Trends in preventive activities for the adult population in family medicine in Croatia: 1995-2012.

A few preventive activities were recorded in Croatian family medicine (FM) from 1995 until 2003, and then in 2004, additional fee-for-service reimbursement for general check-ups for people aged 45 to 65 years was introduced. The aim of this study was to investigate the trends in preventive activities before and after the introduction of those measures by using the Croatian Health Service Yearbooks for 1995-2012 as the main database. Data on the number of preventive, general, and total number of check-ups were collected. The results showed that the total number of check-ups registered in FM was low, suggesting that the additional reimbursement did not bring any improvements. In fact, the trend in the number decreased after 2004. These results are not unexpected because of the ineffectiveness of general check-ups as indicated in the literature. General check-ups should be replaced by targeted preventive interventions with evidence-based effectiveness.

Preventive health care for women in Croatia: ongoing trends from 1995 to 2012.

The privatization of gynecological services and the introduction of additional reimbursements to capitation fees are ongoing mini reforms in Croatia. In order to evaluate the outcomes of this, study was performed with the main aim of determining trends in preventive activities carried out in public and private gynecological practices from 1995 to 2012. The Croatian Health Service Yearbooks served as the basis for data collection. Data were collected on the number of general check-ups, the number of targeted check-ups, and the number of follow-up check-ups. The results indicate a trend of continuous decline in the number of general and follow-up check-ups, as well as breast examinations and Pap smears, in public gynecological practices even after the introduction of contractual obligations and additional reimbursements and fee-for-service payments. One important note is that many resources were invested in general checks-up interventions, which proved to be ineffective, while fewer resources were invested in the more effective Pap smear interventions.

[Comparision of costs of secondary prevention and treatment of stroke--cost-effectiveness analysis]. / Usporedba cijena sekundarne prevencije i lijecenja mozdanog udara--cost-effectiveness analiza.

UNLABELLED: Cerebrovascular accident (CVA) is a serious complication of untreated arterial hypertension. INTRODUCTION: The aim of this paper is to compare the cost of secondary prevention and treatment of CVA caused by untreated arterial hypertension. METHODS: Cost-effectiveness analysis of diagnosis and therapy of arterial hypertension in comparison with CVA treatment. RESULTS: The cost of secondary prevention of CVA per patient per year in 2006. was 1.589,19 kunas, which comes to 15.107,75 kunas in thirty years of treatment (discount factor included), whereas a single CVA treatment was 17.207,54 kunas on average. In every 850 treatments of hypertension (NNT) comes a prevented CVA which is 1.350.811,5 kunas, and is therefore more expensive than a single CVA treatment. CONCLUSION: Secondary prevention has a long-term protective effect improving the patients' quality of life, inhibiting the potential post-CVA handicap and pre-retirement. Thus, the main advantage of both primary and secondary prevention is in their greater benefit for patients.

[Community health course--student's evaluation]. / Evaluacija predmeta "zdravlje u zajednici" studenata medicine.

