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Healthcare workforce shortage is a worldwide problem (1). Workforce shortage may be defined as not having the right number of people with the right skills in the right place at the right time, to provide the right services to the right people (2). In this regard, the trends are worrisome, and the situation is getting worse. The consequences are also very consistent – limited care health services and limited quality of health care (1). In short, there is an imbalance between need and supply. The solution: as health care needs increase worldwide, the “production” of personnel must be increased! But is it really that simple? Are the problem and the solution so reciprocal and directly linked?

Healthcare workforce shortage is a worldwide problem (1). Workforce shortage may be defined as not having the right number of people with the right skills in the right place at the right time, to provide the right services to the right people (2). In this regard, the trends are worrisome, and the situation is getting worse. The consequences are also very consistent – limited care health services and limited quality of health care (1). In short, there is an imbalance between need and supply. The solution: as health care needs increase worldwide, the “production” of personnel must be increased! But is it really that simple? Are the problem and the solution so reciprocal and directly linked?

Spontaneous precipitation of calcium oxalate monohydrate (COM) in additive-free systems with nearly the same initial supersaturation has been investigated. The influence of thermodynamic parameters such as: temperature (t = 25, 36.5 and 48 °C), calcium concentration range of 5 mmol dm−3 ≤ ci(Ca2+) ≤ 10 mmol dm−3 and pH (5.6, 6.5 and 7.5), on the potential changes in structure, morphology and crystal size of COM have been studied. The values of the initial parameters were varied in a wide range and included values relevant for mimicking the physiological conditions related to those in biological systems and kidney stone formation. The results contributed to the knowledge about the influence of the selected individual parameters as well as their interplay influence on in vitro precipitation of COM. The findings have indicated that COM was the only precipitated phase exhibiting predominant dendritic morphology. The effects on crystal size, structure and morphology are more pronounced at higher temperature, pH and calcium concentration. These results provide basis for future studies of overall mechanism of COM formation and the future studies of kidney stone prevention. This work is licensed under a Creative Commons Attribution 4.0 International License.

Spontaneous precipitation of calcium oxalate monohydrate (COM) in additive-free systems with nearly the same initial supersaturation has been investigated. The influence of thermodynamic parameters such as: temperature (t = 25, 36.5 and 48 °C), calcium concentration range of 5 mmol dm−3 ≤ ci(Ca2+) ≤ 10 mmol dm−3 and pH (5.6, 6.5 and 7.5), on the potential changes in structure, morphology and crystal size of COM have been studied. The values of the initial parameters were varied in a wide range and included values relevant for mimicking the physiological conditions related to those in biological systems and kidney stone formation. The results contributed to the knowledge about the influence of the selected individual parameters as well as their interplay influence on in vitro precipitation of COM. The findings have indicated that COM was the only precipitated phase exhibiting predominant dendritic morphology. The effects on crystal size, structure and morphology are more pronounced at higher temperature, pH and calcium concentration. These results provide basis for future studies of overall mechanism of COM formation and the future studies of kidney stone prevention. This work is licensed under a Creative Commons Attribution 4.0 International License.

Spontaneous precipitation of calcium oxalate monohydrate (COM) in additive-free systems with nearly the same initial supersaturation has been investigated. The influence of thermodynamic parameters such as: temperature (t = 25, 36.5 and 48 °C), calcium concentration range of 5 mmol dm−3 ≤ ci(Ca2+) ≤ 10 mmol dm−3 and pH (5.6, 6.5 and 7.5), on the potential changes in structure, morphology and crystal size of COM have been studied. The values of the initial parameters were varied in a wide range and included values relevant for mimicking the physiological conditions related to those in biological systems and kidney stone formation. The results contributed to the knowledge about the influence of the selected individual parameters as well as their interplay influence on in vitro precipitation of COM. The findings have indicated that COM was the only precipitated phase exhibiting predominant dendritic morphology. The effects on crystal size, structure and morphology are more pronounced at higher temperature, pH and calcium concentration. These results provide basis for future studies of overall mechanism of COM formation and the future studies of kidney stone prevention. This work is licensed under a Creative Commons Attribution 4.0 International License.

U današnje vrijeme postoji mnogo algoritama inteligencije rojeva koji se uspiješno koriste za rešavanje raznih teških problema optimizacije. Zajednicki elementi svih ovih algoritama su operator za lokalnu pretragu (eksploataciju) oko prona enih obecavajucih rješenja i operator globalne pretrage (eksploracije) koji pomaže u bijegu iz lokalnih optimuma. Algoritmi inteligencije rojeva obicno se inicijalno testiraju na neogranicenim, ogranicenim ili visoko-dimenzionalnim skupovima standardnih test funkcija. Nadalje, mogu se poboljšati, prilagoditi, izmijeniti, hibridizirati, kombinirati s lokalnom pretragom. Konacna svrha je korištenje takve metaheuristike za optimizaciju problema iz stvarnog svijeta. Domeni rješenja odnosno prostori pretrage prakticnih teških problema optimizacije mogu biti razliciti. Rješenja mogu biti vektori iz skupa realnih brojeva, cijelih brojeva ali mogu biti i kompleksnije strukture. Algoritmi inteligencije rojeva moraju se prilagoditi za razlicite prostore pretrage što može biti jednostavno podešavanje parametera algoritma ili prilagodba za cjelobrojna rješenja jednostavnim zaokruživanjem dobivenih realnih rješenja ali za pojedine prostore pretrage potrebnao je skoro kompletno prepravljanja algoritma ukljucujuci i operatore ekploatacije i ekploracije zadržavajuci samo proces vo enja odnosno inteligenciju roja. U disertaciji je predstavljeno nekoliko algoritama inteligencije rojeva i njihova prilagodba za razlicite prostore pretrage i primjena na prakticne probleme. Ova disertacija ima za cilj analizirati i prilagoditi, u zavisnosti od funkcije cilja i prostora rješenja, algoritme inteligencije rojeva. Predmet disertacije ukljucuje sveobuhvatan pregled postojecih implementacija algoritama inteligencije rojeva. Disertacija tako er obuhvaca komparativnu analizu, prikaz slabosti i snaga jednih algoritama u odnosu na druge zajedno s istraživanjem prilagodbi algoritama inteligencije rojeva za razlicite prostore pretrage i njihova primjena na praktic

Background: The connection between socio-economic status and health is documented, yet not fully understood. The goal of this research was to analyze the relationship between socio-economic status, lifestyle and health status, availability of health-care, social capital, and satisfaction with life. Subjects and methods: Subjects were 1117 women aged 25-65 years divided in two groups. Group 1 consisted of women who receive public assistance (N1=591), while Group 2 consisted of women who do not (N2=526). The sample was stratified by random choice into multiple stages based on six regions of Croatia, residential area size, and the age of respondents. Visiting nurses surveyed the deprived population, while in Group 2 self-interviewing was conducted. A questionnaire entitled “Inequalities in health” was used. The respondents participated in this research voluntarily and anonymously. Results: Socially deprived women consume spirits and wine more often (p<0.001). There is no difference between groups regarding tobacco consummation. Working women perform significantly less strenuous physical tasks (p<0.001). Deprived women are significantly less engaged in physical activities (p<0.001). Health conditions in deprived women more commonly limit their physical activity (p<0.001). There is a significant difference in utilization of health-care among groups (p<0.001). Younger women who are married, with a higher number of household members, a larger income, and with higher education are generally more satisfied with life (p<0.001). Although deprived women are significantly less satisfied with their lives, feel less free, are less physically active, and less likely to consume spirits or beer, they are significantly happier than working women (p<0.001). Conclusions: Personal health status and lifestyle, access to health-care services, and life satisfaction have a high importance as predictors and protective factors of mental health in women - recipients of state-provided financial

