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.

Estimated Pulse Wave Velocity and All-Cause and Cardiovascular Mortality in the General Population.

Background: Carotid-femoral pulse wave velocity (cfPWV), acknowledged as a reliable proxy of arterial stiffness, is an independent predictor of cardiovascular (CV) events. Carotid-femoral PWV is considered the gold standard for the estimation of arterial stiffness. cfPWV is a demanding, time consuming and expensive method, and an estimated PWV (ePWV) has been suggested as an alternative method when cfPWV is not available. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in the general population. Methods: In a stratified random sample of 1086 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 ± 16), subjects were followed for 17 years. ePWV was calculated using the following formula: ePWV = 9.587 - 0.402 × age + 4.560 × 10-3 × age2 - 2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP - 1.832 × 10-2 × MBP. MBP= (DBP) + 0.4(SBP - DBP). Results: At the end of the follow-up period, there were 228 deaths (CV, stroke, cancer, dementia and degenerative diseases, COLD, and others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the third ePWV tercile, we observed more deaths due to CV disease than to cancer (20.5% vs. 51.04%). In a Cox regression analysis, for each increase in ePWV of 1 m/s, there was a 14% increase risk for CV death. In the subgroup of subjects with higher CV risk, we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) CI 1.108; p < 0.029; HR 3.03, 95% CI 1.118-8.211). Conclusions: In subjects with high CV risk, ePWV was a significant and independent predictor of CV mortality.

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.

Telework-related risk factors for musculoskeletal disorders.

Telework has become considerably more common during the ongoing pandemic. Although working remotely may have numerous advantages, negative impacts on workers' health and safety should also be considered. Telework is a major contributor to the development or aggravation of work-related musculoskeletal disorders where unsuited workstation ergonomics, sedentary behavior, as well as psychosocial and organizational factors play a role. This paper aims to identify telework-related risks and their impact on musculoskeletal health as well as provide recommendations that may be useful in constructing future preventive measures. A comprehensive literature search regarding the topic has been performed. Teleworkers experience musculoskeletal pain and discomfort mostly in low back area, neck, shoulders, arms, and hands. Poor ergonomic solutions when it comes to workstation design resulting in prolonged sitting in non-neutral positions contribute to the development and aggravation of musculoskeletal disorders in teleworkers. Working with inadequately placed screens and laptops and sitting in maladjusted seats without usual functionalities and ergonomic support is associated with musculoskeletal pain and discomfort. Extended working hours with fewer rest periods to meet increased work demands, social isolation, and lack of support from work colleagues and superiors as well as blurred work-home boundaries and omnipresence of work are commonly stated psychosocial and organizational factors associated with musculoskeletal disorders. Environmental factors such as poor lighting and glare, inadequate room temperature, and ventilation or noise, are frequently overlooked remote workstation risk factors. For a certain part of workers, telework will remain a common way of work in the post-pandemic period. Therefore, it is essential to identify telework-related risk factors for musculoskeletal disorders and address them with timely preventive measures tailored to each remote workstation's risks and individual workers' needs.

Psychosocial risks emerged from COVID-19 pandemic and workers' mental health.

This paper examines the impact of work in a pandemic context on workers' mental health. Psychosocial risks have always been a challenging aspect of workplace health and safety practices. Moreover, the COVID-19 pandemic has affected workplaces in all sectors causing unexpected changes in work organization and working conditions, leading to the emergence of new psychosocial risks for health and wellbeing of workers. This mini-review aims to identify the main work stressors during pandemic period and related mental health problems to suggest recommendations and adjust health and safety practices regarding workplace mental health. A literature search has been performed using MEDLINE/PubMed, ResearchGate and Google Scholar databases, selecting articles focusing on work-related stressors and workers' mental health problems related to the pandemic. Specific psychosocial risks have been identified, including fear of contagion, telework-related risks, isolation and stigmatization, rapid digitalization demands, job insecurity, elevated risk of violence at work or home, and work-life imbalance, among others. All those risks can lead to elevated levels of stress among workers and affect their mental health and wellbeing, especially in terms of psychological distress, anxiety, and depression. As one of the social determinants of health, the workplace has an important and moderating role in workers' health. Therefore, in the pandemic context more than ever health protection practices at the workplace should be devoted to mental health problems. Recommendations provided in this study are expected to contribute to workplace practices to preserve and promote workers' mental health.

Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity.

BACKGROUND: The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. METHODS: A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). RESULTS: Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. CONCLUSIONS: The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19.

Knowledge of and attitudes to occupational and sports medicine among medical students in Zagreb, Croatia.

