Trends in incidence of lung cancer in Croatia from 2001 to 2013: gender and regional differences.

AIM: To provide an overview of the lung cancer incidence trends in the City of Zagreb (Zagreb), Split-Dalmatia County (SDC), and Croatia in the period from 2001 to 2013. METHOD: Incidence data were obtained from the Croatian National Cancer Registry. For calculating incidence rates per 100 000 population, we used population estimates for the period 2001-2013 from the Croatian Bureau of Statistics. Age-standardized rates of lung cancer incidence were calculated by the direct standardization method using the European Standard Population. To describe incidence trends, we used joinpoint regression analysis. RESULTS: Joinpoint analysis showed a statistically significant decrease in lung cancer incidence in men in all regions, with an annual percentage change (APC) of -2.2% for Croatia, 1.9% for Zagreb, and -2.0% for SDC. In women, joinpoint analysis showed a statistically significant increase in the incidence for Croatia, with APC of 1.4%, a statistically significant increase of 1.0% for Zagreb, and no significant change in trend for SDC. In both genders, joinpoint analysis showed a significant decrease in age-standardized incidence rates of lung cancer, with APC of -1.3% for Croatia, -1.1% for Zagreb, and -1.6% for SDC. CONCLUSION: There was an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate in Croatia in 2001-20013 period, with similar patterns observed in all the investigated regions. These results highlight the importance of smoking prevention and cessation policies, especially among women and young people.

Trends in the Outpatient Utilization of Antipsychotic Drugs in the City of Zagreb in the Ten-Year Period as a Tool to Assess Drug Prescribing Rationality.

BACKGROUND: The aim was to determine distribution and trends in the outpatient utilization of antipsychotics to evaluate the rationality of antipsychotic drug prescribing during the ten year period. SUBJECTS AND METHODS: The epidemiological method of descriptive and analytical observation was used. Data on drug utilization from Zagreb Municipal Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the World Health Organization Anatomical-Therapeutic-Chemical methodology. The ratio of typical versus atypical antipsychotics served as an indicator on assessing the rationality of the utilization. Data on the use of anticholinergics in the treatment of neuroleptic side effects were also included. RESULTS: Outpatient utilization of antipsychotics showed a declining pattern from 14.17 in 2001 to 8.42 DDD/TID in 2010. The utilization of atypical antipsychotics increased by 60% (from 3.68 to 5.89 DDD/TID), while the utilization of typical antipsychotics decreased by 76% (from 10.49 to 2.53 DDD/TID). The drugs showing the largest increase were olanzapine (from 1.21 to 2.78 DDD/TID) and quetiapine (from 0 to 0.68 DDD/TID). The typical/atypical antipsychotic ratio changed from 1:0.4 in 2001 to 1:2.3 in 2010. A 2.3-fold decrease was recorded in the utilization of anticholinergics (from 2.05 to 0.91 DDD/TID). CONCLUSIONS: Total consumption of neuroleptics significantly decreased. A decrease was also recorded in the utilization of anticholinergics. Study results pointed to two favorable features, i.e. low use of typical antipsychotics and the ratio of typical and atypical antipsychotics. Implementation of the new clinical guidelines for nervous system disorders and updating of the list of reimbursable drugs with the addition of new ones contributed to the observed improvement in the prescribing patterns during the study period. Using the WHO ATC/DDD methodology and rationality indicators in the assessment of trends in the outpatient utilization of psychopharmaceuticals over a ten-year period proved efficient in the evaluation of prescribing rationality.

Depression and Self-Esteem in Early Adolescence.

AIM: Depression prevalence has increased in the last few decades, affecting younger age groups. The aim of this research was to determine the range of depression and low self-esteem in elementary school children in the city of Split. Testing was carried out at school and the sample comprised 1,549 children (714 boys and 832 girls, aged 13). METHODS: Two psychological instruments were used: the Coopersmith Self-Esteem Inventory (SEI) and the Children and Adolescent Depression Scale (SDD). RESULTS: The average value of scores obtained by SEI test was 17.8 for all tested children. No statistically significant difference was found be-tween boys and girls. It was found that 11.9% of children showed signs of clinically significant depression, and 16.2% showed signs of depression. Statistically significant association between low self-esteem and clinically significant depression was found. No statistically significant difference among boys and girls according to dimension of cognitive depression was found, whereas statistically significant level of emotional depression was higher in girls than boys. It was found that both dimensions of depression decreased proportionally with the increase of SEI test score values: cognitive and emotional dimension of depression. CONCLUSION: The results of this study show that it is necessary to provide early detection of emotional difficulties in order to prevent serious mental disorders.

Comparison of Campylobacter jejuni pulsotypes isolated from humans and poultry in Split and Dalmatia County, Croatia.

