Difficulties in recording mortality resulting from drug abuse.

It is considered, according to statements from different sources, that data on the number of deaths in the population of a certain country or region are accurate and correct, but determining causes of death is, for different reasons, often incorrect. There is, therefore,a justified doubt that there are more inaccurately registered drug abuse-related deaths in state registries. Hence, this paper tends to show the most frequent difficulties encountered when recording mortality resulting from drug abuse.

Drug related deaths in the Split-Dalmatia County 1997-2007.

Drug overdoses are a major cause of mortality for drug users and, in many countries, are the leading cause of death in this group. The aim of the present study is to explore the frequency of all drug related deaths in the Split-Dalmatia County in the period between 1997 and 2007 and to analyze some of the characteristics of these deaths to help target preventive policies. The data on drug related deaths were collected using records from the Department of Forensic Medicine, Clinical Hospital Centre Split, University of Split, School of Medicine. There were 190 drug related deaths in the observed period of 11 years. Statistically significant difference (p = 0.004, chi2-test for trend) was found in the number of deaths in 1997 in comparison with the number of deaths in 2007. The majority of 105 (55%) the decedents were 25-34 years old, and 92.1% (175) of them were male. There was a 94% higher probability of mortality in the 25-34 years group (chi2 = 5.55, p = 0.064). Average age of all dead people was 31.01 +/- 7.59 years (median 31.0 years; range 18-49). Almost three quarters of the decedents were single and more than three fifths hadn't been employed. The most common location of death was at home. Approximately, 80% were autopsied followed by full histological and toxicological analyses. Out of all examined cases, the majority of drug related deaths (93 or 60.8%) were attributed to heroin. Heroin was the sole cause of death in 35 (22.9%) cases. Methadone was cause of death in 24 (15.7%) cases. 3.4-methylenedioxy-methamphetamine (MDMA) deaths were rare (3.3%). Cocaine deaths were also rare (1.3%). Three fifths (55.6%) of the cases involved includes multi-substance use. During the investigation there was an evident trend towards multi-substance abuse patterns. These data suggest that interventions to prevent drug related mortality should address the use of drugs such as heroin and alcohol in combination.

Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia.

AIM: To study drug-induced mortality and characteristics of overdose deaths in the war (1991-1995), pre-war (1986-1990), and post-war period (1996-2000) in Split-Dalmatia County. METHODS: We retrospectively searched through Databases of the Department of Forensic Medicine, University Hospital Split, the national register of death records, the archives of the Split-Dalmatia County Police, and the Register of Treated Drug Addicts of the Croatian National Institute of Public Health, covering the period from 1986 to 2000, according to drug poisoning codes IX and X of the International Classification of Diseases. The indicators were statistically analyzed. RESULTS: There were 146 registered drug-induced deaths, with 136 (93%) deceased being men. The median age of all cases was 27 years (interquartile range 8). Most of them were single (70.6%), unemployed (44.6%), and secondary school graduates (69.2%). In the war period, there were 4.8 times more deaths than in the pre-war period (P=0.014), and in the post-war period there were 5.2 times more deaths than in the pre-war period (P=0.008). The most common site of death was the deceased person's home. The toxicological analyses showed that 59 (61%) deaths were heroin related, alcohol use was found in 62 cases (42.5%), and multi-substance use was found in more than a half of the cases. In 133 (91.1%) cases, deaths were classified as unintentional, whereas 13 (8.9%) were classified as suicides. CONCLUSION; The war, along with other risk factors, contributed to unfavorable developments related to drug abuse in Split-Dalmatia County, including the increase in the drug-induced mortality rate.

Predicting AH1N1 2009 influenza epidemic in Southeast Europe.

AIM: To use the data on the AH1N1 2009 influenza epidemic in the Southern hemisphere countries to predict the course and size of the upcoming influenza epidemic in South-Eastern Europe (SEE) countries and other regions of the World with temperate climate. METHOD: We used a comparative epidemiological method to evaluate accessible electronic data on laboratory-confirmed deaths from AH1N1 2009 influenza in the seasons 2009/2010 and 2010/2011. The studied SEE countries were Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Hungary, Kosovo, Macedonia, Montenegro, Romania, Serbia, and Slovenia, while Southern hemisphere countries were Argentina, Australia, Chile, New Zealand, Paraguay, Uruguay, and South Africa. RESULTS: In influenza season 2009/2010, Southern hemisphere countries with temperate climate reported 1187 laboratory-confirmed influenza AH1N1 2009 deaths (mortality rate 0.84/100000; 95% confidence interval [CI], 0.50-1.24). SEE countries with similar climatic conditions reported 659 deaths and similar mortality rates (0.86/100000, 95% CI, 0.83-1.10). In the whole Europe without the Commonwealth of Independent States countries (CIS, former Soviet Union), there were 3213 deaths (0.60/100000; 95% CI, 0.65-0.93). In 2010/2011, Southern hemisphere countries reported 94 laboratory-confirmed deaths (mortality rate 0.07/100000; 95% CI, 0.02-0.28) or only 7.9% of the previous season. SEE countries by the end of the 11th epidemiological week of 2010/2011 season reported 489 laboratory-confirmed deaths, with a mortality rate of 0.64/100000 (95% CI, 0.26-0.96) or 74.2% of the previous season, which was significantly higher than in the Southern hemisphere countries (χ(2) (1) =609.1, P<0.001). In Europe without CIS countries, there were 1836 deaths, with a mortality rate of 0.34/100000 (χ(2) =153.3, P<0.001 vs SEE countries). CONCLUSION: In the 2009/2010 season, SEE countries and Southern hemisphere countries had similar influenza AH1N1 2009 mortality rates. In the 2010/2011 season, the forecast of 10% increase in total mortality in SEE countries and Europe compared with the 2009/2010 season was significantly exceeded, while the expected impact of type-specific vaccines against influenza AH1N1 2009 was not achieved. Consumption of epidemic potential has greater importance for the prognosis of the course and size of influenza epidemic than the degree of vaccine immunity.

