Showing papers in "Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti in 2007"

[Custom-made mouthguards and prevention of orofacial injuries in sports].

Abstract: The importance of sports dentistry has become even greater due to the role that sports have in modern society. As the risk of sports-related injuries appears already in the period of children's play and is constantly present in various risk-related sporting activities, the role of dental profession has become extremely important. Custom-made mouthguards are the most highly recommended mouthguards used for successful prevention of orofacial and dental injuries. It is important to inform athletes of the best characteristics of a custom-made mouthguard such as retention, comfort, fit, ease of speech, resistance to tearing, ease of breathing as well as good protection of the teeth, gingiva and lips. The shape and surface of the mouthguard which encloses the teeth, the gingival and the hard palate can vary depending on the anatomical features of the athlete's jaw, his/her dental arch, the type of sports activity, as well as the materials used in the manufacture of the mouthguard. Mouthguards should not extend distally further than the first molars because some athletes complain of the vomiting reflex. In addition, mouthguards may interfere with breathing. They should reach the mucogingival border labially and extend a few millimeters palatally in order to provide the best protection for the labial gingival and good retention. The labial flange should extend up to 2 mm of the vestibular reflection. The palatal flange should extend about 10 mm above the gingival margin thus enclosing the greatest part of the anterior palate surface with a slight narrowing distally not further than the first molars. Materials used in the manufacture of mouthguards should satisfy a number of physical, mechanical and biological requirements. Essential properties of materials used in the manufacture of mouthguards include water absorption, density, thickness as well as temperature transmission, energy absorption and drawing strength (tensile strength) of custom-made mouthguards. Such materials should have an optimal consistency in order to cushion the traumatic impact. Currently, ethylene-vinyl acetate (EVA) is the most commonly used mouthguard material. An optimal thickness of the mouthguard is achieved by the application of vacuum forming pressure-lamination technique in two layers of a thermoplastic sheet of EVA copolymer and if needed, by placing two layers of protective air-cells against the critical area. Some investigations in the Croatian samples showed that the most common injuries in water polo occur in the orofacial region (96.4% of cases), of which 80% are injuries of lips, tongue and cheek. In the period from 1997 to 2005 the number of orofacial injuries increased by 62%. Dental trauma occurs in 7.6% of cases. In basketball players soft tissue injury in the orofacial complex was established in 69.4% and dental trauma in 11.3% of the respondents. In the selected sample of handball players, soft tissue injuries were established in 78.8%, dental trauma and loss of teeth in 13.6% and temporomandibular joint injuries in 6.8% of the cases. In tae-kwon-do players 88% of orofacial injuries were lacerations, but only 12% reported dental and temporomandibular joint trauma. Only a half of the examined professional basketball players wore mouthguards, and none of the examined tae-kwon-do players. Clinical value of intraoral custom-made mouthguards was proven. Dentists play the key role in the prevention and treatment of sports-related dental and orofacial injuries, collection and dissemination of relevant information, as well as promotion of research on the preventive procedures related to injuries of such a specific aetiology.

[Disease duration, patient compliance and presence of complications in diabetic patients]

Abstract: UNLABELLED Diabetes mellitus (especially type 2) is one of the most common metabolic diseases in care of general/family physician. AIM The aim of the study was to investigate the duration of the disease, association of the disease duration with the onset of complications, and physician's assessment of patient compliance. The study was a part of the international Health Monitoring Project carried out by the Chair of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, Zagreb, in cooperation with The Netherlands Institute of Primary Health Care (NIVEL). The aim was to assess the value of data on the incidence and prevalence of diabetes mellitus in primary health care. SUBJECTS AND METHODS Family physicians, general/family practice specialists, teachers and heads of general/family practice practical teaching who were collecting data for the questionnaire structured for this purpose were included in the study. Description and distribution analysis was used on data analysis, and chi2-test on testing of differences. RESULTS Out of 96 general/family physicians who agreed to participate in the study, 58 (60.4%) collected data on 3065 patients: 1275 (41.6%) men and 1790 (58.4%) women. In 1044 (34.1%) patients the disease lasted for 1-5 years, in 990 (32,3%) for 6-10 years and in 1031 (33.6%) for more than ten years. Complications were recorded in 1521 (49.62%) patients, showing a statistically significant correlation with the duration of the disease (chi2 = 627.889; df = 2; p < 0.001). Physicians estimated that good compliance was established in 1579 (51.52%) patients. There were significantly less complications in these patients (chi2 = 6.098; df =2; p = 0.047). DISCUSSION AND CONCLUSION The number of complications in diabetes mellitus increased proportionally with the length of the disease, while the number of complications was lower in cases with better patient compliance. In the care for a patient with diabetes mellitus family physician should train the patient in self-care, tending to establish partnership in long lasting treatment, which is a precondition for good compliance.

[Painful ophthalmoplegia--Tolosa-Hunt syndrome].

Abstract: Tolosa Hunt syndrome is a rare disorder caused by nonspecific inflammation in the cavernous sinus/superior orbital fissure and/or orbital apex. It is clinically characterized by alternating remissions and exacerbations, and manifested as diplopia associated with unilateral periorbital hemicranial headache. The symptoms include blepharoptosis, which is usually mild if present, bulbomotor paresis involving the pupil, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Therapy for Tolosa-Hunt syndrome are systemic steroids. The course of disease in a 25-year-old man hospitalized for painful ophthalmoplegia and diplopia is presented. The history included severe pain on rightward eye movement and parabulbarly on the right, considerable defect in the area supplied by the first division of the trigeminal nerve, right hemicrania, and diplopia on looking to the left, right, upward and downward that developed after four days. A month before, the patient was observed at neurology department for severe right hemicrania. Current status included severe pain parabulbarly on the right, discrete proptosis with mild ptosis on the right eye, restricted right eye bulbar motoricity on looking nasally, nasally upward and downward, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Pupilar motoricity was normal. Upon admission, neuroradiologic examination (orbit CT) and brain MR were performed, and therapy with systemic corticosteroids was initiated ex iuvantibus, in consultation with a neurologist. At 24 hours of corticosteroid therapy, the pain subsided, whereas diplopia disappeared almost completely after 5 days, now being only occasionally recorded on looking to the left and upward.

[Health care professionals--attitudes towards their own health].

