Publications (11)10.82 Total impact
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Article: Physicians' strike and general mortality: Croatia's experience of 2003.
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ABSTRACT: The aim of the study was to establish whether the physicians' strike, which took place in Croatia in 2003, had an impact on the mortality of the population. Mortality data from the National Bureau of Statistics relating to the strike period (15 January - 14 February 2003) were selected and compared with the previous and subsequent periods of the same duration in 2001, 2002 and 2004. Of the 52,575 deaths in 2003, Croatia recorded 4,682 (8.9%, 95% Confidence interval 8.4-9.4) in the strike period from the 15th of January to the 14th of February 2003 or 1.1 deaths per 1000. No deviations of the 15th of January to the 14th of February period's share of the death total in relation to other observation periods were noted. It is impossible to associate the strike based on the figures shown in this paper with either an increase or decrease in population mortality.Collegium antropologicum 10/2007; 31(3):891-5. · 0.61 Impact Factor -
Article: Chronic respiratory symptoms in Croatian Adriatic island metapopulations.
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ABSTRACT: To investigate the prevalence of chronic respiratory symptoms in 9 metapopulations on Adriatic islands in Croatia, and the relationship between respiratory symptoms and individual genetic background. We obtained random sample of 1001 adult inhabitants of 9 Adriatic island villages in Croatia, that also included immigrants to these villages. European Union respiratory health questionnaire and World Health Organization non-communicable diseases questionnaire were used. Personal genetic histories were reconstructed, based on the two-generation ancestral pedigrees. Bivariate and multivariate methods were used in the analysis. Women reported the occurrence of acute dyspnea (P=0.017), cough (P=0.002), and asthma (P=0.002) more often than men. Gender was the strongest predictor for acute and/or chronic cough (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.23-2.33) and asthma (OR, 2.00; 95% CI, 1.00-4.01), whereas smoking was the strongest risk factor for acute and chronic dyspnea (OR, 1.90; 95% CI, 1.21-2.99) and airway narrowing (OR, 1.84; 95% CI, 1.18-2.87). Residence on the northern islands increased the odds of allergy, whereas the highest odds ratio of 3.20 was associated with the interaction of northern residence and immigrant background. Genetic background was a significant predictor only for the occurrence of allergy symptoms. Differences in respiratory findings among the island inhabitants were often associated with smoking prevalence. Interaction of residence on northern Adriatic islands and immigrant background proved to be the strongest predictor for the occurrence of allergy symptoms. This study indicated that environmental factors played a very important role in the occurrence of respiratory symptoms.Croatian Medical Journal 09/2006; 47(4):627-34. · 1.80 Impact Factor -
Article: Effects of inbreeding, endogamy, genetic admixture, and outbreeding on human health: a (1001 Dalmatians) study.
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ABSTRACT: (1001 Dalmatians) research program collects biomedical information from multiple small isolated populations ((metapopulation)) on Adriatic islands, Croatia, and investigates health effects of human population isolation, inbreeding, admixture, and outbreeding. We collected random samples of 100 individuals from 9 island settlements and an additional sample of 101 immigrants to the islands, pooled from all study populations. According to their personal genetic histories, the examinees were categorized as inbred, autochthonous, admixed, and outbred. A total of 76 inbred individuals from a total sample of 1001 examinees were matched to 76 autochthonous, 76 admixed, and 76 outbred controls by gender, age (+/-5 years), village of residence, education, and socio-economic status. We investigated the effects of presumed individual genome-wide heterozygosity predicted from personal genetic histories on the following 10 traits: systolic and diastolic blood pressure, body mass index, high and low density lipoproteins and total cholesterol, triglycerides, uric acid, creatinine, and blood glucose. Personal genetic history significantly affected systolic blood pressure (Spearman rho=0.157, P=0.006), while the effect on cholesterol (rho=0.105, P=0.069), and high density lipoprotein cholesterol (rho=0.104, P=0.071) was suggestive. Admixed individuals and immigrants consistently showed values associated with lower health risk. When inbred and autochthonous samples were merged and compared with the admixed and outbred samples to increase the power of the study, the effects on the three traits above and also on body mass index and diastolic blood pressure became statistically significant. The medians for all 10 medically relevant traits in inbred and autochthonous group, with lower values of presumed individual genome-wide heterozygosity, were less favorable in terms of health. The combined effects of founder effect, genetic drift, and inbreeding can increase the frequency of detrimental rare variants in human metapopulations, leading to overall worsening of population health, whereas admixture and outbreeding appear to have the opposite effect.Croatian Medical Journal 09/2006; 47(4):601-10. · 1.80 Impact Factor -
Article: [Clinical and radiographic characteristics of patients with osteoarthritis of knees].
