[Show abstract][Hide abstract] ABSTRACT: A case-control retrospective association study was conducted to investigate a possible association of the TP53 polymorphisms, Arg72Pro and PIN3 (+16bp), with sporadic breast cancer in Croatian women. Ninety-five women with breast cancer and 108 age-matched healthy women were analyzed. Arg72Pro polymorphism was detected by TaqMan essay. For designation of PIN3 (+16bp) polymorphism DNA amplification was performed by the polymerase chain reaction (PCR) while the PCR products were detected by capillary electrophoresis. Homozygous genotype of minor allele of the PIN3 (+16bp) polymorphism was associated with sporadic breast cancer (OR = 2.15, 95% confidence interval [CI] 1.80-2.56, p = 0.006). For Arg72 polymorphism, the odds ratio for breast cancer of ArgPro versus reference genotype ArgArg was 0.55 (95% CI 0.30-1.02, p = 0.039) suggesting the protective effect. Although different haplotypes did not influence the susceptibility to the disease, the joint occurrence of genotype combination ProPro/A2A2 frequent in cases, was associated with sporadic breast cancer (OR = 2.20, 95% CI 1.89-2.56, p = 0.021). The study provides evidence of the association of the TP53 gene polymorphisms Arg72Pro and PIN3 (+16bp) with sporadic breast cancer in the Croatian population.
Full-text · Article · Jan 2010 · European journal of gynaecological oncology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to obtain an accurate estimate of diabetes prevalence in Croatia and additional estimates of impaired fasting glucose (IFG), undiagnosed diabetes, and insulin resistance. The study was part of the First Croatian Health Project. Field work included a questionnaire, anthropological measurements, and blood sampling. A nationally representative sample of 1653 subjects aged 18-65 years was analyzed. A total of 100 participants with diabetes were detected, among them 42 with previously unknown diabetes. The prevalence was 6.1% (95% CI: 4.59-7.64), with a significant difference by age. IFG prevalence (WHO-criteria) was 11.3%. The ratio of undiagnosed/diagnosed diabetes was 72/100, unevenly distributed by the regions. HOMA-IR was >1 in 40.4% of the subjects. This survey revealed a higher prevalence of diabetes than previously estimated, whereas that of IFG was as expected. A significant difference in the proportion of undiagnosed diabetes among the regions warrants attention.
Full-text · Article · Jul 2008 · Diabetes research and clinical practice
[Show abstract][Hide abstract] ABSTRACT: The metabolic syndrome, an assemblage of risk factors, viz., obesity, dyslipidemia, carbohydrate intolerance, and hypertension, associated with development of cardiovascular diseases and Type 2 diabetes, has become a major public health problem in the developed countries. However, data on its prevalence in worldwide populations, particularly in non-industrialized societies is sparse. We report the prevalence of metabolic syndrome in an island population of the eastern Adriatic coast of Croatia, a distinctly homogenous population living in relative isolation with a traditional way of life style pattern. The participants consist of 381 unrelated individuals (136 males, 245 females) from the island of Hvar, age 19 and above. Hvar is among the most populated Croatian islands with a total population of 11,459 individuals according to the 1991 census. Metabolic syndrome was assessed following the National Cholesterol Education Program (NCEP) criteria, with the exception of using body mass index and waist hip ratio as the predictors of obesity. Overall age-adjusted prevalence of metabolic syndrome is 26% (32% in males and 24% in females) with body mass index, and 42% (57% in males and 36% in females) with waist hip ratio as the measures of obesity. Pairwise correlations of the age and sex-adjusted individual components show that with the exception of fasting plasma glucose, the other components of metabolic syndrome are significantly associated with each other, suggesting their co-morbidity. In spite of adherence to a relatively traditional life-style pattern together with a "Mediterranean diet" and rural habitat, the prevalence of metabolic syndrome is substantially high in the population of Hvar. It is likely that factors other than nutritional practices, that might include genetic susceptibility, could potentially be important in predisposition to metabolic syndrome.
Full-text · Article · Apr 2008 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: A case-control association study was conducted to investigate a possible involvement of polymorphisms of three renin-angiotensin system genes: ACE (I/D and T-3892C), AGT (M235T and T174M), and AT1R (A1166C) in the early development of hypertension.
