Raising Epidemiological Awareness: Assessment of Measles/MMR Susceptibility in Highly Vaccinated Clusters within the Hungarian and Croatian Population-A Sero-Surveillance Analysis.

Perceptions of the complete eradication of vaccine-preventable diseases such as measles, mumps, and rubella (MMR) may foster complacency and compromise vaccination efforts. Decreased measles vaccination rates during the COVID-19 pandemic have heightened the risk of outbreaks, even in adequately vaccinated populations. To address this, we have aligned with ECDC recommendations, leveraging previous cross-border sero-epidemiological assessments between Pécs, Hungary, and Osijek, Croatia, to identify latent risk groups and uncover potential parallels between our nations. Testing 2680 Hungarian and 1764 Croatian serum samples for anti-MMR IgG via ELISAs revealed anti-measles seropositivity ratios below expectations in Croatian cohorts aged ~20-30 (75.7%), ~30-40 (77.5%) and ~40-50 years (73.3%). Similarly, Hungarian samples also showed suboptimal seropositivity ratios in the ~30-40 (80.9%) and ~40-50 (87.3%) age groups. Considering mumps- and rubella-associated seropositivity trends, in both examined populations, individuals aged ~30-50 years exhibited the highest vulnerability. Additionally, we noted congruent seropositivity trends across both countries, despite distinct immunization and epidemiological contexts. Therefore, we propose expanding research to encompass the intricate dynamics of vaccination, including waning long-term immunity. This understanding could facilitate targeted interventions and bolster public awareness. Our findings underscore persistent challenges in attaining robust immunity against measles despite vaccination endeavors.

Following Natural Autoantibodies: Further Immunoserological Evidence Regarding Their Silent Plasticity and Engagement in Immune Activation.

Contradictory reports are available on vaccine-associated hyperstimulation of the immune system, provoking the formation of pathological autoantibodies. Despite being interconnected within the same network, the role of the quieter, yet important non-pathological and natural autoantibodies (nAAbs) is less defined. We hypothesize that upon a prompt immunological trigger, physiological nAAbs also exhibit a moderate plasticity. We investigated their inducibility through aged and recent antigenic triggers. Anti-viral antibodies (anti-MMR n = 1739 and anti-SARS-CoV-2 IgG n = 330) and nAAbs (anti-citrate synthase IgG, IgM n = 1739) were measured by in-house and commercial ELISAs using Croatian (Osijek) anonymous samples with documented vaccination backgrounds. The results were subsequently compared for statistical evaluation. Interestingly, the IgM isotype nAAb showed a statistically significant connection with anti-MMR IgG seropositivity (p < 0.001 in all cases), while IgG isotype nAAb levels were elevated in association with anti-SARS CoV-2 specific seropositivity (p = 0.019) and in heterogeneous vaccine regimen recipients (unvaccinated controls vector/mRNA vaccines p = 0.002). Increasing evidence supports the interplay between immune activation and the dynamic expansion of nAAbs. Consequently, further questions may emerge regarding the ability of nAAbs silently shaping the effectiveness of immunization. We suggest re-evaluating the impact of nAAbs on the complex functioning of the immunological network.

The adaptation of noise-induced temporary hearing threshold shift predictive models for modelling the public health policy.

OBJECTIVES: It has been shown that monitoring temporary threshold shift (TTS) after exposure to noise may have a predictive value for susceptibility of developing permanent noise-induced hearing loss. The aim of this study is to present the assumptions of the TTS predictive model after its verification in normal hearing subjects along with demonstrating the usage of this model for the purposes of public health policy. MATERIAL AND METHODS: The existing computational predictive TTS models were adapted and validated in a group of 18 bartenders exposed to noise at the workplace. The performance of adapted TTS predictive model was assessed by receiver operating characteristic (ROC) analysis. The demonstration example of the usage of this model for estimating the risk of TTS in general unscreened population after exposure to loud music in discotheque bars or music clubs is provided. RESULTS: The adapted TTS predictive model shows a satisfactory agreement in distributions of actual and predicted TTS values and good correlations between these values in examined bartenders measured at 4 kHz, and as a mean at speech frequencies (0.5-4 kHz). An optimal cut-off level for recognizing the TTS events, ca. 75% of young people (aged ca. 35 years) may experience TTS >5 dB, while <10% may exhibit TTS of 15-18 dB. CONCLUSIONS: The final TTS predictive model proposed in this study needs to be validated in larger groups of subjects exposed to noise. Actual prediction of TTS episodes in general populations may become a helpful tool in creating the hearing protection public health policy. Int J Occup Med Environ Health. 2023;36(1):125-38.

