A large cross-sectional study of health attitudes, knowledge, behaviour and risks in the post-war Croatian population (the First Croatian Health Project).

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.

Variations of body mass index in Croatian school children and adolescents.

The purpose of the study is to present the percentile distribution of body mass index in Zagreb school children and to assess whether it differs from those in other countries; in addition, to assess whether the values of mean BMI in Zagreb school children differ markedly from those in other regions in Croatia i.e. in Medimurje and Osijek. Data on height and weight have been derived from growth surveys organized or performed by the Andrija Stampar School of Public Health over the last decade. The results have shown the skewed distribution of data i.e. the agglomeration of high values of BMI in upper percentile positions. Percentile values of BMI for Zagreb school children were higher than the reference data for American white children and adolescents except at the upper percentile positions (85 and 95) for the older age groups. Mean values of BMI of Zagreb school boys and girls were in general higher than in their peers in other European countries. However, the means of BMI for two other groups of Croatian children--in Osijek and Medimurje--were lower. Regarding the association of overweight with risk factors for cardiovascular diseases, the results have pointed out a great importance of the respective health education programme for school children and adolescents. The presented results may also serve as a basis for a study of secular changes in variations of body mass index in the adolescent period.

A pH-dependent colon targeted oral drug delivery system using methacrylic acid copolymers. I. Manipulation Of drug release using Eudragit L100-55 and Eudragit S100 combinations.

Lactose-based placebo tablets were coated using various combinations of two methacrylic acid copolymers, Eudragit L100-55 and Eudragit S100, by spraying from aqueous systems. The Eudragit L100-55-Eudragit S100 combinations (w/w) studied were 1:0, 4:1, 3:2, 1:1, 2:3, 1:4, 1:5 and 0:1. The coated tablets were tested in vitro for their suitability for pH dependent colon targeted oral drug delivery. The same coating formulations were then applied on tablets containing mesalazine as a model drug and evaluated for in vitro dissolution rates under various conditions. The disintegration data obtained from the placebo tablets demonstrate that disintegration rate of the studied tablets is dependent on: (i) the polymer combination used to coat the tablets, (ii) pH of the disintegration media, and (iii) the coating level of the tablets. Dissolution studies performed on the mesalazine tablets further confirmed that the release profiles of the drug could be manipulated by changing the Eudragit L100-55 and Eudragit S100 ratios within the pH range of 5.5 to 7.0 in which the individual polymers are soluble respectively, and a coating formulation consisting of a combination of the two copolymers can overcome the issue of high gastrointestinal (GI) pH variability among individuals. The results also demonstrated that a combination of Eudragit L100-55 and Eudragit S100 can be successfully used from aqueous system to coat tablets for colon targeted delivery of drugs and the formulation can be adjusted to deliver drug at any other desirable site of the intestinal region of the GI tract on the basis of pH-variability. For colon targeted delivery of drugs the proposed combination system is superior to tablets coated with either Eudragit L100-55 or Eudragit S100 alone.

Changes in growth patterns in Zagreb school children related to socio-economic background over the period 1973-1991.

The purpose of this paper is to present the changes in growth patterns in different socio-economic classes of Zagreb school children over the period 1973-1991. Classes are defined by parental occupation. Surveys were performed in 1973, 1982 and 1991 covering 8938, 10700, and 7400 examinees aged 7 to 19 respectively. In all three observed generations boys and girls belonging to social group I (nonmanual workers' families) were taller than their peers in group III (manual workers' families). Differences were most pronounced in 1973. Mean height of children from 'mixed' families (class II) were mostly between two other groups. Positive secular changes in both genders were most pronounced in children belonging to manual workers' families--girls observed in 1991 being 2-4cm and boys 2-6cm taller than their peers in 1973. In children from nonmanual workers' families the secular increase was small in younger age groups--in boys up to 11 hardly noticeable, while in both genders from the age of 13 on, the mean height increase reached or even surpassed that observed in manual workers' children. Positive changes in all observed groups were more pronounced in the period 1973-1982 than in 1982-1991. Mean weight changes, in general over period 1973-1991 corresponded to changes in height. However, the average weight gain in girls in class I was somewhat lower compared to the gain in height, particularly in older age groups. In the same period, 19731991 the mean menarcheal age in girls showed the reversed trend i.e. a shift towards the older age. In class I the reversal was noticed in the first period, parallel to intensive height increase, while in class III positive changes in height were accompanied by significant lowering of menarcheal age. In this group the reversal was observed in the second period 1982-1991.

