The Impact of Physical Activity on Adolescent Idiopathic Scoliosis.

The prevalence of adolescent idiopathic scoliosis (AIS) is increasing, partly due to a lack of physical activity. In a cross-sectional study with 18,216 pupils (5th, 6th, and 8th grades) from four Croatian counties using the forward bend test (FBT; presumed AIS), the prevalence of AIS and its correlation with physical activity were evaluated. Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). Abnormal FBT was more prevalent among girls than boys (8.3% vs. 3.2%). Boys were more physically active than girls (p < 0.001). Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). A higher prevalence of presumed AIS was found among inactive or just recreationally active schoolchildren than among those engaged in organized sports (p = 0.001), girls especially. Pupils with presumed AIS were less active and had fewer weekly sports sessions than their peers without scoliosis (p < 0.001). Notably low prevalence of AIS was detected among pupils engaged in soccer (2.8%, p < 0.001), handball (3.4%, p = 0.002), and martial arts (3.9%, p = 0.006), while it was higher than expected in swimming (8.6%, p = 0.012), dancing (7.7%, p = 0.024), and volleyball (8.2%, p = 0.001) participants. No difference was detected for other sports. A positive correlation was found between time spent using handheld electronic devices and the prevalence of scoliosis (rs = 0.06, p < 0.01). This study confirms the increasing prevalence of AIS, particularly among less athletic girls. Further, prospective studies in this field are required to explain whether the higher prevalence of AIS in these sports is due to referral or other aspects.

The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.

OBJECTIVE: To analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists. METHODS: Historical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation. RESULTS: In the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only. CONCLUSION: While actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

BACKGROUND: Studies show that hyperuricemia is an element of the pathophysiology of many conditions. Therefore, the aim of this study was to assess primary care physicians' knowledge and attitudes toward asymptomatic hyperuricemia and gout management. METHODS: A survey-based cross-sectional study was conducted to assess the primary physicians' attitudes, knowledge, and patient management regarding hyperuricemia and gout. RESULTS: A total of 336 primary care physicians were included. Physicians who read at least one scientific paper covering the topic of hyperuricemia in the past year scored significantly higher in knowledge questions (N = 152, 6.5 ± 2.05 vs. N = 183, 7.04 ± 2.14, p = 0.019). Only around half of physicians correctly identified drugs that can lower or elevate serum uric acid levels. Furthermore, the analysis of correct answers to specific questions showed poor understanding of the pathophysiology of hyperuricemia and possible risk factors. CONCLUSIONS: This study identified gaps in primary care physicians' knowledge essential for the adequate management of patients with asymptomatic hyperuricemia and gout. As hyperuricemia and gout are among the fastest rising non-communicable diseases, greater awareness of the available guidelines and more education about the causes and risks of hyperuricemia among primary care physicians may reduce the development of diseases that have hyperuricemia as risk factors.

Emphasized warning reduces salt intake: a randomized controlled trial.

Excessive salt intake is a major cardiovascular risk factor. At variance to the developed countries, the main source of sodium in transitional and developing countries is salt added while cooking and/or at the table. The objective of this trial was to examine the impact of warning labels placed on home salt containers on daily salt intake.A sample of treated hypertensives (n = 150) was randomized in two subgroups, one receiving just a leaflet about the harmful effects of excessive salt intake (control; n = 74), and the other one receiving in addition warning stickers for household salt containers (intervention; n = 76). Arterial blood pressure (BP) and 24-hour urinary sodium excretion (Na24) were measured in all the subjects at the start of the trial, and 1 month and 2 months later. The average starting Na24 was 207 ± 71 mmol in the control group and 211 ± 85 mmol in the intervention group (P = .745). One month and 2 months later, a significant decrease was observed in the intervention group (to 183 ± 63 mmol and 176 ± 55 mmol; P < .0001), as opposed to the control group (203 ± 60 mmol and 200 ± 58 mmol; P = .1466). Initial BP was 143.7/84.1 mm Hg in the control, and 142.9/84.7 mm Hg in the intervention group (P = .667). One month and 2 months later, a significant drop in BP, by 5.3/2.9 mm Hg, was observed in the intervention group as opposed to the control group (0.4/0.9 mm Hg). Decrease in Na24 positively correlated to BP lowering (r(2) = 0.5989; P < .0001). A significant reduction in 24Na and BP is achieved with warning labels on harmful effects of excessive salt intake. Decreasing daily salt input by 35 mmol may result in an extra BP lowering by some 5-6/2-3 mm Hg.