Occupational and sports medicine (OSM) education is poorly represented in Croatian university undergraduate medical curricula. Zagreb University medical students are required to take OSM classes for a week on their final year of studies. The classes are organised around team-based learning (TBL). Given that students who attend TBL classes have significantly higher exam scores than students who take lectures ex cathedra, the aim of this study was to assess students' knowledge and attitudes immediately after TBL OSM classes. This cross-sectional study included 162 final-year Zagreb University School of Medicine students taking TBL classes in OSM in the academic year of 2019/2020. They were recruited from 30 September 2019 to 4 March 2020. Participants filled in a 20-item questionnaire compiled by the authors and adapted to the Croatian legislation. Their answers demonstrated positive attitude toward OSM classes and negative attitude toward occupational medicine practice and OSM specialty. They showed moderate interest only for the job of sports physician. Even though they showed sufficient knowledge of OSM immediately after the course was completed, they were moderately satisfied with their knowledge. Our findings call for rethinking the practical aspects of teaching OSM classes in order to promote OSM practice among medical students or at least raise awareness about the importance of prevention of numerous work or sport-related disorders.

Improving Education and Training to Reduce the Burden of Occupational Cancer. The Riga-European Association of Schools of Occupational Medicine (EASOM) Statement on Work-Related Cancer.

Reducing the burden of occupational cancers (OCs) is currently one of the most challenging Occupational Health (OH) issues. The European Union (EU) has made efforts to improve the existing legal framework and developed specific legislation aimed at reducing the burden of OC. However, available data suggest that OC are underreported. In August 2019, the European Association of Schools of Occupational Medicine (EASOM) adopted a statement that highlighted the importance of improving the education and training of Medical Doctors (MDs) to facilitate improvements in recognizing and reporting OC. To achieve this, EASOM proposes to promote OH education and training of MDs at undergraduate and postgraduate levels, foster harmonization of OH education and teaching standards and programs across EU countries, and enhance cooperation between universities and international scientific associations. Finally, we suggest that occupational data should be recorded in cancer and medical registers. By engaging MDs more fully in the debate about OCs, they will become more aware of the Occupational Physician's role in reducing the burden of OCs and, furthermore, embed consideration of occupation as a potential cause of cancer into their own practice. These interventions will help promote the implementation of policies and interventions aimed to reduce OC in the workplace.

Evaluation Studies on Education in Occupational Safety and Health: Inspiration for Developing Economies.

BACKGROUND: Education and training of students, workers, and professionals are essential for occupational safety and health (OSH). We noticed a lack of debate on how to advance coverage and quality of OSH education given high shortages in developing economies. OBJECTIVES: International discussion on future options might be stimulated by an overview of recent studies. METHODS: We employed a search of the Cochrane Library and PubMed/MEDLINE databases for articles from the last decade on evaluation of OSH education. FINDINGS: We selected 121 relevant studies and 6 Cochrane reviews. Most studies came from the United States, Western Europe, and Asia. Studies from low-income countries were scarce. From a global perspective, the number of evaluation studies found was disappointingly low and the quality needs improvement. Most commonly workers' education was evaluated, less often education of students, supervisors, and OSH professionals. Interactive e-cases and e-learning modules, video conferences, and distance discussion boards are inspiring educational methods, but also participatory workshops and educational plays. Ways to find access to underserved populations were presented and evaluated, such as educational campaigns, farm safety days, and OSH expert-supported initiatives of industrial branch organizations, schools, and primary, community, or hospital-based health care. Newly educated groups were immigrant workers training colleagues, workers with a disease, managers, and family physicians. CONCLUSIONS: Developing economies can take advantage of a variety of online facilities improving coverage and quality of education. Blended education including face-to-face contacts and a participatory approach might be preferred. For workers, minor isolated educational efforts are less effective than enhanced education or education as part of multifaceted preventive programs. Collaboration of OSH experts with other organizations offers opportunities to reach underserved worker populations. Increasing international collaboration is a promise for the future. National legislation and government support is necessary, placing OSH education high on the national agenda, with special attention for most needed professionals and for underserved workers in high-risk jobs such as in the informal sector. International support can be boosted by a high-level international task force on education and training, funded programming, and a global online platform.

Tracking variability: recent anthropometric data for croatian population and comparison with other world populations.

The variability that exists within the populations of individual countries and the variability that exists between the populations of different countries are both of interest in practical application. For these reasons, a comparison is made in this work between certain anthropometric variables of our sample of Croatian population and anthropometric variables that are available for other human populations in the world of the same or a similar age. The total sample was 1,372 subjects aged from 23 to 59 years old. For the purpose of comparison, data were taken from the study "International Data on Anthropometry" which provides an overview of anthropometric variables for many world populations, as well as data from Rudan's research that was carried out on Croatian population in the late seventies of the last century. Mean value, standard deviation and coefficient of variation have been calculated for every measured parameter. A comparison between the two research samples of Croatian population fairly displays up going trend, for body mass and other bodily dimensions, formed in three decades of difference. Mean value for body height in Rudan's sample is 161.0 cm, and for Bubas's sample in this research was 170.6 cm, both values state for Croatian population but with difference of more than 30 years. Human biologists use term "secular trend" to describe alterations in the measurable characteristics of a population of humans that occur over a century. Accordingly, in adult age, the rate of gain, concerning body height, is 10 to 30 mm per decade. The changes in body proportions during recent decades are less marked than those in body size, but the relationships between stature and weight within one national group have changed significantly.