One hundred nineteen hypertensive and 125 normotensive participants aged 18 to 40 years were selected from a broader sample representative of the general population of Croatia. The selection criteria for hypertensive cases were systolic blood pressure (BP) higher than 140 mm Hg or diastolic BP higher than 90 mm Hg and a history of hypertension according to patient interview.
Among the polymorphisms investigated, only those located on the ACE gene were associated with hypertension. For ACE I/D, the odds ratio for hypertension of DD versus II homozygote individuals was 2.50 (95% confidence interval [CI] 1.19-5.25) and for ACE T-3892C, the odds ratio of CC versus TT individuals was 2.32 (95% CI 1.05-5.10). Both polymorphisms of the ACE gene were in tight linkage disequilibrium. Of the investigated risk factors for hypertension, only body mass index (BMI) showed an influence on the early development of hypertension, acting independently of the ACE polymorphism. Their additive effect gives rise to 86% of hypertensives in subjects having both the DD genotype and BMI >or=30 kg/m(2).
The present study provides evidence of the association of the ACE gene polymorphisms and premature hypertension. In addition, BMI proved to be another important predictor of the disorder acting independently of the ACE gene.
Full-text · Article · Sep 2006 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to investigate the degree of burnout experienced by intensive care staff particularly, in Medical (MICU) and Surgical Intensive Care Units (SICU) General Hospital "Sveti Duh", Zagreb. A sample group of 41 emergency physicians and nurses from MICU and 30 from SICU was tested. The survey included demographic data and Maslach Burnout Inventory (MBI) scoring test identified by the three main components associated with burnout: emotional exhaustion (MBI-EE), depersonalization (MBI-DEP), and personal accomplishment (MBI-PA) were assessed using 22-item questionnaire. The degrees of burnout were stratified into low, moderate, and high range. Mean total MBI (X +/- SD) were high in both groups: higher for the MICU (65.5 +/- 6.7) than for SICU staff (55.7 +/- 3.8, p < 0.05). MICU staff showed moderate degree of MBI-EE (24.9 +/- 11.2), MBI-DEP (6.0 +/- 5.6), and as well as MBI-PA (34.4 +/- 8.8). The same parameters showed better results among SICU staff: low degree of MBI-EE (17.1 +/- 5.2), as well as low level of MBI-DEP (5.2 +/- 5.0), and moderate degree of MBI-PA (33.7 +/- 9.8). The differences between the groups was statistically significant only for the total MBI, and for MBI-EE (p < 0.05). There were no significant differences between MICU and SICU staff for MBI-DEP or MBI-PA parameters. Overall job burnout represented in a moderate degree. The presence of burnout is a serious phenomenon, because it can lead to psychosomatic complaints, work-associated withdrawal behaviour, and a lower quality of care at intensive care units. Early recognition of burnout phenomenon as a result of prolonged stress and frustration among intensive care staff, contributes to better professional behavior, organizational structure changes in the work environment and better health care quality for critically ill patients.
Preview · Article · Apr 2006 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: About 50% of adults in the developed and 80-90% in the developing countries are estimated to be infected by Helicobacter pylori. Being 68% nationally, this rate is higher in the northern continental parts of Croatia, which also have higher gastric cancer rates. Low socio-economic status, poor living conditions in childhood (the age when Helicobacter pylori is typically acquired), and exposure to the stomach content of an infected person are risk factors for Helicobacter pylori. Most of the infected are symptomless, with 10 to 20% subsequently developing the disease, and this mainly from peptic ulcer, asymptomatic chronic gastritis and chronic dyspepsia. Less than 5/10,000 become affected with adenocarcinoma, MALT lymphoma or primary non-Hodgkin's gastric lymphoma. Helicobacter pylori is under intensive study for possible association with other diseases. As transmission route of the infection is still unclear, any mechanism allowing the bacteria entry into a non-infected individual's stomach is probably a possibility. In addition to improved socio-economic status, eradication or vaccination may be contributors to the reduction in the number of the infected.
