Improving blood pressure and dyslipidemia control by increasing health literacy in Croatia-missions 70/26 & Do you know what is your number.

PURPOSE: In 2022 hypertensive disease was the second cause of death in Croatia. The crude prevalence of hypertension is increasing and still majority of hypertensive patients did not reach blood pressure and cholesterol goals Low awareness, and small number of treated and controlled patients point on poor adherence and even worse clinical inertia. MATERIALS AND METHODS: Croatian Hypertension League (CHL) has started the permanent public health action Hunting the Silent Killer aiming to increase health literacy. In 2023 we decided to intensify program with two missions - '70/26', and 'Do you know what is your number?' aiming to achieve target values in 70% and in 50% of patients treated for hypertension and dyslipidaemia, respectively, by 2026. For the health care workers, the program will primarily involve digital education, and 'School of Communication in Hypertension'. In the second arm of the program, we will advise patients and general population to visit our educational website with important and useful information on how to improve bad lifestyle, how to proper measure blood pressure, why is it important to sustain in taking drugs etc. In 2026, the CHL will organise field research to assess the success of programs using the same methodology as we used in previous EH-UH studies. CONCLUSION: We will monitor and analyse trends in the management and control of patients treated for hypertension and dyslipidaemia. This will enable us to make an evidence-based conclusion how successful we were in increasing health literacy.

Hypertension is the most compelling cause of death in Croatia with increasing prevalence.Still 50.1% of treated hypertensive patients and more than 70% of patients with dyslipidaemia in Croatia are uncontrolled.Programs 70/26 and Do you know your number aimed to achieve 70% and 50% control of hypertensive and dyslipidaemia patients, respectively, by 2026.To accomplish these goals, health literacy of healthcare workers, patients, and general population we will try to improve mostly using digital education and by organising schools of communication.

Tear Biomarkers and Alzheimer's Disease.

Alzheimer's disease (AD) is an age-related progressive neurodegenerative brain disorder that represents the most common type of dementia. It poses a significant diagnostic challenge that requires timely recognition and treatment. Currently, there is no effective therapy for AD; however, certain medications may slow down its progression. The discovery of AD biomarkers, namely, magnetic resonance imaging, positron emission tomography and cerebrospinal fluid molecules (amyloid-ß and tau) has advanced our understanding of this disease and has been crucial for identifying early neuropathologic changes prior to clinical changes and cognitive decline. The close interrelationship between the eye and the brain suggests that tears could be an interesting source of biomarkers for AD; however, studies in this area are limited. The identification of biomarkers in tears will enable the development of cost-effective, non-invasive methods of screening, diagnosis and disease monitoring. In order to use tears as a standard method for early and non-invasive diagnosis of AD, future studies need to be conducted on a larger scale.

What Constitutes a "Good Death"?-A Representative Cross-Sectional Survey Among the General Public in Croatia.

Understanding the attitudes of a particular society on a "good death" is important when it comes to end-of-life decision-making and palliative care. In the Republic of Croatia no systematic research has been done on the attitudes of the general population about the concept of a "good death". This cross sectional survey was conducted on a three-stage random sample, stratified by regions, counties and locations within those counties (N = 1203) during November and December, 2019. ANOVA, to determine differences, factor analysis and multiple regression analysis were used. The most important characteristics of a good death outlined by the respondents were: the absence of pain, the presence and unencumberedness of family and loved ones, the importance of a sense of fulfilment and meaning in life in this regard, reconciliation with God, the presence of awareness and sobriety, and the possibility of treatment.

The Power of Transformation and the Leadership Supporting It - Including Mental Health Perspective.

World in which we live in, has been changing so unpredictably in the recent years that has become more than ever volatile, uncertain, complex and ambiguous (VUCA) world. Especially in this post Covid-19 era in which extreme change has becomes our constant, economies around the world are suffering and today's organizations and institutions are broken. We can agree that our current approach is not working. Leadership in general and leaders of global mental health institutions in particular are failing on their goals and we have desperate need for better leaders and leadership strategies in the future. In this article, authors are going to take a dive on the leadership perspective, transformation of organizations and institutions and try to narrow the gap and support leaders to become the best version of themselves. We are going to present our perspective on what is the future bringing us in terms of leadership and leaders, as well as what would be the desired team dynamic within organizations or institutions.

Perception of communication between doctors and patients - On-line research among doctors in Croatia.

BACKGROUND: Different studies clearly show that doctor-patient relationship and communication are extremely important. They have a big influence on the outcome of medical treatment, but also on the cooperability, quality of life, safety of patients, teamwork, cultural sensitivity and fewer complaints to the doctor+s work. In this paper, we present results of our original research about attitudes of doctors and their perception related to the importance of communication between doctors and patients and person-centered approach. SUBJECTS AND METHODS: This cross-sectional study used a 28 items on-line survey to collect data from doctors in the period from 29 September 2015 till 23 November 2015 by using the Google forms. Total of 939 doctors from the entire Croatia responded. RESULTS: Main results of the study suggest that doctors are aware of the importance of communication between doctors and patients and that education about communication skills was not appropriate during their study. Doctors have undoubtedly expressed their desire for further development and learning about a better communication between doctors and patients and they have showed in this research that they love their job. CONCLUSION: The research unambiguously speaks in favor of the need of the significant strengthening of this segment within the program of the School of Medicine and support the current changes in the medical curriculum at the School of medicine University of Zagreb.

