Fitts' Tapping Task as a New Test for Cognition and Manual Dexterity in Multiple Sclerosis: Validation Study.

Introduction. Studies suggest that people with multiple sclerosis (pwMS) experience continuous and subclinical physical worsening, even as early as their disease diagnosis. Validating sensitive and reproducible tests that can capture subclinical disease activity early in the disease are clinically useful and highly warranted. We aimed at validating the utility of Fitts' Tapping Task (FTT) as reproducible measure of psychomotor performance in pwMS. Materials and Methods. Thirty newly-diagnosed pwMS (within 2 years of diagnosis and Expanded Disability Status Scale; EDSS ≤ 2.0), 30 people with migraine (pwMig), and 30 healthy controls (HCs) underwent a psychomotor assessment using the FTT, O'Connor hand dexterity test, and Visual Reaction Time Test (VRTT). Hand strength was measured using a hand-grip dynamometer. Subjects also provided patient-reported outcomes (PROs) using the 36-Item Short Form Survey (SF-36). Intrarater and interrater reproducibility was acquired on 5 HCs by two independent operators. Test−retest reproducibility was determined in 5 pwMS over a 1-week follow-up. Eight pwMS returned for the same test procedures 2 years after the baseline assessment. Bland−Altman plots were used to determine the minimally detectable change (MDC) and logistic regression models determined the ability to differentiate between newly-diagnosed pwMS and HCs. Results. FTT exhibited a high intrarater and interrater reproducibility (interclass correlation coefficient of 0.961, p < 0.001). The test−retest demonstrated an MDC of the average FTT at > 15%. PwMS had significantly a slower FTT time and O'Connor dexterity time when compared to pwMig and HCs (p < 0.001 for both). Higher Fitts' difficulty levels (4th and 6th difficulty) and average performance on the O'Connor test were able to differentiate newly-diagnosed pwMS from HCs with 80% accuracy (p < 0.01). Slower FTT performance was correlated with worse PROs due to physical health. Over the 2-year follow-up, and despite being clinically stable (no change in EDSS), 6 out of 8 (75%) pwMS had more than a 15% worsening in their average FTT time. Conclusions. FTT is a highly-reproducible test for measuring psychomotor performance in newly-diagnosed pwMS. FTT can capture insidious worsening in psychomotor performance and cognitive function in early stages of MS.

PAIN AND ANXIETY EXPERIENCE IN THE CHOICE OF EPIDURAL ANALGESIA IN DELIVERY.

The experience of labor pain is a complex process that represents the interaction of the nociceptive stimulus within the physiologic process with a series of psychological factors. The aim of this study was to investigate the relation between the choice of epidural analgesia as a form of pain management and psychological state of woman in labor; moreover, whether the women in labor with a higher level of anxiety have a more intensive experience of pain during labor and therefore decide on epidural analgesia. Pain was evaluated by the visual analog scale, while the sensory and affective pain components were evaluated by the McGill Pain Questionnaire, and anxiety as a trait was measured with the State-Trait Anxiety Inventory-form X. Women in labor with a higher level of anxiety had a significantly increased affective component of pain, but did not significantly more frequently decide on labor with epidural analgesia. The women having chosen epidural analgesia experienced more intense pain during delivery before epidural analgesia, with the sensory component of pain being less pronounced in the women in labor without epidural analgesia, while there was no difference in the affective component of pain.

Characteristics of Persons Registrated Due to Cannabinoid Abuse in Croatia - Do We Have enough Effective Intervention?

BACKGROUND: It is known that cannabis increases mood, decreases anxiety and causes mild euphoria, but also it can cause serious mental diseases. Previous studies showed harmful effects of cannabis and the aim of this study is to show characteristics of persons registrated because of cannabinoids abuse in Croatia in the period 2008-2018 and show effectiveness of interventions using statistic methods. SUBJECTS AND METHODS: Research data were collected based on the national Registry of Treated Psychoactive Drug Abusers in period 2008 to 2018 and included 10 533 registrated persons. Statistical analysis was performed by chi-square test and binary logistic regression. RESULTS: Results showed that men and very young people took cannabinoids more often than women and older people. There was a changing trend of registrated people in a ten-year period. The most commonly used intervention of obligatory healthcare treatment is consultation, but the difference between apstinents and people with unchanged status isn't statistically significant. The most people are referred by repressive mechanism and they are more likely to have apstinent status compared to unrepressive source of referral, with one exception - referred by the family. The highest probability of abstinence have those referred by the center for social welfare. CONCLUSIONS: Registrated people were mostly referred by repressive way, which makes question of its efficiency and prevention of long term addiction, because system like that more likely stigmatizes and punishes young people, opposite to giving support and help.

