Search

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 aim of this paper was to analyse the regional variations and trends in mortality from cardiovascular diseases in the population aged 0–64 years in Dalmatia and Slavonia, over the period 1998 to 2009. Mortality data were derived from Central Bureau of Statistics. The results show that age-standardized mortality rates from total cardiovascular diseases, ischaemic heart diseases and cerebrovascular diseases were lower in Dalmatia than rates for Slavonia, for both genders. All mortality rates, except rates for ischaemic heart diseases mortality for men in both regions, showed the trend of decline. Dalmatia has a more protective factors in pattern of Mediterranean diet. The improvement of cardiovascular health and reduction of premature mortality from cardiovascular diseases requires a system and comprehensive intervention approach at all levels of health care and multisectorial coordination.

The aim of this study was to provide an overview of the exceptional longevity patterns in Croatia. The prevalence of nonagenarians (aged 90 years or more) and centenarians (100 years or more) was calculated from the 1953–2001 census data. The data were analyzed with chi-square test and trend analysis. The results indicate steady and significant increasing trends in both age groups, more pronounced in women. Geographical distribution of the exceptional longevity had a clear coastline-to-mainland gradient, with higher prevalence of exceptionally old people in the coastal parts of the country. Additionally, exceptionally old respondents from the Croatian Adult Health Survey (CAHS) were compared to elderly ones (65–89 years old). The results suggested that exceptionally old respondents had lower prevalence of overweight and obesity and lower blood pressure, thus exhibiting strong survivor phenomenon. At the same time, exceptionally old respondents from the CAHS had higher prevalence of confirmed hypertension in medical history and reported taking blood pressure medication more often. The results of this study suggest that the pattern of exceptional longevity in Croatia has a clear coastline-to-mainland gradient, which is likely to be associated with the different lifestyle and dietary patterns between these two populations.

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.

The estimation of socioeconomic inequalities has lately become one of the major topics in public health research, as the numerous studies are showing strong association of inequalities with health status and outcomes. The aim of this study was to provide a general overview of the individual data available for the socioeconomic inequalities estimation from a public health survey and to compare different proxies used for socioeconomic inequalities estimation. The data from the Croatian Adult Health Survey were used, which is a large representative cross-sectional study of the general Croatian population that was performed in 2003. Four variables were compared – education and occupation class, and objective and subjective socioeconomic estimation. Strong regional differences were recorded within Croatia, generally showing better socioeconomic indices in the capital, city of Zagreb. Although all of these variables were significantly associated to one another, breakdown into the gender stratified education-by-occupation groups indicated that income was unevenly distributed in these groups and that it had non-linear association with education, especially in the white-collared occupations. Although socioeconomic inequalities do show striking association with many health related indices and outcomes and should therefore be included in all types of research on human subjects, due attention is needed in research planning, data encoding and entry, as well as interpreting the results based on this data.

The subject of this paper is how to incorporate a multi-disciplinary and inter-sectored approach into development of public health policy and plans at the local (county) level in Croatia by educational program. Method used was the public health capacity building program »Health – Plan for it«, which was developed with the aim to assist the counties to overcome recognized weaknesses and introduce more effective and efficient local public health practices. Two main instruments were used: Local Public Health Practice Performance Measures Instrument, and Basic Priority Rating System. This program has helped counties to asses population health needs in a participatory manner, to plan for health and, ultimately, assure provision of the right kind and quality of services (better tailored to population health needs). This program’s benefits are going beyond and above the county level. It provides support for the Healthy Cities project locally, and facilitates changes in national policymaking body’s mindset that a »one-size-fits-all« approach is sufficient.