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Purpose: The aim of the study was to determine importance and intensity of individual or groups of health and social factors that could influence school success. Background: Medical examination before enrollment in primary school might detect factors described as predictors of school success before enrollment. It is not possible to change social factors or family characteristics, but they could worn that children have risk, especially if they have psychosomatic, emotional, neurotic or hyperactivity disorders or social immaturity or if they had poorer results on “Draw a man” test. Material and methods: The longitudinal study comprised 361 children (50.4% girls) in primary school in Zagreb, Croatia. Children were examined before enrollment in primary school and followed over the eight year of primary school by school medicine specialist. Results: Predictors of school success known before enrollment might account 57-60%, and together with predictors collected during primary school might account 75-82% of school success. Out of studied predictors known before enrollment, the greatest contribution to the determination coefficient was observed to be parent’s education level. Among predictors collected during the primary school, the greatest impact was observed to be supplementary classes. In boys, success in school was observed to be more influenced by behavior disorders, hyperactivity and social immaturity than intellectual capacity. In girls, intellectual capacity, result obtained on test “Draw a man” together with social immaturity, had the same impact on school success. Conclusions: Predictors collected during primary school have indicated many specific characteristics of poor success, especially in boys: class re-attendance, make-up exams, supplementary classes, behavior disorders and absence without leave. It is like a vicious circle-“once it starts, it never ends” and “poor success maintains poor success”. It is very important to support pupils with poor success to improve their self confidence and skills, especially if they have learning disabilities.

Poznavanje tjelesnog rasta unutar neke populacije važno je iz nekoliko razloga. U svakodnevnom preventivnom i kliničkom radu važno je procijeniti kakav je rast nekog djeteta, je li u granicama karakterističnim za dob i spol, odnosno postoje li odstupanja. S javnozdravstvenog gledišta, tjelesni rast je vrlo osjetljiv pokazatelj zdravlja. Pojam rasta u užem smislu obuhvaća kvantitativne promjene, povećanje tjelesne visine i tjelesne mase. Razlike u tjelesnoj visini i masi djece odražavaju stanje zdravlja i prehrane stanovništva, ako se na odgovarajući način izuzme utjecaj genetskog potencijala. Model tjelesnog rasta i razvoja tijekom vremena se mijenja, a praćenje dinamike tih promjena u određenoj populaciji omogućuje prepoznavanje čimbenika koji utječu na rast, time i na zdravlje djece i mladih.U zaključku je potrebno ukazati na porast centilnih vrijednosti za tjelesnu visinu u našem istraživanju u usporedbi s vrijednostima iz istraživanja koje je provela Prebeg prije dvadeset dvije godine. To ukazuje na važnost obnavljanja centilnih krivulja u populaciji obzirom na prisutnost sekularnog trenda, uslijed kojeg su do sada korištene krivulje rasta zastarjele. Drugi važan razlog za ponavljanje antropometrijskih mjerenja i izrade krivulja rasta jest važnost relevantnih kriterija za procjeni rasta i razvoja djece i mladih (51). Ukoliko se današnja djeca s rizikom za smanjen rast procjenjuju na temelju „starih“ centilnih krivulja, veliki broj djece s poremećajem ne bi bio otkriven. To naglašava potrebu za kontinuiranom obnovom centilnih krivulja rasta. Kroz djelatnost mjera specifične preventivne zdravstvene zaštite školske djece i mladih koje provode službe za školsku i sveučilišnu medicinu u Hrvatskoj mogu se prikupljati podaci potrebni za reviziju i obnavljanje referentnih vrijednosti i krivulja rasta za tjelesnu visinu, masu i ITM. Za ITM su sada po prvi puta izračunate referentne vrijednosti i izrađene centilne krivulje za školsku djecu i mlade u Hrvatskoj . Podaci o opseg struka i bokova za školsku djecu i mlade po prvi puta su u Hrvatskoj prikupljeni istraživanjem u sklopu projekta. Za reviziju i obnavljanje referentnih vrijednosti i krivulja potrebno je razmotriti uvrštenje mjerenja opsega struka i bokova u antropometrijska mjerenja koja se rutinski provode u sklopu sistematskog pregleda.

Metabolički sindrom (MS) definira se kao skup čimbenika rizika za nastanak diabetes mellitus-a tipa II (DM tip II) i kardiovaskularnih bolesti. Dijagnoza MS kod djece i mladih postavlja se temeljem kriterija koje je definirala International Diabetes Federation (IDF) i opseg struka je glavna komponenta dijagnostičkih kriterija. U našem istraživanju provedenom među adolescentima u dobi od 16 do 18 godina bila su prisutna dva kriterija za MS, povećan opseg struka i povišene vrijednosti arterijskog tlaka imalo je 66 (5, 4%) mladića od 1223 i 46 (4, 1%) od 1118 djevojaka. Adolescenti s navedena dva kriterija za MS su populacija kod koje treba učiniti dodate laboratorijske pretrage kako bi se mogla i postaviti dijagnoza MS. Program mjera specifične zdravstvene zaštite školske djece i mladih u Hrvatskoj uključuje antropometrijska mjerenja koje se rutinski provode tijekom sistematskih pregleda i time je omogućen probir djece s rizicima za MS uz dodatne laboratorijske pretrage.

Purpose The aim of The Course is to give insight on health care system and epidemiological and socio-medical determinants of health. Background The Community Health Course is a part of Curriculum University of Zagreb School of Medicine since 1952. One of obligatory activities on The Course is health education of school children. Material and methods The Course practical has been performed in Požega County which has 27042 pupils in 14 main elementary schools and 1383 pupils are dispersed in 20 dislocated schools in small villages. Students learn how to teach teaching and develop communication skills, by performing the usual activities of local school medicine service. This is also help for local health service because of small numbers of school medicine teams which take care of large number of school children. Results “Puberty” is a teaching unit routinely taught every year. Students prepare the class under the supervision of course tutors and lecture by themselves. At the end of The Course students are required to fulfill evaluation questionnaire about performed activities (community nurses, family medicine, health education in schools, …) using grades from “1-bad” to “5-excellent.” Course evaluation by 224 student’s right after the course and 192 of the same generation of students 2 years later showed that health education of elementary school children is among the best evaluated activities, with average grades of 4.85 and 4.36. Conclusion The community health course is commonly one of the best evaluated courses at School of Medicine in Zagreb, with health education recognized as valuable part of medical program. “…the preparations I made for lecturing school children I took seriously, because our task as doctors is not only to cure but also to educate people”. “…(.the lecture was the best and the most educational part of the practice.”) “…applause after the lecture – priceless!” (Students, 2008).

Background: Vocational guidance is a multidisciplinary activity founded on scientific bases of medicine, psychology, pedagogy and other sciences which provides systematic, complex and continuing help to the person in carrier developing process. It sustains professional informing, counseling and selection. School medicine doctor monitors pupil’s health condition during the school time by preventive and specific measures as well as their professional development. Purpose: The aim of this study was to present reasons for vocational guidance in 10 primary schools in Varaždin County in Croatia from year 1997 to 2010. Material and methods: The study included 5800 8th grade pupils in 10 primary schools from year 1997 to 2010. On regular systematic examination in 8th grade of primary school, school medicine specialist gives assessment of pupil’s psycho-physical abilities for further education. During examination, counseling is provided for all pupils, and vocational guidance for pupils with chronic diseases and developmental difficulties. All procedures are oriented to personal abilities and preferences. Results: Vocational guidance was performed on 538 (9.3%) pupils with chronic diseases and developmental difficulties. The main reasons for vocational guidance were mental and behavioural disorders in 128 (37.3%) boys and 70 (35.9%) girls. After vocational guidance, pupils received assessment with suggestion for at least two occupation opportunities. Sixty seven pupils (12.5%) didn’t follow the suggestion of expert team, because of subjective or objective reasons. Conclusions: Through follow-up of pupil’s growth, development and health condition, school medicine specialist monitors opportunities for career choice. Special attention is needed for schoolchildren with chronic diseases and developmental difficulties, because of limited occupation choices. Parents and pupils should be informed before career choice, about diseases or limitations in other to develop interests for occupation without contraindication on time.

The “Community Health Course” is based on approach in medical education that main fields of action for physicians are human settlements, not laboratories and consulting rooms. The course is performed on 4th year of study and organised by Andrija Štampar School of Public Health. The course is composed of seminars (18 hours) and practical (30 hours) and is performed in rural community 200 km far from Zagreb, throughout 6 days. Practical work takes place in different health care settings: out-hospital care (community nurses, family medicine, primary paediatrics care, occupational medicine) ; county public health institute (school medicine, social medicine, epidemiology and environmental health) ; local general hospital ; practical health education in schools, kindergartens, retirement homes ; practical with families in their homes and public health field research. The course has been one of the best evaluated courses at School of medicine in Zagreb. The student’s essays are full of very emotional experiences from the practical, where they felt the real sense of working with people far away from clinics and laboratories. Living for a while in population and taking part in activities of the local health services gives them the opportunity to understand social, organizational and epidemiological determinants of health as well as the knowledge and skills necessary to improve it. Analysis of evaluation showed that students were mostly oriented to clinical specializations, before attending the course. After the course, students developed motivation for work in rural areas which could influence choice of their future specialization in family medicine or public health. They also recognised the importance of public health interventions and especially health promotion activities. Evaluation suggests that students recognize the value of community oriented course not just to keep it in memory as one of the most valuable experiences during their studies, but has influence on their professional attitudes.

Purpose The purpose of this paper was to point out the importance of internet and other forms of cyber-bullying. This kind of bullying could cause serious consequences on mental health of children, especially threatened are children with special needs. Background Internet bullying is the use of Internet to send or post text or images intended to hurt or embarrass another person. Cyber-bullying instances have been increasing over the last several years. Material and methods We used data from medical records of school medicine counseling service. Results A number of parents of children with special needs visited counseling service in school medicine because of cases of cyber and internet bullying. Children with special needs in Croatia are integrated in regular school program. Many of them try as much as possible to be involved in a number of aspects of regular life like use of electronic media for communication with peers. In recent years, like use electronic media for communication, cyber bulling is also increasing among children. Mostly, parent of children with special needs have access on Facebook profile or e-mail of their children and often they notice cruel and nasty massages sent by other children. When children were asked why they do that, they answered that it was just a massage, it is not something personal, or they didn’t taught something like that and they didn’t do nothing bad. Children don’t recognize massages as their own personal opinion. Conclusion School medicine service together with schools should provide intensive education of children and parents how to use electronic media for communication, and not as a source of violence.