No preview · Article · Oct 2002 · Lijec̆nic̆ki vjesnik
[Show abstract][Hide abstract] ABSTRACT: The aim of the privatization of the primary health care is to reduce cost and improve the quality of service by introducing the market-based system. In the Republic of Croatia, the privatization of the primary health care started in 1995. It was based on renting the existing facilities at a moderate price to the practitioner. After that, the practitioner registers the private practice and signs a contract with the obligatory health insurance institution. The aim of this article is to present a part of the project of long-term research of privatization related to the health care accessibility in general practices. The research sample consisted of three groups: privatized general practices, to-be-privatized general practices and non-privatized general practices during 1997 and 1999. Privatized general practices have exhibited a significant improvement in the number of registered patients, the scheduling of first visit appointments during working hours, the possibilities of scheduling follow-up visit appointments during working hours, scheduling visits by telephone, obtaining telephone advice after working hours and visiting the practitioner after working hours. This kind of research is vital in order to bring about the necessary changes in the existing system by scientifically approved methods.
No preview · Article · Jan 2002 · Lijec̆nic̆ki vjesnik
[Show abstract][Hide abstract] ABSTRACT: As the liberation of occupied Croatian territories ended the war in the country in 1995, the Ministry of Health and Croatian Health Insurance Institute have agreed to create the new framework for developing a long-term strategy of public health planning, prevention and intervention. They provided financial resources to develop the First Croatian Health Project, the rest of the support coming from the World Bank loan and the National Institute of Public Health. A large cross-sectional study was designed aiming to assess health attitudes, knowledge, behaviour and risks in the post-war Croatian population. The large field study was carried out by the Institute for Anthropological Research with technical support from the National Institute of Public Health. The field study was completed between 1995-1997. It included about 10,000 adult volunteers from all 21 Croatian counties. The geographic distribution of the sample covered both coastal and continental areas of Croatia and included rural and urban environments. The specific measurements included antropometry (body mass index and blood pressure). From each examinee a blood sample was collected from which the levels of total plasma cholesterol (TC), triglycerides (TG), HDL-cholesterol (High Density Lipoprotein), LDL-cholesterol (Low Density Lipoprotein), lipoprotein Lp(a), and haemostatic risk factor fibrinogen (F) were determined. The detailed data were collected on the general knowledge and attitudes on health issues, followed by specific investigation of smoking history, alcohol consumption, nutrition habits, physical activity, family history of chronic non-communicable diseases and occupational exposures. From the initial database a targeted sample of 5,840 persons of both sexes, aged 18-65, was created corresponding by age, sex and geographic distribution to the general Croatian population. This paper summarises and discusses the main findings of the project within this representative sample of Croatian population.
Full-text · Article · Jul 2001 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: During winter time in the period from 1993 to 1998, 18 elderly patients: 11 female and 7 male aged 65-88 years, were treated because of hypothermia. Rectal temperature on admission was 20-34.5°C. Ten patients suffered from moderate hypothermia (35-32°C), and eight suffered of severe hypothermia (< 32 °C). Arterial hypotension was recorded in 7, and shock in 11 patients. In all of them, and in 18 controls, an electrocardiogram was analyzed with the special reference to the corrected Q-T interval. Decompensated metabolic acidosis was observed in 7 / 8 patients with severe hypothermia and in 4 / 10 with moderate hypothermia. Among patients with moderate hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 2, idioventricular rhythm in 2 and atrial fibrillation in 4 / 10 patients. In patients with severe hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 3, idioventricular rhythm in one, and atrial fibrillation in 2 / 8 patients. In moderate hypothermia Osborn's or Tomaszewski's J wave was present in 7 / 10, and it only appeared in 3 / 10 patients; in severe hypothermia it was present in 6 / 8 and only appeared in 2 / 8 patients. The corrected Q-T interval in the group with hypothermia ranged 0.450-0.688 s, in the control group 0.343-0.444 s. The X minimum (s) in the group with hypothermia was 0.508±0.079, in the control group it was 0.371-0-139 s, and the difference was statistically significant (p < 0.001). The X maximum (s) in the group with hypothermia was 0.576±0.067 s, in the control group 0.390±0.019 s, and the difference was also statistically significant (p < 0.0001). In both groups the most significant prolongation of the corrected Q-T interval in the majority of patients was found in anteroseptal leads. The dispersion of the corrected Q-T interval in the group with hypothermia was 87.19±28.44 ms, in the control group it was 32.06±8.94 ms, and the difference was statistically significant (p < 0.001).