Abstract: AIM The aim of the study was to investigate differences in health behavior and life habits between physicians and medical nurses as related to their own health. EXAMINEES AND METHODS Study subjects were health professionals from various parts of Croatia attending a scientific meeting, who filled out a special questionnaire (36 males and 178 females). They were divided into two groups according to education and work performed: physicians (n = 125) and medical nurses (n = 89). The questionnaire designed for the study, How medical workers keep their health, was used to estimate the factors influencing their health. The study was performed during 2005. RESULTS The results showed that, regardless of education or work, our health professionals did not have healthy life habits. Both physicians and nurses were equally obese (p = 0.423) and physically inactive (p = 0.403). There was a significant difference between these two groups in smoking habits (p = 0.008), occasional alcohol consumption, regularity of breakfast intake (p = 0.019), and number of daily meals (p = 0.047). The following was done for the control of risk factors: laboratory tests of cholesterol and glucose, measurement of blood pressure, dental examination (p = 0.404), prostate examination (p = 0.406), breast self examinations (p = 0.810), mammography (p = 0.289), and Pap test (p = 0.683). None of these factors showed significant between group differences. There was a statistically higher number (64.9%; p < 0.001) of physicians without family physicians than among medical nurses (8.1%). CONCLUSION Medical nurses consulted their family physicians more frequently than doctors, but most physicians were inclined to self treatment. A great proportion of nurses were smokers, whereas many physicians reported alcohol consumption. Physicians used sedatives more than nurses, and their physical activity was better. Nurses had more frequent control laboratory tests of cholesterol and glucose, and measurements of blood pressure. They were also better in the number of daily meals. A vast majority of patients cite their physicians as their primary source of information regarding healthy lifestyle decisions. These findings suggest strategies to improve the physicians' health behavior.

[Obesity--a global public health problem].

Abstract: Obesity and overweight, as a part of the metabolic syndrome, are well known risk factors for the development of diabetes, hypertension, coronary heart disease, hyperlipidemia, stroke, sleep apnea syndrome, osteoarthritis and certain forms of cancer. Cardiovascular disease remains the leading killer in industrialized countries, where it accounts for 40% of deaths. Obesity is defined either by increased waist circumference, waist to hip ratio, or body mass index. Obesity results from an interaction of genes and lifestyle. As people in both developed and developing countries eat more and more energy dense food, and have ever less physical activity, the number of overweight and obese people increases to epidemic proportions. Abdominal obesity plays a key role in the pathophysiology of metabolic disorders, is associated with insulin resistance, and predicts the development of type 2 diabetes and subsequent coronary artery disease. In the general population, obesity is associated with an increased mortality, but paradoxically, a positive correlation between body mass index and survival in congestive heart failure has been reported. In secondary prevention, obesity is underrecognized, underdiagnosed and undertreated in persons with cardiovascular diseases. Weight loss and prevention of weight gain have to be considered one of the most important strategies to reduce the incidence of cardiovascular disease. Increased physical activity and appropriate diet are the cornestones of treatment. Considering the high prevalence of overweight and obesity in Croatia, there is urgent necessity to improve the level of knowledge and skills in understanding obesity by health care services, and to implement appropriate professional strategy to achieve the desired lifestyle modifications.

[Clinical and histopathological characteristics of biopsy-proven renal diseases in Croatia].

Abstract: There is little data on the spectrum of renal diseases in children in Croatia. The Croatian Society for Pediatric Nephrology has established the Registry of Biopsy-Proven Renal Diseases in an attempt to address this issue nationwide. Here we report preliminary results of a retrospective analysis of clinical and histopathological data of 565 children aged < or =17 years presenting to 9 hospitals in Croatia from 1991 to 2004, in whom kidney biopsy was performed. The most common indication for renal biopsy was nephrotic syndrome (39.1%), followed by asymptomatic proteinuria/hematuria (22.0%) and acute nephritic syndrome (17.0%). All biopsies were analysed by light-, immunofluorescent and electron microscopy. The majority of children, 552 out of 565 (92.4%), had glomerulonephritis (GN). Tubulointerstitial nephritis was found in 16 (2.8%), congenital renal parenchyma anomalies in 14 (2.5%) and vascular disease in 11 (1.9%) cases. One (0.2%) child had sarcoidosis with nephrocalcinosis. The sample was non-diagnostic in 1 (0.2%) case. Among children with GN, primary GN accounted for 70.9%, secondary GN for 16.1% and hereditary GN for 13.0% cases. The most frequent primary GN forms were focal segmental glomerulosclerosis (FSGS) (24.6%), mesangial proliferative glomerulonephritis (MEPGN) (19.2%) and IgA nephropathy (18.1%). Acute GN in resolution was found in 11.1% and minimal changes GN in 6.8% of cases. Most children with secondary GN had nephritis of Henoch-Schonlein purpura (HSP) (54.7%) and nephritis of systemic lupus erythematosus (SLE) (40.5%), while among hereditary GN Alport syndrome was most common (80.9%). In the group of children with primary GN who presented with nephrotic syndrome, most common forms were FSGS (38.5%) and MEPGN (24.0%). Minimal changes GN accounted for only 10.9% of cases. IgA nephropathy, primary or related to HSP (20.0%), FSGS (16.1%), MEPGN (12.6%) and Alport syndrome (9.7%) were the most common biopsy-proven renal diseases in Croatian children. The analysis provided data on the frequency of histological renal lesions in children in Croatia. The higher frequency of FSGS and MEPGN among Croatian children in comparison with other countries deserves further evaluation.

[Pathophysiologic effects of CO2-pneumoperitoneum in laparoscopic surgery].

Abstract: Today, laparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative manipulation. Carbon dioxide is the most commonly used gas for creating pneumoperitoneum, because of its high diffusibility and rapid rate of absorption and excretion. Certain specific operations that in the past required long hospitalization and were associated with severe postoperative pain and frequent complications are today performed laparoscopically. This minimally invasive technique potentially offers reduced operative time and morbidity, decreased hospital stay and earlier return to normal activities, less pain and less postoperative ileus compared with the traditional open surgical procedures. Because the postoperative benefits are superior to open surgical procedures, laparoscopy is today also used in many high risk patients in advanced age and pre-existent cardiopulmonary and respiratory diseases. However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance, cardiovascular and pulmonary physiology. Although these changes may be well tolerated in healthy patients, in high risk patients they may increase the rate of perioperative complications. Therefore, it is very important that the anesthesiologist thoroughly understands the pathophysiology of carbon dioxide-pneumoperitoneum and treatment of potential complications. In this article, the acid-base balance, cardiovascular and pulmonary changes associated with laparoscopic surgery, and their potential complications and management are discussed based on our experience and literature data.

[Croatian health survey: cigarette smoking].

