Prikaz epidemije – Alimentarna toksoinfekcija Salmonellom enteritidis

Dana 09.10.2005. godine u 16 sati i 45 minuta pripravni epidemiolog županijskog Zavoda za javno zdravstvo zaprimio je telefonski poziv od dežurnog liječnika hitnog bolničkog prijema Opće bolnice u Koprivnici o prijavi epidemije na temelju šest osoba koje su se u poslijepodnevnim satima javile u hitni bolnički prijem radi gastrointestinalnih smetnji – povraćanje, bolovi u trbuhu i proljev te povišene temperature oko 40°C praćene glavoboljom i općom slabosti. Četvero pacijenata odmah je zadržano na zaraznom odjelu, a dvoje je otpušteno kući nakon primljene infuzije i ostale simptomatske terapije. Dežurni liječnik hitnog bolničkog prijema ustanovio je da je svih šestero pacijenata bilo na svadbi 08/09.10. kod istog organizatora i u istom ugostiteljskom objektu u Koprivnici na osnovu čega je i prijavio epidemiju

Prikaz epidemije – Alimentarna toksoinfekcija Salmonellom enteritidis

Dana 09.10.2005. godine u 16 sati i 45 minuta pripravni epidemiolog županijskog Zavoda za javno zdravstvo zaprimio je telefonski poziv od dežurnog liječnika hitnog bolničkog prijema Opće bolnice u Koprivnici o prijavi epidemije na temelju šest osoba koje su se u poslijepodnevnim satima javile u hitni bolnički prijem radi gastrointestinalnih smetnji – povraćanje, bolovi u trbuhu i proljev te povišene temperature oko 40°C praćene glavoboljom i općom slabosti. Četvero pacijenata odmah je zadržano na zaraznom odjelu, a dvoje je otpušteno kući nakon primljene infuzije i ostale simptomatske terapije. Dežurni liječnik hitnog bolničkog prijema ustanovio je da je svih šestero pacijenata bilo na svadbi 08/09.10. kod istog organizatora i u istom ugostiteljskom objektu u Koprivnici na osnovu čega je i prijavio epidemiju

MONITORING OF NITRATE CONTENT IN DRINKING WATER IN KOPRIVNICA-KRIŽEVCI COUNTY

Prema Nitratnoj direktivi EU poljoprivreda je izvor onečišćenja pitke podzemne vode nitratima. Na području Koprivničko-križevačke županije, podzemna voda koristi se kao jedini izvor vode za piće pa je od iznimnog interesa spoznaja o koncentraciji nitrata s obzirom na mogućnost štetnog djelovanja na ljudsko zdravlje. Prema literaturi, prekomjerni unos nitrata u organizam može doprinijeti pojavnosti methemoglobinemije, tumora, spontanih abortusa te poremećaju intrauterinog rasta. U razdoblju od 2002. do 2007. godine na području Koprivničko-križevačke županije, uzorkovano je 1170 uzoraka vode za piće iz plitkih bunara u kojima je utvrđena koncentracija nitrata metodom ionske kromatografije (HRN EN ISO 10304-1:1998). Od svih ispitanih uzoraka, u 25% (N=294), utvrđena je koncentracija nitrata iznad maksimalno dopustive, propisane Pravilnikom o zdravstvenoj ispravnosti vode za piće. Na području Križevaca utvrđeno je 38% (N=382) neispravnih uzoraka u vodi za piće iz domaćinstava, na području Koprivnice 23% (N=613), dok je na području Đurđevca utvrđeno 6% (N=175) neispravnih uzoraka. U radu je dokazano onečišćenje pitke vode iz točkastih izvora poljoprivrednog porijekla. Utvrđena je pozitivna ili negativna korelacija između povišene koncentracije nitrata i količine oborina. Na području Koprivničko-križevačke županije postoje razlike u kvaliteti podzemne vode koje mogu biti posljedica i različitog intenziteta utjecaja poljoprivrede na onečišćenje vode.Aims: The aim of the study was to establish nitrate concentrations in drinking water originating from shallow wells across Koprivnica- Križevci County, to assess the influence of agricultural point sources on nitrate water contamination, and to explore the correlations between water nitrate concentrations and agro-ecologic factors. Methods: During the 2002-2007 period, a total of 1170 potable water samples were taken from 104 shallow wells across Koprivnica-Križevci County. Given the geographical and developmental determinants, the investigated area was divided into three sections: Koprivnica, Križevci and urđevac areas. Potable water was sampled throughout the 6-year, all season-period conformant to the HRN ISO 5667-3 standard. Nitrate concentrations in potable water samples were established using ion chromatography (HRN EN ISO 10304-1:1998). The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service. Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations (MAC) stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive. The _2-test produced statistically significant differences. Results: In 25% (n=294) of water samples, nitrate concentration exceeded MAC. The majority of unsafe samples were recovered in Križevci area (38%; n=382), followed by Koprivnica (23%; n=613) and urđevac area (6%; n=175). The mean range spanned from 0.1 to 279.0 mg/L, while the total mean nitrate concentration was 41.7 mg/L. The highest mean nitrate concentration of 53.9 mg/L was measured in Križevci area, followed by 38.8 mg/L in Koprivnica and the lowest 24.9 mg/L in urđevac area. Out of 75% of safe water samples, the measured nitrate concentration was below 25 mg/L limit value recommended under the Directive in as much as 52% of samples. Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory. The influence of point sources was assessed based on their distance. In roughly 50% of samples taken from occasionally or definitely unsatisfactory wells, point sources were located up to 10 meters away, while in as much as 93% of samples taken from satisfactory wells the point sources were situated over 20 meters away (p<0.01). For some of the wells, statistically significant positive (r=0.45 to 0.87) or negative (r=-0.30 to -0.66) correlations between the amount of downfalls and nitrate concentrations were established, while in the third well group this correlation (r=-0.14 to -0.24) was lacking. Discussion and Conclusions: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile. Across the Koprivnica-Križevci County, differences in the underground water quality may arise as a consequence of water contamination due to distinctive agricultural activities. The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high (41.7 mg/L). The distribution of relative concentrations revealed 25% of samples to have nitrate concentrations higher than MAC under the Ordinance. Spatial distribution revealed the majority of unsafe water samples to stem from Križevci area (38%), consistent with the majority of large husbandries situated therein. Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water. Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established