Negatively ionisable poly-L-glutamic acid (pGlu) and poly-L-aspartic acid (pAsp), considered as analogues of the naturally occurring acidic macromolecules involved in biomineralization processes, were used as additives in the calcium carbonate precipitation systems in order to investigate their interactions with the vaterite crystallites. Poly-L-lysine (pLys), a positively ionisable poly(amino acid), was also used in order to elucidate the impact of the side chain charge. The growth kinetics of vaterite was found parabolic, indicating that the integration of growth units into the spiral step at the vaterite crystal surfaces is the rate-determining mechanism. The presence of small amounts of pGlu and pAsp inhibited the crystal growth. At the highest concentrations of both acidic macromolecules the exponential rate law was observed, which indicates the surface nucleation as the rate controlling mechanism. The addition of pLys in the range of applied concentrations did not significantly influence the crystal growth of the vaterite. Thus, the kinetic results, corroborated by morphological observations, pointed out to the significance of the negative charge of the side chains of selected polypeptides in the interfacial interactions with mineral planes. This work is licensed under a Creative Commons Attribution 4.0 International License.

Negatively ionisable poly-L-glutamic acid (pGlu) and poly-L-aspartic acid (pAsp), considered as analogues of the naturally occurring acidic macromolecules involved in biomineralization processes, were used as additives in the calcium carbonate precipitation systems in order to investigate their interactions with the vaterite crystallites. Poly-L-lysine (pLys), a positively ionisable poly(amino acid), was also used in order to elucidate the impact of the side chain charge. The growth kinetics of vaterite was found parabolic, indicating that the integration of growth units into the spiral step at the vaterite crystal surfaces is the rate-determining mechanism. The presence of small amounts of pGlu and pAsp inhibited the crystal growth. At the highest concentrations of both acidic macromolecules the exponential rate law was observed, which indicates the surface nucleation as the rate controlling mechanism. The addition of pLys in the range of applied concentrations did not significantly influence the crystal growth of the vaterite. Thus, the kinetic results, corroborated by morphological observations, pointed out to the significance of the negative charge of the side chains of selected polypeptides in the interfacial interactions with mineral planes. This work is licensed under a Creative Commons Attribution 4.0 International License.

Comprehensive whole-genome structural variation detection is challenging with current approaches. With diploid cells as DNA source and the presence of numerous repetitive elements, short-read DNA sequencing cannot be used to detect structural variation efficiently. In this report, we show that genome mapping with long, fluorescently labeled DNA molecules imaged on nanochannel arrays can be used for whole-genome structural variation detection without sequencing. While whole-genome haplotyping is not achieved, local phasing (across >150-kb regions) is routine, as molecules from the parental chromosomes are examined separately. In one experiment, we generated genome maps from a trio from the 1000 Genomes Project, compared the maps against that derived from the reference human genome, and identified structural variations that are >5 kb in size. We find that these individuals have many more structural variants than those published, including some with the potential of disrupting gene function or regulation.

Comprehensive whole-genome structural variation detection is challenging with current approaches. With diploid cells as DNA source and the presence of numerous repetitive elements, short-read DNA sequencing cannot be used to detect structural variation efficiently. In this report, we show that genome mapping with long, fluorescently labeled DNA molecules imaged on nanochannel arrays can be used for whole-genome structural variation detection without sequencing. While whole-genome haplotyping is not achieved, local phasing (across >150-kb regions) is routine, as molecules from the parental chromosomes are examined separately. In one experiment, we generated genome maps from a trio from the 1000 Genomes Project, compared the maps against that derived from the reference human genome, and identified structural variations that are >5 kb in size. We find that these individuals have many more structural variants than those published, including some with the potential of disrupting gene function or regulation.

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

Terapija pacijenata s oralnim karcinomom složena je i zahtijeva multidisciplinaran pristup koji uključuje maksilofacijalnog i oralnog kirurga, onkologa i stomatološkog protetičara, a često je potrebna i psihološka pomoć. U ovom prikazu slučaja opisana je protetička rehabilitacija pacijentice nakon uklanjanja oralnoga karcinoma izradom resekcijske proteze. Resekcijska šupljina nalazi se na srednjem dijelu tvrdog nepca, a prema Aramanyju pripada trećem razredu maksilarnih defekata. Otisak ležišta proteze i resekcijske šupljine proveden je u dva koraka. Prvi je korak otisak ireverzibilnim hidrokoloidom za ležište proteze, a drugi, otisak resekcijske šupljine dobiven kondenzacijskim silikonskim materijalom s pomoću metalne baze resekcijske proteze. Resekcijskom protezom pacijentici su nadomješteni izgubljeni zubi te joj je, uz minimalne troškove, poboljšana oralna funkcija i estetika., The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area and the resection cavity was performed. A primary impression- the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression – the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

Te²ki optimizacioni problemi, nere²ivi u prihvatljivom vremenu izvr²avanja deterministi £kim matemati£kim metodama, uspe²no se poslednjih godina re²avaju populacionim stohasti£kim metaheuristikama, me u kojima istaknutu klasu predstavljaju algoritmi inteligencije rojeva. U ovom radu razmatra se unapre enje metaheuristika inteligencije rojeva pomo¢u hibridizacije. Analizom postoje¢ih metaheuristika u odre enim slu£ajevima uo£eni su nedostaci i slabosti u mehanizmima pretrage prostora re²enja koji pre svega proisti£u iz samog matemati£kog modela kojim se simulira proces iz prirode kao i iz nedovoljno uskla enog balansa izme u intenzikacije i diversikacije. U radu je ispitivano da li se postoje¢i algoritmi inteligencije rojeva za globalnu optimizaciju mogu unaprediti (u smislu dobijanja boljih rezultata, brºe konvergencije, ve¢e robustnosti) hibridizacijom sa drugim algoritmima. Razvijeno je i implementirano vi²e hibridizovanih metaheuristika inteligencije rojeva. S obzirom da dobri hibridi ne nastaju slu£ajnom kombinacijom pojedinih funkcionalnih elemenata i procedura razli£itih algoritama, ve¢ su oni utemeljeni na sveobuhvatnom izu£avanju na£ina na koji algoritmi koji se hibridizuju funkcioni²u, kreiranju hibridnih pristupa prethodila je detaljna analiza prednosti i nedostataka posmatranih algoritma kako bi se napravila najbolja kombinacija koja nedostatke jednih neutrali²e prednostima drugih pristupa. Razvijeni hibridni algoritmi verikovani su testiranjima na standardnim skupovima test funkcija za globalnu optimizaciju sa ograni£enjima i bez ograni£enja, kao i na poznatim prakti£nim problemima. Upore ivanjem sa najboljim poznatim algoritmima iz literature pokazan je kvalitet razvijenih hibrida, £ime je potvr ena i osnovna hipoteza ovog rada da se algoritmi inteligencije rojeva mogu uspe²no unaprediti hibridizacijom..., Hard optimization problems that cannot be solved within acceptable computational time by deterministic mathematical methods have been successfully solved in recent years by population-based stochastic metaheuristics, among which swarm intelligence algorithms represent a prominent class. This thesis investigates improvements of the swarm intelligence metaheuristics by hybridization. During analysis of the existing swarm intelligence metaheuristics in some cases deciencies and weaknesses in the solution space search mechanisms were observed, primarily as a consequence of the mathematical model that simulates natural process as well as inappropriate balance between intensication and diversication. The thesis examines whether existing swarm intelligence algorithms for global optimization could be improved (in the sense of obtaining better results, faster convergence, better robustness) by hybridization with other algorithms. A number of hybridized swarm intelligence metaheuristics were developed and implemented. Considering the fact that good hybrids are not created as a random combination of individual functional elements and procedures from dierent algorithms, but rather established on comprehensive analysis of the functional principles of the algorithms that are used in the process of hybridization, development of the hybrid approaches was preceded by thorough research of advantages and disadvantages of each involved algorithm in order to determine the best combination that neutralizes disadvantages of one approach by incorporating the strengths of the other. Developed hybrid approaches were veried by testing on standard benchmark sets for global optimization, with and without constraints, as well as on well-known practical problems. Comparative analysis with the state-of-the-art algorithms from the literature demonstrated quality of the developed hybrids and conrmed the hypothesis that swarm intelligence algorithms can be successfully improved by hybridization...

