Q fever outbreak in the village of Nocaj, Srem County, Vojvodina Province, Serbia, January to February 2012.

From 27 January to 10 February 2012, a total of 43 cases of Q fever were notified in the village of Nocaj, Srem county, Autonomous Province of Vojvodina, Republic of Serbia. Q fever was laboratory confirmed in 37 notified cases. Alhough, the outbreak is considered over, the outbreak investigation is still ongoing in order to identify aetiologic factors relevant for this outbreak.

Prevalence of metabolic syndrome and related metabolic traits in an island population of the Adriatic.

BACKGROUND: Metabolic syndrome, a constellation of risk factors associated with cardiovascular disease and Type 2 diabetes, has reached epidemic proportions worldwide. Epidemiological studies in transitional societies will provide insight into the underlying factors that interact in its manifestation. AIMS: To estimate the prevalence of metabolic syndrome, provide a comparative analysis of two metabolic syndrome definitions and assess clustering and association of metabolic traits and cardiovascular diseases in an Adriatic island population. SUBJECTS AND METHODS: In a cross-sectional study, data on four anthropometric, blood pressure and 11 biochemical traits were obtained from 1430 adults from the island of Hvar. RESULTS: Prevalence of metabolic syndrome was 25% and 38.5% based on Adult Treatment Panel III and International Diabetes Federation definitions, respectively. Rates of abdominal obesity, elevated blood glucose and hypertension were high. Among the traits not included in the definitions, levels of LDL, total cholesterol and fibrinogen were markedly elevated. The majority of the phenotypes were significantly associated with the syndrome, the strongest being waist circumference. CONCLUSION: The Croatian islanders are characterized by a high prevalence of metabolic abnormalities. Central obesity is the strongest contributor of the syndrome. With a high prevalence of dyslipidemia and pro-inflammatory factors, the population is at substantial risk for cardiovascular diseases.

TP53 gene polymorphisms and breast cancer in Croatian women: a pilot study.

A case-control retrospective association study was conducted to investigate a possible association of the TP53 polymorphisms, Arg72Pro and PIN3 (+16bp), with sporadic breast cancer in Croatian women. Ninety-five women with breast cancer and 108 age-matched healthy women were analyzed. Arg72Pro polymorphism was detected by TaqMan essay. For designation of PIN3 (+16bp) polymorphism DNA amplification was performed by the polymerase chain reaction (PCR) while the PCR products were detected by capillary electrophoresis. Homozygous genotype of minor allele of the PIN3 (+16bp) polymorphism was associated with sporadic breast cancer (OR = 2.15, 95% confidence interval [CI] 1.80-2.56, p = 0.006). For Arg72 polymorphism, the odds ratio for breast cancer of ArgPro versus reference genotype ArgArg was 0.55 (95% CI 0.30-1.02, p = 0.039) suggesting the protective effect. Although different haplotypes did not influence the susceptibility to the disease, the joint occurrence of genotype combination ProPro/A2A2 frequent in cases, was associated with sporadic breast cancer (OR = 2.20, 95% CI 1.89-2.56, p = 0.021). The study provides evidence of the association of the TP53 gene polymorphisms Arg72Pro and PIN3 (+16bp) with sporadic breast cancer in the Croatian population.

The evidence of mtDNA haplogroup F in a European population and its ethnohistoric implications.

Mitochondrial DNA polymorphism was analysed in a sample of 108 Croatians from the Adriatic Island isolate of Hvar. Besides typically European varieties of human maternal lineages, haplogroup F was found in a considerable frequency (8.3%). This haplogroup is most frequent in southeast Asia but has not been reported before in Europe. The genealogical analysis of haplogroup F cases from Hvar suggested founder effect. Subsequent field work was undertaken to sample and analyse 336 persons from three neighbouring islands (Brac, Korcula and Krk) and 379 more persons from all Croatian mainland counties and to determine if haplogroup F is present in the general population. Only one more case was found in one of the mainland cities, with no known ancestors from Hvar Island. The first published phylogenetic analysis of haplogroup F worldwide is presented, applying the median network method, suggesting several scenarios how this maternal lineage may have been added to the Croatian mtDNA pool.