[Does Croatia have hospital surplus?]. / Ima li Hrvatska visak bolnica?

BACKGROUND: In addition to human resources in health care, hospitals are unavoidable factor in international deliberations of development level of health systems. Besides education of health workers, equipped devices and efficiency of work in hospitals, it is important to compare the number of hospitals, their size, type of hospitals, their distribution and availability to users. These elements are essential to the overall quality and efficiency of health work of an area. AIM: To identify and analyze the hospital by the number, type and size, number and type of beds in them, and the disposition in relation to population and unit area (km2) in Croatia, County of Split-Dalmatia and other European countries in total and by groups of European countries by the gross national product per capita (GDP pc), in 2007. Based on the analysis, to answer the question whether Croatia has a sufficient number of hospitals, particularly in County of Split-Dalmatia and Dalmatia. METHOD: In this article are used methods of descriptive epidemiology based on available electronic data of the WHO Office for Europe. RESULTS: Of the 44 European countries, Croatia is in the 35th place with a total of 79 hospitals (1.7 hospitals/100,000 population; Europe 3.4/100,000). Without 10 hospital wards, and 6-of-hospital maternity, Croatian average is 1.4/100,000 which places Croatia in 41st place. By the number of acute hospitals with no out-patient clinic and maternity wards, Croatia is in the penultimate 43rd place with 36 hospitals (0.8/100,000; Europe 2.6/100,000). According to the average number of beds/100,000 population, Croatia is at the 23rd place (Europe: 489 beds/100,000 population; Croatia: 352 beds/100,000). By the size of the hospitals per average number of hospital beds per one acute hospital Croatia has no clinic and outpatient hospitals (446) which puts Croatia in the second place behind the Netherlands (541). According to the number of acute hospitals/1,000 km2 with no out-patient clinic and maternity wards, Croatia is at the 39th place (0.6/1,000 km2; European average without Russia: 2.3/1,000 km2). In Croatia, most hospitals/100,000 population has County of Pozega-Slavonia (3.5/100,000), while the least are in Split-Dalmatia County (0.4/100,000). The most acute hospitals are in County of Pozega-Slavonia (2.3/100,000), and the least in County of Split-Dalmatia (0.2/100,000) or 7 times less than the Croatian average, and 13 times less than the European average. By the number of acute hospitals with no out-patient clinic and maternity wards/1,000 km2 in Croatia, there are most hospitals together, in City of Zagreb and County of Zagreb (3/1000 km2), and the least in County of Lika-Senj and County of Split-Dalmatia (0.2/1,000 km2). DISCUSSION: Croatia is getting behind by the number of hospitals, compared to Europe, especially concerning acute hospitals. Given the density and area unit in the Southern Croatia there is a striking lack of acute hospitals, causing a disparity in the availability of hospital and specialist health care. To make hospital and specialist health care available to the 170,000 inhabitants of Dalmatia, who are more than an hour away from the hospital, it is necessary to replace outpatient-clinics and maternity hospitals with the general hospitals. CONCLUSION: Given the fact that Croatia is at the top of Europe by the size of the hospitals by the number of beds for acute patients, and there is the sufficient number of beds to population, but also a lack of spatial coverage of acute hospitals and therefore poor availability of hospital and specialist care for the advisory large population of south and east of the state and Istria. Croatia should achieve further necessary hospital facilities by planning and building small municipal/town/local hospitals for acute patients with the necessary agreed facilities at the headquarters of the former health centers where already exists specialist diagnostic and therapeutic activities of secondary level health care.

The geographic patterns of the exceptional longevity in Croatia.