Deep breathing: A simple test for white coat effect detection in primary care.

AIM: White coat hypertension (WCH) is hard to differentiate from sustained hypertension without the use of 24-h ambulatory blood pressure monitoring (ABPM). This invaluable procedure is nevertheless cumbersome and expensive. A simple test of deep breathing over 30 s (DBT) was proposed as a method to unveil WCH. METHODS: Two hundred and fourteen outpatients referred for the evaluation of uncontrolled hypertension (blood pressure, BP > 140/90 mmHg despite therapy) were enrolled in a controlled clinical trial. The examinees were randomly divided in two groups: control (n = 108; sequential standard BP measurement only) and intervention (n = 106; the same+DBT), using ABPM as the reference standard. RESULTS: The relative decrease in BP was significantly larger in the intervention group than in the control group, by 15/4 mmHg (p = 0.005). The best detection of WCH was obtained at ≥ 15% systolic BP reduction following DBT, with a positive predictive value of 94.0% (95% CI 72.0-100.0). BP reduction of ≤ 8% may rule WCH out with a negative predictive value of 78.4% (95% CI 64.0 - 85.9). CONCLUSION: DBT is a reliable, inexpensive and fast test for the detection of WCH in primary care.

Academic cooperation in family medicine: a viewpoint from Split.

UNLABELLED: The problems, current status, and opportunities of national and international collaboration between the academic family medicine institutions in Southern Europe, particularly in the region of ex Yugoslavia, as perceived from the standpoint of the Department of Family Medicine in Split University School of Medicine, Split, Croatia, are presented in this brief review. A historical survey of this department's educational, professional, and scientific development from its establishment in 1997 is given to place the regional issues in context. Family physicians are strong in number here - around 53 family practitioners per 100,000 inhabitants in Croatia, similar to surrounding countries, but weak in academic representation, with only 18 active faculty members. This compares to general internal medicine with 28 practitioners per 100,000 inhabitants and 106 active faculty members. The reasons for such a disproportion are analyzed, and the importance of collaboration is stressed. CONCLUSION: Although there have been several cooperative efforts, these activities can and should be intensified. While there is much work to be done, there are many opportunities for improvement.

Trauma symptoms in pupils involved in school bullying--a cross sectional study conducted in Mostar, Bosnia and Herzegovina.

To determine the association between involvement in school bullying and trauma symptoms and to find whether children with presence of trauma symptoms participate in school bullying more as victims, as bullies or as bully/victims. The study included 1055, 6th to 8th grade (12-14 years of age) elementary school pupils from the western part of Mostar, The pupils were self-interviewed using a Questionnaire on School Violence developed in 2003 and validated in Croatia, and Trauma Symptoms Check List for Children (TSCC). The pupils involved in the school violence, either as victims, bullies, bully/victims had significantly more trauma symptoms than the not involved. Involvement in school bullying as a bully/ victim was a strong indicator of trauma symptoms, particularly anxiety, anger, posttraumatic stress, dissociation, obvious dissociation, and dissociation fantasy symptoms, while the victims of school violence had the highest odds ratio for the development of depressive symptoms. There is strong association between bullying and trauma symptoms in young adolescents. From our results, emphasis should be placed at the regularly screening on bullying in praxis of family physicians and regularly conduction of preventive measures and early intervention in every primary school.

Psychometric assessment of the croatian version of the breastfeeding self-efficacy scale-short form.

BACKGROUND: Many mothers find it difficult to breastfeed exclusively for the recommended 6 months postpartum. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was developed to measure breastfeeding self-efficacy, an important predictor of breastfeeding outcomes. OBJECTIVE: To translate and psychometrically assess the BSES-SF among women in Croatia. METHODS: A convenience sample of 190 breastfeeding mothers was recruited from a Baby-Friendly hospital in Zagreb, Croatia. In-hospital mothers completed questionnaires that included the translated BSES-SF, Sense of Coherence Scale (SOC-13), and a demographic questionnaire. The follow-up questionnaires were administered to mothers at 1 and 6 months postpartum to determine their infant feeding method. RESULTS: The mean total score of the Croatian version of the BSES-SF was 55 ± 7. The Cronbach α coefficient for internal consistency was 0.86, suggesting good reliability. In-hospital BSES-SF scores significantly predicted breastfeeding duration and exclusivity at 1 and 6 months postpartum, providing support for predictive validity. The BSES-SF scores were significantly correlated with the total SOC scores (r = 0.32, P < .001) and the SOC subscales of comprehensibility (r = 0.35, P < .001), manageability (r = 0.26, P < .001), and meaningfulness (r = 0.20, P = .005), providing support for construct validity. CONCLUSION: This study provides evidence that the translated version of the BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among postpartum women in Croatia.

