Are Patients Ready for Lesbian, Gay and Bisexual Family Physicians - A Croatian Study.

Discrimination and harassment of lesbian, gay and bisexual (LGB) physicians from their colleagues and superiors are known. However there is little knowledge about the patients' attitudes and discrimination toward physicians. A cross sectional Internet survey was conducted in urban Croatian regions. The participants were asked to answer questions regarding their socio-demographic status, the Attitudes Towards Lesbians and Gay Men Scale (ATLG), and whether they would refuse to see a LGB physician and, if so, why. Of the 1004 participants, 8.8% said they would refuse a male GB physician while 7.9% would refuse a female LB physician, and 7.3% would refuse both. The two most common reasons for discriminating were: "disaccord with political or religious beliefs" and "fear of being sexually harassed". A logistical regression model showed that male sex, higher ATLG score and higher age were associated with more refusals of male GB physicians. Also higher age, higher ATLG score were associated with more refusals of female LB physicians, while personal contact with LGB people was associated with less refusals of both groups. The observed prevalence of discrimination is significant. The results suggest that discrimination is based on emotional reasons and stereotypical beliefs. Educational efforts should be directed towards changing misconceptions about LGB people.

How to Improve Patient Safety Culture in Croatian Hospitals?

Patient safety culture (PCS) has a crucial impact on the safety practices of healthcare delivery systems. The purpose of this study was to assess the state of PSC in Croatian hospitals and compare it with hospitals in the United States. The study was conducted in three public general hospitals in Croatia using the Croatian translation of the Hospital Survey of Patient Safety Culture (HSOPSC). A comparison of the results from Croatian and American hospitals was performed using a T-square test. We found statistically significant differences in all 12 PSC dimensions. Croatian responses were more positive in the two dimensions of Handoff s and Transitions and Overall Perceptions of Patient Safety. In the remaining ten dimensions, Croatian responses were less positive than in US hospitals, with the most prominent areas being Nonpunitive Response to Error, Frequency of Events Reported, Communication Openness, Teamwork within Units, Feedback & Communication about Error, Management Support for Patient Safety, and Staffing. Our findings show that PSC is significantly lower in Croatian than in American hospitals, particularly in the areas of Nonpunitive Response to Error, Leadership, Teamwork, Communication Openness and Staffing. This suggests that a more comprehensive system for the improvement of patient safety within the framework of the Croatian healthcare system needs to be developed. Our findings also help confirm that HSOPSC is a useful and appropriate tool for the assessment of PSC. HSOPSC highlights the PSC components in need of improvement and should be considered for use in national and international benchmarking.

Development of a Croatian version of the US Hospital Survey on Patient Safety Culture questionnaire: dimensionality and psychometric properties.

BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPSC), originally developed in the USA, is used worldwide to assess patient safety culture in hospitals. A limited number of studies have provided data on psychometric properties outside of the US healthcare system. Our aim was to determine if all 12 dimensions of the US HSOPSC were applicable, valid and reliable to Croatian healthcare workers. METHODS: The study was conducted from September 2010 to April 2011. Questions were translated into Croatian and then translated back into English. The questionnaires (ie, the Croatian translation of the US HSOPSC) were distributed in unmarked envelopes along with a consent form to all the doctors and nurses in four Croatian hospitals. The responses were analysed using explorative factor analyses, reliability testing, and confirmatory factor analyses. RESULTS: The study included 561 healthcare workers in four Croatian hospitals--a response rate of 32.69%. Our results are similar to the original US sample, but with some differences: 11 dimensions with acceptable reliability scores were identified by exploratory factor analysis compared with the original 12 in the US sample; five of 12 dimensions had a Cronbach's α higher than 0.7, suggesting a reasonable fit to the original US HSOPSC; the dimensions 'Staffing' and 'Organisational learning--continuous improvement' were found to have a Cronbach's α <0.6. The use of confirmatory factor analysis confirmed a good fit to the original US model. CONCLUSIONS: Results show that the Croatian translation of the US HSOPSC is compatible in 11 of the original 12 dimensions. Results suggest that for the purposes of research in Croatia, the dimensions 'Staffing', 'Communication openness', and 'Organisational learning-continuous improvement' should be revised. For example, the use of question A7 ('We use more agency/temporary staff than is best for patient care') in the context of European healthcare systems should be adapted or removed for the Croatian version of the US HSOPSC questionnaire.

Attitudes towards and knowledge about homosexuality among medical students in Zagreb.

