The Influence of COVID-19 Pandemic on the Frequency of Suicides in Croatia.

BACKGROUND: Suicides are among the leading causes of death in the world and pose a major public health problem. It is not yet entirely clear to what extent the 2019 coronavirus pandemic (COVID-19) affects suicide rates, but is likely to result in an increase in risk factors for suicidal behaviors. The research objective was to compare the suicide rate in 2019 with the suicide rate in 2020 in the Republic of Croatia. SUBJECTS AND METHODS: A cross-sectional study was conducted for the period from January 2019 to December 2020. The necessary data on persons who committed suicide in the Republic of Croatia in that period were collected in cooperation with the Osijek-Baranja County Police Department. The number of suicides in that period was statistically processed according to demographic characteristics, suicide motives, days of the week and months by years. RESULTS: There was no significant difference in the total number of suicides comparing 2019 and 2020. Observed by months, significantly more suicides were committed during February 2020 compared to February 2019 (χ2-test, p=0.04). According to marital status, in 2019 compared to 2020, significantly more suicides were recorded among married persons (χ2-test, p<0.001) and among those who were unemployed (χ2-test, p<0.001). Persons with the status of veterans committed suicide significantly more often in 2019, compared to 2020 (χ2-test, p<0.001) During 2019, compared to 2020, significantly more suicides were committed by persons working in service and trade occupations (χ2-test, p=0.001). CONCLUSION: At the beginning of the pandemic in Croatia, in February 2020, there was a significant increase in suicides compared to 2019, which may indicate that the spread of the pandemic since the end of 2019, with uncertainty and cataclysmic atmosphere, had a negative effect on mental health.

Right Heart Morphology and Its Association With Excessive and Deficient Cardiac Visceral Adipose Tissue.

Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.

Impact of Meteorological Factors on Suicide Attempts and Completed Suicides in Croatia, Osijek-Baranja County.

BACKGROUND: Significant changes in the values of temperature, pressure, humidity and cloud cover can participate in the human behaviour including the mood disorders (especially depression and bipolar disorders) which can trigger suicidal ideas or their realization. The aim of this study is to estimate the connection between the aforesaid weather changes and a committed suicide along with the suicide attempts. SUBJECTS AND METHODS: We conducted a retrospective study in Osijek-Baranja County in the period from 2000 to 2011. Meteorological, demographic and epidemiological analysis was performed on 569 suicides and 478 suicide attempts (total of 1047 events). We analyzed the values of the above-mentioned meteorological parameters at the exact time when the event had happened, as well as three days before the event and one day after the event, comparing it with the monthly mean values. RESULTS: The results showed that the changes of temperature and pressure were significantly related with the suicides i.e. suicide attempts in general, while by separating genders, a connection with all examined meteorological factors was found by woman whereas men expressed significance only in the matter of temperature changes. CONCLUSIONS: Despite the fact that suicidality is caused by numerous factors, this study confirms that a sudden change of weather in the days preceding the suicide can be a trigger to suicidal behaviour. The study also suggests that in the matter of suicidal behaviour, female population is more susceptible to sudden weather changes.

Prognostic role of Nectin-4 expression in luminal B (HER2 negative) breast cancer.

Nectins are Ca2+-independent immunoglobulin (Ig) superfamily proteins that participate in the organization of epithelial and endothelial junctions and regulate several cellular activities including the entry of some viruses. Nectin-4 has recently been shown as a metastasis-associated protein in several cancers. In the following study, we have evaluated the expression of Nectin-4 inthe luminal B HER2 negative subtype breast cancer. The study group consisted of 147 patients presenting with primary unilateral breast carcinoma with no evidence of distant metastases. Nectin-4 protein expression was assessed by immunohistochemistry and the results were correlated with the clinical data using Kaplan-Meier curves, univariate and multivariate stepwise proportional-hazard analysis (Cox model). Nectin-4 overexpression was significantly correlated with the tumour size (p<0.05; Fisher's Exact Test), also Nectin-4 expression was negatively associated with overall survival, disease free survival and distant relapse free survival with the same significance (p<0,001; Kaplan-Meier, Cox model). We did not find statistically significant correlation between Nectin-4 and age, ER, PR, age, lymph node metastasis, tumour differentiation, histologicalsubtype and Ki-67proliferation index. We suggest that Nectin-4 is a relevant prognostic factor and a therapeutic target in luminalB (HER2 negative) breast cancer.