Quality of life assessment in migraine and relapsing remitting multiple sclerosis: self-perceived health is similar.

OBJECTIVE: The aim of this study was to compare self-perceived health between migraine and early stages of relapsing-remitting multiple sclerosis (RRMS) and to explore whether and how accurate those health domains predict overall quality of life. METHODS: Ninety patients aged 18-55 years were enrolled in this cross-sectional study. Thirty follow-up outpatients were recruited with migraine (with or without aura), 30 patients with RRMS, and 30 healthy subjects. They were asked to complete the Health status questionnaire (SF-36) and Personal Wellbeing Index (PWI). RESULTS: Patients with RRMS and migraine had significantly worse self-reported health regarding role limitation due to physical problems and general health than the healthy control group. Additionally, migraine patients had more bodily pain, while RRMS patients expressed more difficulties regarding physical functioning. Differences between migraine and RRMS patients were not significant. Hierarchical regression analysis revealed that role limitation due to physical problems, mental health, and general health represents significant predictors of overall quality of life. CONCLUSIONS: Migraine may affect quality of life similarly to early stages of RRMS. Bio-psycho-socio-medical understanding of the two diseases and their impact on patients QoL should be reconsidered.

Quality of life and health of patients in early stages of Multiple sclerosis.

BACKGROUND: Multiple sclerosis is a chronic neurologic condition with a variety of symptoms which have a great impact on quality of life even in the early stages. The aim of this study was to investigate, and to compare overall subjective quality of life with self-perceived health in patients with early stages of MS. SUBJECTS AND METHODS: Thirty patients with MS (22 women, 8 men; mean age 37.3±9.7years; relapsing-remitting MS; EDSS<2.5; all on immunomodulatory therapy: IFN, GA) were enrolled in the study. The QOL was assessed using the Personal well-being index (PWI) and health was measured by the Short Form 36-Item Health Survey (SF-36) questionnaire. RESULTS: Results indicate that MS patients in early stage experience similar health and quality of life, comparing to the general adult population. Analysis of self-reported change in health by categories showed that 50% patients access their health about the same as a year before, 9 rate their health as worse as one year before and 5 rate their health even better. Correlation analysis revealed that SF-36 domain Mental health correlates with most PWI domains. CONCLUSION: This study demonstrates that MS patients in early stage experience similar quality of life as general adult population. Also, it was revealed that health domain Mental health is correlated with various quality of life domains, suggesting that mental health is of great significance for subjective quality of life perception. However, it is important to emphasize the distinction between the health and quality of life, due to the fact that one can perceive his/hers own health as impaired, but at the same time can have satisfactory quality of life.

Health-related Quality of Life and Mental Health in the Process of Active and Passive Ageing.