The aim of the study was to investigate whether students in their fifth and sixth years of medical school in Zagreb have homophobic attitudes and assess their knowledge about homosexuality. A survey was conducted among fifth and sixth year medical students during the 2009/2010 academic year. The survey consisted of general demographic data, two validated questionnaires--"Knowledge about Homosexuality Questionnaire" and "Heterosexual Attitudes towards Homosexuality Scale"--and questions about personal experiences created for this study. The mean knowledge scores were X = 14.8 out of 20. Furthermore, gender differences in attitudes were observed, indicating less negative attitudes among the female participants. The regression model was significant (ANOVA: Sum of Squares = 38.065; df = 17, Mean Square= 2239, F = 10.6; p < 0.001) with 38% of explained variance. The significant predictor variables that indicate lower attitudes about homosexuality score were female gender (beta= -0.14, p = 0.015), sixth year of study (beta = -0.16, p = 0.009) and more knowledge about homosexuality (beta = -0.48, p < 0.001). Negative attitudes are present among the students; therefore, educational efforts should be included in the curricula of medical schools to diminish the negative perceptions of the lesbian, gay, bisexual and transgender community.

Predictors of lower work ability among emergency medicine employees: the Croatian experience.

BACKGROUND: Worldwide research has indicated that emergency medicine employees and particularly ambulance personnel have symptoms related to traumatic events, and experience more chronic stressors in their work than workers in other health service settings. Unlike other countries which conducted similar studies, no specialty branch in emergency medicine exists in Croatia. STUDY OBJECTIVES: To identify possible predictors of low work ability, including occupational stress and quality of life, among emergency medicine employees. METHODS: A cross-sectional study was conducted from May 2010 till July 2010 in the Institute of Emergency Medicine in the City of Zagreb. Questionnaires were distributed to all employees with gathered total sample of 125 subjects (39 physicians, 38 medical nurses /technicians and 48 drivers). Data were collected using the socio-demographic questions, occupational stress assessment, work ability index (WAI) and WHO quality of life (WHOQOL-BREF) questionnaires. RESULTS: Emergency physicians were significantly more exposed to public criticism (p=0.008) but drivers had more exposure to hazards at workplace (p=0.001) regarding other employee groups. Binary logistic regression model showed two significant predictors of lower work ability (WAI score <37): lower physical WHO-BREF domain (OR=0.78; 95% CI 0.68 to 0.89; p<0.001) and the professional and intellectual demands (OR=1.09; 95% CI 1.01 to 1.19; p=0.043). CONCLUSION: Strenuous physical activity should be reduced in order to increase the overall work ability of the emergency medicine employees and better structural organisation and introduction of a residency in emergency medicine should significantly improve total work ability among emergency physicians.

Are physician-patient communication practices slowly changing in Croatia? -- a cross-sectional questionnaire study.

AIM: To explore physician-patient communication practices during the process of obtaining informed consent in a hospital setting in Croatia. METHODS: Two hundred and fifty patients (response rate 78%) from five tertiary level hospitals in Zagreb, Croatia, anonymously filled in the questionnaire on informed consent and communication practices by Nemcekova et al in the period from April to December 2011. RESULTS: Eighty five percent of patients received complete, understandable information, presented in a considerate manner. Patients in surgical departments received a higher level of information than those in internal medicine departments. Patients were informed about health risks of the proposed treatments (in 74% of cases) and procedures (76%), health consequences of refusing a medical intervention (69%), and other methods of treatment (46%). However, patients pointed out a number of problems in physician-patient communication. CONCLUSION: Communication practices during informed consent-obtaining process in hospitals in Zagreb are based on a model of shared decision-making, but paternalistic physician-patient relationship is still present. Our results indicate that Croatia is undergoing a transition in the physician-patient relationship and communication.

Shift work, quality of life and work ability among Croatian hospital nurses.

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007-2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses' work ability and quality of life.

Characteristics of people with the perceived stress in croatia: the CroHort study.

This study aimed to assess levels of stress in Croatian adult population using PSS, in a population study (Croatian Adult Cohort Health Study - CroHort). Our results show that the levels of stress were 17.46 (SD = 6.73) for men and 18.32 (SD = 6.46) for women in Croatia. The lowest levels of stress experienced men living in urban area while women living in rural area had the highest level. Men and women who had university degree had significantly lower level of stress. The lowest levels of stress experienced participants who had much better financial condition than average. In men, stress was associated to weak heart, lower back pain, poor financial condition of the household and high alcohol consumption. In women, stress was associated to poor mental health, poor social functioning, poorer financial condition of the household, higher age, lower education, low monthly income of the household and poor general health.

