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The goal of every organisation is to have employees with high self-esteem and employees with a good work-related quality of life (WRQoL), given that such employees are more satisfied and provide better service, which is ultimately a benefit for the organization. In order for employees to have the best possible WRQoL, the responsibility lies with the administration or health system of a particular country, which is obliged to improve the organisation in all aspects. A sample of 409 participants in the Children’s Hospital Zagreb examined their self-esteem and WRQoL. The research included both health and non-health employees. For the purpose of the research, the Rosenberg self-esteem scale and the WRQoL scale were used. The Pearson correlation coefficient between these two variables was calculated, which is the first such study. The results showed that we have employees with a high level of self-esteem, which is an excellent resource given the fact that high self-esteem has positive implications for job satisfaction and job performance. In contrast to self-esteem, employees were extremely dissatisfied with the quality of life-related to work, especially in the following categories; Working Conditions, Job and Career Satisfaction, and Control at Work. Following the above, and qualitative research, key factors were found that the management needs to address to raise the WRQoL of employees.

The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, defines 17 Sustainable Development Goals (SDGs) (1). There is a close link between SDGs and another concept championed by the United Nations: WHO – Social Determinants of Health (SDH) (2), incorporated into the WHO Health 2020 policy framework (3) (Table 1). The synergy and obvious similarity between the aims stated in both documents guided the WHO decision to introduce the SDGs into their future strat- egies. The European Commission created the Proposal for a New European Consensus on Development – Our World, our Dignity, our Future (4,5), setting new agenda in the light of global challenges and the AGENDA 2030 by the United Na- tions.

It is well known that inequalities in health are result of unequal life opportunities. Since Croatia does not have a strategy of investment in early development, during the last two years, Croatian Healthy Cities Network had supported the development of the initial policy documents (state of the art and policy paper) and formulated an operational document for the implementation of the Strategy, firstly (as a pilot project) in the City of Zagreb. In Croatian (transition) society numbers testify the change in family structure. The number of newly born is decreasing steadily, whereas the number of children at social risk is on the rise (around 20% of children up to 7 years old are at risk of poverty) and so is the number of children at neuro and developmental risk (around 10%). There are many laws and regulations governing the rights of parents and children (especially those with developmental difficulties) but parents are ill informed about them. Our intervention is aiming at creating safe, stable, supporting relationships and environment for children, i.e. on strengthening family setting and providing additional support when necessary. The best system for a 'healthy start' includes health, social, and education policies which provide: a) excellent health care in pre- and post-natal period; b) social system which recognizes risks caused by early childhood poverty; c) good possibilities of maternity leave use; and d) high quality early education and care. Although our intervention is inter-sectoral, the key actors who will carry it out are community nurses. They are extended arm of the primary health care service towards community. They will visit the pregnant women in their homes two times during the pregnancy (16th and 24th week of pregnancy) and, through the interview, assess health, social and environmental risks. If the family shall need additional support, nurses will liaise them with appropriate service provider. Existing lack of information on local services (health, education, social care, NGO and community) will be addressed by the creation of the Directory of resources that will consolidate information on the available services in one place. Community nurses will visit mothers and their new-borns again within 24 hours of their hospital discharge and seven days later. These visits will focus on the assessment of the child's progress and health, breastfeeding status, navel examination, child bathing, baby handling and information on the rights and access to other needed services. In the next visit, when the baby is 30 days old, community nurse will check the child's progress and enquire mother’s mental health (detection of post-partum depression). In the visits to follow, community nurses will use GMCD instrument (the International Guide for Monitoring Child Development) suitable for the early detection of developmental disorders. Part of the intervention is development of an information system, which would enable better exchange of information between primary health care workers and between health and social services; development of instruments and standards in risk assessment; protocols development and continuous development and empowerment of professional staff involved in early child development.

