Development and validation of scale for measuring attitudes towards e-professionalism among medical and dental students: SMePROF-S scale.

BACKGROUND: Social media permeated everyday life and consequently it brought some changes to behaviour of health professionals. New form of professionalism emerged called e-professionalism depicting professional behaviour while using social media. There are a number of studies conducted in the past several years measuring behaviour of different populations of health professionals on social media and social media sites. Many studies have investigated aspects of e-professionalism of medical or dental students as future health professionals, but there are no validated instruments made for assessing attitude towards e-professionalism of those two populations. Objective of this paper is to validate a newly developed scale for measuring attitudes towards e-professionalism among medical and dental students. METHODS: The original 32-item scale was developed and administered to 411 medical students (RR 69%), and 287 dental students (RR 49.7%). Exploratory factor analysis was used to investigate the existence of underlying factors. Principal component analysis was used as an extraction method with oblimin as selected oblique rotation method. Cronbach's alpha was used to assess reliability. RESULTS: Total of 698 student answers entered analysis. The final scale had 24 items that formed seven factors named: ethical aspects, dangers of social media, excluding physicians, freedom of choice, importance of professionalism, physicians in the digital age, negative consequences. Cronbach's alpha indicating scale reliability was .72. Reliability conducted on each factor ranged from .570 to .877. CONCLUSIONS: The scale measures seven factors of attitude towards e-professionalism and exhibits satisfactory reliability. Based on insights from validation, some possible improvements are suggested.

The Connection between Alexithymia and Somatic Morbidity in a Population of Combat Veterans with Chronic PTSD.

PURPOSE: To investigate the connection between alexithymia and somatic illness, or, somatization, in veterans suffering from chronic combat-related post-traumatic stress disorder, PTSD. METHODS: Croatian combat veterans (N=127) were studied at the Department of Psychology, Zagreb Clinical Hospital Center. The diagnosis of PTSD was confirmed and verified according to the International Classification of Diseases (ICD-10). A version of the Mississippi Scale for Combat Related PTSD (M-PTSD) standardized for the Croatian population was used to assess the severity of PTSD. In addition to the clinical interview, the existence of alexithymia was confirmed by the score on the Toronto Alexithymia Scale (TA S-20). RESULTS: A statistically significant association was found between the total number of diagnosed physical illnesses and the scores on three subscales of an alexithymia questionnaire, the TA S-20, with a 1% risk (p<0.01, 0.487; 0.450; 0.335). Regression analysis confirmed the most statistically significant predictive value of the first item of the TA S-20, which refers to difficulty in identifying feelings (=0.408, p=0.019). The total score on the M-PTSD scale correlated significantly to the subscales for alexithymia. There was a statistically significant negative correlation of the total score on the M-PTSD scale with social support. CONCLUSION: The total scores obtained in this study, particularly those related to alexithymia, indicate the importance of this construct in the etiopathogenesis of somatic morbidity in the study population and confirm that as in other countries the TA S-20 is a useful instrument in Croatia for the assessment of this phenomenon.

Psychiatric disorders and aggression in the printed media: is there a link? A central European perspective.

BACKGROUND: A content analysis was used to describe the association between psychiatric disorders and aggression in the printed media in the Czech Republic and Slovakia. METHODS: Articles were chosen from the most widely read daily newspapers and magazines in both countries during five one-week periods in 2007. A coding manual was developed and a content analysis was performed. Aggressive behavior was assessed by two separate categories - the role of the mentally ill person in the violent act (perpetrator/victim) and the type of aggressive act (homicide, suicide). RESULTS: A total of 375 articles were analyzed. MAIN FINDINGS: 1) The proportion of articles depicting psychiatric disorders together with either self- or other-directed aggressive behavior is 31.2%; 2) Homicide was most frequently mentioned in the context of psychotic disorders and schizophrenia, while affective disorders were most frequently associated with both completed suicides and homicides; 3) Eating disorders and anxiety disorders were seldom associated with any kind of aggressive behavior, including self-harm; 4) The vast majority of articles presented mentally ill people as perpetrators, and these articles were more often coded as stigmatizing. 5) Articles with aggressive behavior mentioned on the cover are roughly as frequent as those with aggressive behavior in the later sections of the media (36.7% vs. 30.7%). CONCLUSIONS: The results are similar to the findings in countries with longer histories of consistent advocacy for improved depiction of mental illness in the media. However, we have shown that persons with mental illness are still over-portrayed as perpetrators of violent crimes, especially homicides.

Case oriented approach to co-occurrence of risk lifestyle behavior with overweight, excess abdominal fat and high blood pressure: the CroHort study.

Objective of this paper is to estimate interim risk factors (INTF) proportions and changes within 5-years of groups with at least one risk health behavior (BEHF) in CroHort population. Results show that CroHort 2008 group has higher proportions of excess abdominal fat and overweight. Men older than 65 without any BEHF have smaller proportions of INTF in 2008 than in 2003. Proportion of people with high blood pressure is smaller in 2008 for all groups except for young women who show increase. Analysis of middle age group shows significant increase in all INTF in women smokers while men smokers have the highest increase in abdominal fat. Physical inactivity in women is associated with increase of all INTF, while men have decrease in overweight INTF. Alcohol intake has protective effect on middle aged men, except for increase in waist circumference. Women show constant increase in all INTF with heavy alcohol intake.