The Role of PTSD in Perception of Health-Related Quality of Life and Social Support among Croatian War Veterans.

BACKGROUND: Different studies clearly show that posttraumatic stress disorder (PTSD) is important factor in a reduction of the overall quality of life. PTSD remains a substantial problem in Croatia, nearly three decades after the beginning of the Croatian Homeland war. In this paper, we present results of our original research about impact of PTSD on the self-perceived health-related quality of life and social support in Croatian Homeland war veterans. SUBJECTS AND METHODS: A total of 277 war veterans were included from all Croatian counties. 158 (57.03%) veterans has PTSD and 119 (42.47%) are without PTSD. Strucured questionnaire was designed for socio-demographic data and information about combat experience and health problems. SF-36 was used in the estimation of health-related quality of life and Multidimesional Scale for Perceived Social Support for estimation of social support. Research was performed from June 2017 till November 2017. RESULTS: Main results of the study suggest that Croatian veterans with PTSD have lower health-related quality of life in almost all doimains, and that they perceive less social support from family, friends and significant others in comparison to veterans without PTSD. CONCLUSION: The results of this study reiterate strong impact of PTSD on quality of life and perception of social support. The research speaks in favor of the need to develop person-centered interdisciplinry health-care programs for this population, with special emphasis on their overall quality of life.

The attitudes of international medical students toward educational methods and styles applied in a 6-year longitudinal course in fundamentals of medical skills in Croatia.

AIM: To investigate international medical students' attitudes toward the impact of 6-year longitudinal course, Fundamentals of Medical Skills (FMS), at Medical Studies in English at the University of Zagreb on the development of their practical, clinical, and communication skills. METHODS: This cross-sectional study used a 23-item online survey to collect data from five generations of students attending the FMS course from January 31 to February 3, 2017. First-year students were not included. Invitations and reminders were sent to 202 FMS students by e-mail, SMS, and in closed groups in social networks Results. The response rate was 69.8% (141/202 students). The majority of students found the course useful (83.7%); favored practical over communication skills (92.9%); found practical skills more useful in higher years (82.3%); thought more time was needed to practice by simulation on mannequins (75.2%); preferred Objective Structured Clinical Examination (OSCE) stations to traditional oral exams (78%); and would recommend a course like FMS to future students or students at other universities (79.4%). Significantly more women than men favored practical over communication skills (P=0.044). Significantly more 5th and 6th students than students at lower years preferred OSCE stations to traditional learning (P=0.025) and would recommend a course like FMS to future students or students at other universities (P=0.001). CONCLUSION: Students positively evaluated the FMS course, but underestimated the communication skills aspect.

Factor structure and cut-off scores of the Hospital Anxiety and Depression scale (HADS) in a Croatian sample of adult patients suffering from advanced cancer.

BACKGROUND: Patients with cancer should be systematically screened for psychological problems at key points in their pathway. Usage of self-report scales for measuring anxiety and depression (such as Hospital Anxiety and Depression scale (HADS)) is a very practical methodfor detecting anxiety and depression. The aim of this research was to determine latent structure, reliability and cut-off scores of HADSin a Croatian sample of adult patients suffering from advanced metastatic cancer. SUBJECTS AND METHODS: According to inclusion and exclusion criteria, participant were recruited at University Hospital Centre Zagreb (N=46; January 2015) and Clinical Hospital Centre 'Sisters of Mercy' (N=29; April 2015). All participants underwent short structured psychodiagnostic interview, cognitive evaluation (usingMontreal Cognitive Assessment (MoCA) test) and were given HADS. RESULTS: When using PCA separately for the items of each original scale of HADS, only four items for the component Depression satisfactorily saturate principal component and when using PCA for all the items, only seven items from the original scale satisfactorily saturate unique principal component. Maximum Likelihood extraction method showed that only four items from the original scale satisfactorily saturated the theoretical scales. CONCLUSIONS: The results show that the best solution to use HADS, in defined Croatian population, is as one-dimensional screening instrument (Cronbach's alpha coefficient of internal consistency=0.774) with cut-off score 11/12.

Is experimentally induced pain associated with socioeconomic status? Do poor people hurt more?

BACKGROUND: The association of pain and socioeconomic status is widely reported, yet much less clearly understood. The aim of this study was to investigate the association of experimentally induced pain threshold and tolerance with socioeconomic status. MATERIAL/METHODS: The study sample consisted of 319 adult subjects from the population of the island of Vis, Croatia, which was previously shown to have a high level of social homogeneity. A manual dolorimeter was used to measure mechanical pressure pain threshold (least stimulus intensity) and pain tolerance (maximum tolerance stimulus intensity) on both hands. Pain tolerance interval was defined as the difference between pain tolerance and threshold. Years of schooling and material status were used as socioeconomic estimates. RESULTS: Both of the socioeconomic estimates were significantly correlated with pain threshold, tolerance, and tolerance interval (P<0.001). The mixed modeling analysis, controlled for the effects of age, gender, and 4 psychological variables, indicated that education was not a significant predictor in any of the 3 models. However, lower material status was significantly associated with lower pain tolerance (P=0.038) and narrower pain tolerance interval (P=0.032), but not with pain threshold (P=0.506). The overall percentages of explained variance were lower in the tolerance interval model (20.2%) than in pain tolerance (23.1%) and threshold (33.1%), suggesting the increasing share of other confounding variables in pain tolerance and even more so in tolerance interval model. CONCLUSIONS: These results suggest a significant association between experimentally induced pain tolerance and tolerance interval with material status, suggesting that poor people indeed do hurt more.