Purpose: The aim of this study was to analyze physical activity, eating habits, smoking, personal and family medical history among school children in order to recognize risk factors for development of CVD. Background: Cardiovascular diseases (CVD) are a major cause of premature death and disability worldwide. The risk of CVD can be reduced quickly and substantially with successful preventive practices. Material and methods: Cross-sectional study was conducted on representative sample of 40 elementary and 20 high schools in Croatia. The study comprised 2869 children (46% girls) in 1st and 8th grade of elementary school and 3rd grade of high school. Children completed questionnaire and anthropometric measures were taken. Data were analyzed using descriptive statistics. Results: Analysis of eating habits among pupils of 8th grade showed that 23.4% of boys didn’t consume fruit and 43.3% of girls had less than 3 meals daily. Fast food consumption more than 3 times a week was reported by 32.9% of boys. 62.0% of boys trained in sport club. Physical activity with sweating less than three times a week was reported by 78.3% girls. Smoking was reported by 70% girls. CVD in own medical history was reported by 3.6% of boys. Hypertension was reported in family medical history by 34.9- 45.4% of pupils. TV-viewing more than 2 hours daily was reported by 19% of children in 1st grade. Alcohol consumption more than six times last month was reported by 5.3% of boys in 1st and 28.9% in 8th grade. All studied habits were worse among pupils in 3rd grade of high school. Conclusions: The results of these study showed that habits recognized risk for CVD from childhood to adolescence. Except family history, other recognized risks belong mostly to modifiable CVD risks factors that could be prevented or changed trough appropriate preventive programs.

Purpose: The aim of this study was to analyze difference of health related life style habits using different criteria for classification of nutritional status in schoolchildren, as a precondition of intervention. Background: The risk factors for cardiovascular disease (CVD) are high blood pressure, glucose and lipids, increased body mass index (BMI/ kg/m2), tobacco consumptions and positive family history. Important determinants are also eating habits and physical activity. Material and methods: Cross-sectional study comprised 965 children in 8th grade of elementary school. Self administrated questionnaire was completed and anthropometric measures were taken. International (1) and national (2) age and gender specific criteria for BMI were used to determine nutritional status as normal weight, overweight or obese. Data were analyzed using descriptive statistics. Results: Using international criteria 18% boys and 15% girls were overweight or obese. BMI>95th percentile using Croatian national standards had 7% boys and 10% girls. Classification according to different criteria statistically significant didn’t match in 13.54% boys and 4.9% girls (p0.05) in physical activity in a form of sport training in club was not observed between boys and girls. Conclusions: The results of this study confirmed importance of appropriate criteria for assessment of nutritional status of children, in order to recognize those with objective risk and involve them in CVD preventive programs. References: 1. Cole TJ et al. establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000 ; 320:1240-3. 2. Jureša V, Musil V, Kujundžić Tiljak M. Croatian reference values of BMI for children aged from 6.5 to 18.5 years. Available at: http://www.mef.hr/druga.php?grupa=020331050100

Background: Since 1952 many generations of medical students attended The Community Health Course at University of Zagreb School of medicine, organised by Andrija Štampar School of Public Health. The practical part of the course is performed in rural communities where students work under supervision of local health professionals in out-hospital care and take parts in activities of local county public health institute. Objectives: The course is based on approach in medical education, that main fields of action for physicians are human settlements, not laboratories and consulting rooms. The students attend the course throughout 6 days with 18 seminar hours and 30 hours of practical. They are required to describe and evaluate (using grade from 1-bad to 5- excellent) activities of each course day. Results: Analysis of students (n=225) course evaluation in academic year 2007/08 showed that students were very satisfied with preparatory seminar (98%), final seminar (97%), course content (89%), organisation (90%) and practical work: community nurse service (94%), water sampling (87%), general practice (93%), health promotion activities (93%) and field research (98%). Satisfaction with the course was very emotionally expressed in descriptions and essays, such as: “…practical with community nurse in the poorest area in the poorest county in Croatia changed my life. In only few hours I learned to want less and to give more. Each medical doctor should experience it, because it is a real world.” Conclusions: The course encouraged students to comprehend the importance of communities in the health of individuals and families. Students have opportunity to perceive community inside and outside of health care system, and to study epidemiological and socio-medical determinants of health, throughout activities of health and social care systems.

Dobre preventivne programe moguće je provoditi ako postoje valjani podaci o učestalosti i proširenosti čimbenika rizika od srčanožilnih bolesti u dječjoj i adolescentnoj dobi. U Hrvatskoj je provedeno istraživanje na reprezentativnom uzorku od tri kohorte učenika, prvi i osmi razred osnovne škole i treći razred srednje škole, o životnim navikama, osobnim i obiteljskim rizicima od srčanožilnih bolesti i antropometrijskim mjerenjima. Istraživanjem je obuhvaćeno 2.869 učenika, 960 prvih i 965 osmih razreda osnovne škole te 944 trećih razreda srednje. Rezultati pokazuju da se s dobi povećava broj čimbenika rizika od srčanožilnih bolesti, kao što su: svakodnevno puši cigarete 24, 0% mladića i 28, 5% djevojaka srednjoškolaca, indeks tjelesne mase veći od 30 kg/m2 ima 4, 2% mladića i 1, 3% djevojaka u srednjoj školi. Sistolički krvni tlak jednak ili viši od 130 mmHg i/ili dijastolički jednak ili viši od 85 mmHg ima 35, 9% mladića i 13, 8% djevojaka srednjoškolaca. Sve navedene čimbenike rizika moguće je prepoznati preventivnim pregledima u ranijoj školskoj dobi. Preventivne aktivnosti, koje bi uključivale djecu i njihove obitelji, ali i širu zajednicu, ponajprije bi trebale biti usmjerene na pravilnu prehranu, povećanje tjelesne aktivnosti i smanjenje pušenja duhana.

The approach in teaching at The Andrija Stampar School of Public Health of the Zagreb University Medical School, that physicians have to work mostly in patients’ natural environment instead of surgeries and clinics, resulted in Community Health Course held in rural area 200 km far from Zagreb. The aim of this paper is to compare student’s evaluation done immediately after completing the course in 8th semester of study of medicine with that of the evaluation of the same course two years later in 12th semester. Investigation covered 225 students of the 2007/08 generation and vas repeated with same students when they were at the sixth year of the study. Out of 225 students at the entry, 192 repeated the interview two years later) response rate 85.3%). Preparatory seminars, final seminar, organization of the field activities, the content of the course, field research which they performed, practical work with family practitioner and field visiting nurse, their own performance in health education session in elementary school and environmental control of water supplies were rated by students with grades 1 (very bad) to 5 (excellent). Introductory seminars were graded with 4-5 by 98% of students at entry compared with 64% of the same students two years later. Same grades for final seminars were 97% and 78% respectively. The content was very good and excellent for 89% at entry and 86% two years later. Figures for other categories were also very high: 90% and 82% for organization, 98% and 63% for engagement in field research, 94% and 92% for work with home visiting nurse, 93% and 92% for work with family practitioner, 93% and 94% for their engagement in health education as well as (7% and 49% for environmental control of water supplies. Free comments were very emotional as for instance: “….. the work in patient’s homes in very poor area changed my life. Every physician has to experience this real life.” Evaluation suggests that students recognize the value of our community oriented course and keep it in memory as one of the most valuable experiences during their studies. Living for a wile in population and taking part in activities of the local health services gives them the opportunity to understand social, organizational and epidemiological determinants of health as well as the knowledge and skills necessary to improve it.

Predmet Zdravlje u zajednici provodi Škola narodnog zdravlja “Andrija Štampar” Medicinskog fakulteta Sveučilišta u Zagrebu od 1952. godine i temelji se na pristupu da je područje djelovanja liječnika zajednica i ljudsko okruženje, a ne samo ordinacija i klinika. Cilj rada je usporedba rezultata evaluacije predmeta Zdravlje u zajednici provedene među studentima neposredno nakon nastave i dvije godine kasnije. Istraživanjem je obuhvaćeno 224 studenata koji su pohađali predmet Zdravlje u zajednici na četvrtoj godini studija akademske godine 2007/08. i 192 studenta (85, 7%) iste generacije na šestoj godini studija. Studenti su popunjavali upitnik o aktivnostima tijekom predmeta. Rezultati: Neposredno nakon prakse, od 224 studenta, veliko zadovoljstvo (ocjene 4 i 5) je iskazalo 98 % pripremnim i 97 % završnim seminarom, 90 % organizacijom i 89% sadržajem predmeta terenskim istraživanjem 98 %, radom s patronažom 94 %, te u obiteljskoj medicini i zdravstvenim odgojem 93 %. Rezultati ankete dvije godine kasnije pokazuju i dalje veliko zadovoljstvo ovim predmetom, posebice zdravstvenim odgojem 94 %, radom u patronaži i obiteljskoj medicini 92 %. Zaključak: Praksa u ruralnoj sredini omogućila je studentima uvid u organizaciju i djelovanje zdravstvenog sustava, međusektorsku suradnju te socijalno-medicinske determinante zdravlja, stoga ovaj predmet doživljavaju kao jedno od najljepših i najkorisnijih iskustava tijekom studija.

During ORPHEUS conference in Aarhus 2009, representatives of 42 institutions from 26 European countries answered questionnaire on organisation of PhD studies, conditions for enrolment into studies, and prerequisites for obtaining PhD. According to answers, PhD programmes at 34 (83%) institutions are combination of research for the PhD thesis and organised courses which students can choose according to their wishes and needs. Institutions have proposed number of ECTS credits that students have to accumulate, and proposed number of articles that students have to publish before obtaining PhD. Prerequisite for enrolment into PhD study is Master (3+2), or MD degree. Those requirements are harmonised which make mobility of students possible. Conditions that make mobility of students impossible or hard possible are: to sign up for PhD study students must have supervisor/ mentor for PhD thesis at 31 (74%), scientific project at 32 (76%), and prepare periodical reports of work at 26 (62%) of institutions. All those mean that student’s mobility depends on supervisor. Student should have agreements of supervisor and employer for enrolment into course or research work at the other institution. Mobility of student will be support by supervisor and employer only if course or research work is related to scientific project of supervisor, and only in that case employer will give positive assess of student’s work. Student also should ensure funds for mobility. Supervisor must be person involved into international project. In that case student’s mobility would be part of research project with ensured funds for it.