[Why do treated hypertensives disregard our advice? A contribution to the "crash" initiative]. / Zasto lijeceni hipertonicari ne postuju nase savjete? Doprinos inicijativi "crash".

Salt intake contributes to the rise in blood pressure and prevalence of hypertension. In this interventional trial on 110 treated hypertensives over three months a permanently elevated sodium excretion was found, averaging 187.9 +/- 81.5 mmol/day (range 103-297), because of inappropriate salt intake. The treated hypertensives, despite opposite claims, consume large amounts of salt, which, in addition to noncompliance, is the leading cause of poor hypertension control. Dietary education is an important part of preventive care in family medicine, and legal measures to enforce salt labeling on alimentary products are mandatory.

Education in family medicine at the University of Mostar School of Medicine.

Department of Family medicine has been formed in academic year 2002/2003, few years later after the foundation of the School of Medicine University of Mostar. The formal members of department are professor and assistants who lecture and lead seminars. In addition, physicians in rural practices contribute to teaching of family medicine. Clinical teaching of family medicine at Mostar School of Medicine is organized in the summer semester of sixth year of the study. It lasts six weeks and contains lectures, seminars and practices. Every student has right and obligation to evaluate educational process at the end of the course in a form of questionnaire and essay. Family medicine continuously receives high marks by students, especially practices. Evaluation of teaching by students is good way of giving feedback about teaching. We believe that student opinion can revise and improve teaching practice. Our good experience and good marks may prompt the changing our educational curriculum to include family medicine at each study year of medical program.

Prohypertensive effects of non-steroidal anti-inflammatory drugs are mostly due to vasoconstriction.

Non-steroidal anti-inflammatory drugs (NSAIDs) have prohypertensive effects and blunt the effects of many antihypertensives. The mechanism of this interaction is still not understood enough. The objective of this investigation was to determine the level of prohypertensive effects of two NSAIDs (ibuprofen, piroxicam) and paracetamol, co-prescribed with two antihypertensive drugs (lisinopril + hydrochlorothiazide, amlodipine), and to improve the understanding of this interaction. A prospective clinical trial, conducted in a Croatian family practice, included 110 already treated hypertensive patients, aged 56-85 years; 50 control patients and 60 patients who were also taking NSAIDs for osteoarthritis treatment. The antihypertensive regimens remained the same during this study, while NSAIDs and paracetamol were crossed-over in three monthly periods. Blood pressure, body weight, serum creatinine, potassium, sodium, diuresis and 24 h urinary sodium excretion were followed-up. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated mean arterial pressure by 8.9-9.5% (p < 0.001). Body weight increased significantly in the lisinopril/ hydrochlorothiazide + piroxicam subgroup only, while creatinine, urinary output and electrolyte values did not change appreciably in any of the subgroups. NSAID's prohypertensive effects seem to be mostly due to vasoconstriction and, to a minor degree, to volume expansion, since no marked changes in body weight, urinary output, serum creatinine or serum/urinary electrolyte profile were observed.

[Merits of paracetamol in osteoarthritic hypertensive patients]. / Prednosti paracetamola u lijecenju osoba s hipertonijom i artrozom.

