HEALTH CARE IN SLAVONIAN PROVINCE DURING THE 19th CENTURY

Due to its proximity to the Ottoman Empire, Slavonia was constantly exposed to the threat of invasion by numerous infectious and non-infectious diseases. An additional aggravating circumstance was the poor living and hygienic conditions in Slavonia, poverty, droughts, and floods. After the withdrawal of the Ottomans at the end of the 17th century, medical care was provided only by a few barbers and ‘ranarniks’ (i.e., feldshers) who remained in the Slavonian province. Due to the poor medical care, in 1770, the Empress and Queen Maria Theresa issued the General Health Law, which applied to the entire Habsburg Monarchy, including Slavonia. Among other things, it provided for the introduction of formal training for health personnel, ultimately leading to a better quality medical workforce. At the same time, charlatans were increasingly prohibited from working. The shortage of trained physicians, dentists, midwives, pharmacists, and veterinarians was addressed through various measures to promote their education and training. After obtaining their diplomas, these professionals were employed in hospitals, old people’s homes, nursing homes, homes for people with disabilities, and other healthcare institutions where the inhabitants of the Slavonian province received medical care.

Adherence to Dietary Recommendations in Organized Living Beneficiaries with Severe Mental Disorders and Their Caregivers

People with severe mental disorders often require special care. Other than institutionalized care, some organizations provide housing options and special care in the form of organized living. Few studies provide a detailed description of nutrient intake in this type of care. The aim of this prospective study was to assess nutritional status and adherence to dietary recommendations in both people with mental disorders (beneficiaries) and their caregivers. Across three levels of care, 46 beneficiaries and 19 caregivers participated in the study. The mean intakes of energy (kcal/day) and macro- and micronutrients (g/day) were estimated from a 3-day dietary record and compared with dietary reference values (DRVs) set by the European Food Safety Authority (EFSA). The majority of participants did not meet energy intake recommendations (kcal/day). The contribution of total fat to energy intake (% E) was higher than recommended in both beneficiaries and caregivers with 42.1 ± 4.4% and 38.5 ± 6.5%, respectively. A total of 45.2% of beneficiaries and 61.1% of caregivers had their carbohydrate intake within the recommended range. Fiber intake was well below the recommendations (25 g/day) in all groups. Across all levels of care, lower micronutrient intake for pantothenic acid, biotin, folate, potassium, magnesium, copper, selenium, and iodine was observed. Based on the current results, the development and implementation of nutritional guidelines may be targeted to specific populations and nutrient intakes.

Tendencies towards emigration and their association with introversion and ethnocentrism among final-year medical students from Osijek, Croatia: a cross-sectional study

BACKGROUND

The migration of healthcare workers is attracting growing attention worldwide. Attitudes towards emigration develop over the years, and it is possible that, in addition to social factors, they are influenced by the characteristics of a person's personality and the sense of belonging to the social environment. This study aimed to determine the tendencies of final-year medical students' from Osijek, Croatia, towards emigration after graduation and after specialization, as well as their specialty preferences and to investigate whether introversion and ethnocentrism have an impact on attitudes toward leaving the country in search of employment elsewhere.

METHODS

A cross-sectional study was conducted among final-year (6th year) medical students from Osijek, Croatia, in two consecutive academic years - 2014/2015 and 2015/2016. Students completed a questionnaire about sociodemographic characteristics, academic and scientific performance, preferences about their future medical career, the medical specialty of choice, emigration tendencies after graduation and specialization, ethnocentrism and introversion.

RESULTS

There were 124 students who participated in the study (response rate: 96%). A quarter of participants agreed that they are likely or very likely to emigrate after graduation (25.0%) or after specialization (23.39%). Variables associated with the intention to emigrate were specialty preferences (students that prefer endocrinology and psychiatry had the highest emigration tendencies), academic year in which the participants were included (students included in 2014/2015 were more prone to emigrate after specialization, p = 0.060), prior involvement in scientific projects (students with experience in scientific projects expressed higher tendencies to emigrate after graduation, p = 0.023), and ethnocentrism (higher ethnocentrism was associated with a lower tendency towards emigration after specialization, Spearman's rho = -0.191).