Work ability as a major determinant of clinical nurses' quality of life.

AIMS AND OBJECTIVES: To examine quality of life determinants among clinical nurses in Croatia with an emphasis on their work ability. BACKGROUND: An important personnel management challenge is to explore factors that stimulate or hinder the development of individual work ability and quality of life throughout a career. DESIGN: A cross-sectional study. METHODS: The study was performed during 2007-2008 in six randomly selected hospitals in Croatia. The self-administered questionnaires included the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health, the Quality of Life questionnaire (WHOQL-BREF) developed by the World Health Organization and additional socio-demographic questions. A total number of 1212 nurses completed the questionnaires, giving a response rate of 67(.) 3%. Binary logistic regression was performed to assess how socio-demographic characteristics and work ability groups predict each of the WHOQL-BREF domains. RESULTS: Having a satisfactory WAI score (WAI ≥ 37) was significantly the most important predictor for all quality of life domains, with the odds ratios (OR) being as follows: OR = 6(.) 8 (95% CI: 4(.) 8-9(.) 6) for the physical domain, OR = 2(.) 3 (95% CI: 1(.) 7-3(.) 1) for the psychological domain, OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 4) for the social relationship domain and OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 3) for the environmental domain. CONCLUSIONS: Satisfactory work ability was a major quality of life determinant in all WHOQL-BREF domains with the highest odds ratio for the physical domain. Maintaining clinical nurses' work ability is an important issue, because it is foundational for the quality of life of the workforce. RELEVANCE TO CLINICAL PRACTICE: Our study provides quantified estimates of the extent to which a satisfactory WAI score predicts a better score in physical, psychosocial, social relationships and environmental domain of nurses' quality of life. Therefore, maintaining or improving nurses' work ability remains the essential aim of hospital managers.

Occupational diseases, working ability and employment status in the working population of Croatia.

The paper gives insight into the working ability and employment status of workers with recognized occupational diseases in Croatia. The analysis based on working ability data from 212 workers shows that 12 (5.5%) workers have general disability for work, 75 (35.5%) occupational disability for work, 98 (46.4%) danger of disability onset, 13 (6%) no disability and 14 (6.5%) are sent for further medical treatment. The highest frequency of occupational diseases is in the group of workers with 41-50 years of age, in the category of 20-24 exposure years. Official data imply that the incidence rate of occupational diseases in Croatia is 4 times lower than in European Union. Such a low incidence rate derives from problems in the system of healthcare and health insurance, and also from problems in the system of monitoring and registering of occupational diseases.

[The development of health care for workers through history]. / Prepoznavanje potrebe zdravstvene skrbi o radnicima tijekom povijesti.

The definition of occupational health has changed significantly over time to cover broader aspects of health care and to promote worker's health. Over the centuries, the relationship between workplace hazards and occupational health care has been influenced by the character of work, social evolution and changes in manufacture, economy and demographics of the working populations. Numerous old civilizations showed deep prejudice towards human work. Very often manual work was done by slaves, and their health and safety were neglected. A spectrum of occupational diseases (acute, chronic, malignant and damage of reproduction) cover all organic body system, each of which can be affected by exposure to specific agents at workplace. Work and working conditions may deteriorate and worsen an existing illness which is not necessarily work-related. Living habits may also interfere with occupational factors leading to the development of a disease. Today, occupational medicine is the only medical field encompassing occupation and environment and health. This article also describes the historic development of occupational medicine in Croatia and some of the current regulations on occupational health in the country.

[Alcoholism--how it affects health and working capacity]. / Ovisnost o alkoholu - posljedice za zdravlje i radnu sposobnost.

Alcoholism is a growing medical and public health issue both in adult and in younger populations. It is a multi-aetiological phenomenon influenced by genetic, psychological, cultural and other factors. Alcoholic beverages have traditionally been prepared from various ingredients, such as grapes, malt, and rice. Drinking prevalence has varied and is more pronounced in women and the youth. Alcoholism is shown to be of neurophysiologic origin and may lead to the impairment of all human body systems. The most frequent cause of death in alcoholics are the diseases of the cardiovascular system. Alcoholism at workplace is a very important issue as it affects health, reduces productivity, and may lead to accidents, injuries and decreased working capacity. Alcohol-related difficulties develop much earlier than the clinical picture. The diagnosis of alcoholism includes early detection of alcohol-related problems, so it is necessary to orient the healthcare services towards primary prevention and early intervention.