Background and Purpose: The aimof this study is to evaluate the use of EriscssonMobileHealth (EMH) system for rural, distant, older, chronically ill patient monitoring in SisakMoslavina County in the region of ASSC. The aim is to evaluate quality, patient satisfaction, health care provider satisfaction with EMH system as well as possible obstacles and points for possible cost savings. Materials and Methods: The solution we tested is Ericsson Mobile Health (EMH), a mobile medical device of class IIa, composed of several components that include package for patient, server and applications. Package for patient includes several sensors depending on type of monitoring, communication device and expendable material. Package for patient consists of sensors for Pulse Oximetry (SaO2), Electro Cardio Graph (ECG), Peak Expiratory Flow (PEF) and Forced Expiratory Volume in 1 Second (FEV1), Blood Pressure (BP) and Blood Glucose Level. Communication device is central part of patient package. It collects sensor measurements available via Bluetooth interface and it sends themtowards server available viamobile network.Doctor access to server and browse through patient data using application for doctors. As amethod for evaluationwe used interviews with open-ended questions for both patients and medical personnel. Data were analyzed using qualitative conventional content analysis. Results: Common denominator in all interviews with patients was feeling of security and possibility of quick intervention if needed. Also, they felt they can substantially save on transportation. Medical personnel observed mainly technical objections regarding devices. As for benefits they recognized continuity of care, easy access to primary care, responsiveness to specific patients needs, in one visit field nurse can cover group of patients, and accurate data for decision making. Conclusion: EMHis adaptable and secure systemthat can reduce costs of health care in distant rural areas both for population and

U radu je analizirana kvaliteta vode za napajanje goveda i konja na obiteljskom gospodarstvu. Uzorci vode uzimani su jednom mjesečno od lipnja do prosinca iz termopojilica koje su priključene na vodovodnu mrežu. Istraživani su sljedeći pokazatelji kvalitete vode: temperatura, boja, pH, vodljivost, utrošak kalijeva perman-ganata, amonijak, nitriti, nitrati, kloridi te aerobne mezofilne i koliformne bakterije. Vrijednosti za utrošak kalijeva permanganata i amonijevih iona kao kemijskih pokazatelja koji ukazuju na količinu organske tvari u vodi premašivale su maksimalno dozvoljene koncentracije tijekom ljetnih mjeseci u vodi za napajanje goveda i konja. Značajno veće (p<0,05) koncentracije utvrđene su u vodi za goveda. Tijekom mje¬seca kolovoza u vodi za napajanje goveda također je uočen porast koncentracije ni¬trita iznad dopuštenih vrijednosti. U vodi za napajanje obiju vrsta životinja zabilježen je pozitivan nalaz koliformnih bakterija te povećan broj mezofilnih bakterija iznad dopuštene granice tijekom cijelog razdoblja istraživanja. Broj mezofilnih bakterija bio je značajno veći (p<0,05) u vodi za napajanje goveda tijekom ljetnih mjeseci, a u vodi za napajanje konja tijekom zimskih mjeseci. Rezultati istraživanja kvalitete vode navode na zaključak da su se goveda radije napajala iz termopojilice tijekom toplijeg razdoblja, dok konji tijekom hladnijeg razdoblja. Osim toga, vrijednosti istraživanih pokazatelja kvalitete vode za napajanje obiju vrsta životinja upućuju na potrebu redovitijeg čišćenja i dezinfekcije termopojilica., Water quality for cattle and horse watering at a family farm was analysed in the study. Water samples were collected once per month from June to December from thermo drinkers connected to water network. The following water quality parameters were analysed: temperature, colour, pH, potassium permanganate consuming capacity, ammonium, nitrite, nitrate, chloride, aerobic mesophilic and coliform bacteria. Values of potassium permanganate consuming capacity and ammonium ions as chemical parameters which indicate the amount of organic substance in the water exceeded maximum permissible levels during the summer in the water for cattle and horse watering; nevertheless, significantly higher (p<0.05) concentrations were determined in the water for the cattle. Also, during the month of August increase in the nitrite concentration above the permissible levels was observed in the water for the cattle watering. In the water for both animal species positive coliform bacteria and increased number of meso philic bacteria above the permissible level were recorded during total study period. The number of mesophilic bacteria was significantly higher (p<0.05) in the water for the cattle watering during the summer, and in the water for the horse watering during the winter. Study results of the water quality suggest that the cattle preferred to drink from thermo drinker during the warmer period, while horses during the cooler period. Moreover, the values of the observed parameters of the water quality for the watering of both animal species point to the necessity of disinfection of the thermo drinkers and more regular cleaning.