By following a child’s growth, development, and health, school medicine specialist can see opportunities for career choice. Special attention is needed for schoolchildren with chronic diseases and developmental diffi culties, because of limited occupation choices. Studies report 10 % to 15 % prevalence of chronic diseases among schoolchildren. Parents and children should be informed about child’s limitations before career choice. It would be helpful for the students to develop interests for occupations that are not contraindicated for their condition. Physical examination gives an insight into the psycho-physical abilities of an eighth-grade primary school student for further education. During examination, counselling and vocational guidance is provided for all students with chronic diseases and other health problems. All procedures are oriented to personal abilities and preferences. The aim of this study was to analyse the reasons for vocational guidance in the Varaždin County of Croatia. It included eighth-grade students from ten primary schools from 1998/99 to 2007/08. Of 4939 students, 458 (9.3 %) with chronic diseases and health diffi culties were referred to vocational guidance. Of these, 41.3 % were referred due to mental and behavioural disorders. These students were assessed and received a recommendation for at least two occupations. Forty-eight students (10.5 %) did not follow the recommendation. In a coordinated effort, school physicians, vocational guidance experts, and school and local authorities should secure enrollment of students with chronic diseases and health diffi culties in secondary schools and follow their development and education to provide them the best available career opportunities.

Introduction: This study was a part of research project: “Cardiovascular risks of school children and youth – intervention model development”. The aim was to investigate anthropometric measurements as a predictor of systolic blood pressure (SPB) and diastolic blood pressure (DBP) among school children, differed by gender and age. Methods: The study was conducted on 11 480 school children (5694 boys and 5786 girls) in age 6 - 18 year. Body height, body weight, waist circumference (WC), hip circumference (HC) and blood pressure (BP) was measured and BMI (kg/m²) was calculated. Data were analyzed using multivariate regression analysis. Results: Using body height, body weight, WC, HC and age as independent variables, statistically significant predictors of SBP in boys were body weight (p

The course aim is to encourage students to comprehend the importance of communities in the health of individuals and families. The course is based on approach in medical education that main fields of action for physicians are human settlements, not laboratories and consulting rooms. Students have opportunity to perceive community inside and outside of health care system, and to study epidemiological and socio-medical determinants of health, throughout activities of health and social care systems. Students work under supervision of local health professionals, physicians and community nurses, in order to facilitate experience, knowledge, skills and attitudes transfer. Course, composed of seminars (18 hours) and practical (30 hours) is performed in local, mostly rural communities, throughout 6 days, from Monday to Saturday. A full day of preparatory seminar, held at the School of Public Health “Andrija Štampar” precedes the field visit. In local setting, students have every evening summing up seminar with reports from morning and afternoon tasks, preparation of health education lectures. The last day is final seminar with course evaluation. Practical work takes place in different health care settings: out-hospital care (community nurses, family medicine, primary paediatrics care, occupational medicine) ; county public health institute (school medicine, social medicine, epidemiology and environmental health) ; local general hospital ; practical health education in schools, kindergartens, retirement homes ; practical with families in their homes and public health field research. Expecting learning outcomes for students considering knowledge are: economic, historic, cultural, ecological, social determinants of community ; community development, organisation and health status as a result and determinant of socioeconomic status ; influence of moral, cultural, social values on health status of individuals ; public health assessment of community needs for health care ; efficiency of public health interventions, critical analysis of organization of local health care system ; preparation of health educational methods in different settings (lectures, small group work, counselling) ; health promotion in community nursing, and inter-sector collaboration in practice. Considering skills, students are required to develop: communication with people where they live, work and go to school ; collaboration with medical professionals and stakeholders in community ; working rapport with public health research subjects ; taking of water samples ; interview techniques ; performance of epidemiologic survey ; organisation and implementation of vaccination programme ; assessment of water supplies ; performance of health education through lectures and group work with healthy and chronically ill individuals ; participation in community based public health programs (in houses, schools, workplaces), assessment of living and working conditions and performance of local health system regular activities. The course has been one of the best evaluated courses at School of medicine in Zagreb. The student’s essays are full of very emotional experiences from the practical, where they felt the real sense of working with people far away from clinics and laboratories.

Cilj: Ispitati učestalost navike pušenja cigareta u studenata medicine na prvoj i završnoj godini studija obzirom na spol i pušenje roditelja. Metode: Upitnikom o zdravstvenom stanju i ponašanju mladih anketirani su studenti upisani u prvu godinu studija medicine Medicinskog fakulteta Sveučilišta u Zagrebu ak. godine 2004./05. i ponovno na šestoj godini studija ak. godine 2009./10. Između više pitanja koja se odnose na pušenje, izabrali smo pitanje o broju popušenih cigareta dnevno u posljednjih 30 dana pri čemu smo pušačima smatrali one koji su pušili dvije ili više cigareta dnevno. Uspoređeni su podaci o učestalosti pušenja na prvoj i šestoj godini studija i to obzirom na spol i pušenje roditelja, a razlike su testirane χ2 testom na razini p=0, 05. Rezultati: Anketirana su 243 studenta prve godine studija (68, 7% studentice) od kojih je njih 126 (75, 4% studentice) ponovno ispunilo isti upitnik na šestoj godini studija (tzv. čista generacija). Na prvoj godini studija učestalost svakodnevnog pušenja bila je 15, 6% (18, 7% u studenata i 14, 5% u studentica), dok je na šestoj godini taj postotak 12, 7% (16, 1% i 12, 0%). Iako je očita manja učestalost pušenja na šestoj godini u odnosu na prvu godinu studija isto kao i da studentice puše u manjem postotku od svojih muških kolega, niti jedna od tih razlika nije se pokazala statistički značajnom. Nađena je statistički značajna povezanost pušenja studenata s pušenjem njihovih roditelja: svaki drugi student koji puši ima i roditelja pušača, dok među studentima nepušačima tek svaki treći ima roditelja pušača (p=0, 033). Zaključak: Očito je transgeneracijsko prenošenje navike pušenja. Smanjenje učestalosti pušenja tijekom studija medicine je neznatno ali bi trebalo istražiti koji su čimbenici na njega utjecali jer bi rezultati mogli biti korisni za kreiranje preventivnih programa i programa za prestanak pušenja koji su nužni kako u školskoj dobi tako i za vrijeme studija, pa i studija medicine. Očito je da znanje o štetnosti pušenja koje bi studenti nužno trebali steći tijekom studija nije dovelo do statistički značajnog smanjenja udjela pušača ali bi podatke trebalo usporediti s podacima za studente drugih fakulteta.

Čimbenici rizika za kradiovaskularne bolesti (KVB) brojni su, a dijele se na nepromjenjive i promjenjive. Najvažnijim nepromjenjivim čimbenicima smatraju se: dob, spol, obiteljsko opterećenje, porođajna masa te utjecaji gena. Najvažniji promjenjivi čimbenici (na koje se može utjecati) su: povišeni kolesterol vezan za lipoproteine male gustoće (LDL), pušenje, hipertenzija, intolerancija glukoze i debljina centralnog tipa [1]. Tjelesna neaktivnost i pušenje, uz nezdravu prehranu, mogu dovesti do povišene razine glukoze i serumskih lipida u krvi, prekomjerne tjelesne težine i pretilosti te povišenog arterijskog tlaka. Brojne socijalne, ekonomske i kulturalne promjene, siromaštvo, stres, procesi globalizacije, urbanizacije i starenja populacije utječu na razvoj čimbenika rizika za KVB [2]. Obzirom na potvrđenu prisutnost čimbenika rizika za razvoj KVB u djece školske dobi, od kojih su neki promjenjivi, programe prevencije i intervencije koji uključuju dijetni način prehrane, redukciju/kontrolu tjelesne težine i povećanje tjelesne aktivnosti potrebno je početi provoditi u što ranijoj dobi [2, 3]. Škola predstavlja vrlo pogodno mjesto za provedbu takvih aktivnosti. Primarnom prevencijom moguće je obuhvatiti veliki broj djece u kojih još nije završio rast i razvoj, a štetne navike nisu usvojene. Interventnim programima, koji uključuju promjenu navika prehrane i povećanje tjelesne aktivnosti, moguć je obuhvat i kontinuirano praćenje učinaka programa tijekom razdoblja školovanja [3]. Prema dosadašnjim iskustvima i rezultatima provedbe programa za redukciju i prevenciju KVB promjene navika prehrane i tjelesne aktivnosti među adolescentima pokazali da je moguće smanjiti vrijednosti arterijskog tlaka [4], uočen je i trend sniženja razine LDL-a, dok je za promjenu indeksa tjelesne mase (ITM u kg/m2) očito potrebno dulje vrijeme [5]. Liječnici školske medicine koji provode mjere preventivne zdravstvene zaštite školske djece, koje uključuju pregled za upis u prvi razred osnovne škole i sistematske preglede tijekom školovanja, u mogućnosti su otkriti djecu s čimbenicima rizika za KVB [3]. Problem implementacije javno zdravstvenih interventnih programa, uz relativno nisku cijenu koštanja i veliku korist u konačnici, proizlazi iz činjenice da do vidljivih rezultata treba proći dosta vremena, dok su individualno usmjerene intervencije odmah vidljive. Potreba za njihovom provedbom je neupitna, no pitanje: „Kako može niska razina KV rizika u djetinjstvu biti održana do odrasle dobi?” još uvijek je neodgovoreno [6].

