countries (range, 1.8 to 10.1/1000) published in the literature, our rate of mammography screening was in the middle of other countries' range. The "recall rate" in DNC was 11.1%, which is higher than acceptable (acceptable, <7%). The National Program specifies that diagnostic evaluation of all women with suspect findings should be completed within one month, however, in DNC 48.5% of women with newly diagnosed breast cancer of the BI-RADS 4 or 5 group were processed within a month. Diagnostic evaluation of all women with suspect findings was difficult to achieve due to the lack of necessary equipment and experts. CONCLUSION: It is crucial to ensure quality and systematic promotion of the importance of mammography screening, to improve the level of cooperation between all holders of program activities, and to shorten the time interval between mammography recording and additional diagnostic and therapeutic procedures for women with lesions suspect of malignancy (to provide appropriate diagnostic and therapeutic care).

The geographic patterns of the exceptional longevity in Croatia.

The aim of this study was to provide an overview of the exceptional longevity patterns in Croatia. The prevalence of nonagenarians (aged 90 years or more) and centenarians (100 years or more) was calculated from the 1953-2001 census data. The data were analyzed with chi-square test and trend analysis. The results indicate steady and significant increasing trends in both age groups, more pronounced in women. Geographical distribution of the exceptional longevity had a clear coastline-to-mainland gradient, with higher prevalence of exceptionally old people in the coastal parts of the country. Additionally, exceptionally old respondents from the Croatian Adult Health Survey (CAHS) were compared to elderly ones (65-89 years old). The results suggested that exceptionally old respondents had lower prevalence of overweight and obesity and lower blood pressure, thus exhibiting strong survivor phenomenon. At the same time, exceptionally old respondents from the CAHS had higher prevalence of confirmed hypertension in medical history and reported taking blood pressure medication more often. The results of this study suggest that the pattern of exceptional longevity in Croatia has a clear coastline-to-mainland gradient, which is likely to be associated with the different lifestyle and dietary patterns between these two populations.

[The risk and protective cardiovascular factors in Dubrovnik-Neretva county in comparison with Croatia]. / Rizicni i zastitni kardiovaskularni cimbenici u Dubrovacko-Neretvanskoj zupaniji i u hrvatskoj--raspodjela i usporedba.

OBJECTIVE: To establish the prevalence of overweight, obesity, elevated systolic (SBP) and diastolic blood pressure (DBP), and adding salt to meals as cardiovascular risk factors; the prevalence of fruit and leaf-vegetable consumption; and the prevalence of physical activity at leisure time as protective factors in Dubrovnik-Neretva County (County); and to compare these data with the respective figures in the Republic of Croatia (Croatia). METHODS: We used the 2003 Croatian Health Survey (CHS 2003) to provide data for our study. The CHS 2003 was a cross-sectional survey in a random sample of the general population aged > or =18. RESULTS: In the County, the prevalence of obesity, SBP, DBP, adding salt to meals, physical activity and leaf-vegetable consumption was higher in male population, and the prevalence of fruit and other green-vegetable consumption in female population. The prevalence of SBP, DBP, physical activity and leaf-vegetable consumption was higher in the County compared with Croatia. CONCLUSION: The monitoring of all relevant indicators is required to identify the risks and protective cardiovascular factors in the County population, to allow for planning of public health programs for the prevention of cardiovascular disease.