U ruralnim područjima živi 47,6 % ukupnog stanovništva Hrvatske. Procjenjuje se da ima 1.485.647 članova poljoprivrednih kućanstava u koje ubrajamo pored radno aktivnih muškaraca i žena, djecu te starije i invalidne osobe. Na članove poljoprivrednih kućanstava ne primjenjuju se mjere i pravila sigurnosti za osiguranje njihove zaštite zdravlja, ni nadzor nad njihovom primjenom temeljem postojećih zakona jer nije zasnovan radni odnos. Broj ozljeda i profesionalnih bolesti se ne može utvrditi jer ne postoji obveza prijavljivanja. Cilj rada je utvrditi postojeće stanje zaštite zdravlja i sigurnosti članova poljoprivrednih kućanstava na području Požeško-slavonske županije, opasnosti i štetnosti koje se javljaju prilikom obavljanja poljoprivrednih poslova zbog uređivanja i donošenja specifičnih mjera i minimalnih uvjeta za zaštitu zdravlja i sigurnost kojima se mogu otkloniti i smanjiti ozljede te profesionalne bolesti. Upitnikom su prikupljeni podaci o članovima poljoprivrednih kućanstava, najčešćim ozljedama, profesionalnim bolestima, nošenju zaštitne opreme te uporabi pesticida. Istraživanje je provedeno na području Požeško-slavonske županije u razdoblju od veljače do travnja 2011. godine, a obuhvatilo je 164 ispitanika, od toga 104 žene (dobi od 18 do 83) i 60 muškaraca (od 18 do 93 godina). Ozljede prilikom obavljanja poljoprivrednih poslova zadobilo je 32 (19,5 %) ispitanika. Utvrđene ozljede klasificirane su kao lakše i teže, a otrovanje pesticidima zabilježeno je u 6 ispitanika (3,6 %). Zaštitnu opremu, uglavnom rukavice, nose njih 84 (51,2 %). Od ukupno 91 djeteta, njih 58 (63,7 %) obavlja poljoprivredne poslove u kućanstvima. Prikazani podaci o stanju zaštite zdravlja i sigurnosti upućuju na potrebu proširivanja istraživanja ruralnih područja RH te pristupanja uređivanju i donošenju mjera i pravila kojima bi se svim članovima poljoprivrednih kućanstava osigurali bolji uvjeti rada i zaštite zdravlja., In Croatia, 47.6% of the population lives in rural areas. It is estimated that the number of persons working in farm households is around 1,485,647 which includes labour-active male and female population, children, the elderly and disabled persons. Occupational safety measures and regulations are not enforced in the case of the farm households and their implementation cannot be controlled as the people are not officially employed. The exact number of injuries and professional diseases cannot be determined since there is no obligation of reporting. This research aims to describe the current status of health protection and safety in farm households as found in Požeško-slavonska County. The gathered information can be used to introduce specific minimum health protection and safety measures in agriculture intended to remove causes of injuries and occupational diseases. Using the HELS questionnaire data was collected regarding participants' health status, behaviour and perception of typical factors related to agriculture and rural life, most frequent injuries and occupational diseases, usage of protective equipment and methods of pesticides application. The research was conducted from February to April 2011 in Požeško-slavonska County. The research sample consisted of 164 participants, 104 women (aged 18 to 83) and 60 men (aged 18 to 93). Injuries were reported in 32 (19,5%) participants and categorised from minor to severe. Pesticide intoxication was reported in 6 (3,6%) participants. The questionnaire shows that protective equipment, mostly work gloves, is used by 84 (51,2%). Out of 91 children in families that participated in this research, 58 (63,7%) worked in agriculture. Presented results suggest the need for further research in rural areas of Croatia regarding health protection and safety of farm households and a need for securing the implementation of equal or at least minimum health and safety measures for all members of farm households.

Background and Purpose: The aimof this study is to evaluate the use of EriscssonMobileHealth (EMH) system for rural, distant, older, chronically ill patient monitoring in SisakMoslavina County in the region of ASSC. The aim is to evaluate quality, patient satisfaction, health care provider satisfaction with EMH system as well as possible obstacles and points for possible cost savings. Materials and Methods: The solution we tested is Ericsson Mobile Health (EMH), a mobile medical device of class IIa, composed of several components that include package for patient, server and applications. Package for patient includes several sensors depending on type of monitoring, communication device and expendable material. Package for patient consists of sensors for Pulse Oximetry (SaO2), Electro Cardio Graph (ECG), Peak Expiratory Flow (PEF) and Forced Expiratory Volume in 1 Second (FEV1), Blood Pressure (BP) and Blood Glucose Level. Communication device is central part of patient package. It collects sensor measurements available via Bluetooth interface and it sends themtowards server available viamobile network.Doctor access to server and browse through patient data using application for doctors. As amethod for evaluationwe used interviews with open-ended questions for both patients and medical personnel. Data were analyzed using qualitative conventional content analysis. Results: Common denominator in all interviews with patients was feeling of security and possibility of quick intervention if needed. Also, they felt they can substantially save on transportation. Medical personnel observed mainly technical objections regarding devices. As for benefits they recognized continuity of care, easy access to primary care, responsiveness to specific patients needs, in one visit field nurse can cover group of patients, and accurate data for decision making. Conclusion: EMHis adaptable and secure systemthat can reduce costs of health care in distant rural areas both for population and

U radu je analizirana kvaliteta vode za napajanje goveda i konja na obiteljskom gospodarstvu. Uzorci vode uzimani su jednom mjesečno od lipnja do prosinca iz termopojilica koje su priključene na vodovodnu mrežu. Istraživani su sljedeći pokazatelji kvalitete vode: temperatura, boja, pH, vodljivost, utrošak kalijeva perman-ganata, amonijak, nitriti, nitrati, kloridi te aerobne mezofilne i koliformne bakterije. Vrijednosti za utrošak kalijeva permanganata i amonijevih iona kao kemijskih pokazatelja koji ukazuju na količinu organske tvari u vodi premašivale su maksimalno dozvoljene koncentracije tijekom ljetnih mjeseci u vodi za napajanje goveda i konja. Značajno veće (p<0,05) koncentracije utvrđene su u vodi za goveda. Tijekom mje¬seca kolovoza u vodi za napajanje goveda također je uočen porast koncentracije ni¬trita iznad dopuštenih vrijednosti. U vodi za napajanje obiju vrsta životinja zabilježen je pozitivan nalaz koliformnih bakterija te povećan broj mezofilnih bakterija iznad dopuštene granice tijekom cijelog razdoblja istraživanja. Broj mezofilnih bakterija bio je značajno veći (p<0,05) u vodi za napajanje goveda tijekom ljetnih mjeseci, a u vodi za napajanje konja tijekom zimskih mjeseci. Rezultati istraživanja kvalitete vode navode na zaključak da su se goveda radije napajala iz termopojilice tijekom toplijeg razdoblja, dok konji tijekom hladnijeg razdoblja. Osim toga, vrijednosti istraživanih pokazatelja kvalitete vode za napajanje obiju vrsta životinja upućuju na potrebu redovitijeg čišćenja i dezinfekcije termopojilica., Water quality for cattle and horse watering at a family farm was analysed in the study. Water samples were collected once per month from June to December from thermo drinkers connected to water network. The following water quality parameters were analysed: temperature, colour, pH, potassium permanganate consuming capacity, ammonium, nitrite, nitrate, chloride, aerobic mesophilic and coliform bacteria. Values of potassium permanganate consuming capacity and ammonium ions as chemical parameters which indicate the amount of organic substance in the water exceeded maximum permissible levels during the summer in the water for cattle and horse watering; nevertheless, significantly higher (p<0.05) concentrations were determined in the water for the cattle. Also, during the month of August increase in the nitrite concentration above the permissible levels was observed in the water for the cattle watering. In the water for both animal species positive coliform bacteria and increased number of meso philic bacteria above the permissible level were recorded during total study period. The number of mesophilic bacteria was significantly higher (p<0.05) in the water for the cattle watering during the summer, and in the water for the horse watering during the winter. Study results of the water quality suggest that the cattle preferred to drink from thermo drinker during the warmer period, while horses during the cooler period. Moreover, the values of the observed parameters of the water quality for the watering of both animal species point to the necessity of disinfection of the thermo drinkers and more regular cleaning.