Predictors of the desire/decision to quit smoking in a cohort of Croatian adult smokers followed for five years: the crohort study.

This study provides an overview of the incidence of smoking, the socio-demographic characteristics of Croatian smokers during a five-year period and an assessment of predictors of the desire/decision to quit smoking. Analyses were performed separately for 2003 and 2008. A total of 3,229 subjects were included in the survey. There is a significant trend of a decreasing number of smokers in all age groups in 2008, compared to 2003. Almost half of the smokers included in the study expressed desire to quit smoking. Factors contributing significantly to decision to quit smoking were different in 2003 and 2008, except one. Concern about the harmful effects of tobacco smoking on health was a significant predictor in both models. Very worried respondents were more likely to decide to quit smoking (OR 17.6, 95% CI 9.41 to 33.17 vs. OR 12.54; 95% CI 6.0 to 26.2) than those who were not worried at all.

Prevalence and five-year cumulative incidence of psychological distress: the CroHort study.

The aims of this paper are to investigate the change in prevalence of psychological distress (PD), to investigate the cumulative incidence of the psychological distress and to indicate are there any differences between genders and various age groups in Croatian adult population. Psychological distress status was measured by the five-item Mental Health Scale (MHI-5) of the Short Form questionnaire (SF-36). Psychological distress was present in 28.5% (95% CI 25.7%-31.2%) of men and 32.1% (95% CI 30.1%-34.0%) of women in 2003. In 2008 PD was present in 33.0% (95% CI 30.1%-35.9%) of men and 34.1% (95% CI 32.1%-36.0%) of women. The highest incidence of PD, both for men and women, was in the oldest age group (> 65 years). Results of this study demonstrating the fact that every third adult men and woman in Croatia are in psychological distress, the fact that there is an increase in PD prevalence for men and women should be taken into account in the future mental health policy planning.

Association of the psychological distress and cardiovascular risk behaviors, conditions and diseases: the CroHort study.

Aim of this study was to explore and compare association of PD (psychological distress) and cardiovascular risk behaviors, conditions and diseases in Croatian adult population. The sample of this study consisted of 3,229 respondents. Psychological distress status was measured by the five-item Mental Health Scale (MHI-5) of the Short Form questionnaire (SF-36), hence one distinguished subgroup consisted of population with PD and other without PD. Prevalence of cardiovascular risk behaviors, cardiovascular risk conditions and self-reported cardiovascular diseases within each subgroup were calculated. During the follow up period physical inactivity remained the only risk behavior showing significant difference between PD status subgroups for both genders demonstrating higher prevalence in men and women with PD. During follow up period hypertension, myocardial infarction, angina pectoris and self-reported heart failure in women remained constant in showing statistically significant prevalence difference among population with and without PD. In men that type of constant association was shown only for heart failure.

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.

The picture of mental health/illness in the printed media in three Central European countries.

Even in the era of the Internet, printed media are still among the most frequently identified sources of mental health information. Many studies have shown that this information is frequently negative and contributes to stigmatization of people with mental illness. This international comparative study describes the content of media messages about mental health/illness in terms of stigma in three Central European countries. The study sample comprised all articles pertaining to the topic of mental health/illness (N = 450) identified during five week-long periods in 2007 chosen from the six most widely read newspapers and magazines in each country. The authors used content analysis methods to achieve quantitative and qualitative objectives. More than half of all articles contained negative statements reflecting stigma toward persons with mental illness. Substance abuse disorders are the most frequent mental conditions covered in all three countries (22%), and psychotic disorders are the most stigmatized. Countries significantly differ in length of articles, in the association of aggressive behavior with persons with mental illness, and in the use of a sensationalized style of writing. Coverage of mental health/illness issues differs to some extent across countries but is generally of poor quality. On the basis of the authors' findings, practical recommendations for journalists can be tailored specifically for each country.

Development of the PICMIN (picture of mental illness in newspapers): instrument to assess mental illness stigma in print media.

PURPOSE: The aim of this paper is to report on the development and applicability of a standardised and objective measure of stigma of mental illness in print media. Picture of mental illness in newspapers (PICMIN) instrument consists of eleven descriptive and five analytical categories. It is intended to allow comparison among countries and different studies over time. METHODS: The research team conducted a three-phase study to develop the instrument based on the principles of content analysis and test its inter-coder reliability (ICR). In the first phase, keyword search and ICR assessment was performed on articles from Croatia (75), Czech Republic (203), and Slovakia (172). The second phase consisted of instrument revision and training, along with ICR reassessment on 40 articles from USA and UK. In the third, main phase articles from Croatia (238), Czech Republic (226), and Slovakia (158) were analysed with the final version of the PICMIN instrument. RESULTS: Across three countries, ICR was found acceptable to assess mental illness representations related to stigma in print media. Print media representations of the mental illness in Croatia, Czech Republic, and Slovakia significantly differed in the type of media distribution, whether headline of the article was positioned on the media cover, in the use of a sensationalistic style of writing, in the association of aggressive behaviour with persons with mental illness and in the distribution of the global impression of the headline. CONCLUSIONS: PICMIN instrument allows comparison among countries and different studies over time.

