SOME INDICATORS OF HEALTH CARE STATUS IN CROATIA.

The article presents the basic principles of health care, health care measures and strategic objectives of these measures in Croatia. The health of the population does not depend solely on the activities of the health care system but also on various demographic indicators. Our success in implementing health care depends largely on the structure of health facilities and health workers. The Croatian health system in late 2013 had permanently employed 74,489 workers. Out of these, 77% were health care workers. Most health care workers had only secondary school education (37.7%); physicians represented 17.4% of the workforce. On assessing the health of the population, certain health indicators are of utmost importance. The leading cause of deaths were circulatory diseases (in 2012, 24,988 persons died, 585.5/100,000). Neoplasms were the cause of death in 13,940 persons (326.6/100,000), then injuries and poisoning (69.1/100,000), diseases of the gastrointestinal system (53.1/100,000), and respiratory diseases (50.4/100,000). Data are presented on the basis of diseases reported from several national registries (cancer, psychoactive drug abuse, the disabled, diabetes, and suicides). The importance of vaccination for the control of infectious diseases in Croatia is especially emphasized, as well as the experience and excellent results achieved in this area. The epidemiological situation in Croatia in terms of infectious diseases can be assessed as favorable. This is due to the general living conditions, which contributed to the entire health system, making Croatia equal to other developed countries of Europe and throughout the world.

[A STUDY INVESTIGATING THE FACTORS OF INTERNET ADDICTION]. / ISTRAZIVANJE CIMBENIKA NASTANKA OVISNOSTI O INTERNETU.

The aim of the study was to explore the characteristics of Internet use among elementary school eighth-graders in the Bjelo- var-Bilogora County, to evaluate gender and sociodemographic differences, and to examine predictors for Internet addiction. The study included 437 (female 51%) eighth-graders, mean age 13.8 ± 0.5 years. An anonymous questionnaire was used to measure the participants' Internet use, the functions for which they used Internet, their parents' attitude towards the child's Internet use, and their signs of Internet addiction. Logistic regression was conducted to evaluate predictors for Internet addiction. The majority of children (71.5%) reported using Internet every day. Considering important risk factors of Internet addiction development, we found that 32% of children almost always stayed on-line longer than intended, 13% of boys and 4% of girls almost always neglected chores to spend more time on-line and 51.7% of children thought their life would be boring and uninteresting without the Internet. There was no significant difference between urban and rural students. In terms of the function for which they used the Internet, they were mostly engaged in on-line community/chat websites (70%), to listen to music and watch movies (81 %), and boys in gaming websites. Most of the students (43.4%) spent 1-2 hours daily on-line, 26.2% of students spent 3-4 hours on-line, and 9% spent more than 5 hours daily on-line. In conclusion, more public health preventive measures should be conducted to raise public awareness and concern about the negative effect of Internet use and Internet addiction, especially in the young population.

[Relationship of perception conflict and assertiveness in nurses]. / Ispitivanje odnosa percepcije sukoba i asertivnoski kod medicineskih sestara.

At their workplace, nurses are exposed to a number of conflict situations. On dealing with such situations, a significant role is played by assertiveness skills. Assertiveness is the necessity of efficient communication between nurses and patients. Thus, development of these skills can enhance patient confidence in the nursing profession. The aim of the study was to determine whether there are differences in assertiveness with respect to age and sex, and whether there is and what is the connection between assertiveness, potential sources of conflict at work, conflicts due to the behavior of associates, resolving conflicts and self-assessment in resolving conflicts. The survey included 87 hospital nurses. The questionnaire included assessment of assertiveness. On processing the results, we calculated the indicators of descriptive statistics, carried out the variance analysis and t-test, and calculated Pearson's correlation coefficients. It was found that the majority of subjects expressed a medium level of assertiveness, i.e. they could be considered as relatively assertive persons. There were significant differences in assertiveness according to age of the subjects and length of service, where the oldest age group was significantly less assertive. More assertive subjects frequently observed behaviors that may be a source of conflict and problems in the organization of work. At the same time, they often had conflicts because of such behavior, which indicated that more assertive subjects were bolder and more secure. More assertive subjects believed that they were more successful in resolving conflicts than non-assertive subjects.

Spinal deformities among pupils - A growing issue.