Consumption of poultry is considered to be an important source of human infection with Campylobacter. In the period from 2008 to 2010, 50 isolates of Campylobacter jejuni from human faeces were analysed and compared with 61 isolates from poultry by pulsed field gel electrophoresis using SmaI and KpnI. Based on the analysis of SmaI macrorestriction profiles, 86 isolates (77.5 %) were assigned to 15 S clusters: 31 (62 %) from humans and 55 from poultry (90.2 %). Altogether 21 isolates (19 %) exhibited macrorestriction profiles common to both humans and poultry after restriction with SmaI and KpnI. A total of five identical pulsotypes were isolated from both poultry and patients and one of them appeared in eight different locations in the time interval of one year. These results indicate that poultry could be an important source of Campylobacter infection in Split and Dalmatia County which is the biggest County in Croatia and the most important tourist destination.

Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia.

BACKGROUND: Drug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period. METHODS: Using the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization. RESULTS: Total cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators. CONCLUSIONS: The lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.

Epidemiological characteristics of invasive meningococcal disease in the Split-Dalmatia County 1996-2010.

The aim of this paper is to present epidemiological features of reported patients with invasive meningococcal disease in the Split-Dalmatia County in the period from January 1996 to December 2010. During the 15-year period (1996-2010), a total of 119 patients were reported to have invasive meningococcal disease, yielding a mean annual incidence rate of 1.7/100,000 inhabitants. There were 69 (58%) male and 50 (42%) female patients. Five of 119 patients died, yielding a case fatality rate of 4.2%. Among 83/119 (70%) cases with proven etiology, serogroup was determined in 56/83 (67.5%) patients, whereas in 28/83 (32.5%) patients serogroup could not be determined. The most common serogroup was B, found in 43/56 (76.8%) patients. During the 1996-2010 period, dissemination of the disease in epidemic proportions was not recorded.

The role of nm23 gene in colorectal carcinogenesis.

The aim of this study was to investigate the correlation of immunohistochemical expression of nm23 gene in colorectal cancer cells with tumor stage according to Dukes, tumor differentiation, occurrence of distant metastases and patient survival. This retrospective study included 100 colorectal cancer patients who underwent surgical treatment. Both pathological and clinical data were analyzed according to sex, age, immunohistochemical expression of nm23, tumor stage, tumor differentiation, occurrence of distant metastases and patient survival. Overexpression of nm23 gene was related to both good tumor differentiation and Dukes' stage A, whereas no significant correlation was found between the occurrence of metastases and nm23 gene expression. There was no significant correlation between nm23 gene expression and 5-year survival of colorectal cancer patients either. Although the results of this study suggested that higher expression of nm23 gene correlated with an early stage of tumor and its good differentiation, this parameter cannot yet be taken as an independent and reliable prognostic indicator in colorectal cancer.

Distribution of microbiological indicators of fecal pollution in the riverine substrates.

Distribution of fecal microorganisms in water, periphyton, and sediment was studied along the Zrnovnica river (Croatia) over a 1.5-year period. It was found that periphyton was inhabited by the highest number of investigated bacteria, while lower numbers of them were found in sediment and the lowest in surface water of the river. The concentrations of fecal microorganisms in periphyton and partly in sediment were found to be significantly higher in the middle of the river course, near the town of Zrnovnica, while according to the analysis of surface water the highest degree of pollution was reached on its estuary. The results were explained with respect to bacterial-algal associations. Considering the fact that most of the river microorganisms are associated with periphyton and sediment particles and only a small number of them is in the free-living form, microbiological analysis of both periphyton and sediment together with water samples has been suggested when fecal pollution of a river is concerned.

Occurence of visceral and cutaneous leishmaniasis in Croatia.

UNLABELLED: The purpose of this study was to show epidemiological characteristics and clinical manifestations of visceral and cutaneous leishmaniasis in Croatia. METHODS: Analysis of data on reported visceral and cutaneous leishmaniasis cases and description of the most common clinical manifestations of the disease was based on meta analysis of collected data. RESULTS: A total of 124 cases of visceral and cutaneous leishmaniasis were reported from 1954 until the end of 2006. During the 1994-2006 period, 35 people became infected: 23 with visceral and 12 with the cutaneous form of the disease. The diagnosis of cutaneous leismaniasis is based on the clinical picture, epidemiological data, and light microscopic histology. The clinical picture of visceral leishmaniasis was confirmed by detection of amastigotes in bone marrow aspirate (n=22; 95.7%) and liver (n=1; 4.3%) and by serology-indirect immunofluorescent assays (n=23; 100%). Age-specific morbidity is highest in the 0 to 4 age group (0.29%). None of the infected was human immunodeficiency virus positive. CONCLUSION: It is estimated that there have been some changes in epidemiological characteristics of the natural foci of leishmaniasis in Croatia.

