Simultaneous exposure to both Zika virus and household insecticides during pregnancy, and fetal growth and infant developmental behavior outcomes at 18 months, in Guadeloupe.

BACKGROUND: Perinatal infection with Zika virus (ZIKV) could result in adverse growth, developmental and behavioral outcomes, while insecticides used to control mosquitoes are neurotoxic. OBJECTIVES: We aim to study the role played by exposure during pregnancy to both ZIKV and household insecticides in newborn health, development and behavior at age of 18 months. METHODS: Maternal and cord blood samples from a cohort of pregnant women (created during Guadeloupe's Zika epidemic of 2016) were used to identify ZIKV infection during pregnancy. A self-administered questionnaire at birth documented prenatal household use of insecticides. Birth weight and head circumference were collected from maternity records (n = 708). Infant development and behaviors were documented at 18 months of age through the Ages and Stages Questionnaire and the Quebec Longitudinal Study of Child Development (n = 409). Logistic and linear regression models were performed, taking into account confounding factors. RESULTS: Use of household insecticides was associated with smaller head circumference and lower birth weight among newborns from mothers not exposed to ZIKV: 0.3 cm (95% CI: 0.6, 0) and -82 g (95% CI: 165, 0), respectively. Similar decreases were observed with ZIKV exposure among mothers not reporting household insecticides use, and with presence of both exposures. The combined presence of ZIKV exposure and insecticide use was associated with lower ASQ fine motor scores (-3.9; 95% CI: 7.3, -0.4), and higher hyperactivity scores (0.8; 95% CI: 0.0, 1.5), compared to no exposure to either. A higher opposition score was observed in association with ZIKV exposure among non-users of insecticide (0.6; 95% CI: 0.0, 1.2). CONCLUSION: Adverse neurodevelopmental outcomes at 18 months of age were observed with prenatal ZIKV exposure, and with higher magnitude when mothers reported use of household insecticides. At birth, rates of adverse fetal growth were however similar for the combined presence of exposure and either of the exposures.

Electric field induced Lyman-α emission of a hydrogen beam for electric field measurements.

Electric field induced Lyman-α emission is a new way of measuring weak electric fields in vacuum and in a plasma. It is based on the emission of Lyman-α radiation (121.6 nm) by a low-energy metastable H atom beam due to Stark-quenching of the 2s level induced by the field. In this paper, we describe the technique in detail. Test measurements have been performed in vacuum between two plates polarized at a controlled voltage. The intensity of emitted radiation, proportional to the square of the field modulus, has been recorded by a lock-in technique, which gives an excellent signal to noise ratio. These measurements provide an in situ calibration that can be used to obtain the absolute value of the electric field. A diagnostic of this type can help to address a long standing challenge in plasma physics, namely, the problem of measuring electric fields without disturbing the equilibrium of the system that is being studied.

[Telemedicine: who--what--how]. / Telemedicina: sto--zasto--kako.

Telemedicine, or medicine at a distance, is based on electronic communications and digital technology, so their development has led to the rapid development of telemedicine as well. Today, telemedicine covers many areas of health care, such as signal transmission on patient health state, image transmission, vertical and horizontal consultations among remote experts, interventions at a distance, teleeducation, medical patient monitoring and alarm, etc. The greatest advantages of telemedicine are increased access to health care, reduced costs and quality improvement. Telemedicine in Croatia has been developing parallel to the world achievements thanks to the well developed infrastructure and enthusiasm of the concerned professionals.

Public health training and research collaboration in South Eastern Europe.

The health care systems in South Eastern Europe are characterized by a predominantly curative orientation. During the last decade public health became insufficient due to war as well as economic and political changes. Today there is a lack of competence in public health above all in health management and strategy development, but also in the fields of health surveillance and prevention. The great need for a sustainable collaboration and support in advanced training and continuous education of qualified professionals to reach required conditions was recognized. Therefore, the project for the development of training modules and research capabilities in public health in South Eastern European countries (SEE) was proposed to the Stability Pact (PH-SEE Project). The project is to support the reconstruction of postgraduate public health training through development of teaching materials in English for the Internet. A regional network of lecturers in the health sciences will be established. The up to date texts should be of international standard but also be of regional specificity.

Ultrasound screening of the neonatal hip: cost-benefit analysis.

AIM: To explore the economic justification for introducing ultrasound screening for developmental dysplasia of the hip in Croatia. METHODS: The analysis was based on the two formulas: that cost-benefit equals benefit/cost, and that net benefit equals benefit minus cost. Screening costs were expressed as a sum of training costs and fee for ultrasound screening of neonates. The neonatologists' working hours and utilization of ultrasound instruments were expressed by multiplying the number of infants born per year in Croatia (N = 47,792) with the standard time needed for one examination and then dividing the product by the number of employed neonatologists (N = 54) and number of ultrasound instruments (N = 58). The benefit was expressed as a late case treatment costs and screening costs ratio. Savings, which would have resulted from the reduction in expected treatment costs of patients with hip problems at later age, represent the indirect benefit. RESULTS: Total hip screening costs would have amounted to US$329,537.80, including the training costs of US$31,035.90. On the average, a neonatologist would spend 71.4 hours screening per year, whereas the instrument utilization would be 64.7 hours. An ultrasound-screening program would save annually US$195,336.50, compared with the existing diagnostic approach. The treatment costs without ultrasound screening were 1.6 times higher than the screening costs. Hospital treatment costs for 165 patients needing endoprosthesis would cover the total screening program in the whole country. CONCLUSION: It is economically justified to introduce ultrasound screening for developmental dysplasia of the hip in neonates in Croatia, a country with transitional and developing economy.

