Epidemiological study of visual functions--refractive errors, macular degeneration and glaucoma in children in the Karst area of Opatija.

Authors of earlier studies examined the epidemiological characteristics of certain eye diseases: age-related macular degeneration (AMD), refractive errors and glaucoma in the area of Primorsho-goranska County (the island of Rab, Novi Vinodolshi and Delnice). It was found that the occurrence of AMD is most common on the island of Rab, followed by Novi Vinodolski and it is least common in Gorshi Kotar. This fact is associated with the intensity of solar radiation in the UV-A and UV-B fields. The highest percentage of the occurrence of glaucoma was also identified on the island of Rab. In comparison to this study, it was found that in the karst area of Opatija (Mune, Brgud, Zejane, Bresca, Zvonece, Pasjak, Sapjane and Zaluki) there is a very high incidence of glaucoma (27% suspected and 7% diagnosed glaucoma) within the indigenous population. Glaucoma does not appear among children whose parents migrated to the karst area of Opatija. Refractive errors are far less common among children of indigenous population than among the children whose parents migrated to this area. The occurrence ofAMD was not found in any child that was born and lives in this area, regardless of whether their parents are indigenous or not. This statement is very important because it confirms author's earlier statement which claims that at low exposure to solar UV-A and UV-B there is no occurrence of AMD.

Refractive errors in children of Primorsko-Goranska County--epidemiological study.

Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association "Albert Einstein" and Eye Clinic "Dr B.Vojnikovid" Rijeka agreed a five-year project to study children's health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50-60 years ago, it was a very rare occurrence of some refractive errors in children.

Patient satisfaction and quality in home health care of elderly islanders.

Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Losinj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease (14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.

Increasing burden of melanoma in Croatia.

Melanoma consists 4-5% of all skin cancers, but it contributes to 71-80% of skin cancers deaths. It is controversial whether worldwide increases in melanoma incidence represent a true epidemic but at the same time that dramatic increase in incidence occur in setting of relatively stable mortality trends, observed in Croatia also. The majority of authors accept that main risk factors for melanoma relate to environmental exposure and genetics with epidemiologic studies linking sun exposure to melanoma development. Data were obtained from Croatian cancer register for patients diagnosed between 1999 and 2008, for malignant melanoma of the skin (ICD-10 code C43) at national level and from 2003 to 2008, at the County level (Primorsko-goranska County). Melanoma incidence nearly doubled in males from 8.75 to 13.4/10(5) per year, fold in females from 9.1 at the start of observation to the end of 12.0/10(5) per year in Croatia. Melanoma incidence rates were much more higher for Primorsko-goranska County with range from 10.1 to 17.5/10(5) per year. The greatest increase of melanoma incidence rates was in males 60 years and over year group at diagnosis. National comparison of variation in cancer incidence by region and age can provide basis for public health prevention. It requires the integration of information on risk factors, incidence that could help to reduce regional inequalities in incidence and reduce the future cancer incidence.

Increasing smoking prevalence among pupils of several Croatian secondary medical schools between 1990 and 2006.

Smoking among pupils of secondary medical schools is of particular public health interest because of their role in the health system in the future. The study was part of the survey of smoking among students of Croatian medium medical schools. Data of 3 survey periods were available (1990-2002-2006). Specific smoking trends among 14-18 year olds were examined using odds ratios and multiple regressions. Sex ratios were calculated for each survey period. Daily smoking prevalence in 1990 was 15.9% in boys and 14.1% among girls. Occasional smoking in 1990 occurred among 8.9% of boys and 15.0% of girls. Twelve years after, smoking prevalence increased for daily smoking in boys to 32.9% and among girls to 30.4%. Occasional smoking decreased to 6.3% in boys, and increased to 17.8% among girls. There were no remarkable changes in prevalence from 2002 to 2006. Among adolescents in Croatia, there was high risk for smoking among adolescent population. High smoking rate among pupils of medical schools predicts not only high mortality due to smoking over 20-30 years, but also implicates for bad habit among professional health workers, if no policy interventions were taken.

Monitoring the presence of genetically modified food on the market of the Republic of Croatia.