Many living organisms form mineral phases through biologically controlled processes, known as biomineralization. Thus created materials are composites of both, mineral and organic components. The shell of the gastropod mollusc red abalone (Haliotis rufescens) consists of calcite and aragonite layers, each of them containing characteristic biopolymers responsible for biomineralization. In this work, the effect of interstitial green sheet polypeptide, GP, extracted from the green layer of the mollusc red abalone shell, on the process of spontaneous precipitation of calcium carbonate polymorphs, was investigated. Three precipitation systems, in which the initial mineralogical composition of the precipitate was different, have been studied. Thus, in system (1) calcite appeared, in system (2) a mixture of calcite and vaterite was found, while in system (3), ASW, only aragonite precipitated. However, the precipitation kinetic measurements, X-ray diffraction, FT-IR spectroscopy, and light and scanning electron microscopy indicated that the addition of GP in the model systems caused the inhibition of precipitation and change of morphology of crystals as a consequence of GP adsorption on the crystal surfaces and its entrapment into the mineral structure. (doi: 10.5562/cca2197)

Groundwater in the Eastern Croatia, as well in the South-eastern Hungary, contains relatively high concentrations of arsenic that can cause chronic toxicity to humans. Therefore, the aim to find an ef-fective composite adsorbent that can be applied for arsenic water remediation by introducing it in the groundwater treatment is very important. The presented results were obtained using layered double hy¬droxide (LDH) as a sorbing system. MgAl LDH samples with a Mg:Al molar ratio of 2:1 were synthe¬sized. Adsorption of arsenic anions from groundwater samples from Eastern Croatia, as well as adsorption of model aquatic arsenic sample solutions, on MgAl layered double hydroxide was investigated. Induc¬tively coupled plasma atomic emission spectrometry (ICP-AES) was used for determination of arsenic concentration after adsorption. It was shown that in both cases the adsorption process could be interpreted in terms of Kroeker adsorption isotherm regardless to the presence of other ions in the groundwater. Addi¬tionally, the influence of phosphate concentration on adsorption of model arsenic samples was examined and it was shown that (at least in examined range of arsenic and phosphate concentration) there is no sig¬nificant influence of phosphate on adsorption of arsenic. (doi: 10.5562/cca2283)

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for bothmen and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

The aim of this article was to identify parameters that determinate PCS and MCS values, and analyze 5-year changes in those values according to the age, sex and geographic region. Cohort of 3229 participants was obtained from the CAHS 2003–2008. Results revealed no statistically significant differences between same age group, sex, and different region regarding PCS and MCS. When chronic conditions were in themodel difference was present, PCS beingmore influenced by all conditions but bronchial asthma. The strongest influence comes from musculoskeletal conditions; followed by weak heart. Values for PSC and MSC decreased in 2008 compared with 2003, but only in few cases decrease was statistically significant. Values of PCS and MCS are higher in men in all regions, but they show higher variability than woman. Our results support the findings that data obtained through SF-36 could be the useful for public health interventions regarding chronic diseases.

This study examined individual and combined influence of smoking, physical inactivity, alcohol drinking, and unhealthy diet on total mortality. Relationship between individual and combined poor health behaviours and total mortality were examined using Cox proportional hazards regression. Out of 7490 individuals included in the study, during 5 years follow up 808 died. Adjusted hazard ratios (HRs), and 95% confidence intervals (95%CIs) for men with health behaviour scores 1, 2, 3, and 4 compared with those with score 0 were 1.67 (1.24–2.24), 2.28 (1.64–3.18), 2.24 (1.32–3.84), and 2.86 (0.77–11.70), respectively (p value for trend<0.001). Adjusted HRs (95%CIs) for women with health behaviour scores 1, 2, and 3 compared with those with score 0 were 1.17 (0.97–1.42), 1.37 (1.02–1.86), and 1.20 (0.37–3.61), respectively (p value for trend=0.04). A unit of the health behaviour score increased mortality risk equivalent to being 5.9 and 2.9 years older, for man and woman respectively.

Croatia has a long tradition of non-communicable disease prevention, but also obstacles to the implementation of preventive programs related to the general attenuation of public health and primary health care sector. The aim of this study was to determine trends in behavioral and biomedical risk factors and evaluate primary non-communicable disease and cardiovascular prevention. Physical inactivity was a leading risk factor with increasing trend and prevalence of 33.9% and 38.9% in men and women in 2008. In 2008, obesity was present in 26.1% and 34.1%, and hypertension in 65.8% and 59.7% of men and women. During the follow-up only smoking and alcohol consumption in men decreased significantly, while alcohol consumption and obesity in women, and hypertension in both sexes significantly increased. In the present situation, with the existing trends and environment it will not be possible to stop negative trends. Revitalization of public health activities and primary health care is essential.

The aim of this study is to identify factors that influence the success of the implementation of the primary and secondary prevention programs in Croatia by the visiting/community services. Two main sources of information were used: reports about regular visiting nurse services in Croatia and research about visiting nurse participation in the Croatian Adult Health Cohort Study (CroHort) 2008. Out of the total number 9,070 respondents who participated in CAHS 2003 survey, during CroHort 2008 program 3,229 (35.6%) participants were re-interviewed. The qualitative analysis was done with a sample of 34 visiting nurses, which participated in the CroHort 2008. Results show that there are three key problems which limit preventive programs: inability of the health care system to recognize the importance of the primary prevention; visiting nurses’ lack capacity to implement prevention and populations’ lack of motivation and education.

The aims of this paper are to investigate the change in prevalence of psychological distress (PD), to investigate the cumulative incidence of the psychological distress and to indicate are there any differences between genders and various age groups in Croatian adult population. Psychological distress status was measured by the five-item Mental Health Scale (MHI-5) of the Short Form questionnaire (SF-36). Psychological distress was present in 28.5% (95% CI 25.7%–31.2%) of men and 32.1% (95% CI 30.1%–34.0%) of women in 2003. In 2008 PD was present in 33.0% (95% CI 30.1%–35.9%) of men and 34.1% (95% CI 32.1%–36.0%) of women. The highest incidence of PD, both for men and women, was in the oldest age group (>65 years). Results of this study demonstrating the fact that every third adult men and woman in Croatia are in psychological distress, the fact that there is an increase in PD prevalence for men and women should be taken into account in the future mental health policy planning.

Eliminating four behavioral risk factors (tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol) could contribute to a decrease of up to 80% in burden of non-communicable diseases, including cardiovascular diseases. Primary healthcare providers have a unique position within the healthcare system, which allows them to actively contribute to the prevention of cardiovascular behavioral risk factors (CVBRFs) by providing individual counseling. The aim of this article is to show the change in frequency and the effects of counseling on CVBRFs by healthcare providers between two periods: up until 2003 and between 2003 and 2008. Results, obtained within the CroHort study, show a low frequency and undesired effects of counseling within the healthcare system in both studied periods. This points to a lack of consistency with which the healthcare system tackles prevention of behavioral risk factors for cardiovascular diseases.

Nutritional habits between urban and rural population differ as much as life style and socioeconomic standards of these populations. In Croatia, rural populations are mostly live stock producers. Their nutrition frequently depends on their own production, which includes high quantity of cured meat products, eggs and dairy products. Data were obtained from longitudinal the Croatian Adult health Survey and pilot cross-sectional survey in three villages in Sisa~ko-moslava~ka county. Our findings show that there is no great difference between urban and rural population regarding salt intake. The difference is in the type of food and food preparation, as well as life style. We propose combination of more culturally and socially sensitive questionnaires along with analytical methods that include biological matrix, such as 24-hour urine collection.

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisa~ko-moslava~ka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia’s rural population. Specific public health intervention and services for rural populations must be promoted.

Aim To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. Methods The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Results Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Conclusion Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking.

