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Biomedical subjects

M Ljubicić

Publications and source records attributed to M Ljubicić.

At least 19 recordsLinked to original sources

A large cross-sectional study of health attitudes, knowledge, behaviour and risks in the post-war Croatian population (the First Croatian Health Project).

As the liberation of occupied Croatian territories ended the war in the country in 1995, the Ministry of Health and Croatian Health Insurance Institute have agreed to create the new framework for developing a long-term strategy of public health planning, prevention and intervention. They provided financial resources to develop the First Croatian Health Project, the rest of the support coming from the World Bank loan and the National Institute of Public Health. A large cross-sectional study was designed aiming to assess health attitudes, knowledge, behaviour and risks in the post-war Croatian population. The large field study was carried out by the Institute for Anthropological Research with technical support from the National Institute of Public Health. The field study was completed between 1995-1997. It included about 10,000 adult volunteers from all 21 Croatian counties. The geographic distribution of the sample covered both coastal and continental areas of Croatia and included rural and urban environments. The specific measurements included antropometry (body mass index and blood pressure). From each examinee a blood sample was collected from which the levels of total plasma cholesterol (TC), triglycerides (TG), HDL-cholesterol (High Density Lipoprotein), LDL-cholesterol (Low Density Lipoprotein), lipoprotein Lp(a), and haemostatic risk factor fibrinogen (F) were determined. The detailed data were collected on the general knowledge and attitudes on health issues, followed by specific investigation of smoking history, alcohol consumption, nutrition habits, physical activity, family history of chronic non-communicable diseases and occupational exposures. From the initial database a targeted sample of 5,840 persons of both sexes, aged 18-65, was created corresponding by age, sex and geographic distribution to the general Croatian population. This paper summarises and discusses the main findings of the project within this representative sample of Croatian population.

Adolescent↗

Improvements for multipurpose bacteriological identification tables to suit the diagnosis of Vibrio cholerae.

The aim of the study was to reduce to key tests the 4 extensive polyvalent diagnostic biochemical tables most widely used in Croatia and to adapt them for the demonstration of Vibrio cholerae and its differentiation from the 3 Vibrios (V. alvinolyticus, V. mentschikovii, V. fluvialis) important in differential diagnosis. The fourth table has now been adapted to differentiate among all 12 Vibrio species known to be human pathogens (V. mimicus, V. cincinatiensis, V. holisae, V. damsela, V. furnisi, V. parahaemolyticus, V. vulnificus, V. carchariae). Using the inductive Learning by Logic Minimization Method (ILLM), we analyzed 2 tables (i.e. identification matrices) that were a part of bioMérieux's commercial packaged polyvalent identification systems widely used in Croatia (API 20E and ATB 32E), as well as 2 compilation tables by M. T. Kelly et al. The tables contained 27, 32, 59 and 8 tests, respectively. Cutting these solely to the key tests involved rationalizing them from 59 to the 5 necessary to differentiate Vibrio cholerae from 3 related Vibrios. Further rationalizations were from 32 to 2 and from 27 to the 3 necessary to differentiate Vibrio cholerae from 2 related Vibrios. By reducing the table of 8 tests to 7, and adding 4 new ones to these we achieved an optimization permitting mutual differentiation of all 12 known human Vibrio pathogens. Use of the selective TCBS plating medium was the only precondition for making these tables effective.

Bacteriological Techniques↗

An increasing incidence of VDRL serononreactors in an eldery, T. pallidum infected population.

Changes in the proportion of VDRL nonreactors among the people who had come into contact with Treponema pallidum in the course of their lifetime were assessed within the frame of the Diagnostic Proficiency Program covering serologic laboratories for the detection of syphilis in Croatia. Based on the analysis of the CNIPH serologic laboratory records the paper shows a clear increase in the above share over the past 22 years. Data on 491 infected persons (those reactive to the reference TPHA test), mean age 52.87 years, were analyzed. During 22 years of observation (1976-1998), this proportion rose from 21.92% (1976-1979) through 51.79% (1980-1989) to 64.86% (1990-1998). At the same time, this tendency reveals a considerable decrease in the number of infected persons exhibiting VDRL reaction (i.e. with potentially active late syphilis), which could be ascribed to the ever more effective detection of the infected and to their ever earlier and more efficient treatment.

Adult↗

A comparative study of reactogenicity and immunogenicity of an oral and an inactivated polio vaccine.

