Evaluation of genital human papillomavirus infections by polymerase chain reaction among Croatian women.

Infection with specific human papillomavirus (HPV) types is the strongest risk factor in cervical carcinogenesis. In this study we analysed, by means of polymerase chain reaction (PCR), cervical specimens obtained from consenting women with abnormal Pap smears collected from 1996 to 1998. Consensus- and type-specific-primers directed PCR were used in order to detect the presence and to determine the most common HPV types: 6, 11, 16, 18, 31 and 33. Out of 1874 specimens, 1207 (64%) contained one or more HPV types. Approximately half HPVs were typed (621 out of 1207) and the others remained untyped (586 out of 1207), 51% and 49%, respectively. Beside low-risk HPV 6/11 (5%), the most frequently observed HPVs were high-risk HPV types, especially type 16 (12%), while HPV types 18 (2%), 31 (5%) and 33 (3%) were less frequent. The HPV positivity rate declined with age, although all HPV types were equally distributed in different age groups. The presence of HPV DNA significantly increased from 55% to 78% along with the severity of the cervical lesions, i.e. low- and high-grade squamous intraepithelial lesions (LSIL, HSIL). Undetermined HPV types, other than 6/11, 16, 18, 31 and 33 were equally distributed in LSIL and HSIL which indicates that they represent low- as well as high-risk HPV types. Our results indicated that HPV infections, especially those with HPV 16, represent a significant public health concern in Croatia.

Clinical and epidemiological aspects of respiratory syncytial virus lower respiratory tract infections.

This paper has analyzed respiratory syncytial virus lower respiratory tract infections in 201 hospitalized children. In children with wheezing, erythrocyte sedimentation rate (ESR) was significantly higher in those with pneumonia than with syndroma pertussis, while the white blood cell (WBC) count was significantly lower in patients with bronchitis than in those with bronchiolitis and syndroma pertussis. Bronchodilatators were applied in 75.6% and corticosteroids in 20% of patients. Ten patients were ventilated. Fatal disease outcome was observed in one infant. Twelve consecutive-year study of respiratory syncytial virus (RSV) infections showed that 27.3% of these diseases were bronchiolitis and pneumonia.

Out-of-pocket payments for health care in Croatia: implications for equity.

AIM: To assess the distribution of out-of-pocket payments for health care in Croatia by income groups. METHODS: The study is based on data from 1994 out-of-pocket health expenditure survey carried out through interviews of randomly selected adults in two major cities of Croatia, Zagreb and Split. We analyzed co-payments for public health care services and other payments related to private practice, non-prescription medicaments, or informal payments to health care providers. Spending of each income group was analyzed as a share of its income and as proportion of total payments. RESULTS: We found an inequitable pattern of out-of-pocket health care payments. Burden of out-of-pocket expenditure was not equally distributed among income groups, with persons from the low income group paying about six times larger share of their income than the high income group. When we compared the proportions of income received by different groups with the proportions of their payments, the results indicated (again) that the low income persons payed proportionally more than those with high income. CONCLUSION: Distribution of out-of-pocket payments in Croatia is regressive, with a greater burden falling on lower income persons. Possible introduction of the mix of health care financing would need reconsideration of the policy measures to balance equity and efficiency.

Digital image analysis of silver-stained nucleolar organizer region--associated proteins in endometrial cytologic samples.

OBJECTIVE: Digital image analysis was applied to determine the number, area and size of silver-stained nucleolar organizer regions (AgNORs) in cytologic samples from curettage in normal, hyperplastic and malignant endometrium. STUDY DESIGN: Thirty-two archival cytologic smears from curettage (previously stained by the Papanicolaou method) with the histologic diagnosis (4 inactive endometrium, 5 secretion, 5 proliferation, 5 simple hyperplasia, 5 complex hyperplasia, 3 atypical hyperplasia, 5 adenocarcinoma, grade 1) were analyzed with the AgNOR technique. Count, area and size of AgNORs were analyzed in 50 cells per sample using a magnification of 1,000x. Quantitative analysis was performed on an SFORM digital imaging system. Data were analyzed with the SPSS/PC+ program. Mann-Whitney and chi 2 tests were performed. RESULTS: The average value of AgNOR count increased from normal to hyperplastic endometrium and well-differentiated adenocarcinoma. Differences were significant except between atypical hyperplasia and adenocarcinoma. Four, five and more AgNORs in 40% or more of the nuclei were found in complex and atypical hyperplasia and adenocarcinoma. Proliferation, and simple and atypical hyperplasia had similar mean values of AgNOR area. The mean total AgNOR area value increased from normal to hyperplastic had similar mean values of AgNOR area. The mean total AgNOR area value increased from normal to hyperplastic and well-differentiated adenocarcinoma. Differences were statistically significant. AgNOR size in well-differentiated adenocarcinoma was significantly different from that in normal endometrium and different grades of hyperplasia. CONCLUSION: Digital image analysis of AgNOR count, area and size enabled a distinction to be made between normal, hyperplastic and malignant endometrium.