Pristupačna gradnja je prihvatljiva i predstavlja izravno investiranje u vrijednost građevina u sustavu zdravstva, jer se klasično građene građevine koriste i dulje od 80 godina. Gradnja pristupačnih građevina u mnogim je članicama Europske unije potpomognuta i dodatnim fi nancijskim sredstvima. Provođenje odredbi za poboljšanje kvalitete života osoba s invaliditetom (OSI) u RH usklađeno je s međunarodnim standardima. Ti standardi uključuju temeljno načelo ljudskih prava, a to je načelo nediskriminacije. Kako bi se postiglo navedeno načelo nužno je osigurati pristupačnost sustava zdravstva osobama s trajnim ili privremenim invaliditetom te senzornim, intelektualnim i psiho-socijalnim teškoćama. Pristupačnost sustava zdravstva uključuje uz prostornu i “specijalističku” pristupačnost po odjelima, zdravstvenim jedinicama/ ustanovama, kako bi sustavi zdravstva mogli pružili sveobuhvatnu zdravstvenu uslugu OSI. U osiguravanju pristupačnosti sustava zdravstva osobama s invaliditetom značajna je uloga mnogih dionika u gradnji i intersektorska suradnja. Prvi korak u realizaciji pristupačnosti sustava zdravstva osobama s invaliditetom jest utvrditi stanje pristupačnosti sustava zdravstva OSI. U tu svrhu potrebno je izraditi alate, tehnike i tehnologije za procjenu i kasniju evaluaciju. Osnovni dio alata je upitnik samoprocjene (samoevaluacije) pristupačnosti sustava zdravstva OSI sukladno zakonskim propisima, izrada IT programa za obradu podataka prikupljenih probirom te izrada akcijskog plana za uspostavu i evaluaciju pristupačnosti sustava zdravstva OSI. Uspostava mehanizama samoprocjene pristupačnosti sustava zdravstva OSI kao konačan rezultat imat će unaprjeđenje neovisnosti i kvalitete življenja OSI, ali i kvalitete i učinkovitosti sustava zdravstva pružanjem zdravstvenih usluga primjerenih potrebama., Accessible construction is acceptable and represents direct investment in the infrastructure, as well in the healthcare system, while the infrastructure is used for more than 80 years. In many EU Member States, construction of accessible buildings has been supported by additional fi nancial resources. Implementation of the framework for the quality of life improvement of persons with disabilities in the Republic of Croatia is in line with international standards. These include the principles of fundamental human rights, i.e. the principle of non-discrimination. In order to achieve this principle, it is necessary to provide access to healthcare system to persons with permanent or temporary disabilities and sensory, intellectual and psychosocial diffi culties. Accessibility of the healthcare system includes both spatial availability and ‘specialized’ (medical services and equipment) availability within departments, health units and institutions, with the main goal to provide comprehensive healthcare service for people with disabilities. Very important is the role of stakeholders in the construction industry and intersectional co-operation. The fi rst step in achieving accessible healthcare system for people with disabilities is to assess and defi ne the level of accessibility of healthcare institutions. Therefore, it is necessary to develop the tools, techniques and technologies for assessment and subsequent evaluation in accordance with legal regulations, such as questionnaire for (self)assessment of the accessibility of healthcare institutions for persons with disabilities, and an IT program for data processing. This can lead to development of an action plan, i.e. framework for improvement of accessibility of healthcare institutions for persons with disabilities. As the ultimate result of the establishment of this process, the healthcare system will increase its accessibility to persons with disability and enhance their independence and quality of life. It will also improve the overall system quality and effi ciency through provision of appropriate healthcare services.

