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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.

Adult

Folnegović & Folnevogić-Smalc's "Schizophrenia in Croatia: inter-regional differences in prevalence and a comment on constant incidence".

"STUDY OBJECTIVE--The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. DESIGN--Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. SETTING--The study covers the whole of Croatia (4,601,469 inhabitants, 1981 census). SUBJECTS--By the age of 31 years, out of 80,445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. MAIN RESULTS--Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. CONCLUSIONS--Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations."

Adolescent

Schizophrenia in Croatia: interregional differences in prevalence and a comment on constant incidence.

STUDY OBJECTIVE: The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. DESIGN: Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. SETTING: The study covers the whole of Croatia (4,601,469 inhabitants, 1981 census). SUBJECTS: By the age of 31 years, out of 80,445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. MAIN RESULTS: Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. CONCLUSIONS: Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations.

Bipolar Disorder

Haplotype distribution and mutations at the PAH locus in Croatia.

Restriction fragment length polymorphism (RFLP) haplotypes and mutations at the phenylalanine hydroxylase (PAH) locus have been studied in 25 unrelated families from Croatia. The results of RFLP analysis demonstrated that 80% of the mutant alleles were associated with three haplotypes (1, 2 and 4). Eight mutations were detected on the background of six mutant haplotypes, comprising 68% of phenylketonuria (PKU) alleles in Croatia. The mutation in codon 408 was most frequent, as was the haplotype 2 allele with which it was associated. These data are in accordance with formerly published population genetic analyses at the PAH locus, and with studies revealing the molecular basis of the phenotypic heterogeneity of PKU. The codon 281 mutation was more frequent in Croatia than previously observed in other populations.

Alleles

A contribution to the history of spectacles in Croatia.

The earliest data on spectacles in Croatia originate from the 14th century. Inventories of personal belongings and valuables of distinguished individuals testify about the existence of spectacles from the 14th century onward. Pictorial representations of spectacles and spectacle cases are found in Croatia in various forms: as a watermark in a 14th century paper, on a silver altar-piece from 1477, on paintings, frescoes and wood-cuts from the 15th century onward. A pair of 16th century spectacles are kept in Split (Poljud) and a selection of 18th to 20th century spectacles are on display in various museums in Croatia. In 17th century literature the effect of lenses on ametropia is discussed and Latin and Croatian terms for spectacles and opticians are mentioned.

Croatia

Hereditary palmoplantar keratoderma, type papulosa, in Croatia.

BACKGROUND: Hereditary palmoplantar keratoderma (HPPK), type papulosa, is rare, and epidemiologic data are sporadic and inconsistent. An epidemiologic population study of this disease has not been performed previously. OBJECTIVE: We performed a large population study on prevalence of HPPK, type papulosa, in Croatia. METHODS: The data were collected from medical records of dermatology departments throughout Croatia; 14 patients and their relatives were examined. Histopathologic studies were performed in 11 of these 14 patients. RESULTS: Fifty-five patients were identified and the prevalence was 1.17 per 100,000 inhabitants. All 55 patients belonged to 20 different families. An autosomal dominant mode of inheritance was confirmed in 13 families. All 14 patients examined by the authors had both palmar and plantar lesions; the volar aspects of fingers were also involved. Thickened nails were observed in four patients, and no significant skin lesions were found elsewhere. CONCLUSION: HPPK, type papulosa, is rare, and its prevalence in Croatia is about four times lower than HPPK, Unna-Thost type. It should be considered a distinct entity.

Adolescent

[Incidence of skin manifestations of Lyme disease in Croatia].

In the study, the most relevant historical data concerning Lyme-borreliosis are shortly reviewed. The most frequent skin manifestations, i.e. erythema cronicum migrans (ECM), lymphocytoma cutis (LCC) and acrodermatitis chronica atrophicans (ACA) are described. The clinical course of Lyme disease and the chronologic review of the most significant data on the disease are given. The frequency of skin manifestations of Lyme-borreliosis in various areas of Croatia from 1988 to 1989 based on the reports of dermatologists throughout Croatia is presented. According to our results, it can be concluded that skin manifestations of Lyme-borreliosis are much more frequent in the central and western parts of Croatia than elsewhere. The authors hope that the use of a fluorescent method for detecting antibodies to Borrelia burgdorferi since 1989 in the Serologic Laboratory of the Department of Dermatology, Salata, Zagreb will lead to more precise results about this disorder in the future.

Croatia

[The University of Zagreb Medical School and the war in Croatia 1991-1992].