Population structure of the Island of Korcula, Croatia.

Serogenetic data on 16 systems and migration data from birthplaces of parent and offspring, collected from 949 inhabitants of 8 vilages on the island of Korcula in the eastern Adriatic (Croatia), were analysed. Geographic distance is not a strong determinant of the population structure on the island. The pattern of the genetic variation now observed derives mainly from history and migration behavior. © 1993 Wiley-Liss, Inc.

Sex differences in pubertal growth of the heart.

The aim of this study was to determine sex differences in growth of the heart during puberty. Three-year increments of growth of the heart and body structures and functions related to heart size were compared between the sexes. Echocardiographically estimated left ventricular mass (LVM) represented heart size, body surface area (BSA) represented the area supplied by the left ventricle, and diastolic blood pressure (DBP) represented a segment of arterial resistance. Pubertal changes in these and several other parameters were compared in 67 healthy girls and 84 healthy boys followed longitudinally from 11.5 to 14.5 years. Increments were compared by t-tests. Left ventricular mass of boys was larger than in girls. The sex difference was not significant at 11.5 years, but increased during the three pubertal years. LVM increased 26% in girls and 53% in boys (P <.001). During the same period, BSA increased 22% in girls and 29% in boys (P <.001), while DBP increased 6% in girls and 9% in boys (P <.05). The larger increment of BSA and DBP in boys corresponds to the sex difference in the increment of the heart size. These differences account, in part, for the greater increase (P <.001) in physical working capacity in boys compared to girls. Am. J. Hum. Biol. 9:297-302, 1997. © 1997 Wiley-Liss, Inc.

Genetic epidemiological studies of eastern Adriatic Island isolates, Croatia: objective and strategies.

In this paper, the authors discuss why isolate island populations represent a particularly helpful model for genetic epidemiological studies. A thorough previous anthropological research carried out in Eastern Adriatic island isolates, Croatia, in terms of ethnohistory, geography and current demography is reviewed. The major results of the studies of population genetic structure of those populations, including model-bound and model-free approaches, the analyses of serogenetic polymorphisms and most recent studies using HLA class II, VNTR and STR DNA polymorphisms, are briefly presented. The organization of health care on the islands is analyzed and some relevant details of specific medical problems and some autochtonous diseases in these island populations is noted. The authors present in outline four illustrative examples of research opportunities which are afforded by the unique circumstances found in these isolate communities. These relate to hereditary dwarfism on Krk island, Mal de Meleda on Mljet island, extreme inbreeding on Susak island and population genetics of cancer on the islands of Brac, Hvar, Korcula, Vis and Lastovo. Finally, the authors develop objectives and strategies for a long-term genetic epidemiological research of these populations and suggest that such a programme of investigation would further our understanding of the causes of (rare) diseases which are uniquely important to these communities but also of common diseases which are important contributors to the burden of disease both in these islands and throughout the world.

Family correlations of metacarpal bones--heritable (h2) and environmental (c2) components of total phenotypic variation.

The analysis of family data of 18 metacarpal morphometric dimensions (bone length -L, total diaphysis width-T and medullary canal width-M of the second, third and fourth metacarpals of both hands) has been performed on 956 randomly sampled adult examinees (age 18 to 85), inhabitants of the islands of Brac and Hvar and the Peljesac peninsula, Croatia. Interclass (for parent-offspring family pairs) and intraclass (for siblings) correlation coefficients have been calculated as well as heritability coefficient (h2) and coefficient quantifying effects of common sibling environment (c2) have been estimated. Heritability estimates (h2) for the medullary canal width dimensions (54%-71%) showed to be at least as high, and c2 (2%-14%) values showed to be at least as low as those obtained for bone length dimensions (h2 = 51%-65%; c2 = 5%-16%) suggesting a strong influence of genetic factors in medullary canal width formation. For both traits the highest heritability and the lowest environmental component is found for dimensions of 4th metacarpal bone, which could be explained by lower biomechanical pressures acting on that bone owing to it's anatomical position. Analysis of family resemblance for medullary canal width showed the tendency of female family pair (Mother-daughter) to be less correlated than other family pairs, which is especially pronounced in fourth metacarpals. We assume that lower correlation values of Mother-daughter pair can be the result of non-linearity of age dependent changes in medullary canal width dimensions associated with the osteoporotic process which is more active in females. Clearly lower heritability values obtained for total diaphysis width dimensions (25%-48%) and higher values obtained for c2 (14%-23%), in addition to findings of higher correlation values in same sex family pairs (Father-son, Mother-daughter) speaks in favor of substantial importance of common family environmental factors--particularly sexually specific physical activity--which through the short-term adaptation processes modify the total diaphysis width dimension phenotype.