Abstract: AIM The aim of the study was to calculate the prevalence of smoking habit among Croatian population according to sex, age groups and country regions. The aim was also to analyze the use of health services by smokers and nonsmokers. METHODS Data collected during the 2003 Croatian Health Survey were used in the study. The sample was representative of particular regions. A total of 12,254 individuals aged 18 were interviewed. RESULTS According to data obtained in the survey, there were 27.4% of daily smokers in the population aged 18. There were great differences between the regions. The prevalence of smoking habit was found to be higher in the east regions of inland Croatia and north Adriatic region than in other regions (29% vs. 32%). The lowest prevalence was recorded in the City of Zagreb (23%). The prevalence of cigarette smoking was higher in men (33.8%) than in women (21.7%). The highest prevalence of cigarette smoking in men was recorded in the Slavonia (east) region and lowest in north region (40.1% vs. 28.5%). In women, the highest prevalence was recorded in north Adriatic region (Istria) and lowest in Zagreb (29.2% vs. 13.9%). The prevalence of daily smokers also differed between counties within the same region. The prevalence of cigarette smoking was higher in the young than in older individuals. In some counties (mostly in the east of Croatia), more than 40% of daily smokers were aged 18-20. The lowest prevalence was in central Croatia. The prevalence of cigarette smoking in young individuals was higher in south Adriatic than in north Adriatic region. According to the level of education, the highest prevalence of smokers was recorded among individuals with with secondary school. Considering the use o health services, smokers were found to have less primary health care visits but more frequent and longer hospitalizations. Nonsmoker more frequently used preventive check-ups for high blood pressure, prostate carcinoma screening and colorectal carcinoma, whereas female smokers more frequently used screening for cervical and breast cancer than female nonsmokers. DISCUSSION Croatia is an average European country. Now the situation is better than it was in the past. A survey conducted in 1972 showed the prevalence of daily cigarette smoking to be 56.9% in male and 10.1% in female population. Since then, smoking habit has decreased in men and increased in women. CONCLUSION The differences recorded according to regions, sex and age groups are high. War situation and socioeconomic conditions (war, unemployment, low income) could influence the differences among regions and counties. The data collected can be used as a guidance on planning intervention measures.

[Nordic walking: a new form of physical activity in the elderly].

Abstract: Nordic walking is a form of kinesiologic activity recognized in the Scandinavian countries more than ten years ago. This physical activity activates muscles of the whole body. The use of special sticks for Nordic walking has a simultaneous impact on the strength of shoulder, arm and trunk muscles. Walking with sticks is suitable for all seasons, age groups and all levels of physical ability. The results of studies conducted in the Scandinavian countries confirm that Nordic walking is more effective than walking without sticks.

The Misgav Ladach method for cesarean section

Abstract: The Misgav Ladach method for cesarean section is based on the principles of surgical minimalism. This is based on the Joel Cohen laparotomy, somewhat higher than the Pfannenstiel incision. Subcutaneous tissue is left undisturbed apart from the midline, rectus muscles are separated by pulling. The peritoneum is opened by stretching with index fingers. The hysterotomy is closed with one layer extraendometrial continuous absorbable stitches (Vicryl), and the visceral and parietal peritoneal layers are left open. Fascia is stitched with a continuous synthetic absorbable stitch. The skin is closed with intracutaneous resorptive suture or metallic stapler sutures. The Misgav Ladach method is restrictive in the use of sharp instruments preferring manual manipulation: it gives faster recovery, shorter period to normal bowel function, less peritoneal adhesions and less scarring in the abdominal layers, less use of postoperative antibiotics, analgesics and antipyretics, and a shorter anesthetic and operative time. It is ideal for emergency and planned cesarean section.

[Arterial hypertension in Croatia. Results of EH-UH study].

Abstract: Arterial hypertension (AH) is the most important independent risk factor of cardiovascular diseases. The prevalence of AH is higher than it was several decades before, and in Europe it is approximately 40%. A higher prevalence of AH has been reported in Europe than in the United States and Canada. According to the results of epidemiology of arterial hypertension in Croatia study (EH-UH), the prevalence of AH in Croatia is 37.5%. Women are more aware, they were treated more often, and blood pressure control was more frequently achieved than in men. However, body mass index and socioeconomic factors have a greater influence on blood pressure values and prevalence of AH in women. A low level of health education and inappropriate treatment are the most important reasons for the poor blood pressure control observed. Measures of primary prevention should be performed continuously and adjusted to special population subgroups. As an increase of obesity and hypertension was observed in school children, these measures should start at that age.

[Value of ultrasound-guided percutaneous renal biopsy in diagnosis of the renal diseases]

Abstract: Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is a safe and effective tool in the diagnosis of glomerular, vascular and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. PRB of native kidneys was performed by nephrologists in 249 patients consecutively from May 1997 through May 2005 at the Department of Nephrology, Dubrava University Hospital, Zagreb, Croatia. The biopsy was done using continuous ultrasound guidance and a 16-gauge biopsy needle (Tru-Cut) in an automated gun (Biopty Bard). All biopsies were processed for light, immunofluorescence and electron microscopy. We analyzed yield of diagnostically useful material and frequency of postbiopsy complication. Adequate tissue for histologic diagnosis was obtained in 95% of the procedures. The mean glomerular yield was 11.9 glomeruli. The main indications for renal biopsy were nephrotic syndrome (33%) hematuria and/or non-nephrotic proteinuria (13%) and renal failure (12%). The dominant types of primary glomerulonephritis (GN) were focal segmental glomerulosclerosis (FSGS) in 27%, mesangioproliferative in 13%, IgA nephropathy in 11%, membranous GN in 11%, membranoproliferative GN in 5%, crescentic GN--5%, and minimal change disease (MCD) in 3% of cases. The most frequent complications were perirenal hematoma (clinically asymptomatic) in 3.6%, macrohematuria in 1.2%; bleeding complications requiring blood transfusion and/or therapeutic radiologic intervention were not seen, and surgical procedure was indicated in one (0.4%) patient. We conclude that real-time ultrasound is a safe, accurate method in localizing the kidney for percutaneous renal biopsy and a very effective approach for early detection of perirenal hematoma and other potential postbiopsy complications. The present data are an important contribution to the epidemiology of renal disease, highlighting significant epidemiological differences in European countries, particularly a higher incidence of FSGS as a proportion of primary GN in our population. This report represents a basis for the future Croatian Registry of Renal Biopsies and is intended to serve as a source of information for further studies.