BACKGROUND: To analyse the differences in the self-estimate of life quality depending on the ageing type - passive, active. SUBJECTS AND METHODS: Life-quality linked to health was measured with an SF-36 survey, which gives multi-dimensional criteria of health and life-quality. SF-36 survey represents a theoretically based and empirically proven operationalization of two overal health concepts, which are body and mental health, and its two general manifestations, functioning, and welfare. 200 examinees in total, aged from 55 to 92, were included in the research. Divided by sex, in the research participated 148 women and 52 men. Depending on the ageing way, the examinees were divided into 2 categories: passive ageing (n=100), active ageing (n=100), and for these groups a detailed result analysis was done. Statistical analysis includes descriptive statistics, Hi-square test, Spearman's correlation coefficient, and Mann-Whitney U test. RESULTS: In all dimensions of health, examinees from the category Active ageing achieve higher scores, which indicates better health and better functioning. Between the groups, a statistically significant difference was determined, on the following dimensions: Overall health, Pains, Energy and vitality, Social operations, and Limits due to emotional difficulties. With the Hi-square test, it was determined that there are differences between the groups. The biggest difference can be seen in the reply categories related to health deterioration (χ2=10.391; df=4; p=0.034). Examinees from the Active ageing group mention significantly less that their health has gotten worse compared to the previous year (26% of the active ones state that their health is somewhat worse, and only 2% that their health is significantly worse, compared to the passive ones where 36% state that their health is worse, and 9% that it's much worse compared to the year before). Tested was the difference between arithmetic middles on the issue of mental health based on the ageing type (p>0.05), and the results show that it's not statistically significant. CONCLUSION: On all dimensions, examinees from the category Active ageing achieve higher scores, which indicates a better health and better functioning.

Sense of coherence and health in adolescents: a longitudinal cohort study.

OBJECTIVE: Several studies indicate an association between adolescents' sense of coherence (SOC) and health. However, a few longitudinal studies have been conducted. The aim of the study was to analyze the association between SOC and health among adolescents during secondary education. METHODS: Participants of longitudinal cohort study were followed by questionnaires at the age of 15 (N = 441), and 17 (N = 354). The data were analyzed using the methods of descriptive and inferential statistics. We used hierarchical regression to examine significant predictors of health. RESULTS: Adolescents' SOC was stable during the analyzed two-year period (128.84 ± 22.17; 129.24 ± 23.06). A strong significant positive correlation was found between SOC and mental health (r = 0.635, p<.001; r = 0.670, p<.001). A significant difference was found between adolescents with a low SOC and those with a high SOC in physical functioning (p<.018), general health (p<.001), vitality (p<.001), social functioning (p<.001), emotional role functioning (p<.013) and mental health (p<.001). Boys had higher SOC and most of the health dimensions. Having a stronger SOC, being male, and living with both parents were predictors of better mental health. CONCLUSIONS: Sense of coherence was a significant and stable factor associated with mental health. Thus, salutogenic interventions for improving the sense of coherence during adolescence should be explored.

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

The aim of this study was to analyze gender and age differences in physical inactivity in Croatia and physical inactivity pattern changes during the five-year period. The study is based on the data obtained from the Croatian Adult Health Cohort Study which was carried out in 2003 and 2008. The prevalence of physical inactivity in 2008 was 37.7%, 36.8% in men and 38.1% in women. In both study waves the prevalence was increasing with age in both men and women. The prevalence is statistically significantly higher in subjects older than 64 years than in younger age groups. The incidence of physical inactivity in the five-year period in total was 29.9%, 27.2% in men and 31.1% in women. The increase in prevalence of physical inactivity despite the number of preventive activities carried out periodically emphasizes the need for systematic and comprehensive approach in increasing the number of regularly physically active individuals.

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.

Health-related quality of life of women with disabilities in relation to their employment status.

AIM: To compare the health-related quality of life of unemployed and employed women with disabilities and establish factors affecting their life satisfaction. METHODS: The study included 318 women with disabilities, 160 of whom were employed and 158 unemployed, paired according to age and region of residence. The health-related quality of life was assessed by The World Health Organization Quality of Life questionnaire, and social demographics and factors affecting life satisfaction were collected by a general questionnaire. The factors affecting life satisfaction were defined according to respondents' statements. RESULTS: Unemployed women with disabilities had a lower mean score (±standard deviation) on all health-related QoL domains: psychological health (14.52±2.80 vs 15.94±2.55), social relationships (15.12±3.08 vs 16.06±2.69), environment (12.80±2.78 vs 13.87±2.49), as well as on a separate item of self-assessed health (3.33±1.16 vs 3.56±0.92) than their employed counterparts (P<0.01). This disparity was not found only in the domain of physical health. The largest positive impact on life satisfaction in both groups was family. CONCLUSION: As disabled women are a particularly vulnerable population group, stressing the importance of employment and family as factors affecting their quality of life may help equalizing opportunities and upgrading the quality of life of all - particularly unemployed women with disabilities.

Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study.

AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.

Psychometric evaluation and establishing norms of Croatian SF-36 health survey: framework for subjective health research.

AIM: To provide population norms and evaluate metric characteristics of the Croatian version of SF-36 Health Survey, an internationally used instrument for assessing subjective health. METHOD: The questionnaire was administered to a representative sample of Croatian adult population (n=9070). Three standard techniques were used in data analysis: reliability tests, descriptive statistics, and factor analysis. The population norms were presented in two standard forms--the SF-36 Health Profile and percentile values for different age groups of men and women. RESULTS: The Croatian version of the SF-36 had generally acceptable metric characteristics including its construct validity. The internal consistency of the SF-36 scales ranged from 0.78 to 0.94. Pearson bivariate correlations showed moderate associations between SF-36 scales, and factor analysis provided one latent dimension underlying all SF-36 scales which explained 63.3% of the score variance. Less favorable results were obtained concerning its discriminative validity. All SF-36 scales showed negative asymmetry of score distributions, and some had high floor and ceiling effects--skewness estimations ranged from -0.12 to -0.91, with the highest floor effect of 30% and ceiling effect of 63%. CONCLUSION: Presented population norms for the Croatian version of SF-36 Health Survey showed that SF-36 may be used as a valid and reliable instrument in research in subjective health of Croatian population.

[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.

Impact of war on growth patterns in school children in Croatia.

The objective of this paper is to present the growth patterns of school children in Osijek--the city which was exposed to severe attacks during the aggression on Croatia. The mean height and weight of Osijek schoolchildren aged 7 to 18 and the menarcheal age in girls in academic year 1995/96 were compared to the analogous data collected in 1980/81. The secular changes in height were heterogeneous. In older age groups from 12 in girls and 13 in boys, the mean height in 1995/96 increased markedly, whereas from 9 to 11 or 12, changes were undulating. In the youngest groups--at the age of 7 in both genders, and at 8 in boys, negative changes were observed. Markedly smaller height in this cohort was still pronounced in 1999/2000 when these children reached the age of 11. However, one year later (2000/01), at the age of 12, boys and girls caught up with their peers in the previous generations. These children during the war were approximately at the age of 2.5 to 4, a period when growth patterns are highly sensitive to adverse environmental influences. It might be possible that the emotional stress caused by a change of environment and separation from home, contributed to the deceleration of growth rate, i.e. the smaller height in a large part of childhood.

Health of returnees in Osijek Region and required special measures of health care and community organization.

Many citizens from the Osijek-Baranja County, in order to survive, left their homes during the 1991/92 war in Croatia and spent between 5 and 7 years in exile. The aim of this pilot research was to assess the health status (physical, mental and social) of refugee /returnee population and their use of health services, to identify the factors influencing their adaptation, and to propose the health programs, psychological and social support, which could help foster integration into the social and community life, education and employment. The study was done on a randomized sample of 589 respondents using the 2003 Croatian Health Survey with an additional questionnaire related to the problems of returnees. The results of the study show good organization of health service in returnees' communities, with exception of gynecological and dental services. There was also a presence of health transportation problem and the problem in the supply of medicines. Finally, the results show that the returnees' communities were dominated by social problems such as lack of employment, lack of support for elderly, poverty, and concerns for children's prospects. This implies the necessity for intervention in both mental and social aspects. Measures to be undertaken in the next stage of the Project will be aimed at the work in the refugee communities and based on public health working methods such as organization of the community by stimulating intergenerational solidarity, education and raising awareness of self-help.

Lost in transition--the Island of Susak (1951-2001).