Measles Vaccination and Outbreaks in Croatia from 2001 to 2019; A Comparative Study to Other European Countries.

Due to the current burden of COVID-19 on public health institutions, increased migration and seasonal touristic traveling, there is an increased risk of epidemic outbreaks of measles, mumps and rubella (MMR). The aim of the present study was to analyze the epidemiological data on MMR immunization coverage and the number of measles cases in 2001−2019 in Croatia and a number of European countries. Results revealed a decreasing trend in vaccination in 2001−2019 throughout Europe. However, Croatia and Hungary still have the highest primary and revaccination coverage, compared to other analyzed countries. The highest number of measles cases was in 2017 in Romania. There was no significant correlation between the percentage of primary vaccination and the number of measles cases (r = −0.0528, p = 0.672), but there was a significant negative correlation between the percentage of revaccination and the number of measles cases (r = −0.445, p < 0.0001). In conclusion, the results of the present study emphasize the necessity to perform a full protocol of vaccination to reach appropriate protection from potential epidemic outbreaks. Furthermore, in the light of present migrations, documenting the migrants' flow and facilitating vaccination as needed is of utmost importance to prevent future epidemics.

Dynamic Features of Herd Immunity: Similarities in Age-Specific Anti-Measles Seroprevalence Data between Two Countries of Different Epidemiological History.

(1) Background: Measles immunization gap(s) raise the concern of potential outbreaks. Both Croatia and Hungary are situated in the vicinity of measles-endemic countries. Potentially compromised immunization activities due to the COVID-19 surge is a ground for concern. Our aim was to compare age-stratified seroprevalence results in the cross-border region. (2) Methods: Anti-MMR specific antibody levels (IgG) of 950 anonymous Croatian samples were compared with previous Hungarian results (n > 3500 samples), and former Croatian seroprevalence data (n = 1205). Seropositivity ratios were determined using our self-developed anti-MMR indirect ELISA (Euroimmun IgG ELISA kits were used as control). (3) Results: Measured seropositivity ratios of the Croatian samples were largely overlapping with our earlier published Hungarian data (the lowest seropositivity ratios were measured among individuals of 34-43 years of age with 78% of seropositivity) and are in accordance with earlier published data of Croatian researchers. (4) Conclusion: Although the epidemiological histories of the two countries are different, analogies in age-specific measles susceptibility have been discovered. We suggest that besides the potential coincidence in vaccination ineffectiveness, the inherent biological dynamics of vaccination-based humoral protection might have also contributed to the experienced similarities. Our findings may also serve as a lesson regarding the current anti-COVID-19 vaccination strategy.

Adenoma Characteristics and the Influence of Alcohol and Cigarette Consumption on the Development of Advanced Colorectal Adenomas.

Background: Colorectal cancer (CRC), one of the leading public health problems worldwide, is a disease that can be prevented when it is detected in time. The objectives of this cross-sectional study were to investigate the characteristics of colorectal adenomas and whether alcohol consumption and cigarette smoking correlated with the development of advanced adenomas in participants in The National Programme for Early Detection of Colorectal Cancer (NP) in Osijek-Baranja County (OBC), Croatia. Methods: The screening methods were the guaiac Faecal Occult Blood Test (gFOBT), colonoscopy, histological analysis, and risk factor questionnaire. Results: The results showed the presence of adenomas in 136 men (57.4%) and 101 women (42.6%), p < 0.001. There was one adenoma in 147 (62%) most commonly located in sigmorect, in 86 (59%) participants, and 44 (18.6%) participants had multiple adenomas, most commonly found in multi loc, p < 0.001. According to size, 118 (49.8%) of all adenomas were between 0.1 and 0.9 cm, while adenomas of 3 cm 19 (8%) were the fewest, p < 0.001. There were 142 (59.9%) advanced adenomas. Conclusions: Adenoma development in the OBC population was correlated with predictors: adenoma size, high-grade dysplasia, smoking and alcohol consumption of 20 g per day. Non-smoking was found to be a health protective behaviour.

A Data-informed Public Health Policy-Makers Platform.