Uvod: Kolegij stručna praksa u zajednici provodi Škola narodnog zdravlja “Andrija Štampar” u Zagrebu od 1952. godine, na temelju pristupa u medicinskoj edukaciji da je područje djelovanja liječnika zajednica i ljudsko okruženje, a ne samo ordinacija i klinika. Cilj: Cilj ovog rada bio je usporedba studentske evaluacije kolegija stručna praksa u zajednici, neposredno nakon pohađanja na četvrtoj i na šestoj godini studija. Ispitanici i metode: Istraživanjem je obuhvaćeno 225 studenata u generaciji koji su pohađali stručnu praksu na četvrtoj godini studija u akademskoj godini 2007./08. i 192 (obuhvat 85, 3%) studenta iste generacije na šestoj godini 2009./10. Studenti su popunili evaluacijski upitnik o aktivnostima tijekom kolegija, ocjenjujući ih ocjenama 1-vrlo loše do 5-izvrsno, uz opisna zapažanja i esej. Rezultati: Studenti (n=225) u akademskoj godini 2007./08. bili su vrlo zadovoljni (ocjene 4 i 5) s pripremnim seminarom 98 %, završnim seminarom 97 %, organizacijom 90 % i sadržajem 89 % prakse. Terenskim istraživanjem bilo je zadovoljno 98 %, praktičnim radom s patronažnom 94 %, radom u obiteljskoj medicini i zdravstvenim odgojem 93 % i uzimanjem i analizom uzoraka vode 87 % studenata. Zadovoljstvo stručnom praksom vrlo je emotivno opisivano i u završnim esejima:“…rad s patronažnom sestrom u najsiromašnijem području Hrvatske promijenio mi je život. U svega par sati naučio sam da trebam željeti manje, a davati više. Svaki bi liječnik to trebao iskusiti, jer to je stvarni svijet.“ U akademskoj godini 2009./10. (n=192) dobiveni rezultati pokazuju da su isti studenti i dalje vrlo zadovoljni s aktivnostima u kojima su sudjelovali na stručnoj praksi: zdravstvenim odgojem 94 %, radom u patronaži i obiteljskoj medicini 92 %, sadržajem 86 % i organizacijom 82 % prakse, završnim seminarom 78 %, pripremnim seminarom 64 %, terenskim istraživanjem 63 %, te uzorkovanjem i analizom uzoraka vode 49 % studenata. Zaključak: Rezultati evaluacije kolegija pokazuju da studenti prepoznaju vrijednost stručne prakse i doživljavaju je kao jedno od najljepših i najkorisnijih iskustava tijekom studija. Sudjelujući u aktivnostima lokalnog sustava zdravstvene i socijalne zaštite u ruralnoj sredini, stječu uvid u epidemiološke i socijalno-medicinske determinante zdravlja u zajednici.

Uvod: Stručna praksa u zajednici je kolegij koji provodi Škola narodnog zdravlja “Andrija Štampar” Medicinskog fakulteta Sveučilišta u Zagrebu za studente viših godina studija od 1952. godine. Jedan od važnih principa ovog dijela medicinske edukacije, temelji se na pristupu da je područje djelovanja liječnika zajednica i ljudsko okruženje, a ne samo ordinacija i klinika. Cilj: Cilj rada je usporedba studentske evaluacije kolegija stručna praksa u zajednici, neposredno nakon pohađanja na četvrtoj i na šestoj godini studija i to prvenstveno onog dijela koji se odnosi na rad patronažne službe i obiteljske medicine. Ispitanici i metode: Istraživanjem je obuhvaćeno 224 studenata koji su pohađali stručnu praksu u zajednici na četvrtoj godini studija medicine u akademskoj godini 2007/08. i 192 (obuhvat 85, 3%) studenta iste grupe studenata na šestoj godini 2009/10. Studenti su popunili evaluacijski upitnik o aktivnostima tijekom kolegija, ocjenjujući ih ocjenama 1-vrlo loše do 5-izvrsno, uz opisna zapažanja i esej. U ovom radu su prvenstveno obrađeni podaci koji se odnose na rad s patronažnim sestrama i liječnicima obiteljske medicine s područja Požeško – slavonske županije gdje su tada studenti boravili na stručnoj praksi u zajednici. Rezultati: Studenti (n=224) u akademskoj godini 2007/08. bili su vrlo zadovoljni (ocjene 4 i 5) s organizacijom 90 % studenata i sadržajem prakse 89 % studenata. S ocjenama odličan i vrlo dobar ocijenilo je 94 % studenta praktični rad s patronažnom sestrom i 93 % studenata rad u obiteljskoj medicini. U akademskoj godini 2009/10. (n=192) dobiveni rezultati pokazuju da su isti studenti, sada na šestoj godini studija, i dalje vrlo zadovoljni (ocjene 4 i 5) s aktivnostima u kojima su sudjelovali na stručnoj praksi: sadržajem 86 % studenata i organizacijom prakse 82 % studenata, radom u patronažnoj službi i obiteljskoj medicini 92 % studenata. Konzistentnost u visokim ocjenama koje studenti daju radu na stručnoj praksi u zajednici upućuju kako je ovaj kolegij trajno ostao vrijedno i bogato iskustvo tijekom studija. Zadovoljstvo stručnom praksom vrlo je emotivno opisivano i u završnim esejima, a jedno od takvih zapažanja je i ovo :“…rad s patronažnom sestrom u najsiromašnijem području Hrvatske promijenio mi je život. U svega par sati naučio sam da trebam željeti manje, a davati više. Svaki bi liječnik to trebao iskusiti, jer to je stvarni svijet.“ Zaključak: Rezultati evaluacije kolegija pokazuju da studenti prepoznaju iznimnu vrijednost stručne prakse u zajednici u cjelini i doživljavaju je kao jedno od najljepših i najkorisnijih iskustava tijekom studija i nešto posve drugačije u odnosu na rad na klinici. Posebno ističu trud i zalaganje koje u svakodnevnom radu iskazuju patronažne sestre i obiteljski liječnici u pružanju zdravstvene zaštite populaciji u ruralnoj sredini.

Introduction: The study is a part of research project: “ Cardiovascular risks of school children and youth – intervention model development” , approved by Croatian Ministry of Science, Education and Sports. The objective was to investigate which anthropometric measurements, such as height, weight, body mass index (BMI), waist circumference (WC) is better predictor of blood pressure - systolic blood pressure (SPB) and diastolic blood pressure (DBP). Methods: The study included 11 480 children (5694 male and 5786 female) aged 6 - 18, representative sample of Croatian school children. Anthropometric measurements included height, weight, BMI (kg/m² ; ; ), waist circumference and blood pressure measurements. Statistical analyses were performed by STATISTICA 8.0 for Windows: StatSoft, Inc., 2000. Descriptive statistics and Pearson’ s correlation analysis were calculated. Results: A statistically significant correlation was observed between WC and BMI, Pearson’ s correlation coefficient (r) was 0.8805, significant at 0.001 for boys and 0.8419 significant at 0.001 for girls. Pearson’ s correlation coefficient between WC and SBP was r = 0.5413, P

OBJECTIVES: Study examines high school graduates' knowledge and attitudes towards sexually transmitted diseases. METHOD: High school graduates from three different high schools completed a simple questionnaire about sexually transmitted diseases (STD). The high schools included were a nursing secondary school, a general education high school, and a technical secondary school. The questionnaire consisted of nine true-false questions. The goal of the study was to examine students’ level of knowledge about STDs and to find out if there is any difference in knowledge among the three high schools. RESULTS: Out of 280 participants, 66 were nursing school students, 129 general education school students, and 85 technical school students. As it was expected, the level of knowledge was very high in all three high schools. The percentage of true answers was between 81.82%-95.45% in nursing school, 79.07%-100% in general education school, and 68.24%-98.82% in technical school for most of the questions. The most commonly missed question among all participants was the one regarding condom use: «Condoms protect me of all sexually transmitted diseases». Only 25.76% students in nursing school, 69.77% students in general education school, and 60% students in technical school answered correctly. CONCLUSION: The study showed that the current generation of high school graduates has a very good general knowledge about STDs. However, there are still certain issues they need to be educated about, e.g., condom-use and their role in STD-prevention.

Background and aims Regular daily exposure to sources of noise is common. Level of hearing impairment depends on intensity, frequency and type of noise. The most intensive impairment is induced by impulse noise such as gunshot or explosion. First dropouts are in the area of high frequency (4000 Hertz) and caused by noise intensity of 80 decibel. There is no effective treatment of consequences caused by noise. The aim of this study is detecting of school children with hearing impairment, by audiometric screening before entering high school. Subjects and Methods Hearing was tested by tonal audiometer on regular check up on pupils in 8th grade elementary school in year 2008/09. Children with suspect screening results were referred to specialist for further examination. Results Hearing impairment had 7, 2% boys and 0, 5% girls out of 208 tested boys and 210 girls. Two children had previous hearing impairment: unilateral deafness and bilateral sensorineural hearing loss. Conductional hearing loss was detected on 4 children. The cause of hearing loss in 10 children was acoustic trauma. Previous findings were present In 3 of children, but impairment was minor. Pupils with hearing loss cased by acoustic trauma have not dificulties in normal communication. Conclusions High percentage of hearing loss after acoustic trauma implicates importance of audiometric screening especially before entering high school. Children with hearing loss should be excluded from educational programs with high noise exposure and instruct about hearing preservation opportunities.

BACKGROUND AND AIMES: Study examines association between childrens' television viewing and computer use and eating and drinking habits. METHOD: Children in 5th grade from 5 elementary schools completed a questionnaire regarding time they watch television and use computer on typical school day and on typical weekend day. Children answered how often they eat and drink while watching TV and using computer. BMI was calculated from measured height and weight at last medical exemination. RESULTS: Of 250 participants (116 boys and 134 girls), there are 20, 8% overweight students and 9, 2% obese students, also there are 42% normal weight and 28% underweight students. From all students, 50, 8% are using computer two or more hours per school day and 59, 2% are using computer two or more hours on weekend day. While using a computer 50% of all students are eating, at least sometimes. Most of them are eating fruits, snacks or sandwiches. From all students, 82, 8% are watching TV two or more hours per school day and 66% are watching TV two or more hours on weekend day. While watching TV most of the students, 89, 2%, are eating at least sometimes. Most of them are eating sandwiches, snacks and fruits. Most of the children are phisicaly active two or more hours a week (58, 8%). CONCLUSION: This study showed that children in 5th grade are spending too much time using computer and/or watching TV, most of them then eat something. Most of the children are phisical active during a week and have normal weight.

Background and aims Health promotion project “Menstrual cycle and hygiene” is run in high schools in Croatia for female students by school medicine specialist. Unique methodology consists of lecture, demonstration and oriented discussion about structure and function of female reproductive system and menstrual hygiene. This study obtains data collected in 2008 in order to determine participant’s satisfaction with project. Methods Descriptive analysis of student’s evaluation is carried out on 2359 gymnasium, 3132 for-year, and 898 three-year school education students of 1st grade. Results In gymnasium 49%, in four- year 41% and in three- year school 46% girls find the content as a recapitulation and for 23%, 30% and 27% the content is completely new. For 65% gymnasium, 69% four- year and 64% three- year school students, presented material is very interesting, and 81%, 82% and 80% evaluate it as very beneficial. To 80%, 79% and 77% students, presentation gives answers on interesting questions. Completely satisfied with presentation are 89%, 86%, 85% students. For 42%, 49%, 50% students the most useful in presentation is “everything”. That “nothing” should be changed in presentation answer 85%, 87%, and 92% students and “nothing” should be added to the content answer 59% gymnasium, 58% four-year school and three- year school education students. Conclusions As results shows there is no important difference in answers of students from different type of high schools in project evaluation. Evaluation is used to adjust and improve project content to target population, emphasising preserving of reproductive health.