CONCLUSION

Our finding that a quarter of final-year medical students from the Faculty of Medicine Osijek were considering emigrating from Croatia in search of employment elsewhere after graduation or specialization is not as high as in previous Croatian studies or studies conducted in other European countries. Even though these data may be encouraging, considering the lack of physicians in Croatia, interventions are needed to prevent permanent emigration to protect the future functioning of the Croatian health system. Furthermore, our study did not find significant associations between levels of introversion and ethnocentrism and tendency to emigrate from Croatia. It seems that the phenomenon covering the emigration of students is more complex and influenced by many other factors which were not included in our study.

The influence of propolis and bee pollen on chicken meat quality

Across the world, as well as in Croatia, there is a continuous increase in the consumption of chicken meat, and attempts are being made in modern poultry production to improve its quality as much as possible by using various natural additives. The aim of this study was to determine the influence of dietary supplementation with propolis and bee pollen on the quality of chicken meat. In order to determine this effect, the carcass body weight of slaughtered chickens and carcass yield were determined, as well as the average pH1 and pH2 of chicken breast muscle, drip loss values, and skin color and chicken breast muscle color expressed as values of L* (lightness), a* (redness), and b* (yellowness). The study was conducted on 200 Ross 308 chickens, divided into five groups. Throughout the study, the control group of chickens was fed with a basal diet, while the experimental groups of chickens were fed with the basal diet supplemented with propolis and bee pollen, each supplement given separately or in combination in specific proportions. At the end of the experiment (42nd day), 10 chickens from each group were slaughtered for the analyses mentioned above. The carcass yield values were significantly higher (P = 0.038) and the drip loss values were significantly lower (P = 0.003) in the experimental groups in comparison to the control group. In addition, there was a statistically significant difference in b* skin color (P = 0.017) and b* chicken breast muscle color (P<0.001) between the groups of chickens. The study showed that dietary supplementation with propolis and bee pollen has a significant positive effect on the quality of chicken meat.

Cognitive Functioning and Life Quality of the Elderly: A Cross-sectional Study

BACKGROUND: According to the Gerontological Health Statistics for Croatia, the number of elderly people in Croatia is increasingly growing. The UN classification ranks the Republic of Croatia as the country which belongs to group four of the European countries with elderly population. AIM: The aim of this paper is to examine cognitive functioning and life quality of the elderly. SUBJECTS AND METHODS: A total of 156 participants took part in the study. The cross-sectional study was conducted from March 2016 to October 2016 in the Osječko-baranjska County, Croatia. The World Health Organization quality of life (QOL)-BREF scale was used to test the QOL; cognitive functioning was tested using mini-mental state examination (MMSE) questionnaire. RESULTS: A total of 156 subjects were tested during the study. The MMSE questionnaire for cognitive abilities and dementia assessment: 83 (53%) participants scored 24 or more which indicates a normal result. The participants whose results indicate the presence of disorders also have notably lower life quality in all domains. The participants suffering only from a physical illness exhibit significantly lower values in the environmental domain (Mann–Whitney U-test, p = 0.010) when compared to those suffering both from physical and mental illness whose results show extremely low values in practically all the segments regarding the QOL. The values of the cognitive functioning questionnaire are related to the life quality domains; the strongest connection relates to mental health (Spearman’s rank correlation coefficient Rho = 0.493 p < 0.001) and the weakest connection refers to social functioning. CONCLUSION: After reaching a certain age, the elderly seems to exhibit the lowering in cognitive functioning which consequently reflects on lowering of the life quality as well. The problems regarding the QOL occur as a direct consequence of the gap between the possibilities of the elderly and the demands and conditions set by modern life.

Poverty and other correlates of obesity and underweight among 7-year-olds from Croatia and Montenegro

OBJECTIVES

This study aimed at investigating poverty and other correlates of childhood underweight and obesity in two urban regions with lower (Podgorica, Montenegro) and higher economic development (Osijek, Croatia).

STUDY DESIGN

Comparative study.

METHODS

A comparative study was conducted on 693 children (52% boys), aged 7 years old (224 from Podgorica and 469 from Osijek). Parents completed the study-specific questionnaire on relevant factors for children's nutritional status. We measured children's height and weight and calculated their body mass index (BMI). International Obesity Task Force cut-off values of BMI were used to assess children's nutritional status. Subjective social position was assessed by the Mac Arthur scale.