ANXIETY AND DEPRESSION IN ELDERLY – PREVALENCE AND ASSOCIATION WITH HEALTH CARE

Cilj: Istražiti pojavnost anksioznosti i depresivnosti u starijih osoba u Koprivničko-križevačkoj, Istarskoj i Dubrovačko-neretvanskoj županiji te njihovu povezanost sa socio-demografskim obilježjima i korištenjem zdravstvene zaštite. Metode: Presječno istraživanje provedeno 2006. na uzorku od 1469 ispitanika u dobi od 70 i više godina, odabranih metodom klasterskog uzorka. Stupanj anksioznosti i depresivnosti ocijenjen je HAD-ljestvicom (Hospital Anxiety and Depression scale) i povezan sa sociodemografskim obilježjima i podacima o korištenju zdravstvene zaštite. Rezultati: U starijih osoba utvrđene su visoke stope prevalencije granične i vjerojatne anksioznosti (43%) i depresivnosti (53%) te regionalne razlike (p<0,001). Žene su anksioznije od muškaraca (p<0,001), a za depresivnost nije nađena statistički značajna razlika među spolovima. S porastom dobi raste prevalencija vjerojatne depresivnosti (p=0,034), a smanjuje se prevalencija vjerojatne anksioznosti (p=0,028). Anksioznost i depresivnost povezane su s povećanim korištenjem specijalističko-konzilijarne zdravstvene zaštite i češćom hospitalizacijom. Zaključak: Visoka prevalencija anksioznosti i depresivnosti u starijih osoba povezana je sa socio-demografskim obilježjima i učestalijim korištenjem zdravstvene zaštite.Objective: To investigate the prevalence of anxiety and depression in the elderly inhabiting Koprivnica-Križevci, Istria and Dubrovnik-Neretva Counties and their association with socio-demographic characteristics and healthcare utilisation. Methods: A cross-sectional cluster survey carried out in 2006, encompassing a total of 1,469 examinees aged 70+. The Hospital Anxiety and Depression (HAD) Scale was used to screen for self-reported symptoms of anxiety and depression, which were further associated with socio-demographic characteristics and healthcare utilisation. Results: The elderly have shown a high prevalence of borderline and probable anxiety (43%) and depression (53%), and regional differences (p<0.001). The level of anxiety was higher in women than men (p<0.001); as for depression, no statistically significant gender-based differences were found. The prevalence of probable depression increases (p=0.034) and that of probable anxiety decreases (p=0.028) with age. Anxiety and depression are associated with increased use of specialist health care and more frequent hospitalizations. Conclusion: High prevalence of anxiety and depression in elderly is associated with socio-demographic characteristics and frequent use of health care

