Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

BACKGROUND: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. METHODS: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. RESULTS: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). CONCLUSIONS: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

Bullying and Attitudes Toward Masculinity in Croatian Schools: Behavioral and Emotional Characteristics of Students Who Bully Others.

Prevention of bullying is paramount to creating a positive and welcoming school environment. This study compared the following characteristics reported by students who had perpetrated bullying in Croatian schools and those who did not: gender, type of school, family wealth, negative emotionality, behaviors that may compromise health, and endorsement of traditional masculinity. Within the framework of the "Croatian Adolescent Masculinity Study," second and third grade students of secondary schools (equivalent to tenth and eleventh grade in the United States) in the city of Zagreb (N = 4,072) completed a cross-sectional, paper-and-pencil survey. Descriptive and logistic regression analyses were conducted separately for males and females to identify constructs associated with bullying perpetration. More males (12.7%) than females (5.8%) perpetrated bullying. Compared to students who did not report bullying others, significantly more students, who perpetrated bullying reported feeling sad or hopeless, having suicidal ideation, carrying a weapon, missing school because of feeling unsafe, drinking alcohol, getting inebriated, being victims of bullying, and endorsing traditional masculinity norms. The proportion of males reporting bullying others did not vary by type of school; females were more likely to perpetrate bullying in predominantly male and mixed-gender vocational schools. Bullying prevention interventions should address the complexity of problems associated with bullying others. Students who reported bullying others were more likely to participate in other harmful behaviors and have emotional problems. Endorsement of traditional masculinity norms should be further researched in other cultures and included in investigations of bullying perpetration, given its association with increased bullying among male and female students.

Analysis of data on breastfeeding in Croatia from 2005 to 2016.

Aim To analyse available breastfeeding data in Croatia and to describe the process of gathering, collecting, recording and reporting on them to the official institutions. Methods Infant nutrition data collected at maternity wards and infant nutrition data from primary health care units during the period 2005 to 2016 have been used. Descriptive statistics was used to analyse the data and to show the trends in breastfeeding. Results More than 85% of newborns were exclusively breastfed in the maternity wards. Data on breastfeeding from primary health care showed growth in exclusive breastfeeding up to 2011, followed by a fall in 2013. From 2012, paediatric teams had the obligation to join information system (CEZIH), but electronic forms did not contain infant nutrition information. Similarly in the E-Newborn project (E-novorodence) the question on the feeding method in the application was not designated as mandatory. Conclusion The routinely collected data on breastfeeding did not allow us to draw any conclusion regarding breastfeeding trends in Croatia. In order to improve the process of gathering, recording and reporting data on breastfeeding to the proper authorities, it would be necessary to clearly align definitions, employ a uniform methodology, and upgrade the computer applications in primary health-care. Only then may the reports required for compulsory health insurance be obtained via the CEZIH, as well as the public health reports necessary to monitor preventive work in care of children's health, and monitoring public health indicators.

Prevalence of diabetes five years after having gestational diabetes during pregnancy - Croatian national study.

AIMS: The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. METHODS: This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. RESULTS: Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p=0.587), level of education (p=0.549) or marital status (p=0.849) except that the diabetes group was significantly more obese than the group without diabetes (p=0.002). CONCLUSIONS: Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.

The Child Health Care System of Croatia.

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children.

Epidemiology and Outcomes of Congenital Diaphragmatic Hernia in Croatia: A Population-Based Study.

BACKGROUND: Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia. METHODS: All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed. RESULTS: We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1). CONCLUSIONS: The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.

Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia.

CONTEXT: Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. OBJECTIVE: Description of perinatal health care quality assessment key indicators in Croatia. METHODS: Retrospective review of reports from all maternities from 2001 to 2014. RESULTS: According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks' (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32-36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22-27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. CONCLUSIONS: The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

Prevalence, prenatal screening and neonatal features in children with Down syndrome: a registry-based national study.

