HIV/AIDS epidemiology in Croatia and the services of HIV counseling and testing centers

Članak prikazuje epidemiološku situaciju u Hrvatskoj od početka praćenja HIV/AIDS-a do danas. U radu se prikazuje i rad centara za besplatno i anonimno savjetovanje i testiranje na HIV (HIV savjetovališta) koji od 2003. djeluju pri Hrvatskom zavodu za javno zdravstvo (HZJZ) u Zagrebu, županijskim zavodima za javno zdravstvo u Puli, Rijeci, Splitu, Zadru, Osijeku, Slavonskom Brodu, Dubrovniku i Korčuli, te pri Zatvorskoj bolnici i Klinici za infektivne bolesti “Dr. Fran Mihaljević” u Zagrebu. U Registru oboljelih od HIV/AIDS-a Službe za epidemiologiju HZJZ-a u razdoblju od 1986. do 2012. godine registrirano je 1017 osoba s HIV infekcijom, od čega 371 oboljeli od AIDS-a. U istom je razdoblju 187 osoba umrlo od HIV/AIDS-a. HIV/AIDS se u Hrvatskoj registrira gotovo isključivo unutar grupa povećanog rizika, a prema vjerojatnom putu prijenosa dominira homoseksualni. Godišnja učestalost HIV infekcije kreće se oko 12–17 na milijun stanovnika, što Hrvatsku i dalje svrstava u zemlje s malim brojem zaraženih HIV-om (57/1 milijun prosjek za zemlje EU/EEA u 2011.). Od 2003. do 2012. godine HIV savjetovališta koja djeluju u Hrvatskoj su pružila 37 509 savjetovanja za 20 804 korisnika, a 20 106 osoba su testirane na HIV pri čemu je otkrivena 181 osoba zaražena HIV-om.The paper presents the epidemiological situation in Croatia regarding HIV/AIDS from the beginning of HIV/AIDS surveillance to date. The paper alse describes the activities of the centers for free-of-charge and anonymous counseling and testing for HIV (HIV counseling centers) that were founded in 2003 offering their services at the Croatian National Institute of Public Health (CNIPH), County Public Health Institutes in Pula, Rijeka, Split, Zadar, Osijek, Slavonski Brod, Dubrovnik and Kor~ula, Prison hospital in Zagreb and the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”. In the period 1986–2012, the Registry of HIV/AIDS patients at the Epidemiology Service of the CNIPH recorded 1017 persons infected with HIV, of whom 371 developed AIDS. In the same period, 187 persons died of AIDS. In Croatia, HIV/AIDS is registered almost exclusively among high risk population, with homosexual route being the most dominant route of transmission. The annual incidence of HIV infection amounts to about 12–17 per million inhabitants, which categorizes Croatia as a country with a low level incidence of HIV (57/1 million was the average for EU/EEA countries in 2011). From 2003 until 2012, HIV counseling centers in Croatia have provided 37 509 counseling sessions for 20 804 clients and conducted HIV testing for 20 106 persons, during which 181 persons with HIV-infection were detected and referred to further care and therapy

Uloga ekološke politike u pomorskom brodarstvu

tu sreću da je njime okružena te ima mogućnost njegovog korištenja. U današnje vrijeme more je opterećeno sve većim i većim prometom pomorskih brodova. Pomorski brodovi vrlo su bitni za razvoj svjetskog gospodarstva i prometnog povezivanja zemalja, a uz to imaju i brojne druge prednosti. U današnje vrijeme, kada je ekologija i zaštita okoliša vrlo aktualna tema, brod je stavljen u središte zanimanja jer je označen kao izvor mnogih onečišćenja i predstavlja veliku prijetnju onečišćenju mora. Posebno velike opasnosti prijete od brodova za prijevoz kemikalija, nafte i naftnih derivata. Činjenica je da bi, ukoliko bi došlo do nezgode takvih brodova, nastale pogubne posljedice za more i morski okoliš. Stoga je potrebno razvijati mjere i aktivnosti kako bi se što više afirmirala ekološka politika u pomorskom brodarstvu te poticati brodare na pridržavanje zakona i konvencija kojima je cilj zaštita mora