Hearing loss is a disease exhibiting a growing trend due to a number of factors, including but not limited to the mundane exposure to the noise and ever-increasing size of the older population. In the framework of a public health policymaking process, modeling of the hearing loss disease based on data is a key factor in alleviating the issues related to the disease and in issuing effective public health policies. First, the paper describes the steps of the data-driven policymaking process. Afterward, a scenario along with the part of the proposed platform responsible for supporting policymaking are presented. With the aim of demonstrating the capabilities and usability of the platform for the policy-makers, some initial results of preliminary analytics are presented in the framework of a policy-making process. Ultimately, the utility of the approach is validated throughout the results of the survey which was presented to the health system policy-makers involved in the policy development process in Croatia.

Value of cytology in small cell lung carcinoma diagnostic--single-center study.

Small cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosis was SCLC. The value of cytological diagnosis was determined by comparing it with histological findings obtained from a biopsy sample during bronchoscopy or on a resection specimen in 50 patients. In the remaining 77 patients, histological verification of cytological diagnosis was not made and the patients were treated based on cytological diagnosis of small cell carcinoma. In 76% of cases (38/50) cytological diagnosis of small cell lung carcinoma was also confirmed histologically. In 8% of cases (4/50) adenocarcinoma was histologically confirmed, in 10% (5/50) of the cases the squamous carcinoma was confirmed, and there was one case of urothelial carcinoma, one case of sarcoma and one undifferentiated carcinoma. Cytological diagnosis of SCLC was made in all cases in a brush smear while the catheter aspirate was positive in only 32 cases (25.8%). Median survival in the group of patients with histologically confirmed small cell cancer was 238 days, for women 250 days, and for men 237 days. Cumulative survival was 63.2% for 6 months, 26.3% for 12 months, 13.2% for 18 months and 7.9% for two years. In conclusion, cytology is a reliable and relatively non-invasive method for patients. Our results confirm that there is a good correlation between cytology and histology diagnoses, especially when it comes to malignant lesions. In determining the type of tumor cytology must be supported with additional methods, especially in cases when it is not possible to take samples for histological verification.

Malignant neoplasms of respiratory and intrathoracic organs (C30-C39) in the Osijek-Baranja County, Croatia.

The Institute of Public Health of the Osijek-Baranja County in collaborate with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The cancers were defined according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), codes of malignant neoplasms of respiratory and intrathoracic organs (C30-C39). The aim of this article was to show the size of cancer problem with the C30-C39 cancer group in the Osijek-Baranja County (OBC). This article processes data on cancer incidence and mortality, appertaining age distribution, median age, cancer survival and length of stay in hospital collected in period 2001-2009. Out of all patients diagnosed with C30-C39 cancers, there were 18.2% of females and 81.8% of males. The total incidence rate in males (119.5/100,000) decreases while the total mortality rate (110.9/100,000) does not change in 9-year period. In the same period, the total mortality rate in females (15.7/100,000) increase moderately. The age-standardized incidence rate was six times higher in males than in females. The overall median age at diagnosis of C30-C39 cancers of both genders was 64.5 years, which exceeds the average age at diagnosis of cancer in general in the OBC by 4.8 years. Five-year relative survival rate was 14.8%, 19.7% for females and 13.7% for males. Male lung and bronchus cancer patients (C34) were 1 year younger at diagnosis of cancer than the respective female patients. An average C30-C39 cancer patient was hospitalized 2.0 times during the course of their illness while the median length of stay in hospital amounted to 16.1 days. The number of hospital admissions in both genders decreased over the 2001-2009 period. In both genders, the total length of stay in hospitals was slightly reduced. Females spent 0.4 days more in hospital than males. The overall incidence and mortality rate in the OBC were among the highest in Europe. However, these rates in females reached neither the Croatian nor the EU average. Other data are similar to those in Europe.

The burden of hospitalised carcinoma patients in Osijek-Baranja County, Croatia, 1998-2010.