This paper presents data obtained by somatic examination of pupils in the 1st, 5th and 8th grade of elementary school in the area of the Town of Split in the period of three school years. There was a corresponding increase in bad posture, over the school years observed, with an increase in kyphosis among pupils of both genders, The occurrence of kyphosis among boys ranged from 0.49% in the first grade, 0.88% in the fifth grade, to 2.11% in the eighth grade. The frequency of kyphosis was at first somewhat lower in girls; however, it significantly increased later, exceeding the frequency among male students. Thus, kyphosis in girls ranged from 0.42% in the first grade, 0.88% in the fifth grade, and even up to 4.60% in the eighth grade of elementary school. Therefore, the ratio of 14-year old girls to boys with kyphosis was 2.2:1. The frequency of scoliosis among boys ranged from 0.55% in the first grade, 2.13% in the fifth grade, and up to 3.01% in the eighth grade. Throughout the whole period, the frequency of this deformity was higher in girls than boys. Thus, scoliosis in female students ranged from 0.89% in the first grade, 3.23% in the fifth grade, and even up to 5.70% in the eighth grade. It is obvious that scoliosis as a deformity affects girls significantly more often than boys during the entire period of elementary school, and the ratio at the age of 14 is 1.8:1.

Q fever in Croatia: war-induced changes in epidemiological characteristics.

The article describes the epidemiological characteristics of Q fever in Croatia, during the period before and after the Homeland War. In the ten years prior to the Homeland War (1983-1992) 1053 cases of Q fever were recorded, 16.2% (171) of which on islands and in coastal areas. In the period after the Homeland War (1995-2008), a total of 654 cases was recorded, 59.9% (392) of which on islands and in coastal areas. In addition to reduced incidence, geographic distribution of the disease also changed. Before the war, the highest morbidity rate was recorded in the Sisak-Moslavina County. After the war, the Split-Dalmatia County recorded the highest morbidity rate because in the post-war period sheep from Bosnia and Herzegovina went to this county for winter grazing. The disease might be relevant to the Croatian Army and other armed forces that stay in Croatia as part of NATO forces.

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.

Historic, demographic, and genetic evidence for increased population frequencies of CCR5Delta32 mutation in Croatian Island isolates after lethal 15th century epidemics.

AIM: To assess the frequency of 32 base pair deletion in CCR5 (CCR5Delta32), which has been shown to confer resistance to HIV infection in a homozygous form, in 10 isolated island communities of Dalmatia, Croatia, with different histories of exposure to epidemics during and since the medieval period. METHODS: In 2002, DNA analysis of 100 randomly selected individuals from each of the 10 isolated communities of 5 Croatian islands (Susak, Rab, Vis, Lastovo, and Mljet) showed high levels of 3-generational endogamy, indicating limited gene flow. Five of the communities were decimated by epidemics of unknown cause between 1449-1456, while the other 5 villages remained unaffected. Genotyping of the CCR5 gene was performed using the polymerase chain reaction method with primers flanking the region containing 32-bp deletion. RESULTS: The frequency of CCR5Delta32 in the 5 villages affected by the epidemic was 6.1-10.0%, and 1.0-3.8% in the 5 unaffected villages. The Delta32 mutation was found in 71 of 916 alleles among the individuals from the affected villages (7.5%), and in 24 of 968 alleles in unaffected villages (2.5%, chi(2)=27.3, P<10-6). A previous study in 303 random Croatian blood donors showed the frequency of the CCR5 Delta32 of 7.1% in the general population. The difference remained significant after correcting for population structure using both STRAT and STRUCTURE software and the genomic control test, to ensure results do not arise from the background genetic differences. CONCLUSION: Our results and historical evidence, suggest that the mid-15th century epidemic could have acted as a selection pressure for the CCR5Delta32 mutation.

The antioxidant power and level of lipid peroxidation products in the sera of apparently healthy adult males.