RESULTS

There were more underweight children in Osijek compared with Podgorica, both among boys (5.5% vs. 1.6%) and girls (6.9% vs. 1.0%). Obesity was more frequent in Podgorica than Osijek, both among boys (11.3% vs. 5.9%) and girls (10.0% vs. 4.3%). However, poverty in two cities diminished observed differences in children's nutritional status. The odds for child underweight decreased by 12.2%, while the odds for obesity increased by 3.6% per each paternal BMI unit. The frequency of child obesity was lowered per each step higher on the Mac Arthur scale and with breastfeeding by 23.2% and 68.0%, respectively.

CONCLUSIONS

We show that a higher economic development is related to less obese children but more underweight children. However, poverty seems to impact nutritionally all children equally, regardless of the regional economic development. Paternal and not maternal BMI is relevant for both extremes in children's nutritional status. Breastfeeding and higher social position independently protect from child obesity.

THE EFFECT OF DAILY PHYSICAL ACTIVITY ON THE ACTIVITY OF INFLAMMATORY BOWEL DISEASES IN THERAPY-FREE PATIENTS

It has been suggested that various environmental factors play a very important role in the etiology of inflammatory bowel diseases (IBDs) and that they have a significant effect on the course of these diseases. The aim of this study was to investigate the effect of daily physical activity on the activity of IBDs in therapy-free patients. This cross-sectional population based study was conducted in eastern Croatia from January to June 2016. The study included 312 patients, mean age 49.9±15.0 years, 53.2% of males and 46.8% of females; there were 63.4% of ulcerative colitis (UC) and 36.6% of Crohn’s disease (CD) patients. Sociodemographic characteristics of patients, data on their daily physical activity and type of therapy taken were collected through a specifically designed and validated questionnaire, while the activity of UC and CD was evaluated using the Mayo index and Harvey-Bradshaw index. The study showed that 24.0% of patients were not taking therapy. Daily physical activity was connected to IBD in study patients when taking both diseases collectively (Fisher exact test; p<0.001), as well as to the inactivity of CD (Fisher exact test; p=0.001) and UC (Fisher exact test; p=0.006), when observing each disease separately. Daily physical activity was connected to the inactivity of IBDs in patients not taking therapy. It is necessary to educate all IBD patients about the importance of physical activity in order to control their disease.

Green extraction techniques of bioactive components from cocoa shell

The aim of this study was to demonstrate that certain types of extraction techniques can give extracts with various bioactive components in different concentrations. Four green extraction techniques were used in this study: supercritical CO2extraction, ultrasound-assisted extraction, cold atmospheric plasma extraction and extraction using deep eutectic solvents. Those modern techniques gave better yields of bioactive components and showed better antioxidant activity of obtained extracts than classical Soxhlet extraction. The bioactive components in obtained extracts were quantified by High Performance Liquid Chromatography. Supercritical CO2extraction gave the highest yields for theobromine content, while ultrasound-assisted extraction with 50% aqueous ethanol solution gave the highest caffeine yields during 30 min of extraction, 35 Hz and 60 °C. The extraction with deep eutectic solvent mixture of choline chloride: oxalic acid and 50% pure H2O at room temperature during 180 min of extraction time gave the highest total phenol content while the same mixture under the same conditions, but during longer extraction time (360 min), gave the highest antioxidant activity. Cocoa shell (CS), due to its nutritional value and bioactive components, has a potential to become a desirable raw material in a large spectrum of functional and pharmaceutical products.

New Topical Treatment of Symptomatic Internal Haemorrhoids in a General Practice Setting