Uvod: Rad prikazuje rezultate akcijskog istraživanja potreba jednoroditeljskih obitelji Poreča te implementaciju lokalnih intervencija u korist jedno roditeljskih obitelji s područja Poreča. Isto tako prikazuje razvoj lokalnih politika kojima se uređuje provedba lokalnih intervencija za zaštitu jednoroditeljskih obitelji u neposrednom okruženju zajednice. Jednoroditeljske obitelji su prepoznate kao ranjiva skupina u populaciji sa značajnim rizikom za siromaštvo i lošije zdravlje svih članova. Dostupni pokazatelji ukazuju da se struktura obitelji u razvijenim europskim zemljama mijenja te da raste udio jednoroditeljskih obitelji. Istraživanja ranog razvoja djece pokazuju da je utjecaj funkcionalne obitelji te stabilnog okruženja u kojemu dijete raste, bez obzira na strukturu obitelji, od dugoročnog značenja za zdravlje pojedinca i čitave populacije. Postoje dokazi o tome da rani razvoj polaže temelje zdravlja u odrasloj dobi. U Hrvatskoj nema sustava koji dobro zadovoljava potrebe ove ranjive skupine ni programa kontinuirane, sveobuhvatne podrške jednoroditeljskim obiteljima. Projektni tim Zdravog grada Poreč pristupio je ovom kvalitativnom akcijskom istraživanju pod nazivom „Utvrđivanje potreba jednoroditeljskih obitelji u hrvatskim zdravim gradovima“ u razdoblju od 2011. do 2016. godine. Istraživanje je provedeno u 6 hrvatskih zdravih gradova (Labinu, Vinkovcima, Rijeci, Zagrebu, Dubrovniku i Poreču) pod okriljem i uz stručno vodstvo Suportivnog centra HMZG pri Školi narodnog zdravlja „Andrija Štampar“ Medicinskog fakulteta Sveučilišta u Zagrebu. Uzorak i metode: Ukupni uzorak je činilo 79 ispitanika (uz iznimku jednog oca sve su ispitanice bile majke) iz jednoroditeljskih obitelji u dobi do 35 godina s djecom u dobi do 7 godina. Porečki uzorak obuhvatio je 10 roditelja (majki) iz jednoroditeljskih obitelji. Kao osnovni instrument za prikupljanje podataka korišten je standardizirani intervju, sastavljen od četiri skupine pitanja, koji su vodile educirane patronažne sestre. Rezultati su u svim gradovima, pa tako i u Poreču, pokazali da su jednoroditeljske obitelji ranjiva skupina koja vrlo teško osigurava temeljne životne potrebe. Svrha je ovog istraživanja bila da svaka zajednica temeljem rezultata dobivenih istraživanjem u svom okruženju planira i provodi intervencije te uspostavi specifi čne lokalne nadstandarde zaštite i podrške jednoroditeljskim obiteljima. U rezultatima smo prikazali nadstandarde Grada Poreča kojima je unaprijeđena kvaliteta života i rada roditelja i djece iz jednoroditeljskih obitelji., Introduction: This paper presents results of the action research into the needs of single-parent families in Poreč and implementation of local interventions to the benefi t of single-parent families in the Poreč area. The aim of the study was to identify the problems and needs of single-parent families and to implement the interventions as local above standards, to meet the needs recognized in these families in the local community environment. The single-parent families were recognized as a vulnerable population group at a high risk of poverty and health problems for both parents and children. The data available revealed a change of family structure in Croatia (as in other developed European countries) and an increase in the number of single-parent families. The researches related to early childhood indicate that the infl uence of functional family and stable environment (social determinants of health) has long-term impact on the child growth, health and development. There is evidence that early development is the basis for health in adult life. The present study assessed the needs of single-parent families in Croatia (and in Poreč), followed by the implementation of local interventions to meet the needs recognized in these families. The Healthy City project team and Poreč as member of the Croatian Healthy City Network (CHCN) readily approached this qualitative action research entitled Identifying the Needs of Single-Parent Families in Croatian Cities, during the 2011-2016 period. Methods and Subjects: The research was conducted simultaneously in six Croatian Healthy Cities (Labin, Vinkovci, Rijeka, Zagreb, Dubrovnik and Poreč) with academic support provided by supervisors from Andrija Štampar School of Public Health, School of Medicine, University of Zagreb. There were 79 respondents from six cities, all mothers with the exception of one father. All of them were single parents aged