Work ability as a major determinant of clinical nurses' quality of life.

AIMS AND OBJECTIVES: To examine quality of life determinants among clinical nurses in Croatia with an emphasis on their work ability. BACKGROUND: An important personnel management challenge is to explore factors that stimulate or hinder the development of individual work ability and quality of life throughout a career. DESIGN: A cross-sectional study. METHODS: The study was performed during 2007-2008 in six randomly selected hospitals in Croatia. The self-administered questionnaires included the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health, the Quality of Life questionnaire (WHOQL-BREF) developed by the World Health Organization and additional socio-demographic questions. A total number of 1212 nurses completed the questionnaires, giving a response rate of 67(.) 3%. Binary logistic regression was performed to assess how socio-demographic characteristics and work ability groups predict each of the WHOQL-BREF domains. RESULTS: Having a satisfactory WAI score (WAI ≥ 37) was significantly the most important predictor for all quality of life domains, with the odds ratios (OR) being as follows: OR = 6(.) 8 (95% CI: 4(.) 8-9(.) 6) for the physical domain, OR = 2(.) 3 (95% CI: 1(.) 7-3(.) 1) for the psychological domain, OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 4) for the social relationship domain and OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 3) for the environmental domain. CONCLUSIONS: Satisfactory work ability was a major quality of life determinant in all WHOQL-BREF domains with the highest odds ratio for the physical domain. Maintaining clinical nurses' work ability is an important issue, because it is foundational for the quality of life of the workforce. RELEVANCE TO CLINICAL PRACTICE: Our study provides quantified estimates of the extent to which a satisfactory WAI score predicts a better score in physical, psychosocial, social relationships and environmental domain of nurses' quality of life. Therefore, maintaining or improving nurses' work ability remains the essential aim of hospital managers.

Known symptoms and diseases of a number of classical European composers during 17th and 20th century in relation with their artistic musical expressions.

Medical history and relationship to the medical conditions as well as to the music creativity and productivity of some of the classical European composers have been described. In this review article we analyzed their illnesses as well as association between physical or mental diseases and their creativity and adaptability to disease. Some classical composers suffered from organic diseases, while others complained of mental disturbances. However, in spite of their disorders, the intensity of their creativity mostly remained unchanged.

[Maintenance of work ability among hospital health care professionals]. / Ocuvanje radne sposobnosti bolnickih zdravstvenih djelatnika.

AIM: The aim of this study was to investigate the values of the Work Ability Index (WAI) and to analyze the factors that may be associated with work ability among hospital health care professionals. METHODS: A total of 1856 health care professionals employed at 5 Zagreb hospitals participated in this cross-sectional study. Data were collected using the Work Ability Index Questionnaire and Occupational Stress Assessment Questionnaire for hospital health care professionals. RESULTS: The average WAI of all participants was 38.68+/-6.28, indicating very good work ability. WAI was significantly higher in men than in women, 40.43+/-5.81 and 38.27+/-6.32, respectively (p<0.001). Younger participants had greater WAI compared with those of older age groups (p<0.001). There was a substantial difference in the proportions of participants in the categories of WAI (poor, good, very good and excellent) between physicians and nurses (p<0.001). Although physicians were considerably older than nurses (p<0.001), the proportion of those with excellent WAI was greater among physicians than among nurses, suggesting that the jobs of highly educated participants, which are characterized by broad decision-making latitude and promotion possibilities maintain work ability better in comparison with low decision-making latitude jobs and low control jobs. About 5 percent of all participants had poor WAI. We identified the following significant predictors of suboptimal WAI among health care professionals: female sex, age, service accrual, and stressors related to organization and financial issues (p<0.001), risks and hazards (p=0.040), and shift work (p=0.001). CONCLUSION: The average WAI of all participants indicated very good work ability, but small percent of them had poor WAI. Our results suggest the need of preventive measures that would target maintenance of work ability at an organizational and individual level. The organizational level should include the provision of a sufficient number of workers, adequate financial resources for work and adequate salaries, less paperwork, positive collaboration with the public, especially media, and education of medical staff on the risks and hazards at work. The individual level should include individual assessment of sensitivity to night work and shift work considering age and health status, and training in stress management techniques.

80th Anniversary of the Publication of Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb.