Psychological distress within cardiovascular risks behaviors, conditions and diseases conceptual framework.

Psychological distress (PD) is being increasingly recognized as a risk factor for cardiovascular diseases (CVD). Our aim was to recognize an association of PD and CVD in the Croatian adult population. We also explored association's strength obtainable as relative risk of PD on three levels; cardiovascular risk behaviors, conditions and diseases. This study used Croatian Adult Health Survey 2003 (CAHS 2003) data (N = 9,070). PD status was measured by the five-item Mental Health Scale of the Short Form questionnaire (SF-36) hence one distinguished subgroup consisted of population with PD and other without PD. Prevalence of cardiovascular risk behaviors, cardiovascular risk conditions and self-reported cardiovascular diseases within each subgroup were calculated using bootstrap method. Women had higher prevalence of PD in general population. Among distressed population women had higher prevalence of body mass index over 30, metabolic syndrome and angina pectoris. Men with PD had higher prevalence of high blood pressure and myocardial infarction with contradictory lower prevalence of angina pectoris then myocardial infarction. Physical inactivity was proven to be a risk behavior determinant with most impact on mental health. All CVD are consistently associated with higher prevalence and relative risks for PD both in men and women.

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.

Association of social roles, health, and health behavior of elderly women in Croatia.

AIM: To explore the association between the social role and objective and subjective health measures and use of health care services in the population of women older than 65 years in Croatia. METHODS: We used the data from the 2003 Croatian Adult Health Survey (Short Form 36 Health Survey). Two sub-populations, retired women and housewives aged over 65 years, were analyzed and compared according to anthropometric measures, health self-assessment, utilization of health care services, and socioeconomic status. RESULTS: The final sample consisted of 791 housewives and 1151 retired women. Housewives had larger waist circumference (98.44+/-13.9 vs 96.49+/-13.5, P=0.002, t test) and higher systolic blood pressure (152.88+/-25.2 vs 147.79+/-22.8, P<0.001, t test). On self health assessment, housewives had lower index on Mental Component Summary (MCS) (40.28+/-12.5 vs 42.96+/-12.4, P<0.001, t test). They also had lower self-assessed quality of life (40.28+/-12.5 vs 42.96+/-12.4, P<0.001, t test). Housewives performed regular breast check-ups significantly less often in the 12 months before the survey (7.5% vs 13.6%, chi2=18.0350, P<0.001), but they performed other forms of medical examinations, including general physical check-ups as often as retired women. CONCLUSION: Housewives differed from retired women of the same age in objective and subjective measures of health status, use of health care services, self perceived health, and self-assessed quality of life. These differences should be taken into account when planning public health measures for these age groups of women.

Counties selecting public health priorities--a "bottom-up" approach (Croatian experience).

The subject of this paper is how to incorporate a multi-disciplinary and inter-sectored approach into development of public health policy and plans at the local (county) level in Croatia by educational program. Method used was the public health capacity building program "Health--Plan for it", which was developed with the aim to assist the counties to overcome recognized weaknesses and introduce more effective and efficient local public health practices. Two main instruments were used: Local Public Health Practice Performance Measures Instrument, and Basic Priority Rating System. This program has helped counties to asses population health needs in a participatory manner, to plan for health and, ultimately, assure provision of the right kind and quality of services (better tailored to population health needs). This program's benefits are going beyond and above the county level. It provides support for the Healthy Cities project locally, and facilitates changes in national policymaking body's mindset that a "one-size-fits-all" approach is sufficient.

[Formulating a health strategy at the local level using the "Urban Health Profile" and "Urban Health Planning"]. / Kreiranje strategije zdravlja na lokalnoj razini procesom "Gradske slike zdravlja" i "Gradskog plana za zdravlje".

The aim of this article was to describe the method that Croatian cities have used in the development of the City Health Profile and City Health Plan. Selected as the most appropriate and applied was the Rapid Appraisal to Assess Community Health Needs. Three sources of information were used in this research: panelist essays reflecting local community views on health, problems and potentials of their city, observations about what is diminishing and what is giving beauty of living in their city and information derived from the existing written data sources. A free-text processing program analyzed essays. During the Consensus conference, based on presented data, participants had selected (Healthy City Project) priority areas. Between 1996 and 2002 The Rapid Appraisal was applied in six Croatian cities: Pula, Metkovic, Rijeka, Karlovac, Varazdin and Zagreb. By applying the method of Rapid Appraisal the cities assessed their health and health needs and created the City Health Profile. They selected their (Healthy City Project) priority areas, established the working groups on priority areas, and developed the City (action) Plan for Health. The method proved that communities have the capacity to recognize and deal with their health problems.