BACKGROUND: Nonsteroidal anti-inflammatory drug (NSAID) side effects can impair quality of life in patients with osteoarthritis. Due to its particular mechanism of action, paracetamol might bypass these negative effects. OBJECTIVES: To determine both the role of paracetamol in the treatment of osteoarthritis patients and optimal combination of antihypertensives and antirheumatics for these patients. METHODS: A prospective clinical trial in a family practice included 110 treated hypertensives aged over 55 years: 50 controls and 60 also taking NSAIDs for osteoarthritis. This 3-month study compared two antihypertensives, lisinopril/hydrochlorothiazide fixed combination and amlodipine, with two NSAIDs, ibuprofen and piroxicam, and with paracetamol. Following clinical work-up and NSAID discontinuation for at least 3 days (run-in period of only 3-7 days), osteoarthritis subjects were randomized to 1-month periods of ibuprofen (400-600 mg t.i.d.) or piroxicam (10-20 mg o.d.) with one month of paracetamol (1000 mg t.i.d.) in the middle as a "wash-out" interval, continuing the prescribed amlodipine (5-10 mg o.d.) or lisinopril/hydrochlorothiazide fixed drug combination (10/6.25-20/12.5 mg o.d.), while control subjects (hypertensives with no osteoarthritis) were just keeping their antihypertensive therapy. Blood pressure was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting and supine position. The intensity of arthritic pain (on a visual analogue scale from 1 to 10, where 0 means "no pain" and 10 "the worst pain you may imagine") and the patient's quality of life estimate (on a visual analogue scale from 1 to 10, where 0 means "general condition excellent" and 10 "the worst possible") were recorded. RESULTS: Blood pressure control was unchanged in the amiodipine group across the study periods and impaired in the lisinopril/ hydrochlorothiazide group during either ibuprofen or piroxicam, but not during paracetamol. In the amlodipine +/- ibuprofen subgroup, the reduction of the average pain intensity score throughout the study was significant (chi2 = 8.250; df 3; P = 0.037). In the lisinopril/hydrochlorothiazide +/- piroxicam subgroup, the assessed quality of life differed significantly (chi2 = 9.716; df 3; P = 0.018), while in the amlodipine +/- ibuprofen and amlodipine +/- piroxicam subgroups the changes were marginal (chi2 = 6.936; df 3; P = 0.072 and chi2 = 7146; df 3; P = 0.065, respectively).

Job satisfaction among medical doctors in one of the countries in transition: experience from Croatia.

Our aim was to explore and compare the job satisfaction between family physicians and hospital specialists in Split, Croatia. The survey was carried out in 2005 and 2006. A validated questionnaire was composed of two parts: 92 statements and questions about job satisfaction in the form of a Lickert scale (range 1-5) and eight questions concerning demographic issues. The questionnaire was completed and returned by 165 hospital specialists from the University Hospital and by 131 family physicians from the Split County. Response rate for family physicians was 39.81% and 41.46% for hospital specialists. Hospital doctors were divided in two groups: internal and surgical. There were no significant differences between family physicians and hospital specialists in total job satisfaction (F = 1.02; p = 0.41). Family physicians were more satisfied with their workplace conditions than internal medicine specialists (19.37 +/- 4.23 vs. 17.37 +/- 4.59; F = 5.93; p = 0.003), and less satisfied with the possibilities for postgraduate training than surgeons (5.27 +/- 1.90 vs. 6.59 +/- 2.07; F = 9.26; p < 0.001). Global job satisfaction was rather low but does not differ between the three medical groups. Disparities were observed in some segments (opportunity for further training and academic advancement, vacation, and salary). The reason for the family physician's relative satisfaction may be due to stable working conditions, independence in organizing work schedules and personal responsibility.

Association between psychosomatic and traumatic symptoms in early adolescence.

INTRODUCTION: This study investigates association between psychosomatic and traumatic symptoms among adolescents. SUBJECTS AND METHODS: This cross-sectional survey using self-completion questionnaires was conducted among 868 adolescent in grade 6th, 7th and 8th of primary schools in Mostar (Bosnia and Herzegovina). RESULTS: Psychosomatic symptoms are strongly associated with traumatic symptoms, with exception of symptom of anger. The association is the highest between anxiety, depression and PTS symptoms on the one side and cardiovascular symptoms on the other side. CONCLUSION: According to our results, psychosomatic symptoms are strongly associated with psychosomatic symptoms in early adolescence.

Predictive impact of coronary risk factors in southern Croatia: a case control study.

