Increased Arterial Stiffness in Children Treated with Anthracyclines for Malignant Disease

Survivors of childhood cancer have a significantly higher late morbidity and mortality from cardiovascular diseases. The aim of this study was to determine whether anthracyclines used in childhood could increase arterial stiffness, a well-known independent predictor of cardiovascular diseases. The study included 53 children and adolescents aged 6–20 years having completed anthracycline treatment for a malignant disease according to various protocols at least a year before. The patients were free from clinical or laboratory signs of the underlying disease or cardiac disease. Control group consisted of 45 age- and sex-matched healthy children. Arterial stiffness was determined by measuring aortic pulse wave velocity (PWVao) using oscillometric method (Arteriograph TensioMed device). PWVao value was significantly increased (6.24±1.34 m/s vs. 5.42±0.69 m/s; p<0.001) in patients having received anthracyclines as compared to control group. Increased arterial stiffness was present irrespective of the following parameters: age, sex, body mass index, systolic and diastolic blood pressure, mean arterial pressure and heart rate. It is possible that the effect of anthracycline on increased cardiovascular morbidity and mortality in long-term childhood cancer survivors is associated not only with cardiotoxicity, but also with increased arterial stiffness

HOSPITAL HEALTHCARE WORKERS AND STRESS AT WORK: STUDY IN ZAGREB

Stres na radu je specifična vrsta stresa čiji je izvor u radnom okolišu. Individualna procjena objektivnog stanja ili događaja uvelike utječe na pojavu stresnog odgovora u pojedinca. Cilj istraživanja bio je u skupini zdravstvenih djelatnika u bolnici ispitati koje čimbenike stresa (stresore) na radu doživljavaju kao stresne i/ili izrazito stresne te postoje li razlike u doživljavanju stresa na radu između liječnika i medicinskih sestara/tehničara. U istraživanje je bilo uključeno 1.900 ispitanika. Ankete je ispunilo 1.477 zdravstvenih djelatnika sa stopom odgovora 78%. Rezultati su pokazali da zdravstveni djelatnici u bolnicama doživljavaju više različitih stresora s velikim intenzitetom. Među najčešćim stresorima koji su obje skupine ispitanika prepoznale su financijski i organizacijski čimbenici. Liječnici u odnosu na medicinske sestre/tehničare doživljavaju neke od tih čimbenika stresa s većim intenzitetom. Na vrhu hijerarhijske ljestvice u većine liječnika prvenstveno su stresori vezani uz financijske mogućnosti, organizaciju i neadekvatan prostor dok su medicinske sestre i tehničari uz stresore financijske prirode naveli i mali broj djelatnika. Medicinske sestre i tehničari češće od liječnika doživljavaju kao izvor stresa na radu strah od specifičnih opasnosti i štetnosti u zdravstvu, što ukazuje na potrebu poboljšanja edukacije i mjera zaštite i sigurnosti na radu. S druge strane, liječnici uz neprimjerenu javnu kritiku svojeg rada kao izraziti stres navode i psihološki pritisak pacijenata povezan s pogrešnom informiranošću i nerealnim očekivanjima, što ukazuje na potrebu unapređenja komunikacije na relaciji liječnik-pacijent.Stress at work is a specific type of stress arising from the work environment. The individual’s estimate of the objective situation or event greatly affects the level of stress in the individual’s response. It was the aim of the study to test the sample of hospital healthcare workers on the stressors at work which they find stressful and/or greatly stressful and to establish whether there are differences in the experience of stress between physicians and nurses/lab technicians. The study was based on a sample of 1,900 participants. Of the total number of participants, 1,477 healthcare workers completed the questionnaire and the response rate was 78%. Results indicated that hospital healthcare workers experience great intensity of stress from several stressors. Among the most common for both groups were the financial and organisational factors. Physicians, as opposed to nurses and technicians, experience some of these stressors with greater intensity. At the top of the scale for most physicians are the stressors related to financial aspects of their work, organisation and inadequate workspace, whereas nurses and technicians listed inadequate (insufficient) number of workers as a stressor alongside the inappropriate financial remuneration. Nurses and technicians, more frequently than physicians, experience as stressful the fear of specific work-related dangers and harms in healthcare, indicating a need to improve education and safety measures at work. On the other hand, physicians find stressful the exposure to unjust public criticism and, much more so, the psychological pressure from the patients poorly informed and labouring under unrealistic expectations, indicating a need to improve physician-patient communication

Increased Arterial Stiffness in Children Treated with Anthracyclines for Malignant Disease

Survivors of childhood cancer have a significantly higher late morbidity and mortality from cardiovascular diseases. The aim of this study was to determine whether anthracyclines used in childhood could increase arterial stiffness, a well-known independent predictor of cardiovascular diseases. The study included 53 children and adolescents aged 6–20 years having completed anthracycline treatment for a malignant disease according to various protocols at least a year before. The patients were free from clinical or laboratory signs of the underlying disease or cardiac disease. Control group consisted of 45 age- and sex-matched healthy children. Arterial stiffness was determined by measuring aortic pulse wave velocity (PWVao) using oscillometric method (Arteriograph TensioMed device). PWVao value was significantly increased (6.24±1.34 m/s vs. 5.42±0.69 m/s; p<0.001) in patients having received anthracyclines as compared to control group. Increased arterial stiffness was present irrespective of the following parameters: age, sex, body mass index, systolic and diastolic blood pressure, mean arterial pressure and heart rate. It is possible that the effect of anthracycline on increased cardiovascular morbidity and mortality in long-term childhood cancer survivors is associated not only with cardiotoxicity, but also with increased arterial stiffness

Prevalence of increased body weight and hypertension in the population of Croatian mainland and Adriatic Islands - are islanders really healthier? [Usporedba prevalencije povećane tjelesne težine i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i Jadranskih otoka - jesu li otočani uistinu zdraviji?]

