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.

Organization and functioning of primary healthcare for pre-school children in Croatia: a longitudinal study from 1995 to 2012.

Primary health care for children in Croatia are mostly provided by primary pediatricians (PP) in the urban and by family doctors in rural areas. During past decades, as apart of health care reforms, primary pediatric care experiences several changes. This study was undertaken in order to investigate the trends in organizational structure and functioning of the PPs, based on routinely collected data from Croatian Health Service Yearbooks, 1995 to 2012. The results have consistently shown a shortage of PPs in Croatia. The shortage obviously affects the average number of children per PP; number increased from 994 in 1995, to 1556 children in 2010, which was far above the standard. The shortage of PPs is also related to the high number of visits (30 to 40) per PP and per working day. The obtained results clearly show only the trends, therefore further research is needed for a full understanding of the PHC for pre-school children.

Association of early menarche age and overweight/obesity.

AIM: The aim of the study is to assess the association of overweight/obesity and early menarcheal age. PATIENTS AND METHODS: The study comprised 2127 healthy girls aged 9 to 16 years. Menarcheal age was estimated by status quo method. The girls' body weight and height were measured and their body mass index (BMI) calculated. The diagnostic criteria of the WHO were used to define overweight and obesity. Girls with a BMI in the range of 1-2 for age and sex were considered overweight. Girls with a BMI >2 standard deviation (SD) for age and sex were considered obese. Girls with a BMI >1 SD for age and sex were considered overweight/obese. Social and economic status was analyzed according to years of education completed, parents' occupations, and the number of children in the family. RESULTS: Median menarcheal age was 12.83 years; 25% girls had menarche before 11.98 years and 75% by 13.69 years. By 11.21 years, 10% of girls had had menarche, and 95% by 14.91 years. Girls who had menarche before 11.98 years had higher body weight values (48.5 vs. 40.2 kg) (p<0.001), height (159.3 vs. 149.2 cm) (p<0.001), and BMI (18.9 vs. 17.8 kg/m2) (p=0.003) than their peers without menarche. Girls with menarche before 11.98 years had significantly higher BMI values than girls with menarche after 13.69 years (18.94 vs. 17.84 kg/m2) (p=0.008). Girls with menarche before 11.98 years and those after 13.69 years differ significantly in distribution of thinness (3.4% vs. 2.54%), normal weight (85.3% vs. 91.8%), and overweight/obesity (11.2% vs. 5.7%) (p=0.002). CONCLUSIONS: 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.

Growth and obesity in 7-year-old Croatian children: secular changes from 1991 to 2008.

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.

Neonatal birth weight variations between inland and littoral Croatia.

The aim of the study was to assess neonatal birth weight (BW) differences between inland and littoral Croatia, to identify BW groups with most pronounced differences, and possible variations in the rate of BW > or = 4000 g between Sibenik area and the rest of littoral (counties with access to the Adriatic Sea) and inland Croatia. The study included data on 99.42% of 200,740 live births recorded in 37 Croatian maternity hospitals during the 2001-2005 period. Distribution of 500-g BW groups was analyzed irrespective of neonatal sex and gestational age. Differences were found between the inland and littoral parts of Croatia according to distribution of the BW groups of < 2500 g (5.4% vs. 4.4%), 2500-3999 g (84% vs. 80.2%) and > or = 4000 g (10.6% vs. 15.4%) (chi2 = 882; p < 0.001).The highest rate of BW > or = 4000 g was recorded in Sibenik-Knin County (5-year mean 18.32%) and was greater throughout the littoral as compared with inland Croatia (5-year mean 14.99% vs. 9.58%). A shift towards higher BWgroups recorded throughout littoral as compared with inland Croatia supports the hypothesis on variation in anthropologic characteristics in the respective populations to be pronounced as early as at birth. Study results confirmed fetal macrosomia not to be exclusively characteristic of Sibenik-Knin County, since the rate of neonatal BW > or =4000 g was significantly higher in the entire littoral as compared with inland Croatia.

[Child in contemporary Croatian society]. / Dijete u suvremenome hrvatskom drustvu.

The symposium on the topic "Child in contemporary Croatian society", organized by Croatian Pediatric Society, Croatian Academy of Sciences and Arts, Ministry of health and social welfare and UNICEF Croatia Office, was held in Zagreb on December 12, 2009. The lecturers have shown important information on difficulties the children in Croatia are exposed to. Namely, diseases of the so called "new morbidity", which are becoming more and more frequent in the contemporary world, demand a new approach of work from all who participate in healthcare for children, including additional education. These diseases are not part of a practitioner's routine activity. Due to variety of problems children are exposed to, the approach can be only multidisciplinary. Basic national interest of every country (basic interest of every human society) should be to direct more attention and financial resources to the healthcare of children, which would ensure the existence and healthy future of the society. This approach requires a national consensus and clear political decision of all responsible official services.

Associations between parental and child overweight and obesity.

Results of the analysis showed that parents and children overweight/obesity were significantly correlated. The sample includes 318 pairs of mothers and children, and 336 pairs of fathers and children at the age 11.3 +/- 0.4 years in Trogir, Croatia. Child overweight and obesity were defined according to body mass index (BMI) 25 and 30 equivalents (kg/m2). The prevalence of total overweight in girls was 25.6% and among boys was 20.5%. Mother's weight (p = 0.003) and BMI (p = 0.006) were greater in obese than in other groups of children. Overweight/obese children were more often found among overweight/obese mothers (p = 0.009) and fathers (p = 0.039). Correlation between overweight/obese children and their father (odds ratio 3.2, 95% CI 1.5-6.8) was stronger than between overweight/obese children and their mothers (odds ratio 2.2, 95% CI 1.2-3.9). Associations with mothers' and daughters' overweight/obesity were stronger (p = 0.017) than mothers' and sons'(p = 0.12). Correlations between children's BMI and fathers' BMI (r = 0.265, p < 0.0001) and between children's BMI and mothers' BMI (r = 0.173, p = 0.002) were significant. Children whose parents are overweight/obese look for greater attention in future preventive programme.

[Growth in macrosomic neonates during the first year]. / Rast makrosomne novorodencadi tijekom prve godine.

Growth of macrosomic newborns (birth weight 4000 grams and more) and control group newborns (birth weight from 2500 to 3999 grams) in the course of their first year of life has been compared. Although the absolute growth in weight and length is higher in macrosomic boys and girls, the relativity in their growth in the course of the first year of their life is higher among the control group infants. Boys from the control group have increased their birth weight for 203%, while macrosomic infants for 177% (control group girls 196% against macrosomic 159%). The relative difference in weight between the groups of macrosomic and control group boys decreased from 26% (at delivery) to 14% in the course of their first year of life, and in girls from 23% to 8%. Control group boys have increased their birth length for 53%, while macrosomic for 49% (girls: control group 52% against macrosomic 47%). The observed tendency to decrease the difference in antropometric characteristics between the macrosomic and control groups of newborn children of both sexes, probably may be explained by the weakening of the influence of prenatal factors which have resulted in macrosomy and strengthening of the influences of postnatal factors (socio-economic) by which the groups didn't differ significantly.

Changes in menarcheal age in girls exposed to war conditions.

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.