Anthropogenetical analysis of abnormal human alpha-globin gene cluster arrangement on chromosome 16.

An earlier study of human globin gene polymorphism in two Adriatic islands of Olib and Silba showed an abnormal arrangement of alpha-globin genes in two different individuals. The next step was to determine the degree of the kinship relationship between the two probands, one with a deleted and another with triplicated alpha-globin gene on the island Silba, and to determine the stability of this disorder through generations. We reviewed the parish registers (Status Animarum) of the island of Silba, dating from the year 1527, and constructed family trees for the two probands. Restriction endonuclease mapping was performed to study the arrangement of the alpha-globin genes in the offspring of our probands. A total of 183 ancestors completed the two family trees. The kinship relationship between them was established in the 5th, 6th, and 7th generation. The analysis of alpha-globin genes in the offspring of our probands showed the triplicated alpha-globin genes in two persons. We also found alpha-globin gene triplication in other three relatives. We did not find any deleted alpha-globin genes. We determined the kinship relationship between the two probands, one with deleted and the other with triplicated alpha-globin genes. This finding enabled us to determine the stability of this gene disarrangement through generations. It also showed new possibilities in anthropogenetic research, by combining the analyses of parish registers with those of modern genetic methods, such as restriction endonuclease mapping.

The aging process--an analysis of the latent structure of body morphology (in males).

The morphological characteristics (20 anthropometric variables) of a total of 2,351 examinees (from the age of 18 to 90) were analyzed by a model of the principal components of the factor analysis. Four factors were extracted that explain 71.4% of the total variance. The factors-"general body voluminosity", "subcutaneous fat tissue", "longitudinal body dimensionality" and "upper body voluminosity"-were analyzed within the context of their appearance in different age-determined cohorts. The differences between cohorts (groups per ten years of age) were studied by the canonical discriminant analysis. The first two discriminant functions (describing mostly the variability of cohorts-96.11%) indicate a constant decrease of body and sitting height, and an increase of upper body voluminosity till the fourth age cohort, which is the most crucial one in the change of latent morphological structure. Results of the correct classification of cohort members show that only 48.45% of probands were correctly placed (the best classification determined was in the age between 46 and 55 years) indicating that in males, at least three different groups exist according to the specificity of morphological aging in human organisms.

MtDNA haplogroups in the populations of Croatian Adriatic Islands.

The number of previous anthropological studies pointed to very complex ethnohistorical processes that shaped the current genetic structure of Croatian island isolates. The scope of this study was limited to the general insight into their founding populations and the overall level of genetic diversity based on the study mtDNA variation. A total of 444 randomly chosen adult individuals from 32 rural communities of the islands of Krk, Brac, Hvar and Korcula were sampled. MtDNA HVS-I region together with RFLP sites diagnostic for main Eurasian and African mtDNA haplogroups were analysed in order to determine the haplogroup structure. The most frequent haplogroups were "H" (27.8-60.2%), "U" (10.2-24.1%), "J" (6.1-9.0%) and "T" (5.1-13.9%), which is similar to the other European and Near Eastern populations. The genetic drift could have been important aspect in history, as there were examples of excess frequencies of certain haplogroups (11.3% of "I" and 7.5% of "W" in Krk, 10.5% of "HV" in Brac, 13.9% of "J" in Hvar and 60.2% of "H" in Korcula). As the settlements on the islands were formed trough several immigratory episodes of genetically distant populations, this analysis (performed at the level of entire islands) showed greater genetic diversity (0.940-0.972) than expected at the level of particular settlements.