School of Medicine, University of Zagreb (as an institution as well as through the efforts of individual faculty and staff members) has actively participated in all the phases of the war against Croatia: the preparatory phase (1990 and the first half of 1991), the phase of local war (July and August 1991) and the phase of total war (September 1991 to January 1992). In defense preparations, leading faculty members, supervised by the Croatian Government, have: 1. prepared the University hospitals for the case of mass casualties, 2. initiated donation of essential medical supplies and equipment, and 3. prepared the preclinical staff and facilities for research, documentation and information services for Crisis management. On July 11, 1992, Ministry of Health of the Republic of Croatia formed the Medical Headquarters to coordinate the health services in the defense of Croatia. Several faculty members were appointed heads of the following Headquarters divisions: Division of Informatics and Research, Division of Education and Publicity, Division of Toxicology, The Fourth Echelon, Division of Mental Health and Division of Rehabilitation. Assistant lecturers, technicians and students actively joined work in the Division of Donations, which acquired and provided almost all medical supplies used in our battlefields and hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Croatia

A brief review of the development of ophthalmology in Croatia.

Autochtonous folk medicine practice in Croatia was mostly based on the use of herbs in the treatment of eye diseases. The first document on the presence of medical activity was one in which the Republic of Venice gave Draga Slava permission to practice medicine in 1330. The 19th century was the turning-point for the development of ophthalmology in Croatia. The basis for well-organized clinical, preventive and social ophthalmological care was established. The Cathedra for Ophthalmology was founded in 1920 and its first head was Albert Botteri, who was along with Nizetić, Spanić, Gradilicić and Meixner, the most prominent ophthalmologist in the first half of the century. Zvonimir Pavisić and Kresimir Cupak were the leading persons in Croatian ophthalmology in the second half of the century. Croatian ophthalmologists were organized in the Section for Ophthalmology as the part of the Medical Association of Croatia from 1926 up to 1992, when the Section changed its name to the Croatian Ophthalmological Society, with more than 250 members. Inspite of the difficulties, Croatian ophthalmologists tend to use almost all modern diagnostic and therapeutic methods in use in the world.

Croatia

Military injuries to the popliteal vessels in Croatia.

OBJECTIVE: The paper reviews military popliteal vascular injuries in Croatia. SUMMARY BACKGROUND DATA: Popliteal vascular injuries still pose difficult problems for vascular surgeons despite improvements in resuscitation, surgical techniques and wound coverage. Popliteal vascular injuries, both arterial and venous, with a high incidence of associated musculoskeletal injuries are presented in patients with military injuries in South Croatia. METHODS: 26 wounded with popliteal vascular injuries are presented. Explosive injuries are found in 21 and associated fractures in 9 cases. In immediate repair group the time interval between trauma and surgery was 2 to 30 hours (average 9.8 hours). In the delayed repair group the interval between trauma and surgery was 11 days to 24 days. RESULTS: 21 out of 26 patients with popliteal vascular injuries had combined arterial and venous injuries; 4 patients had isolated popliteal arterial injuries, while 8 patients had other vascular injuries along with the popliteal ones; 8 amputations resulted (30.8%). CONCLUSION: Popliteal vascular injuries caused by typical military mechanism during the war in Croatia present large and extensive defects of tissues and bones, are often associated with other injuries and require more extensive surgical therapy. Evacuation of the wounded under very difficult conditions as well as considerable organization and transportation problems are characteristic for this war and greatly affect the success of vascular reconstruction. Hyperbaric oxygen therapy offers a safe noninvasive method of improving wound healing and decreasing edema formation in popliteal vascular injuries.

Adult

Occurrence of hereditary bullous epidermolyses in Croatia.

To determine the occurrence of hereditary bullous epidermolyses (EB) in Croatia, Yugoslavia, from 1960 to 1987, cases were gathered from the hospital files of dermatologic and pediatric clinics and departments throughout the area. The diagnosis of EB type was made on the basis of clinical features, patients' histories, and light microscopy and electron microscopy findings. Fifty families with 58 patients were registered; 44 patients were examined personally by one of the authors. The most frequent type of EB in Croatia was recessive dystrophic EB Hallopeau-Siemens, occurring in 35 of the 58 individuals. Regional accumulation of cases within the Varazdin area was noted (13 patients). Prevalence of EB in Croatia is 0.956 cases per 100,000 inhabitants. One case of recessive dystrophic EB Hallopeau-Siemens occurred in about every 52,000 live births.

Epidermolysis Bullosa

[Problems and recommendations for the care of refugees displaced by war in Croatia].

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.

Humans

[Work at the Department of Psychiatry and Psychology at the Medical Headquarters of the Republic of Croatia].

During the summer 1991, the Ward of Psychiatry and Psychology at the Medical Headquarters, Republic of Croatia has been established as a direct reaction to the cruel war in Croatia. The aim of the Ward is to prevent mental disorders among the individuals participating in the war and among the population of Croatia. Special attention is given to the threatened groups. These are: injured patients, displaced persons, children who have lost one or both of its parents, members of families of persons who have been killed or injured and the others. Treatment doctrines have been provided as well. Besides, a regional psychiatric service which has been formed in accordance with the characteristics of this war which is carried out without a known front, mobile psychiatric groups have also been established. They are made up of volunteers. Particular attention has been directed toward the education and publishing. The first Croatian war psychiatry entitled "Introduction into the War Psychiatry" is going to be published very soon. A program of the so-called veterans hospital has been worked out as well.

