Effects of in-feed clinoptilolite treatment on serum metabolic and antioxidative biomarkers and acute phase response in dairy cows during pregnancy and early lactation.

The objective of this study was to evaluate the effects of in-feed clinoptilolite (CPL) on serum metabolic and antioxidative biomarkers, acute phase proteins and reproductive performance in cows during pregnancy and lactation. A total of 78 Holstein-Friesian cows were randomly assigned into two groups: the treatment group, cows fed CPL (n = 38) which received 50 g of powdered CPL twice a day from day 180 before parturition to day 60 postpartum; and the control group (n = 40). Blood samples were taken on days 180, 90, 60, 30 and 10 before parturition, on day of calving and on days 5, 12, 19, 26, 33, 40 and 60 postpartum, and were analysed for metabolic biomarkers: glucose, triglycerides, total cholesterol, high density lipoprotein cholesterol, non-esterified fatty acids, beta-hydroxybutyrate (BHB), antioxidative biomarkers and acute phase proteins: paraoxonase-1 (PON1), apolipoprotein A-I, haptoglobin (Hp) and serum amyloid A (SAA). CPL supplementation increased concentration of glucose and significantly decreased (P < .05) level of BHB during puerperium. The SAA concentration in CPL-fed cows was significantly decreased (P < .05) on days 33, 40 and 60 postpartum as well as Hp concentration on days 0 and 12 postpartum. The results of this study suggest that the CPL-fed cows may have improved metabolic status due to the tendency of greater glucose levels and decreased BHB values during early lactation. In addition, acute phase response was lower (P < .05) in CPL-fed cows. Such an outcome might be attributed to the effect of dietary CPL on intensity and severity of the negative energy balance and inflammatory response in dairy cows.

Psychogeriatric Diagnoses in Old People's Homes and Negative Health Behavior.

BACKGROUND: The study was designed as a gerontologic-public health analysis of the relationship between the leading and accompanying psychogeriatric diagnoses and negative health behaviors recorded in the old people's home users, with the aim to evaluate and redefine gerontologic-public health priorities and geroprophylactic measures, with special reference to persons suffering from Alzheimer's disease and other dementias. SUBJECT AND METHODS: Gerontologic-public health indicators obtained by monitoring health care needs of the elderly in specific institutional primary health care at 10 old people's homes (N=1185) in Croatia in 2013 were analyzed using the professional methodology developed at Department of Health Gerontology, Andrija Stampar Teaching Institute of Public Health (Registry List 1 that refers to monitoring specific primary health care needs of elderly at old people's homes). RESULTS: Study results revealed that essential arterial hypertension was the principal (leading) principal diagnosis in the old people's home users as of 2013, accounting for 13% of all leading diagnoses recorded in the elderly in institutional health care. In the study population, psychogeriatric diagnoses were recorded among the first five accompanying and leading diagnoses. Refusal of occupational therapy was the most common unfavorable health behavior recorded in the old people's home users, accounting for 22%, followed by poor personal and environmental hygiene (19%), physical inactivity (18%), mental inactivity (15%), obesity (13%) and smoking (5%) of 861 unfavorable behaviour characteristics recorded in study subjects. Study results showed the leading diagnoses in the old people's home users (such as circulatory system diseases, hip fracture, non-insulin dependent diabetes mellitus) to be associated with negative health behaviors that can be considered as risk factors for the development or progression of the disease, in psychogeriatric patients in particular. CONCLUSIONS: The results obtained by gerontological-public health indicator analysis indicate that programs of geroprophylaxis, gerontologic and psychogeriatric measures should be implemented in old people's homes as a priority, with day centers for Alzheimer's disease patients. It is necessary to identify and evaluate risk factors for the occurrence of preventable diseases, change the negative health behaviors in the elderly, and apply the nutritional-gerontologic dietary standards at old people's homes including follow up of dietary intake of nutrients such as vitamins and mineral, with special reference to psychogeriatric patients.

Trends in the Outpatient Utilization of Antipsychotic Drugs in the City of Zagreb in the Ten-Year Period as a Tool to Assess Drug Prescribing Rationality.