The Croatian health survey--patient's satisfaction with medical service in primary health care in Croatia.

The aim of the study was to investigate patient satisfaction with nurses and general practice organization in Croatia. A total of 2,252 patients 18 years of age and over from 47 randomly selected general practices were included in the study. 72.1% of patients were satisfied with nurses and general practice organization. Older and less educated patients were generally more satisfied. Patients were more pleased with nurses' behavior (81.9%) than with practice organization (62.3%). Factor analysis revealed two underlying discriminates of patient satisfaction--"positive attitude towards the nurse" and "inaccessibility of practice". The former discriminate emphasized a great potential of nursing, which should be taken into consideration in the transformation of health care system in Croatia.

Health status and service utilisation of older people in different European countries.

OBJECTIVE: Care of elderly demands more and more resources. The purpose of this study was to compare the health of the elderly and the differences in utilisation of services. DESIGN: Health status was measured using the Short Form 36, the Barthel Index of Activities of Daily Living, the Abbreviated Mental Test and the Hospital Anxiety and Depression Scale. Information was also obtained on health and social service utilisation. SETTING: Eight European districts. SUBJECTS: 4004 elderly aged 70-94 years were studied. RESULTS: General health perception measured with SF-36 was significantly better in men than in women and in elderly living outside institutions. Measured with the Barthel scale, the elderly living in the southern districts were more disabled. Women were more disabled than men. Depression and anxiety were common, but inadequately treated and strongly linked with disability. There was a north-south difference also in mental disability, people in the north feeling healthier. CONCLUSION: Cultural differences probably explain most of the differences observed. However, treating depression and anxiety more adequately could help elderly people to avoid early institutionalisation.

Organization of health care in Croatia: needs and priorities.

AIM: Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. METHODS: A descriptive method was used. The data from the regular statistical publications were used for the analysis. RESULTS: Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. CONCLUSION: In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.

Young child injury analysis by the classification entropy method.

The project 'The Register and Preventive Programs for Accidents and Injuries' enabled data collection on all the injured who sought medical aid in Koprivnica County (population 61,052), Croatia, since 1992. Children aged 1-4 years are 5.03% of the whole population of the district. Complex injury attributes were analysed. Binary attributes were classified as input: age, gender, place of injury; and output: severity of injury. A new application of information entropy was introduced and applied to the classification of injury-causes attributes. The information entropy was calculated for the classification of input attributes according to the minimum information content. The decision procedure is given as a sequential procedure separating important from unimportant causes of injury at each decision level. Thus a decision tree with increasing entropy, i.e. decreasing determinism, was obtained showing that age (0.5347 N), place (0.6062 N) and gender (0.6105 N) are measurable attributes in child injury ascertainment in a descending pattern. It was shown that this method is, at the same time, an optimal way of using an attribute decision process of injury causes classification.

[Is a military hospital needed in the Republic of Croatia?]. / Treba li Republici Hrvatskoj vojna bolnica?

The paper is an attempt to answer the question whether the military hospital is necessary or not in such a small country. Some arguments (and contra-arguments) are listed and discussed. Between the others are: (1) the necessity of developing "war" medical skills and knowledge (cannot be developed during peace-time neither in the military nor civil hospitals, and civilian health services are capable to adapt and to fulfill specific war tasks as it was shown in war in Croatia in 1991), (2) the possibility to develop specific, even peculiar, specialties as hyperbaric or space medicine (these are necessary at the airports, navy bases etc, not in military hospitals), (3) specific health needs of the population of soldiers, officers, and their families (as a rule this population is younger and positively selected i. e. healthier than the general population), (4) security reasons (the data are more accessible from the military service in one place than from the scattered civilian health services), (5) privileges in health care for population of soldiers, officers, and their families due to their particular merits (military forces themselves deny this reason; also, separate military health services is not really the privilege due to bureaucracy, and rather narrow choice of services, (6) separate services could be less expensive and more efficient than the civilian one (experiences from the other countries are completely opposite). The conclusion is that, for such expensive parts of health services, as hospital care (spending between 40% and 70% of the total health expenditure), there is the growing need for rational and planned development within the comprehensive and integral healthcare system. Inside such comprehensive system the military hospital does not look like a rational solution.

[Problems and recommendations for the care of refugees displaced by war in Croatia]. / Problemi i preporuke za zbrinjavanje prognanika iz ratom zahvacenih podrucja Hrvatske.

The present situation in Croatia and the principles of displaced person camp organization are described. Displaced person care has become the urgent problem imposed on the Croatian social service and health care system. The up to now work has revealed that their is a need for more precise categorization of displaced persons in order that a comprehensive registration system be developed. The number of registered displaced persons in Croatia up to 26 September 1991 is quoted. Based on problems noted in the organization of displaced person camps, elements of organization and known principles of health care system in Croatia, a new model of displaced person camp organization is proposed.

Selected aspects of the epidemiology of psychoses in Croatia, Yugoslavia. IV. Representative sample of Croatia and results of the survey.

This is the fourth paper in a series on the epidemiology of psychoses in Croatia, Yugoslavia. Data collected from 1960-1975 on a representative sample of the population of the study area, including the Istrian Peninsula and the northern Adriatic littoral, and the control area, the rest of Croatia, indicate that functional psychotic illnesses are more frequent in the study area, with the highest rates in older population groups. The finding is not associated with coastal or inland residence, with educational level, or with occupational group. Other diseases in excess in the study area are diabetes mellitus, psoriasis, and alcoholism. Nutritional disorders are about equally distributed between study and control areas. Data on extent of cigarette smoking was more prevalent in the study area, cases of functional psychoses smoked no more than the general population.