RESUMEN
The World Health Organization recommends adjusting salt intake as a part of the nine global targets to reduce premature mortality from non-communicable chronic diseases as a priority and the most cost-effective intervention. In 2006, the main aim of the Croatian Action on Salt and Health was to decrease salt intake by 16% because of its critical intake and consequences on human health. We have organized educative activities to increase awareness on salt harmfulness, define food categories of prime interest, collaborate with industries and determine salt intake (24 h urine sodium excretion). It was determined that the proportion of salt in ready-to-eat baked bread should not exceed 1.4%. In the period 2014-2022, salt in semi-white bread was reduced by 14%, 22% in bakery and 25% in the largest meat industry. Awareness of the harmfulness of salt on health increased from 65.3% in 2008 to 96.9% in 2023 and salt intake was reduced by 15.9-1.8 g/day (22.8% men, 11.7% women). In the last 18 years, a significant decrease in salt intake was achieved in Croatia, awareness of its harmfulness increased, collaboration with the food industry was established and regulatory documents were launched. However, salt intake is still very high, underlying the need for continuation of efforts and even stronger activities.
Asunto(s)
Cloruro de Sodio Dietético , Croacia , Humanos , Cloruro de Sodio Dietético/administración & dosificación , Industria de Alimentos , Femenino , Política Nutricional , Masculino , Dieta Hiposódica , Promoción de la Salud/métodos , PanRESUMEN
AIM: To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program. METHODS: Colorectal cancer (CRC) was the second leading cause of cancer mortality in men (n = 1063, 49.77/100,000), as well as women (n = 803, 34.89/100,000) in Croatia in 2009. The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare, and its implementation started in September, 2007. The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing (FOBT) to the participants, followed by colonoscopy in all positive cases. The FOBT was performed by hypersensitive guaiac-based Hemognost card test (Biognost, Zagreb). The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period. Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis. About 4% FOBT positive cases are expected in normal risk populations. A descriptive analysis was performed. RESULTS: A total of 1,056,694 individuals (born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011. In total, 210,239 (19.9%) persons returned the envelope with a completed questionnaire, and 181,102 of them returned it with a correctly placed stool specimen on FOBT cards. Until now, 12,477 (6.9%), FOBT-positive patients have been found, which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union (EU) Guidelines]. Colonoscopy was performed in 8541 cases (uptake 66%). Screening has identified CRC in 472 patients (5.5% of colonoscopied, 3.8% of FOBT-positive, and 0.26% of all screened individuals). This is also in the expected range according to EU Guidelines. Polyps were found and removed in 3329 (39% of colonoscopied) patients. The largest number of polyps were found in the left half of the colon: 64% (19%, 37% and 8% in the rectum, sigma, and descendens, respectively). The other 36% were detected in the proximal part (17% in the transverse colon and 19% in ceco-ascending colon). Small polyps in the rectum (5-10 mm in diameter), sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases, with a low degree of dysplasia, and 40% were classified as hyperplastic. Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component, but still had a low degree of dysplasia. Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous, and among them, 32% had areas with a high degree of dysplasia, especially those polyps in the ceco-ascending or transverse part. The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows: relatively low percentage of returned FOBT, higher number of FOBT-positive persons but still in the range for population-based programs, and higher number of pathologic findings (polyps and cancers). CONCLUSION: These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Anciano , Colonoscopía , Croacia/epidemiología , Heces , Femenino , Educación en Salud , Humanos , Masculino , Persona de Mediana Edad , Sangre Oculta , Prevalencia , Encuestas y CuestionariosRESUMEN
The aim of this research was to assess differences in the frequency of individual minor physical anomalies (MPA) between healthy controls and children with hearing impairment (HI) and to find out whether some MPAs are more informative in discriminating between two groups than cumulative Waldrop's scores. The aim was also to investigate the influence of gender on MPA in children with HI and those with normal hearing (NH). The study was carried out on a sample of 424 children (121 children with hearing impairment (82 boys and 39 girls) aged from 5 to 18 and 303 healthy schoolchildren with normal hearing (152 boys and 151 girls) aged from 8 to 16). In HI children, the mean value of MPA was 2.2 times higher than in the controls. Binary Logistic Regression Model is entirely (with all 18 predictors) statistically significant, that is, it recognizes partial deafness. The comparisons between the studied groups of boys and girls HI and boys and girls NH showed a higher relative involvement of MPA in boys than in girls. MPA comparison of HI boys versus NH boys and HI girls versus NH girls according to topographic regions revealed that for HI children there were higher mean scores than for the same-sex controls from all regions, but differences are particularly pronounced in the ear and tongue region. However and that the difference is statistically significant for the majority of regions but this difference tended to be more pronounced in girls with relatively better expressed peripheral dysmorphia in the former and craniofacial dysmorphia in the latter. From the obtained results, it can be seen that in HI children, common etiological factors were probably in effect leading to physical anomalies and hearing impairments. Given the present findings of increased MPAs in HI children, further investigations are necessary to determine whether these developmental abnormalities arise from genetic factors or as a consequence of environmental influences.
Asunto(s)
Discapacidades del Desarrollo/epidemiología , Trastornos de la Audición/epidemiología , Anomalías Musculoesqueléticas/epidemiología , Índice de Severidad de la Enfermedad , Adolescente , Niño , Croacia/epidemiología , Discapacidades del Desarrollo/fisiopatología , Femenino , Trastornos de la Audición/fisiopatología , Humanos , Masculino , Anomalías Musculoesqueléticas/fisiopatología , Prevalencia , Distribución por SexoRESUMEN
Croatia has a low-level HIV epidemic; 553 persons were diagnosed with HIV infection in the period 1985-2005. The principal mode of transmission was sex between men (40% of cases) and heterosexual contact (40%). Only about 10% of cases were injecting drug users. Testing data also suggest a low prevalence of HIV infection in Croatia, even in vulnerable groups. Behavioral data indicate risky sexual behaviors, with the clear need for interventions. National policy towards HIVIAIDS is operated through the National Committee on HIV/AIDS, a multisectorial advisory body to the Government of Croatia. Croatia applied to the Global Fund to fight AIDS, tuberculosis and malaria in 2002 which resulted in a 4,9 million USD grant for scaling up prevention interventions. Croatia has a centralized system of treatment and care which is provided at the University Hospital for Infectious Diseases in Zagreb. Highly active antiretroviral treatment is provided free of charge from April 1998.