The relationship of periodontitis and diabetes mellitus

Abstract: Periodontitis is a chronic, dental-plaque induced inflammatory disease of the tooth-supporting tissues, resulting in a gradual loss of connective tissue attachment and alveolar bone. The interrelationship between diabetes mellitus and periodontitis has been studied for many years. At,present, there is strong evidence to suggest that the incidence and severity of periodontitis is influenced by the presence or absence of diabetes mellitus as well as by the degree of diabetes control by patients. Elevated blood glucose levels in poorly controlled diabetics result in an increase of protein glycosylation leading to amplified formation of so-called Advanced Glycation End products (AGE). AGEs are glucose products that have the ability to attract and stimulate inflammatory cells to produce inflammatory cytokines, elevating the risk of periodontal attachment and/or alveolar bone loss. Gram-negative periodontal infection significantly decreases glucose tolerance and can lead, like other types of inflammation, to an increase in the severity of diabetes. Thus, diabetes and periodontal disease form a system in which periodontitis is aggravated and metabolic control of blood glucose levels becomes more difficult. This in turn leads to mutual aggravation that results in a self-enforcing catabolic process, a vicious circle of inflammation, tissue destruction and insulin resistance.

Risk factors as prognostic factors of hospital mortality in patients with acute myocardial infarction

Abstract: Objective To determine whether there are any differences in the prevalence of risk factors between survivors and nonsurvivors among acute myocardial infarction (AMI) patients hospitalized in a county hospital. Methods Case histories of AMI patients treated at Department of Medicine, Bjelovar General Hospital from July 1, 1996 until December 31, 2000 were retrospectively analyzed. AMI was diagnosed using the World Health Organization definition. Demographic factors (age and sex), smoking habits, clinical and laboratory results (hypertension, diabetes, blood lipids--total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides), personal history of angina pectoris, myocardial infarction and stroke and family history of atherothrombotic disease were considered as potential risk factors. Comparisons were made between survivors and nonsurvivors during hospital treatment. On group comparisons Student's t-test and chi2-test were used. Statistical significance was set at p Discussion In a total of 396 study patients, there were 316 (79.8%) survivors, showing male predominance (87.1% vs 67.3% of women; p or =5.0 mmol/L) and LDL-cholesterol (> or =3.0 mmol/L) were found in the group of survivors than among nonsurvivors. The latter were 8 years older than survivors (71.0+/-9.3 vs 63.0+/-11.9 years; p or =75 age group; women: 7.1% in or =75 age group). A higher percentage of men nonsurvivors were smokers in comparison to female nonsurvivors that also had a lower level of total cholesterol. The prevalence of hypertension showed no significant sex difference. Conclusion The prevalence of risk factors, especially the most important ones, i. e. hypertension, smoking and abnormal lipid values in AMI patients should be considered according to sex and age. The impact of these factors on patient outcome, i. e. survival rate during hospital treatment, can only be analyzed taking into account sex and age.

Epidemiologic characteristics of endemic nephropathy in Croatia in 2005

Abstract: INTRODUCTION Endemic nephropathy (EN) is chronic renal disease of unknown etiology, characterized with ominous onset and progressive clinical course. It occurs in rural areas in values of tributaries of the river Danube. According to the census from 2001, 10865 farmers live in Croatian endemic focus, i. e. 14 villages in Brod Posavina County. Apart from kidney impairment, high incidence of urothelial cancers is a hallmark of EN. Due to this, most agents that have been investigated were nephrotoxic and carcinogen. PARTICIPANTS AND METHODS In the last 25 years approximately 70% of 13 Croatian endemic villages' inhabitants were examined following WHO criteria. In spring 2005, 1081 inhabitants of 3 endemic villages (Kaniza, Bebrina, Banovci) and control village of Klakar were examined using the same criteria, and persons were divided as follows: diseased of EN, suspect of having EN, at risk for EN and others. RESULTS In the group of 1081 persons, we found 25 diseased of EN (12 men and 13 women): Bebrina 11, Banovci 9, Kaniza 5 (chi2 = 8.06; p < 0.05). Prevalence of EN in Kaniza was 0.6%, Bebrina 2.1% and Banovci 2.3%, while prevalence of suspect of EN was 1.7%, 6%, 6%, respectively. One fifth of inhabitants were at risk of having EN. CONCLUSION This epidemiologic survey that was conducted in spring 2005 found out that prevalence of EN in Croatia is approximately the same as it was in the last decades. Apart from renal impairment, high incidence of urothelial cancers is characteristic of EN in this region. In addition to medical and scientific, we will need social and political help in elucidating the etiology of EN as well as in improving treatment and cure of this poor rural population.

Physical inactivity in Croatia

Abstract: Cilj ovog rada je utvrditi prevalenciju tjelesne neaktivnosti u Republici Hrvatskoj, te njenu distribuciju glede dobi, spola te regije. Tjelesna je aktivnost dokazano izuzetno znacajan i nezamjenjiv faktor u zastiti i unapređenju zdravlja, odnosno sniženju morbiditeta i mortaliteta nekih kronicnih bolesti. Tjelesna neaktivnost, s druge strane, jedan je od faktora rizika za razvoj kardiovaskularnih bolesti. Podaci za reprezentativni uzorak od 12540 osoba su dobiveni anketnim upitnicima. Rezultati pokazuju da je 35, 8 % populacije u Hrvatskoj tjelesno neaktivno. Postotak neaktivnih osoba je nesto veci u muskaraca (43, 7 %) nego u žena(30 %). Najporazniji rezultati su dobiveni u Gradu Zagrebu, gdje je cak 85, 6 % muskaraca i 45, 2 % žena neaktivno. S druge strane najmanje je tjelesno neaktivnih muskaraca u Južnoj Hrvatskoj (14, 8 %), dok je najmanje takvih žena u Centralnoj Hrvatskoj (20, 8 %). Najvise, pak, zabrinjava podatak da je među mlađim muskarcima u Zagrebu (18-34 godina) cak 94, 8 % njih tjelesno neaktivno. Takvi rezultati ukazuju na potrebu dizajniranja interventnih mjera usmjerenih posebno prema stanovnistvu urbanih sredina, a među njima posebno prema osobama mlađe odrasle dobi. Prvenstvo među mjerama svakako pripada unapređenju infrastrukture za aktivan nacin življenja i pokretanju programa za podizanje razine tjelesne aktivnosti, posebno u urbanim sredistima.