Colorectal cancer in the Split-Dalmatia County.

Colorectal cancer was the second leading cause of cancer deaths in the Split-Dalmatia County during the 1993-2005 period. The primary aim of this study was to analyze recent trends in the mortality caused by colorectal cancer in the Split-Dalmatia County. Secondly, the aim was also to analyze data on colorectal cancer patients operated on at Split University Hospital Center according to sex, age, localization of cancer and Dukes staging, in the period from January 1, 2003 to December 31, 2004. The colorectal cancer death rate was found to be on an increase in both men and women; however, it was higher in men in both study years. The colorectal cancer death rate was also found to increase with age in both men and women. Analysis of data on patients operated on for colorectal cancer yielded a 2:1 male to female ratio. Analysis of histopathologic staging according to Dukes produced a statistically significant difference (P < 0.0001). Dukes B or C was diagnosed in 84.3% and Dukes A in 9.3% of cases. According to cancer localization, sigmoid colon and rectum were involved 1.8 times more frequently than other sites of the colon. The data obtained in this study indicated that only 9.3% of patients were treated in the early stage of disease (Dukes A), pointing to the need of organized medical examinations for early detection of colorectal cancer in order to reduce the mortality rate associated with the disease.

Role of insulin-like growth factor-1 in colon cancerogenesis: a case-control study.

BACKGROUND: Our aim was to establish whether individuals who developed colon cancer have elevated blood levels of insulin-like growth factor-1 (IGF-1). METHODS: This was a case/control study in which 52 patients with colon cancer and a corresponding control group were investigated. Data on age, weight, height, and sex of subjects were recorded and levels of IGF-1 and growth hormone, as well as insulin and C-peptide levels, were measured in the morning before eating, 90 min after breakfast and again 90 min after lunch. RESULTS: We found significantly higher levels of IGF-1 in blood of colon cancer patients compared to the control group. No differences in the levels of growth hormone, insulin and C-peptide in blood were found between colon cancer patients and the control group. It was found that the increase of IGF-1 level was followed by a 3.15-fold increased risk for developing colon cancer. There were no differences in the levels of IGF-1 in blood in all three measurements in the group of colon cancer patients, whereas differences were found in the control group. We found differences in the levels of insulin and C-peptide in blood in all three measurements in both groups of patients. No differences were found in the levels of growth hormone in blood in all three measurements in both groups of patients. CONCLUSIONS: The results of this study suggest a positive correlation between the increased levels of IGF-1 and colon cancer and are thus consistent with the hypothesis that the level of IGF-1 plays an important role in the development of colon cancer.

Insulin increase in colon cancerogenesis: a case-control study.

BACKGROUND: Our aim was to establish whether individuals who develop colon cancer have elevated blood insulin concentrations. METHODS: This was a case-control study in which 56 normoglycemic patients with colon cancer and a corresponding control group were investigated at the Clinical Hospital Split from April 1998 to April 1999. Data on age, weight, height, and sex of examinees were recorded and concentrations of glucose, insulin, and C-peptide were measured first in the morning before breakfast and again 90 min after breakfast. RESULTS: In the male group of colon cancer patients, we found statistically significant higher blood insulin concentrations 90 min after breakfast (median 34.7 mIU/L, range 3.3-162.6 mIU/L) in comparison to male control group (median 20.7 mIU/L, range 3.1-122.1 mIU/L) (p=0.044). Concentration of C-peptide in blood 90 min after breakfast (median 3.28 nmol/L, range 0.38-6.1 nmol/L) was higher in the male group of colon cancer patients than in male control group (median 1.68 nmol/L, range 0.26-4.26 nmol/L) (p=0.001). No difference was found in concentrations of insulin, C-peptide, and glucose in blood measured in the morning before breakfast between the male group of colon cancer patients and male control group. Ratio of insulin 90 min after breakfast with respect to insulin in the morning before breakfast was higher in the male group of colon cancer patients (median 4.65, range 0.83-22.1) than in male control group (median 1.78, range 0.38-8.75) (p=0.005). Ratio of C-peptide 90 min after breakfast with respect to fasting C-peptide was higher in the male group of colon cancer patients (median 3.22, range 0.74-11.9) than in male control group (median 1.42, range 0.54-6.0) (p=0.001). Women with colon cancer also had statistically significant higher ratio of insulin and C-peptide with respect to female control group. In the female group of colon cancer patients, median for ratio of C-peptide was 2.42 (range 0.43-8.87), while in female control group it was 1.19 (range 0.62-15.4) (p=0.025). Median for ratio of insulin in the female group of colon cancer patients was 4.23 (range 0.25-8.54), while in female control group it was 1.17 (range 0.29-26.89) (p=0.007). CONCLUSIONS: There was a higher increase of insulin 90 min after breakfast in the group of patients with colon cancer than in control group.