The aim of this study was to assess the value of the “Health-Plan for It” Program for the capacity of Croatian counties to plan health and implement services based on locally recognized health needs. From 2002 to 2008, the county health teams formed in twenty Croatian counties passed the first set of training modules. First assessment was conducted in 2006. Based on assessment results, in 2008-2009 a new set of training modules was organized and attended by six counties. In second assessment conducted in 2012, three instruments were applied: Local Public Health Practice Performance Measures Instrument and Procedure Chart as self-reporting instruments, and tutorial notes assembled/analyzed by the Faculty. All 13 county health teams that participated in second assessment showed an increase in the 2012 score compared to 0-point. The score change showed statistical significance on both the overall core public health functions and on any of its components (assessment, policy development, assurance). All counties showed improvement in assessment and policy development functions. The assurance function was improved in counties that attended the second set of training modules. The Procedure Charts showed that all counties had developed their own health profiles and health plans, with prioritized health needs and identified actions to address them. Like the first evaluation workshop in 2006, results of the second evaluation workshops in 2012 showed that the Program increased the counties’ public health capacity. Two of the counties that had enrolled late in the Program (2007/2008) achieved much better results than ‘older’ counties, showing that the time spent in the Program was not a key factor contributing to local project success. Different levels of achievement due to ‘institutional or personal capacity to change’, reported by other authors, are in line with our findings that individual county success in the Program depended on the team composition and the level of (regional) political stability. In conclusion, the program showed improvement of all core public health functions in all counties. Assurance function showed generally a higher change in counties that had passed both sets of modules. The counties’ capacity for change differed and the Program was not equally efficient in all of them. The differences in county achievements could be explained by stability of political support at the county level, team composition, and commitment of the team leader., Cilj ovoga istraživanja bio je ocijeniti vrijednost učinaka programa “Rukovođenje i upravljanje za zdravlje” na sposobnost hrvatskih županija da planiraju za zdravlje te implementiraju programe temeljene na lokalno prepoznatim zdravstvenim potrebama u podizanju javnozdravstvene i upravne kompetencije hrvatskih županija dvanaest godina nakon pokretanja toga Programa. U razdoblju od 2002. do 2008. godine svih dvadeset županijskih timova za zdravlje provedeno je kroz prvi set edukacijskih modula. Prva evaluacija Programa napravljena je 2006. godine. Temeljem rezultata evaluacije izrađen je drugi set edukacijskih modula kroz koji je, u razdoblju od 2008. do 2009. godine provedeno šest županijskih timova. U drugoj evaluaciji Programa održanoj 2012. godine primijenjena su tri evaluacijska instrumenta: Matrica temeljnih funkcija javnog zdravstva (Local Public Health Practice Performance Measures Instrument) i hodogram aktivnosti županijskih timova (Procedure Chart) kao instrumenti za samoprocjenu te zabilješke/zapažanja mentora sa Škole narodnog zdravlja “Andrija Štampar”. Rezultati timova za zdravlje trinaest županijskih timova, sudionika u drugom krugu evaluacije u 2012. godini bolji su u usporedbi s njihovim početnim stanjem (0-point). Promjene u rezultatima pokazuju statistički značajnu razliku kako u ukupnom zbroju (sve tri temeljne funkcije zajedno) tako i za svaku funkciju pojedinačno (procjena stanja, oblikovanje zdravstvene politike, osiguravanje resursa). Sve su županije pokazale napredak u funkciji procjene stanja i oblikovanja zdravstvene politike. Funkcija osiguravanja sredstava bila je unaprijeđena kod županija sudionica u drugom setu edukacijskih modula. Hodogrami aktivnosti županijskih timova pokazali su da su sve županije (sudionice u evaluaciji) izradile Županijske slike zdravlja i Planove za zdravlje s jasno definiranim prioritetima i aktivnostima kojima ih namjeravaju riješiti. Rezultati evaluacije provedene 2012. godine, kao i rezultati evaluacije iz 2006. pokazuju da su Programom unaprijeđene javnozdravstvene kompetencije županija. Dvije županije uključene u Program tek 2007./2008. godine postigle su bolje rezultate od „starih“ (ranije uključenih) županija te time pokazale da vrijeme provedeno u programu nije ključni čimbenik uspješnosti projekta lokalno. Razlika u postignućima može se pripisati „institucionalnom ili osobnom kapacitetu za promjenu“ o kojem izvještavaju i drugi autori. Ovdje prikazani rezultati ukazuju na to da je razlika u postignućima u Programu među županijskim timovima bila uvjetovana sastavom tima i političkom stabilnosti lokalno. Programom su unaprijeđene sve temeljne javnozdravstvene funkcije u županijama sudionicama Programa. Funkciju osiguravanja sredstava najviše su unaprijedile županije uključene u oba seta edukacijskih modula. Županije imaju različit kapacitet za uvođenje promjene pa sudjelovanje u Programu nije kod svih polučilo jednako dobre rezultate. Razlike u razini postignuća između županija moguće je objasniti postojanjem (ili odsustvom) kontinuirane političke potpore na županijskoj razini, sastavom tima i predanošću njegovog voditelja.