Physical activity in the prevention and treatment of cardiovascular diseases

Abstract: Cardiovascular diseases represent the leading health problem of the modern age. They are the first cause of mortality in developed as well as in transition countries. Physical activity has a beneficial impact on the cardiovascular system, both directly by improving endothelial function and indirectly by normalizing risk factors of atherosclerosis, such as dyslipidemia, high blood pressure, obesity and by positive effects on coagulation mechanism. The impact of physical activity on the cardiovascular system is manifested by immediate changes in hemodynamics, blood pressure and heart rate during physical training. After some time, consequences of continuous training are manifested as a decrease in the basal heart rate, blood pressure and heart rate responsiveness to physical activity stress, which indicates good conditioning i.e. increased physical capacity. Prospective epidemiological studies have shown that sedentary style of life has a twice-higher risk of sudden death and cardiovascular mortality. Physical activity should be permanent to have positive effects on the cardiovascular system; it means 4 to 5 times weekly depending on duration and intensity of exercises. In case of exercises 60-75% of the maximum, duration should be 30 to 45 minutes. Evidence based data show a 20-25 % lower mortality rate after myocardial infarction in the patients submitted to rehabilitation program of physical exercises. Physical activity in patients with coronary artery disease must be individualized, quantified and under control. In subjects with impaired function of the heart muscle, physical activity is limited with characteristic symptoms - dyspnea and stenocardia. These patients are classified into groups with mild, moderate and high risk, and based on this the allowed intensity of their physical activity is assessed, as well as the grade of its control. Physical exercises must be without range of tolerance and must not exceed this limit of symptoms. The aim of physical activity and training is increasing threshold of tolerance of symptoms. It has been shown that physical training in controlled quantities decrease relative risk of mortality by 35% and hospitalization by 28% in chronic heart failure. Physical training is beneficial for all forms of heart failure in terms of decreased mortality and improvements of the muscle mass and physical status.

Obesity and overweight in Croatia

Abstract: Aim Obesity has become a growing public health problem. The number of obese people in the world is increasing, carrying a number of risks for the development of cardiovascular and other diseases. There are no easy or short-term solutions for this problem. The causes differ and the number of obese and overweight people varies from region to region. The aim of the study was to estimate the distribution of obese and overweight people in Croatia. Methods The study was carried out in 2003 in a sample of 9070 subjects, representative of the population of Croatia. We used three measures of obesity and overweight: body mass index (BMI); waist circumference, and waist/hip ratio (WHR). Overweight is defined as BMI of 25.00-29.99 kg/m2, and obesity as BMI of 30 kg/m2. The other two measures vary according to sex. Waist circumference greater than 102 cm (40 in) in men and greater than 88 cm (35 in) in women is considered to show unfavorable fat distribution, and WHR > or = 1 in men and > or =0.85 implies an increased risk of heart disease, diabetes, hypertension, and some forms of cancer. Weighted data were analyzed with SPSS statistical software. Results The analysis of each of the variables yielded the following results: BMI: generally, more than 1 in 5 adults (about 720,000) in Croatia were obese with no sex differences. The highest rate of obesity was found in the inland part of the country and lowest along the Adriatic coast. Overweight was more common than obesity, showing some sex differences [705,000 (43%) men and 625,000 (34%) women]. The greatest number of overweight men lived along the Adriatic cost and in Zagreb, the capital of Croatia, while the greatest number of overweight women lived along the Adriatic coast. The greatest number of overweight young men lived along the Adriatic coast and of young overweight women in the east inland part of Croatia. Waist circumference showed great sex differences: 54% of women (993,000) had waist circumference greater than 88 cm (35 in), and 37% of men (607,000) had waist circumference greater than 102 cm (40 in). The greatest number of men with such waist circumference were found in the inland part, and in the middle and southernmost part of the Adriatic coast. The greatest number of women with waist circumference over 88 cm lived in the continental part of Croatia. WHR showed even greater sex difference: 41.0% of women (754,000) and 18.5% of men (303,000) had unfavorable WHR. The greatest number of men and women with unfavorable WHR lived in the inland and southern parts of Croatia. Conclusions Obesity and overweight pose major problems in Croatia. There are regional and sex differences, and differences according to the variables observed. In order to get proper insight in the current situation, we recommend that BMI be adjusted for fat distribution and comorbid conditions.

[Coronary heart disease risk factors in Croatia and worldwide: results of the Interheart study].

Abstract: Rezultati INTERHEART studije parova, provedene u 52 zemlje, poazuju da se globalno i regionalno vecina infarkta miokarda (IM) može predvidjeti s devet jednostavno mjerljivih cimbenika rizika. Cilj ovog istraživanja je odrediti vezu pojedinih cimbenika rizika s pojavnosti IM u hrvatskoj podskupini INTERHEART studije. Ukupno su analizirane 263 osobe s akutnim IM i 264 kontrolne osobe. Najveca razlika frekvencija između ovih skupina zabilježena je za sadasnje pusenje (p<0, 001), dijabetes (p<0, 001), arterijsku hipertenziju (p=0, 038) i abdominalnu pretilost (p<0, 001). Pusenje je odgovorno za 75% veci rizik od nepusenja (OR 1, 74 ; p=0, 006), dijabetes utrostrucava rizik (OR 2, 83 ; p<0, 001), arterijska ga hipertenzija povecava za 70% (OR 1, 68 ; p=0, 007), abdominalna pretilost odvostrucava (OR 1, 96 ; p=0, 007), a visoki omjer ApoB/ApoA-1 ga povecava za gotov 2, 5 puta (OR 2, 23 ; p=0, 005). Znacajnim protektivnim cimbenicima nisu se pokazali ni tjelesna aktivnost niti redoviti unos voca i povrca. Umjereni unos alkohola smanjuje rizik za trecinu (OR 0, 63 ; p=0, 044). Nasi rezultati uglavnom odgovaraju onima dobivenim globalno i regionalno. Nepusenje i tjelovježba uz povecan unos voca i povrca osnova su prevencije koronarne bolesti diljem svijeta, a u nasem im se slucaju može dodati i umjeren unos alkoholnih pica.

