Improving blood pressure and dyslipidemia control by increasing health literacy in Croatia-missions 70/26 & Do you know what is your number.

PURPOSE: In 2022 hypertensive disease was the second cause of death in Croatia. The crude prevalence of hypertension is increasing and still majority of hypertensive patients did not reach blood pressure and cholesterol goals Low awareness, and small number of treated and controlled patients point on poor adherence and even worse clinical inertia. MATERIALS AND METHODS: Croatian Hypertension League (CHL) has started the permanent public health action Hunting the Silent Killer aiming to increase health literacy. In 2023 we decided to intensify program with two missions - '70/26', and 'Do you know what is your number?' aiming to achieve target values in 70% and in 50% of patients treated for hypertension and dyslipidaemia, respectively, by 2026. For the health care workers, the program will primarily involve digital education, and 'School of Communication in Hypertension'. In the second arm of the program, we will advise patients and general population to visit our educational website with important and useful information on how to improve bad lifestyle, how to proper measure blood pressure, why is it important to sustain in taking drugs etc. In 2026, the CHL will organise field research to assess the success of programs using the same methodology as we used in previous EH-UH studies. CONCLUSION: We will monitor and analyse trends in the management and control of patients treated for hypertension and dyslipidaemia. This will enable us to make an evidence-based conclusion how successful we were in increasing health literacy.

Hypertension is the most compelling cause of death in Croatia with increasing prevalence.Still 50.1% of treated hypertensive patients and more than 70% of patients with dyslipidaemia in Croatia are uncontrolled.Programs 70/26 and Do you know your number aimed to achieve 70% and 50% control of hypertensive and dyslipidaemia patients, respectively, by 2026.To accomplish these goals, health literacy of healthcare workers, patients, and general population we will try to improve mostly using digital education and by organising schools of communication.

Croatian Action on Salt and Health (CRASH): On the Road to Success-Less Salt, More Health.

The World Health Organization recommends adjusting salt intake as a part of the nine global targets to reduce premature mortality from non-communicable chronic diseases as a priority and the most cost-effective intervention. In 2006, the main aim of the Croatian Action on Salt and Health was to decrease salt intake by 16% because of its critical intake and consequences on human health. We have organized educative activities to increase awareness on salt harmfulness, define food categories of prime interest, collaborate with industries and determine salt intake (24 h urine sodium excretion). It was determined that the proportion of salt in ready-to-eat baked bread should not exceed 1.4%. In the period 2014-2022, salt in semi-white bread was reduced by 14%, 22% in bakery and 25% in the largest meat industry. Awareness of the harmfulness of salt on health increased from 65.3% in 2008 to 96.9% in 2023 and salt intake was reduced by 15.9-1.8 g/day (22.8% men, 11.7% women). In the last 18 years, a significant decrease in salt intake was achieved in Croatia, awareness of its harmfulness increased, collaboration with the food industry was established and regulatory documents were launched. However, salt intake is still very high, underlying the need for continuation of efforts and even stronger activities.

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.

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.

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.

Increasing smoking prevalence among pupils of several Croatian secondary medical schools between 1990 and 2006.

Smoking among pupils of secondary medical schools is of particular public health interest because of their role in the health system in the future. The study was part of the survey of smoking among students of Croatian medium medical schools. Data of 3 survey periods were available (1990-2002-2006). Specific smoking trends among 14-18 year olds were examined using odds ratios and multiple regressions. Sex ratios were calculated for each survey period. Daily smoking prevalence in 1990 was 15.9% in boys and 14.1% among girls. Occasional smoking in 1990 occurred among 8.9% of boys and 15.0% of girls. Twelve years after, smoking prevalence increased for daily smoking in boys to 32.9% and among girls to 30.4%. Occasional smoking decreased to 6.3% in boys, and increased to 17.8% among girls. There were no remarkable changes in prevalence from 2002 to 2006. Among adolescents in Croatia, there was high risk for smoking among adolescent population. High smoking rate among pupils of medical schools predicts not only high mortality due to smoking over 20-30 years, but also implicates for bad habit among professional health workers, if no policy interventions were taken.

Role of epidemiologic information system in sudden death prevention among Croatia's haemodialysis patients.

The main aim of Croatia's epidemiological information system is to enable the monitoring of infectious diseases as well as to enable necessary interventions. Its 24-hour epidemiologic alert mechanism made it possible for initial reports of sudden death clusters in haemodialysis units to reach epidemiologists on the night of 12 October 2001. The alert about the sudden deaths among haemodialysis patients in two hospitals has prompted us to do an epidemiological inquiry during that night and early the next morning. It looked at suspicions of a possible link between Baxter Plivadial P-15 lot 2001F075 dialyser and these deaths. As the suspicion was based on a small amount of data, it needed confirmation from a countrywide inquiry involving the other 40 haemodialysis units. A phone inquiry showed that 23 haemodialysis deaths occurred on 8-13 October 2001. It suggested that also dialyser of a different type and lot (P-18 2001B17R) should be incriminated. During the inquiry (October 13), all haemodialysis units were informed of the suspicions regarding incriminated dialysers, and of the necessity of temporary withdrawal of these from use. The withdrawal on 13 October of incriminated dialysers stopped the deaths among haemodialysis patients. No more such sudden deaths have been recorded since that could be linked either to the described period or to this clinical picture.