Značaj samoprocjene zdravlja za ocjenu mentalnog zdravlja i korištenje zdravstvene zaštite starijih osoba

The aging of population increases the cost of health care and therefore an active and healthy aging process is an important factor of social development. The aim of this study was to investigate the importance of self-rated health on the occurrence of depression and anxiety and the impact of modifying factors on health and the use of health care by older persons in the following counties: Koprivnica-Krizevci, Istria and Dubrovnik-Neretva county, along with proposing measures for preserving mental health and an active and independent life at an elder age. The study used data collected in a comparative cross-sectional study in the international project TTB Second Decennial Survey of the Health Needs and Health Care for Older People in Europe (Elderly study) conducted in Croatia in 2006. The study included 1496 respondents of both gender aged 70 years and over who lived alone or in the same household with permanent residence in the study area. The socio-demographic data (age, gender, "live alone") and data on the use of health care (visits to family physicians, specialists and hospitalization in the last 12 months and data on the treatment of anxiety or depression in the last 4 weeks) were collected. Self-rated health and level of anxiety and depression were assessed with the SF-36 questionnaire and the HAD scale. The results showed that there were significant differences in self-rated health, prevalence of anxiety and depression and the use of health care at both primary and secondary level between the three counties studied. Respondents in the Koprivnica-Krizevci County rated their health the worst in all eight dimensions of health and most of them were depressed and anxious, while respondents in the Dubrovnik-Neretva County assessed their health the best and the least of them were depressed and anxious. Self-rated health and prevalence of depression and anxiety in respondents of the Istria County were similar to respondents in the Dubrovnik-Neretva County. The physical dimensions of health are generally rated worse than the mental ones, while depression is generally more common than anxiety in the elderly. Men rate their health significantly better than women in all eight dimensions, and women are more anxious than men. Self-rated health deteriorates and depression is more common, while the prevalence of anxiety decreases with older age. Respondents who live alone do not differ in self-rated health, the prevalence of anxiety and depression nor in the use of health care than those who do not live alone. Poor self- rated health, particularly the dimensions of mental health, is associated with anxiety and especially depression in the elderly. Older people in the Koprivnica-Krizevci County use health care less often than their peers in the other two counties. Secondary (specialist) health care is used most often in Istria, while primary health care by general practitioners/family physicians is used most often in the Dubrovnik-Neretva County. Women significantly more often visit only their general practitioner/family physician while men visit specialists more often. Younger respondents (70-79) use health care more often, especially specialist-consultative care, while older (80 +) significantly more often visit only general practitioners/family physicians. Poor self-rated general health, bodily pain and better vitality are important predictors of the use of specialist health care in the elderly. The probable and the borderline depressed and the probable anxious have a significantly higher risk for hospitalization compared with respondents who are not depressed and anxious, while the probable and the borderline anxious are more likely to use specialist health care. A high prevalence of depression and anxiety was found in the elderly but general practitioners/family physicians rarely recognize and treat depression and anxiety. Planning of public health measures aimed at preserving and improving mental health and early diagnosis and adequate treatment of mental disorders should be implemented at the local level, taking into account the specificities of the region and socio-demographic characteristics of the population as well as the scientific knowledge about the mutual influence of self-rated health and mental health on the use of health care. Better coordination of health care professionals at all levels of health care and an intersectoral approach of the wider community is needed for enabling older people to maintain an active and independent life through as long a period as possible