BACKGROUND: The aim was to determine distribution and trends in the outpatient utilization of antipsychotics to evaluate the rationality of antipsychotic drug prescribing during the ten year period. SUBJECTS AND METHODS: The epidemiological method of descriptive and analytical observation was used. Data on drug utilization from Zagreb Municipal Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the World Health Organization Anatomical-Therapeutic-Chemical methodology. The ratio of typical versus atypical antipsychotics served as an indicator on assessing the rationality of the utilization. Data on the use of anticholinergics in the treatment of neuroleptic side effects were also included. RESULTS: Outpatient utilization of antipsychotics showed a declining pattern from 14.17 in 2001 to 8.42 DDD/TID in 2010. The utilization of atypical antipsychotics increased by 60% (from 3.68 to 5.89 DDD/TID), while the utilization of typical antipsychotics decreased by 76% (from 10.49 to 2.53 DDD/TID). The drugs showing the largest increase were olanzapine (from 1.21 to 2.78 DDD/TID) and quetiapine (from 0 to 0.68 DDD/TID). The typical/atypical antipsychotic ratio changed from 1:0.4 in 2001 to 1:2.3 in 2010. A 2.3-fold decrease was recorded in the utilization of anticholinergics (from 2.05 to 0.91 DDD/TID). CONCLUSIONS: Total consumption of neuroleptics significantly decreased. A decrease was also recorded in the utilization of anticholinergics. Study results pointed to two favorable features, i.e. low use of typical antipsychotics and the ratio of typical and atypical antipsychotics. Implementation of the new clinical guidelines for nervous system disorders and updating of the list of reimbursable drugs with the addition of new ones contributed to the observed improvement in the prescribing patterns during the study period. Using the WHO ATC/DDD methodology and rationality indicators in the assessment of trends in the outpatient utilization of psychopharmaceuticals over a ten-year period proved efficient in the evaluation of prescribing rationality.

Pharmacist Competences and Impact of Pharmacist Intervention on Medication Adherence: an Observational Study.

BACKGROUND: The aim of this study is to determine the results of pharmacist interventions on patient's adherence to drugs in community settings. SUBJECTS AND METHODS: The study was designed using a standard EQ-SDQ questionnaire and a Culig questionnaire about the adherence to drug. General Level Framework (GLF) was used as a tool for competence assessment among community pharmacists. Participants were pharmacists that issued the medication on repeat prescription in the pharmacy. They interviewed the patient at the first visit to the pharmacy and the next time when the patient came to refill the prescription. The survey was conducted during a two-month period in the Atlantic Pharma pharmacy chain. A total of 152 patients were included at the first visit and 87 patients at the second visit. RESULTS: About two thirds of patients (65.5%) identified themselves as adherent during the first survey, and this number increased slightly during the second interview (by 3.5%), but not statistically significant (p=0.75). A total number of drugs prescribed during the first and second survey was 252 and 253 respectively. The percentage of the advices given to the patients increased during the second survey, but not statistically significant (p=0.62). CONCLUSION: It is definitely important to check that a patient understands current disease and what are doubts and difficulties in taking a therapy. The reasons for possible nonadherence are different: fears, worsening of the clinical state or other negative treatment outcomes. Enough time should always be left to clarify anything that is unclear and to listen. Application of GLF program for improving pharmacist competences resulted in slightly increased patient adherence to medication. For further development of competences, pharmacist intervention should include some other contents, i.e. tailoring the dosage scheme, counselling about drug-drug and drug-food interactions. The pharmacist counseling should be reimbursed by the Croatian Health Insurance Fund.

Comparison of Psychotropic Drug Prescribing Quality between Zagreb, Croatia and Sarajevo, B&H.

BACKGROUND: The purpose of this paper was to compare outpatient consumption and quality of psychotropic drug prescribing between Croatia and Bosnia & Herzegovina 2006-2010. METHODS: Data on drug utilization from Zagreb Municipal Pharmacy and Sarajevo Public Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic-Chemical methodology. RESULTS: Total utilization of psychopharmaceuticals increased in both cities; however, it was higher in Zagreb than in Sarajevo throughout the study period. The utilization of psycholeptics increased in Zagreb by 2.4% (from 74.5 to 76.3 DDD/TID) and in Sarajevo by 3.8% (from 62.4 to 64.8 DDD/TID). The utilization of anxiolytics decreased in Zagreb by 2.1% and in Sarajevo by even 18.7%. The utilization of antidepressants increased in both cities with predominance of SSRI over TCA utilization, greater in Sarajevo (96.6%) than in Zagreb (10.2%). The anxiolytic/antidepressant ratio decreased by 11.1% in Zagreb (from 2.87 to 2.55) and by 58.7% in Sarajevo (from 5.66 to 2.34). Outpatient utilization of antipsychotics increased significantly in Sarajevo, predominated by typical ones, whereas in Zagreb the utilization of antipsychotics was stable, predominated by atypical ones. CONCLUSIONS: In Croatia and Bosnia & Herzegovina, there was an obvious tendency to follow western trends in drug prescribing, as demonstrated by the increased use of antidepressants and reduced use of anxiolytics. Despite some improvement observed in the prescribing quality, high use of antipsychotics with dominance of typical antipsychotics in Sarajevo points to the need of prescribing guidelines for antipsychotics.

