Girls who experienced early menarche are significantly more often overweight/obese. Overweight/obesity may be considered as one of the predictors for the early occurrence of menarche.

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The purpose of this study was to assess changes in mean menarcheal age of girls in the city of Sibenik in the period from mid-1980s to the mid-1990s. Sibenik is a Dalmatian town which was exposed to hard war conditions in 1991-1995. Menarcheal status of Sibenik girls was surveyed three times, in 1981, 1985, and 1996, and included 720, 1,207, and 1,680 girls, respectively, ages 9.5-16.5 years. Mean menarcheal age was estimated by the status quo method and application of probit analysis. Results show a slight decrease in menarcheal age from 1981 to 1985 (from 12.97 +/- 0.06 years to 12.87 +/- 0.05), and then a significant increase from 12.87 +/- 0.05 years in 1985 to 13.13 +/- 0.10 years in 1996. The increase in mean menarcheal age occurred in all socioeconomic groups based on parental occupation and number of siblings. In the group of girls whose homes were damaged during war, menarche occurred at an average of 13.53 +/- 0.14 years, while those who lost a family member experienced menarche at an older mean age, 13.76 +/- 0.27 years. However, when the girls who experienced personal tragedies were excluded the onset of menarche was still later than in girls surveyed in the earlier periods. The results suggest that the general reversal in the secular trend of menarcheal age in Sibenik girls can be attributed to persistent psychological pressures and uncertainties associated with conditions of war. Am. J. Hum. Biol. 12:503-508, 2000. Copyright 2000 Wiley-Liss, Inc.

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The study analyses secular changes in body weight, height and body mass index (BMI) in children in the Splitsko-dalmatinska County, Croatia, in the period from 1991 to 2008. The overweight/obesity trends from 1991 to 1999 and from 2000 to 2008 are assessed. The study included three cohorts of healthy 7-year-old children, measured during their regular medical examination before enrolment at school: 1991 (n = 514), 1999 (n = 428) and 2008 (n = 452), in a total of 1,394 children, 686 (49.21%) of whom were girls. Overweight/obesity was defined according to the International Obesity Task Force criteria. From 1991 to 2008, there was a statistically significant rise in body weight and BMI in boys and girls (1.47 vs 1.50 kg; 0.55 vs 0.75 kg) and height in boys (1.4 cm). In 2008, the girls were 0.14 kg heavier and 0.39 cm taller than the girls of the same age measured in 1999, but their BMI was lower by 0.02 units. The frequency of obesity rose from 1991 to 2008 by 1.4 times in boys and 1.7 times in girls. The prevalence of obesity in girls rose from 1991 to 1999 (from 4.3% to 8.6%), but in 2008, it fell (7.1%). The prevalence of obesity in boys fell in 1999 (from 4.3% to 3.9%) but rose in 2008 (6.2%). The values of body weight, height and BMI in the observed population moved from 1991 to 2008 towards higher WHO standard values, which is descriptive of the problem of obesity and supports the need to consider the choice of cut-off points for obesity/overweight in local and national studies. In conclusion, the slowdown noticed in secular changes in body weight and BMI is encouraging and shows the importance of continuous paediatric health care for children, combined with an altered attitude in society towards obesity in children.

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children.

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Background and aimsDevelopmental dysplasia of the hip (DDH) is the most common deformation of the loco-motor system, caused by multiple factors, which meets the criteria to be included in national screening.The aim of this study was to present arguments why paediatricians should be responsible for the DDH screening programme, on the basis of our own twenty-years of experience in conducting non-selective, combined clinical and ultrasound DDH screening, and a critical analysis of the available literature.MethodsAt their first regular check-up by a paediatrician at the age of 5 weeks, a total of 2720 infants with 5440 hips were examined clinically and by ultrasound. The clinical examination included the Barlow and Ortolani tests.The Graf method was used for the ultrasound examination.Results89.4% of the infants had normal findings by ultrasound and 92.3% of the infants examined clinically. Three had a positive Ortolani test result, and one for Barlow: type II a + in 7.8%, type IIA- hips in 1.2%, type IIC in 0.9%, type IIIA in 0.5%, and type IV in 0.2% of the infants. 72% of the pathological hips shown by ultrasound were not recognised clinically. 9% of the population covered by the tests were referred to a paediatric orthopaedist for further observation. 2.8% of the population underwent conservative orthopaedic therapy, and none of the children were treated surgically.ConclusionsPaediatricians responsible for non-selective combined clinical and ultrasound screening of the hips using the Graf method, are able to discover all forms of DDH at the age of 4 to 5 weeks, and provide orthopaedic therapy that is rational, accessible and practical for the parents and their child. Despite the sensitisation of paediatricians to the problem of early diagnosis of DDH, clinical examination as a screening method is subjective and insufficient due to its low sensitivity and the large proportion of false negative findings. Well-structured training, provided by licensed, professionally authorised educators, with the possibility of continual renewal of knowledge, is vital for optimal screening for DDH. The consistent application of diagnostic methods according to Graf, contributes to the objectivity, repeatability, feasibility and economically viability of DDH screening.