Background In academic year 2007 and 2008, while attending Social medicine course, first year medical students completed questionnaire about health and social problems of youths. Methods Questionnaire was completed by 489 students, 149 male and 340 female. For the purpose of this paper, we analysed answers about alcohol drinking habits and behaviour, using descriptive statistical methods. The aim of the study was to investigate differences in alcohol consumption habits and behaviour between genders, and considering origin of students. Students that lived in Zagreb for more than 6 year were considered as representatives of metropolitan life style. Students that lived in Zagreb less than one year (those who lived out of Zagreb since they come to medical school) were considered as students from nonmetropolitan area. Those two categories encompassed 468 students. Results Out of 468 students, nonmetropolitan group encompassed 192 (41%) female, 85 (18 %) male, and metropolitan group 134 (29 %) female, and 57 (12 %) male students. Significant difference between genders (p= 0.0047) was found in nonmetropolitan group of students that have never dunk more than sip of alcohol, 26 female vs. 2 male students. At age 10 or less, out of home alcohol drank 3 (1.56%) female and 9 (10.71%) male nonmetropolitan students, 10 (7.52%) female and 2 (3.51%) male metropolitan students without significant differences. Considering students which regulary consume or have tasted alcohol, significant difference between genders was found in answer about excessive drinking: in total number 111 male vs. 180 female (p

Tjelovježba primjerena dobi i zdravstvenom stanju svakog pojedinca se smatra jednim od važnih čimbenika u prevenciji srčanožilnih bolesti i dio je terapijskog programa oboljelih od ovih bolesti. Navika redovite tjelovježbe stječe se u najranijoj dobi a škola ima posebno važno mjesto u poticanju i podržavanju redovite tjelovježbe školske djece i mladih. Cilj: Procijeniti postoje li razlike u tjelesnoj aktivnosti školske djece i mladih Ispitanici: Ispitanici su bili učenici iz 40 osnovnih škola i 20 srednjih škola. Uzorak je reprezentativan za Hrvatsku, a osnovne škole su stratificirane prema veličini mjesta i veličini – broju učenika u školi, a srednje škole prema vrsti srednje škole i veličini – broju učenika u školi. Istraživanjem je obuhvaćeno 960 učenika prvih razreda osnovne škole, 965 učenika osmih razreda osnovne škole i 944 učenika trećih razreda srednje škole. Metode: Anonimni upitnik imao je 75 pitanja o: prehrambenim navikama, uporabi računala i interneta, tjelesnoj aktivnosti, gledanju televizije, zdravstvenom statusu, školskoj spremi roditelja, a izvršena su i antropometrijska mjerenja, tjelesna masa, tjelesna visina, određen indeks tjelesne mase (ITM, kg/m²). U statističkoj analizi korištene su metode deskriptivne statistike, faktorska i diskriminacijska analiza. Rezultati: Vježba ili trenira u športskom klubu 31, 0% dječaka i 29, 1% djevojčica prvih razreda osnovne škole, 62, 0% dječaka i 36, 0% djevojčica osmih razreda osnovne škole i 41, 1% mladića i 39, 6% djevojaka trećih razreda srednje škole. Tri i manje puta tjedno vježba u slobodno vrijeme 54, 0% dječaka i 71, 1% djevojčica prvih razreda osnovne škole, 49, 9% dječaka i 78, 3% djevojčica osmih razreda osnovne škole i 66, 8% mladića i 86, 2% djevojaka trećih razreda srednje škole. Šetalo je ili trčalo dulje od 30 minuta jedanput ili manje u posljednjih sedam dana 19, 1% dječaka i 28, 9% djevojčica prvih razreda osnovne škole, 37, 0% dječaka i 45, 7% djevojčica osmih razreda osnovne škole i 39, 5 mladića i 39, 0% djevojaka trećih razreda srednje škole. Vozilo je bicikl dulje od 30 minuta jedanput ili manje u posljednjih sedam dana 61, 3% dječaka i 57, 4% djevojčica u prvih razreda osnovne škole, 63, 0% dječaka i 83, 2% djevojčica osmih razreda osnovne škole i 79, 8% mladića i 88, 5% djevojaka trećih razreda srednje škole. Dulje od dva sata dnevno gleda televiziju 19, 3% dječaka i 19, 3% djevojčica u prvom razredu osnovne škole. Dulje od dva sata dnevno zabavlja se s „igricama“ 2, 5% dječaka i 0, 4% djevojčica u prvom razredu osnovne škole. Za ispitanike, učenike prvih razreda osnovne škole, faktorskom analizom dobiveni su faktori koji su uvršteni u diskriminacijsku analizu. Kriterijska varijabla je bila ITM svakog ispitanika podijeljenih u tri grupe: uredno uhranjeni, prekomjerno uhranjeni i adipozni temeljem Cole-ovih standarda [1]. Diskriminacijska analiza je pokazala da su prekomjerno uhranjena i adipozna djeca, za razliku od uredno uhranjenih, opisana sljedećim: manjim brojem djece u obitelji i nižim redom rođenja, višim obrazovanjem roditelja, jedu manje voća i povrća, više sati provedu igrajući igrice na računalu, imaju manje fizičkih aktivnosti, piju više alkohola uz obrok. Zaključak: Tjelesna aktivnost/neaktivnost je jasno je prepoznat čimbenik za povećanu tjelesnu težinu i srčanožilne bolesti. Škola je okružje koje bi trebalo poticati tjelesnu aktivnost, ali poticaj vrlo često ostaje samo na deklarativnoj razinu [2], [3], [4]. Umjerena i dobi primjerena tjelovježba u zdravih mladih osoba značajno utječe na autonomni živčani sustav što ima koristan učinaka na neurokardijalnu regulaciju i stoga ju treba preporučiti i podržavati [5]. Literatura [1] T J Cole, M C Bellizzi, K M Flegal, W H Dietz. BMJ. 2000 May 6 ; 320(7244) ; 1240 [2] Hardman, K. Physical education in schools: a global perspective. Kinesiology 2008 ; 40 (1):5-28. [3] Ivančev V. Učinci prekomjerne tjelovježbe na mladi organizam. Paediatr Croat 2009 ; 53 (Supl 1): 212-15. [4] Podvalej L, Karković N, Trkulja Petković D. Osvrt na kvalitetu rada u nastavi tzk na Visokoškolskim ustanovama. U: Zbornik radova 15. Ljetna škola kineziologa Republike Hrvatske, Rovinj 2006. str. 318-21. [5] Raczak G et al. Cardiovagal Response to Acute Mild Exercise in Young Healthy Subjects. Circ J 2005 ; 69: 976 – 980.

Postgraduate professional study in school medicine has a long tradition. The first has been organized in 1951 at Andrija Stampar School of Public Health and it was obligatory part of residency in school medicine introduced the same year. Postgraduate professional study in school medicine has been so far obligatory part of three(in future four) year residency program in school medicine. Postgraduate professional study in school medicine is meant to be a one year study (in future four mounts) with 400 hours of active teaching, ten mandatory and ten elective courses, 60 ECTS credits and graduated thesis. The aim of the study is accomplishment of knowledge and skills in professional work and research in the field of the school medicine and health care of school children and youth, especially training in assessment and measurement of health care of this population, recognizing and estimating risks affecting youth health, planning and evaluating health care measures and solving the leading public health problems of school children and youth. Postgraduate professional study on School medicine could attend candidates which graduate at Medical school with license to practice medicine or school medicine residents. The need for this kind of education is generally accepted as a condition for the work with school children and the youth in school health services in institutes of public health, and they are conducting through preventive, specific and health educational measurements for the primary and secondary school children and university students.

Since 1952, generations of medical students of Medical School University of Zagreb attended community health course, in order to be aware of community and social factors influence on health. Course is organized and provided by Andrija Štampar School of Public Health in different rural areas of Croatia, for one week. The main purpose of practical lectures for students is to investigate living conditions and life styles in direct communication with people in their homes. For that reason students spend substantial part of the course throughout one week, in homes interviewing all adult household members and collecting data for different research projects each academic year, but at the same time it is opportunity for students to get holistic picture of human life and multi-factorial influence on health by observing, feeling, and understanding them. Students don’t simply collect information ; they also experience and “feel” most of important facts in delivery of health care. The course aim is to encourage students to comprehend the importance of communities in the health of individuals and families. The course is based on well known approach in health service: “main fields of action of a physician are human settlements, not laboratories and consulting rooms” (A. Štampar). Students have opportunity to perceive community members inside and outside of health care system, and to study epidemiological and socio-medical determinants of health, under activities of health and social care systems. Students work with supervision of the School lecturers working together with local health professionals, physicians and community nurses in order to facilitate experience, knowledge, skills and attitudes transfer. Practical work comprises treatment of patients from the initial contact with the health system, diagnostics, therapy, home and workplace visits. In addition, students learn basic principles of health education, epidemiological and environmental diagnosis and public health field research. Since 2008, an innovative method in data collection was introduced. Students are equipped with iPAQ hx2100 pocket PCs, instead of paper questionnaires. The advantage of this approach, apart from the practical side of collecting complete, correct, and logical data is the possibility of immediate data processing and analysis, making collected data much more useful in terms of better understanding the sense of information. The examples of innovative approach are programs such as: “Drinking habits gender morbidity differences at rural area of Velika Municipality”: out of 584 (195 male, 389 female) interviewed inhabitants aged 18 -87 years, 73.3% male and 41.4% female inhabitants were alcohol consumers. Male non alcohol consumers, more often had diabetes, chronic bronchitis, bronchial asthma, gastritis, rheum and senility, and female chronic bronchitis, bronchial asthma, elevated blood cholesterol and lipids. “Smokers and non smokers differences in morbidity at rural area of Velika Municipality“: smokers were 33.9% males and 19.6% females and both had more mental illnesses and chronic bronchitis. “Predictors of woman attending and not- attending national mammography screening”: out of 160 interviewed women aged 50-69, 87.5% received invitation for mammography. Socio-demographic characteristics of 69 attendees were: higher school education, living with family, more family members, residence in urban area, but there were not identifiable predictors.