[A new organization of school health services: its twilight or renaissance?]. / Nova organizacija skolske medicine: suton ili renesansa?

Starting from the beginning of January 1998, school health service in Croatia became exclusively a preventive activity. This change provoked a lot of controversial discussions among general public and medical profession. This paper gives an outline of the historic course, the aims and content of school health in different countries. From its very beginning in the middle of the 19th century, school health started to develop as a preventive activity directed primarily towards organic etiology dominant in the morbidity of school children at that time (infectious diseases, tuberculosis, malnutrition). The morbidity has changed over time. Nowadays, the problems of psychosocial etiology have emerged into the first plane. Moreover, schooling has been prolonged. It covers a great part of childhood and almost the entire adolescence. The problems of adolescents are different and complex. Health care of school children and adolescents is functionally bound to the school as their natural environment. The most efficient health care is provided in close cooperation between medical personnel and teachers. Besides, the classical model of school health offers, particularly with respect to current problems, large possibilities for health promotion of children and adolescents, and in the long run, of the whole population. Health care of school children is not equally organized in different countries. The main difference depends on whether the school health team is directed only towards preventive and specific activities or towards comprehensive primary health care. In Croatia, traditionally, the integrated health care has developed. Beside preventive health care, the school doctors provided curative care for students in their schools. Within the reorganization of health care a new situation has arisen. Compulsory integration of preventive and curative activities at the school level is completely incompatible with the right to a free choice of primary care physician. However, by the strict interpretation of the principle of indivisibility of preventive and curative care, one school should cooperate with numerous personal doctors for its students. The essential principle of school health would be lost. The school represents a community which is exposed to the same health risks but keeps a great potential for health promotion. So, if this advantage is to be utilized, preventive care must be organized at the school level. This is the very nature of the reorganization in school health service which is performed in Croatia under the auspices of the Ministry of Health. Providing the preventive and specific health care for all school children and adolescents is the responsibility of school doctors who have become the employees of the Institutes of Public Health, while the curative care is provided by the personal physician of a student's or his parents' choice.

Secular growth changes in Zagreb schoolchildren over four decades, 1951-91.

Secular changes in growth and development vary over past decades in intensity and in trend. The purpose of this paper is to present changes in growth patterns of Zagreb schoolchildren aged 7-19 years over the past four decades. Surveys were performed in 1951, 1964, 1973, 1982 and 1991. The mean height of boys and girls in all observed groups has increased significantly over the 40-year period. Age groups up to 9 years in 1991 were 4-7.5 cm taller than their coevals in 1951. Differences increased from the age of 10 in girls and 12 in boys, reaching 10 cm in girls of 12 years and even 14 cm in boys of 14 years. They were also highly pronounced in adult height (5 cm in girls, 7 cm in boys). The most pronounced changes appeared from 1951 to 1964, while in the period from 1964 to 1973 the increase was smaller; in girls only up to 13 years, in boys to 17 years. However, between 1973 and 1982 positive changes were again significantly pronounced, especially in the older age groups. In the last period, 1982-91, the trend seemed to come to an end. Changes in average weight mostly corresponded to the height changes, being somewhat greater in boys. Moreover, in the last two periods, weight gain in older girls was smaller compared to height. Menarche in the period 1964-73 shifted to a younger age by 8 months (13.34-12.67 years), retaining the same level over the next 9 years. However, since 1982 a slight reverse trend has been noticed.

[Evaluation of genetic factors in the variability of menarche]. / Ocjena genetskog faktora u varijabilnosti menarhe.

