Undiagnosed hypertension in Croatia.

AIM: To determine the prevalence of undiagnosed hypertension in Croatia, and to assess its association with various demographic, socioeconomic, lifestyle, and health care usage factors. METHODS: We used the data from European Health Interview Survey wave 3, conducted in Croatia in 2019. The representative sample consisted of 5461 individuals aged 15 years and older. The association of undiagnosed hypertension with various factors was assessed with simple and multiple logistic regression models. The factors that contribute to undiagnosed hypertension were identified by comparing undiagnosed hypertension with normotension in the first model and with diagnosed hypertension in the second model. RESULTS: In the multiple logistic regression model, women and older age groups had lower adjusted odds ratio (OR) for undiagnosed hypertension than men and the youngest age group. Respondents living in the Adriatic region had a higher adjusted OR for undiagnosed hypertension than those living in the Continental region. Respondents who did not consult their family doctor in the previous 12 months and those who did not have their blood pressure measured by a health professional in the previous 12 months had a higher adjusted OR for undiagnosed hypertension. CONCLUSION: Undiagnosed hypertension was significantly associated with male sex, age from 35 to 74, overweight, lack of consultation with a family doctor, and living in the Adriatic region. The results of this study should be used to inform preventive public health measures and activities.

CHRONIC MULTIMORBIDITY OF LOW BACK PAIN OR OTHER CHRONIC BACK DISORDERS IN THE REPUBLIC OF CROATIA.

The aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014-2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. Amoung fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney diseases, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, diabetes mellitus, myocardial infarction, stroke, depression, and the common category "other". We analyzed data on 268 participants with BD and 511 without it. Participants with BD had a significantly higher relative risk of any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001), as well as of non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes.

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS).

BACKGROUND: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

Prevalence of somatic comorbidities among coronavirus disease 2019 patients in Croatia in the first pandemic wave: data from national public health databases.

AIM: To determine the prevalence of common somatic comorbidities among coronavirus disease 2019 (COVID-19) positive patients in Croatia in the first pandemic wave, and assess the differences in clinical outcomes depending on the presence of comorbidities. METHODS: We analyzed data from patients confirmed to be SARS-CoV-2-positive from February through May 2020. The data were obtained from clinical laboratories, primary health care providers, and hospitals. Previously recorded comorbidities, including diabetes, cancer, circulatory diseases, chronic pulmonary, and kidney disease, were analyzed. RESULTS: Among 2249 patients, 46.0% were men (median age 51 years; median disease duration 27 days). Hospitalization was required for 41.8% patients, mechanical ventilation for 2.5%, while 4.7% of all patients died. Patients who died were significantly older (median 82 vs 50 years, P<0.001) with a higher prevalence of all investigated comorbidities (all p's <0.001), more frequently required mechanical ventilation (34% vs 1%, P<0.001), and had shorter length of hospital stay (median 13 vs 27 days, P<0.001) with no sex preponderance. Patients requiring mechanical ventilation were significantly older (median age 70 vs 51 years, P<0.001), more frequently men (59.6% vs 45.7%, P=0.037), showed a higher prevalence of all comorbidities except ischemic heart and chronic kidney disease (all p's <0.001), and demonstrated a higher case-fatality rate (63.2% vs 3.2%, P<0.001). CONCLUSION: COVID-19 patients who died in the first pandemic wave in Croatia were more likely to suffer previous somatic comorbidities. This corroborates the findings of similar studies and calls for further research into the underlying disease mechanisms, hence providing ground for more efficient preventive measures.

Utilization of somatic healthcare in Croatian patients with schizophrenia spectrum disorder, major depression, PTSD and the general population.

BACKGROUND: Utilization of somatic healthcare services is highly predictive of the development of chronic physical illnesses and increased mortality risks. The objective of this study was to assess the differences in healthcare utilization among patients with schizophrenia spectrum disorders (SSD), major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and the general population in Croatia. METHODS: We enrolled 566 Croatian participants from the general population, 282 with SSD, 178 with MDD, and 86 with PTSD. The primary outcome was a self-reported specialist consultation for non-psychiatric (e.g., somatic) causes within the previous 12 months. RESULTS: Although SSD patients with chronic physical illnesses were significantly more often hospitalized for physical illness than the general population, the proportion of patients who had a specialist consultation were equal in SSD and the general population. MDD and PTSD patients had significantly higher adjusted odds for specialist consultation than the general population and SSD patients (MDD compared to SSD: OR = 2.14; 95% CI 1.27-3.59; PTSD compared to SSD: OR = 2.03; 95% CI 1.00-4.10). CONCLUSIONS: SSD patients' utilization of somatic healthcare is equal to the general population, despite their increased healthcare needs. However, their utilization is lower than in MDD and PTSD patients and, therefore, probably not adequate. TRIAL REGISTRATION: The study protocol was registered at ClinicalTrials.gov ( NCT02773108 ) on May 16, 2016.