The purpose of this paper was to determine the number and trend of hospitalisations caused by carcinoma in the Osijek-Baranja County, to to determine the proportion of these hospitalizations compared to all other hospitalization, as well as to determine the burden put on the hospitals by external patients (those not residing in the Osijek-Baranja County area). There has been an average of 10.1% of hospitalisations caused by carcinoma in the Osijek-Baranja County from 1998 to 2010. In the aforementioned period there have been an average 15.9% days of hospitalisation caused by carcinoma. Patients hospitalised due to carcinoma stay in hospital 5.3 days longer than other patients. The number of hospitalisations as a whole, as well as those due to carcinoma, is rising, while the number of days of hospitalisation per patient is decreasing. The number of hospitalisations which refer to men is slightly higher than for women (51.2%:48.8%). Almost one third of patients hospitalised are not residents of the Osijek-Baranja County due to a gravitational hospitalisation instance. Residents of northern Bosnia and Herzegovina are the most common patients being treated in our county. This burden has to be taken in to account when planning our health care due to the geographically, economically and politically specific situation of Osijek-Baranya County. This data has to be taken in to account when further planning our health care, as to relieve the acute medical situation hospitals of some of their burden, as well as to provide adequate care to patients suffering chronically from carcinoma. It is especially important to stress out that our county does not have a palliative care facility, nor a hospice for the terminally ill.

Malignant neoplasms of digestive organs (C15-C26) in the Osijek-Baranja County, Croatia.

The Institute of Public Health for the Osjek-Baranja County (OBC) has processed the data on cancer patients that were collected from mandatory county hospitals data reports, county bureaus of statistics and the County Register of Deaths. The cancers were defined according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), codes of malignant neoplasms of digestive organs (C15-C26). The aim of this article is to show the size of the problem and the burden of the health care system caused by cancers of the digestive system (C15-C26) in the OBC in the period 2001-2006. This article deals with cancer incidence and mortality data, appertaining age distribution, cancer survival, median age at diagnosis and at death and length of stay in hospitals. The overall incidence and mortality rate from cancer group C15-C26 (101.1 and 80/100,000, respectively, EU standard population) declined in all age groups, comparing the data originating from the 2001-2003 period to the data referring to the 2004-2006 period. The median age at diagnosis of cancer was 67.8 years with a shift of 0.91 year up in second period (the median age in the first period was 67.3 years and in the second one 68.2 years). The median age at diagnosis of cancer in females was 69.7 years while in males was 66.3 years, which represents a difference of 2.9 years in favour of females. The overall relative survival rate of all ages was 23.6%. This figure was slightly bigger for females (24.3%) than for males (23.1%). Concerning all age groups, the number of hospital admissions of males increased during the observation period while the number of hospital admissions of women decreased at the same time. The average length of stay over the six years did not changed significantly. Group of cancer C15-C26 was the most common group of cancers regarding both genders. The five-year relative survival as one of the reliable benchmarks of the quality of the health care system needs to be raised to a great extent in order to come nearer to the EU average within a short period of time.

Malignant neoplasms of breast and female genital organs (C50, C51-C58) in the Osijek-Baranja County, Croatia.

Breast cancer (C50) and neoplasms of female genital organs (C51-C58) represent one of the most frequent cancer groups among females in economically developed countries. The Institute of Public Health of the Osijek-Baranja County in collaboration with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The aim of this article is to provide information on the tendencies relating to these cancer groups in the OBC during the period from 2001 to 2009, which will be the first report on these cancer sites on a county level in Croatia. This article processes data on cancer incidence and mortality, appertaining age distribution, median age, cancer survival and length of stay in the county hospitals collected in period 1996-2010. In the OBC, the overall incidence rates of breast, cervix uteri, corpus uteri and ovary cancer were, using the EU standard population, 82.9, 13.0, 19.0 and 14.5/100,000, respectively, and are all characterized by a declining tendency in the second period except breast can- cer. The overall breast incidence rate resembles the Croatian average and way exceeds the corresponding Central and Eastern Europe incidence rates, but is still bellow the Northern Europe ones. Also, the overall mortality rates of breast, cervix uteri, corpus uteri and ovary cancer were 29.6, 5.0, 8.1 and 9.6/100,000, respectively, and are all featured by a increasing tendency. The cancer 5-year relative survival rate from breast, cervix uteri, corpus uteri and ovary cancer in period 2001-2005 amounted to 64.2%, 66.1%, 57.4% and 43.0%, respectively. The overall median ages at diagnosis of breast, cervix uteri, corpus uteri and ovary cancer totalled 61.9, 56.4, 66.4 and 60.8 years, respectively, while the median ages at death from these cancers were 68.7, 65.7, 70.3 and 67.6 years, respectively. During the entire 9-year period, the average length of stay in hospital due to breast, cervix uteri, corpus uteri and ovary cancer were 12.1, 14.8, 18.5 and 11.3 days, respectively. The length of stay in hospital decreased for all but for ovary cancer. Implementation and consolidation of women's awareness of these cancers and relating early diagnostic activities within the OBC population seem to be the most effective ways to reduce the appertaining risks and thus to encourage changes in the lifestyle.