BACKGROUND: Down syndrome (DS) is one of the most common chromosomal abnormalities among newborns. In recent years advances in perinatal and neonatal care have improved chance of survival for the children with DS. The objective of this Registry-Based study was to get more accurate data of DS prevalence with evaluation of antenatal screening, neonatal and maternal features among total births in Croatia from 2009 to 2012. METHODS: We used retrospectively collected data for DS newborns from the medical birth database and perinatal mortality database for the period of 2009-2012. Differences between DS and the referent population for each year in quantitative measures were assessed with the independent t-test. Other differences in nominal and categorical values were analyzed with the chi-square test. RESULTS: The total prevalence for DS in the period of 2009-2012 was 7.01 per 10,000 births, while the live-birth prevalence was 6.49 per 10,000 births. The significant differences (p < 0.05) between the DS and reference populations for each year were noticed for birth weight and length, gestational age, mother age, Apgar score of ≥6 after 5 min and breastfeeding. Among newborns with DS, there were 64 (53.33 %) males and 56 (46.67 %) females versus 88,587 (51.76 %) males and 82,553 (48.23 %) females in the reference population. In the DS group compared to the reference population the mean birth weight was 2845 grams versus 3467 grams in males and 2834 grams versus 3329 grams in females, respectively, with a mean birth length of 47 cm versus 50 cm for both genders. The mean gestational age of the DS births was 37 weeks and the mean age of the mothers was 32.6 years, versus 39 weeks and 29.1 years, respectively, in the reference population. Only 68.3 % of children with DS were breastfed from birth, compared with 94.72 % of children in the reference population. CONCLUSIONS: The significant differences for neonatal and maternal features between DS and the referent population were found similar to other studies. The total prevalence of DS in Croatia in the period of 2009-2012 was lower than the previously estimated prevalence based on EUROCAT data. The establishment of a new national registry of congenital malformations covering 99 % of all births in Croatia is necessary to improve the health and prosperity of children, adolescents and adults with DS in Croatia.

The impacts of media messaging and age and sex variance on adolescent smoking habits in Croatia.

OBJECTIVES: To analyze the effects of age, sex, and media messages that encourage or discourage smoking, in conjunction with having 1 or more parents, close friends, teachers, or family members who smoke, on differences in patterns of adolescent smoking. METHODS: This research is based on Croatian responses to the 2011 Global Youth Tobacco Survey. A total of 4245 Croatian youths responded to the Global Youth Tobacco Survey, of which individuals 3551 were aged 13 to 15 years. Of this cross section, 1644 individuals were male; 1856 were female; and 51 were of unknown sex. RESULTS: There were significant differences among responses in terms of age. Older adolescents were more likely to smoke (P < 0.001) and more likely to experience the following: (1) outdoor exposure to other smokers, including teachers (P < 0.001) and fellow students (P < 0.001); (2) smoking in the presence of parents or guardians (P < 0.001) and best friends (P < 0.001). The most prominent predictor of smoking among male adolescents was the existence of a best friend who smokes, with an odds ratio of 6.38 and a corresponding 95% confidence interval of 3.69 to 11.01. Likewise, the most prominent predictor among female adolescents was also the existence of a best friend who smokes, with an odds ratio of 10.21 and a corresponding 95% confidence interval of 4.94 to 21.13. The majority of nonsmokers, 65.5% (n = 1640), and smokers, 58.8% (n = 506), have never seen advertisements for cigarettes broadcast during televised concerts, and 58.5% of nonsmokers (n = 1469) and 58.6% of smokers (n = 505) have never seen advertisements for cigarettes while attending concerts. CONCLUSIONS: Our study shows that there is no sex difference between the number of nonsmokers and smokers. Older adolescents tend to smoke more, and students who smoke outside reported seeing other adolescents and their teachers smoking almost daily. A majority of youths who reported that they smoke have parents who smoke at home and have close friends who smoke; having a close or best friend who smokes is the highest prediction factor that both male and female youths will begin smoking. The majority of nonsmokers and smokers have never seen pro-smoking messages when going to concerts or during other community and social events. This lack of exposure to smoking-related advertising is the result of new legal restrictions imposed in 2008 on tobacco-product producers. There is no statistical significance among smokers' and nonsmokers' perceptions of antismoking media messaging. Peer pressure has been shown to be the second-most influential factor, after having a best friend who smokes, for the likelihood that an individual will become a smoker, among both male and female adolescents.

Trends in the morbidity of pre-school children registered in family medicine and primary pediatrics in Croatia: 1995-2012.

Primary health care for pre-school children in Croatia is provided by the primary pediatricians (PPs) in urban, or family doctors (FDs) in rural areas. The main aim of the study was to determine the trends in morbidity as recorded by FDs, and those recorded by PPs, from 1995-2012. The study was based on the routinely collected, national statistics data from the Croatian Health Service Yearbooks. The results obtained clearly indicate that there are no differences in the morbidity patterns registered by FDs and PPs. The average annual number of diagnoses per child, and the most frequently registered diagnostic groups were almost the same for both services. The number of children under the particular service was the only difference, with a decreasing trend in family medicine and an increasing in pediatric service. The national routine health statistics system does not provide enough information to permit a deeper analysis of the childhood morbidity in two services.