Health care for school children and youths in Croatia is disintegrated since 1998. General practitioner provides curative, and school medicine specialist specific health care and health education. Efficient implementation of that program, including preventive, specific and health education procedures, demands these organisational requirements: a) accessibility of school medicine teams to school children and students and other primary health care services, b) school medicine team consists of school medicine specialist, nurse and psychologist for 4 to 6 teams, c) number of patients 3000 – 3500 elementary and high school children per team and 5000 for students, d) head fee should be different for elementary school children, high school children and students, e) number of patient should be corrected depending of terrain characteristics – large number of schools with low number of children in wide areas, dislocated schools, children with special needs in institutions or dormitories, f) work space, equipment and norms have to be standardised, g) enable school doctors as a elected curative doctors with obligation to provide at least 2/3 of working hours as a school doctor for listed schools, and enable general practitioners with school medicine postgraduate study to provide preventive health care, h) presented model should be controlled and financed by public health system. Group practice model (with family doctors, school medicine specialists and paediatricians) in health centres enable integrated health care for school children. Group practice model enable school medicine specialists to provide preventive health programs in school settings and be “link” between school health service and group practice.

The study was conducted on 489 first year students of Medical School University of Zagreb, attending social medicine course, in order to determine attitudes towards human sexuality. After finishing study and working in health system, they are very important source of information and deal with different areas of human sexuality. Questionnaire about health and social problems of youths was completed by 149 male and 340 female students. Answers about attitudes towards human sexuality were analysed by descriptive statistic methods. For male students television (44%) and erotic magazines (18%) are main source of information about human sexuality and for female students television (29%) and youth magazines (30%). Friends are on third place for both (12%). Use of condom reduces enjoying sex, think 12% male and 25% female students. That youths in their age should not have sex think 4% students. Does masturbation makes “feel guilty” could not decide 17% male and 35% female students. That abortion should be prohibited, completely agree 19% male and 15% female students. Do women enjoy sex less than men, 40% male and 26 % female students could not decide. Results suggest a need for additional attention in planning of sexual education for medical students in order to improve attitudes and perception of human sexuality. Because of their future responsibilities as medical doctors, it could influence general perception an attitudes.

Centilne vrijednosti tjelesne težine dječaka / Percentiles of weight for Croatian boys 6.5 to 18.5 years of age Centilne vrijednosti tjelesne težine djevojčica / Percentiles of weight for Croatian girls 6.5 to 18.5 years of age Centilne vrijednosti tjelesne visine dječaka / Percentiles of height Croatian boys 6.5 to 18.5 years of age Centilne vrijednosti tjelesne visine djevojčica / Percentiles of height Croatian girls 6.5 to 18.5 years of age Centilne vrijednosti indeksa tjelesne mase dječaka / Percentiles of body mass index Croatian boys 6.5 to 18.5 years of age Centilne vrijednosti indeksa tjelesne mase djevojčica / Percentiles of body mass index Croatian girls to 6.5 to 18.5 years of age * The chards were derived using Cole's LMS method, which adjusted the BMI distribution for skewnees and allows BMI in individual subject to be expressed as an exact centile or SD score.

U okviru programa «Unapređenje borbe protiv HIV/AIDS-a u Hrvatskoj 2003.–2006.», proveden je i projekt «Trening profesionalaca za primjenu programa prevencije HIV/AIDS». Jedan od ciljeva projekta bilo je procijeniti znanje i stavove o HIV/AIDS-u profesora i učenika srednjih škola prije i nakon provedbe projekta. Na početku provedbe programa anketirano je 476 profesora i 1026 učenika prvih i trećih razreda srednjih škola i na kraju programa 1024 učenika istih škola i uzrasta. Očekivano razina znanja profesora je veća od znanja učenika. Pozitivni trend usvojenog znanja pokazuju učenici anketirani po završetku programa. Unatoč provedenom programu, 10, 8% učenika smatra da se osoba može zaraziti HIV-om ako dijeli obrok s osobom zaraženom HIV-om ili ubodom komarca 23, 9% učenik. Svaki četvrti učenik ne bi dozvolio školovanje HIV pozitivnom učeniku i 40% ne bi dozvolilo rad u školi HIV pozitivnim učiteljima. Tek svaki peti učenik bi išao liječniku koji je HIV pozitivan i svega 17% stomatologu. Rezultati istraživanja ukazuju kao bolje znanje ne znači i pozitivniji stav prema osobama s HIV/AIDS-om. Stoga, treba naglasiti potrebu sveobuhvatne, kontinuirane i sustavne edukacije mladih, ali i cjelokupnog stanovništva o HIV/AIDS-u.

Background and aims Obesity is one of major public health problems among school children. Early detection of children with risks for overweight and adiposity could enable intervention programs. The aim of this study is to assess body mass index (BMI) in 8th grade on its values achieved in 1st and 5th grade measurements. In longitudinal study of 985 elementary school children, 494 boys and 491 girls, anthropometric measurements were taken at enrollment in school and on regular checkups in 5th and 8th grade. Methods Body height, body weight and BMI were measured according previously determinate methodology. Participants were distributed in three groups by BMI (“Cole” standards): normal weight, overweight, obesity. Results Overweight boys were 11, 7% in 1st, 21, 7% in 5th and 19, 6% in 8th grade, for girls 14, 5%, 18, 3% and 15, 7%. Obese boys were 6, 1% in 1st and 6, 3% in 5th and 8th grade, for girls 5, 9%, 3, 9% and 3, 3%. Between 6, 5 and 14 years 67, 5% boys and 74, 5% girls didn’t change BMI group. Out of 334 normally weight boys 90, 7% stayed normal weight in 5th and 8th grade, out of 355 girls normally weight stayed 96, 8%. Boys and girls who were normal weighted in 1st and 5th grade were normal weighted in 8th grade. Conclusions Results show that body weight assessment in 5th grade could be good predictor of body weight at 14 years for children with normal weight at enrollment to school.

Background and aims Medical School first year students attending social medicine course in 2007 and 2008 completed questionnaire about health and social problems of youths. The aim of the study is to identify contraception use among sexually active medical students, differed by gender and length of living in Zagreb. Methods Anonymous questionnaire was completed by 489 students. Answers were analysed by descriptive statistic methods. Results Out of 340 female and 149 male students 43% female and 58% male students are sexually active. Less than one year live in Zagreb 59% female and 65% male students. More than six years or from ever live in Zagreb 41% female and 33% male students. Out of students living in Zagreb less than one year, 68 % female and 47 % male students reported contraception use in first sexual intercourse by themselves or their partner. Use of condom reported 22% female and 31 % male students. Regular contraception use (always) reported 63% female and 58% male students. Out of students living in Zagreb more than six years or from ever, 56 % female and 67 % male students reported contraception use in first sexual intercourse. Condom use reported 26% female and 22% male students. Contraception is used regularly (always) by 68 % female and 74% male students. Conclusions Results strongly suggest that education and counselling in reproductive and sexual health must be offered to all students. In education emphasis should be on empowerment of attitudes regarding family planning and prevention of sexually transmitted infections.

Cilj istraživanja je procijeniti postoje li razlike i koje u pobolu, socioekonomskim i bihevioralnim obilježjima pušača i nepušača duhana na ruralnom području Općine Velika. Anketom je obuhvaćeno 508 stanovnika, 177 muškaraca i 331 žena, u dobi od 19 do 85 godina s područja Općine Velika. Sve ispitanike su intervjuirali anketari prema unaprijed pripremljenom upitniku. Upitnik je skraćena verzija Hrvatske zdravstvene ankete (HZA 2008).U ispitivanoj populaciji je među muškarcima 33, 9% pušača i 19, 6% pušačica među ženama. Prosječna dob žena pušačica je 43, 4 godine, nepušačica 55, 6 godina i 46, 4 godine muškaraca pušača te 58, 5 godina u nepušača. U skupini muškarca nepušača statistički značajno (p

Introduction The aim was analysis of level of knowledge and attitudes regarding female reproductive system and menstrual hygiene on university female students. Methods Education was provided in form of presentation, demonstration and discussion with participants. Level of knowledge and attitudes were tested on 224 students 1st year in Zagreb by anonymous questionnaire with questions about sexual activity, female reproductive system and menstrual hygiene products. Results After education (3-6 month) 75% female students were tested again. Sexually active were 53% participants. In answers regarding female reproductive system 95% were correct before and after education, regarding menstrual hygiene before 68, 3% to 98, 7 and after 74, 4% to 98, 8% , menstrual calendar had 77, 6% before and 85, 1% after, menstrual hygiene products were bought by student’ s mothers 36, 6% before and 32, 1% after. Virgins could not use tampons, answered 6, 5% students. The worst results were regarding pregnancy. Education was graded with 4-5 (1-5 grade scale) by 77, 2% students. Conclusion Methods used in health promotion increased level of knowledge and had positive influence on attitudes. Results proved that education should be provided continuously.

We analyzed advantages and disadvantages of integrated and preventive health care model for school children and youth by comparing both models that existed in Croatia. Five experts, school medicine specialists with at least 5 year experience in school health services analyzed each model’ s advantages and disadvantages. Integrated model advantages: better insight of child’ s health, easier health care measures implementation, frequent students contact, better parent’ s, student’ s , children’ s and physician’ s acceptation. Disadvantages: hard achievable for secondary school students – schooling and living place differ, separate head fees for preventive and curative care. Preventive model advantages: better specific and preventive health care measures planning and implementation, more time for specific and preventive health care measures, safer preventive health care measures implementation, recognized as a specific and preventive profession. Disadvantages: two or more physicians in charge for one child, unclear school medicine specialist and family doctor (predominantly curative oriented) work areas for parents, teachers and children, colleges and other health professionals not recognizing the profession, school medicine specialist as a preventive professionals can lose interest in permanent education and improving. Optimal model which could reduce both models’ disadvantages would link School health services through the school medicine specialist’ s work in group practices.

Objective To examine association between children's body mass index and television viewing, computer and internet use, eating and drinking habits. Design Anonymous questionnaire about computer and internet use, television watching, eating and drinking habits, parents education, children's height and weight. Subjects Accidental sample of children from 8 typical elementary schools from city of zagreb, 5th and two 8th grade. Methods Statistic analysis: descriptive methods, factor analysis, factor discriminant analysis. Iotf criteria for overweight and obese. Results Normal weight children are described with: higher parental education, more eating and drinking while online, less using computer and internet, less tv watching, less cause for tv watching and computer use Overweight and obese children are described with: lower parental education, less eating and drinking while online, more using computer and internet, more tv watching, more cause for tv watching and computer use Conclusion We could assume that although normal weight children eat and drink more while using internet they spent less time in front of computer and tv.