Peripheral blood CD5+ B cell subset in the remission phase of systemic connective tissue diseases.

OBJECTIVE: To get a better insight into the level of circulating CD5+ B cells as related to the systemic connective tissue disease activity. METHODS: Peripheral blood CD5+CD19+ cells of patients in the remission phase of systemic lupus erythematosus (SLE) (n = 28), Sjögren's syndrome (SS) (n = 20), rheumatoid arthritis (RA) (n = 26), and 19 control healthy subjects were analyzed by 2-color flow cytometry. RESULTS: In comparison to control group, the patients with SLE had a significant increase in the relative CD19+CD5+ blood cell count (p < 0.0005); this count was also different from the finding in both RA (p < 0.005) and patients with SS (p < 0.05). In contrast, the proportion of B cells expressing CD5 (within an individual B cell population) was significantly increased in all the 3 diseases compared to healthy subjects (SLE, p < 0.0001; SS, p < 0.05; and RA, p < 0.01). In the multivariate discriminant analysis, a discriminant function defined by the CD19+CD5+ subset strongly discriminated SLE, SS and RA from the control, but also SLE from both SS and RA. CONCLUSION: Our findings demonstrated that, in relation to healthy control subjects, the blood CD5+ B subset tended to be elevated in the patients in the remission phase of systemic connective tissue diseases, particularly in SLE.

[Are there too many doctors in Croatia?]. / Imamo li previse lijecnika u Hrvatskoj?

Estimates of the needs for education of physicians in Croatia must be based on analysis of population health condition and age structure, on the country's economic capacities on which the employment of those specialists depends, and on estimates of realistic educational capacities of the Croatian medical schools. Basic analysis of mentioned parameters indicates that in the upcoming decade there are no possibilities of more extensive employment. Thus, it is obvious that it is necessary to educate only a certain number of physicians: those which will serve as replacement for the deceased, retired or physicians leaving for other positions. To keep in mind--presently the unemployed physicians constitute a number which usually satisfies two-year needs for new employment. Thus it is recommended that the number of enrolled medical students in Croatia be reduced to around 400 students yearly. Together with a proper selection of candidates at admission, these would guarantee that about 320 students would be graduating eventually. This number does not include students from abroad, yet their number is almost inconsiderable according to the past few years and their studies are financed from separate funds. Medical studies should not be financed according to the number of enrolled students, because it stimulates larger enrollment, but according to the actual cost of the educational programme. Financing the programme, and not the number of students, would improve its quality and stimulate a larger number of highly skilled and competent students. Medical studies are expensive not only because of the length of the programme (6 years) but also because of the nature of these studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Ulcerative colitis in Zagreb, Yugoslavia: incidence and prevalence 1980-1989.

We present a ten-year incidence of ulcerative colitis in Zagreb, Yugoslavia. The study included both outpatients and inpatients regardless of the extent and severity of the disease. The mean annual incidence rate was 1.5 per 100,000 inhabitants for the period of 1 January 1980 through 31 December 1989. There was no increase in the incidence of ulcerative colitis during the study period. A prevalence rate estimate of 21.4 per 100,000 inhabitants was based on July 1985 official estimated population. The results confirm the low frequency of ulcerative colitis in central Europe.

Epidemiology of Crohn's disease in Zagreb, Yugoslavia: a ten-year prospective study.

A ten-year prospective study of Crohn's disease was carried out in Zagreb, Yugoslavia. It included both inpatients and outpatients regardless of the extent and severity of the disease. The mean annual incidence rate was 0.7 per 100,000 between 1 January 1980 and 31 December 1989. There was no increase in the incidence of Crohn's disease during the study period. The prevalence of Crohn's disease was 8.3 per 100,000 on 31 December 1989. The results confirm the low frequency of Crohn's disease in central and southern Europe.

Epidemiological picture of respiratory viral infections in Croatia.

This paper presents the epidemiological study of respiratory viral infections in Croatia from 1 September 1986 till 31 August 1987. A total of 527 patients with acute respiratory diseases were examined. Their nasopharyngeal secretion and/or throat swab were taken and the viruses were demonstrated by the method of direct viral diagnosis (isolation and rapid immunofluorescent detection). This 12-month study on acute respiratory infections in Croatia in 1986/1987 shows that viruses were the agents in 47.2% of these infections. Out of a total of 527 patients with acute respiratory disease, 177 patients had RSV (prevalence 33.6%), 40 adenovirus (prevalence 7.6%), 18 enterovirus (prevalence 3.4%), 12 parainfluenza (prevalence 2.3%), 8 herpes simplex virus (prevalence 1.3%) and 3 influenza virus (prevalence 0.6%) infection; (9 patients had mixed infections with two viruses). Viral etiology was proved in 44.0% of upper respiratory tract infections, 86.5% of bronchiolitis, 63.3% of pneumonia, 57.5% of bronchitis, and 33.3% of croup. The epidemical wave of RSV infections started in October 1986 and lasted for the next 7 and a half months with a peak in December 1986. Infections with parainfluenza occurred in November 1986 and subsided in March 1987 with a peak in December 1986. An epidemic of adenovirus occurred in two waves and lasted throughout 9 months. Enteroviruses caused infections during the fall and at the beginning of the winter 1986 but also again in the spring 1987.