Cilj je ovoga rada na primjeru Odjela za psihijatriju Opće bolnice „Dr. Tomislav Bardek“ Koprivnica prikazati proces samoprocjene te ugradnje koncepta kliničkog promicanja zdravlja u svakodnevni rad bolnice. Metode: Koristeći Model za procjenu potreba promicanja zdravlja, pregledom 50 medicinskih zapisa pacijenata hospitaliziranih u razdoblju od 1. 11. do 30. 11. 2014. g, procijenjeni su indikatori Standarda 2. (procjena pacijenata vezano uz potrebe za promicanjem zdravlja), 3.1.1. (informiranje pacijenata o značajnim čimbenicima vezanim uz njihovo zdravstveno stanje) i 5. (kontinuitet suradnje s drugim pružateljima zdravstvene zaštite i drugim relevantnim sudionicima). Rezultati: Samoprocjenom medicinske i sestrinske dokumentacije, vezano uz zapise podataka o preventabilnim rizicima i zdravstvenom ponašanju hospitaliziranih pacijenata (pušenje, pijenje alkohola, prehrambene navike, fi zička neaktivnost, psihosocijalni odnosi), utvrđena je potreba za unaprjeđenjem - u obliku sustavnog i standardiziranog unosa informacija u cilju boljeg planiranja aktivnosti promocije zdravlja. Defi niranje potreba pacijenata i davanje informacija o njima nedovoljno se bilježi u pacijentovoj dokumentaciji. Sestrinska lista ima jasniju strukturu za upis pojedinih vrijednosti praćenih rizičnih čimbenika, ali ne objedinjuje sve rizične čimbenike na jednom mjestu. Najveći izazov je područje Standarda 5. Otpusna pisma sadrže opis stanja pacijenta i potreba u smislu promocije zdravlja, međutim nedostatno sadržavaju preporuke o dostupnim programima izvan bolnice i plan oporavka. Razlog tome je dijelom u nepostojanju izvanbolničkih programa liječenja, a dijelom u nedostatnoj suradnji bolnice i drugih ustanova, udruga i sl. Zaključak: Iako glavna odgovornost bolnice za pacijenta prestaje s otpustom, gledano iz pozicije zdravstvenog sustava - veliki broj rehospitalizacija i komplikacija može biti prevenirano ako su pacijenti bolje pripremljeni te ako su u proces uključeni drugi pružatelji medicinske i socijalne pomoći., In 2006, the World Health Organization (WHO) published the manual entitled Implementing Health Promotion in Hospitals: Manual and Self-Assessment Forms, which defi nes fi ve standards and related indicators, allowing systematic self-assessment of health promotion in hospitals. In 2014, the Bispebjerg University Hospital, Denmark, the WHO Collaboration Center for Evidence Based Health Promotion in Hospitals, launched an international research project that sought to explore the effectiveness of clinical health promotion (Recognition project). Department of Psychiatry, Dr. Tomislav Bardek General Hospital from Koprivnica took part in this research. The aim of this paper is to present self-assessment and integration of the clinical health promotion concept in daily work of a general hospital, exemplifi ed by Department of Psychiatry, Dr. Tomislav Bardek General Hospital from Koprivnica. Using the Health Promoting Hospitals DATA Model for Identifi cation of Health Promotion Needs, records on 50 patients (hospitalized in November 2014) were audited in December 2014 by the local research team. Methods: The following indicators were assessed: Standard 2 – patient assessment related to body weight, body mass index, appetite, metabolic disease, physical activity, smoking, and harmful alcoholic drinking; Standard 3.1.1 – patient needs and information on smoking, drinking alcohol, eating habits, physical inactivity, and psychosocial relationships; and Standard 5 – information in discharge summary including plan for rehabilitation, recommendations of interventions, and patient status. Results: Systematic audit of medical and nursing documentation on preventable health risks of hospitalized patients detected areas for improvement that would allow better planning of health promotion activities in clinical settings, i.e. improve treatment effi cacy and patient safety. Auditors found that patient needs and information provided were not recorded appropriately in medical documentation (nursing documentation was more clearly structured). Discharge letters had comprehensive description of patient status but scarce recommendations of interventions and rehabilitation plan (what to do after discharge from the hospital). Explanation can be found in disrupted continuity of care. There are weak formal communication channels between hospital and other (health, social welfare, nongovernmental organizations) care providers, institutions and community, so patients and their families cannot (automatically) be referred to other support programs and services. The use of standardized Manual and self-assessment forms allows systematic assessment of health promotion in hospitals. In addition, it can detect areas for improvement that will lead (fi nally) to the integration of the concept of clinical health promotion in daily work of the hospital. However, proper pursuit of the continuity of healthcare is particularly important. Conclusion: In order to improve the quality of care for patients with chronic, long-term illnesses, clinical health promotion in hospitals should be built into a wider healthcare framework.