Preview · Article · Jan 2000 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: The purpose of our study was to evaluate the effects of orally administered combined sequential estradiol (2 mg 17 beta estradiol) with progestin (1 mg norethisteron acetate) daily during ( +/- SD) 15.34 +/- 13.89 months on bone markers in perimenopausal cigarette smoking women. The control group consisted of cigarette smoking perimenopausal women without hormone replacement therapy (HRT). The following biochemical bone markers were analyzed in hormone replacement users (N = 35) and non-users (N = 28): serum total calcium (Ca), total alkaline phosphatase (ALP), procollagen I C-terminal propeptide (PICP), cros-linked carboxyterminal collagen I telopeptide (ICTP) and osteocalcin (OC). When we compared the results of bone markers in the cigarette smoking current users and non cigarette smoking non-users, we found statistically significant lower levels of bone formation markers, ALP and OC, and lower level of bone resorption marker; ICTP in users than in non-users. In perimenopausal cigarette smoking women on HRT lower levels of new biological markers reflected less intensive bone remodelling and probable decrease in bone loss than in non-users. These results indicate that the measurement of biological bone markers are useful to identify risk women for osteoporosis who may have special benefit from the treatment with hormone replacement therapy, even when they smoke.
No preview · Article · Jul 1999 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: Apo E genotypes and plasma metabolic risk factors (total cholesterol, triglycerides, HDL and LDL cholesterol, total/HDL cholesterol ratio, lipoprotein Lp (a), apolipoprotein A-I, A-II, apo B, and apo E) were determined in 134 healthy middle-aged (X +/- SD 49.62 +/- 4.83) women. The aim of this study was to investigate metabolic risk markers according to various apo E genotypes, and to evaluate a possible risk for coronary heart disease. The results revealed that the frequencies of apo E3/3 are the most frequent (46%), followed by E4/4 (2%), E3/4 (14%), E2/3 (14%), and E2/4 (2%) in the middle-aged women. Higher mean triglycerides, LDL-C and apo B levels were found with apo E3/4, and lower mean levels of HDL-C i.e. apo A-I than in other analyzed genotypes. Greater mean of total/HDL ratio and lower levels of apo A-II were seen with E2/4. Serum lipoprotein Lp (a) concentration was higher in women with genotypes E3/3. Apo E concentration was the lowest with genotypes E4/4, i.e. the highest with E2/3. Serum total cholesterol tended to be higher in women with genotypes E4/4. Genotype E3/4 is connected with the highest concentrations of (X +/- SD) triglycerides (1.74 +/- 0.78), LDL (4.28 +/- 1.88), apo B (1.03 +/- 0.32) and with the lowest concentrations of HDL cholesterol (1.11 +/- 0.21) in the relation to the other analyzed genotypes. This group of women could possibly represent high risk women for CHD. Genotype E3/3 is associated with the highest concentration of independent genetic risk marker for CHD, lipoprotein Lp (a) (0.19 +/- 0.27). The genotype E4/4 has the highest concentration of total cholesterol (5.93 +/- 1.01), and has to be taken in account for risk evaluation in women. High level of apo E (0.11 +/- 0.05) and low level of apo A-I (1.80 +/- 0.44) were associated with E2/3 genotypes. The significance of E3/4 with the high total/HDL ratio (5.52 +/- 2.21) and low apo A-II (0.53 +/- 0.09) is important indicator, because total/HDL cholesterol ratio represents independent Established Risk Factor (ERF) for CHD. Apolipoprotein E genotypes as genetic markers and investigation of serum metabolic risk markers appear to be important in view for further evaluation of high risk women for CHD in our population.
Full-text · Article · Jul 1998 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: During 1993-1998, in winter time 14 elderly patients: 8 female and 6 male aged 65-88, were treated because of hypothermia. Rectal temperature on admission was 20-34.9 degrees C. Sopor was present in 2 and various grades of coma were present in 10 patients. Arterial hypotension was recorded in 5, and shock in 9 patients. Increased serum creatinine level was found in 8 patients. The mean rectal temperature in the whole group was 31.3 degrees C +/- 4.7, ranging from 20.0 to 34.9 degrees C, and the mean serum creatinine level was 172.2 +/- 93.5, in range of 66.0 to 360.0 mumol/L. Negative correlation between those two parameters was found: r = -0.572. In 2 of them parameters of renal failure were analyzed: urine sodium concentration, creatinine urine/plasma ratio, urine osmolality, urine/plasma osmolality ratio, renal failure index and fractional excretion of filtered sodium. In one of the patients all parameters were within the range of functional oliguria, in an other the urine sodium concentration serum showed acute renal failure, but all other findings showed borderline values between functional oliguria and acute renal failure. Twelve out of 14 patients died within 1-216 hours from admission.
