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.

Normative Data for Blood Pressure in Croatian War Veterans: A Population-Based Study.

Purpose: The current study aimed to investigate the normative data for blood pressure. Materials and Methods: From 2017 to 2020, 2032 men and women classified as 'war veterans' were recruited (mean age ± standard deviation (SD): 60.97 ± 7.98 years; mean stature: 172.50 ± 9.10 cm; mean body mass: 90.25 ± 36.45 kg; mean body-mass index: 29.66 ± 5.59 kg/m2; 29.9% women). Their systolic and diastolic blood pressures were measured three times. The procedure was carried out according to the American Heart Organization. The sex-specific and age-specific normative data for the 5th, 25th, 50th (median), 75th, and 90th percentiles for systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (measured as SBP-DBP) and mid-BP (the average of SBP and DBP) were presented. Results: The men had higher SBP (p < 0.001), DBP (p < 0.001), pulse pressure (p < 0.001) and mid-BP (p < 0.001) compared to the women. The age-specific differences showed that older individuals had higher values of SBP (p < 0.001), pulse pressure (p < 0.001), and mid-BP (p < 0.001), while no significant differences for DBP (p = 0.496) were observed. Conclusions: This is the first study providing sex-specific and age-specific normative data for blood pressure in war veterans.

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 effect of chronic physical illnesses on psychiatric hospital admission in patients with recurrent major depression.

People with major depressive disorder (MDD) have an increased burden of chronic physical illnesses (CPI). However, information about the effect of CPIs on recurrent MDD treatment outcome is limited. The objective of this study was to explore whether the number of CPIs in patients with recurrent MDD was associated with higher rate of psychiatric admissions. Data were collected for a consecutive sample of 190 patients diagnosed with recurrent MDD. The key outcome was the number of psychiatric admissions following psychiatric diagnosis. The independent variable was the number of CPIs. The effects of different clinical, sociodemographic, and lifestyle confounding factors were controlled using robust regression. The patients with CPI had significantly more psychiatric admissions than the patients without CPI, and the number of CPIs was significantly associated with the number of psychiatric admissions. The results of our study largely confirmed that more than two CPIs in patients diagnosed with recurrent MDD are associated with higher rates of psychiatric admission, independent of psychiatric comorbidities and other clinical and sociodemographic factors. These findings indicate that to improve treatment outcome and to reduce recurrence, it is crucial to enhance early recognition and treatment of physical comorbidity.

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.

Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study.

BACKGROUND: The aim of this study was to investigate the association between neuroticism, pain catastrophizing, and experimentally induced pain threshold and pain tolerance in a healthy adult sample from two regions of the country of Croatia: the island of Korcula and city of Split. METHODS: A total of 1,322 participants were enrolled from the Island of Korcula (n = 824) and the city of Split (n = 498). Participants completed a self-reported personality measure Eysenck Personality Questionnaire (EPQ) and pain catastrophizing questionnaire Pain Catastrophizing Scale (PCS), followed by a mechanical pain pressure threshold and tolerance test. We have explored the mediating role of catastrophizing in the relationship between neuroticism and pain intensity. RESULTS: The results showed that pain catastrophizing partially mediated the relationship between neuroticism and pain intensity, suggesting the importance of pain catastrophizing in increasing vulnerability to pain. The results also indicated gender-related differences, marked by the higher pain threshold and tolerance in men. CONCLUSIONS: This study adds to the understanding of the complex interplay between personality and pain, by providing a better understanding of such mechanisms in healthy adults.

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.

Psychosocial Determinants of Satisfaction with Hospital Care in Adult Patients Suffering from Advanced Cancer.

In this observational study, direct and indirect (moderator and mediator) relationships between sociodemographic (age, gender, life partner, education level, income and length of treatment) and psychological (Hospital Anxiety and Depression Scale, HADS) variables and satisfaction with hospital care (EORTC INPATSAT32) in adult (advanced cancer) patients were investigated. Study sample consisted of 75 hospitalized advanced cancer patients recruited at the Zagreb University Hospital Centre and Sestre milosrdnice University Hospital Centre in 2015. Statistically significant negative correlations were found between HADS and elementary school education level, as well as with all satisfaction variables (satisfaction with physicians, nurses and organization). Moderate to high and statistically significant positive correlations were found between elementary school level and all satisfaction variables. Gender and level of education appeared as significant moderator variables in the relationship between HADS and satisfaction with nurse care. There were no significant mediator effects of sociodemographic variables on the correlation between HADS and satisfaction with care. Male participants who were more disturbed emotionally were more satisfied with nurses. Participants with elementary and high school levels of education and lower scores on HADS were more satisfied with nurses, while participants with university level of education had higher HADS scores and lower level of satisfaction with nurses.

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.