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.

Utilization of cardiovascular drugs in Zagreb 2001-2005.

OBJECTIVE: The purpose of this study was to investigate the outpatient utilization of cardiovascular drugs in Croatia, during the period 2001-2005, using the Anatomical Therapeutic Chemical classification of drugs/Defined Daily Dose (ATC/DDD) methodology. METHODS AND RESULTS: Data on outpatient drug utilization were obtained from the Zagreb Municipal Pharmacy to calculate the number of defined daily dose (DDD), and DDD per 1000 inhabitants per day (DDD/1000/day). The drug utilization 90% (DU90%) method was used on drug prescribing quality assessment. Data on hospital admissions were collected from the inpatient database kept at the Zagreb Institute of Public Health. Total utilization of cardiovascular drugs (ATC group C), was between 402.9 Defined Daily Dose per 1000 inhabitants per day (DDD/TID) and 362.9 DDD/TID in Croatia between 2001 and 2005. Agents acting on the renin-angiotensin system (C09) (104.2 DDD/TID) and calcium channel blockers (C08) (80.5 DDD/TID) accounted for more than 50% of drugs used for the treatment of hypertension in 2005. A great increase in the utilization was observed for statins (78.3%). A markedly increasing utilization was recorded for angiotensin-converting enzyme (ACE) inhibitors in combination with hydrochlorothiazide (HCTZ) (40.5%) and angiotensin II antagonists (278%). Comparison of the DU90% segment between 2001 and 2005 revealed pentoxifylline and amiodarone to be absent, whereas cilazapril and ramipril in combination with HCTZ, bisoprolol, valsartan and losartan alone or in combination with HCTZ were added in 2004 and 2005. The total rate of hospital admissions for major cardiovascular events decreased by 18.2%. CONCLUSION: The utilization pattern was improved in 2005, showing a decrease in the number of hospital admissions for major cardiovascular events.

Emerging risk for viral hepatitis A in Croatian adults.

An objective of the study was to determine the changes in the risk of developing hepatitis A in the 30-years period and discuss the need for vaccination against HAV infection in Croatia and the city of Rijeka comparing incidence of hepatitis A between 1970-1974 and 2000-2004 periods. Hepatitis A declined in both populations and affected more prominently older population groups. Improvement of hygiene and sanitary conditions appears to have decreased hepatitis A incidence among children and adults, but only a seroepidemiological study can give more accurate data as a basis for discussion on the necessity of vaccination as a further measure in reducing hepatitis A incidence.

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.

Micro-scale socioeconomic inequalities and health indicators in a small isolated community of Vis Island, Croatia.

AIM: To investigate whether socioeconomic inequalities at a micro-scale, through their effect on major health risk factors and other health indicators, contribute to health status in an isolated island population with demonstrated reduced genetic and environmental variability. METHODS: This cross-sectional study was performed in 2003 and 2004 in the adult population of the island of Vis, Croatia. Participants were recruited from the electoral register. A total of 1024 participants were included in the study, which represented a response rate of approximately 70%. The level of education and household socioeconomic status were used as the socioeconomic status indicators. Associations of these indicators with hypertension, obesity, hyperlipidaemia, smoking, diet indicators, and supplementary vitamins and calcium intake were investigated. Data analysis was performed by multivariate methods. RESULTS: Age and gender were most commonly associated with the presence of major health risk factors. Level of education did not show significant association with any of the investigated risk factors, supplements intake, or with dietary habits. Household socioeconomic status was significantly associated only with excessive alcohol intake (logistic regression odds ratio [OR], 1.85; 95% confidence interval [CI], 1.12-3.07, P=0.016), obesity (OR, 1.78; 95% CI, 1.13-2.81 P=0.013), and high-fat diet (multiple linear modeling F=2.75, P=0.042). CONCLUSION: In isolated communities, socioeconomic stratification may be a less important health determinant than in large general populations, making these populations favorable resource for biomedical research into other health risk factors.

Demonstrating reduced environmental and genetic diversity in human isolates by analysis of blood lipid levels.

AIM: To test the hypothesis that phenotypic diversity in isolated human populations is decreased in comparison with general outbred population because of reduced genetic and environmental diversity. To demonstrate this in populations for which reduced genetic and environmental diversity had already been established, by studying the amount of variation in plasma lipid levels. METHODS: Fasting plasma lipid levels (cholesterol, triglycerides, low density lipoprotein [LDL], and high density lipoprotein [HDL]) were measured in randomly selected 300 inhabitants from 2 isolated human populations, the island of Rab and the neighboring islands of Vis and Lastovo, Croatia. The populations were chosen based on previous analyses of genetic diversity and lifestyle patterns, which were shown to be both less diverse and more uniform than the general Croatian population. We studied whether the 25'-75' and 5'-95' interpercentile ranges in observed values were consistently smaller in 2 samples of 300 examinees from isolated populations in comparison with nearly 6000 examinees from an earlier study who were demographically targeted to represent the larger Croatian population. RESULTS: General population had much wider range of observed values of triglycerides and HDL than both isolated populations. However, both isolated populations exhibited greater extent of variation in the levels of LDL, while the ranges of cholesterol values were similar. CONCLUSION: Although reduced genetic and environmental diversity in isolated human populations should necessarily reduce the variance in observed phenotypic values, it appears that specific population genetic processes in isolated populations could be acting to maintain the variation. Departure from the Hardy-Weinberg equilibrium due to consanguinity, sub-structuring and differentiation within the isolates, and increased rate of new mutations could theoretically explain this paradox.

Work related diseases and injuries on an oil rig.

The analysis of diseases and injuries in the workers on an American oil rig, operating in the Mediterranean Sea, was done in the period of one year, from 1 May 1996 to 1 May 1997. In total, 518 medical examinations of sick and injuried workers were conducted. At the first place in morbidity, there were injuries and poisonings (26.7% of all registered cases). Then followed musculo-skeletal (17.5%), respiratory (14.2%), gastrointestinal diseases (12.1%), mental disorders (10.3%), nervous system (9.2%), skin (6.5%), urogenital (2.9%) and circulatory system diseases (0.6%). Out of all cases, the hand and finger injuries (48.3%) were most frequent, followed by injuries of the leg (13.4%), eye (11.3%), head and neck (10.1%), arm (7.9%), foot (6.7%) and trunk (2.3%). To reduce the incidence of diseases and injuries, special attention should be paid to the workers' basic medical education, to protective measures and providing first aid at the work site.