First six years of implementing colorectal cancer screening in the Osijek-Baranja County, Croatia--can we do better?

The primary goal of this paper is to evaluate the efficiency of the Colorectal Cancer Screening Program in the Osijek-Baranja County. The screening method for early detection of colorectal cancer was the guaiac Faecal Occult Blood Test (gFOBT) and colonoscopy for gFOBT positive finding. The target population were asymptomatic subjects at average risk, aged 50-74. The responding rate was 20.3% (14.9% of men and 19.3% of women). The percentage of gFOBT positive tests was 8.5% (11.2% of men and 6.6% of women). From the 1,657 individuals who were invited to further assessment (884 men and 773 women), 1,157 underwent a colonoscopy exam (649 men and 508 women). We can conclude that the response to FOBT in our county was extremely poor. 83 carcinomas were found, with almost double findings among men than among women. Our population has a significantly higher number of men with malignant and premalignant changes when compared with women. Considering the higher incidence among men, as well as an increase in incidence in the entire population, we have to take care that our public health programmes are being created with this taken into account, as to increase the response rate, especially among those with a higher risk of developing a disease.

Neoplasms (C00-D48) in Osijek-Baranja County from 2001 to 2006, Croatia.

The Institute of Public Health of the Osijek-Baranja County has processed the data on cancer patients that were collected from mandatory county hospitals data reports, county bureaus of statistics and the County Register of Deaths. The cancers were defined according the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), codes of malignant neoplasms (C00-C97), in situ neoplasms (D00-D09) and neoplasms of uncertain or unknown behaviour (D37-D48). The aim of this article was to show the size of the cancer problem in Osijek-Baranja County (OBC) according to the all ICD-10 cancer groups. The cancer incidence and mortality estimated in period 2001-2006 were prepared for all cancers based on gender and for age groups 0-19, 20-44, 45-64, 65+ by the year of the first diagnosis of cancer. The median age at cancer diagnosis was 62.7 years, 61.2 years for females and 64.1 years for males. Applying the EU age-standardized rate, the average annual incidence and mortality rates in the OBC were 411.6/ 100,000 and 240.7/100,000, respectively. The incidence rates in both genders were highest for neoplasms of digestive organs (C15-C26), respiratory and intrathoracic organs (C30-C39) and for breast (C50) (101.1, 63.6 and 44.3/100,000, respectively). The first two groups of cancer in both genders were also the leading groups of cancer in males (141.6 and 124.9/100,000). The third position in males belonged to neoplasms of male's genital organs (C60-C63, 58/100,000). The leading group in females was C50 (79.3/100,000), followed by groups C15-C26 (73.2/100,000) and in situ neoplasms (D00-D09) (51.4/100,000). The course and shape of mortality rate in the whole corresponded to the incidence rate, but at the lower level. The only exception referred to group C15-C26 (56.8/100,000) as leading mortality cancer group in females. The overall 5-year relative survival was 40.1%. Considering females, this rate amounted to 48.8% while this figure was much lower in men--32.4%. In age group 65+, 52.6% of cancer patients developed a cancer and 65.4% of patients died at the same age. These basic parameters indicate that the OBC must put great efforts in creating a long-term strategy for cancer prevention and early diagnostics in order to prolong life and improve the quality of life of cancer patients and raise the proportion of 5-year survival.

Five-year cumulative incidence of smoking in adult Croatian population: the CroHort study.

The aim of this paper is to investigate the incidence of smoking and changes in smoking habits in Croatia during a 5-year period. Data from the Croatian Adult Health Study of 2003 and 2008 was used for the study (N = 3229). The results of this study suggest that the incidence of smoking is the highest in youngest men and decreases with age. In ages 35 to 64 and older than 65 the incidence was higher in women than men. The cumulative smoking incidence is low in Croatia, but particularly alarming is a higher incidence in women than in men.

Drinking in adolescents--qualitative analysis.