Cilj istraživanja je bio istražiti postoji li povezanost socioekonomskih i demografskih obilježja i odaziva žena na pregled – mamografiju u okviru Nacionalnog programa za rano otkrivanje raka dojke na jednom ruralnom području Hrvatske. Ciljana populacija su bile žene u dobi od 50 do 69 godina iz Općine Velika u Požeško-slavonskoj županiji, uključene u Nacionalni program ranog otkrivanja raka dojke. Podaci su prikupljeni metodom intervju s unaprijed pripremljenim upitnikom. Od 160 žena u dobi 50-69 godina koje su anketirane zaprimilo je poziv za mamografiju 140 ili 87, 5% ispitanica, 18 ili 11, 3% nije zaprimilo poziv i 2 ili 1, 3% nije odgovorilo na ovo pitanje. Odazvalo se na poziv za mamografiju 69 ili 49, 3% od ukupno 140 koje su zaprimile poziv, a tri ispitanice, 2, 1% nisu odgovorile na ovo pitanje. Žene koje su se odazvale pozivu na pregled statistički značajno imaju višu školsku naobrazbu (p=0, 0001), žive s obitelji (p=0, 0033), žive u višečlanim obiteljima (p=0, 0304) i na urbanom području (p=0, 0320) nego žene koje se nisu odazvale pozivu na mamografiju. Žene koje nisu došle na pregled su u manjem broje radno aktivne, u manjem broju obavljaju stručne i uredske poslove, manje ih je radno aktivnih od onih koje su se odazvale na pregled, ali ove razlike nisu statistički značajne. U daljnjoj provedbi Nacionalnog programa za rano otkrivanje raka dojke, kako bi se dosegao željeni obuhvat, posebnu pozornost treba posvetiti ženama koje se ne odazivaju na mamografski pregled, a moguće ih je identificirati temeljem opisanih obilježja. Veće bi uključivanje liječnika opće/obiteljske medicine i patronažnih sestara moglo tome doprinijeti.

Background Poverty is a social construction described with many dimensions(socioeconomic determinants) ; lack of education, inadequate housing, social exclusion, unemployment, environmental degradation, and low income are just some of those. Sex, age, employment status and education correlate with occurrence of psychological distress (PD) in a same way as with poverty. There is a large body of evidence from studies in industrialized countries demonstrating association between poverty and mental health status, also replicated in low and middle income countries with the most consistent association being with low levels of education. Aim of this study was to determine whether there is significant correlation in Croatian population at the county level between poverty and bad mental health status described as psychological distress. Methods Data used in this analysis comes from Croatia Adult Health Survey 2003, pooled 2002, 2003 and 2004 Household Budget Survey and county statistics from Central Bureau of Statistics for year 2003. As the mental health outcome measure we used the Mental Health Inventory (MHI-5) subscale of the SF-36 health status questionnaire, with the score lower than 52 determined as psychological distress. Socioeconomic determinants used in this study are unemployment rate, divorce rate, average years of education, population older than 65 years, criminality rate, alcohol consumption, and smoking. Data were analyzed for each socioeconomic determinant fit into linear model with PD as analysis variable. Also, linear regression model is done with PD as dependant variable and all socioeconomic determinants as explanatory variable, controlled for poverty rate. Results The only socioeconomic determinant showing statistical significance for both poverty and PD is education level (PD=59.635094 - 3.5462554 average_years_of_education, p=0.0054). Linear regression model was not significant (p=0.2063). Conclusion Literature shows that determinants constructs for PD and poverty look much alike suggesting that there should be some correlation between them. Our study presented major differences between poverty and psychological distress constructs with the education as the only socioeconomic determinant significant for both.

Cilj istraživanja je procijeniti postoje li razlike i koje u pobolu, socioekonomskim i bihevioralnim obilježjima ispitanika koji su u posljednjih godinu dana pili alkohol i žive na ruralnom području Općine Velika. Anketom je obuhvaćeno 584 stanovnika, 195 muškaraca i 389 žena, u dobi od 18 do 87 godina s područja Općine Velika. Sve ispitanike su intervjuirali anketari prema unaprijed pripremljenom upitniku. Upitnik je skraćena verzija Hrvatske zdravstvene ankete (HZA 2008). Kriterij za procjenu pijenja, bilo je pitanje ispitanicima jesu li u proteklih godinu dana konzumirali bilo kakvo alkoholno piće. Pozitivno na ovo pitanje je odgovorilo 73, 3% muškaraca i 41, 4% žena. Prosječna dob žena koje su konzumirale alkohol je 52, 9 godina i žena koje ne piju je 58, 3. Muškarci koji konzumiraju alkohol su prosječne dobi 58, 3 godine a oni koji ne piju 60, 2 godine. Obzirom na školsku spremu i zanimanje nema statistički značajne razlike u muškaraca i žena obzirom na naviku pijenja alkohola. Neovisno o navici pijenja alkohola, radnici su najzastupljeniji u svim skupinama ispitanika. Muškarci, neovisno o navici pijenja alkohola, ne razlikuju se statistički značajno prema radnom položaju i radnoj aktivnosti, za razliku od žena. Među ženama koje piju je više zaposlenih, a među ženama koje ne piju domaćica i umirovljenica (p=0, 0002). Žene koje ne piju su manje radno aktivne (p=0, 0006) u odnosu na žene koje piju. Bračno stanje ispitanika, i muškaraca i žena, ne razlikuje se statistički značajno obzirom na naviku pijenja alkohola. Muškarci i žene koji piju rjeđe redovito doručkuju u odnosu na ispitanike koji ne piju, ali samo u muškaraca je razlika statistički značajna (p=0, 0087), muškarci koji piju češće ponekad doručkuju u odnosu na one koji ne piju. Muškarci i žene neovisno o navici pijenja alkohola se statistički značajno ne razlikuju prema navici pijenja kave. Usporedba pobola ispitanika obzirom na naviku pijenja alkohola pokazuje da muškarci i žene koji ne piju imaju u većem postotku većinu navedenih bolesti radi kojih se liječe u odnosu na ispitanike koji piju. Ovaj podatak zahtijevao bi dodatnu analizu, iz dva razloga, ispitanici koji ne piju su u prosjeku starije dobi od ispitanika koji piju i bilo bi potrebno skupinu ispitanika koji piju alkoholna pića podijeli u podskupine prema intenzitetu pijenja alkoholnih pića. Muškarci koji piju alkoholna pića, u odnosu na one koji ne piju, češće obolijevaju od: zloćudnih bolesti, povišenih masnoća u krvi, srčanog infarkta, bolesti jetara, bolova u križima i bubrežnih bolesti. Žene koje piju alkoholna pića, u odnosu na one koje ne piju, češće obolijevaju od: senilnosti, moždanog udara, proširenih vena, reume i bolova u križima. Ostale promatrane bolesti više su zastupljene u muškaraca i žena koji ne piju alkohol. Posebice su interesantni podaci iz skupine bolesti cirkulacijskog sustava. Muškarci koji ne piju u većem postotku se liječe od većine bolesti iz ove skupine u odnosu na muškarce koji piju: angine pektoris, moždanog udara, proširenih vena, visokog tlaka, “ slabog” srca. Podjednaki podaci i razlike dobiveni su i za žene koje piju i ne piju alkoholna pića. Žene koje ne piju alkoholna pića češće obolijevaju od: angine pektoris, visokog tlaka, “ slabog” srca i srčanog infarkta. Muškarci koji ne piju imaju češće šećernu bolest, kronični bronhitis, bronhalnu astma, gastritis, reumu i senilnost. Žene koje ne piju češće se liječe od kroničnog bronhitisa, bronhalne astme i povišenih masnoća u krvi. Muškarci i žene, neovisno o navici pijenja alkohola, podjednako ocjenjuju vlastito zdravlje. Kompleksnost dobivenih rezultata zahtijeva dodatnu analizu i primjenu multivarijatnih metoda statističke analize.

The purpose of the Program is to stimulate collective and individual action on HIV/AIDS among young people. Scaling-up HIV/AIDS Response Program in Croatia from 2003 to 2006 resulted in numerous health education activities: distribution of educational material, establishing anonymous testing counseling services, education of high school population (lectures, workshops and peer education). High school population was asked at the beginning and at the end of the Program about knowledge an attitude regarding HIV/AIDS. the goal is to compare knowledge and attitude regarding HIV/AIDS before and after the Program. Students completed anonymous questionnaire. In representative stratificated sample were 1026 (first and third grade) students from 20 high schools. Number of correct answers decreased in both group of questions (regarding knowledge and attitude). Despite the Program 27% of students don’t consider condom use as a safe protection from HIV/AIDS and think mosquito could transmit HIV infection , 25% of student would not let HIV positive students to continue high school education and 40% would not let HIV positive teacher to continue with work.

First child health booklet has been printed in Croatia in 1985 and it followed growth and development of a child from delivery to sixth year. Ministry for health and social care of Republic Croatia decided in 2006. to represent unique Health booklet of a child form birth to eighteenth. Information gathered in School child health booklet (SCHB) enable systematic surveillance with unique methodology of growth and development. It is possible to follow other entities: anomalies, anthropometric measures, risks (neurorisks, blood pressure, nutrition, hearing, sight and others), social surroundings and family history. Information are base for creating records which will have operative value and it will enable rapid and diverse intervention (with results follow-up and self-evaluation) with a purpose of protection and improvement children’ s health. SCHB is, primarily, aimed to preventive health care: regular health checkups, screenings, control and aimed checkups, but it provides following of illness, radiological checkups, dental checkups, implemented health education and consultation work. SCHB is excellent preparation for informatisation in school health services. Important in disintegrated model of health care for school children and adolescents accessibility of information on procedures performed to the doctors who give preventive health protection and/or cure school children and adolescents

Introduction: The goal is to analyze the differences in psychophysical conditions of urban and rural school children enrolling 1st grade elementary school. Methods: A commission for determination of psychophysical condition of child enrolling 1st grade elementary school is constituted of school medicine specialist, psychologist or pedagogue, teacher and speech rehabilitator. Medical examination by school medicine specialist is an obligatory part of commission procedure. Commission determines eight categories of problems: Vision, hearing, speech, physical disability, mental retardation, autism, behavior disorder and combined disorders. Results: First three problems in Zagreb (Croatia’ s capital) are: speech and language problems (44, 7%), physical disability (36, 6%) and mental disability (10, 5%). First three problems in Ivanec (rural area of Varaždinska County) are: mental disability (62, 5%), children with combined disorders (20, 2%) and speech and language problems (7, 2%). Regarding the variety and degree of problems Commission is determine the type of educational program: regular school program with rehabilitation support, special school program related to psychophysical condition and school programs in schools for children with special needs. Conclusion: Results implicate great differences regarding urban and rural area and importance of Commission work for determination of the best school program for every single child.