Topical corticosteroids and corticosteroid sparing therapy in psoriasis management

Abstract: Psoriasis is a chronic, recurrent, genetically determined, inflammatory dermatosis that affects the skin, scalp and joints. Psoriasis is caused by various triggers (infections, drugs, physical and emotional factors). It ranges in severity from mild to severe, and patients with moderate to severe disease suffer significant deterioration in the quality of life. Clinical types of psoriasis are psoriasis guttata, nummular psoriasis, plaque, generalized and erythrodermic psoriasis. Skin changes affect intertriginous regions (inverse psoriasis), and there also are special forms of pustular psoriasis and arthropathic psoriasis. The goals of psoriasis treatment are to gain initial and rapid control of the disease; to decrease plaque lesions and percentage of body surface area involved, to achieve long-term remission; and to minimize adverse events. Topical treatment for mild psoriasis includes topical corticosteroids, calcipotriene, tazarotene, topical tars, anthralin and keratolytics, and immunomodulators (pimecrolimus, tacrolimus). The treatment of moderate to severe psoriasis includes systemic therapies such as methotrexate, acitretin, cyclosporine, hydroxurea and biologicals. Topical treatment can be effective using combination, rotational or sequential regimens for patients with more severe disease. The aim of successful treatment of psoriasis is fast control of the disease and regression of lesions in a short period, prolonged remission and minimal adverse reaction. Local therapy with various topicals is administered for mild and localized forms of the disease, with or without phototherapy (UVB). Topical corticosteroids are used in a variety of formulations, with a potential ranging from superpotent to least potent (class 1-7), which decrease symptoms in tne first two weeks of treatment with improvement in subsequent weeks; D3 vitamin analog (effective in 6-8 weeks), retinoids (effective in 1-2 weeks), tars (2-4 weeks), anthralin (2-4 weeks), and keratolytics (most effective in combination with corticosteroids. Topical corticosteroids have been the first choice in the treatment of and inflammatory dermatoses since 1952 to the present. Corticosteroids are effective as monotherapy or in combination for sequential or rotational treatment. They are effective in short time, simple for use and inexpensive. Psoriasis is a chronic skin disease that requires long-term therapy. For patients with mild to moderate form, intermittent corticosteroid therapy is the most effective treatment. Every-other-day or weekend-only application may be effective in chronic stage. Calcipotriene and tazarotene are more effective in combination with corticosteroids in the initial weeks of therapy. Tar preparations, anthralin and keratolytics may be used with ultraviolet light and corticosteroids. Topical immunomodulators are effective on the face and intertriginous psoriatic lesions.

Arterial hypertension in renal transplant recipients

Abstract: Arterial hypertension develops in up to 80% of renal transplant recipients. Uncontrolled hypertension induces left ventricular hypertrophy, heart failure and death, but also promotes deterioration of allograft function. Cadaveric transplantation, delayed graft function, renal artery stenosis, presence of native kidneys, increased body weight and therapy with calcineurin inhibitors and steroids have been associated with an increased incidence of hypertension after kidney transplantation. Cyclosporine increases both systemic and renal vascular resistance, enhances sympathetic activation, endothelin production and, possibly, decreases vascular relaxation by decreasing the generation of nitric oxide. Tacrolimus has less pronounced prohypertensive role after renal transplantation. Corticosteroids contribute to the development of hypertension, since their withdrawal results in a significant decrease of blood pressure in the majority of patients. Renal artery stenosis occurs in almost 12% of hypertensive renal transplant recipients. It is a correctable cause of hypertension, and for this reason should be investigated in all suspected patients. Doppler ultrasonography is used as the screening method that is highly sensitive and specific in the hands of a well-experienced investigator. However, dependence of the method on the experience of the investigator is its major drawback. Magnetic resonance angiography and spinal computed tomography angiography are useful noninvasive methods, but arteriography remains a method for establishing the definitive diagnosis. Percutaneous balloon angioplasty, with or without placement of the stent, is successful in the majority of patients, but with a high incidence of restenoses (20%). Surgery is indicated for stenoses that cannot be treated with angioplasty or that recur. Auto-transplantation of the kidney with complex stenoses of graft arteries is useful in selected cases. Posttransplant hypertension should be aggressively treated to prevent the development of end-organ damage. Every effort should be invested in reducing immunosuppression when appropriate, together with salt restriction and weight reduction. Calcium channel blockers have good antihypertensive properties accompanied with minimization of cyclosporine-induced renal vasoconstriction. Angiotensin-converting enzyme inhibitors (ACEi) should be used in patients with proteinuria. Renal function should be carefully monitored after their introduction since they may cause transitory deterioration of glomerular filtration and/or hyperkaliemia. ACEi can induce anemia in renal transplant recipients, side effect that is often used in the treatment of posttransplant erythrocytosis. All other antihypertensive drugs could be used, with minoxidil being the most potent one. Patients with resistant hypertension should be investigated for the presence of renal artery stenosis. After exclusion of rejection, renal artery stenosis and recurrent disease, in cases of severe hypertension, native kidneys laparoscopic nephrectomy should be considered.

Sports injuries of temporomandibular joints and oral muscles in basketball players

Abstract: All sporting activities have an associated risk of orofacial injuries due to falls, collisions with players, devices, and hard surfaces. Many authors have reported about incidence of orofacial injuries during sports activities. Flanders and Bhat concluded that 34% of all injuries in basketball are orofacial injuries, while orofacial injuries account for only 0.07% of all injuries in American football. AIM, METHODS AND EXAMINEES: The aim of this investigation was to identify the incidence, type and severity of temporomandibular joint injuries, stiffness and pain in oral muscles, and pain during opening and closure of the mouth while playing basketball.The sample consisted of 195 basketball players, 135 professionals and 60 non-professionals. They filled out the questionnaire individually with help of the researchers. RESULTS: The data received by the survey revealed a total of 350 temporomandibular joint injuries and/or pain, oral muscles stiffness and pain during opening and closure of the mouth during basketball career. The incidence of injuries was higher in professional 72.6% (254) than in non-professional players 27.4% (96). Twenty-four professional and 9 non-professional players reported pain or oral muscles stiffness, while 58 professional and 15 non-professional players reported pain during opening and closing the mouth. Only 1 non-professional player and 6 professional players reported injuries of the temporomandibular joint. All basketball players who were injured during their career had more than one injury. During career, professional players reported pain while opening and closing of the mouth more often than non-professional players, on the average 1.3 and 0.9 times, respectively. Pain or oral muscles stiffness during basketball career was reported 0.6 times on the average by non-professional players, as compared to 0.5 times by professional players. Non-professional players reported 5.2% injuries of temporomandibular joints during their career, while professional players only 3.2%. With regard to positions in the team, most injuries of temporomandibular joints, stiffness and pain in oral muscles were reported by forwards, on the average 2.33 incidents. Centers were the second most frequently injured group with an average of 1.96 incidents, followed by point guards with 1.74, power forwards with 1.62 and guards with 1.55 incidents. CONCLUSION: Only 2 basketball players (1%) frequently used a mouthguard and 93.3% of them never even tried to wear a mouthguard. Implementation of mandatory mouthguard usage in sports, such as basketball, would decrease such a large number of sports injuries. Mouthguards would absorb the force of impact and consequently stiffness and pain in oral muscles so that injuries of temporomandibular joints would be reduced or even avoided. Such a low percentage of mouthguard use in basketball players reflects poor awareness and education of both athletes and coaches, as well as an insufficient role of dentists in sports medicine and education. Language: hr