From the beginning of the human race people have been applying different methods to change the genetic material of either plants or animals in order to increase their yield as well as to improve the quality and quantity of food. Genetically modified organism (GMO) means an organism in which the genetic material has been altered in a way that does not occur naturally by mating and/or natural recombination. Analysing the presence of GMO in food is done by detecting the presence of either specific DNA sequences inserted in the genome of transgenic organism, or detecting proteins as a result of the expression of the inserted DNA. In this work food testing for the presence of genetically modified organisms was conducted during the period from 2004 to 2007 in the GMO laboratory of the Croatian National Institute of Public Health. According to the regulations, among the samples in which the presence of GMO was detected, all those which had more than 0.9% of GMO content were either rejected from the border or removed from the market, because such GM food has to be appropriately labelled. Among the food samples which were analysed in 2004: 127 (2.37%) of a total of 1226 samples contained more than 0.9% of GMOs; in 2005 there was only one in 512 (0.20%) samples in total; in 2006 there were 4 out of 404 samples (0.99%), and in 2007: 7 of a total of 655 samples (1.07%) had GMO content above the allowed threshold of 0.9%.

Diet quality of middle age and older women from Primorsko-Goranska County evaluated by healthy eating index and association with body mass index.

Accorded dietary habits provide adequate nutrient intakes, especially important for quality aging. Adequate nutrition for older persons has vital influence on maintaining good health and social functioning. Therefore, using simple tool for evaluation of diet of older population in relation to overweight and obesity is of public health importance. Among many factor that influence quality of aging has obesity, where in Croatia the prevalence of obesity is greater in older women than men. Our aim was to evaluate diet quality of middle age and older women from Primorsko-Goranska County by Healthy Eating Index (HEI) and to see the association of HEI to overweight and obesity. Diet quality of 124 women with average age 59.91 +/- 5.31 years was graded with 10 component HEI score, ranging from 0 to 100, where HEI score less than 51 implies "poor" diet. Overweight and obesity was classified according to WHO classification. The majority of women had diet that "needs improvement" (66.1%), and only 3.2% had "good" diet. Older women had better HEI score than middle-aged women, while overweight was statistically significant positively related to better HEI score (P = 0.26, p = 0.048). Older women better scored for meat, dairy, cholesterol and dietary variety. "Poor" diet mostly had women with normal weight and middle-aged. Age did not influenced overall HEI score, neither its components. Obese women had lower achievements for almost all recommended HEI components. Women having "poor" diet quality could raise a chance for overweight and obesity for almost two times ([OR] = 1.67, 95% [CI] = 1.072-2.59, p = 0.023; [OR] = 1.51, 95% [CI] = 1.08-2.10, p = 0.015, respectively). The provided results showed that with age, women tended to have better diet. These could be because of that with aging are higher disease incidences that essentially need diet improvements; so older women tended to improve their diet to reduce disease discomforts. Being obese influenced the diet quality of our sample of women, therefore, for quality aging, the importance of public health nutrition programs are strongly needed. HEI score is a good assessment for diet quality, but further investigation of influence on other sociodemographic and health characteristics is required.

[Health status and health needs assessment--state of the art of the public health practice in Croatia]. / Procjena zdravlja i zdravstvenih potreba populacije javnozdravstvena praksa u hrvatskoj danas.

Public health practice performance is measured through its three core functions, i.e. assessment, policy development and assurance. We describe the existing health status and health care needs assessment practices in the Republic of Croatia. Health care needs assessment in Croatia includes mortality and morbidity information available through vital records but does not include community input (opinion and attitude) and participation. Health needs are not analyzed in order to determine the causes of health problems. Analysis of health needs of the population groups at highest risk also does not exist. Resources assessment is not part of the process, so we do not know how adequate the existing health resources are. In the Croatian health care system practice, the assessment function is limited through the almost exclusive use of the routine health and demographic statistics. Academic public health has introduced other kinds of more participative, subgroups oriented, qualitative methodologies but in daily routine, these methods are hardly used. Since health needs assessment is one of the core public health functions, in the future its practice has to be reoriented from pure monitoring towards identifying and solving community health problems. Partnership with community has to be a cornerstone for more efficient health needs assessment practice. In the light of previous statement, we present and discuss new trends in the assessment practice in Croatia, i.e. revision of routine health data collection, ways of performing intervention aimed health surveys, naturalistic approach in health needs assessment, and health needs research of population groups at highest risk.

Perceived exposure to substance use and risk-taking behavior in early adolescence: cross-sectional study.