Reactogenicity and immunogenicity of the oral live attenuated (OPV) and inactivated polio vaccines (IPV) were studied in primary vaccination of toddlers. Three doses were administered simultaneously with DPT following the usual schedule valid in Croatia. The two groups of children had about 100 children each. Postvaccinal reactions were recorded for three days after each vaccination, and seroconversion was determined one month after the last injection. Although a conclusive analysis of postvaccinal reactions is not possible, since the staff of four different health centers apparently did not observe the same criteria, vaccination with IPV + DPT was not associated with remarkably more adverse events than OPV + DPT. Seroconversion rates attained with OPV ranged between 95.2% and 99.0%. With IPV, the rates were between 96.5% and 100%. Antibody levels for virus types 1, 2, and 3, as measured by GMT (reciprocal value), were 277, 1017, and 222 for OPV, and 465, 526, and 758 for IPV, respectively. IPV appears to be perfectly acceptable as a substitute for OPV for primary vaccination.

Antibodies, Viral↗

Immunity of the Croatian population to poliomyelitis--a serosurvey.

Eight years after the last case of poliomyelitis it was of a special interest to determine the immunity level of the Croatian population to polio and thus to evaluate the possible risk of the revival of this infection. For this purpose, 200 sera samples were collected from individuals of different age and place of residence. Neutralizing antibodies (NT) for all three polioviruses were searched for. Antibody titers of > or = 1:8 were considered positive. Results of the study showed some 75% of the study subjects to have antibodies to polio type 1 and 2, and some 83% to type 3. Only 4% of the sera tested had no NT antibodies to any of the three types. The lowest mean geometric antibody titer (GMT) was for polio type 3 (GMT3 = 19.4; reciprocal value) and somewhat higher for type 1 (GMT1 = 23.5) and type 2 (GMT2 = 22.6). When the antibody titers were related with the age of the subjects, they were found not to decline with age, which was ascribed to periodical boosters with vaccinal strains. It is stressed that, in spite of the eradication of poliomyelitis achieved in Croatia, compulsory vaccination of the children should be continued until its global eradication.

Adolescent↗

Persistence of humoral immunity to rabies 1100 days after immunization and effect of a single booster dose of rabies vaccine.

Forty-four vaccinees immunized with rabies vaccine and human rabies immunoglobulin according to the abbreviated intramuscular regimen (the 2-1-1 schedule) were followed-up after 1100 days and had their blood samples taken. The persistence of rabies neutralizing antibody was proven in the sera of all vaccinees. 56% of whom demonstrated titres > or = 0.5 IU ml-1. At the same day the vaccinees were given a single booster dose of vaccine whose effect was measured 2 weeks later. With the RFFI test on day 1114, sera revealed an extraordinarily high booster response in all 44 vaccinees. The study proved the anamnestic response after a full course of rabies vaccination to be a very stable one, and the capability of a single booster dose of vaccine to evoke high-titred rabies antibody response. Of the four vaccines used in the study, under comparable conditions HDCV proved superior to PCECV PDEV and PVRV on all 3 days of serology-35, 1100 and 1114, though this difference was statistically attested only on days 35 and 1114.

Adult↗

[Immunity to diphtheria in the Croatian population in 1994].

The large outbreak of diphtheria in the former SSSR countries, which has been linked, among others, to low herd immunity, has led us to determine the level of this immunity in the Croatian population in view to undertake, if necessary, extra prophylactic measures (vaccination). For the purpose, C. diphtheriae serum antibody levels were determined in persons aged from 20 to above 60 years and coming from four major Croatian towns (Zagreb, Rijeka, Osijek and Split). A commercial ELISA test and neutralization test (NT) on guinea pig were used. Whereas 223 sera were examined with ELISA, only 51 underwent NT. Both tests showed herd immunity to decline gradually with age, ELISA also revealing a wide variation range of antibody concentrations by individual age groups (Table 1). There was not a single serum sample below the "critical" level of 0.01 IU/ml. in Table 2, ELISA results are classified in three groups by antibody level: up to 0.01 IU/ml, between 0.01 and 0.09 and above 0.09 IU/ml, i.e. as unprotected, partially protected and protected persons. Such grouping of findings shows that not one of the subjects belongs to the first category, that most of them belong to the third (68%), as well as that the latter are passing into the second with growing age. It is concluded that by carrying out the mandatory immunization programme, in force in Croatia, it has been possible to attain and to sustain a high level of herd immunity. Hence there is no need for booster immunizations at older age.