Preventive health care for pre-school children in Croatia: ongoing trends from 1995 to 2012.

In Croatia, primary health care for pre-school children is organized by pediatricians (PPs) for children in urban and family doctors (FDs) for children in remote areas. This study was undertaken with the aim to determine the trends in preventive activities (general, targeting, and control check-ups and total visits) in both services (FDs, PPs), between 1995 and 2012. The main adapt source was the Croatian Health Service Yearbooks. According to the results, the number and the structure of preventive activities performed by PPs are relatively stable, while those performed by FDs decreased rapidly, primarily because the number of children under the care decreased. It is probable in relations with the regulations to direct the children to PPs and not to the FDs. The average numbers of all preventive activities are under the optimum. There are many similarities between FDs' and PPs', some activities were frequently performed by FDs and others by PPs'.

Organization and functioning of primary care for women in Croatia: in relation to the health care reforms introduced between 1995 and 2012.

The main aim of this study was to investigate trends in the organization and functioning of the HC service. The Croatian Health Service Yearbooks, from 1995 to 2012, served as the basis for the data. The results showed that the HC reforms aimed at the organization and functioning of primary care for women somehow compromised their accessibility. A general lack of around 100 gynecologists, the huge number of women on the lists, from 4, 350 to 8,061 women, and excessively heavy daily consultations, between 23.8 and 28.4, were all observed. The location of the majority of gynecological practices in the big cities also makes the service inaccessible to women from the rural areas. A flow of service away from the public to the private providers was also observed. Since, the results of this study can be viewed only in terms of trends and more detailed research will be needed in future.

Neonatal birth weight variations between inland and littoral Croatia.

The aim of the study was to assess neonatal birth weight (BW) differences between inland and littoral Croatia, to identify BW groups with most pronounced differences, and possible variations in the rate of BW > or = 4000 g between Sibenik area and the rest of littoral (counties with access to the Adriatic Sea) and inland Croatia. The study included data on 99.42% of 200,740 live births recorded in 37 Croatian maternity hospitals during the 2001-2005 period. Distribution of 500-g BW groups was analyzed irrespective of neonatal sex and gestational age. Differences were found between the inland and littoral parts of Croatia according to distribution of the BW groups of < 2500 g (5.4% vs. 4.4%), 2500-3999 g (84% vs. 80.2%) and > or = 4000 g (10.6% vs. 15.4%) (chi2 = 882; p < 0.001).The highest rate of BW > or = 4000 g was recorded in Sibenik-Knin County (5-year mean 18.32%) and was greater throughout the littoral as compared with inland Croatia (5-year mean 14.99% vs. 9.58%). A shift towards higher BWgroups recorded throughout littoral as compared with inland Croatia supports the hypothesis on variation in anthropologic characteristics in the respective populations to be pronounced as early as at birth. Study results confirmed fetal macrosomia not to be exclusively characteristic of Sibenik-Knin County, since the rate of neonatal BW > or =4000 g was significantly higher in the entire littoral as compared with inland Croatia.

[Evaluation of the action plan for Roma people in health area]. / Evaluacija akcijskog plana za Rome za podrucje zdravstva.

By virtue of the national program for Romanies and participation in the Decade of Roma Inclusion 2005-2015, Croatia has chosen its strategic standpoint toward programs of social inclusion of Romanies in four priority areas: housing, education, employment and health. The objectives of the Roma Action Plan (AP) for 2005-2015 in the health area focus on: * ensuring equal availability of health services through information about personal rights and health insurance options; * child health improvement and care, as well as mortality reduction; * raising health awareness and care in terms of safe motherhood, family planning and reproductive health; * financial support to schooling of Roma people in health professions In order to monitor the implementation of AP and measure the availability of health care and condition, certain indicators of the number and coverage of Romanies are crucial for each of the above objectives: indicators for the Roma informed about personal rights resulting from the mandatory health insurance; for Romanies who have health insurance; for vaccinated Romani children, for Romani newborns born in maternity hospitals, for prenatal and pregnancy health care in Romani women, for Romanies included in family planning, for the mortality rate and causes of death in Romanies, and for the Roma receiving scholarships for education in health professions. Most of these indicators are only obtainable through special studies, while routinely monitored indicators simply do not satisfy quantitative needs. Another problem is Romanies not stating their ethnic denomination. Consequently, routine Roma mortality and cause of death statistics are unreliable. At the state level, no specific indicators of implementation could be obtained for any of the above health objectives, while some were obtainable for specific units of local and self-government (Baranja, Medimurje and Primorje-Goranska County). According to the research, more than 50% of Romanies in Croatia are situated in Medimurje, where they make up 3.4% of overall population, but also 53% of recipients of unemployment compensation. In Medimurje County, local and EU funds were used to undertake certain measures of protection from infectious diseases, alongside health education in combating ignorance and mistrust of Roma towards vaccination. Baranja used state budget funds to conduct preventive examinations of Romani women who have no health insurance, and to educate them in health measures of safe motherhood, family planning and infant health care. Although the AP includes a series of measures for improving Romanies' health, it cannot be implemented or its effects measured without clearly defined organizers of activities, resources assigned for implementation, and process and outcome indicators.