Uloga ekološke politike u pomorskom brodarstvu

tu sreću da je njime okružena te ima mogućnost njegovog korištenja. U današnje vrijeme more je opterećeno sve većim i većim prometom pomorskih brodova. Pomorski brodovi vrlo su bitni za razvoj svjetskog gospodarstva i prometnog povezivanja zemalja, a uz to imaju i brojne druge prednosti. U današnje vrijeme, kada je ekologija i zaštita okoliša vrlo aktualna tema, brod je stavljen u središte zanimanja jer je označen kao izvor mnogih onečišćenja i predstavlja veliku prijetnju onečišćenju mora. Posebno velike opasnosti prijete od brodova za prijevoz kemikalija, nafte i naftnih derivata. Činjenica je da bi, ukoliko bi došlo do nezgode takvih brodova, nastale pogubne posljedice za more i morski okoliš. Stoga je potrebno razvijati mjere i aktivnosti kako bi se što više afirmirala ekološka politika u pomorskom brodarstvu te poticati brodare na pridržavanje zakona i konvencija kojima je cilj zaštita mora

Seroprevalence and risk factors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia

HIV and sexually-transmitted diseases (STDs) represent a significant public health problem worldwide. We analyzed the seroprevalence and risk factors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia. During a three-year period, a total of 443 men who have sex with men (MSM) / bisexual persons, sex workers (SW) / clients of SW, persons with multiple sexual partners, and persons with a history of STD were tested for the presence of HIV, hepatitis B virus (HBV), and Treponema pallidum(syphilis) antibodies within the framework of second generation HIV surveillance. Participants were recruited from 11 Croatian counties, the vast majority among clients of voluntary counselling and testing centers. The overall prevalence of HIV, HBsAg, anti-HBc, and syphilis was 1.4%, 2.6%, 12.1%, and 3.4%, respectively. HBV and syphilis seroprevalence differed significantly between, genders with higher prevalence among men (anti-HBc 13.8% vs. 5.7%, P=0.043; syphilis 4.4% vs. 0%; P=0.049), as well as between age groups, with a steady increase according to age. Participants with a history of STD were more often seropositive than participants who did not report STD (HBsAg 8.2% vs. 1.0%, P=0.002; anti-HBc 32.4% vs. 6.4%, P&lt;0.001; syphilis 12.0% vs. 1.7%, P&lt;0.001). Syphilis seroprevalence was higher in homo / bisexual persons(12.2%) compared with heterosexual persons (1.2%, P&lt;0.001). Logistic regression showed that history of STD was a significant risk factor for hepatitis B (HBsAg AOR=6.229, 95% CI=1.491-26.022; anti-HBc AOR=5.872, 95% CI=2.899-11.896) and syphilis seropositivity (AOR=5.572, 95% CI=1.751-17.726), while homo / bisexual behavior was associated with syphilis seropositivity (AOR=12.820, 95% CI=3.688-44.557). Our results highlight the importance of continuing STDs screening and prevention in at-risk populations. </p

Vaccine Regulations in Croatia

In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian legislation concerning vaccine licensing, marketing authorisation and utilization is reviewed. The procedures for including a vaccine into the Mandatory Childhood Vaccination Programme are also discussed with focus on Human papillomavirus (HPV) vaccines. Non-obligatory vaccination recommendations are given when according to professional opinion; vaccination is beneficial for the vaccinee. There is little doubt that HPV vaccines should be recommended for preadolescent girls in Croatia. However, reaching a decision on its possible introduction into the Childhood Vaccination Programme will require careful consideration of the larger picture and a comparison of the cost-effectiveness of a mandatory vaccination against other competing public health priorities