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P < 0.001), and were more frequently overweight (P < 0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P < 0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P < 0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions

Prevalence of Increased Body Weight and Hypertension in the Population of Croatian Mainland and Adriatic Islands – Are Islanders Really Healthier?

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N=9,070) served as an estimate for the mainland Croatian population, while the data from »1001 Dalmatian study« (N=1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P<0.001), and were more frequently overweight (P<0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P<0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P<0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions

Usporedba prevalencije povećane tjelesne težine i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i Jadranskih otoka - jesu li otočani uistinu zdraviji?

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P < 0.001), and were more frequently overweight (P < 0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P < 0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P < 0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions.Cilj istraživanja bio je usporediti prevalenciju povećane tjelesne težine (ITM) i povišenog krvnog tlaka između stanovnika kopnene Hrvatske i jadranskih otoka. Podaci za studiju dobiveni su iz Hrvatske zdravstvene ankete (N=9.070) kao izvora podataka za kopnenu Hrvatsku, i iz istraživačke studije »1001 Dalmatinac« (N=1.001) kao izvora podataka sa četiri jadranska otoka; Raba, Visa, Lastova i Mljeta. Prevalencije povećane tjelesne težine i povišenog krvnog tlaka izračunate su za četiri dobne skupine i analizirane korištenjem hi-kvadrat testa. Rezultati upućuju na to da muškarci na otocima rjeđe imaju normalnu tjelesnu težinu (P<0,001) i veću prevalenciju povećane tjelesne težine (P<0,001). Među ženama nije zabilježena statistički značajna razlika u prevalenciji povećane tjelesne težine između otočana i stanovnika kopna. Postotak ispitanika s normalnim krvnim tlakom bio je manji na otocima (P<0,001), dok je postotak novodijagnosticiranih ispitanika s povišenim krvnim tlakom kod oba spola bio veći na otocima (P<0,001). Rezultati upućuju da zdravstvena slika otočana nije tako povoljna, unatoč prikladnijem životnom stilu i mediteranskom načinu prehrane, barem u smislu prevalencije čimbenika rizika za nastanak kardiovaskularnih bolesti. Ovakav nalaz bi, osobito među muškarcima, mogao biti posljedica otežanog pristupa zdravstvenoj službi, odnosno manje brige za preventivne preglede i kontrolu zdravlja, što je mogući uzrok većoj pojavnosti novodijagnosticiranih ispitanika s povišenim krvnim tlakom i manjoj prevalenciji ispitanika s prikladno liječenom hipertenzijom. Dobiveni rezultati upućuju na to da su otočne populacije prikladne za javnozdravstvene intervencije i akcije kojima je cilj promicanje zdravlja i prevencija bolesti

Genome-wide Association Study of Anthropometric Traits in Korčula Island, Croatia

AIM: To identify genetic variants underlying six anthropometric traits: body height, body weight, body mass index, brachial circumference, waist circumference, and hip circumference, using a genome-wide association study. ----- METHODS: The study was carried out in the isolated population of the island of Korcula, Croatia, with 898 adult examinees who participated in the larger DNA-based genetic epidemiological study in 2007. Anthropometric measurements followed standard internationally accepted procedures. Examinees were genotyped using HumanHap 370CNV chip by Illumina, with a genome-wide scan containing 316730 single nucleotide polymorphisms (SNP). ----- RESULTS: A total of 11 SNPs were associated with the investigated traits at the level of P<10(-5), with one SNP (rs7792939 in gene zinc finger protein 498, ZNF498) associated with body weight, hip circumference, and brachial circumference (P=3.59-5.73 x 10(-6)), and another one (rs157350 in gene delta-sarcoglycan, SGCD) with both brachial and hip circumference (P=3.70-6.08 x 10(-6). Variants in CRIM1, a gene regulating delivery of bone morphogenetic proteins to the cell surface, and ITGA1, involved in the regulation of mesenchymal stem cell proliferation and cartilage production, were also associated with brachial circumference (P=7.82 and 9.68 x 10(-6), respectively) and represent interesting functional candidates. Other associations involved those between genes SEZ6L2 and MAX and waist circumference, XTP6 and brachial circumference, and AMPA1/GRIA1 and height. ----- CONCLUSION: Although the study was underpowered for the reported associations to reach formal threshold of genome-wide significance under the assumption of independent multiple testing, the consistency of association between the 2 variants and a set of anthropometric traits makes CRIM1 and ITGA1 highly interesting for further replication and functional follow-up. Increased linkage disequilibrium between the used markers in an isolated population makes the formal significance threshold overly stringent, and changed allele frequencies in isolate population may contribute to identifying variants that would not be easily identified in large outbred populations