The prevalence of muscular dystrophy and spinal muscular atrophy in Croatia: data from national and non-governmental organization registries.

AIM: To determine the prevalence of muscular dystrophy (MD) and spinal muscular atrophy (SMA) in Croatia by use of multiple epidemiological tools. METHODS: This epidemiological study collected data from three national patient registries and one database of a non-governmental organization (NGO) of MD and SMA patients. The study involved all individuals who either had undergone hospital treatment for MD or SMA, had consulted their primary health care providers for MD- and SMA-related symptoms, were listed as disabled due to MD or SMA, or were members of the mentioned NGO in 2016. In order to prevent double entries, we created a new database of all living individuals, each with a unique identification number. The prevalence rates for 2016 were calculated by age and sex groups. RESULTS: There were 926 patients diagnosed with MD (544 men). Most men diagnosed with MD were in the age group 10-19, whereas most women were in the age group 50-59. MD prevalence in Croatia was 22.2 per 100000 population. There were 392 patients diagnosed with SMA (198 men). Most men with SMA were in the age group 50-59, whereas most women were in the age group 60-69. SMA prevalence in Croatia was 9.3 per 100000 population. CONCLUSION: SMA prevalence rate in Croatia is similar to SMA prevalence worldwide. However, MD prevalence rate is higher than worldwide estimates. This difference could be attributed to the fact that we could not confirm whether every patient registered in these databases actually met the diagnostic criteria for MD and SMA.

Patterns of chronic physical multimorbidity in psychiatric and general population.

OBJECTIVE: A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations. METHODS: We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population. RESULTS: Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: "Relatively healthy", "Musculoskeletal", "Hypertension and obesity", and "Complex multimorbidity" with no significant differences in the nature of multimorbidity latent classes patterns. The class "Relatively healthy" was significantly less (ARI = -25% (CI95% -30% -21%), and the class "Hypertension and obesity" was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI95% 17% - 23%). CONCLUSIONS: These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.

Prevalence of multiple sclerosis in Croatia: data from national and non-governmental organization registries.

AIM: To update the estimate of multiple sclerosis (MS) prevalence in Croatia using multiple epidemiological tools. METHODS: This level IV, epidemiological study gathered data from three national patient registries and one database of a non-governmental MS patients' organization. Data were extracted on all individuals who had undergone hospital MS treatment, consulted their primary health care providers about MS-related symptoms, been listed as having MS-related disability, or been members of the mentioned non-governmental organization in 2015. A new database was formed, in which all living individuals were identified using a common identification number to prevent double entries. The prevalence rates in 2015 were calculated by age and sex groups. RESULTS: In total, 6160 patients diagnosed with MS were identified (72% women). Most women with MS were 50-59 years old and most men were 40-49 years old. The overall MS prevalence rate was 143.8 per 100 000 population. CONCLUSION: The calculated MS prevalence rate in Croatia in 2015 was more than twice as high as the estimate from 2013. This difference warrants further research into MS epidemiology in Croatia and calls for a rational allocation of funds and human resources to provide adequate care and support to MS patients.

Трудоустройство лиц с инвалидностью в Хорватии: межсекторальные действия в области общественного здравоохранения для инклюзивного рынка труда: информационный обзор по передовому опыту

В Хорватии, как во многих других странах восточного региона ВОЗ, люди с инвалидностью представляют собой недостаточно трудоустроенную группу в рабочей силе, что оказывает значительное влияние на их благополучие и способствует социальному неравенству. Для решения этой проблемы, в 2013 году Хорватия приняла закон «О профессиональной реабилитации и трудоустройству лиц с инвалидностью» в целях повышения занятости представителей этой группы. В число основных регулятивных механизмов входят квоты по количеству лиц с инвалидностью и стимулы для работодателей. Еще одним механизмом является создание интегративных мастерских или рабочих центров, в которых навыки лиц с инвалидностью тестируются для участия на рынке труда или в защищенных и интегративных мастерских. Закон также регулирует разумное приспособление рабочего места, включая физические препятствия, рабочее оборудование и личную помощь. Принятие закона привело к увеличению числа лиц с инвалидностью, занятых на рынке труда в Хорватии.