The aim of study was to compare the impact of coronary risk factors on the incidence of acute myocardial infarction (MI) between Croatia, Central and Eastern Europe, and the rest of the world. As a part of the large international INTERHEART case-control study of acute MI in 52 countries (15,152 cases and 14,820 controls) we have investigated the relationship between several known risk factors (smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors) and MI among patients without previously known coronary heart disease in Southern Croatia. The main identified MI risk factors in Southern Croatia were heavy smoking (>20 cig/day; OR 3.86; 95% CI 2.31-6.46), diabetes mellitus (OR 2.83; 95% CI 1.58-5.23), abnormal ratio of B-100 and A-1 apolipoproteins (OR 2.23; 95% CI 1.28-3.89), elevated waist to hip ratio (OR 1.96; 95% CI 1.21-3.18), and arterial hypertension (OR 1.68; 95% CI 1.15-2.45). Protective was moderate alcohol consumption (OR 0.63; 95% CI 0.40-0.99). The prevalence of major MI risk factors in Croatia is similar to that in the surrounding countries and in the world, accounting for over 90% of the population attributable risk. However, physical activity, dietary and psychosocial factors are seemingly less important in this country, while moderate alcohol consumption is more protective than regionally or globally.

Interaction between antihypertensives and NSAIDs in primary care: a controlled trial.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction. OBJECTIVES: To determine the extent of the interaction between two antihypertensives and three NSAIDs. METHODS: A prospective clinical trial in a family practice included 88 treated hypertensives aged over 55 years; 39 controls and 49, also taking NSAIDs for osteoarthritis. During this 3-month study, two antihypertensives, lisinopril/hydrochlorothiazide and amlodipine, were compared with three NSAIDs: ibuprofen, acetaminophen, and piroxicam. BP was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting, and supine position. RESULTS: The average starting blood pressure in the study group was 149.3A+/-9.8/88.6A+/-6.8 mm Hg. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated systolic BP by 7.7-9.9% (p<0.001), which, during the acetaminophen period, decreased by 6.9-9.4% to 0.3-0.9% above baseline (p<0.001), increasing again by 7.0-7.7% (p<0.001) during the second exposition to these drugs. In the amlodipine subgroup, ibuprofen or piroxicam increased BP by 1.1-1.6% (p>0.290) only, and there were no significant shifts in the follow-up periods. Analogous deviations were observed with both measurement devices, in all the examinee's positions. In the control group, BP did not change appreciably. CONCLUSIONS: Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while acetaminophen is almost inert. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine (ClinicalTrials.gov #NCT00631514).

Quality of life after stroke in Croatian patients.

In order to evaluate the microsocial factors affecting quality of life in stroke victims, 100 survivors of ischemic stroke and the same number of their relevant family members (key persons, controls) were interviewed using Stroke Specific Quality of Life Scale (SS-QOL) questionnaire. Total SS-QOL score did not differ significantly between post-stroke patients and key persons (z=0.64, P=0.524). Relevant family members ranked the patients' family (P=0.022) and social role (P=0.08), and their mobility (P=0.09) slightly higher than the patients themselves. However, male patients rated their "family role" (z=-2.82, P=0.005), "mobility" (z=-2.28, P=0.023) and "social role" (z=-1.86, P=0.063) higher than their female peers. Recent (< or =33 months) and remote (>33 months after the ischemic accident) stroke patients did not differ substantially in total SS-QOL score, social role and hand function assessment but in mobility (z=-1.90, P=0.057) and family role estimation (z=-2.47, P=0.014) the difference was in favor of recent stroke patients. The domain scores and total SS-QOL score did not differ by gender between recent stroke patients and their controls either. It is concluded that assessment of general functioning and global quality of life among post-stroke patients provided by relevant patients'family members could be accepted with confidence. Male patients slightly overestimate their mobility and social role. No significant impact of post-stroke time span on quality of life estimation was observed.

Bullying among school children in postwar bosnia and herzegovina: cross-sectional study.

AIM: To compare the prevalence and characteristics of bullying between two towns in Bosnia and Herzegovina-Stolac, which was exposed to firearm conflict during the 1992-1995 war in Bosnia and Herzegovina, and Posusje, which was outside of the active combat zone. METHODS: In this cross-sectional study, we included 484 primary school pupils attending 4th-8th grade of elementary school, 217 (44.8%) of them from Stolac and 267 (55.2%) from Posusje. The pupils were interviewed using a standardized questionnaire on the experience of bullying. RESULTS: Every sixth pupil (16.4%) experienced at least one form of bullying almost every day, while 34 (7.0%) pupils constantly bullied other children. Sixth-eighth graders were more often bullies than 4th-5th graders (P=0.044). Girls were most often victims was of bullying, while boys were most often bullies (P=0.036). The expected difference in bullying between the two towns was not observed, except for older pupils in Posusje, who were more violent than their peers in Stolac (P=0.044). Among the analyzed variables of sex, age, town, and school achievement, only male sex was significant predictor of bullying (P=0.010), increasing the relative risk by 3.005 times. CONCLUSION: Bullying among primary school pupils did not differ between areas that experienced war activities in 1992-1995. Our results could be useful in the introduction of specific prevention measures against bullying in postwar situation.