Introduction: Oral usage of flavonoid-based drugs can be successfully applied in the conservative treatment of internal haemorrhoids; however, its efficiency in a form of topical preparations has not been demonstrated yet. The aim of the present study was to determine the efficiency of ointment with propolis extract (containing minimally 115 mg/kg of flavonoid galangin) in relief and suppression of the symptomatic internal haemorrhoids grade 1 and 2 (bleeding, prolapse, pain, and itching). Methods: This prospective cohort epidemiological study that included 46 participants of both genders, mean age 53.6±14.3 years, was conducted in the general practice setting in Osijek, Croatia and lasted for three months. A specially designed questionnaire was used to collect demographic data and data concerning the haemorrhoid disease symptoms and to evaluate the intensity of the latter data according to the scale defined in the research protocol. Results: The study showed statistically significant improvements in the intensity of all the symptoms connected with the internal haemorrhoids grade 1 and 2 (p<0.001) during the follow up period, as well as statistically significant differences in proportions of participants with and without of the each of the analysed symptoms before and after the therapy (p<0.001). After three months of therapy with ointment containing propolis extract 82.7% patients (38/46) had none of the analysed symptoms. Conclusions: Ointment with propolis extract efficiently affected all the analysed symptoms of the haemorrhoid disease thus having a very significant place within the conservative treatment of haemorrhoids.

Transgenerational Transmission of Violence among Parents of Preschool Children in Croatia

The aim of this study was to determine whether there is a transgenerational transmission of violence within the family on a sample of parents of preschool children in Croatia, and to identify the factors that increase the likelihood of child abuse. The Child Abuse Questionnaire was self-administered to the sample of 118 parents of preschool children (91 mothers and 27 fathers) during February 2013. There were 7.7% of mothers and 3.8% of fathers who answered that they slapped their child, while 15.4% of the fathers answered that they even hit their child with a fist. We found the subjects who were psychologically and/or physically abused in childhood by their parents to have a higher probability of following the exact model of violence on their children. So, children suffer physical violence in larger families from parents who, in turn, suffered physical violence in childhood from their fathers, controlled for all other factors in the model. Children suffer psychological violence from parents who experienced psychological violence from their own parents during childhood, controlled for all other factors in the model. We also found the higher number of family members in a household to be a risk factor for abuse. The study has confirmed that additional interventions are necessary to break the model of transmitting violence from generation to generation.

Sevoflurane preserves regional cerebral oxygen saturation better than propofol: Randomized controlled trial

STUDY OBJECTIVE

To investigate possible effects of volatile induction and maintenance anesthesia with sevoflurane (VIMA) and total intravenous anesthesia with propofol (TIVA) on regional cerebral oxygen saturation (rcSo₂) during laparoscopic cholecystectomy.

DESIGN

Randomized, prospective and single-blinded study.

SETTING

Academic hospital.

PATIENTS

ASA physical status of I and II surgical patients, scheduled for elective laparoscopic cholecystectomy from March 2013 to October 2014.

MEASUREMENTS

Changes of regional cerebral oxygen saturation were measured by near-infrared spectroscopy on the left and right sides of forehead at different time points: before anesthesia induction (Tbas), immediately after induction (Tind), after applaying a pneumoperitoneum (TCo₂), 10 minutes after positioning the patient into reverse Trendelenburg's position (TrtCo₂), immediately after desufflation of gas (Tpost) and 30 (Trec30) and 60 (Trec60) minutes after emergence from anesthesia.

MAIN RESULTS

Study population included 124 patients, 62 in each group. There was no significant difference between these groups according to demographic characteristics, surgery and anesthesia times as well as in the basal rcSo₂ values. Statistically higher rSco₂ values were noted in the VIMA group when compared to the TIVA group in all time points Tind, TCo₂, TrtCo₂, Tpost, Trec30 and Trec60 and incidence of critical rcSo₂ decreases was statistically lower in VIMA group (P<.05). There were no serious perioperative complications.

CONCLUSIONS

VIMA technique provides significantly (4%-11%) higher rcSO₂ values during general anesthesia for laparoscopic cholecystectomy, when compared with TIVA and also provides significantly less number of critical rcSO₂ decreases.