Background and Purpose: High salt intake through food rich in salt is one of the important risk factors for hypertension, and even modest reduction in salt intake lowers the blood pressure (BP). In Croatia 91.6 % of the total territory is classified as rural and 47.6% of population live in rural regions. The study was conducted in order to determine salt intake and awareness on harmful effect of salt on BP, prevalence, treatment and control of hypertension in rural part of Sisak – Moslavina County (SMC), third largest county in Croatia. Materials and Methods: In total there were 107 participants, 50 (46.7%) male, and 57 (53.3%) female. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or current treatment with an antihypertensive medication. Treated hypertension was defined as the current use of an antihypertensive medication. Salt intake was estimated based on questionnaire results. Results: Prevalence of hypertension was 84% for male and 77.2% for female. Out of 88 hypertensive participants, 76.7% were treated, and hypertension of 59.1% was uncontrolled. Salt intake was high. 71% of participants were aware that salt intake is related to hypertension, 70% did not know main sources of salt intake in every day meal, and only 39.2% were advised by health professionals. Conclusion: Prevalence of hypertension, nutrition without variety but rich in salt, and unsatisfactory knowledge on harmful effect of salt on BP and health should attract attention of national and local public health authorities to apply proper measures.

Background and Purpose: High salt intake through food rich in salt is one of the important risk factors for hypertension, and even modest reduction in salt intake lowers the blood pressure (BP). In Croatia 91.6 % of the total territory is classified as rural and 47.6% of population live in rural regions. The study was conducted in order to determine salt intake and awareness on harmful effect of salt on BP, prevalence, treatment and control of hypertension in rural part of Sisak – Moslavina County (SMC), third largest county in Croatia. Materials and Methods: In total there were 107 participants, 50 (46.7%) male, and 57 (53.3%) female. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or current treatment with an antihypertensive medication. Treated hypertension was defined as the current use of an antihypertensive medication. Salt intake was estimated based on questionnaire results. Results: Prevalence of hypertension was 84% for male and 77.2% for female. Out of 88 hypertensive participants, 76.7% were treated, and hypertension of 59.1% was uncontrolled. Salt intake was high. 71% of participants were aware that salt intake is related to hypertension, 70% did not know main sources of salt intake in every day meal, and only 39.2% were advised by health professionals. Conclusion: Prevalence of hypertension, nutrition without variety but rich in salt, and unsatisfactory knowledge on harmful effect of salt on BP and health should attract attention of national and local public health authorities to apply proper measures.

Aim To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. Methods The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Results Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Conclusion Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking.

Biomineralization processes are the subject of numerous investigations. This article gives a review of the study on interactions between the charged polypeptides and the mineral surfaces involved in biomineralization, with an additional kinetic approach. The influence of polypeptides on two types of precipitation processes is discussed: the spontaneous precipitation from supersaturated solution and the growth kinetics of calcite seed crystals. In the first case the phenomenon of the formation and stabilization of metastable phases was found while in the second case the influence of the applied polypeptides on the kinetics and mechanisms of calcite crystal growth was investigated. Calcium carbonate polymorphs, calcite and vaterite, were used as biomineral substrates and acidic polypeptides, poly-L-aspartic (pAsp) acid and poly-L-glutamic (pGlu) acid, as simplified models of naturally occurring soluble acidic proteins. A basic polypeptide, poly-L-lysine (pLys), was also used in experiments in order to find out whether conformity between the crystal surface and the adsorbed polypeptide, or just the electrostatic interactions, have a decisive role in these processes. The addition of a particular polypeptide into the precipitation system caused a significant inhibition of nucleation and growth of vaterite, the extent of inhibition being in the order InhpAsp > InhpGlu >> InhpLys. In addition to the inhibition of precipitation, the change of the polymorphic composition and the crystal morphology of the precipitate were also achieved. The explanation of such acidic polypeptide behaviour is a consequence of kinetic constraints through the diverse efficiency of inhibition of both calcite nucleation and vaterite growth caused by adsorption of acidic polypeptides. The acidic polypeptides also caused the inhibition of calcite crystal growth, the effect being pAsp > pGlu, and changed the observed mechanism of growth controlled by the integration of ions into the spiral steps, as

Psychological distress (PD) is being increasingly recognized as a risk factor for cardiovascular diseases (CVD). Our aim was to recognize an association of PD and CVD in the Croatian adult population. We also explored association’s strength obtainable as relative risk of PD on three levels; cardiovascular risk behaviors, conditions and diseases. This study used Croatian Adult Health Survey 2003 (CAHS 2003) data (N = 9,070). PD status was measured by the five-item Mental Health Scale of the Short Form questionnaire (SF-36) hence one distinguished subgroup consisted of population with PD and other without PD. Prevalence of cardiovascular risk behaviors, cardiovascular risk conditions and self-reported cardiovascular diseases within each subgroup were calculated using bootstrap method. Women had higher prevalence of PD in general population. Among distressed population women had higher prevalence of body mass index over 30, metabolic syndrome and angina pectoris. Men with PD had higher prevalence of high blood pressure and myocardial infarction with contradictory lower prevalence of angina pectoris then myocardial infarction. Physical inactivity was proven to be a risk behavior determinant with most impact on mental health. All CVD are consistently associated with higher prevalence and relative risks for PD both in men and women.

Cardiovascular diseases are the leading cause of death in Croatia, with significant regional differences. Despite high mortality rates, high prevalence of various cardiovascular risk factors and well organized public health network, comprehensive system for cardiovascular disease monitoring and interventions does not exist. In this study we analyzed legislation framework and responsibilities of stakeholders relevant for cardiovascular disease surveillance and prevention. According to the international experiences we analyzed characteristics of cardiovascular disease prevention in Croatia and causes of the problems appeared in the preventive programs in Croatia. Analysis showed that primary problem is not inefficiency, but the existence of barriers in preventive activities definition, responsibilities distribution and task implementation. Main cause for such situation is incompatibility of the existing practices in clinical medicine and public health with recommendations from other countries. For the successful prevention of cardiovascular disease in Croatia at least three changes need to be made – define new terms and contents of prevention, define new responsibilities distribution and provide equity in health as basic criterion for successful preventive programs.

This article explores who among the doctors, other health care workers, family or somebody else most frequently advised women about their lifestyle changes related to cardiovascular health (including smoking, nutritional habits and physical activity). We analyzed who advised the most, in relation to the parameters important in the etiology of cardiovascular diseases: age, systolic blood pressure and body mass index (BMI). Sample was a part of comprehensive Croatian Adult Health Survey, comprised of women from Primorje-Goran, Istra and Lika-Senj Counties. Results indicated low frequency of advising on lifestyle changes in primary health care in all three counties, with most advice from general practitioners on nutritional habits. Family and other health care workers advised about smoking and nutrition and had strong influence in the youngest age groups. The GPs failure to counsel younger population and disease-free women could be regarded as the missed opportunity for avoidance of preventable risk factors that are associated with cardiovascular diseases. Other subjects in the health care process, as well as the family and media could fill the gaps between the patients and health care system messages. In order to create and develop such heterogeneous network approaches to training various programs and activities have to take into account all specific gender and regional characteristics.

The objective of this study was to investigate regional gradient of a synthetic cardiovascular burden (CVRB) in Croatia. Analysis was based on a multistage stratified sample representative of general adult population in six regions of Croatia (Croatian Adult Health Survey). Synthetic CVRB was defined by incidents (heart attack, stroke), blood pressure, overweight/obesity (BMI, waist circumference), and risky behaviours (smoking, physical inactivity, high alcohol consumption, inadequate nutrition). Total CVRB in Croatia was 44.7% for men and 50.3% for women. Combining both high and moderate CVRB, men were found to be under more risk than women (72.8% vs. 61.7%, respectively). The result showed an east-north-west gradient in continental Croatia, with high CVRB in Eastern (40.2%) and Central region (44.3%), City of Zagreb (45.7%) and Northern region (53.1%). Mountainous region had the lowest prevalence of respondents with high CVRB (39.2%). Coastal region with the prevalence of 46.3% of high CVRB was nearly the same as the City of Zagreb. The results suggest the presence of substantial regional differences in the cardiovascular risk burden.