Relationship of regional alcohol drinking habit and cardiovascular risk factors in Croatia

Abstract: Aim The aim was to investigate regional distribution of drinking habit and its relation to the prevalence of cardiovascular risk factors. Subjects and methods Nine thousand and seventy participants older than 18 questioned during THE 2003 Croatian health Survey were analyzed and weighted data extrapolated to the adult Croatian population. Study group included subjects reporting regular intake of any type of alcohol drink (liquor, wine or beer) during the past year. Alcohol abstainers surved as a control group. Results The highest prevalence of alcohol drinking was recorded in south Croatia (32.3%, n= 215529). Alcohol drinkers were mostly men (72%). In all Croatian regions there was a rather uniform distribution of liquor drinking (6-7 glasses, 0.033 L per day). Subjects from west Croatia and the City of Zagreb mostly reported drinking wine (4-5 glasses, 0.2 L per day). A mixture of wine and water predominated in south and north Croatia (7 glasses, 0.2 L per day), whereas subjects that mainly took beer were from east and central Croatia (10 bottles, 0.33 L per day). The highest prevalence of arterial hypertension (56.6%) was found in regular alcohol drinkers from west Croatia. The highest prevalence of acute myocardial infarction (6.7-7.0%) and angina pectoris (8.2-8.6%) was observed in subjects from northn Croatia and the City of Zagreb. However, the occurrence of acute myocardial infarction was more common in regular alcohol drinkers, and of angina in abstainers. The lowest prevalence of acute myocardial infarction was recorded in regular drinkers from central Croatia (1.4%). The prevalence of stroke was generally lower in regular drinkers, with lowest prevalence in west Croatia (0.9%). Conclusion Drinking habit varies among regions of the Republic of Croatia, according to the prevalence, quantity and type of alcohol beverage, and so does the distribution of cardiovascular risk factors. On comparing regional distribution of cardiovascular risk factors between regular consumers and abstainers we observed a divergent influence of alcohol consumption, especially on the occurrence of arterial hypertension and stroke.

The value of hysteroscopy in perimenopausal women

Abstract: The aim of this review is to define clinical guidelines for the management of menopausal women with abnormal uterine bleeding. Hysteroscopy has proved to be the most accurate and reliable method for the diagnosis of intrauterine diseases. Many authors have recently proposed the use of hysteroscopy as a first line procedure in the approach to menopausal women. With continuing improvement in technology, and development of modern narrow-diameter hysteroscopes, light sources and distension-medium insufflators, hysteroscopy can now be performed as an outpatient procedure. Because of its higher diagnostic accuracy, hysteroscopy is replacing dilatation and curettage for the investigation of abnormal uterine bleeding. Diagnostic dilatation and curettage should be done with hysteroscopy to obtain visual image of the endometrial cavity and to exclude focal disease. Hysteroscopy thus turns a ,"blind" procedure into one allowing directed curettage, helps prevent missing unsuspected polypes and ensures that the most visibly abnormal areas are sampled.

The use of foot orthoses in school children with foot problems due to sports and other physical activities

Abstract: UNLABELLED: The study analyses the use of foot orthoses in 125 school children (age 7-16) with foot pain due to sports and other physical activities. The aim of the study was to determine the effectiveness of foot orthoses use in school children with foot pain. METHODS: Foot orthoses were indicated at the first orthopaedic examination. Using a specifically designed survey we determined the following: the age and sex of the examined children, the clinical state of feet, the persistence of pain, the level of pain using the visual analogue scale at the first and control examination, daily wearing of foot orthoses and satisfaction at the control examination. RESULTS: We examined 125 school children, 85 boys (average age--11.7 years) and 45 girls (average age--11.1 years). Eighty-seven of them (69%) complained of pain during sports activities, 26 (21%) experienced pain only while walking and 6 examined children complained of constant pain while standing. Sports-related foot pain was most frequently associated with basketball (32%), to be followed by football (26%), athletics (15%), handball (9%), dancing (8%), tennis (5%) and combat sports (3%), whereas the smallest number of children complained of foot pain related to volleyball (2%). With regard to the pain location most of the examinees reported pain in the inner longitudinal arch (20%). Seventy-two of them were wearing foot orthoses during the whole day. The average level of pain at the first examination was 4.5. At the control examination 95 of examinees no longer complained of pain and in the remaining 30 examinees the pain was reduced to the level of 1.7. The majority of the examined children (94) rated their foot orthoses as "excellent" and the lowest mark "good" was given only by two examinees. CONCLUSION: Foot orthoses are crucial for treatment of foot pain in school children regardless of pain etiology: foot deformities or/and overuse due to external causes. Language: hr

The characteristics of depression in the elderly

Abstract: UNLABELLED Depression is a patologic condition found in all age groups, including the elderly. It is not a normal part of aging. Because of the various symptoms and signs and gradual course of depression, it is very often unrecognized. PATIENTS AND METHODS Study group included 223 patients aged over 65, who visited their family doctor at Postira and Milna clinics, island of Brac, in period from December 1, 2003 till March 1, 2004. Study subjects filled out three questionnaires: personal data, geriatric depression scale, and a short questionnaire about pain, designed by the Croatian Society for Pain Control. RESULTS According to the score on the geriatric depression scale, 15% of patients had symptoms of severe depression and 34% of mild depression. Both sexes were equally represented. In those with depression, anxiety, irritability and nervousness were markedly expressed as compared with those without depression. In patients with ICV, the symptoms of depression were considerably more pronounced than in healthy population. The experience of pain was much more intense in depressive subjects. Painkillers were much more effective in the group of nondepressed subjects. In the depressed group, insomnia, insecurity and disturbing thoughts about future disease were more intense. Interpersonal relationships were disturbed, and the quality of life impaired due to the pain. CONCLUSION Primary care physician is mostly the doctor of first contact for the elderly. Therefore, it is very important that general practitioners know how to recognize depressive symptoms.