Employing people with disabilities in Croatia: intersectoral public health action for an inclusive labour market: good practice brief

In Croatia, like in many countries in the WHO European Region, people with disabilities are an underemployed group in the workforce, which significantly impacts their welfare and contributes to social inequalities. To address this, Croatia implemented the Law on Vocational Rehabilitation and Employment of Persons with Disabilities in 2013 with the aim to increase employment in this group. Key regulatory mechanisms included quotas related to the number of people with disabilities and incentives for employers.Another mechanism was the development of integrative workshops and working centres where the skills of people with disabilities are tested for participation in the labour market or in sheltered and integrative workshops. The Law also regulates reasonable accommodation of the workplace including physical barriers, working equipment and personal assistance. The Law resulted in more people with disabilities employed in the labour market in Croatia.

The Child Health Care System of Croatia.

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.

The impacts of media messaging and age and sex variance on adolescent smoking habits in Croatia.

OBJECTIVES: To analyze the effects of age, sex, and media messages that encourage or discourage smoking, in conjunction with having 1 or more parents, close friends, teachers, or family members who smoke, on differences in patterns of adolescent smoking. METHODS: This research is based on Croatian responses to the 2011 Global Youth Tobacco Survey. A total of 4245 Croatian youths responded to the Global Youth Tobacco Survey, of which individuals 3551 were aged 13 to 15 years. Of this cross section, 1644 individuals were male; 1856 were female; and 51 were of unknown sex. RESULTS: There were significant differences among responses in terms of age. Older adolescents were more likely to smoke (P < 0.001) and more likely to experience the following: (1) outdoor exposure to other smokers, including teachers (P < 0.001) and fellow students (P < 0.001); (2) smoking in the presence of parents or guardians (P < 0.001) and best friends (P < 0.001). The most prominent predictor of smoking among male adolescents was the existence of a best friend who smokes, with an odds ratio of 6.38 and a corresponding 95% confidence interval of 3.69 to 11.01. Likewise, the most prominent predictor among female adolescents was also the existence of a best friend who smokes, with an odds ratio of 10.21 and a corresponding 95% confidence interval of 4.94 to 21.13. The majority of nonsmokers, 65.5% (n = 1640), and smokers, 58.8% (n = 506), have never seen advertisements for cigarettes broadcast during televised concerts, and 58.5% of nonsmokers (n = 1469) and 58.6% of smokers (n = 505) have never seen advertisements for cigarettes while attending concerts. CONCLUSIONS: Our study shows that there is no sex difference between the number of nonsmokers and smokers. Older adolescents tend to smoke more, and students who smoke outside reported seeing other adolescents and their teachers smoking almost daily. A majority of youths who reported that they smoke have parents who smoke at home and have close friends who smoke; having a close or best friend who smokes is the highest prediction factor that both male and female youths will begin smoking. The majority of nonsmokers and smokers have never seen pro-smoking messages when going to concerts or during other community and social events. This lack of exposure to smoking-related advertising is the result of new legal restrictions imposed in 2008 on tobacco-product producers. There is no statistical significance among smokers' and nonsmokers' perceptions of antismoking media messaging. Peer pressure has been shown to be the second-most influential factor, after having a best friend who smokes, for the likelihood that an individual will become a smoker, among both male and female adolescents.

Presentation of Certain Parameters Found In 2009-2013 Annual Dental Medicine Reports.

UNLABELLED: The Croatian Institute of Public Health (CIPH) collects health care related statistical data based on the Republic of Croatia's Annual Plan of Implementation of Statistical Activities. The purpose of this study was to analyse the CIPH data retrieved from annual reports, obtained from contractual teams and institutions related to dental medicine activities, collected in respective counties and for the entire country. MATERIAL AND METHODS: The data were collected from the Croatian Statistical Health Care Yearbook for the period from 2009 to 2013. RESULTS: The analysis has shown the increase in the number of insured persons (5%), but the decrease in the number of persons who received care (10%) and the increase in the number of visits (14%) and general examinations (13%). The majority of the beneficiaries were from the City of Zagreb with the highest number of visits, but with a low number of general examinations included in these visits (11%); while the Zadar County had the highest number of general examinations in terms of dental health care users (90.6%) and the proportion of general examinations in visits (30%). The most common diagnosis was dental caries (43%). The incomplete and insufficient reporting from some counties, inadequate recording of diagnoses and of curative and preventive procedures could be the factors affecting the quantity and quality of obtained data. Proper and regular submissions of reports to counties' public health institutes, regular preventive examinations, adequate recording of diagnoses and procedures would contribute positively to further health planning and the implementation of preventive measures for the improvement of oral health. CONCLUSION: The data analysis gives an insight into the current situation allowing on such basis further planning and conducting of activities at national and local level. Further analyses would help to get a better perspective and improvement of dental medicine activities.

Presentation of DMFT/dmft Index in Croatia and Europe.