Prema demografskim pokazateljima u Hrvatskoj se bilježi porast broja jednoroditeljskih obitelji. Pregledom literature dolazi se do zaključka da strukturna manjkavost jednoroditeljskih obitelji utječe na roditelje i djecu iz tih obitelji koje imaju veći rizik od siromaštva, zdravstvenih problema te problema s edukcijom. Cilj istraživanja bio je prepoznati specifi čne potrebe jednoroditeljskih obitelji u gradovima Hrvatske koje bi bile podloga za razvoj učinkovitih programa pomoći i podrške na lokalnoj razini. Ispitanici i metode: U istraživanju je sudjelovalo šest članova Hrvatske mreže zdravih gradova (HMZG). U oblikovanju uzorka koristila se strategija namjernog uzorkovanja „informacijama bogatih“ ispitanika. Ograničenje je bila dob roditelja do 35 godina koji imaju dijete u dobi do 7 godina. Od odabranih ispitanika informacije su prikupljene pomoću vođenog (standardiziranog) intervjua koji su provele patronažne sestre. U obradu je primljeno sveukupno 79 transkripta intervjua. Obrada transkripata intervjua provedena je metodom analize sadržaja redukcijom teksta. Ranjivost jedno-roditeljskih obitelji, identifi cirana pretraživanjem publicirane literature, potvrđena je ovdje prikazanim istraživanjem. Rezultati: Konkretni problemi s kojima se te obitelji suočavaju su nezaposlenost, nedostatak podrške i nedovoljno poznavanje s propisima i organizacijama koje im nude pomoć. Zaključak: Istraživanje je doprinos europskim istraživanjima nejednakosti u zdravlju. Njime se naglašava značenje intervencija u ranom razvoju djeteta, posebno djece koja odrastaju u nepovoljnim socijalno-ekonomskim uvjetima., According to demographic indicators, the number of single-parent families in Croatia has been increasing over years. Literature review leads to a conclusion that a structural defi cit in single-parent families increases their risk of pauperization, health risks and educational problems in children. The aim of this study was to identify specific needs of single-parent families in the Croatian cities. Recognized needs will serve as the foundation for future development of effective support programs at the local level. Subjects and Methods: This applied research was conducted in (and by) six members of the Croatian Healthy Cities Network. While forming the sample, the strategy of purposeful sampling of ‘information rich’ respondents was used. The limit was the age of parents of ≤35 years with a child aged ≤7 years. Data were collected through structured (tape-recorded) interview with parents, performed by visiting nurses. A total of 79 transcripts of interviews were received. Data analysis was performed by use of qualitative analytical method (text reduction content analysis). Vulnerability of single-parent families, identifi ed through literature review, was confi rmed in this research. Results: The specifi c problems faced by these families are unemployment, lack of support, insuffi cient understanding of legal rights and regulations, and organizations that can provide them with assistance. Conclusion: This research can contribute to the body of European health inequity research. It emphasizes the importance of interventions during early childhood development, especially in children growing up in adverse socioeconomic conditions.