The aim of this paper was to explore alcohol consumption and the development of this habit in the adolescent population based on qualitative data from 59 anonymous essays written by high school students. We found that the most of adolescents had their first experiences with alcohol in the seventh or eighth grades. They reported that they usually drank alcohol to be happy, to relax, to be courageous in approaching the opposite sex, to fit into society, and to be popular. Factors affecting drinking are influence of peers, family and social attitude towards drinking, laws and enforcement of legislation. In further prevention programs, we must be able to demonstrate that "having a good time" does not mean drinking alcohol. Programs for the prevention of alcohol-related problems must begin by adolescence, including both sexes equally and can be achieved through a coordinated and intense public health effort.

Risk behavior of customers in centers for free voluntary HIV counselling and testing in two Croatian cities--Osijek and Zadar.

The primary goal of this research is to compare risks and occurrence of HIV infection in Osijek-Baranja and Zadar County. Several chosen socioeconomic factors controlled by sex and age were investigated including level of education, employment and marital status of the free-of charge voluntary counseling and testing center (VCT) customers in the towns of Osijek and Zadar and their risk behaviors for acquiring HIV. Bivariate analysis of the differences between the customers from Osijek and Zadar showed statistically significant differences in the following variables: gender, education, number of VCT clients who use intravenous drugs (IDU), promiscuous behavior, number of homosexual clients, mode of receiving information on the VCT services, marital and partnership status, having children, inclination towards homosexual and bisexual relations, the main reasons for not using condoms, injecting drugs (IDU) needle sharing and the occurrence of hepatitis C. The analysis showed that significantly more males were counseled and tested in the city of Osijek, significantly less hepatitis C positive persons and promiscuity among all behavioral risk factors more often. A higher number of the customers of the VCT in the city of Osjek were "in permanent" relationship. Strategic management of health and health care, methods of comparing regional and national standardized indicators can provide valuable information about setting the focus, choosing priorities and establishing a good economic policy at the micro level. This study clearly established the dimensions of problems in HIV/AIDS prevention onto which it should be influenced through regional and local measures and actions. The indexes measured indicate which special initiatives and programs should be focused and set up as priorities in particular regions. The determined differences point to the need for a regional approach to HIV/AIDS prevention in purpose of improving preventive activities according to most common risk behaviors. Even though Croatia is a relatively small country, it has many regional and local features which need to be taken into consideration when developing prevention programs and activities.

The heart frequency and its variability in hypertensive patients considering A/B type of behaviour and eight basic emotions and levels of anger expression.

The aim of this paper was to compare between autonomic regulation of the heart rate and it's variability within 100 essential hypertensive patients and 100 examinees in healthy control group. Essential hypertensive patients had significantly shorter average RR interval, that is, faster heart frequency then the control group. Average variability of the heart frequency was statistically considerably lower in hypertensive than in the healthy control group. Sistolic blood pressure, diastolic blood pressure, duration of hypertension, levels have considerate total influence on heart frequency and it's variability during calm and during deep breathing. The most distinctive negative connection was found between variability of the heart frequency and duration of hypertension. The type A behaviour within hypertensive patients and the control group was more common then type B. In the hypertensive group, total influence of all independent Bortner's variables on to variability of the heart frequency during calm breathing was statistically important. Within hypertensive patients and the control group, the heart frequency and it's variability were connected with eight basic emotions. In the group of hypertensive patients variability of the heart frequency is significantly positively connected with emotional dimension Incorporation, but negatively with emotional dimensions Protection, Rejection and Reproduction. Our data shows that patients with long-term hypertension have increased heart frequency and reduced variability of the heart frequency, which are well-known risk factors for increased cardial mortality.

Regional pattern of smoking in Croatia.

The aim of this paper was to investigate the regional smoking pattern in Croatia. The data from the Croatian Adult Health Survey from 2003 were used for the study (N = 9,070). The results of this study suggest that the prevalence of smoking among men was the highest in the Eastern parts of the country, followed by the Mountainous region. In contrast, the prevalence of smoking among women was the highest in City of Zagreb. The results support the strong regional pattern, with more pronounced differences in women (those from the City of Zagreb had more than twice higher prevalence than those from the Northern parts of the country). Smoking is still relatively highly prevalent in Croatian adult population (24-33% in men, and between 10 and 21% in women, depend on region). This suggesting that preventive actions and public health interventions are needed to reduce the smoking prevalence and thus improve the population health.