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ABSTRACT: The study of 60 outpatients with clinical diagnosis of the osteoarthritis (OA) of the knees is performed. Measured parameters were: general demographic data, clinical data and standard radiographic x-ray of knees in standing position, graduated by Kellgren and Lawrence clasificiation from 0-4. The aim of this study was to establish clinical and radiographic features of OA of knees and to compare those characteristiscs in the two subgroups of patients according to radiographic stages: a group of an early disease (stages 0 or 1) and a group of late disease (stages from 2 to 4). The mean age was 60 years with range from 39 to 85 years. 85% of patients were female. Distribution of patients according to Kellgren and Lawrence radiographic stages was as follows: 13 patients (21,7%) in grade 0, 17 (28,3%) in grade 1, 10 (16,7%) in grade 2, 11 (18,3%) in grade 3, and nine patients (15%) in grade 4. Crepitus on movement was registered in aproximatelly 80% of all patients, with no difference between early and late disease. Instability of the knee was present in eleven patients (18%), with more than a half of them (56%) in a radiographic grade 4 of OA of knees. There were no difference between functional parameters comparing original group of patients and two sub-groupes. Crepitus on movement was not related to any specific radiographic stage of disease, but instability of knee was frequently registered in late disease.Reumatizam 02/2006; 53(1):11-7. -
Article: [Comparison of two or more samples of quantitative data].
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ABSTRACT: In the study of the difference between the two or more data groups, first a scientific hypothesis is to be presented involving guessing, questing, and hypothesizing that motivate research. Statistical hypothesis is drawn from the scientific hypothesis, namely, the hypothesis of the researcher (which, as a rule, is affirmative). The mode of statistical hypothesis is presented so as to be valued by statistical and analytical procedures. Testing of the hypothesis is a statistical procedure that can determine whether and how reliably the available data support the given hypothesis. Testing of hypotheses, namely, testing of the significance is basically the procedure of the quantification of impressions regarding the specific hypothesis. The sequence of actions in the testing of the hypothesis: stating a null and an alternative hypothesis; the choice of the significance level (alpha); collection of relevant data based on the adequate sample of subjects; evaluation of the value of results of the statistical test specific for the null hypothesis (Ho); comparison of results of the statistical test with the values from the known value distribution specific for the given test; interpretation of the statistical test results in the probability terms (P-value). The Ho is a supposition of the absence of effect, i.e. that there is no difference between the samples in the population of interest (for example, that there is no difference in arithmetical means). This is a hypothesis of no difference. It is (mostly) made with the aim of rejection. It is either rejected or accepted. The choice of the corresponding statistical test depends on the researcher's design (dependent or independent study design of two or more data samples) as well as on the nature of data (distribution normality and variance homogeneity). Parametric tests carry more strength (the power to detect the difference if in reality it really exists) than nonparametric or distribution free tests. The latter are practical for smaller samples and situations in which the conditions for conducting parametric tests have not been satisfied.Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 02/2006; 60 Suppl 1:37-46. -
Article: Expression and possible prognostic role of MAGE-A4, NY-ESO-1, and HER-2 antigens in women with relapsing invasive ductal breast cancer: retrospective immunohistochemical study.