The effect of salt on the behaviour of bovine serum albumin (BSA) in solution and on the interactions between BSA and the weakly charged polyelectrolytes poly(allylamine hydrochloride) and poly(dimethylaminoethylmethacrylate) was investigated by potentiometric titrations. Titrations of pure BSA solution and of the BSA solution with the addition of polyelectrolyte were performed in the presence of different salts. Three electrolytes having the same anion and a different cation were used, lithium chloride, sodium chloride, and caesium chloride. The corresponding base served as titrant. Experiments were performed at four electrolyte concentrations. The titration curves showed a strong influence of ionic strength and the electrolyte type. The cation effect was found to be in accordance with the Hofmeister series.

Cilj Ispitati povezanost društvene uloge i objektivnog i subjektivnog odnosa prema zdravlju i korištenju zdravstvenih usluga u populaciji žena starijih od 65 godina u Hrvatskoj. Postupci Uporabljeni su podatci Hrvatske zdravstvene ankete (Short Form 36 Health Survey) iz godine 2003. U žena umirovljenica i domaćica starijih od 65 godina analizirane su i uspoređene antropometrijske mjere samoprocjena zdravlja, korištenje zdravstvenih usluga i društvenoekonomsko stanje. Rezultati Krajnji uzorak sastojao se od 791 domaćice i 1151 umirovljenice. Domaćice su imale veći opseg pojasa (98.44±13.9 vs 96.49±13.5, P=0.002, t test) i viši sistolički krvni tlak (152.88±25.2 vs 147.79±22.8, P<0.001, t test). U samoprocjeni zdravlja domaćice su imale niži indeks na Mental Component Summary (MCS) ljestvici (40.28±12.5 vs 42.96±12.4, P<0.001, t test). Slabijom su procjenjivale i kvalitetu svojega života (40.28±12.5 vs 42.96±12.4, P<0.001, t test). Značajno rjeđe su obavljale regularne preglede dojki u godini koja je prethodila anketi (7.5% vs 13.6%, χ2=18.0350, P<0.001), ali druge oblike pregleda, uključivši i općemedicinske, obavljale su jednako redovito kao umirovljenice. Zaključak Domaćice se od umirovljenica razlikuju u objektivnim i subjektivnim mjerama zdravstvenog stanja, korištenju zdravstvenim uslugama i samoprocjeni kvalitete života. To treba držati na umu pri odgovarajućem javnozdravstvenom planiranju., Aim To explore the association between the social role and objective and subjective health measures and use of health care services in the population of women older than 65 years in Croatia. Methods We used the data from the 2003 Croatian Adult Health Survey (Short Form 36 Health Survey). Two sub-populations, retired women and housewives aged over 65 years, were analyzed and compared according to anthropometric measures, health self-assessment, utilization of health care services, and socioeconomic status. Results The final sample consisted of 791 housewives and 1151 retired women. Housewives had larger waist circumference (98.44 ± 13.9 vs 96.49 ± 13.5, P = 0.002, t test) and higher systolic blood pressure (152.88 ± 25.2 vs 147.79 ± 22.8, P<0.001, t test). On self health assessment, housewives had lower index on Mental Component Summary (MCS) (40.28 ± 12.5 vs 42.96 ± 12.4, P<0.001, t test).They also had lower self-assessed quality of life (40.28 ± 12.5 vs 42.96 ± 12.4, P<0.001, t test). Housewives performed regular breast check-ups significantly less often in the 12 months before the survey (7.5% vs 13.6%, χ2 = 18.0350, P<0.001), but they performed other forms of medical examinations, including general physical check-ups as often as retired women. Conclusion Housewives differed from retired women of the same age in objective and subjective measures of health status, use of health care services, self perceived health, and self-assessed quality of life. These differences should be taken into account when planning public health measures for these age groups of women.

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.

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.

Gospodarenje medicinskim otpadom, koji po svojim svojstvima može biti opasan i/ili inertan, u Hrvatskoj je regulirano trima temeljnim pravnim aktima: Zakonom o otpadu, Pravilnikom o vrstama otpada te Naputkom o postupanju s otpadom koji nastaje pri pružanju zdravstvene zaštite. Uz njih još su i Zakon o prijevozu opasnih tvari i Zakon o otrovima akti koji podupiru provedbu ovih propisa. Slijedom razvoja suvremenih cjelovitih sustava za gospodarenje otpadom razvijen je i cjeloviti sustav za gospodarenje medicinskim otpadom koji se zasniva na hijerarhijskome načinu postupanja s otpadom, i to od kontrole mjesta nastanka do mjesta konačne dispozicije. Prioritet je svakako izbjegavanje nastanka otpada, tj. smanjenje potencijala otpada, međutim to nije uvijek moguće, stoga je otpad potrebno sortirati, primjereno predobraditi, na poseban način transportirati, konačno obraditi te ostatke prikladno deponirati. Konačna metoda obrade mora biti ona koja će proizvesti najmanji rizik za ljudsko zdravlje i okoliš. Provođenjem cjelovitog sustava gospodarenja otpadom velike količine otpada mogle bi se zbrinuti u okviru tehnološkog i komunalnog otpada, čime bi zbrinjavanje opasnoga medicinskog otpada zahtijevalo manja financijska sredstva. Svaki od ovih koraka zakonski je definiran i opisan, međutim njegovo je provođenje najveći problem. U lancu od mjesta nastanka u zdravstvenim ustanovama pa sve do konačne dispozicije nailazimo na neprimjereno rukovanje, nepoštivanje propisa o ambalaži, pa sve do obrade u postrojenjima bez uporabne dozvole. Nema potpunih podataka o količinama i tokovima medicinskog otpada, ali ni sustava državne kontrole putem sanitarne inspekcije. Poseban su problem lokacije za konačno odlaganje, tj. nedostatak sanitarnih odlagališta. Hrvatska je potpisnica međunarodnih konvencija o nadzoru prekograničnog prometa opasnog otpada i njegovu odlaganju (Baselska konvencija). U okviru projekta CARDS započeta je izrada analize stupnja usklađenosti zakonodavstva RH s pravno, Medical waste management in Croatia is regulated by three fundamental legal acts: Waste Act, Ordinance on Waste Types and Directive on Manipulation of Waste Generated in Health Care. The implementation of these acts and waste management in general are also supported by Transport of Hazardous Materials Act and Toxic Substances Act. Modern trends in waste management promote an integral approach also called “waste chain”. This integral approach to medical waste management is based on hierarchical structuring of waste management structure from the point at which the waste is produced to its final disposal. Priority is always given to reducing the amount and the harmfulness of waste by replacing harmful materials with those that are not, but where this is not possible, waste management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Methods of choice for the final treatment should be the least harmful for human health and environment. Integral medical waste management could greatly reduce quantities of medical waste and consequently financial strains. Even though Croatian regulations define and cover all steps in the waste management chain their implementation is one of the country’s greatest issues. Improper practice is seen from waste production in healthcare institutions to the final disposal, and includes handling, sorting, use of containers, or treatment in incinerators. Information on quantities, type and flow of medical waste are inadequate, just as sanitary control. In addition, Croatia lacks locations for sanitary landfills. Croatia has signed international conventions on the supervision and control of transfrontier waste shipments. Within the CARDS project, Croatia has started to harmonise its laws with acquis communitaire related to waste management. Although waste management is one of the priorities defined within the National Environment Action Plan, Croatia still has not made a