Certain regions of Bosnia and Herzegovina were prominent European sites of endemic syphilis. In 1934 and 1935 the School of Public Health in Zagreb, later the Andrija Stampar School of Public Health, conducted two surveys on endemic syphilis in Bosnia and Herzegovina. The surveys were well-described in the monograph published in 1939 by the School, under the title Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb ("Endemski sifilis u Bosni anketa Skole narodnog zdravlja u Zagrebu"). This paper provides a description of the publication for the first time, presents the most important data from it, and explores its significance from the historical perspective.

Gender and respiratory findings in workers occupationally exposed to organic aerosols: a meta analysis of 12 cross-sectional studies.

BACKGROUND: Gender related differences in respiratory disease have been documented. The aim of this study was to investigate gender related differences in respiratory findings by occupation. We analyzed data from 12 of our previously published studies. METHODS: Three thousand and eleven (3011) workers employed in "organic dust" industries (1379 female and 1632 male) were studied. A control group of 806 workers not exposed to any kind of dust were also investigated (male = 419, female = 387). Acute and chronic respiratory symptoms and lung function were measured. The weighted average method and the Mantel-Haentszel method were used to calculate the odds ratios of symptoms. Hedge's unbiased estimations were used to measure lung function differences between men and women. RESULTS: There were high prevalences of acute and chronic respiratory symptoms in all the "dusty" studied groups compared to controls. Significantly less chronic cough, chronic phlegm as well as chronic bronchitis were found among women than among men after the adjustments for smoking, age and duration of employment. Upper respiratory tract symptoms by contrast were more frequent in women than in men in these groups. Significant gender related lung function differences occurred in the textile industry but not in the food processing industry or among farmers. CONCLUSION: The results of this study suggest that in industries processing organic compounds there are gender differences in respiratory symptoms and lung function in exposed workers. Whether these findings represent true physiologic gender differences, gender specific workplace exposures or other undefined gender variables not defined in this study cannot be determined. These data do not suggest that special limitations for women are warranted for respiratory health reasons in these industries, but the issue of upper respiratory irritation and disease warrants further study.

Regional pattern of physical inactivity in Croatia.

The aim of this paper was to analyze the regional pattern of physical inactivity in Croatia based on the Croatian Adult Health Survey 2003 data. A total of 9,070 adult respondents were included in this study. In men, the highest prevalence of physical inactivity was recorded in the City of Zagreb (39.6%), and it was significantly higher than in Central (25.6%), Coastal (25.6%) and Mountainous region (14.1%). Mountainous region had significantly lower prevalence of physical inactivity compared to any other region, except the Central region. The highest prevalence of physical inactivity in women was also recorded in the City of Zagreb (43.6%), and it was also significantly higher than in all other regions. The lowest prevalence of physical inactivity was recorded in Eastern Region (24.7%). The highest levels of physical inactivity in both in both genders were recorded in urban regions, suggesting that intervention measures in terms of health promotion should be undertaken, with strong emphasis on the people living in urban settings.

Respiratory function in wind instrument players.

BACKGROUND: The playing of wind instruments has been associated with changes in respiratory function. STUDY OBJECTIVES: To investigate the effect of playing wind instruments on lung function and respiratory symptoms. METHODS: The present study included 99 wind instrument players and a group of 41 string instrument players as a control from 3 major orchestras in Zagreb, Croatia. Data on chronic respiratory symptoms were recorded in all studied subjects. Lung function was measured in wind instrument players by recording maximum expiratory flow-volume curves. RESULTS: Wind instrument players demonstrated significantly higher prevalences of sinusitis, nasal catarrh and hoarseness compared to control musicians. One wind instrument player developed asthma associated with his work. Odds ratios for wind instrument players were significant for chronic cough, chronic phlegm and chronic bronchitis by smoking habit (p<0.05 or p<0.01) but not for length of employment. Ventilatory capacity data indicate that wind instrument players had significantly greater FEV1 (smokers and nonsmokers) as well as FEF50 (nonsmokers) (p<0.05) compared to predicted values. Regression analysis of pulmonary function tests in wind instrument players demonstrate a significant link between FEV1 and FEF50 and length of employment. Those wind instrument players with longer employment had the greatest increases in lung function. CONCLUSIONS: Our data suggest that musicians playing wind instruments may be susceptible to chronic upper airway symptoms. Interestingly wind instrument playing may be associated with higher than expected lung function parameters.

Harassment in workplace among school teachers: development of a survey.