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ABSTRACT: To evaluate the possible prognostic role of the expression of MAGE-A4 and NY-ESO-1 cancer/testis antigens in women diagnosed with invasive ductal breast cancer and determine the expression of HER-2 antigen. The expression of MAGE-A4, NY-ESO-1, and HER-2 antigens was evaluated immunohistochemically on archival paraffin-embedded samples of breast cancer tissue from 81 patients. All patients had T1 to T3, N0 to N1, M0 tumors and underwent postoperative radiotherapy and, if indicated, systemic therapy (chemotherapy and hormonal therapy). The antigen expression in women who were disease-free for 5 years of follow up (n=23) was compared with that in women with either locoregional relapse (n=30) or bone metastases (n=28). Patient survival after 10 years of follow up was assessed. The three groups of women were comparable in terms of age, type of operation, tumor size, tumor grade, number of metastatically involved axillary lymph nodes, Nottingham prognostic index (NPI), progesterone receptor (PR) status, and adjuvant hormonal therapy. Estrogen receptors (ER) were positive in 13 women in the 5-year relapse-free group vs 8 in locoregional relapse and 7 in bone metastases group (P=0.032). There were significantly fewer women who received adjuvant chemotherapy in the 5-year relapse-free group than in other two groups (7 vs 23 with locoregional relapse and 25 with bone metastases; P<0.001). This group also had a significantly better 10-year survival (14 women vs 1 with locoregional relapse and 1 with bone metastases; P<0.001). The three groups did not differ in the NY-ESO-1 or HER-2 expression, but the number of patients expressing MAGE-A4 antigen was significantly lower in the group with locoregional relapse (P=0.014). In all groups, MAGE-A4 antigen expression was associated with the NY-ESO-1 antigen expression (P=0.006), but not with tumor size and grade, number of metastatically involved axillary lymph nodes, or the ER and PR status. MAGE-A4-positive patients had a significantly longer survival than the MAGE-A4-negative patients (P=0.046). This was not observed with NY-ESO-1 and HER-2 antigens. Our results suggest that the MAGE-A4 antigen may be used as a tumor marker of potential prognostic relevance.Croatian Medical Journal 02/2006; 47(1):32-41. · 1.80 Impact Factor -
Article: Smoking habits, signs of chronic diseases and survival in inland and coastal regions of Croatia: a follow-up study.
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ABSTRACT: Aim of the study was to estimate, the relationship between survival, smoking habits, and the results of medical examinations in inland and coastal regions of Croatia. Age and sex stratified sample of general population (1,571 men and 1,793 women, 37-56 years old in 1972; followed in 1982: N = 1,090 men; 1,325 women and/or 1972-1999 controlling vital status). Relative risks and 95% confidence limits were estimated using Cox regression in the model with time dependent covariates, separately by sex. In all regions, the proportion of male smokers decreased between 1972 and 1982. The proportion of female smokers increased, differently in urban and rural regions. During the follow-up between 1972 and 1999, 568 deaths were recorded among men and 382 among women. In men, in addition to age, significant hazards of death were the number of smoked cigarettes per day, body mass index, sedative intake, vital lung capacity (FVC), 100FEV1/VC, systolic blood pressure, electrocardiogram, history of heart attack, and region. In women, in addition to age, significant predictors were the number of smoked cigarettes per day, systolic blood pressure, electrocardiogram, history of heart disease (excluding coronary diseases), and region. Survival relative risk increased with each additional smoked pack of cigarettes by 2.4% in women and 1.3% in men. Regional differences vs. smoking habit were observed. These data emphasize the need for prevention of smoking.Collegium antropologicum 01/2005; 28(2):689-700. · 0.61 Impact Factor -
Article: Frequent attenders in family practice in Croatia: retrospective study.
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ABSTRACT: To determine the number of "frequent attenders" in family practice offices in Croatia according to the number and proportion of frequent attender visits in the total number of visits, and to follow up the frequent attenders and the number of visits they made over a period of three years. The retrospective study involved 8 family practice offices in Northern Croatia. The number of visits to family practice was determined for 4,312 patients aged over 18 years. There were 1,826 men (42.3%) and 2,486 (57.7%) women. The follow up period lasted from January 1, 1997 to December 31, 1999. The borderline value that divided the frequent from non-frequent attenders was the value at the third quartile of the number of visits in a single age-sex group of patients. We recorded a total of 58,088 visits of patients older than 18 years to 8 family practice offices in the three-year period. In 1997, out of 4,312 patients who made a total of 17,938 visits, 944 (22%) frequent attenders made 11,257 (63%) visits. In 1998, there were a total of 20,350 visits made, with 966 (22%) frequent attenders making 12,145 (60%) visits. In 1999, a total of 20,725 visits were made, with 988 (23%) frequent attenders making 12,259 (59%) visits. The differences in the distribution of frequent vs non-frequent attenders according to age and sex were not statistically significant in any of the three study years (chi-square, p=0.727). Older men and older women were not more often frequent attenders than younger men and younger women, respectively. Out of 4,312 patients, 1,714 (40%) were frequent attenders in one of the three study years. Of these, 884 (21%) were frequent attenders in one year, 476 (11%) in two years, and 354 (8%) in all three subsequent study years. Out of 4,312 patients, 1,762 (41%) patients in 1997, 1,139 (26%) in 1998, and 1,116 (26%) patients in 1999 did not make a single visit to a family physician. Frequent attender visits make a great proportion of the total number of visits to family practice offices in Croatia, a country with a health care system in transition. Eight percent of patients remained being frequent attenders during all three study years.Croatian Medical Journal 11/2004; 45(5):620-4. · 1.80 Impact Factor -
Article: Youth and AIDS--a study of attitudes, knowledge, behavior and risks in the post-war Croatia.
