Health-related Quality of Life and Mental Health in the Process of Active and Passive Ageing.

BACKGROUND: To analyse the differences in the self-estimate of life quality depending on the ageing type - passive, active. SUBJECTS AND METHODS: Life-quality linked to health was measured with an SF-36 survey, which gives multi-dimensional criteria of health and life-quality. SF-36 survey represents a theoretically based and empirically proven operationalization of two overal health concepts, which are body and mental health, and its two general manifestations, functioning, and welfare. 200 examinees in total, aged from 55 to 92, were included in the research. Divided by sex, in the research participated 148 women and 52 men. Depending on the ageing way, the examinees were divided into 2 categories: passive ageing (n=100), active ageing (n=100), and for these groups a detailed result analysis was done. Statistical analysis includes descriptive statistics, Hi-square test, Spearman's correlation coefficient, and Mann-Whitney U test. RESULTS: In all dimensions of health, examinees from the category Active ageing achieve higher scores, which indicates better health and better functioning. Between the groups, a statistically significant difference was determined, on the following dimensions: Overall health, Pains, Energy and vitality, Social operations, and Limits due to emotional difficulties. With the Hi-square test, it was determined that there are differences between the groups. The biggest difference can be seen in the reply categories related to health deterioration (χ2=10.391; df=4; p=0.034). Examinees from the Active ageing group mention significantly less that their health has gotten worse compared to the previous year (26% of the active ones state that their health is somewhat worse, and only 2% that their health is significantly worse, compared to the passive ones where 36% state that their health is worse, and 9% that it's much worse compared to the year before). Tested was the difference between arithmetic middles on the issue of mental health based on the ageing type (p>0.05), and the results show that it's not statistically significant. CONCLUSION: On all dimensions, examinees from the category Active ageing achieve higher scores, which indicates a better health and better functioning.

A five-year follow-up study of the general public awareness and perception of epilepsy in Croatia.

Public reception of epilepsy in Croatia was re-assessed in 2009, 5 years after an initial survey, by interviewing 1000 randomly selected adults. Ninety-two percent (-5.0%) of the respondents had heard about epilepsy, 47% (-7.9%) knew someone with epilepsy, and 38.6% (-6.0%) had witnessed a seizure. Interviewees were quite ready to accept a person with epilepsy. Almost 8% (+1.1%) would object if their child played with a child with epilepsy, and 77.8% (+1.8%) believed that a child with epilepsy could succeed as well as a child without epilepsy. Although 45.9% (-6.6%) would approach a person having a seizure and help, 36.1% (+3.0%) would also call "911." Citizens of Croatia re-declared a high tolerance toward people with epilepsy and positive attitude toward children with epilepsy. Experiential factors remained strong predictors of more positive attitudes. A more prominent role of patients and implementation of social marketing in addressing a large persisting degree of prejudice and stigmatization worldwide are warranted.

Use of preventive health care services among the unemployed in Croatia.

AIM: To analyze the association between unemployment and the use of preventive health care services in Croatia. METHODS: Data on the use of preventive health care services and employment status were taken from the 2003 Croatia Adult Health Survey. A multistage stratified sample design was used to define a representative sample (n=9070 individuals) of the Croatian general adult population. Binary logistic regression was used for analysis. Odds ratios were estimated for the association between employment status and preventive health care services, controlling for age, sex, region, marital status, level of education, occupation, and distance from general practitioner (GP) facilities. RESULTS: Our sample comprised 1356 men and 1932 women. Out of them, 382 men (28.2%) and 472 women (24.4%) were unemployed. Unemployment was negatively associated with the use of some preventive health care services in the year before the study among healthy individuals (regular blood pressure control odds ratio [OR], 0.738, 95% CI, 0.576-0.945; blood glucose control OR, 0.751, 95% CI, 0.565-0.999; attending general preventive examinations OR, 0.563, 95% CI, 0.410-0.772) as well as among individuals who reported cardiovascular and/or metabolic diseases (attending general preventive examinations OR, 0.661, 95% CI, 0.456-0.959; receiving doctor's advice for food habit change and influenza immunizations OR, 0.627, 95% CI, 0.424-0.928). CONCLUSION: Both the unemployed who had cardiovascular and metabolic diseases and those who did not, used less preventive health services than respective subgroups of the employed. In order to achieve a more equitable distribution of preventive health care services, the Croatian health care system should provide additional attention to the unemployed; for instance by developing a program of preventive health examinations targeting this vulnerable population.

Health care funding reforms in Croatia: a case of mistaken priorities.

This study provides an overview of funding mechanisms in Croatian health care and analyses them in terms of sustainability, efficiency and equity. The study presents an in depth investigation of problems facing funding health care in Croatia: high expenditure, inadequate financial resources, continuous deficits of the state insurance fund, lack of transparency in funding, an aging population, etc. Furthermore, the study provides a critical overview of reforms that have been implemented to counter those issues from 1990 to 2002. The study argues that the implemented reforms over relied on shifting health expenditure from public to private sources in addressing financial deficits in the system. The study argues that, instead, the reforms should have focused more on curbing rising expenditure in health care providers. Emphasis has been put on the extent to which the reforms affected the conceptual-social foundations of the system. Finally, the paper provides recommendations for policy makers in Croatia and presents an overview of Croatian experiences that might be of interest to researchers and policy makers internationally.

Citizens' views on health insurance in Croatia.