Double suicide.

Most suicides are solitary and private; but few result from a pact between 2 people to die together. Two young men made a pact to commit suicide by hanging from a tree. It was the first case among 1320 single suicides in more than 2 decades in eastern Croatia. Double suicide between people of the same gander is an unusual event. It is predominantly made by male-female partners and by less violent methods. One of the 2 members experienced depression. He may have been the initiator and the other partner may have been the dependent. The initiator usually plans the act and stimulates the other party. Whether the decision was evenly shared by both partners and initiative came from one of the two or it was result of 2 independent decisions remains open for analysis. Double suicide is also very interesting from the perspective of medical examiners. They need to make comprehensive postmortem examination to finally conclude the proper cause and the manner of death.

Infanticide in Eastern Croatia.

For the layperson no crime is more difficult to comprehend than the killing of a child by his or her own parents. This is a retrospective study of neonaticide and infanticide in Eastern Croatia from 1980 to 2004. Judicial records of infanticide cases stored in Regional and County Courts were analyzed for the circumstances surrounding the offense. Twenty-four babies were discovered in various places during investigating period of time. The victims were almost equally divided between boys (12) and girls (11). The gender of one baby was unknown. The mean weight of babies was 2.7 SD = 0.66 kg. The perpetrators preferred rubbish-heaps (33.4%), burying in soil (16.7%), various premises in or around the house (16.7%) and garbage cans (12.5%) as places for hiding the dead babies. The most dominant cause of death in sixteen cases of live birth was asphyxia (37%) with equal distribution of smothering, stuffing the mouth with rags and strangulation. Other frequent causes of death were placing the child in a plastic bag and abandonment (25%), brain injury (25%) and wounding using a sharp weapon (12.5%). The cause of death for six babies remained unknown due to advanced decomposition. Two babies were stillborn. The age of accused mothers varied from 16 to 33, mean 24 SD=5.2 years. Most of them were unmarried (60%) and had limited formal education. They usually kept the pregnancy a secret (73%) and gave birth (93%) without public welfare assistance. The mother lived in the terror of shame and with the guilt that accompany conception without marriage. Fear seemed to be a pronounced motivating factor for committing infanticide. The data on court proceedings were available in fifteen cases. The mothers were officially indicted in all cases for infanticide under the Croatian Criminal Code. The perpetrator remained unidentified in nine suspicious crimes. The court convicted ten mothers of the crime of infanticide. Often juries were unwilling to punish the mother, citing the mother's lifelong guilt of having killed her child as enough punishment.

Epidemiological features of suicides in Osijek County, Croatia, from 1986 to 2000.

Suicide is a devastating tragedy associated with social, cultural and psychological factors. It takes approximately 1,060 lives in the Republic of Croatia each year. We retrospectively reviewed all cases referred to in the Registrar office and Police Department at Osijek County from 1986 to 2000. The cases of suicide totaled 1,017. All of the cases were analyzed as to age, gender, marital status, occupation, place and time of suicide and method of suicide. The suicide rate for the entire population of the County averaged 20.5/100,000 inhabitants per annum. The age of the suicides ranged from 15 to 92. The male to female ratio was 2.1:1. The highest suicide incidence was among the age groups from 55 to 64 (19.27%), followed by age group from 45 to 54 (16.12%). The lowest suicide incidence was among the age group < 19 (3.4%). The incidence in the group 85 > years was also low (2.06%). The suicide was frequent among people who live alone: single, widowed, divorced (47.29%). Eighty percent of victims were found in surroundings familiar to them. These included various premises of their residences. The retired, the laborers and the unemployed (67.36%) were predominant among suicide victims. The most common methods of suicide were hanging (43%), followed by firearms (24%). No correlation was found with the day of the week or the month of the year. The study showed a slightly increased rate of suicide, from 21 cases at the beginning of the investigation (in 1986) to 22.3/100,000 population fifteen years later (in 2000).