Person-centered pain management - science and art.

We are witnessing an unprecedented development of the medical science, which promises to revolutionize health care and improve patients' health outcomes. However, the core of the medical profession has always been and will be the relationship between the doctor and the patient, and communication is the most widely used clinical skill in medical practice. When we talk about different forms of communication in medicine, we must never forget the importance of communication through art. Although one of the simplest, art is the most effective way to approach the patient and produce the effect that no other means of communication can achieve. Person-centered pain management takes into account psychological, physical, social, and spiritual aspects of health and disease. Art should be used as a therapeutic technique for people who suffer from pain, as well as a means of raising public awareness of this problem. Art can also be one of the best forms of educating medical professionals and others involved in treatment and decision-making on pain.

Person-centered medical interview.

We are witnessing an unprecedented development of medical science and personalized medicine. However, technological superiority must not make us lose sight of the physical, psychological, social, and spiritual totality of the patient. The core of the medical profession has always been and will be the relationship between the health professional and the person seeking assistance. However, the traditional relationship between the physician and the patient has changed and is greatly impacted by huge social, philosophical, economic, and scientific developments. It is important to develop and promote the culture of health instead of the culture of illness through a patient-doctor collaborative partnership, as well as partnership among professionals. Person-centered medical interview is an important bridge between personalized and person-centered medicine.

Psychiatrists' empathy, beliefs and attitudes towards veterans suffering from combat-related posttraumatic stress disorder.

BACKGROUND: Empathy is a powerful and necessary skill for understanding another person's subjective experience. In this study we wanted to explore psychiatrists' attitudes towards PTSD, general empathy, possible differences related to age, sex and regional location in Croatia. SUBJECTS AND METHODS: 205 psychiatrists from different Croatian regions participated in this study. To define psychiatrists' attitudes towards PTSD patients a questionnaire was devised. It contained 14 items related to psychiatrists' ability to live through emotional and social conditions of PTSD patients. BarOn Emotional Quotient-Inventory Empathy Subscale was used to measure the empathy among the subjects. RESULTS: This study has found statistically significant differences regarding gender in measured variables of the designed questionnaire. Male participants believed they were able to understand war veterans' feeling's and relate to traumatic experience while female participants stated that they had the ability to understand the trivial triggers for suicidal intentions. Regional differences were found in the understanding of war traumatic experience and social deviations occurring in PTSD. Older psychiatrists stated their incomprehension of the social difficulties the PTSD patients were facing. The years of experience in the psychiatric field were associated with inability to understand the patients' feelings'. Differences in empathy among the subjects were not found. CONCLUSION: The understanding of the empathic process in the therapeutic approach towards PTSD explored in this study was associated with basic variables such as gender and age but the construct of empathy itself is more complex and related with variables not assessed in this study, so our findings are preliminary and further research is needed.

Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain.

BACKGROUND: The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP). METHODS: A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering. RESULTS: The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator. CONCLUSIONS: The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.

Correlation of sleep disturbances, anxiety and depression in Croatian war veterans with posttraumatic stress disorder.

The aim of the study was to examine the relationships between global sleep quality and its specific components and Posttraumatic Stress Disorder (PTSD) symptom severity questionnaire. We also researched whether sleep quality and sleep disturbances differed among groups of PTSD based on symptom severity categories. This study was conducted on the sample of 120 Croatian war veterans with PTSD. The following self-report instruments were used: Pittsburgh Sleep Quality Index, the Pittsburgh Sleep Quality Index Addendum for PTSD, the Mississippi Scale for Combat-Related PTSD, the Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory. There were statistically significant differences between the three PTSD severity groups on general nervousness (PSQI-A variable), where patients with extremely severe PTSD have more symptoms of general nervousness than groups with severe or moderate PTSD. Differences were found between PTSD severity groups in episodes of terror and acting-out dreams, where patients with extremely severe PTSD have more symptoms of episodes of terror and acting-out dreams than groups with severe or moderate PTSD. Sleep quality was significantly correlated with state anxiety, trait anxiety, and depression, indicating that with decrease of anxiety and depression, sleep quality improves. Sleep latency was positively correlated with both state and trait anxiety. There wasn't any significant correlation between sleep latency and depression. Study suggests that sleep disturbances are equally severe across groups of veterans based on PTSD severity and that the severity of sleep disturbances is significantly related to severity of anxiety and depression symptoms.

Life satisfaction in persons of the third age after retirement.

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.