Objective To determine the progress in the development and implementation of health policies on a county level resulting from the learning-by-doing training provided through the County Public Health Capacity Building Program started in 2001 in Croatia. Methods Modular training using management tools, public health theory and practice, and SMDP's Healthy Plan-it™ tool, followed by the self-evaluation of the progress made by county teams in health needs assessment and health policy development, implementation, and assurance. Fifteen county teams consisting of politicians, executive officers, public health professionals, and community members. Results Twelve of 15 county teams completed the program. The teams made progress in the evaluated areas, although to a different extent, which did not depend on the amount of time they had or the governance experience. The differences in improvement depended on the differences in the strength of political, executive, and professional components of the teams. Teams with a strong political and/or executive component, but weak public health professional and community components made major improvements in policy development and/or assurance function, but performed less well in the health needs assessment and constituency building. The reversed was also true. Conclusion Learning-by-doing training program improved public health practices on a county level in Croatia.

Public health draws from a range of academic disciplines, social, medical and statistical, and answers questions relevant to improving the health of populations. We have initiated a Europe-wide study, Strengthening Public Health Research in Europe, to assess the development and use of public health research in both public policy and local decision making. The contemporary challenge for public health research is to integrate the capabilities of different academic disciplines to address policies for health. We have considered the development of public health research in five fields: political epidemiology, community health, health services, economics, and evaluation evidence and synthesis. The organisation and funding of research in Europe should be able to support new research fields and issues, to contribute to policy development and public health practice. European Union.

The goal of this study is to identify and describe variables contributing to the efficiency of health promotion interventions, and to assess whether these variables can serve as reliable and early indicators of the success of such interventions. The study sample includes 44 interventions selected through a network of key informants from five cities--Liverpool, Sandwell, Vienna, Pula, and Rijeka--by using a chain technique. Data on each intervention are collected through an in-depth interview with a program leader, the collection of project-related documents, and on-site observation. Qualitative analysis of data performed with content analysis and computer-assisted free-text analysis reveals different characteristics of interventions depending on whether they are initiated by the city government sector, health-care system, or citizens sector (independent of the city or country). The assessment of the efficiency of these three groups of interventions also differs because of varying features, scope (activity potentials) and impact they are able to accomplish. We have identified ways in which the efficiency of all three groups of interventions can be improved. The efficiency of the interventions within the city sector can be increased through an improved process of delegation to other sectors, higher involvement of user groups, and higher receptivity and organizational flexibility. The efficiency of the interventions within the citizens sector can be improved through professional, organizational, and financial support. Support from the professional community is important for citizens sector interventions in confirming the importance of the problem they address and legitimizing the actions they propose and undertake.

