Challenges in Implementing Croatian Regional Policy within semi-European context

Croatia is geographically, historically and culturally a part of the European territory. Regions, as specific units within a national territory, are defined differently on EU level than in Croatia, where counties are far too small to be considered as regions in EU terms. The implementation of European regional policy requires "comparability" of territories, which is done on the basis of the Nomenclature of Territorial Units for Statistics (NUTS). After long discussions with the European Commission and Eurostat, Croatia has three "new" NUTS II regions (March, 2007): Adriatic, North-Eastern (Pannonian) and North-Western Croatia including the capital city of Zagreb. These regions are now acceptable for EU regional policy and funds. Institutional structures for managing regional development on this new regional level does not exist, as well as legislative framework necessary to implement policies, strategies, plans or projects prepared at the respective levels, while at the same time very interesting developments from the bottom-up can be observed. Regional development agencies established have recently been nominated as regional coordinators for elaboration of planning documents at the County level initiating development processes, still at the county level and through informal mechanisms at the regional level. Territorial cohesion across Europe stands out as one of the top European priorities. Considerably large number of programmes, measures and priorities, aim at achievement of this goal. Croatia, as an acceding country, strives to harmonise numerous requirements prior to entering European union space in all aspects of entry, including territorial cohesion. Last decade was marked by a certain shift in shaping and implementing Croatian regional policy at programming and regulatory level towards that aim, among others. Many documents were produced – to serve national purpose, European and/or both. New policy, regulatory and programming environment imposed also creating of institutional set up (structure) that will enable successful implementation at all these fronts. However, regional development has to evolve from the bottom, but the initial push or supporting incentives have to come from above. This is a mutually enhancing development process, where efforts from above (EU and national level) and bellow (regions, counties, and local units) merge and contribute to overall development. This paper explores possibilities and obstacles in implementing of Croatian regional development policy at all levels, within a semi-European context and a given national framework

Impact of crisis on regional development in Croatia

The economic crisis has affected the EU regions very differently over the last five years, depending on the region's strengths or weaknesses, its sectoral structure and the response of national and regional governments. In some countries, downturns can lead to narrower interregional disparities, while in some can trigger regional divergence. Previous empirical studies indicate that there is a tendency for regional disparities to grow during recessions, and diminish in the period of economic growth (Dunford and Parron, 1994; Evans and MacCormic, 1994, Audas and Mackay, 1997). Although the reduction of regional disparities represents one of the priorities of EU regional policy and of Croatian regional policy, regional disparities within the Croatia are still significant. The current economic crisis that has emerged in the Croatian economy has already an enormous negative effect on several national and regional development indicators like GDP per capita, unemployment, and productivity. Some areas are coping with structural changes such as de-industrialization. In line with that the main aim of the paper is to find out if regional imbalances within Croatia have been more exposed by the current crises? This paper analyses the disparities between economic developments of Croatian counties before the crisis (before 2009) in comparison with the recession period. The analysis focuses on regional development index and other available socio-economic indicators (GDP per capita, unemployment rate). Obtained results can serve as a ground for improvements in Croatian regional economic policy

Prognostički utjecaj niskog pozitiviteta estrogenih i progesteronskih receptora u luminalnim B (HER2 negativnim) karcinonima dojke