The isolated population of the Island of Susak was thoroughly studied by a multidisciplinary team of the Croatian Academy of Sciences and Arts in early 1950's. Recently, a team of scientists revisited the island. This paper describes the main characteristics of the transition process during which a massive exodus occurred with 90% of the island's population migrating to New Jersey, USA. We summarise the differences in lifestyle, economy, social structure and sense of identity between the historic (1950's) and contemporary (2001) Susak population. We applied contemporary methods (analysis of microsatellite DNA polymorphisms) to investigate local myths about extreme levels of inbreeding and genetic homogeneity among the Susak islanders. Analysis of short-tandem-repeat (STR) loci showed that Susak displayed characteristics of a small homogeneous breeding isolate. The average heterozygosity was found to be low compared to outbred populations. The signature of a recent severe bottleneck could be detected. Analysis of 8 markers located on Xq13-21 in 71 individuals suggested extensive level of linkage disequilibrium (LD). A migrant study was designed to investigate the effects of large environmental changes (Susak vs. USA) and inbreeding (Susak vs. Croatian general population) on some biologically important quantitative traits, such as blood pressure and serum lipids. The results confirmed the positive correlation between inbreeding level and blood pressure that has been reported in the literature on several occasions. The last remnants of this traditional island community will soon be lost forever.

Youth and AIDS--a study of attitudes, knowledge, behavior and risks in the post-war Croatia.

According to the latest reports, the Eastern Europe currently exhibits the greatest relative increase in the number of newly registered HIV infections in the world. At the same time, Central Europe remains relatively spared from the epidemic, with reported rates significantly lower than those in both Eastern and Western Europe. Croatia geographically affiliates to Central Europe, but it has two specific potential risk factors in comparison to neighboring countries: recent War events and a summer season when immigration of large number of tourists from Central and Eastern Europe is expected. Therefore, it is critical to examine AIDS attitudes in young people, increase their knowledge, monitor their behavior and warn on risks in order to prevent larger spread of epidemics from Eastern Europe to Croatia. In this study, we report on a large related survey and education program among 17-year-old high school pupils that was conducted in years immediately following the War (1996-1999).

[Knowledge and attitudes on breastfeeding among parturients]. / Znanje i stavovi rodilja o dojenju.

UNLABELLED: During human history, the natural process of breastfeeding has become ever less present as a mode of infant feeding. Numerous incentives have been introduced worldwide to stop this unfavorable trend. AIM OF THE STUDY: The aim of the study was to find the basic attitudes and knowledge about breastfeeding among mothers after delivery while they were at maternity wards. METHODS: Two surveys were conducted, with 940 participants in 1989-1990, and 626 participants in 1997. The women answered a self administered questionnaire with multiple choice questions. Data from the 1989-1990 and 1997 surveys were analyzed and compared. RESULTS AND DISCUSSION: A high percentage of women (98%), stated that they wanted to breastfeed their children, but only about 44% of them expected it to be problem-free. A great number of women did not know how and when to estimate milk secretion, or its adequacy for the baby. A significant proportion of the mothers believe that milk of some women is "watery" and thus inappropriate for their children. A great number of mothers (83%), answered correctly that the child need to be fed on demand rather than according to a strict schedule. In the second phase of the survey some positive changes in their knowledge were found, however, yet quite inadequate. CONCLUSION: Comprehensive and continuing education about breastfeeding of future mothers and fathers and the society as a whole is required.

[What makes quality of life: study on Croatian urban population]. / Sto cini osobnu kvalitetu zivota: studija na uzorku hrvatske gradske populacije.

The subjective quality of life of 315 healthy persons from Croatian urban population was assessed using SEIQoL. 61 different life areas were nominated as import determinants of the quality of life. The individual quality of life was reflected in the variety of life areas nominated as important by individuals through the differences in importance attached to these areas, and their level of functioning in each area. However, majority of the nominated areas can be classified in eight more general life domains, which are: health, Emotional well-being, Material well-being, Relationships, Achievement, Safety, Community and Spiritual domain. Qualitative analysis was performed on the free text area descriptions. Analysis yielded typical descriptions of quality of life domains. For each individually nominated area importance was assessed. Health, Family, Relationships, Love and Religion were rated as most important in subjective quality of life. There were differences in importance rang according to age groups. In addition, for each area was assessed level of functioning on seven point Lickert scale. Summary measure from functioning levels on five domains gives global measure of subjective quality of life (Quality of life Index). In average, subjective quality of life was assessed at 67% of scale maximum with the standard deviation of 13.7. No gender or age differences were found in Quality of life Index.

[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.