MONITORING OF NITRATE CONTENT IN DRINKING WATER IN KOPRIVNICA-KRIŽEVCI COUNTY

Prema Nitratnoj direktivi EU poljoprivreda je izvor onečišćenja pitke podzemne vode nitratima. Na području Koprivničko-križevačke županije, podzemna voda koristi se kao jedini izvor vode za piće pa je od iznimnog interesa spoznaja o koncentraciji nitrata s obzirom na mogućnost štetnog djelovanja na ljudsko zdravlje. Prema literaturi, prekomjerni unos nitrata u organizam može doprinijeti pojavnosti methemoglobinemije, tumora, spontanih abortusa te poremećaju intrauterinog rasta. U razdoblju od 2002. do 2007. godine na području Koprivničko-križevačke županije, uzorkovano je 1170 uzoraka vode za piće iz plitkih bunara u kojima je utvrđena koncentracija nitrata metodom ionske kromatografije (HRN EN ISO 10304-1:1998). Od svih ispitanih uzoraka, u 25% (N=294), utvrđena je koncentracija nitrata iznad maksimalno dopustive, propisane Pravilnikom o zdravstvenoj ispravnosti vode za piće. Na području Križevaca utvrđeno je 38% (N=382) neispravnih uzoraka u vodi za piće iz domaćinstava, na području Koprivnice 23% (N=613), dok je na području Đurđevca utvrđeno 6% (N=175) neispravnih uzoraka. U radu je dokazano onečišćenje pitke vode iz točkastih izvora poljoprivrednog porijekla. Utvrđena je pozitivna ili negativna korelacija između povišene koncentracije nitrata i količine oborina. Na području Koprivničko-križevačke županije postoje razlike u kvaliteti podzemne vode koje mogu biti posljedica i različitog intenziteta utjecaja poljoprivrede na onečišćenje vode.Aims: The aim of the study was to establish nitrate concentrations in drinking water originating from shallow wells across Koprivnica- Križevci County, to assess the influence of agricultural point sources on nitrate water contamination, and to explore the correlations between water nitrate concentrations and agro-ecologic factors. Methods: During the 2002-2007 period, a total of 1170 potable water samples were taken from 104 shallow wells across Koprivnica-Križevci County. Given the geographical and developmental determinants, the investigated area was divided into three sections: Koprivnica, Križevci and urđevac areas. Potable water was sampled throughout the 6-year, all season-period conformant to the HRN ISO 5667-3 standard. Nitrate concentrations in potable water samples were established using ion chromatography (HRN EN ISO 10304-1:1998). The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service. Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations (MAC) stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive. The _2-test produced statistically significant differences. Results: In 25% (n=294) of water samples, nitrate concentration exceeded MAC. The majority of unsafe samples were recovered in Križevci area (38%; n=382), followed by Koprivnica (23%; n=613) and urđevac area (6%; n=175). The mean range spanned from 0.1 to 279.0 mg/L, while the total mean nitrate concentration was 41.7 mg/L. The highest mean nitrate concentration of 53.9 mg/L was measured in Križevci area, followed by 38.8 mg/L in Koprivnica and the lowest 24.9 mg/L in urđevac area. Out of 75% of safe water samples, the measured nitrate concentration was below 25 mg/L limit value recommended under the Directive in as much as 52% of samples. Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory. The influence of point sources was assessed based on their distance. In roughly 50% of samples taken from occasionally or definitely unsatisfactory wells, point sources were located up to 10 meters away, while in as much as 93% of samples taken from satisfactory wells the point sources were situated over 20 meters away (p<0.01). For some of the wells, statistically significant positive (r=0.45 to 0.87) or negative (r=-0.30 to -0.66) correlations between the amount of downfalls and nitrate concentrations were established, while in the third well group this correlation (r=-0.14 to -0.24) was lacking. Discussion and Conclusions: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile. Across the Koprivnica-Križevci County, differences in the underground water quality may arise as a consequence of water contamination due to distinctive agricultural activities. The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high (41.7 mg/L). The distribution of relative concentrations revealed 25% of samples to have nitrate concentrations higher than MAC under the Ordinance. Spatial distribution revealed the majority of unsafe water samples to stem from Križevci area (38%), consistent with the majority of large husbandries situated therein. Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water. Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established

Anksioznost i depresivnost u starijih osoba - pojavnost i povezanost s korištenjem zdravstvene zaštite [Anxiety and depression in elderly - prevalence and association with health care]

OBJECTIVE: To investigate the prevalence of anxiety and depression in the elderly inhabiting Koprivnica-Križevci, Istria and Dubrovnik-Neretva Counties and their association with socio-demographic characteristics and healthcare utilisation. ----- METHODS: A cross-sectional cluster survey carried out in 2006, encompassing a total of 1,469 examinees aged 70+. The Hospital Anxiety and Depression (HAD) Scale was used to screen for self-reported symptoms of anxiety and depression, which were further associated with socio-demographic characteristics and healthcare utilisation. ----- RESULTS: The elderly have shown a high prevalence of borderline and probable anxiety (43%) and depression (53%), and regional differences (p<0.001). The level of anxiety was higher in women than men (p<0.001); as for depression, no statistically significant gender-based differences were found. The prevalence of probable depression increases (p=0.034) and that of probable anxiety decreases (p=0.028) with age. Anxiety and depression are associated with increased use of specialist health care and more frequent hospitalizations. ----- CONCLUSION: High prevalence of anxiety and depression in elderly is associated with sociodemographic characteristics and frequent use of health care