Surname as 'cancer risk' in extreme isolates: example from the island of Lastovo, Croatia.

The aim of this study was to analyze whether there are surnames which appear more frequently among the ancestors of cancer cases in a small isolate, in comparison to the ancestral surnames of the healthy controls, using the classic case-control design. The chosen setting was the island of Lastovo, Croatia, located more than 100 kilometers from the nearest coastal region. The period of study was 1970-1995, during which a total of 76 cancer cases were recorded in a population of approximately 800. The comparison of surname frequencies was performed in current and in five ancestral generations. The leading hypothesis was that, if inbreeding and common ancestry contributed to the development of the disease, then those phenomena should be reflected in increasing frequency of some surnames among ancestors, identifying the 'hidden' consanguinity, or 'following' cancer-promoting genes on the Y-chromosome. The results imply that there are surnames representing a classic "risk" for cancer, but also those "protecting" from its development, which all underscores the importance of founder effect and genetic predisposition to the disease in a small, reproductively isolated population. All of the results become more evident and increasingly significant when analyzed in more distant ancestral generations.

Inbreeding and nephrolithiasis in Croatian island isolates.

The aim of this study was to investigate a recessive genetic component in susceptibility to nephrolithiasis (NL) by comparing its prevalence in highly inbred, moderately inbred and non-inbred villages of three Croatian islands: Brac, Hvar and Korcula. The average inbreeding coefficient of each village population (F) was estimated in a random sample of 20-30% adults from 14 villages using Wright's path method (based on genealogical information), isonymy data and average deviation from Hardy-Weinberg expectations for MN, Ss and Kk serogenetic polymorphisms. The six villages with the greatest genealogical F value (0.025-0.049; current total population N=1,401), the four with intermediate value (0.012-0.015; N=998) and the four with the smallest value (0.002-0.008; N=1,500) were chosen for this study. Medical records of entire populations were reviewed and the diagnosis of NL was established according to unified criteria, based on the information from the specialists in general hospitals and on the agreement in diagnosis between the investigators and local general practitioners. The variance in environmental and socio-cultural factors between villages was shown to be minimal. Prevalence of NL in each village was standardised by sex and age to the total population of all 14 villages. The standardized prevalence of NL was 1.5% in the group of villages with low F, 2.3% in the group with moderate F (p<0.10), and 5.4% in the group with high F (p<0.001). The correlation factor between F values by villages and the standardized prevalence of NL was 0.45 (p<0.05). The study showed that a large number of predominantly recessive genetic factors might mediate the susceptibility to formation of renal stones in humans.

Inbreeding and learning disability in Croatian island isolates.

The aim of this study was to investigate the prevalence of learning disability (LD) in isolate populations with different inbreeding coefficients (F). Prevalence of LD and F were determined in 10 villages from five Croatian islands: Brac, Hvar, Korcula, Lastovo and Susak. For the purpose of this study, LD was defined as the inability to attend the public school system. As the elementary schools (grade 1-8) in the place of the study are both public and compulsory, the assessment of child's inability to attend the school is performed at the age of six. This is required by all children in the country based on standard set of tests of cognitive performance defined by the Ministry of Education and Culture of the Republic of Croatia. The average inbreeding coefficients in each village population (F) were estimated in a random sample of 20-30% adults in each of the 10 villages based on 4 ancestral generations and using Wright's path method. Prevalence of LD ranged from 0.43% to 2.47%, and the inbreeding coefficients ranged from 0.8% to 4.9%. The Pearson's correlation coefficient between F and LD prevalence was 0.80 (p < 0.01). Although the relative risk per 5% inbreeding appeared very high (about 10), the absolute risk only increased from 0.18% to 1.77%. The genetic effect of inbreeding (GEI) was approximately 0.69% and the population-attributable fraction 76.6%. A review of the literature and the results of this study lead to a conclusion that a very large number of predominantly recessive genetic factors might mediate the genetic susceptibility to various forms of LD in these populations.

HLA class II gene and haplotype diversity in the population of the island of Hvar, Croatia.