Orofacial injuries reported by professional and non-professional basketball players in zagreb and zagreb county.

BACKGROUND: Injuries are common during sport activities, a part of which is also injuries to the stomatognathic system. According to the data from literature orofacial injuries are frequent, but relatively minor. World Dental Federation has listed basketball as a medium-risk sport in sustaining orofacial injuries. The purpose of this investigation was to determine incidence, type and severity of orofacial injuries during basketball and frequents of mouthguard use. SUBJECT AND METHODS: The sample consisted of 195 athletes who actively participate in basketball, 60 amateurs/non-professional and 135 professionals. RESULTS: A total of 2 265 injuries to the stomatognathic system were documented in this research; 200 (8.8%) of those injuries refer to the non-professionals and 2 065 (91.2%) to the professionals. The most common injuries are lacerations and contusions of soft tissue (a total of 2 208 or 97.5%), followed by dental injuries (a total of 57 or 2.5%). Out of all recorded laceration injuries 59.8% lacerations of soft tissue occurred during practice (12.6% amateurs and 87.4% professionals), while 40.2% of them occurred during games (2.5% amateurs and 97.5% professionals). Of a total of 57 dental injuries recorded during an athletes career, in 78.9% it were the professionals who suffered an injury, and in 21.1% of them the amateurs. Out of a total of 195 basketball players only 1% (2 players - one professional and one amateur) frequently used mouthguard during practice and games, while 93.3% of them never tried to wear a mouthguard. Such low percentage of mouthguard use in basketball players reflects poor awareness and education of athletes and coaches, as well as insufficient role of dentists in education. CONCLUSIONS: Orofacial injuries during basketball are not severe (80% lacerations), and therefore do not stimulate the use of a protecting devices even their use will totally diminish this type of injuries.

Melitococcosis in the republic of croatia.

BACKGROUND: Melitococcosis is one of the most widespread zoonoses worldwide. In the period from 2009 to 2013, comprehensive melitococcosis testing was conducted in the Republic of Croatia. METHODS AND RESULTS: During the testing, the Rose Bengal test was applied to 344019 blood samples of sheep and goats, and positive reactions were confirmed in 1143 (0.3%) of samples. The complement fixation test (confirmatory test) was conducted on 43428 samples, with positive reactions confirmed in 768 (1.8%) of samples. The organs and tissues of 336 sheep and goats were inspected bacteriologically, and Brucella sp. was isolated in 15 (4.5%) of samples. Positive serological and bacteriological reactions were confirmed in the Karlovac, Lika-Senj and Split-Dalmatia Counties. Bacteriological and molecular techniques (Bru-up/Bru-low and Bruce-Ladder) in isolates proved the presence of Brucella melitensis biovar 3. CONCLUSION: On the basis of this study, it can be concluded that Croatia has a favourable situation concerning the infection of ruminants with B. melitensis, and that ongoing controls of the disease are necessary.

Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia.

BACKGROUND: Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period. METHODS: Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization. RESULTS: Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators. CONCLUSIONS: The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

[Cardiovascular health, diet and salt in the elderly]. / Kardiovaskularno zdravlje, prehrana i prehrambeni unos soli kod starijih osoba.

