(Dis)organization of Palliative Care as a Potential Quality-of-Life Issue in the Senior Population--Croatian Experiences.

This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building. Although we cannot ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, approximately half of patients--users of palliative care--have some type of oncological diagnosis; a significant number of patients suffer from dementia, stroke, or heart failure. As for the Primorsko-goranska county and the City of Rijeka, they show similar trend, as can be illustrated with data from the 2011 census, when the share of citizens over 65 years in the population of the Primorsko-goranska county reached 18.91%, and in the population of the City of Rijeka 19.74%. Thus, one of the main quality-of-life issues in the Croatian senior population is the (dis)function of the palliative medicine/care system. Practice, namely, shows that there has still been no implementation. In particular, palliative medicine is not yet recognized as a speciality or sub-speciality, standards and norms for this activity are not set, palliative care is still not included in the system of obligatory health insurance, and as far as the national strategy of health policy for the area of palliative care, Croatian Government at its meeting held on 27th December 2013 finally adopted the "Strategic Plan for Palliative Care of the Republic of Croatia for the period from 2014 to 2016". Exactly because we are a decade behind European standards (Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organization of palliative care), it is more than legitimate to place this subject at the centre of the current Croatian gerontology interest.

Can Croatian medicine do without palliative medicine?--Study investigating the need for formal education.

The aim of this study was to determine the public's, i.e. citizens' attitude on one hand, and health-care professionals' attitude on the other, regarding the public education in palliative care. Also, the assessment of health-care professionals' attitude regarding the need to establish a sub-specialty in palliative medicine in Croatia was performed. The study was carried out during 2007 and 2008 in the capitals of 7 Croatian counties, involving 2353 participants. Two types of anonymous questionnaire were distributed. Citizens were surveyed at public places, business offices, waiting rooms, while health-care professionals were surveyed in medical centers. The survey was conducted personally by the authors, i.e. "face to face" with the respondents. The collected data were entered into a database and analyzed, taking into account the anonymity, privacy and data confidentiality. The response rate was 99% for the public and 97% for health-care professionals. 44% of the public thought that educating the public in palliative care is absolutely necessary, and 42% that it is mostly necessary; compared with 47% of health-care professionals who thought education was absolutely necessary, and 45% who thought it is mostly necessary. In addition, health-care professionals were asked about their opinion regarding the establishment of a sub-specialty in palliative medicine and 76% of respondents considered it absolutely necessary. Both the public and health-care professionals recognize the need for public education in palliative care. The authors wish to especially emphasize health-care professionals' perception of a great need for the establishment of an official medical curriculum and a medical sub-specialty in palliative medicine.

An increasing older population dictates the need to organise palliative care and estabilish hospices.

The aim of this study is to assess population needs for the organisation of palliative care and establishment of hospices. An opinion poll was created to investigate these needs. The research was carried out in 2007/2008 among 1564 citizens not working in health services, and 789 health service workers--a total of 2353 people questioned in 7 towns of the Republic of Croatia. The significant results obtained using adequate statistical methods confirm that 90.6% of all respondents favour the introduction of a palliative care system and 88% favour the establishment of hospices. This leads us to conclude that the need to establish a palliative care system and hospices has been recognised by citizens and health service workers, thus their implementation in the Republic of Croatia without further delay should be recommended.

Influence of the "Rijeka model" of bioethics education on attitudes of medical students towards death and dying--a cross sectional study.

The aim of this study was to assess attitude towards euthanasia, and the influence of socio-demographic data and death education carried out through the "Rijeka model" of bioethics education for the first-year medical students of the School of Medicine, University of Rijeka, Croatia. The cross-sectional study was conducted in the academic year 20031 2004. 124 (61% female) participants were surveyed by using an anonymous questionnaire before and after training. Catholics (p = 0.003) and students from areas with populations of less than 50,000 inhabitants (p = 0.001) had significantly negative attitude towards euthanasia than others before the course, yet no differences were found following this training. Attitude towards euthanasia was significantly positive after the course (p = 0.005). All items in the questionnaire, except "Croatia should legalise euthanasia", received more positive scores after the course. Death education carried through the "Rijeka model" of bioethics education has changed attitudes of medical students towards a more positive perception of euthanasia.

CURRENT PERSPECTIVES OF POTTER'S GLOBAL BIOETHICS AS A BRIDGE BETWEEN CLINICAL (PERSONALIZED) AND PUBLIC HEALTH ETHICS.

In the context of modern scientific and technological developments in biomedicine and health care, and the potential consequences of their application on humans and the environment, Potter's global bioethics concept resurfaces. By actualizing Potter's original thoughts on individual bioethical issues, the universality of two of his books, which today represent the backbone of the world bioethical literature, "Bioethics--Bridge to the Future" and "Global Bioethics: Building on the Leopold Legacy", is emphasized. Potter's global bioethics today can legitimately be viewed as a bridge between clinical personalized ethics on the one hand and ethics of public health on the other.

Clinical ethics in Croatia: an overview of education, services and research (an appeal for change).

The aim of this paper is to delineate current position of clinical ethics in the Croatian healthcare system by analyzing the following: representation of clinical ethics contents in the curricula of medical and associated schools; composition and role of clinical ethics consultations; and establishment of an ethical/legal framework for the conduct of research. Curriculum investigation, literature review, arid analysis of the Croatian Act on the Protection of Patients' Rights were performed. The contents of clinical ethics are offered through 63 obligatory and elective subjects at 12 institutions. It is wrongly placed either too early or too late within the curriculum. Continuity at all levels of health professional education is needed. Croatian experience with clinical ethics consultations is shaped only by ethics committees. Problematic is the review of research protocols indicated as their main activity. Inclusion of team and individual consultations would increase the availability and facilitate the usage of ethics support services. The Act on the Protection of Patients' Rights is based on the principles of humanity and availability, ensuring the right to protection when participating in clinical trials. Unfortunately, the outdated paradigm of paternalistic medicine aggravates the respect for patients' rights in cure, care and research. A shift towards the patient/person-centered healthcare system would put the Act into everyday practice. Although clinical ethics has entered the Croatian healthcare system in a formal and practical way, the authors wish to emphasize the need to approach the European and other international standards regarding the recent Croatian accession to the European Union.

[Healthcare usage by elderly people]. / Koristenje zdravstvene zastite od strane lica trece dobi.

The newest demographic changes in the world and in our country show slow population increase and accelerated growth of elderly population. Apart from this growth of elderly population today we are experiencing increase in life expectancy. Our goal is to present socioeconomic status, usage of health services and patients satisfaction with those services. Our research includes 120 persons older than 65 years living in rural areas of Vares municipality. The data was collected in the period of 01/04/2007 to 01/05/2007. Municipality register provided us with data for elderly population using random sampling method. Examination was carried out using questionnaire papers especially formulated for our research. Statistical analysis includes elements of descriptive statistics X2 and the test of correlation; results with p<05 will be used in our research. Research variables are: sex, age, education level, salary, profession before retirement, number of visits to MD as well to a specialist, days spent in hospital and overall satisfaction with health care services.