The DRB1, DRB3, DRB5, DQA1 and DQB1 allele polymorphisms were analysed in 3 western and 3 eastern villages of the island of Hvar using PCR-SSOP method and 12th International Workshop primers and probes. Three DQB1 alleles (*0304, *0305, *0607) detected in the population of the island of Hvar (HP) have not yet been observed in general Croatian population (GCP). Significant differences were observed between two regions of Hvar for: a) DRB1*0701 allele (p < 0.001), b) DQA1*0201 allele (p < 0.01), and c) DRB1*0101-DQA1*0101-DQB1*0501 haplotypic association (p < 0.05). Two unusual haplotypic associations, which have not yet been described in general Croatian population (GCP), DRB1*0101-DQA1*0102-DQB1*0501 and DRB1*1501-DQA1 *0102-DQB1*0604 were observed in the population from the island of Hvar (HP). Measures of genetic kinship and genetic distances revealed isolation and clusterization which coincides with the known ethnohistorical, as well as biological and biocultural data obtained from a series of previous investigations. The five studied village subpopulations formed two clusters (East-West) to which the far eastern village (with the highest rii of 0.0407) joined later, thus indicating possible impact of historical immigrations from the mainland.

Cancer incidence in eastern Adriatic isolates, Croatia: examples from the islands of Krk, Cres, Losinj, Rab and Pag.

As an extension of previous research this study investigates the incidence of cancer in five genetic isolate island populations of the Eastern Adriatic, Croatia. Thorough anthropological research over the past three decades has established some of those populations as outstanding examples of genetic isolates. A previous study which found higher cancer incidence in 5 Eastern Adriatic islands than in a control population supported a hypothesis that among the founders of these populations there were genetic variants (especially with recessive inheritance) responsible for genetic susceptibility to certain types of cancer. This study sought to investigate cancer incidence in 5 further island populations. All cancer cases in five island populations (Krk, Cres, Losinj, Rab and Pag) over the 20-year period (1971 to 1990) was extracted from the data of the Croatian Cancer Registry. The mainland populations of Istrian and Primorsko-Goranska County, characterized by similar environmental factors but an outbred genetic structure, represented a control population. After standardization by by sex and age, cancer incidence was higher in the island populations than in the control population in both sexes. The cancer sites primarily responsible for the excess incidence were prostate, stomach and pancreatic cancer in males, and ovarian, breast, stomach, bowel, and brain cancer in females. The reasons for the increased cancer incidence are uncertain and may be due to different environmental exposure between the two populations. However, it is possible that genetic isolation and inbreeding are important factors. Further investigations of cancer in these isolate populations are warranted to explore these findings further.

A large cross-sectional study of health attitudes, knowledge, behaviour and risks in the post-war Croatian population (the First Croatian Health Project).

As the liberation of occupied Croatian territories ended the war in the country in 1995, the Ministry of Health and Croatian Health Insurance Institute have agreed to create the new framework for developing a long-term strategy of public health planning, prevention and intervention. They provided financial resources to develop the First Croatian Health Project, the rest of the support coming from the World Bank loan and the National Institute of Public Health. A large cross-sectional study was designed aiming to assess health attitudes, knowledge, behaviour and risks in the post-war Croatian population. The large field study was carried out by the Institute for Anthropological Research with technical support from the National Institute of Public Health. The field study was completed between 1995-1997. It included about 10,000 adult volunteers from all 21 Croatian counties. The geographic distribution of the sample covered both coastal and continental areas of Croatia and included rural and urban environments. The specific measurements included antropometry (body mass index and blood pressure). From each examinee a blood sample was collected from which the levels of total plasma cholesterol (TC), triglycerides (TG), HDL-cholesterol (High Density Lipoprotein), LDL-cholesterol (Low Density Lipoprotein), lipoprotein Lp(a), and haemostatic risk factor fibrinogen (F) were determined. The detailed data were collected on the general knowledge and attitudes on health issues, followed by specific investigation of smoking history, alcohol consumption, nutrition habits, physical activity, family history of chronic non-communicable diseases and occupational exposures. From the initial database a targeted sample of 5,840 persons of both sexes, aged 18-65, was created corresponding by age, sex and geographic distribution to the general Croatian population. This paper summarises and discusses the main findings of the project within this representative sample of Croatian population.