Preview · Article · Jul 1998 · Collegium antropologicum
[Show abstract][Hide abstract] ABSTRACT: MRI, DSA) per head of population in developed countries. The lower limit of the West European standard was chosen because of the lack of a single uniform standard and varying data. Devices were purchased on the basis of a uniform international tender, specifying the number needed according to type and technical performance, with a request for a description of the financial conditions of sale. On analysis of the tenders those that were technologically above or below the specified standard levels were readily excluded, thus avoiding a cost increase due to the technology exceeding the anticipated standard. At the end of the 2-year project period, the state of the radiodiagnostic equpiment was compared with the initial data.
No preview · Article · Feb 1998 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: The quality of health care also depends partly on technological equipment. Among the devices which diminish the quality of services if they are old, increasing at the same time the danger when used, are certainly those in radiodiagnostics. Besides, their age controls the dose of radiation to which patients and professional staff are exposed. The knowledge of the age of this equipment is the basis of the plans for further development. The aim of the study is to determine the age of each individual radiodiagnostic device in Croatian institutions. The assessment of each device was made by a qualified professional. The method of data collection was based on the uniform questionnaire which comprised radiodiagnostic devices older than ten years, classified according to type and location (primary health care center or hospital, in total 655 devices). Determination of the age index of generators and x-ray tubes older than seven years (according to the World Bank recommendation), included also mobile units (55 for fluoroscopy and 68 for radiography), devices for dental radiography, devices in private sector (118) and devices which are out of use but not officially blocked (88), which means in total 859 generators and 1111 x-ray tubes. In addition, the availability of image intensifiers for fluoroscopy and manufactures of all devices were determined. The results of the study reveal that in primary health care centers, out of 248 radiodiagnostic devices, 193 are older than ten years (77.8%), while 4 are of unknown age. In hospitals, out of 407 devices, there are 261 older than ten years (64.1%), while 46 are of unknown age (11.3%). Among devices for fluoroscopy, 97 out of totally 206 have no image intensifier (32%). These devices should be immediately excluded from utilization. The index of age above seven years, which is according to the recommendation of the World Bank the lifetime of devices, reveals that 859 generators out of totally 984 (91%) are too old to be used, while there are 1111 x-ray tubes out of totally 1206 (92%) which are in the same condition. Regarding the manufacturers, the ratio is also unfavourable, since 49.3% of devices have been manufactured by comparies whose technology and spare parts are now inaccessible (Elektronska industrija). Such unacceptable obsoleteness of the radiological equipment requires urgent renewal.
No preview · Article · Jul 1996 · Lijec̆nic̆ki vjesnik
[Show abstract][Hide abstract] ABSTRACT: In our study, we have attempted to define biological differences in older and younger subjects in the broader sense, with regard to the variety of reasons and outcome of hospitalization in departments for internal disease. We analyzed data and patients treated in the Department of Internal Medicine Rebro, in Zagreb, one of the leading institutions in this part of the world, during a five-year period: 1987-1991. The major diagnosis on discharge from hospital was analyzed. Diseases were divided into groups of internal medicine subspecialities. Out of a total of 31,808 patients treated during this period in the in-patient departments of the hospital, 26.5% were aged 65 years or more, and 73.5% were younger than 65 years. Gastrointestinal diseases were most frequent: 36.5%, and of this number 35.4% were older and 36.9% younger; followed by cardiovascular disease: 19.8%, 27.7% older and 13.1% younger; and third in order of frequency were renal disease and arterial hypertension: 13.0%, 9.5% older and 14.2% younger. These three groups of diseases amounted to 66.4%, of which number 72.2% were older patients and 64.3% younger patients. With regard to the duration of hospitalization, up to 24 hours was more frequent in older patients than younger patients, and also hospitalization of 10-29 days. Satisfactory outcome and treatment was significantly less frequent in older patients than in younger patients: 85.6%: 92.9%, and lethal outcome was more frequent in older patients than in younger patients: 10.5% :4.2%.
No preview · Article · Jan 1996 · Collegium antropologicum