The aim of this study was to determine the antioxidant potential of the serum and the level of lipid oxidation products in the sera of apparently healthy adult males. The "antioxidant power" of the serum, defined as the ability to reduce ferric ions by antioxidants from the serum (FRAP), was taken as the indicator of total antioxidation potential. The formation of lipid oxidation products was evaluated as thiobarbituric reactive species serum test (TBARS). The ferrous oxidation in xylenol orange version 2 (FOX2) assay coupled with triphenylphosphine was used for measurement of total sera hydroperoxides (ROOHs). The following biochemical variables were determined in the sera: aspartat aminotranspherase (AST), alanine aminotranspherase (ALT), gamma-glutamyl transpherase (GGT), bilirubin, glucose, creatinine, cholesterol, triglycerides and hemoglobin. Blood sera from apparently healthy subjects (166 adult males) were analyzed. Median age of study participants was 36 years (range 25-50 years). The X +/- SD sera FRAP level of the 166 apparently healthy adult males was 1047 +/- 131 micromol/L (779-1410 range). The X +/- SD level of sera TBARS was 1.2 +/- 0.3 micromol/L of the sera (0.5-2.2 range). Compared with the level of TBARS in the sera, the level of FOX2-ROOH was significantly higher The X +/- SD level of lipid hydroperoxides in the fresh sera, determined as FOX2, was 3.9 +/- 1.5 micromol/L of the sera (1.9-6.9 range). Observation of correlation between FRAP and determined biochemical variables in the sera have confirmed a statistically significant linear correlation between sera FRAP and bilirubin, hemoglobine, glucose, ALT and triglycerides (p < 0.05). The results of sera FRAP, TBARS and FOX2 levels can help in estimating the antioxidant status of humans. Significant correlation between the antioxidant power of blood serum and particular biochemical parameters indicates the complexity of defence mechanisms and various molecules involved in increasing the reduction power of the serum.

Epidemiological characteristics and clinical manifestations of Lyme borreliosis in Croatia.

OBJECTIVE: The goal was to show the epidemiological characteristics and clinical manifestations of Lyme borreliosis in Croatia. METHODS: Data on registered Lyme borreliosis cases were analyzed and the most common clinical manifestations of the disease, based on meta-analysis of the data collected, are described. RESULTS: A total of 3,317 cases were reported from 1987 to the end of 2003. Northwestern Croatia is an area in which Lyme borreliosis is endemic, but the disease has also been recorded in the other parts of the country, with the exception of the area south of Zadar. The clinical picture of Lyme borreliosis in Croatia is dominated by erythema migrans, followed by neurological manifestations. The diversified clinical picture is consistent with reports from other European countries, as is the isolation of Borrelia afzelii and Borrelia garinii, which are causally related to these forms of the disease. CONCLUSION: Tick density and tick infection rates of Borrelia burgdorferi have not yet been investigated in the part of Croatia free from the occurrence of Lyme borreliosis.

Effects of inbreeding, endogamy, genetic admixture, and outbreeding on human health: a (1001 Dalmatians) study.

AIM: (1001 Dalmatians) research program collects biomedical information from multiple small isolated populations ((metapopulation)) on Adriatic islands, Croatia, and investigates health effects of human population isolation, inbreeding, admixture, and outbreeding. METHODS: We collected random samples of 100 individuals from 9 island settlements and an additional sample of 101 immigrants to the islands, pooled from all study populations. According to their personal genetic histories, the examinees were categorized as inbred, autochthonous, admixed, and outbred. A total of 76 inbred individuals from a total sample of 1001 examinees were matched to 76 autochthonous, 76 admixed, and 76 outbred controls by gender, age (+/-5 years), village of residence, education, and socio-economic status. We investigated the effects of presumed individual genome-wide heterozygosity predicted from personal genetic histories on the following 10 traits: systolic and diastolic blood pressure, body mass index, high and low density lipoproteins and total cholesterol, triglycerides, uric acid, creatinine, and blood glucose. RESULTS: Personal genetic history significantly affected systolic blood pressure (Spearman rho=0.157, P=0.006), while the effect on cholesterol (rho=0.105, P=0.069), and high density lipoprotein cholesterol (rho=0.104, P=0.071) was suggestive. Admixed individuals and immigrants consistently showed values associated with lower health risk. When inbred and autochthonous samples were merged and compared with the admixed and outbred samples to increase the power of the study, the effects on the three traits above and also on body mass index and diastolic blood pressure became statistically significant. The medians for all 10 medically relevant traits in inbred and autochthonous group, with lower values of presumed individual genome-wide heterozygosity, were less favorable in terms of health. CONCLUSION: The combined effects of founder effect, genetic drift, and inbreeding can increase the frequency of detrimental rare variants in human metapopulations, leading to overall worsening of population health, whereas admixture and outbreeding appear to have the opposite effect.

[Epidemiologic characteristic of hepatitis B in the Splitsko-Dalmatinska County]. / Epidemioloske karakteristike hepatitisa B u Splitsko-Dalmatinskoj zupaniji.