Economic aspects of skin cancer management in Eastern Croatia

Introduction: In the past several decades there has been a substantial increase in the incidence of skin cancers worldwide and Croatia is no exception. The aim of this study was to estimate the financial cost of skin cancer treatment in the Osijek-Baranja County from 2000 to 2009 and to compare it with the cost of a primary prevention campaign organized in the Baranja County.Methods: We conducted a retrospective analysis of patients with skin cancer in the Baranja County and related health care costs. We designed a potential primary prevention campaign on a County level and calculated the financial expenses of campaign and then compared the results to health care costs from previous years.Results: The total cost of the treatment involving skin cancer (C43-C44) cases in the Osijek-Baranja County during the 2000-2009 periods was €483,710. The cost of a primary prevention campaign described in this study suggests that the estimated annual cost of a primary prevention campaign on the County level makes around 5.9% of the annual cost of all the medical treatment involving skin cancer patients in the County, which shows that a planned preventive approach towards the issue of skin cancer in Eastern Croatia is extremely justified and reasonable.Conclusion: The present study reveals the urgent need for the implementation of a primary prevention campaign in Eastern Croatia and puts emphasis on the economic potential of such an approach towards the problem of skin cancer. 

Comparison of knowledge, attitudes and behaviour of health professionals and parents regarding child injuries

OBJECTIVE

We wanted to primarily examine the knowledge, attitudes and behaviour of parents and health workers (community nurses and paediatricians) regarding child injuries in order to understand the essence of the problem and to find out the most common misconceptions.

METHODS

Respondents were tested through an anonymous, self-administered questionnaire and all p values below 0.05 were considered significant.

RESULTS

Of all respondents, paediatricians answered accurately most of the questions considering knowledge than the other groups. More than 90% of respondents, in all groups, identified correct answers to 10 questions about attitudes towards child injury prevention and safety promotion.

CONCLUSION

This study, which shows the current level of knowledge, attitudes and behaviour patterns of parents and health professionals in Croatia, could help in the preparation of appropriate prevention programmes.

Vitamin B12 deficiency and depression in elderly: cross-sectional study in Eastern Croatia

Introduction: Vitamin B12 deficiency occurs frequently among elderly patients and it has recently been connected with the occurrence of depressive symptoms in this population. The aim of this study was to determine the frequency of vitamin B12 deficiency among elderly patients from Eastern Croatia and to evaluate whether there is a connection between this deficiency and the occurrence of depressive symptoms among them.Methods: This cross-sectional study was conducted from April to June 2013, among 140 elderly patients from Vukovar-Srijem County (47.9%, 67/140 males and 52.1%, 73/140 females; mean age 71.0±6.7 years). The anonymous questionnaire was used to obtain demographic data, data regarding socio-economic status and personal history of diseases of study participants as well as data pertaining to the existence of depressive symptoms among them. The competitive immunoassay vitamin B12 kit was used to determine serum levels of vitamin B12.Results: Among all study participants there were 7.1% (10/140) of them with B12 deficiency and 70.0% (98/140) of them with the symptoms of depression. Depressive symptoms occurred in 100.0% (10/10) patients with the vitamin B12 deficiency and 67.7% (88/130) of patients without it.Conclusion: The study showed positive connection between the existence of depressive symptoms and vitamin B12 deficiency among elderly patients. This finding points to the need for frequent vitamin status evaluation in this age group and its consequent correction that could improve overall health of this population subgroup.

The significance of psychosocial factors of the working environment in the development of sick building syndrome

Introduction: Sick building syndrome (SBS) is a medical condition in which people in a certain buildings suffer from symptoms of illness or feeling unwell. The aim of this study was to determine the frequency of exposure of the employees of public institutions from the city of Osijek to harmful psychosocial factors of the working environment, to assess whether there is a connection between the exposure to these factors and the incidence of SBS symptoms and to clarify the nature of this connection.Methods: This cross-sectional study was conducted during May 2013 among 178 employees of public institutions in the city of Osijek. An anonymous questionnaire which contained questions relating to demographic data and working status of the participants, their exposure to various harmful psychosocial factors of the working environment and occurrence of certain symptoms of SBS among them was used as a research tool.Results: 96.1 % (171/178) of participants were exposed to harmful psychosocial factors of the working environment. Employees exposed to those factors more frequently expressed symptoms of SBS. The incidence and the number of symptoms of SBS among employees simultaneously grew with the increase of the number of harmful psychosocial factors of the working environment to which they were exposed.Conclusion: The study showed positive connection between the exposure to harmful psychosocial factors of the working environment and the incidence of SBS symptoms, highlighting this issue as a very important subject in the field of occupational medicine and health protection in the workplace.

Healthcare providers' knowledge, attitudes and counselling on injury prevention for preschool children in Croatia

Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.