INTRODUCTION: The measures of primary prevention of cardiovascular disease are focused on lifestyle modifications in order to reduce the incidence of hypertension. Hypertension is a preventable risk factor for the development of cardiovascular disease, which is the leading cause of mortality in the elderly in Croatia. AIM: The aim of this paper is to present the share of circulatory system diseases in total hospitalization rate of the elderly. The aim is also to propose preventive public health interventions for elderly population to modify their dietary habits considering salt intake. METHODS: Gerontology analysis of the hospitalization rate includes data on geriatric patients from the City of Zagreb and Croatia as a whole for 2007, according to disease groups and prevalence. Databases of the National Institute of Public Health and Department of Gerontology, Dr. Andrija Stampar Institute of Public Health served as the source of data. DISCUSSION: Salt reduction is considered as an efficient and widely applicable measure of lifestyle modification as a non-pharmacological intervention for hypertension in the elderly. The introduction of legal provisions on dietary standards for the elderly is proposed for implementation of appropriate and preventive diet for this population group. CONCLUSION: Comparison of the rate of hospitalization of geriatric patients according to groups of diseases in the Zagreb area and Croatia in 2007 revealed the group of circulatory system diseases to be the leading cause of geriatric hospitalizations at the national level. Steering the health care planning and large-scale implementation of the program of preventive measures for the elderly with emphasis on salt intake reduction to up to 5 grams per day could reduce the prevalence of hypertension in elderly population and consecutively lower the incidence of their consequences.

Outpatient utilization of psychopharmaceuticals: comparison between Croatia and Scandinavian countries (2001-2003).

The aim was to estimate outpatient consumption of psychotropic drugs in Croatia in correlation with Scandinavian countries. Data on drug utilization, from Zagreb Municipal Pharmacy, were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using Anatomical-Therapeutic-Chemical methodology (ATC) by WHO. Data of the Nordic Medico-Statistical Committee were used for Scandinavian countries. In Zagreb, total utilization of psychopharmaceuticals of 144.9 DDD/TID in 2001, 148.9 DDD/TID in 2002 and 141.9 DDD/TID in 2003. The anxiolytic/antidepressant ratio decreased in Zagreb by 35.19% (7.19 in 2001 and 4.66 in 2003), whereas in Scandinavian countries it showed a constant rate (0.7 in Finland, 0.4 in Denmark and Norway, and 0.3 in Sweden). The three-year utilization patterns show that Croatia has been ever more closely following Scandinavian countries although there have been a notable differences between Croatia and Scandinavian countries.

Outpatient utilization patterns of the six main ATC drug groups in Republic of Croatia, city of Zagreb, and Croatia counties in 2004.

The aim of the study was to determine drug utilization according to Croatian counties, and to identify the causes of the possible between-county utilization variation. Zagreb Institute of Public Health in collaboration with the Croatian Drug Agency collected and analyzed data on outpatient utilization of the six main Anatomic-Therapeutic-Chemical (ATC) drug groups. Data on the number and size of packages, and on wholesale price were obtained from all pharmacies in Croatia. Based on these data, the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/ 1000/day) in 2004 were calculated for all drugs. County differences in the drugs utilization were calculated by use of relative standard deviation. This method revealed the outpatient drug utilization to vary among particular Croatian counties. Study results indicated the need of national guidelines for appropriate drug use to develop, along with education of the physicians and general population on their implementation.

Felix Mendelssohn Bartholdy (1809-1847)--Goethe's favorite.

Felix Mendelssohn, Goethe's favorite, who revealed the genius ofJohann Sebastian Bach after almost a century of oblivion, was of a fragile constitution. Last year of his life he was very depressed because of his sister Fanny's sudden death. The last month he had several attacks of severe headaches with agitation, anxiety, confusion and slow pulse. Last three days these episodes became more frequent and his overall health worsened. After stupor and coma, he died from probable subarachnoid (or cerebral) hemorrhage (with hypertension?), like his sister several months before.

Analysis of airborne pollen concentrations in Zagreb, Croatia, 2002.

Employing the volumetric method by use of a Hirst sampler, a total of 71,286 pollen grains, as many as 94.20% of them allergenic, were recorded in the air samples from the city of Zagreb during the 2002 pollen season. Among identified pollen of 35 plant species/genera/families, 23 were allergenic: Taxus/Juniperus, Alnus sp., Fraxinus sp., Betula sp., Corylus sp., Poaceae, Urticaceae, Artemisia sp., Ambrosia sp., Carpinus sp., Castanea sp., Chenopodiaceae, Salix sp., Populus sp., Ulmus sp., Juglans sp., Quercus sp., Platanus sp., Fagus sp., Plantago sp., Pinus sp., Picea sp. and Abies sp. The pollen of these plants also cause the majority of pollinosis in Europe. Study results and the pollen calendar designed for the 2002 pollen season for the City of Zagreb provide useful data for allergologists to reach an accurate diagnosis. The calendar also provides timely information on airborne pollen types and air concentrations for individuals with pollen hypersensitivity, thus allowing them to adjust their daily activities so as to minimize their contact with allergens and improve their quality of life both at home and at work.