Adult↗

Fatalities in the war in Croatia, 1991 and 1992. Underlying and external causes of death.

OBJECTIVE: To show the underlying and external causes of death and selected characteristics of those killed in the war in Croatia between March 1991 and December 1992. DESIGN: Analysis of 4339 fatalities recorded on two national mortality statistics documents that specified war operations as the cause of death: a demography mortality statistical form and a death certificate. MAIN OUTCOME MEASURES: The frequency of clinical causes of death and their association with methods of wounding, length of survival, and attendant diagnoses. RESULTS: Half of those killed were men aged 21 to 35 years. Among women killed, the majority were aged 61 to 75 years. Skull fracture with intracranial injuries was the leading cause of death (28.9%), followed by multiple traumas and injuries of unspecified site (17.9%), and thoracic wounds with lung and heart injuries (17.6%). The most common methods of wounding were bombs and fragments of other explosive devices involving 1907 persons (43.9%), followed by deaths from bullet wounds (33.0%). More than 50% of those killed had sustained multiple injuries. In 78.6% of the cases, death immediately followed the wounding.

Adult↗

Preventive medicine in Croatia through time and space.

The Croatian preventive medicine was well-known in the world through history. It was famous from the time of the quarantine in Dubrovnik, through sanitary cordon and contribution in obligatory first immunization against smallpox. Croatia presented Andrija Stampar as the leader in preventive medicine from the World War I till the sixties. We owe him all kinds of public health work both in organization and education as well as the initiating the World Health Organization. Knowledge and capabilities of Croatian preventive medicine workers were demonstrated the most clearly during the Croatian homeland war in 1991/91 when the infectious diseases as permanent war companions did not have effect on the state of health of the people in Croatia.

Communicable Disease Control↗

ELISA and indirect immunofluorescence in the diagnosis of LCM virus infections.

Thirty-seven matched samples of patient sera with the clinical diagnosis of a lymphocytic choriomeningitis (LCM) infection, as well as 56 matched samples of patient sera with the clinical diagnosis of a CNS infection of vague etiology were examined. Two serological techniques, indirect immunofluorescence (IF) and ELISA were used. They revealed 16.2% of positive sera confirming the clinical diagnosis of the disease; in the cases of clinical diagnosis of CNS infection of vague etiology 8.9% of positive sera were found, which points to an LCM virus-caused infection.

Animals↗

Interaction of rabies vaccine with human rabies immunoglobulin and reliability of a 2-1-1 schedule application for postexposure treatment.

Five commercially available rabies vaccines (HDCV, FBKC vaccine, PCEC vaccine, PVRV and PDEV) applied alone or combined with human rabies immunoglobulin (HRIG) were administered, by random allocation, to 161 volunteer vaccinees, using the abbreviated 2-1-1 postexposure immunization schedule. Protective levels of rabies antibody were demonstrated in all vaccinees by day 14, and in all but one vaccinee from day 21 to day 90. Partial inhibition of the antibody response due to HRIG was observed for three vaccines (PCEC vaccine, PVRV and PDEV). In terms of economy, reliability and rapid antibody induction, the 2-1-1 schedule proves superior to the presently recommended regimen for postexposure rabies prophylaxis.

Adult↗

An evaluation of second generation tissue culture rabies vaccines for use in man: a four-vaccine comparative immunogenicity study using a pre-exposure vaccination schedule and an abbreviated 2-1-1 postexposure schedule.

In a double-blind comparative trial the immunogenicity of three new tissue culture rabies vaccines was evaluated, using a commercial human diploid cell vaccine (HDCV) lot as the reference. Two different vaccination regimens, a pre-exposure schedule, and an abbreviated 2-1-1 postexposure schedule (two doses of the vaccine applied bilaterally on day 0, with subsequent single doses given on days 7 and 21) were employed. In both, two of the new vaccines, purified chick embryo cell vaccine and purified Vero rabies vaccine, induced an antibody response equivalent to that of HDCV, while the geometric mean titres for the fetal bovine kidney cell vaccine were somewhat lower. The 2-1-1 regimen, a candidate regimen for economical rabies postexposure treatment, evoked a rapid and high titre antibody response with all four vaccines, peaking on day 14.

Adult↗