AIM: To develop a questionnaire on harassment in the workplace among teachers at primary and secondary schools. METHODS: We analyzed the existing questionnaires on harassment in the workplace and developed a new one was to specifically address harassment of teachers in the public education sector. The questionnaire was then experimentally applied to a sample of 764 primary and secondary school teachers in Split Dalmatia County, Croatia. It included three scales -exposure to harassment, witnessing harassment, and disturbance by harassment. Validity of the three scales was examined by factor analysis. RESULTS: All three scales showed satisfactory metric characteristics: Cronbach alpha coefficient was 0.93 for exposure scale, 0.95 for witnessing scale, and 0.97 for disturbance scale. Out of 764 teachers surveyed, 164 (22.4%) were exposed to and 192 (31.7%) witnessed different kinds of harassment in the previous 12 months. There were significantly more of those who experienced harassment as witnesses (chi(2)(1)=249.301; P<0.001) than as direct victims. Eighty-six teachers (11.5%) reported having psychological and 76 (10.1%) physical health problems caused by their work. Exclusion as a consequence of harassment disturbed women more than men (chi(2)(1)=5.27; P=0.022). Those who were exposed to harassment had significantly lower median age (42; range 23-68) than those who were not exposed (45; range 23-65) (U=31401.50; z=2.129; P=0.033). CONCLUSION: The questionnaire registered wide spectrum of harassment types, indicating the need for continuous monitoring and systematic work on the prevention of these phenomena. The study showed that exposure to harassment is associated with age, indicating that younger teachers should be the target population for detection and prevention of workplace harassment.

Ancient medicine--a review.

Different aspects of medicine and/or healing in several societies are presented. In the ancient times as well as today medicine has been closely related to magic, science and religion. Various ancient societies and cultures had developed different views of medicine. It was believed that a human being has two bodies: a visible body that belongs to the earth and an invisible body of heaven. In the earliest prehistoric days, a different kind of medicine was practiced in countries such as Egypt, Greece, Rome, Mesopotamia, India, Tibet, China, and others. In those countries, "medicine people" practiced medicine from the magic to modern physical practices. Medicine was magical and mythological, and diseases were attributed mostly to the supernatural forces. The foundation of modern medicine can be traced back to ancient Greeks. Tibetan culture, for instance, even today, combines spiritual and practical medicine. Chinese medicine developed as a concept of yin and yang, acupuncture and acupressure, and it has even been used in the modern medicine. During medieval Europe, major universities and medical schools were established. In the ancient time, before hospitals had developed, patients were treated mostly in temples.

[Causes of climatic changes and their consequences on human health]. / Uzroci klimatskih promjena i njihove posljedice za zdravlje covjeka.

Environmental disasters are common phenomena caused by human factors. Disaster episodes may be the result of climatic changes such as global warming, which can lead to floods or drought. Greenhouse gases, and especially the ozone, represent a special problem. Atmospheric pollutions are the result of fire, storm dusts, winds, acid rain, etc. Underwater earthquakes very often end in tsunami with waves of up to 30 meters. Disasters described in the territory of Croatia include atmospheric pollutions, fires, floods, and droughts. All disasters affect the health of the population, particularly of the elderly. This most often includes the cardiovascular and respiratory systems, allergic reactions, and carcinogenic effects, resulting in increased mortality.

Women in medicine through the ages.

BACKGROUND: Female practitioners of the medical arts have been active since the ancient world The role of women in science, and particularly in medicine, has changed significantly over time. METHODS: We provide a chronological review of the growing knowledge in medicine related to women's activities through the ages with particular attention to occupational medicine. Throughout history hazards have been shaped by the forces that shape work itself social evolution, shifting economic powers and demographic changes. RESULTS: Mythical Greece, Egypt and ancient Rome were the cradle of ancient medicine. In the past century, women were allowed to enter the medical profession with increasing acceptance. Some of the most important women in ancient and modern medicine are recalled, such as Mother Peseshet in ancient Egypt, Artemisia of Caria and Phanostrate and Philista in the Greek period, Hildegard of Bingen, Marie Marguerite Biheron in England, Elisabeth Blackwell, Emily Jennings, Maude E. Abbott and others. Women in occupational medicine are described separately, such as Alice Hamilton, Harriet L. Hardy, Molly Newhouse and Olga Macek. CONCLUSIONS: Certainly, the first few women who iluminated the way for the generations that followed them into medicine, the women who made outstanding contributions to medicine, and the women who are currently finding success in medicine deserve our respect and admiration.