BackgroundMycobacterium tuberculosis is a necessary, but not sufficient, cause of tuberculosis. A number of studies have addressed the issue of risk factors for tuberculosis development. Croatia is a European country with an incidence rate of 14/100 000 which is slowly decreasing. The aim of this study is to evaluate the potential demographic, socioeconomic, behavioural and biological risk factors for tuberculosis in Croatia in comparison to other high-income, low-incidence European countries.MethodsA total of 300 tuberculosis patients were matched for age, sex and county of residence to 300 controls randomly selected from general practitioners’ registers. They were interviewed and their medical records were evaluated for variables broadly described as potential risk factors.ResultsIn multiple logistic regression, the following factors were significant: parents born in a particular neighbouring county (Bosnia and Herzegovina) (OR = 3.90, 95% CI 2.01-7.58), the lowest level of education (OR = 3.44, 95% CI 1.39-8.50), poor household equipment (OR = 4.72, 95% CI 1.51-14.76), unemployment (OR = 2.69, 95% CI 1.18-6.16), contact with tuberculosis (OR = 2.19, 95% CI 1.27-3.77), former (OR = 2.27, 95% CI 1.19-4.33) and current smoking habits (OR = 2.35, 95% CI 1.27-4.36), diabetes (OR = 2.38, 95% CI 1.05-5.38), a malignant disease (OR = 5.79, 95% CI 1.49-22.42), being underweight in the previous year (OR = 13.57, 95% CI 1.21-152.38).ConclusionIn our study, the identified risk groups for tuberculosis reflect a complex interaction between socioeconomic conditions, lifestyle and non-communicable diseases. Interventions focused on poverty will undoubtedly be useful, but not sufficient. Tuberculosis control would benefit from a combination of broad public health activities aimed at the prevention and control of risky lifestyles and non-communicable diseases, interventions outside the health sector, and efforts to constantly improve the Croatian national tuberculosis programme.

BackgroundDelayed diagnosis and treatment of tuberculosis increase both the severity of the disease and the duration of infectivity. A number of studies have addressed the issue of health system delays in the treatment of tuberculosis, but mostly in countries with a high or low incidence of the disease. Our understanding of delay is quite limited in settings with an intermediate burden of tuberculosis. We explore the duration and factors associated with delays in the Croatian health system which has free health care and a sufficient network of health services providing tuberculosis diagnosis and care.MethodsA total of 241 consecutive adults with culture-confirmed pulmonary tuberculosis were interviewed in seven randomly selected Croatian counties and their medical records were evaluated. A health system delay was defined as the number of days from the first consultation with a physician to the initiation of anti-tuberculosis treatment. A long delay was defined as a period exceeding the median delay, while an extreme delay was considered to be above the 75th percentile delay.ResultsThe median health system delay was 15 days while the 75th percentile was 42 days (the 5th and 95th percentile being 1 and 105 days respectively). Almost 30% of tuberculosis patients remained undiagnosed for more than 30 days after the initial health care visit. Female patients (p = 0.005), patients with a negative sputum smear (p = 0.002) and patients having symptoms other than the usual ones (0.027) were found to be in significant correlation with a long delay. In a multivariate model, a long delay remained associated with the same variables (p = 0.008, p = 0.003, and p = 0.037, respectively).A significant association was demonstrated between both the female gender (p = 0.042) and a negative sputum smear (p < 0.001) and extreme delay, while only a negative sputum smear (p < 0.001) remained significant in the multivariate analysis.ConclusionsOur findings suggest that some groups of tuberculosis patients experienced a health system delay. In such a setting where tuberculosis incidence is decreasing, which leads to a lack of physician experience and expertise, training in tuberculosis is required. Such measure may be useful in reducing the number of missed opportunities for tuberculosis diagnosis.

During a 3-year period (1992-1995), 239 index cases of hepatitis B virus (HBV) infection and 459 members of their households from the Osijek-Baranja county were examined. The aim of the study was to determine the spread of HBV infection in the families with a member verified as a virus carrier, and to identify the family members with the highest risk of infection according to kinship degrees. The retrospective and prospective methods were used in the study. The probable route of infection was assessed by the use of an epidemiologic questionnaire, and the serologic status of the study subjects concerning infection with HBV was determined by enzyme immunoassays (HBsAg, anti-HBs, anti-HBe and anti-HBc). The first member of a family identified as a virus carrier was considered an index case. HBV infection was demonstrated in 334 (47.85%) out of a total of 698 subjects. Only 21 (6.28%) of the 334 subjects with verified HBV infection developed the clinical picture of acute hepatitis B. The ratio of clinically manifest vs inapparent infection was 1:16. Serologic traces of infection were detected in 95 of the 459 family members of the index cases, yielding a mean rate of the infection among the virus carrier family members of 20.70%.

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Introduction: Dentists and generally dental personnel work under the risk of being infected by patients suffering from COVID-19, who are unaware that they are infected.  The reason lies in the fact that during dental procedures, aerosol is formed with droplets that may contain the virus. Thus, it is extremely important that dental personnel complies with adequate protective measures and equipment during clinical work. The aim of this investigation was to evaluate the knowledge of COVID-19 and determine the amount of stress with dental personnel of the Faculty of Dentistry in Sarajevo, Bosnia and Herzegovina.  Methods: Health care personnel of the Faculty of Dentistry with Clinics of the University in Sarajevo have been included in the research: teaching staff, clinical doctors, dental nurses and dental technicians. The research was conducted in April 2020. It was conducted by an anonymous survey that participants filled-in. Out of 157 distributed questionnaires in paper form, 134 participants responded. The questionnaire was divided into 3 parts: 1) personal data 2) knowledge of infection COVID-19 (diagnostic methods, transmission pathways, prevention measures); 3) the amount of stress (feelings and thoughts) during epidemic COVID-19 with personnel. Results: The largest number of participants (61.97%) consider that COVID-19 may be transmitted from infected to a healthy person by inhalation of droplets generated through coughing of an infected person and by direct contact with aerosol dispersed from the mouth of the infected patient during dental treatment. The largest number of participants, 80 of them (59.7%) consider that the method of nucleic acid test is used in diagnosing COVID-19.  COVID – 19 had a significantly larger influence on females; they showed higher extent of concern for the claim „I hardly fall asleep because of thinking about it“, „I try not to talk on this topic“ and „In my mind appear pictures in relation to this.“ (p<0.05) Conclusion: Knowledge of COVID-19 and measures of protection of health care personnel at the Faculty of dentistry with Clinics in Sarajevo is satisfactory. The largest fear of participants was fear of unconsciously transmitting the infection on people close to them and that members of their families become infected with COVID-19.