[Saliva as a risk factor for caries in diabetic patients]. / Slina kao cinilac karijes rizika u bolesnika od seérne bolesti.

Saliva is an important factor upon which general health of the oral cavity is dependent and which influences the occurrence of caries. In diabetic patients, xerostomia may occur due to pronounced polyuria in non-regulated and inadequately regulated cases. The aim of this study was to determine the amount of stimulated saliva and salivary pH in diabetic patients and in normal subjects, and to study the possible difference in the occurrence of caries. Results pointed to a significant decrease in the amount of stimulated saliva in insulin dependent diabetics (1.22 ml/min vs. 1.43 ml/min in normal subjects; p less than 0.01). The lowest amount of stimulated saliva was found in non-regulated diabetics (1.00 ml/min). In all diabetic patients, a significantly lower salivary pH was recorded as compared to normal subjects (p less than 0.01). The DMFS index was significantly higher in both insulin dependent and non-insulin dependent diabetics as compared to normal subjects (p less than 0.01). Concerning the state of diabetes control, significant differences at the level of p less than 0.01 in the DMFS index were observed among all groups of subjects (normal subjects, and regulated, inadequately regulated and non-regulated diabetics). A decreased salivary flow and pH may represent one from a series of caries risk factors in diabetics, especially in inadequately regulated and non-regulated cases of the disease.

A microcomputer method for continuous system simulation in health care.

A method for continuous system simulation in biomedicine and health care intended for use with personal computers is described. The method is applicable to multistate deterministic models and based on the use of standard spreadsheet programs used with such computers. It includes features such as model implementation, changes of simulation parameters, execution of simulation experiments as well as tabular and graphic presentation of simulation results. The method can be used for simulation of systems in epidemiology, health-care organization and other biomedical fields where deterministic models are suitable tools for studying phenomena connected with live systems.

[Cigarette smoking and ulcerative colitis--is there a causal relationship?]. / Pusenje cigareta i ulcerozni kolitis--postoji li uzrocna veza?

The relation between cigarette smoking and ulcerative colitis was assessed in a case-control study of 235 cases of ulcerative colitis and 311 age- and sex-matched control subjects admitted to the hospital for conditions unrelated to smoking. Smoking habits and daily number of cigarettes smoked were analysed. We found significantly less number of smokers and more ex-smokers in the ulcerative colitis group. The intensity of smoking was equal in both groups. It was noted that pancolitis occurred more frequently in the ex-smokers group. The intensity of smoking did not influence the extension and clinical course of ulcerative colitis. For ulcerative colitis, the relative risk for nonsmokers was 7.4. The study revealed a positive correlation between nonsmoking and ulcerative colitis, higher incidence of pancolitis among ex-smokers and higher relative risk of ulcerative colitis for never-smokers. Various possible causes of influence of smoking on ulcerative colitis are discussed.

[Computer-assisted teaching in medical education--development of methods and supplemental materials]. / Ucenje pomocu racunala u medicinskoj edukaciji--razvoj metoda i nastavnih materijala.

A review of the elementary types of materials for the computer assisted learning (CAI--Computer Assisted Instruction) is given in this paper. It shows our initial experiences in creating the computer educational materials of the patient management simulation type, destinated for the primary care physicians. A computer simulation program "First Aid in Traffic Accident" is described as an example. A typical structure of these materials is shown. The materials had been developed using the own authoring system, a computer program which enables the teachers and other experts to create the computer educational materials independently, with the minimal help of the professional computer experts.

Respiratory syncytial virus infections in SR Croatia, Yugoslavia.

The prevalence of respiratory syncytial virus (RSV) infection was studied during three consecutive annual outbreaks (1983-1986) in SR Croatia, Yugoslavia. A total of 1,238 subjects were examined, using RSV isolation and immunofluorescent (DTFA) methods, with 1,042 showing the signs of respiratory infection and 207 of these having a positive RSV finding. Generally, the prevalence of mild upper respiratory infection (URTI) was 18%, reaching a peak of 30% at 1 year of age. The prevalence of severe lower respiratory tract infections with bronchiolitis, pneumonia, and croup accounted for 51, 34.4, and 28.3% respectively. The highest incidence of RSV infection among respiratory cases was observed in the first 6 months of life (49.4%), being particularly high at the second month among those with URTI, bronchiolitis, pneumonia, and croup (76.2%). Both sexes were equally susceptible to RSV infection (20.51% females, 19.03% males). RSV infections, seasonal incidence ranged from 25.55 to 30.31% in 1983/84 and 1984/85 respectively and dropped sharply to 8.93% in 1985/86.