Luminal B (HER2 negative) subtype is the most diversiform type of breast cancers, with a high Ki-67 proliferation index (>20%) or/and low progesterone (PR; <20%) with various intensity and distribution of hormone receptors. Considerable difference has also been noticed in disease outcome, wherefore there is the need for a more detailed classification of this tumor subtype. The clinical and pathologic parameters of 147 luminal B (HER2 negative) breast cancers were examined. The expression of hormone receptors in correlation with other prognostic factors and disease outcome was analyzed by Kaplan-Meier curves and multivariate Cox regression analysis. The Kaplan-Mayer analysis showed that low positivity of estrogen (ER) and PR receptors in tumors was associated with a significantly worse disease outcome (overall survival (ER), p=0.020; disease free survival (ER), p=0.019; overall survival (PR), p=0.026; disease free survival (PR), p=0.038)), unlike Ki-67, which did not show a statistically significant connection (overall survival, p=0.343; disease free survival, p=0.322). The intensity of receptor staining and Ki-67 relative to other histopathologic prognostic factors showed a statistically significant correlation solely with histologic grade of tumor. By using the Cox regression model, PR proved to be an independent prognostic factor for overall survival (p=0.004) and disease free survival (p=0.029). The luminal B (HER2 negative) breast cancer with low expression of hormone receptors, independent of the Ki-67 proliferation index, and in correlation with a higher histologic grade, could be a unique subtype of cancer.Luminalni B (HER 2 negativni) karcinomi dojke najheterogenija su podskupina s velikim rasponom proliferacijskog indeksa Ki-67 kao i intenziteta te raspodjele hormonskih receptora unuatar tumorskih stanica. Također je zamjetna različitost u kliničkom ishodu bolesti, zbog čega se ukazuje potreba za detaljnijom subtipizacijom ove skupine tumora. Izdvojeno je 147 luminalnih B HER2 negativih karcinoma, a ispitani su kliničko-patološki parametri u korelaciji s intenzitetom hormonskih receptora (estrogen (ER) i progesteron (PR)) kao i Ki-67 u odnosu na sveukupno preživljenje te preživljenje bez povrata bolesti. Unutar ispitivanih kliničko patoloških parametara slabiji intenzitet hormonskih receptora kao i viši Ki-67 bili su statistički značajno povezani samo s gradusom tumora. Kaplan-Meierovom analizom ustanovljena je statistički značajna povezanost slabog intenziteta ER i PR s preživljenjem (sveukupno preživljenje (ER), p=0,020; preživljenje bez povrata bolesti (ER), p=0,019; sveukupno preživljenje (PR), p=0,026; preživljenje bez povrata bolesti (PR), p=0,038)), za razliku od Ki-67 vrijednosti kojega nisu bile statistički značajno povezane s preživljenjem (sveukupno preživljenje, p=0,343; preživljenje bez povrata bolesti, p=0,322). Coxovom regresijskom analizom PR se pokazao kao statistički značajan neovisni parametar povezan sa sveukupnim preživljenjem (p=0,004) i preživljenjem bez povrata bolesti (p=0,029). Ovi rezultati pokazuju da bi podskupina luminalnih B HER2 negativnih karcinoma dojke s niskim intenzitetom hormonskih receptora, neovisno o proliferacijskom indeksu Ki-67, a u korelaciji s histološkim gradusom tumora mogla biti zaseban podtip karcinoma dojke

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P &lt; 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P &lt; 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P &lt; 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P &lt; 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P &lt; 0.001; OR(BP) = 2.4, P &lt; 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P &lt; 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P &lt; 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Prognostic Impact of Low Estrogen and Progesterone Positivity in Luminal B (HER2 Negative) Breast Cancer

Luminal B (HER2 negative) subtype is the most diversiform type of breast cancers, with a high Ki-67 proliferation index (>20%) or/and low progesterone (PR; <20%) with various intensity and distribution of hormone receptors. Considerable difference has also been noticed in disease outcome, wherefore there is the need for a more detailed classification of this tumor subtype. The clinical and pathologic parameters of 147 luminal B (HER2 negative) breast cancers were examined. The expression of hormone receptors in correlation with other prognostic factors and disease outcome was analyzed by Kaplan-Meier curves and multivariate Cox regression analysis. The Kaplan-Mayer analysis showed that low positivity of estrogen (ER) and PR receptors in tumors was associated with a significantly worse disease outcome (overall survival (ER), p=0.020; disease free survival (ER), p=0.019; overall survival (PR), p=0.026; disease free survival (PR), p=0.038)), unlike Ki-67, which did not show a statistically significant connection (overall survival, p=0.343; disease free survival, p=0.322). The intensity of receptor staining and Ki-67 relative to other histopathologic prognostic factors showed a statistically significant correlation solely with histologic grade of tumor. By using the Cox regression model, PR proved to be an independent prognostic factor for overall survival (p=0.004) and disease free survival (p=0.029). The luminal B (HER2 negative) breast cancer with low expression of hormone receptors, independent of the Ki-67 proliferation index, and in correlation with a higher histologic grade, could be a unique subtype of cancer