BACKGROUND: Dental caries is the most common oral disease affecting all age groups and a major cause of tooth loss. Although a decrease in the prevalence of dental caries has been marked across the globe, in many countries it has remained a major oral-health problem. AIM: The objective of this paper was to show the trends in the DMFT/dmft index ​​in Croatia, compare it with European countries and present further courses of action oriented towards promotion of oral health and decrease in caries prevalence. MATERIAL AND METHODS: The DMFT index databases have been generated based on online database searches for the period from 1985 to 2015. RESULTS: Croatia is one of European countries with a high DMFT index relating to 12-year old children (4.18). The experience of countries with a low DMFT index has shown that dental caries can be controlled through education and prevention activities, which eventually lead to diminished financial costs, at individual and national level, improving overall health and quality of life. CONCLUSION: Tracking and monitoring of oral health i.e. dental caries need to be improved in terms of creation of data base systems on the prevalence of dental caries, determining multi-factorial causes of its occurrence and with respect to the implementation of national oral-health prevention programs.

Five-year cumulative incidence of physical inactivity in adult Croatian population: the CroHort study.

The aim of this study was to analyze gender and age differences in physical inactivity in Croatia and physical inactivity pattern changes during the five-year period. The study is based on the data obtained from the Croatian Adult Health Cohort Study which was carried out in 2003 and 2008. The prevalence of physical inactivity in 2008 was 37.7%, 36.8% in men and 38.1% in women. In both study waves the prevalence was increasing with age in both men and women. The prevalence is statistically significantly higher in subjects older than 64 years than in younger age groups. The incidence of physical inactivity in the five-year period in total was 29.9%, 27.2% in men and 31.1% in women. The increase in prevalence of physical inactivity despite the number of preventive activities carried out periodically emphasizes the need for systematic and comprehensive approach in increasing the number of regularly physically active individuals.

Health-related quality of life of women with disabilities in relation to their employment status.

AIM: To compare the health-related quality of life of unemployed and employed women with disabilities and establish factors affecting their life satisfaction. METHODS: The study included 318 women with disabilities, 160 of whom were employed and 158 unemployed, paired according to age and region of residence. The health-related quality of life was assessed by The World Health Organization Quality of Life questionnaire, and social demographics and factors affecting life satisfaction were collected by a general questionnaire. The factors affecting life satisfaction were defined according to respondents' statements. RESULTS: Unemployed women with disabilities had a lower mean score (±standard deviation) on all health-related QoL domains: psychological health (14.52±2.80 vs 15.94±2.55), social relationships (15.12±3.08 vs 16.06±2.69), environment (12.80±2.78 vs 13.87±2.49), as well as on a separate item of self-assessed health (3.33±1.16 vs 3.56±0.92) than their employed counterparts (P<0.01). This disparity was not found only in the domain of physical health. The largest positive impact on life satisfaction in both groups was family. CONCLUSION: As disabled women are a particularly vulnerable population group, stressing the importance of employment and family as factors affecting their quality of life may help equalizing opportunities and upgrading the quality of life of all - particularly unemployed women with disabilities.

Inequalities in Croatian pupils' unhealthy behaviours and health outcomes: role of school, peers and family affluence.

BACKGROUND: To examine the influence of family affluence (measure of socioeconomic status), school environment (liking school, school pressure, academic achievement and classmates support) and peer group (size of the peer group and frequency of peer contact) on unhealthy behaviours (smoking, drunkenness, physical inactivity, irregular breakfast and soft drink consumption) and health outcomes (self-rated health, multiple health complaints and life satisfaction) in Croatian pupils. METHODS: The Croatian data from Health Behaviour in School-aged Children 2005/06 (HBSC) were used (1666 11-year-olds, and 1630 15-year-olds). Binary logistic regression analysis was conducted (95% confidence intervals, P < 0.05 and P < 0.01). RESULTS: School environment and peer group were connected to more unhealthy behaviours along with greater differences in those behaviours than family affluence. The only exception was physical inactivity at age 11 (compared to high family affluence, low family affluence increased 80% odds for physical inactivity, whereas, compared to favourable school environment, poor school environment increased 50% odds). Compared to favourable school environment, poor school environment was the most consistent and strongest predictor of poor health outcomes (all three measures). No influence of peer group to health outcomes was found. Compared to high-affluent families, low-affluent families were associated to higher odds for poor self-rated health and life dissatisfaction, and, for 11-year-olds, medium-affluent families to lower odds for multiple health complaints. Gender differences in unhealthy behaviours and health outcomes were also found. CONCLUSIONS: Compared to socioeconomic inequalities, greater inequalities in unhealthy behaviours were connected to school environment and peer group, and in health outcomes to school environment.