Effect of war on weapon-related deaths in Croatian children and youth.

OBJECTIVE: To identify trends in weapon-related deaths associated with the Homeland War (1991-1995) among children in Croatia. DESIGN: Retrospective review. PARTICIPANTS: Croatian children aged from birth through 19 years who died as the result of a weapon-related injury from 1986 through 2005. Main Exposure Injury deaths of children by intent (homicide, suicide, operations of war, and unintentional), cause, and age. OUTCOME MEASURES: Number and rate of injury deaths among Croatian children before, during, and after the war. RESULTS: Compared with the period before the war, weapon-related homicide and suicide rates increased by more than 3-fold, and unintentional weapon-related deaths increased by more than 6-fold during the war. These increases persisted for 5 years following the end of the war and decreased more than 5 years after the war. Death rates from non-weapon causes did not increase during this period. Overall, 81.9% of the weapon-related deaths were caused by firearms and 18.1% were caused by explosive devices. CONCLUSIONS: The Homeland War led to an increase in weapon-related deaths of all intents. Programs that focus on the prevention of weapon-related injuries should be integrated into programs that assist countries in rebuilding after political unrest.

[Perinatal care in Croatia. Yesterday, today, tomorrow]. / Perinatalna zastita u hrvatskoj. Jucer, danas, sutra.

The indicators and determinants of perinatal care in Croatia are presented. The maternal mortality is low, less than 10/100.000, at a level of developed countries. The perinatal mortality, following stagnation during 10 years at a level of around 9.0%o, since 2001 started to decrease for all perinatally dead up to the rate of 7.8%, and for those > or =1000 grams or > or =27 weeks up to 5.8%. The fetal mortality continues to be stagnant at a rate of about 4.0%, while the early neonatal mortality continues to decrease up to the rate of 1.9%. The determinants of perinatal care and mortality are analyzed. The pre-term deliveries and the births of low birthweight infants (4-6%), of very low birthweight infants (0.6%) and of extremely low birthweight infants (0.4%) are at the level of developed countries. The antenatal care is continuously improving: the average number of antenatal visits increased to 8.1, over 50% of pregnant patients had 9 or more visits; the average number of ultrasound examinations increased to 3.97, 59% of them had 4 or more US examinations; these values do not correspond to the values in very developed countries with very low perinatal mortality. The rate of Cesarean sections increased to 15.5%. In neonatal care during last 10 years the early mortality of infants > or =2500 grams was continuously low , the early mortality of infants 1000-1499 grams and of 1500-2499 grams is remarkably decreased, but the decrease in those of 500-999 grams was not substantial. In neonatal care the lack of equipment and of specialists neonatologists, especially in NICU-s is registered. Regional organization of perinatal care is voluntary, it is not legally instituted. During 2004, 67.7% of all infants and 73.4% of live-born infants with birthweight <1500 grams in the 3rd level materity wards with NICU were delivered. The causes and regional differences in perinatal mortality are analyzed. With the aim to continue in the future the positive trend, and to achieve a very low perinatal mortality (<5.0%), regional organization of perinatal care, functioning of NICU with adequate equipment, and further education of specialists in neonatology and fetal-maternal medicine should be institutionally established.

[Infant mortality in Croatia 1993-2002]. / Analiza smrtnosti dojencadi u Hrvatskoj od 1993. do 2002. godine.

