Regional variations and trends in mortality from cardiovascular diseases in population aged 0-64 in Dalmatia and Slavonia, 1998-2009.

The aim of this paper was to analyse the regional variations and trends in mortality from cardiovascular diseases in the population aged 0-64 years in Dalmatia and Slavonia, over the period 1998 to 2009. Mortality data were derived from Central Bureau of Statistics. The results show that age-standardized mortality rates from total cardiovascular diseases, ischaemic heart diseases and cerebrovascular diseases were lower in Dalmatia than rates for Slavonia, for both genders. All mortality rates, except rates for ischaemic heart diseases mortality for men in both regions, showed the trend of decline. Dalmatia has a more protective factors in pattern of Mediterranean diet. The improvement of cardiovascular health and reduction of premature mortality from cardiovascular diseases requires a system and comprehensive intervention approach at all levels of health care and multisectorial coordination.

Undergraduate grade point average is a poor predictor of scientific productivity later in career.

The aim of this study was to investigate the usefulness of the undergraduate grade point average in prediction of scientific production of research trainees during their fellowship and later in career. The study was performed in 1320 research trainees whose fellowships from the Croatian Ministry of Science, Education and Sports were terminated between 1999 and 2005. The data were analyzed using logistic regression. The results indicated that undergraduate grade point average was negatively associated with scientific productivity both during and after the fellowship termination. Other indicators, such as undergraduate scientific productivity exhibited much stronger positive association with scientific productivity later in career and should be given more weight in candidate selection process in science and research.

[Analysis of the results of mammography screening in Dubrovnik-Neretva County in the 2006-2009 period]. / Analiza rezultata mamografskog probira u Dubrovacko-Neretvanskoj Zupaniji 2006-2009 godine.

AIM: To analyze the results of the first cycle of mammography screening during implementation of the National Program for Early Breast Cancer Detection (National Program) for women aged 50-69 in the Dubrovnik-Neretva County (DNC) in the 2006-2009 period, and to present new cases of breast cancer among women undergoing screening. METHODS: Data were collected from the DNC Institute of Public Health database. Mammography results were classified according to the Breast Imaging Reporting and Data System (BI-RADS classification). Descriptive method was used to analyze the results of mammography screening. RESULTS: A total of 19,475 women aged 50-69 were invited to the first cycle of mammography screening for early breast cancer detection, conducted from October 2006 to October 2009 in DNC. The overall turnout in mammography screening was 59.5%; according to age groups, it was 61.8%, 60.6%, 58.5% and 56.8% for 50-54, 55-59, 60-64 and 65-69 age group, respectively. According to BI-RADS classification, BI-RADS 0 was recorded in 886 (10.0%), BI-RADS 1 in 2993 (33.8%), BI-RADS 2 in 4023 (45.4%), BI-RADS 3 in 864 (9.8%), BI-RADS 4 in 87 (1.0%) and BI-RADS 5 in eight (0.1%) women. Fifty-seven new cases of breast cancer were diagnosed in the first cycle of mammography screening. Among newly diagnosed cases of breast cancer, in the category of BI-RADS 0, 4 and 5 malignancy was confirmed in 55.6%, 13.9% and 30.6% within 45 days, 46-90 days and more than 3 months of mammography. DISCUSSION: Study results indicated a total turnout on mammography screening of 59.5%, which was below the goal set in the National Program of 70%, and also below the acceptable response rate of 70% or more according to the European guidelines for quality assurance in breast cancer screening. Comparison of our rate of newly diagnosed cancer cases (6.3/1000 screened women) with the rates from other countries (range, 1.8 to 10.1/1000) published in the literature, our rate of mammography screening was in the middle of other countries' range. The "recall rate" in DNC was 11.1%, which is higher than acceptable (acceptable, <7%). The National Program specifies that diagnostic evaluation of all women with suspect findings should be completed within one month, however, in DNC 48.5% of women with newly diagnosed breast cancer of the BI-RADS 4 or 5 group were processed within a month. Diagnostic evaluation of all women with suspect findings was difficult to achieve due to the lack of necessary equipment and experts. CONCLUSION: It is crucial to ensure quality and systematic promotion of the importance of mammography screening, to improve the level of cooperation between all holders of program activities, and to shorten the time interval between mammography recording and additional diagnostic and therapeutic procedures for women with lesions suspect of malignancy (to provide appropriate diagnostic and therapeutic care).

Evaluation of Croatian model of polycentric health planning and decision making.

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.

[The risk and protective cardiovascular factors in Dubrovnik-Neretva county in comparison with Croatia]. / Rizicni i zastitni kardiovaskularni cimbenici u Dubrovacko-Neretvanskoj zupaniji i u hrvatskoj--raspodjela i usporedba.

OBJECTIVE: To establish the prevalence of overweight, obesity, elevated systolic (SBP) and diastolic blood pressure (DBP), and adding salt to meals as cardiovascular risk factors; the prevalence of fruit and leaf-vegetable consumption; and the prevalence of physical activity at leisure time as protective factors in Dubrovnik-Neretva County (County); and to compare these data with the respective figures in the Republic of Croatia (Croatia). METHODS: We used the 2003 Croatian Health Survey (CHS 2003) to provide data for our study. The CHS 2003 was a cross-sectional survey in a random sample of the general population aged > or =18. RESULTS: In the County, the prevalence of obesity, SBP, DBP, adding salt to meals, physical activity and leaf-vegetable consumption was higher in male population, and the prevalence of fruit and other green-vegetable consumption in female population. The prevalence of SBP, DBP, physical activity and leaf-vegetable consumption was higher in the County compared with Croatia. CONCLUSION: The monitoring of all relevant indicators is required to identify the risks and protective cardiovascular factors in the County population, to allow for planning of public health programs for the prevention of cardiovascular disease.