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ABSTRACT: 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).Collegium antropologicum 07/2003; 27(1):161-72. · 0.61 Impact Factor -
Article: Intensive care units in Croatia: 2001 survey.
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ABSTRACT: To establish a framework for the Intensive Care Units (ICU) Register in Croatia, and examine the relation between their present organization and medical practices and their outcome performances. The survey of a total of 123 ICUs in Croatia was conducted between February 1 and October 31, 2001. Census questionnaires were filled out by ICU chiefs of staff. Demographic data, data on hospital and ICU structure and organization, disposable equipment, admission and discharge decision-making, outcome, and patient demographic data were collected for February 1, 2001. Descriptive statistics was used for data analysis. On February 1, 2001, there were 123 ICUs in Croatia. The questionnaire was filled out by 117 ICU chiefs of staff (95% response rate). The total number of ICUs beds was 900, comprising 3.3% of all hospital beds. Croatian ICUs were divided into 13 subtypes; 89% of them were adjoined to hospital departments of various subspecialties and only 13 (11%) were freestanding. The number of ICUs per hospital, number of ICU beds, quantity of disposable equipment, and number of permanently employed medical and nursing staff within hospitals and individual units increased as hospitals enlarged. Also, the number of mixed surgical/medical and coronary care/medical units decreased, and specialized units became prevalent. The mortality data in Croatian ICUs were similar to those reported elsewhere in the world: the lowest mortality was found in psychiatric ICUs (3%) and the highest in an ICU for infective diseases (30%), followed by neurological (19%), medical (17%), and respiratory (16%) ICUs. Establishing a database on intensive care medicine and assessing the performance of ICUs in Croatia could serve as a model for improvement of ICU service in other transition countries.Croatian Medical Journal 01/2003; 43(6):713-21. · 1.80 Impact Factor -
Article: [Epidemiological characteristics of infectious diseases in Croatian island isolates].
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ABSTRACT: In isolated human communities infectious diseases often occur in unusual forms and reveal unexpected patterns of spread. This is not due to differences in biological characteristics of affected populations or infectious agents, but rather a consequence of specific changes in conditions under which the epidemics occur in isolated populations. The aim of this study was to analyze the patterns of the occurrence of salmonellosis, streptococcal angina, varicellae and scabies in 10 Croatian islands (Krk, Cres, Losinj, Rab, Pag, Brac, Hvar, Korcula, Vis and Lastovo) and in the entire Croatian population between 1989 and 1998. The four investigated diseases were selected based on: (1) sufficient number of cases each year the islands to warrant appropriate analysis of occurrence patterns; (2) different pathogenic mechanisms which include alimentary and respiratory bacterial infection, highly contagious viral infection and parasitic disease. The comparison of standardized rates of infection between the island populations and Croatian general population revealed large differences. In the islands the epidemics were less frequent in time, but of much greater intensity, especially in smaller and very isolated communities. Factors such as specific food and water supply, ecologic peculiarities, sociodemographic structure and population subdivision could have contributed to the determination of epidemic patterns in human isolates.Lijec̆nic̆ki vjesnik 10/2002; 124 Suppl 2:70-4.
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2005
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Institute for Medical Research and Occupational Health
Zagreb, Grad Zagreb, Croatia
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