INTRODUCTION: Since 1952, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, has provided a community health course, based on the medical education approach that the main fields of physicians' action are human settlements and not only consulting rooms and clinics. AIM: The aim of the study was to compare community health course students' evaluations immediately after attending the course at the 4th and 6th study years. SUBJECTS AND METHODS: The survey included 224 4th year medical students attending the community course during the academic year 2007-2008 and 192 same-generation 6th year students (85.7%) during the academic year 2009-2010. Students were required to fill out an evaluation questionnaire about the activities during the community health course using grades from 1-poor to 5-excellent, and to write personal remarks and essay. RESULTS: The academic year 2007-2008 students (n=224) were very satisfied (grades 5 and 4) with preparatory seminar (98% of students), final seminar (97%), course organization (90%) and course contents (89%). The same grades were allocated by 98% of students to public health field research, 94% to work in community nurse service, 93% to work in family practice and health promotion in school and kindergarten, and 87% to water sampling. Satisfaction with the community health course was very emotionally described in final essays: "... work with community nurse service in the poorest part of Croatia has changed my life. I have learned in only few hours to wish less and to give more. Every physician should experience it, because that is real life". Results of the same-generation students (n=192) in the academic year 2009-2010, now at 6th study year, showed them to be still very satisfied (grades 5 and 4) with the activities in the community health course: 94% with health promotion, 92% with work in the community nurse service and family medicine, 86% with course contents, 82% with course organization, 78% with final seminar, 64% with preparatory seminar, 63% with field research, and 49% with water sampling. DISCUSSION: At some medical schools, there are similar attempts to bring students more closely to life conditions, especially to rural communities. Different schools of medicine in the world have attempted to improve and adapt current curricula towards community-oriented education of medical students during undergraduate study and residency. In some countries, there is also the need of improvement of health care in rural areas. CONCLUSION: Results of the course evaluation showed that students had recognized the exceptional value of community health course as a whole. They perceived it as the most valuable and most useful experience in their medical study. By participating in local health care and social care activities in rural area, they got an insight into both the health care system and socio-medical determinants of health.

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.

Importance of health care issues in 2005 presidential elections in Croatia.

Health and health care provision are among the most important and politically sensitive public service areas. Politicians carefully incorporate health care program changes in their political agendas to gain votes. However, knowing health care priorities of the electoral body is not useful only to politicians, but also to health policy makers, as it enables them to target the most problematic areas in health care. We conducted a telephone survey of representative sample of voters (n=643) immediately before the presidential elections in Croatia in 2005, to determine the possible differences in health care priorities between left-wing and right-wing voters, and found a high level of homogeneity in their opinions. Health care organization, corruption, and financing issues were identified as the top priorities by both left- and right-wing voters. This agreement in voters' expectations, probably caused by a similar frame of mind of Croatian citizens inherited from pre-democratic times of self-government, could be used by health policy makers to rationally invest the means and efforts in dealing with the most problematic health care issues.

[Minor physical anomalies in children with hearing impairment]. / Zastupljenost tjelesnih minor anomalija u djece ostecena sluha.

The prevalence of minor physical anomalies was studied on a sample of 116 children with idiopathic hearing impairment (66 boys and 50 girls). The control group consisted of 246 children with normal hearing (123 boys and 123 girls) aged from 8 to 12 years. The number of minor anomalies found per child (W1) was compared and the sum of the weighted scores according to Waldrop (W2) in children with normal hearing (CNH) and children with impaired hearing (CIH). A higher minor physical anomalies score was determined per child in the CIH group. In the CNH group there were 4 or more (33.6%) with multiple anomalies, while in the CNH group there were only 7.7% with four or more anomalies. A high score (W2) of five or more anomalies was determined in 18.9% of children in the CIH group and not one subject in the control group. Differences between the CIH and CNH groups for the mean score W1 and W2 were highly significant. The mean score W1 for CIH was 2.90 and for CNH 1.70. The mean score W2 for CIH was 2.93 and for CNH 1.46. According to the obtained results etiological factors probably had a parallel effect in CIH during early development, which lead to physical and hearing impairment. The high incidence found of multiple minor anomalies in CIH suggests a significant role of genetic factors in the aetiology of the basic disorder in the group of analysed children.

[A few thoughts about health system transformation in Croatia]. / Potpora promisljanjima o preobrazbi sustava zdravstva u Republici Hrvatskoj.

The aim of this article was to make reader more familiar with the shift in health and society thinking which occurred during the last fifteen years. Authors are describing changes in macro environment and their impact on health and health needs in Croatia. The notion that behavior is greatly influenced by social context in which people lead their lives is demanding a new approach to health and health system policy development. The key questions they elaborate are: How to make health system aware of these changed health needs and How to make health system more capable to respond to these unmet needs? Authors are discussing two alternatives--Health system reform and health system reorientation advocating the second one as the way to go.