[Ventilatory function of the lungs in Brac stone cutters]. / Ventilacijska funkcija pluca u brackih kamenorezaca.

The study aims at assessing whether occupational exposure to Brac limestone, which contains a minute amount of silica, induces disorders of ventilatory capacity. It included 71 male workers employed in a stone saw-mill and 134 controls. The ventilatory functions VC, FEV1, FEV 1% VC, MEF25, MEF50 i MEF75 were examined, and the values analysed in respect to smoking habit. Variance analysis established a homogenous distribution of VC parameters, while others were heterogeneously distributed. This can be explained by smoking habit as assessable factor, and not by exposure to limestone dust. It is assumed that the production of Brac limestone in the stone saw-mill does not cause disorders in ventilatory function.

Influence of low concentration acid treatment on lithium disilicate core/veneer ceramic bond strength.

OBJECTIVE: This study evaluated the influence of low concentration acid treatment on the shear bond strength between lithium disilicate (LD) infrastructure and veneering porcelain. The surface morphology characteristic after this acid treatment was also examined. STUDY DESIGN: LD reinforced ceramic cylinders (n=10) (IPS e.max Press, Ivoclar-Vivadent, Schaan, Liechtenstein) were treated (LD-treated) with a low concentration acid solution (Invex Liquid - Ivoclar-Vivadent, Schaan, Liechtenstein) or not treated with the acid solution (LD-untreated). They were veneered with a glass ceramic (IPS e.max Ceram, Ivoclar-Vivadent, Schaan, Liechtenstein). A metal ceramic group (CoCr) was tested as control. Shear bond strength (SBS) was conducted using a universal testing machine at 0.5 mm/min. Surface morphology characteristics after acid treatment were analyzed using scanning electron microscopy. RESULTS: The acid treatment at low concentrations did not influence the SBS of the LD/veneering porcelain interface. The CoCr group showed the significant higher SBS value (35.59 ± 5.97 MPa), followed by LD-untreated group (27.76 ± 3.59 MPa) and LD-treated (27.02 ± 4.79 MPa). The fracture modes were predominantly adhesive for CoCr group and cohesive within the infrastructure for DL groups. Scanning Electron Microscopy (SEM) analysis showed no morphological differences between treated and untreated LD surfaces. CONCLUSIONS: Low concentration acid treatment did not improved SBS of veneering ceramic to LD and did not cause morphological changes on the LD surface. Key words:Lithium disilicate, glass ceramics, acid etching, shear bond strength, scanning electron microscopy.

The TP53 gene polymorphisms and survival of sporadic breast cancer patients.

The TP53 gene polymorphisms, Arg72Pro and PIN3 (+16 bp), can have prognostic and predictive value in different cancers including breast cancer. The aim of the present study is to investigate a potential association between different genotypes of these polymorphisms and clinicopathological variables with survival of breast cancer patients in Croatian population. Ninety-four women with sporadic breast cancer were retrospectively analyzed. Median follow-up period was 67.9 months. The effects of basic clinical and histopathological characteristics of tumor on survival were tested by Cox's proportional hazards regression analysis. The TNM stage was associated with overall survival by Kaplan-Meier analysis, univariate, and multivariate Cox's proportional hazards regression analysis, while grade was associated with survival by Kaplan-Meier analysis and univariate Cox's proportional hazards regression analysis. Different genotypes of the Arg72Pro and PIN3 (+16 bp) polymorphisms had no significant impact on survival in breast cancer patients. However, in subgroup of patients treated with chemotherapy without anthracycline, the A2A2 genotype of the PIN3 (+16 bp) polymorphism was associated with poorer overall survival than other genotypes by Kaplan-Meier analysis (P = 0.048). The TP53 polymorphisms, Arg72Pro and PIN3 (+16 bp), had no impact on survival in unselected sporadic breast cancer patients in Croatian population. However, the results support the role of the A2A2 genotype of the PIN3 (+16 bp) polymorphism as a marker for identification of patients that may benefit from anthracycline-containing chemotherapy.