EPIDEMIOLOGY OF VIRAL HEPATITIS

Hrvatska je zemlja niske prevalencije virusnih hepatitisa A, B i C, hepatitis D se u Hrvatskoj ne javlja, a hepatitis E se javlja tek sporadično. S obzirom da je zahvaljujući poboljšanim uvjetima života i higijenskim uvjetima hepatitis A sveden na sporadičnu bolest, najčešći uzročnici virusnih hepatitisa u Hrvatskoj su hepatitis B i C. Uvođenje obveznog cijepljenja školske djece protiv hepatitisa B 1999. godine dovelo je do pada incidencije te bolesti u Hrvatskoj, s najvećim učinkom na adolescente i mlade odrasle osobe i može se očekivati daljnji pad njene incidencije i prevalencije. Incidencija hepatitisa C je također u blagom opadanju. Unatoč relativno povoljnoj situaciji u vezi s virusnim hepatitisima, hepatitis B i C i dalje su važan javnozdravstveni problem s obzirom da procjenjujemo da je oko 25 tisuća osoba u Hrvatskoj kronično zaraženo virusom hepatitisa B, a oko 40 tisuća virusom hepatitisa C.Understanding the country-specific epidemiology of disease, which may vary greatly among countries, is crucial for identifying the most appropriate preventive and control measures. An overview of the local epidemiology of viral hepatitis in Croatia is given in this paper. The overall prevalence of hepatitis B in Croatia is low (less than 2% HBsAg carriers in the general population). Hepatitis B incidence and prevalence began to decline significantly following the introduction of universal hepatitis B vaccination in 1999. Information on HBsAg seroprevalence is derived from routine testing of certain subpopulations (pregnant women, blood donors) and seroprevalence studies mostly targeted at high-risk populations. Universal childhood vaccination against hepatitis B remains the main preventive measure. We recommend testing for immunity one to two months after the third dose of hepatitis B vaccine for health-care workers. The incidence and prevalence of hepatitis C have also been declining in the general population. The main preventive measures are ensuring safety of blood products, prevention of drug abuse, and harm reduction programs for intravenous drug users. Hepatitis A incidence has declined dramatically since fifty years ago, when thousands of cases were reported annually. In the last five years, an average of twenty cases have been reported per year. The reduction of hepatitis A is a consequence of improved personal and community hygiene and sanitation. Hepatitis D has not been reported in Croatia. The risk of hepatitis D will get to be even smaller as the proportion of population vaccinated against hepatitis B builds up. Hepatitis E is reported only sporadically in Croatia, mostly in persons occupationally in contact with pigs and in travelers to endemic countries. In conclusion, Croatia is a low prevalence country for hepatitides A, B and C. Hepatitis D has not been reported to occur in Croatia and there are only sporadic cases of hepatitis E. Since hepatitis A is a rare disease occurring sporadically, which is a consequence of improved sanitation and hygiene, hepatitides B and C are the main causes of viral hepatitis in Croatia. The introduction of universal mandatory hepatitis B vaccination of schoolchildren in 1999 resulted in a decrease in the incidence of hepatitis B, which is most pronounced in adolescents and young adults, and further decrease in the incidence and prevalence is expected as the pool of susceptible individuals decreases through vaccination. The incidence of hepatitis C is decreasing as well. In spite of a relatively favorable epidemiological situation, hepatitis B and C are still a significant public health burden with an estimated 25,000 persons chronically infected with HBV and about 40,000 persons chronically infected with HCV in Croatia

HIV/AIDS epidemiology in Croatia and the services of HIV counseling and testing centers

Članak prikazuje epidemiološku situaciju u Hrvatskoj od početka praćenja HIV/AIDS-a do danas. U radu se prikazuje i rad centara za besplatno i anonimno savjetovanje i testiranje na HIV (HIV savjetovališta) koji od 2003. djeluju pri Hrvatskom zavodu za javno zdravstvo (HZJZ) u Zagrebu, županijskim zavodima za javno zdravstvo u Puli, Rijeci, Splitu, Zadru, Osijeku, Slavonskom Brodu, Dubrovniku i Korčuli, te pri Zatvorskoj bolnici i Klinici za infektivne bolesti “Dr. Fran Mihaljević” u Zagrebu. U Registru oboljelih od HIV/AIDS-a Službe za epidemiologiju HZJZ-a u razdoblju od 1986. do 2012. godine registrirano je 1017 osoba s HIV infekcijom, od čega 371 oboljeli od AIDS-a. U istom je razdoblju 187 osoba umrlo od HIV/AIDS-a. HIV/AIDS se u Hrvatskoj registrira gotovo isključivo unutar grupa povećanog rizika, a prema vjerojatnom putu prijenosa dominira homoseksualni. Godišnja učestalost HIV infekcije kreće se oko 12–17 na milijun stanovnika, što Hrvatsku i dalje svrstava u zemlje s malim brojem zaraženih HIV-om (57/1 milijun prosjek za zemlje EU/EEA u 2011.). Od 2003. do 2012. godine HIV savjetovališta koja djeluju u Hrvatskoj su pružila 37 509 savjetovanja za 20 804 korisnika, a 20 106 osoba su testirane na HIV pri čemu je otkrivena 181 osoba zaražena HIV-om.The paper presents the epidemiological situation in Croatia regarding HIV/AIDS from the beginning of HIV/AIDS surveillance to date. The paper alse describes the activities of the centers for free-of-charge and anonymous counseling and testing for HIV (HIV counseling centers) that were founded in 2003 offering their services at the Croatian National Institute of Public Health (CNIPH), County Public Health Institutes in Pula, Rijeka, Split, Zadar, Osijek, Slavonski Brod, Dubrovnik and Kor~ula, Prison hospital in Zagreb and the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”. In the period 1986–2012, the Registry of HIV/AIDS patients at the Epidemiology Service of the CNIPH recorded 1017 persons infected with HIV, of whom 371 developed AIDS. In the same period, 187 persons died of AIDS. In Croatia, HIV/AIDS is registered almost exclusively among high risk population, with homosexual route being the most dominant route of transmission. The annual incidence of HIV infection amounts to about 12–17 per million inhabitants, which categorizes Croatia as a country with a low level incidence of HIV (57/1 million was the average for EU/EEA countries in 2011). From 2003 until 2012, HIV counseling centers in Croatia have provided 37 509 counseling sessions for 20 804 clients and conducted HIV testing for 20 106 persons, during which 181 persons with HIV-infection were detected and referred to further care and therapy