The aim of this study was to provide an overview of the exceptional longevity patterns in Croatia. The prevalence of nonagenarians (aged 90 years or more) and centenarians (100 years or more) was calculated from the 1953-2001 census data. The data were analyzed with chi-square test and trend analysis. The results indicate steady and significant increasing trends in both age groups, more pronounced in women. Geographical distribution of the exceptional longevity had a clear coastline-to-mainland gradient, with higher prevalence of exceptionally old people in the coastal parts of the country. Additionally, exceptionally old respondents from the Croatian Adult Health Survey (CAHS) were compared to elderly ones (65-89 years old). The results suggested that exceptionally old respondents had lower prevalence of overweight and obesity and lower blood pressure, thus exhibiting strong survivor phenomenon. At the same time, exceptionally old respondents from the CAHS had higher prevalence of confirmed hypertension in medical history and reported taking blood pressure medication more often. The results of this study suggest that the pattern of exceptional longevity in Croatia has a clear coastline-to-mainland gradient, which is likely to be associated with the different lifestyle and dietary patterns between these two populations.

[Mortality caused by injury, poisoning and other consequences of external causes in the Split-Dalmatia county population 2001-2005]. / Smrtnost stanovnistva splitsko-dalmatinske zupanije zbog ozljeda, otrovanja i ostalih posljedica vanjskih uzroka u razdoblju 2001-2005.

AIM: To present mortality caused by injury, poisoning and other consequences of external causes (S00-T98, ICD-10) in the Split-Dalmatia County population during the 2001-2005 period. METHODS: The methods of descriptive epidemiology were used. We included all County population with the diagnosis of fatal injuries (S00-T98, ICD-10) recorded during the study period. Mortality data were collected from the Central Bureau of Statistics. The distribution of mortality indicators according to the cause of death, age and sex is presented as absolute numbers, percentage and specific rates per 100,000 population. RESULTS: The group of injury, poisoning and other consequences of external causes (S00-T98, ICD-10) was the third or fourth leading cause of death in the County population, both males and females. During the study period, the specific injury mortality rates showed no significant oscillations. In this group, male subjects and those aged 75 or older were found to predominate. Concerning external causes of mortality, we determined the circumstances in which fatal injuries were inflicted. Falls were the leading cause of injury and death in females aged 75 or older. Traffic accidents predominantly involved younger and older males, while deliberate self-harm was most common in middle-aged and old aged subjects, male in particular. CONCLUSION: The role of public health is to point to the prevention of injuries because of their growing tendency in the population.

Micro-scale socioeconomic inequalities and health indicators in a small isolated community of Vis Island, Croatia.

AIM: To investigate whether socioeconomic inequalities at a micro-scale, through their effect on major health risk factors and other health indicators, contribute to health status in an isolated island population with demonstrated reduced genetic and environmental variability. METHODS: This cross-sectional study was performed in 2003 and 2004 in the adult population of the island of Vis, Croatia. Participants were recruited from the electoral register. A total of 1024 participants were included in the study, which represented a response rate of approximately 70%. The level of education and household socioeconomic status were used as the socioeconomic status indicators. Associations of these indicators with hypertension, obesity, hyperlipidaemia, smoking, diet indicators, and supplementary vitamins and calcium intake were investigated. Data analysis was performed by multivariate methods. RESULTS: Age and gender were most commonly associated with the presence of major health risk factors. Level of education did not show significant association with any of the investigated risk factors, supplements intake, or with dietary habits. Household socioeconomic status was significantly associated only with excessive alcohol intake (logistic regression odds ratio [OR], 1.85; 95% confidence interval [CI], 1.12-3.07, P=0.016), obesity (OR, 1.78; 95% CI, 1.13-2.81 P=0.013), and high-fat diet (multiple linear modeling F=2.75, P=0.042). CONCLUSION: In isolated communities, socioeconomic stratification may be a less important health determinant than in large general populations, making these populations favorable resource for biomedical research into other health risk factors.

Demonstrating reduced environmental and genetic diversity in human isolates by analysis of blood lipid levels.

AIM: To test the hypothesis that phenotypic diversity in isolated human populations is decreased in comparison with general outbred population because of reduced genetic and environmental diversity. To demonstrate this in populations for which reduced genetic and environmental diversity had already been established, by studying the amount of variation in plasma lipid levels. METHODS: Fasting plasma lipid levels (cholesterol, triglycerides, low density lipoprotein [LDL], and high density lipoprotein [HDL]) were measured in randomly selected 300 inhabitants from 2 isolated human populations, the island of Rab and the neighboring islands of Vis and Lastovo, Croatia. The populations were chosen based on previous analyses of genetic diversity and lifestyle patterns, which were shown to be both less diverse and more uniform than the general Croatian population. We studied whether the 25'-75' and 5'-95' interpercentile ranges in observed values were consistently smaller in 2 samples of 300 examinees from isolated populations in comparison with nearly 6000 examinees from an earlier study who were demographically targeted to represent the larger Croatian population. RESULTS: General population had much wider range of observed values of triglycerides and HDL than both isolated populations. However, both isolated populations exhibited greater extent of variation in the levels of LDL, while the ranges of cholesterol values were similar. CONCLUSION: Although reduced genetic and environmental diversity in isolated human populations should necessarily reduce the variance in observed phenotypic values, it appears that specific population genetic processes in isolated populations could be acting to maintain the variation. Departure from the Hardy-Weinberg equilibrium due to consanguinity, sub-structuring and differentiation within the isolates, and increased rate of new mutations could theoretically explain this paradox.