Epidemiologic characteristics of hepatitis B virus (HBV) infection in the Split-Dalmatia County and in Croatia as a whole from January 1, 1994 till December 31, 2003 were analyzed. The mean number of hepatitis B cases was 28 (morbidity rate 6.03 per thousand) in the Split-Dalmatia County and 208 (morbidity rate 4.68 per thousand) in Croatia. Over the last five years, there was a marked decrease in the incidence of hepatits B in the Split-Dalmatia County (morbidity rate 1.55 per thousand), whereas its incidence at the national level showed a stable pattern (morbidity rate 4.49 per thousand). In the Split-Dalmatia County, the majority of patients (57.51%) were aged 15-29, which could be attributed to risky sexual contacts and intravenous drug use. The male to female ratio was 2.1(188:93). There was no major incidence fluctuation according to months of year. The hepatitis B mortality rate was 0.24% (5/2079) in Croatia as a whole, whereas no case of HBV lethality was recorded in the Split-Dalmatia County. The significant decrease in the hepatitis B morbidity rate in the Split-Dalmatia County most probably resulted from the comprehensive measures of prevention, especially vaccination, the early introduction of the needle exchange program (1955-1996).

Epidemiological characteristics of rickettsial diseases in Croatia.

OBJECTIVE: To show the presence and prevalence of rickettsial diseases and the geographic distribution in Croatia. METHODS: The pattern of these diseases was monitored during the 1992-2003 period. RESULTS: The rickettsial diseases that occur sporadically in the littoral of Croatia (Adriatic islands and the coastal area) include Mediterranean spotted fever, murine typhus, Brill-Zinsser disease, and a clinical entity known as rickettsioses. Mediterranean spotted fever and murine typhus are considered to be endemic exclusively in Dalmatia. CONCLUSION: The term rickettsioses has been used because of inadequate laboratory differentiation of causative agents; therefore, the species of rickettsiae responsible for this clinical entity remains unknown. Highly efficient, military, infectious disease research should be continued, to shed more light on this important issue.

Association of stress and delinquency in children and adolescents.

The aim of investigation was to assess the impact of subjective stress exposure on delinquent behaviour in children and adolescents. The study included 174 young male delinquents, selected by the method of stratified systematic (random) sample and divided into three age groups of <14, 14-17, and 18-21 years. General data, data on the type of criminal offence, and data on the type of deviant behaviour were collected. A standardised scale of subjective stress was used to allow for comparison of the results obtained in the study with those reported elsewhere. Analysis of variance, chi2-test and factor analysis were used on data processing. A majority of study subjects (55.2%) committed one criminal offence. The criminal offence structure was predominated by proprietary violation (66.7%). Common forms of deviant behaviour included shirking school duties (55.2%), and aggressive behaviour at school (31.0%), in public (29.5%) and in the family (23.6). Parental distrust and punishment (abuse) of the child were identified as the major sources of subjective stress. Youngest subjects significantly differed from other age groups according to their experience of subjective stress described as punishment (abuse) (F = 22.1389, p < 0.001). They were considerably more vulnerable to this type of stress than older age groups. These sources of stress were found to positively correlate with the number of criminal offences committed. Among the sources of stress, parents' distrust of the child significantly correlated with commitment of one criminal offence (F = 2.8618, p < 0.05), and child's punishment (abuse) with a higher number of criminal offences (F = 3.1539, p < 0.05). Criminal activity of children and adolescents is significantly associated with their history of stress exposure over the last two years of life. The higher the stress severity, the greater the rate of delinquency.

[Antioxidative activity of propolis from Dalmatia (Croatia)]. / Antioksidacijski kapacitet dalmatinskog propolisa.