UNLABELLED: In Croatia, infant mortality has been registered since 1874. During this period of time, a tremendous decline was recorded from 295.2/1000 live births in 1874 to 7.0/1000 live births in 2002. A tenfold decline was recorded during the second half of the 20th century. In the last years, the decline has been slower. Significant differences were found among counties according to different years. AIM OF THE STUDY: The aim of the study was to analyze data on a ten-year period (1993-2002), to calculate total mortality rate for the country as a whole and for each county in separate, and to discuss the leading causes of infant death. METHODS: Mortality statistics data (death registers supplied by the Central Bureau of Statistics and Croatian National Institute of Public Health) were analyzed. The rate per 1000 and percentage were calculated for the four main death causes in each county. RESULTS AND DISCUSSION: The mortality rate for Croatia was 8.4 for the ten-year study period. Nine counties had rates above and 11 counties below the rate for whole Croatia. The highest mortaliry rate was in Medimurje County (13.3) and lowest in Zagreb County (6.7). The leading causes of infant deaths in the whole country except for Medimurje County were perinatal causes (XVI according to ICD 10), followed by congenital malformations (XVII), symptoms (XVIII) and injuries (XlX). In four counties (Karlovacka, Bjelovarsko-Bilogorska, Viroviticko-Podravska and Istarska), the third and fourth causes exchanged their places. The exception was Medimurje County where respiratory diseases ranked second (X), congenital malformations third and symptoms fourth. During ten years, 96 infants died because of injuries, calling for additional intervention to decrease the rate of these avoidable deaths in mainly healthy children. Data on ethnicity of dead infants were not available, so we could only presume that the difference in the Medimurje County was due to the greater proportion of Gypsies in the area. CONCLUSION: Further analysis is needed, taking into account the socioeconomic and ethnic data which are usually lacking in death certificates although anticipated to collect them. In conclusion, there is space for further decreasing infant mortality in Croatia. Analysis and intervention because of the great differences between counties are necessary, with special reference to Medimurje County because of its highest rate and quite a different pattern of infant deaths from other counties.

Secular birth weight changes in liveborn infants before, during, and after 1991-1995 homeland war in Croatia.

AIM: To assess secular trends in birth weights of liveborn infants in Croatia from 1983 to 2003. METHODS: Of a total of 959,591 liveborn infants in the study period, 384,367 were born in the prewar (1983-1989), 226,226 during the war (1991-1995), and 348 998 in the postwar (1996-2003) period. The birth weight of liveborn infants was assessed by 500 g weight groups on the basis of data provided by the Croatian National Institute of Public Health. RESULTS: The gradual and significant increase in the share of infants with birth weight > or =3500 g (<0.001) was paralleled by a reduction in the share of infants with birth weights 2500-3449 g (P<0.001) and <2500 g (P<0.05) in the study period. There was a positive trend in the proportion of 4000-4499 g, > or =4500 g (P<0.001 for both), and 500-999 g (P=0.002) birth weight groups and negative trend in 1000-1499 g, 2500-2999 g, and 3000-3499 g weight groups (P<0.001 for all). During the war period, the proportion of liveborn infants in the 2500-3499 g weight group decreased in comparison with prewar proportion; this trend continued in the postwar period (P<0.001 for both). In the war period, the proportion of liveborn infants with birth weights of 2000-2499 g was significantly larger (P<0.001) and that of > or =4500 g significantly smaller in comparison with the prewar and postwar proportions (P<0.001 for both). CONCLUSION: Positive secular changes in infant birth weights observed in the prewar and postwar period contrasted negative changes during the war period in Croatia. This finding may suggest the association between war suffering and stress and changes in birth weights of newborns.

[125 years of infant mortality registration in Croatia (1874-1999)]. / 125 godina pracenja dojenacke smrtnosti u Hrvatskoj (1874-1999. godine).

Infant mortality data in Croatia have been registered in the last 125 years. A tremendous decline has happened during this period from 295.2/1000 live births in 1874 to 7.7/1000 live births in 1999. A tenfold decline was obtained during the second half of the 20th century. In the last years the decline has been slower. Significant differences are found between the counties and also in the counties between different years. Further analysis is needed to make conclusions because the small number of live births influences a lot the infant mortality. During the past period the causes of infant mortality have changed, too. There were classical reasons such as inadequate care about children, low hygienic conditions, poor nutrition, and infectious diseases. Today, causes of infant mortality in Croatia don't differ from those in developed countries. In the first place are perinatal causes and congenital malformations. The neonatal mortality accounts for 75% of infant mortality. Having in mind current reasons of infant deaths, it is not easy to separate the influences of socio-economical, biological or medical factors. It is particularly impossible to predict the influence of a risk factor on an individual case, because the outcome under the same conditions could be quite different.