AIM: To examine the relation between perceived exposure to parents, siblings, and peers' substance use and self-reported substance consumption among early adolescents in Primorsko-goranska county, Croatia, and between perceived exposure to substance use and risk-taking behaviors such as going out late at night, gathering at secluded places, skipping school, and gambling. METHOD: A self-reported cross-sectional survey was conducted in 2007 among 2219 eight-grade (14-year old) pupils in elementary schools in Primorsko-goranska county. Exposure to substance use in their immediate social environment, self-reported consumption of cigarettes, alcohol, inhalants, and marihuana, ways of spending free time, and family and peer relationships were assessed. RESULTS: There was a significant association between perceived exposure to substance use and self-reported consumption of cigarettes, alcohol, inhalants, and marihuana in both sexes (P < 0.001). Pupils whose parents, siblings, and peers used substances significantly more often developed the same behavioral patterns. Level of exposure to substance use in the immediate social environment had the strongest effect on experimenting with smoking among girls (from 26.6% in low exposure to 76.2% in high exposure group) and among boys (from 15.8% in low exposure to 69.4% in high exposure); on regular everyday smoking among girls (from 4.4% in low exposure to 45% in high exposure group) and among boys (from 2.7% in low exposure to 36.7% in high exposure group); on hard liquor consumption among girls (from 25.1% in low exposure to 79.5% in high exposure group) and among boys (from 28.1% in low exposure to 78.4% in high exposure group), as well as on binge drinking among girls (from 10.9% in low exposure to 56.6% in high exposure group) and among boys (from 15.5% in low exposure to 62.4% in high exposure group). Girls and boys exposed to substance use engaged more often in risk-taking and potentially delinquent behaviors (F(2, 1180) = 166 502; P < 0.001, two-way ANOVA). CONCLUSION: High exposure to substance use in immediate social environment and its great impact on substance use among early adolescents indicate that there is a need for the introduction of preventive programs that would reduce inappropriate behavior among adolescents' social models.

Regulatory T cells (Tregs) monitoring in environmental diseases.

The prevalence of environmental diseases is increasing worldwide and these diseases are an onerous burden both to the individual and to the public health. Urban air pollution is a grave problem in majority of metropolises, which contain high levels of traffic congestion generating great amounts of genotoxic substances. The contribution of such environmental exposure to increase prevalence of many allergic, environmental diseases and multiple chemical sensitivity or other related syndromes, as a result of an abnormal immune response based on environmental damage of lymphocyte subsets, is marked. Benzene is one of the most important air pollutants that are emitted by oil industry, since they are involved in almost every refinery process. Volatile organic compounds (VOCs) are a major group of air pollutants and play a crucial role in ecological damages, disturbing the ecosystem and human health. The variability of pollutants is an important factor in determining human exposure to these chemicals. The immune system possess a capacity to distinguish between innocuous and harmful foreign antigens and controls this action by mechanisms of central and peripheral tolerance, where crucial role play regulatory T cells (Tregs). We analyzed the characteristics of human Tregs of inhabitants living near gasoline industry which have assessed moderate spyrometric tests and compared them with those situated in rural areas. Our data demonstrate that the chronic inhalation exposure increases the percentage of Tregs cells, but contrary those of inhabitants with decreased spirometry values have shown diminished number of Tregs, which may contribute to the new therapeutic approach of environmental diseases.

Assessment of psychological and social factors in adolescents risk behavior: questionnaire study.

AIM: To investigate the influence of psychological and social factors on health risk behaviors, such as smoking, alcohol and psychoactive drug consumption among adolescents and to determine the prevalence of consuming various psychoactive substances. METHODS: The survey was conducted among adolescents in the Primorsko-goranska County in Croatia in 2003. The prevalence of smokers, alcohol, and psychoactive drugs consumers and abstainers, with general and specific predictors for the development of risk behavior of 2,452 adolescents in Primorsko-goranska County was determined by means of valid self-reported questionnaires. The adolescents were stratified according to gender and type of secondary school. RESULTS: Every third student smoked cigarettes every day, and 73% consumed beer, wine, and alcoholic beverages occasionally. The percentage of illicit drugs consumption (experimental, occasional and regular) ranged from 2,3% for opiates to 35.6 for marihuana. Girls consumed more cigarettes, alcoholic beverages, and sedatives every day, whereas boys consumed more beer, wine, and marihuana. Consumption of all psychoactive substances was more prevalent among senior students. A moderate correlation was found between addictive resources consumption and negative peer influence and ways of spending free time. CONCLUSION: Most adolescents had personal experience with psychoactive substance use, mostly tobacco, alcohol, and marihuana. The strongest predictors were negative peer influence and ways of spending free time. These findings may be useful for formulating strategies for prevention of addiction among adolescents.