AIM: The aim of this study was to determine the antioxidative activity of propolis from ecologically clean parts of Dalmatia. METHODS: Phenol concentration in ethanolic propolis extracts was determined by Folin-Ciocalteu reagent using gallic acid as the standard. Flavonoid phenolic compounds were analyzed after precipitation with formaldehyde. The residual non-flavonoid phenolics were also determined by Folin-Ciocalteu method. By determining the change of peroxide number (PN), of tiobarbiture acid reactive species (TBARS), and of DPPH-radical activity, antioxidative efficiency of propolis was tested and compared with well known and widely used synthetic antioxidants. Values of PN and TBARS were determined at 60 degrees C in samples of trigyceride substrate (lard) without and with the addition of antioxidants. Compared was the efficiency of three antioxidants: propolis (alcoholic extract), vitamin E, and (+)-catechin in a concentration of 1%. PN was monitored during 50 days. By the method of Sedlacek, TBARS were measured during 30 days. Antioxidative activity of propolis extract was also measured in terms of hydrogen donating ability using stable radical alpha,alpha-diphenyl-beta-picril hidrazyl (DPPH*) and compared with commercial synthetic antioxidants of butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and (+)-cathecin. Inhibition degree of DPPH* was calculated by the formula of Yen and Duh. RESULTS: Total phenol content, expressed as gallic acid, in propolis extracts varied from 75.2 to 90.2 g/kg propolis. The proportion of flavonoids in total phenols ranged from 62% to 65%. Values of TBARS were not increased only in samples with added propolis. The inhibition of DPPH-radical by propolis extracts ranged from 93% to 96%, by catechin 95%, by BHT 49%, and by BHA 64%. Compared to BHT and BHA, propolis extracts showed greater reducing activity against DPPH-radical. DISCUSSION: The chemical composition of propolis, and thus its biological activity depend on the plant from which it has been collected, and on the macro- and microclimatic conditions. Many compounds in propolis exert antioxidative activity. A belief was expressed that the biological activity of propolis is very probably based mostly on its antioxidative efficiency. Dalmatian propolis showed high efficiency in the prevention of oxidative processes. This could be explained by the high proportion of polyphenol constituents, especially flavonoids. A very low and equal degree of increase of PN, as a measure of oxidative processes, was noticed in the samples of triglyceride substrate with the addition of propolis and (+)-catechin. The greatest rise of TBARS was measured in the samples of pure lard. There was no increase of TBARS only in the samples with added propolis. Propolis and (+)-catechin showed great efficiency in the inhibition of DPPH-radical, greater than BHT and BHA, which are widely used in food industry. CONCLUSION: The results indicate that Dalmatian propolis could be an efficient protective agent against oxidative processes in food. The high antioxidative activity of propolis, its natural origin, and present knowledge about its biological properties, make it a very promising nutritional additive for human diet.

[Some epidemiologic characteristics of foodborne intoxications in Croatia during the 1992-2001 period]. / Neke epidemioloske osobitosti alimentarnih toksoinfekcija u Hrvatskoj u razdoblju 1992.-2001. godine.

Epidemiologic characteristics of foodborne intoxications registered in Croatia during the 1992-2001 period are described. Salmonellosis, as well as staphylococcal food intoxication, foodborne botulism, Clostridium perfringens food intoxication, histamine poisoning and food intoxication caused by other pathogens, especially conditionally pathogenic bacteria, were analyzed. During the study period, 87,782 cases were reported, 45,721 (52.1%) of them related to salmonellosis and the rest of 42,061 (47.9%) cases to foodborne intoxications of various etiology. The diseases occurred throughout the year, with a higher proportion in summer than at any other time of year. During the study period, 480 outbreaks of foodborne intoxications with 10,567 cases were reported, 405 (84.4%) of them with 8476 cases related to salmonellosis. The most frequently isolated pathogen in salmonellosis outbreaks was Salmonella enteritidis with 345 (85.2%) outbreaks. The outbreaks of salmonellosis were primarily associated with the intake of pastries (40.1%). Ice-cream was associated with a high risk of staphylococcal food intoxication, and bean salad of Clostridium perfringens food intoxication. The food vehicle of transmission most often associated with foodborne botulism outbreaks was smoked ham. Histamine poisoning, recorded in four outbreaks, occurred after consumption of fish and fish products. Salmonellosis outbreaks most frequently occurred at home (n=149; 36.8%), followed by pastry shops with 47 (11.6%) outbreaks, the latter also ranking first in the outbreaks of staphylococcal food intoxication (40%).

[What is new in the epidemiologic characteristics of hemorrhagic fever with renal syndrome in Croatia?]. / Sto je novo u epidemioloskim osobitostima hemoragijske vrucice s bubreznim sindromom u Hrvatskoj?

AIM: The aim was to describe epidemiologic characteristics of hemorrhagic fever with renal syndrome in Croatia. METHODS: We analyzed published data from obligatory infectious disease reports and notification of deaths due to infectious diseases, data on the hemorrhagic fever with renal syndrome epidemics in Croatia, and our own data. RESULTS AND DISCUSSION: During the 1987-2002 period, 555 cases of hemorrhagic fever with renal syndrome were recorded in Croatia, 160 (28.8%) of them in soldiers. The mortality rate was up to 15.4% (mean 1.1%) (6/555). The highest number of cases (317) were recorded during 2002. The epidemic started in winter. The highest number of cases were recorded in June and July, i.e., during the warm season characterized by an increased activity of both animals acting as infection reservoirs and humans as hosts. The epidemic spread almost throughout Croatia. The known natural foci of hemorrhagic fever with renal syndrome are Plitvice and Slunj areas, Dinara mountain, Velika and Mala Kapela mountains, Zagreb area (Velika Gorica and Jastrebarsko), Gorski kotar area (Ogulin, Delnice), west Slavonia, and Novska area. The disease has not been recorded in the littoral area and on Adriatic Islands. The disease was also recorded in the neighboring countries of Slovenia, Bosnia and Herzegovina, Serbia and Montenegro. The identified causative agents include Dobrava and Puumala viruses of the genus Hantavirus, whereas the rodents Clethrionomys glareolus, Apodemus flavicollis, Apodemus agrarius and Apodemus sylvaticus serve as the main reservoirs of the infection in Croatia. Typical biotopes of the infection in Croatia are deciduous woods. CONCLUSION: The 2002 epidemic confirms the presumption that almost all continental part of Croatia contains natural foci of hemorrhagic fever with renal syndrome.