Vertical facial disproportions in children with Class III malocclusion

Introduction/Objective. Class III malocclusion is a sagittal intermaxillary disproportion with dominant presence of mandible. Apart from primary sagittal, anomalies in vertical face dimension can also be present. The aim of this study is to evaluate vertical facial disproportions in the skeletal Class III malocclusion in stage of mixed dentition, in order to better plan its early therapy. Methods. In total 100 children were randomly selected and divided according to cephalometric analyzes in the two equal groups: Group 1 (experimental group) – skeletal Class III malocclusion (n = 50) and Group 2 (control group) – skeletal Class I (n = 50). The groups were further divided into three subgroups according to the age and gender of the children. Vertical craniofacial proportions were measured by anterior (upper, lower and total) and posterior facial height and their proportion. The values were statistically analyzed (p ≤ 0.05). Results. Upper anterior, lower anterior, total anterior and posterior facial height, proportion between lower and total anterior facial height, and proportion of posterior to total anterior facial height did not have a significant difference among children with Class I and Class III malocclusions. Upper anterior facial height proportional to total anterior facial height was statistically significant greater in experimental group when compared to control. Significant gender dimorphism was noted among the same subgroups. Conclusion. Vertical craniofacial proportions in children with Class III malocclusion in stage of mixed dentition was not significantly changed. This finding leaves room for the successful application of early, individually planned orthodontic therapy

Seroprevalence and risk factors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia

HIV and sexually-transmitted diseases (STDs) represent a significant public health problem worldwide. We analyzed the seroprevalence and risk factors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia. During a three-year period, a total of 443 men who have sex with men (MSM) / bisexual persons, sex workers (SW) / clients of SW, persons with multiple sexual partners, and persons with a history of STD were tested for the presence of HIV, hepatitis B virus (HBV), and Treponema pallidum(syphilis) antibodies within the framework of second generation HIV surveillance. Participants were recruited from 11 Croatian counties, the vast majority among clients of voluntary counselling and testing centers. The overall prevalence of HIV, HBsAg, anti-HBc, and syphilis was 1.4%, 2.6%, 12.1%, and 3.4%, respectively. HBV and syphilis seroprevalence differed significantly between, genders with higher prevalence among men (anti- HBc 13.8% vs. 5.7%, P=0.043 ; syphilis 4.4% vs. 0% ; P=0.049), as well as between age groups, with a steady increase according to age. Participants with a history of STD were more often seropositive than participants who did not report STD (HBsAg 8.2% vs. 1.0%, P=0.002 ; anti-HBc 32.4% vs. 6.4%, P<0.001 ; syphilis 12.0% vs. 1.7%, P<0.001). Syphilis seroprevalence was higher in homo / bisexual persons(12.2%) compared with heterosexual persons (1.2%, P<0.001). Logistic regression showed that history of STD was a significant risk factor for hepatitis B (HBsAg AOR=6.229, 95% CI=1.491-26.022 ; anti-HBc AOR=5.872, 95% CI=2.899-11.896) and syphilis seropositivity (AOR=5.572, 95% CI=1.751-17.726), while homo / bisexual behavior was associated with syphilis seropositivity (AOR=12.820, 95% CI=3.688- 44.557). Our results highlight the importance of continuing STDs screening and prevention in at-risk populations