The loss of visual field after proliferative diabetic retinopathy treatment with two different techniques of panretinal photocoagulation

Abstract: UNLABELLED Diabetic retinopathy (DR) is the most common cause of blindness in the active population of industrialized countries. Panretinal argon laser photocoagulation (PRP) is used in the treatment of proliferative diabetic retinopathy. Despite its usefulness, the mentioned treatment has some side effects such as permanent visual field damage. The treatment was performed with two PRP techniques, peripheral panretinal photocoagulation (PPRP) and central panretinal photocoagulation (CPRP). Peripheral visual fields defects were assesed with Vaughans method. The aim of the study was to determine the extent of visual field defects entailed by the two different PRP techniques. RESULTS Visual field loss in percentage was greater in the group treated with PPRP (mean 9.09 +/- 6.36%) than in group treated with CPRP (mean 4.9 +/- 4.5%) (p = 0.000037). The initial functional DR severity and presence of risk factors that influence DR severity were similar in the two treatment groups. Different results were mostly attributable to the PRP techniques employed, being significantlly less favorable with PPRP.

[Dietary habits: Croatian health survey].

Abstract: OBJECTIVE: To examine dietary habits and to determine the presence of possible regional differences in Croatia. SUBJECTS AND METHODS: Survey was performed during 2003 by means of modified food frequency questionnaire. Survey included randomly selected 9070 adult examinees at the age of 18 and above in the whole Croatia. The SPSS program using weighted database was used for statistical analysis. RESULTS: Obtained data indicate existing significant differences in dietary habits at county and regional level in nutrition of the Croatian population. There is a tendency toward grouping as much unhealthy dietary habits as healthy by certain counties, respectively regions. Population of the Eastern and Northern regions (except of the Medjimurska County) living in the counties of Vukovarsko-srijemska, Koprivnicko-krizevacka, Pozesko-slavonska and Viroviticko-podravska in comparison to population of other counties, respectively regions, significantly more often use animal fats, add salt to foods, consume less fruit and vegetables, eat more cakes, sweets and cured meat products. The observed characteristics are considered risk factors for development of cardiovascular diseases and other chronic non-communicable diseases. Population of the Southern and Western regions, in the counties of Primorsko-goranska, Istarska, Zadarska, Dubrovacko-neretvanska, but also in Medjimurska County, significantly more often use vegetable oils ; they also on daily basis consume more often fruit and vegetables, less frequent or rarely add salt and consume sweets and cakes. Differences are also observed in dietary habits between genders, but also within the same sex in certain counties. CONCLUSIONS: Indicators of the present nutrition of the population show regional dietary differences. It is important to point out a need for broader education of general public regarding the impact of diet on health, principles of healthy nutrition, and promotion of comparative advantages of the Mediterranean diet as a prototype of healthy nutrition.

Uropathogens and antimicrobial susceptibility in outpatients

Abstract: Infekcije mokracnog sustava (UTI) su po ucestalosti odmah iza respiratornih infekcija. Za postavljanje tocne etioloske dijagnoze UTI potrebno je uciniti UK i provesti lijecenje na temelju rezultata testova osjetljivosti bakterija na antibiotike. Neracionalna antibiotska terapija povisuje troskove lijecenja i dovodi do selekcije rezistentnih sojeva. Ciljevi istraživanja bili su ustanoviti u kojem postotku nalaz UK potvrđuje sumnju na UTI koja je postavljena u ordinaciji Opce medicine ; koji su najcesci uzrocnici UTI u izvanvanbolnickoj populaciji, ustanoviti njihovu osjetljivost na amoksicilin, amoksicilin s klavulonatom, cefazolin, cefuroksim, nitrofurantoin, sulfametoksazol– trimetoprim i norfloksacin, te ustanoviti kolika je isplativost primjene UK i kolike se ustede mogu ostvariti sirom primjenom UK. Istraživanje je pokazalo da je pozitivna UK nađena kod 27, 4% uzoraka od ukupno 815. Pozitivan nalaz UK ustanovljen je kod 32, 8% žena i 20, 1% muskaraca. Obzirom na dob pozitivnu UK imalo je 26% osoba mlađih od 65.godina i 30, 6% osoba sa 65. i vise godina. Najcesci uzrocnici UTI bili su E.coli (67, 3%) i Enterococcus spp. (12, 6%). Svi sojevi bakterija imali su niži postotak rezistencije od hrvatskog prosjeka prema podacima Akademije medicinskih znanosti. Posebno se izdvaja rezistencije E. coli na SXT (6, 7%). Razlog postojanja ovih razlika vjerojatno je u cinjenici da je istraživanje provedeno na uzorcima izvanbolnicke populacije. Može se zakljuciti da je UK metoda koja tocno dijagnosticira UTI, racionalizira troskove i rezultate lijecenja i sprjecava nepotrebno propisivanje antibiotika.

[Acute infections of the upper respiratory tract--factors that contribute to diagnosis and antibiotic prescription decisions].

Abstract: UNLABELLED Acute infections of the upper respiratory tract contribute to over 20% of the morbidity of the population in ambulatory care, with the highest incidence in children. A noted problem in the treatment of these diseases is overprescription of antibiotics. In addition, there is a high degree of variability among physicians in the frequency and cost of antibiotic prescription. AIM The aim of this study was to evaluate the factors that contribute to the diagnosis, and those that affect the decision of a family care physician or otolaryngologist to prescribe an antibiotic to a patient suffering from an upper respiratory tract infection. PATIENTS AND METHODS In this prospective study, data were collected on 75 patients with acute middle ear infection, 49 with acute tonsillitis, 57 with acute sore throat, and 39 with a streptococcal sore throat and tonsillitis, in 6 family physician offices and otolaryngological practices in Zagreb University Hospital and Osijek University Hospital, Osijek. The questionnaire included general patient data, data on the current disease (patient history and the relevant clinical status), diagnostic and therapeutic procedures and patient follow-up. Doctors noted patients' symptoms and rated (from one to five) the influence of a particular symptom to arriving at the diagnosis, and to deciding to prescribe antibiotics. The physicians also noted any additional factors that influenced antibiotic prescription. The data were analysed using appropriate statistical measures, such as chi2-test, chi2-test using the hypothesis of rectangular distribution and t-test for independent samples. RESULTS AND CONCLUSION The results show that diagnostic criteria for these diseases and decisions for prescribing antibiotics are based on clinical criteria and in concordance with current guidelines. Otolaryngologists recommended microbiological analyses for 54% of patients, while GPs did so for only 4.2% of the patients. While the clinical status is the most important factor for antibiotic prescription, the results of this study indicate that other additional factors such as familiarity with the patient, likelihood of complications, and knowing the patient's living circumstances and his/her ability to use health care facilities should be considered in the complex process of antibiotic prescribing.