Epidemiologic characteristics and military implications of hemorrhagic fever with renal syndrome in croatia.

AIM: To analyze epidemiologic characteristics of hemorrhagic fever with renal syndrome in Croatia, including military implications of the disease and measures for its prevention. METHOD: We analyzed data from obligatory infectious disease reports and notification of deaths due to infectious diseases, data on the hemorrhagic fever with renal syndrome epidemics in Croatia, and data collected by survey of the population, serological findings, and studies of wild rodents serving as reservoirs of the infection. RESULTS: During the 1987-2001 period, 235 cases of hemorrhagic fever with renal syndrome were recorded in Croatia, with 147 (62.6%) of them among Croatian Army soldiers. Mortality rate was up to 15.4% (mean 2.2%) (5/235). The highest number of cases was recorded in months of June and July, ie, during the warm season characterized by increased activity of both the animals acting as infection reservoirs and humans as hosts. The known natural foci of hemorrhagic fever with renal syndrome have been Plitvice and Slunj areas, Velika and Mala Kapela mountains, Zagreb area (Velika Gorica and Jastrebarsko), west Slavonia, Novska area, and Dinara Mountain. The disease has not been recorded in the littoral area and Adriatic islands. The identified causative agents include Dobrava and Puumala viruses of the genus Hantavirus, whereas rodents Clethrionomys glareolus, Apodemus flavicollis, Apodemus agrarius, and Apodemus sylvaticus serve as the main reservoirs of the infection. Typical biotopes of the infection in Croatia are deciduous woods. The measures of prevention in Croatia include pest control, disinfection, hygienic waste disposal, preventing rodent access to food and water, proper choice of camping sites, and health education. CONCLUSION: Hemorrhagic fever with renal syndrome occurs predominantly in soldiers, in a sporadic or epidemic form. Because of the course of disease and potentially lethal outcome, the disease has a considerable impact on the field task performance and combat readiness of military units, and is of great importance for a military community. Accommodation in permanent buildings with appropriate common and personal hygiene standards is recommended.

[Gas gangrene and hyperbaric oxygenation--a lesson forgotten or never learned?]. / Plinska gangrena i hiperbaricna oksigenacija--zaboravljena ili nikad naucena lekcija?

Gas gangrene develops in devitalized hypoxic tissue. It spreads rapidly under strong influence of enzymes produced by the causing bacteria and often results in fatal outcome. It is of utmost importance to stop toxin production as soon as possible, which is most effectively achieved by early application of hyperbaric oxygenation (HBO2), as the first measure in a "trident" (HBO2, antibiotics, surgical measures). The paper reviews the most important data from microbiology, pathophysiology and epidemiology of gas gangrene, current clinical practice, scientific basis for application of HBO2 in the treatment of this disease, and data from the archives of the Naval Medical Institute of the Croatian Navy in Split (NMI). At the NMI, in the period from 1982 to 2000, HBO2 was administered in the treatment of 21 patients with gas gangrene, of average age 41.6 +/- 16.3 years. The average treatment consisted of 6.8 +/- 3.8 sessions. 13 (76%) patients were cured.

[Nutritive density of zinc, copper, iron and manganese in daily diet of adults]. / Nutritivna gustoca cinka, bakra, zeljeza i mangana u dnevnoj prehrani odraslih osoba.

The aim of the present study was to determine the actual daily dietary intake of zinc, copper, manganese and iron in daily meals. The mass amounts of this micronutrients were determined by flame atomic absorption techniques. The daily meals from public organised nutrition were collected using random sampling during 1998-1999. The energetic and nutritive quality of total diet and nutritive density of zinc, copper, iron and manganese were evaluated and compared with WHO/FAO recommendations.