Humans

Incidence of IDDM during 1988-1992 in Zagreb, Croatia.

The objective of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) in the population of Zagreb, Croatia, during 1988-1992. A centralized diabetes registry was the primary source of data, while secondary sources were used to assess ascertainment. A total of 282 new cases of IDDM were diagnosed in the study period, the primary and secondary sources identifying annually 93-100% of the cases. The annual incidence rate ranged from 5.6 per 100,000 to 6.6 per 100,000. Early fatality in persons older than 50 years was the major cause of underascertainment. The incidence peaked in the 10-14 years age group (12.4 per 100,000), and remained stable after age 24 years. Males had a significantly higher incidence in the 5-9 and 24-44 years age groups. In the 45-54 years age group, females had a significantly higher incidence. No seasonality was observed. Despite the war conditions in Croatia, the low overall IDDM incidence rates did not change significantly during the study period.

Adolescent

Emotional reactions of children to war stress in Croatia.

OBJECTIVE: The main purpose of the research was to assess the emotional reaction of children exposed to different levels of war stress in Croatia. METHOD: Four hundred eighty children completed the Croatian version of the Child Depression Inventory (CDI) and the Mood Scale. Their parents and teachers also completed the analogue Mood Scale. RESULTS: Both groups, refugees and local children, showed more depressive symptoms on the CDI in comparison with the children of the same age assessed before the war in Croatia. Displaced children manifested more negative emotions (especially sadness and fear) than did their local peers, based on self-report as well as parents' and teachers' reports. Poor correlations were found between the children's self-report and their parents' and teachers' report on the Mood Scale. CONCLUSIONS: The war stress had a negative impact on the emotional functioning of all children, especially the refugees. The findings of parents' and teachers' knowledge about their children's mood, more obvious in the group of displaced children, deserve special attention because of the increased risk for the children. It is recommended that we consider working with the parents, not just children, in promoting children's mental health during times of stress.

Adaptation, Psychological

Serologic survey for leptospirae in European brown bears (Ursus arctos) in Croatia.

From 1981 to 1991, sera of 42 European brown bears (Ursus arctos) from three areas in Croatia were tested for antibodies against 12 Leptospira interrogans serovars: grippotyphosa, sejroe, australis, pomona, canicola, icterohaemorrhagiae, tarassovi, saxkoebing, ballum, bataviae, poi, and hardjo. Diagnostic levels of antibody were found in 17 (40%) of 42 sera. Evidence of exposure to at least one of the serovars was found in seven of 14 free-ranging bears from the Lika region, four of 12 free-ranging bears from the Gorski Kotar region, zero of six orphaned cubs from the Gorski Kotar region, and six of 10 captive bears from the Zagreb Zoo. Based on the antibody titers, we implicated the following serovars: australis in five bears, sejroe in two bears, canicola in one bear, and icterohaemorrhagiae in one bear. There was a strong correlation between serovars implicated by this survey and serovars previously isolated from small mammals in Croatia.

Agglutination Tests

[Analysis of the flow of medical information from Croatia into the world].

It is commonly thought that an article published in a renown international journal gives its authors better chances for visibility. The present paper aims at answering three questions: (a) does an article published in a top international journal guarantee that its authors will be visible, (b) is an article published in a domestic journal (not covered by ISI) completely inaccessible to the international public, and (c) which are the information flows and how far does the medical information from Croatia reach. Selected was a corpus of 60 authors, who simultaneously publish in foreign journals and in Lijecnicki vjesnik (LV). The corpus consists of 1053 articles published in the 1961-1986 period. Out of these, 369 articles were published in LV and 684 in foreign journals; 177 among them are covered by the Science Citation Index. A total of 4481 citations were collected for the entire corpus of 1053 articles. The citations pertain to 506 articles, i.e. 48% of articles were cited. There are 190 cited and 83 uncited journals. The citations were distributed among 890 journals. Although the studied authors published their papers in renown international journals, a number of examples proves that this does not guarantee their visibility. An article published in LV need not necessarily remain inaccessible to the world--this depends on the article itself. The present analysis provides a compendious insight into the transfer of information from Croatia into the world. The data from citation analysis enable the deduction of "average number of citations per paper". With an appropriate interpretation it can be used as an indicator of information transfer.

Bibliometrics

Preventive medicine in Croatia through time and space.

The Croatian preventive medicine was well-known in the world through history. It was famous from the time of the quarantine in Dubrovnik, through sanitary cordon and contribution in obligatory first immunization against smallpox. Croatia presented Andrija Stampar as the leader in preventive medicine from the World War I till the sixties. We owe him all kinds of public health work both in organization and education as well as the initiating the World Health Organization. Knowledge and capabilities of Croatian preventive medicine workers were demonstrated the most clearly during the Croatian homeland war in 1991/91 when the infectious diseases as permanent war companions did not have effect on the state of health of the people in Croatia.

Communicable Disease Control