[Coronary heart disease risk factors in Croatia and worldwide: results of the Interheart study]. / Koronarni cimbenici rizika u hrvatskoj i u svijetu: rezultati Interheart studije.

OBJECTIVES: In the past 30 years, an increased cardiovascular disease (CVD) mortality has been observed in both industrialized and transition countries. The latter countries, such as Croatia, are considered to be in the third stage of epidemiological transition, defined as having 35%-65% of total as CVD mortality, predominantly ischemic heart disease and cerebrovascular disease. The CVD epidemic in transition countries is due to increasing rates of hypertension, obesity, smoking and sedentary lifestyle. Among CVD diagnoses, the most important is coronary heart disease (CHD), which varies in incidence among different ethnic groups and countries. Worldwide, it is estimated that nine potentially modifiable risk factors contribute to more than 90% of myocardial infarctions. Approximately 80%-90% of patients with symptomatic CHD and more than 95% of patients who died from CHD had at least one of the four traditional risk factors (smoking, hypertension, hyperlipidemia, and diabetes). AIM: Little research has been done to quantify the relationship between the prevalence of CHD risk factors and acute myocardial infarction (AMI) in Croatia. In south Croatia, we expected that specific dietary patterns and lifestyle would have favorable effects on CHD risk. Therefore, we have conducted a case-control study to examine the relationship between several CHD risk factors (smoking, hypertension, hyperlipidemia, diabetes, obesity, alcohol, fruit and vegetable consumption, and physical activity) in AMI patients and persons without previously known CHD in south Croatia. METHODS: We took part in the INTERHEART study over 4 years (1999-2002). Cases were all eligible patients with first AMI admitted to the Coronary Care Unit, Split University Hospital. Within one month of admission at least one control was recruited and matched to every AMI case by age (+/-5 years) and sex. Exclusion criteria were the same for cases and controls. Structured questionnaires were administered and physical examinations were undertaken in the same manner in cases and controls. Relationship between the risk factors and AMI are presented by odds ratios, estimated by multivariate logistic regression. RESULTS: During the study period 263 cases and 264 controls were enrolled. The proportion of males (74.6%) was threefold that of females. The highest relative difference between the case and control risk factors was noted for current smoking (16.6%; p<0.001), diabetes (10.5%; p<0.001), hypertension (9.0%; p=0.038) and abdominal obesity (18.5%; p<0.001). Ever smoking accounted for 75% higher AMI risk than non-smoking (OR 1.74; p=0.006), while current smoking accounted for a 2.6 time higher risk in comparison to non-smoking (OR 2.58; p<0.001). Diabetes had a threefold risk (OR 2.83; p<0.001). Hypertension accounted for a 70% higher risk (OR 1.68; p=0.007). Abdominal obesity was associated with a significantly increased AMI risk (OR 1.96; p=0.007). The highest apolipoprotein B/apolipoprotein A-1 (ApoB/ApoA-1) tertile accounted for nearly 2.5-fold risk (OR 2.23; p=0.005). Physical activity and daily consumption of fruits and vegetables did not prove to be significant factors in Croatia. Regular consumption of alcohol decreased coronary risk by approximately one third (OR 0.63; p=0.044). CONCLUSIONS: The most important AMI risk factor in south Croatia is current smoking, followed by diabetes, abnormal ApoB/ApoA-1 ratio, abdominal obesity, and hypertension. A protective risk factor is alcohol consumption, while physical activity and fruit and vegetable consumption are less important. These results are similar to the global INTERHEART data showing that most of AMI risk could be predicted with nine simple, measurable risk factors worldwide. Protective measures for CHD, including increased daily consumption of fruits and vegetables, moderate physical activity and particularly smoking cessation should be implemented worldwide. In specific regions such as south Croatia, moderate alcohol consumption (mostly red wine) may be included among protective measures due to sociologic and cultural reasons.