Objective was to determine nutritional and behavioral differences in obese, overweight and normalweight children attending first grade elementary school. Children from 40 elementary schools. Sample was stratified by settlements population size. 960 pupils – 493 (52, 4%) boys, 467 (48, 6%) girls Anonymus questionnaire (completed by parents) consisted of 75 questionnes regarding computer and internet use, television, eating and drinking habits, children’ s health status, parents education and height and weight. IOTF Criteria for overweight and obese. Statistic analysis included descriptive methods, factor analysis and factor discriminant analysis. Normalweight children are described with: higher number of children in the family and higher order of birth, lower education of parents, they eat more vegetables and fruits, spend less time playing computer games, have more physical activity, drink less alcohol with their meals. Overweight and obese children are described with: lower number of children in the family and lower order of birth, higher education of parents, they eat less vegetables and fruits, spend more time playing computer games, have less physical activity, drink more alcohol with their meals. We could assume that parents with lower education spend more time at home with their children (more time for cooking?). Regarding nutritional and behavioral differences among overweight, obese and normal nutritioned, prevention programs should include parents in order to eliminate bad habits, primary fast food consumation and computer using.

Introduction:Specific populations as school children and especially adolescents require school health counseling services with easy access and opportunity to solve variety of problems at one place. Methods:We analyzed school children’ s and youth’ s reasons for visiting school health service for elementary, secondary school and university. Results:Younger children from elementary school visited services for: learning difficulties, psychosomatic problems, chronic illnesses. Older children visited services for: behavior problems, school absence, poor school achievement, and tobacco and alcohol consumption. High school students asked help regarding: reproductive health (girls), adolescent problems (conflict with parents, teachers, peers), poor school achievement, drugs consumption. Students came for solving educational problems: health related study discontinuance, student’ s dorm, exemption certificate for different activities and chronic illness counseling, reproductive health. Medical students’ opinion research confirms the need for counseling services for the similar reasons. All populations visit counseling services as necessary after medical examination. Conclusion:Solving all the problems demand health care organization model for which family doctor is not sufficient today, therefore we consider that we need to organize separate School and university health service with greater competence and accessibility then now.

Spolno prenosive infekcije jedan su od vodećih javnozdravstvenih problema među mladima i od osobitog su društvenog značaja obzirom na očuvanje reproduktivne sposobnosti pojedinca. Suvremena medicina učinila je ogromne korake u sprečavanju mnogih, prvenstveno dječjih zaraznih bolesti, upravo zahvaljujući cijepljenu. Nažalost kad je riječ o spolno prenosivim infekcijama nije se pokazala toliko uspješnom. Dosadašnji rezultati u razvoju i primjeni cjepiva protiv spolno prenosivih infekcija nisu dali dovoljno dobre rezultate da bi se sustavno provodilo cijepljenje iz sljedeći razloga: Chlamydia trachomatis – naglašena imunopatologija, Treponema pallidum – slaba imunogenost, Neisseria gonorrhoeae – široka heterogenost antigena, Human herpes simplex virus typ 2 – nepotpuna atenuiranost virusa, Human imunodeficient virus . Uspješno se provodi cijepljenje protiv Hepatitis B virusa. U širu primjenu u posljednjih godina ulazi i cjepivo protiv humanog papiloma virusa (HPV). S aspekta ovih autora cijepljenje protiv humanog papiloma virusa otvara prije svega nekoliko etičkih dilema i pitanja na koje treba odgovoriti: a) Zemlje koje imaju visoki obuhvat skriningom za karcinom cerviksa (prije svega skandinavske zemlje) ovog trenutka ne provode sveobuhvatno cijepljenje školske djece i mladih protiv HPV-a, u okviru obvezatnog programa cijepljenje. Nije posve jasno zašto? Za pretpostaviti je da obzirom na njihovo materijalno stanje “ novac” ne bi trebao biti zapreka ; b) Cjepivo ovog trenutka sadrži HPV tipove 16, 18, 6 i 11. U različitim dijelovima svijeta najčešći izolirani tipovi HPV imaju drugačiju učestalost i distribuciju. U nas nema objavljenih rezultata većih studija o proširenosti pojedinih tipova HPV-a u karcinomima cerviksa. Uvažavajući da postoji unakrsna imunost i visok stupanj zaštite ukoliko se cijepi i s tipovima 16, 18, nije jasno zašto cjepivo ne sadrži i druge tipove HPV, ako već sadrži i tipove 6 i 11 ; c) Svi koji preporučuju cijepljenje, uključujući Svjetsku zdravstvenu organizaciju, ističu da je i nadalje potrebno provoditi sve ostale preventivne mjere za sprečavanje širenja spolno prenosivih infekcija (redovita uporaba prezervativa, kasnije stupanje u seksualni odnos, manji broj seksualni partnera), redoviti sistematski ginekološki pregledi i u okviru toga skrining za rano otkrivanje karcinoma cerviksa. Na koji način će biti u praksi osigurano da uistinu djeca i mladi koji su cijepljeni protiv HPV-a dovoljno dobro budu obaviješteni o potrebi preventivnih pregleda? Ovakve preventivne mjere se razlikuju od dosadašnjih kada smo ih cijepili protiv drugih bolesti, kao što su dječje zarazne bolesti Premda smo bili svjesni da zaštita nije 100%, ipak su bili zaštićeni od težih posljedica ili komplikacija tih bolesti. Umjesto zaključka Djelotvorno cijepljenje protiv bilo koje bolesti, uključujući i spolno prenosivih infekcija, je ideal intervencije svih koji rade u javnom zdravstvu, a posebice zaštitom zdravlja mladih. Ali po prvi puta se nalazimo pred više neodgovorenih pitanja kad je riječ o cijepljenu protiv HPV-a i za nas (autore ovog rada) najvažnije je: Može li i treba li cijena cjepiva, odnosno materijalni status obitelji, biti kriterij da li će neko dijete biti ili ne cijepljeno?. Naš odgovor je “ NE” . Ograničeni materijalni resursi kojima raspolažemo u zdravstvu (a s tim se susreću i vrlo bogati) navodi nas da odaberemo prioritete. Pri odabiru prioriteta rado bi čuli što je više argumenata i stručnih analiza kako bi donijeli najbolju moguću odluku u danim okolnostima.

Prepoznavanje čimbenika rizika za srčanožilne bolesti dječjoj dobi jedan je od temeljnih ciljeva prevencije srčanožilnih bolesti u odrasloj dobi. Cilj: Procijeniti postoje li razlike u prehrambenim i životnim navikama između učenika prvog razreda osnovne škole koji su primjereno uhranjeni i prekomjerno uhranjenih i adipoznih. Ispitanici: Ispitanici su bili učenici iz 40 osnovnih škola. Uzorak je reprezentativan za Hrvatsku, a škole su stratificirne prema veličini – broju učenika u školi. Istraživanjem je obuhvaćeno 960 učenika, 493 (52, 4%) dječaka i 467 (48, 6%) djevojčica. Metode: Anonimni upitnik (ispunjavali su roditelji učenika) imao je 75 pitanja o: prehrambenim navikama, uporabi kompjutera i interneta, gledanju televizije, zdravstvenom statusu, školskoj spremi roditelja, a izvršena su i antropometrijska mjerenja, tjelesna masa, tjelesna visina, određen indeks tjelesne mase (ITM, kg/m&sup2 ; ). U statističkoj analizi korištene su metode deskriptivne statistike, faktorska i diskriminacijska analiza. Za procjenu tjelesne uhranjenosti korišteni su &laquo ; Cole standards&raquo ; [1] te su temeljem tih kriterija ispitanici su podijeljeni u tri grupe: grupa 1 – uredno uhranjeni, grupa 2 – prekomjerno uhranjeni i grupa 3 adipozni. Rezultati: Prekomjerno uhranjenih je 127 (13, 2%) i adipoznih 73 (7, 6%) djevojčica i dječaka. Rezultati analize prehrambenih navika (broj obroka u danu, učestalost konzumacije mesa, mlijeka, voća, povrća, šećera, slatkiša i &laquo ; brze hrane&raquo ; ) pokazala je da prekomjerno uhranjeni i adipozni imaju manje obroka tijekom dana i jedu manje voća u odnosu na primjereno uhranjene. Prekomjerno uhranjeni i adipozni jedu &laquo ; brzu hranu&raquo ; pet i više puta tjedno, što je statistički značajna razlika u odnosi na primjereno uhranjene (p=0, 0009), također provode više vremena za kompjuterom (p=0, 0039). Nije bilo razlike među ispitanicima ove tri skupine u vremenu koje provode gledajući televiziju. Faktorskom analizom dobiveno je dvanaest faktora koji nose opterećenje 60 % varijabilnosti promatrane pojave. Faktori su uvršteni u diskriminacijsku analizu. Kriterijska varijabla je bila ITM svakog ispitanika podijeljenih u tri navedene grupe. Dobivene su dvije diskriminacijske funkcije od kojih se 1. diskriminacijska funkcija pokazala statistički značajnom na razini p=0.010 (χ &sup2 ; = 42, 890 df = 24). Prva diskriminacijska funkcija je pretežno opisana s faktorom 3 Red rođenja i broj djece, faktor 2 Završena škola roditelja, faktorom 7 Konzumiranje voće i povrće, faktorom 12 Broj sati rada, faktorom 5 Fizička aktivnost, faktorom 11 Pijenje alkohola. Zaključak: Djeca koja su uredno uhranjena su opisana sljedećim: većim brojem djece u obitelji i višim redom rođenja, nižim obrazovanjem roditelja, jedu više voća i povrća, manje sati provedu igrajući igrice na računalu, imaju više fizičkih aktivnosti, piju manje alkohola uz obrok. Prekomjerno uhranjena i adipozna djeca su opisana sljedećim: manjim brojem djece u obitelji i nižim redom rođenja, višim obrazovanjem roditelja, jedu manje voća i povrća, više sati provedu igrajući igrice na računalu, imaju manje fizičkih aktivnosti, piju više alkohola uz obrok.