The purpose of the study was to assess the correlation of menarche and the similarity of other features of pubertal development at the onset of menarche in sisters compared to girls which are not in kinship. The longitudinal study was performed in school girls in the city of Osijek. Seventy-four pairs of sisters i.e. 148 girls aged 9 to 15 years in which the menstrual cycle had not started were embraced. The "nonrelated pairs" were formed within the same group of girls. Results showed the significant intrapair correlation of menarcheal age between sisters whereas the correlation in nonrelated pairs did not exist. The body height at the onset of menarche in both groups of pairs--sisters and nonrelated girls--was positively correlated, but significance was on higher level in sisters. Body weight varied in a large range; the intraclass correlation being significant in pairs of sisters only. Menarche appeared in almost equal distribution of breast stage as it was found in other studies. However, breast stage showed considerably higher concordance in sisters than in the nonrelated pairs. The pubic hair stage at menarche also showed higher similarity in sisters which speaks in favour of genetic influence on mutual relationship of certain sequences in pubertal development. Results confirm that age of menarche as well as the total, complex course of pubertal development are under high influence of genetic factors.

A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis.

This study focused on evaluating the impact of the adolescent growth spurt on the onset of idiopathic scoliosis. A total of 698 students (362 girls and 336 boys aged nine to 12 years) were followed for three years to study their growth in the pubertal period and changes in spinal status. Every six months measurements were taken of body height and the development of secondary gender characteristics was recorded. The onset of the adolescent growth spurt could thus be detected in each child. When children with and without scoliosis were compared, it became evident that scoliotic children grew faster. Girls whose scoliosis developed from a previously normal body posture showed a peak height velocity (PHV) of 8.1 cm per year, whereas girls with a normal body posture throughout the pubertal stage had a PHV of 7.1 cm per year. The most rapid growth spurt was observed in Stages 2 and 3 of breast and pubic hair development. Simultaneously, the most frequent spinal status changes occurred in Stages 2 and 3 of sexual maturity; they were twice as frequent as in Stage 1 and four times as frequent as in Stages 4 and 5. Students in whom scoliosis developed in puberty during the adolescent growth spurt grew faster than their peers who did not develop scoliosis, which need not imply that they will eventually be taller after growth is completed.

[Care of reproductive health in adolescents]. / Zastita reproduktivnog zdravlja adolescenata.

Sexual behaviour in adolescent period is an important factor of reproductive health in later life. The scope of the study is to assess features of sexual behaviour in boys and girls aged 15-19 in Croatia. The study included 2466 schoolboys and 2858 schoolgirls in six towns in Croatia. According to obtained data sexual experience has been present in 49% of boys and 22% of girls. 60% of sexually active adolescents don't use any contraceptive means. Basic knowledge in human reproduction as well as in contraception is very poor in almost all examinees. Rate of induced abortion is much lower than in their peers in Western Europe as well as in the United States. The needs for an intensive health education programme of children and adolescents as well as the administration of an effective programme for the protection of their reproductive health have been stressed.

[Somatic maturity of girls in relation to serum hypophyseal hormone values]. / Somatska zrelost djevojcica u odnosu na vrijednost hormona hipofize u serumu.

FSH, LH, PRL (prolactin), HGH, and TSH values were determined in 101 girls ages 11--15. The values were expressed in SI units and compared with the degree of pubertal development assessed according to Tanner's classification. The results have shown that the RSH values are the higher, the higher degree of the girls' maturity. Their even increase is characteristic. LH also increases wtih the degree of maturity but there is a pronounced increase of its values in pubertal stages III and IV. Pre-menarcheal prolactin ranged between 7.86 and 12.67 microgram/l and was lower than in the luteinic phase of the cycle after menarche. HGH gradually goes up with maturity, reaching its highest values in the fourth development stage after Tanner. TSH values proved more or less similar, without changing with the degree of maturity. It is evidenced that TSH is significantly correlated with LH before menarche but later there is no correlation at all. OH proved correlated with weight, height, and age. Other parameters observed did not show any correlation with the degree of sexual maturity. In the group of girls in the post- menarcheal phase (N = 49) the results are classified by the physiological phases of the cycle in three subgroups. It has been shown that FSH and LH in all three phases of the cycle were higher than in the pre-menarcheal phase. FSH was higher in the first two phases of the cycle than in the third one. LH values were highly dispersed in all three phases of the cycle. Prolactin was somewhat higher (14,05 micrograms/l) in the luteinic phase. The HGH and TSH level was subject to no changes in the course of the menstrual cycle.