Phyllodes tumors and fibroadenomas are the most common benign breast tumors. They arise from intralobular fibrous tissue as a unique lesion and after a period of time they differentiate in two direction: to fibroadenoma and to phyllodes tumors. Fibroadenomas grow up to 2-3 cm and then stop growing but phyllodes tumors grow continually and sometimes are to 40 cm big. Both these lesions have two components, epithelial and stromal. Clinically fibroadenomas are well circumscibed, hard, oval, movable lesions. They can be solitary, multiple, unilateral and bilateral. They are hormone dependent changes, because they change their own consistency during menstrual cycle and gravidity. The most commonly used histological classification is in two types: pericanalicular and intracanalicular type. Phyllodes tumors make about 1% of all breast tumors. This tumor has many synonyms. It starts as fibroadenoma in intralobular stromal component. It has continuous growth and biologically it can be benign, borderline and malignant. The first description is from Miller (1838). The main goal is to find the divergence point when the developing is direct to fibroadenoma or phyllodes tumor. The second goal is to investigate the fate of epithelial and stromal component in these two lesions. Retrospective analysis is made of all fibroadenomas and phyllodes tumors in Pathology Department of Medical Center "Bezanijska kosa" in the period from 1998 to 2006. In this period, 2919 women were operated for breast changes. 343 fibroadenoma (24, 4%), were diagnosed, benign phyllodes tumor in 95 women (6.7%) and malignant phyllodes in 4 cases or 0.2%. All slides from these patients were analysed for many different histological parameters and immunohistological investigation for steroid receptors was also used, c-erbB2 (Her2/Neu), PCNA (proliferative cellular nuclear antigen) and Ki-67, androgen receptor and p53. All data were statistically investigated (Odds ratio, confidence interval, Fisher exact test, Wilcoxon sum test and Kendall test). It was concluded that fibroadenomas and phyllodes tumors arise from intralobular fibrous tissue, both changes have very close histology in the beginning and divergent growth starts later. Differences are present in stromal component. Phyllodes tumor has two component stroma. Stromal cells in phyllodes tumors are more PCNA positive than in fibroadenomas, also Ki-67 and androgen receptors are more positive in phyllodes tumors. Histologically phyllodes tumors have perforated capsule with finger like projections. These data determine surgical procedure, wide excision in phyllodes and simple excision in fibroadenomas.

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

Although decentralization is based on the simple idea that smaller organizations, properly structured and steered, are inherently more agile and accountable than larger organizations, in the health system this idea requires much more exploration (Saltman et al. 2007). Health systems are large and composed of several subsystems, including health care providers, health financing, and public administration. All of them have their own organizational patterns and values. Furthermore, inside each of them are further divisions, sometimes with almost opposite approaches: health promotion, disease prevention, clinical medicine, or palliative care. All of these subsystems and divisions could recognize decentralization as an opportunity or a threat.

Rad donosi pregled aktualnog stanja javnog zdravstva u Hrvatskoj.

Opisana je postojeća javnozdravstvena praksa vezana uz funkciju procjene zdravlja i zdravstvenih potreba stanovništva u Republici Hrvatskoj. U našem sustavu zdravstvene zaštite ta se javnozdravstvena funkcija obnosi korištenjem rutinske zdravstvene i demografske statistike te epidemiološkim istraživanjima. Akademski, koriste se i rezultati drugih tipova javnozdravstvenih istraživanja, ali oni u pravilu imaju slabi utjecaj na praksu procjene zdravstvenih potreba stanovništva. Suvremeno javno zdravstvo uvodi novosti u praksu ocjenjivanja zdravstvenih potreba. Prvo, revidira se rutinska zdravstvena statistika kako bi je se moglo koristiti i za aktualne procjene zdravstvenih potreba. Drugo, uvodi se kvalitativna paradigma u javnozdravstvena istraživanja za rutinske potrebe procjena zdravlja stanovništva ili podskupina u populaciji. Treće, uvedene su zdravstvene ankete koje osim pružanja informacija o ponašanju vezanom uz zdravlje imaju za cilj intervencijom unaprijediti kvalitetu u sustavu zaštite zdravlja, Public health practice performance is measured through its three core functions, i.e. assessment, policy development and assurance. We describe the existing health status and health care needs assessment practices in the Republic of Croatia. Health care needs assessment in Croatia includes mortality and morbidity information available through vital records but does not include community input (opinion and attitude) and participation. Health needs are not analyzed in order to determine the causes of health problems. Analysis of health needs of the population groups at highest risk also does not exist. Resources assessment is not part of the process, so we do not know how adequate the existing health resources are. In the Croatian health care system practice, the assessment function is limited through the almost exclusive use of the routine health and demographic statistics. Academic public health has introduced other kinds of more participative, subgroups oriented, qualitative methodologies but in daily routine, these methods are hardly used. Since health needs assessment is one of the core public health functions, in the future its practice has to be reoriented from pure monitoring towards identifying and solving community health problems. Partnership with community has to be a cornerstone for more efficient health needs assessment practice. In the light of previous statement, we present and discuss new trends in the assessment practice in Croatia, i.e. revision of routine health data collection, ways of performing intervention aimed health surveys, naturalistic approach in health needs assessment, and health needs research of population groups at highest risk.

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