AIM: To examine the citizens' attitudes toward health insurance and its reform in Croatia, and their views on private payments for health care services. METHOD: In 1999 and 2000, we surveyed 500 randomly selected adults from all regions of Croatia, aged 40 years and over. The questionnaire included questions on social health insurance, private payments for health care, and background information. The net response was 393 (79%). The analysis of the data collected included univariate and multivariate analyses to test the differences in the attitudes among sociodemographic and socioeconomic groups. RESULTS: Most interviewed Croatian citizens (83.2%) expressed the opinion that everybody should have access to health care services, irrespective of the health insurance contributions. However, 32.1% agreed that the utilization of services should depend on the payment of contribution; 39.1% believed that the money they contributed to health insurance corresponded to health care services they received; 60.1% agreed that insurance rate should increase proportionally to income. When asked about reforms, more than half (53.4%) thought that the current health insurance covered less benefits than 10 years earlier, whereas more than a third believed that changes offered more choice (36.9%) but less equity (37.7%), and 46% disagreed with the introduction of the basic package of health care benefits and supplementary insurance. About the same percentage of respondents thought that they had already been paying too much for health care out of their own pockets. CONCLUSION: Citizens in Croatia do not hold a positive opinion on health insurance reform. They fear the changes would bring about limitations in their social rights and increase their financial burden.

Health-care resource use by asthmatics in Croatia.

We report a survey of the impact of asthma on daily life and on health-care resource use by adult asthma patients in four counties in Croatia. Over a 1-year period beginning November 1998, 185 general practitioners recruited 504 asthma patients, who completed a questionnaire about their drug therapy, health-care resource use, symptoms, limitations in daily activities, and work loss due to asthma. Over a 2-week period, inhaled corticosteroids were used by 51.5% of patients, short-acting and long-acting beta-agonists by 70.8% and 53.5%, respectively, and oral extended-release theophyllines by 29.8%. Nocturnal awakenings were experienced by 58.7% of patients, 75.5% experienced daytime symptoms, and 42.5% were limited in their daily activities. In the previous year, 12.5% of the patients were hospitalized, 33% missed work, and 70% reported reduced effectiveness in the workplace. In the previous 6 months, 35.2% of the patients visited an emergency room due to worsening of asthma symptoms. The human and socioeconomic burden of asthma in Croatia is considerable. These results can help guide the development of asthma policy in Croatia and raise awareness of asthma as a public health issue.

Readability of patient information on diabetes on the Croatian Web sites.

Many studies on readability, have shown that patient information is frequently written at the reading level too high for the average population to understand. The aim of this study was to determine the reading level of patient information on diabetes found on the Croatian Web sites and written in Croatian language. Patient information on diabetes from 10 Croatian Web sites was tested for readability using the SMOG formula. The reading levels of the tested materials ranged from 11 to 15, which showed that these materials would not be understood by at least 80% of the Croatian adult population.

[What the citizens of Croatia think about their health]. / Sto o svome zdravlju misle stanovnici Hrvatske.

AIM: Since self-perceived health represents an important indicator of health status, the aim of this study was to explore socioeconomic differences in self-perceived health in Croatia. METHODS: The study was conducted during the 1997-1999 period in fourteen Croatian counties. A sample of 5,048 respondents aged 18 years and older were recruited by multistaged stratified sampling. Data were collected using an anonymous questionnaire which consisted of questions on the respondents' socioeconomic characteristics and self-perceived health. RESULTS: While 20.7% of the respondents evaluated their health as poor, 25.9% evaluated it as excellent or very good. Women, older respondents and those with lower educational level and lower income more frequently described their health as poor. When comparing their health to the health of age-matched persons, 23.6% of the respondents thought their health was better and 21.0% thought their health was worse than the health of persons of the same age. Women, older respondents and those with lower educational level and lower income more frequently thought their health was worse than the health of their coevals. As many as 53.7% of the respondents thought their health had not changed compared to the previous year, and 31.7% thought their health was worse than in the previous year. Older respondents, respondents with lower income and those with lower educational level more frequently thought that their health had worsened compared to the previous year. DISCUSSION: Results of the study revealed a complex relationship between socioeconomic factors and self-perceived health. Men and women differed significantly in self-perceived health. Women mostly described their health as being poor or satisfactory, while men described it as excellent or very good. These results, similar to those in a large body of literature, raise the question of gender differences in the perception of symptoms. In our research, self-perceived health was poorer in older respondents. This also applies to the comparison of self-perceived health to the health of age-matched persons. An exception was the group of respondents aged > 76; their self-perceived health was described as either much worse or much better than the health of their coevals. Older persons are inevitably sicker than younger ones and poor self-perceived health would be expected. Nevertheless, the relation between self-perceived health and age is sometimes ambiguous in the literature. Income and education are strong markers of socioeconomic status. In our research, respondents with lower income as well as those with lower educational level had poorer self-perceived health. Education is a particularly strong marker of socioeconomic status, and it predicts self-perceived health better than occupation does. A study of self-perceived health does not always give an accurate insight into the real self-perceived health of the respondents. For example, if a person, otherwise in good health, suffered from an acute condition, he could describe his health as being poor at that moment. We tried to minimize this potential bias by adding two questions in self-perceived health assessment--"How do you perceive your health compared to your health a year ago?" and "How do you perceive your health compared to health of the persons of the same age?" Women, older respondents, respondents with lower educational level and lower income generally described their health as poor more often. Since self-perceived health is correlated with health care utilization, these results could be used to identify the specific population groups who are more likely to be potential users of health care services. CONCLUSION: Since education and income represent socioeconomic parameters, it could be concluded that self-perceived health of the respondents with lower socioeconomic status is poorer than self-perceived health of those with higher socioeconomic status.