Udio osoba starije životne dobi u populaciji Republike Hrvatske u kontinuiranomu je porastu. Otprije poznate poteškoće razvijenih zemalja Zapada poput nedostatka zdravstvenih radnika u sustavu te njihove nedovoljne edukacije iz gerontologije i gerijatrije vode u nepripremljenost za specifi čne potrebe starijih, koje postaju značajan problem i u Hrvatskoj. Suočeni smo također i s nestankom obiteljskih zajednica koje su tradicionalno nosile velik dio tereta skrbi za starije. Primjena Programa utvrđivanja, praćenja i proučavanja zdravstvenih potreba i funkcionalne sposobnosti starijih osoba koji se provodi putem centara za gerontologiju županijskih zavoda za javno zdravstvo nužno je razvijati te unapređivati. Planiranje zdravstvene skrbi za osobe starije životne dobi treba biti dovoljno fl eksibilno da prepoznaje ključna društvena kretanja i razvojne procese te da im se prilagođava kako bi moglo adekvatno udovoljiti zdravstvenim potrebama starijih i u budućnosti. Moguća rješenja treba tražiti u već postojećim primjerima suradnje profesionalih skupina, javnoga i nevladinog sektora te na primjerima dobre prakse iz inozemstva. Rješenja treba temeljiti na “bottom up” pristupu, dovoljno osjetljivom da prepoznaje regionalne geografske, populacijske i gospodarske razlike kako bi se svima osigurala kvaliteta i pravednost u osiguranju zdravstvene skrbi. Preduvjeti uspješnog planiranja zdravstvene skrbi za starije uključuju kontinuirano praćenje pokazatelja, rad sa zajednicom te proaktivan pristup javnog sektora, prije svega zdravstvenoga i socijalnog, ali i gospodarstvenoga te mirovinskog i izobrazbenog sustava., The share of the elderly in the overall population of the Republic of Croatia has been continuously growing. The already known diffi culties that western countries have had to face, such as the insuffi cient number of health care providers and the inadequate education in gerontology and geriatrics, have led to the unpreparedness for special needs of elderly patients and have become a major problem in Croatia as well. We are also facing the disappearance of traditional families that were engaged in the care for the elderly to a large extent. The Programme for Defi nition, Monitoring and Studying of Health Needs and Functional Abilities of the Elderly, which is implemented by Centres for Gerontology of County Institutes of Public Health, should be developed and upgraded. The planning of geriatric health care should be suffi ciently fl exible to identify key social trends and development processes, adjust to them and thus be able to adequately meet the health requirements of the elderly in the future. Cooperation of professional associations, public sector and NGOs, as well as best practices applied abroad, should provide a good example. The solutions should be based on a bottom up approach, which is suffi ciently thorough to identify regional, geographical, demographic and economic differences and thus ensure quality and fair health care for everybody. The prerequisites for a successful planning of geriatric health care include the continuous monitoring of indicators, work in the community and the proactive approach of the public sector, primarily health care, social, economic, pension and education systems.

Udio osoba starije životne dobi u populaciji Republike Hrvatske u kontinuiranomu je porastu. Otprije poznate poteškoće razvijenih zemalja Zapada poput nedostatka zdravstvenih radnika u sustavu te njihove nedovoljne edukacije iz gerontologije i gerijatrije vode u nepripremljenost za specifi čne potrebe starijih, koje postaju značajan problem i u Hrvatskoj. Suočeni smo također i s nestankom obiteljskih zajednica koje su tradicionalno nosile velik dio tereta skrbi za starije. Primjena Programa utvrđivanja, praćenja i proučavanja zdravstvenih potreba i funkcionalne sposobnosti starijih osoba koji se provodi putem centara za gerontologiju županijskih zavoda za javno zdravstvo nužno je razvijati te unapređivati. Planiranje zdravstvene skrbi za osobe starije životne dobi treba biti dovoljno fl eksibilno da prepoznaje ključna društvena kretanja i razvojne procese te da im se prilagođava kako bi moglo adekvatno udovoljiti zdravstvenim potrebama starijih i u budućnosti. Moguća rješenja treba tražiti u već postojećim primjerima suradnje profesionalih skupina, javnoga i nevladinog sektora te na primjerima dobre prakse iz inozemstva. Rješenja treba temeljiti na “bottom up” pristupu, dovoljno osjetljivom da prepoznaje regionalne geografske, populacijske i gospodarske razlike kako bi se svima osigurala kvaliteta i pravednost u osiguranju zdravstvene skrbi. Preduvjeti uspješnog planiranja zdravstvene skrbi za starije uključuju kontinuirano praćenje pokazatelja, rad sa zajednicom te proaktivan pristup javnog sektora, prije svega zdravstvenoga i socijalnog, ali i gospodarstvenoga te mirovinskog i izobrazbenog sustava., The share of the elderly in the overall population of the Republic of Croatia has been continuously growing. The already known diffi culties that western countries have had to face, such as the insuffi cient number of health care providers and the inadequate education in gerontology and geriatrics, have led to the unpreparedness for special needs of elderly patients and have become a major problem in Croatia as well. We are also facing the disappearance of traditional families that were engaged in the care for the elderly to a large extent. The Programme for Defi nition, Monitoring and Studying of Health Needs and Functional Abilities of the Elderly, which is implemented by Centres for Gerontology of County Institutes of Public Health, should be developed and upgraded. The planning of geriatric health care should be suffi ciently fl exible to identify key social trends and development processes, adjust to them and thus be able to adequately meet the health requirements of the elderly in the future. Cooperation of professional associations, public sector and NGOs, as well as best practices applied abroad, should provide a good example. The solutions should be based on a bottom up approach, which is suffi ciently thorough to identify regional, geographical, demographic and economic differences and thus ensure quality and fair health care for everybody. The prerequisites for a successful planning of geriatric health care include the continuous monitoring of indicators, work in the community and the proactive approach of the public sector, primarily health care, social, economic, pension and education systems.

Cases of American liver fluke (Fascioloides magna) were detected in Croatia for the first time in January 2000. Initial suspicions with regard to the presence of Fascioloides magna in the red deer (Cervus elaphus L.) population were raised in Baranja, eastern Croatia, during the winter of 1999. Red deer liver samples from that area were examined and 22 adult parasites were recovered. The parasites, as well as mature eggs, were determined to be Fascioloides magna. The parasite was probably introduced into the Baranja region by natural deer migration from neighbouring Hungary., Tijekom siječnja 2000. godine po prvi puta je ustanovljena prisutnost velikog američkog metilja (Fascioloides magna) u Hrvatskoj. Sumnja na njegovu prisutnost u populaciji jelena običnog (Cervus elaphus L.) postavljena je tijekom zime 1999. godine u istočnom dijelu Hrvatske, odnosno Baranje. Dostavljeni i pregledani uzorak jetre jelena običnog s tog područja sadržavao je 22 odrasla parazita. Paraziti i zrela jajašca determinirani su kao Fascioloides magna. Paraziti su vjerojatno uneseni na područje Baranje prirodnom migracijom jelena iz susjedne Mađarske.

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of

This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.