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.

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.

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.

Recipe from the past for the future: public health intervention represent a process for century.

In the poor Bosnia, in the early 20(th) century endemic syphilis was widespread. Combating this disease entailed the necessity of etiology research, diagnosis and clinical nature of the disease, as well as the insight into the epidemiological image of this unresolved health problem. Thanks to the visionary, the enthusiasm and persistence of the expert team of doctors from that time in Croatia, School of Public Health and the Rockefeller Foundation as financial support, conditions were created to conduct population monitoring and research called "survey". The team of experts from Croatia and Bosnia led by Dr. Ante Vuletic began this important public health intervention in Central Bosnia underneath the mountain Vlasic 1934. In villages of mountain Vlasic people were living in very difficult social and unsanitary conditions. "Interviewers" worked in makeshift clinics in the rural schools Opare, Rankovici, Vitovlje Mehorica, Turbe, Bila and Gornji Vakuf. A hundred years later, a team of university professors from the School of Public Health "Andrija Stampar" led by Professor Silvije Viletic followed the footsteps of century "survey" on Vlasic in the summer of 2014. They determined that with the integrated approach to population monitoring and testing endemic syphilis in Bosnia was successfully suppressed.

Healthy occupational culture for a worker-friendly workplace.

Work has numerous health and wellbeing benefits, but it also involves physical hazards and psychological exertion. Today the scale has tipped toward psychosocial factors. Workers' mental health affects their intellectual, emotional, and social growth, as well as work ability, productivity, and ultimately organisational productivity and competitiveness on the market. Even though companies may have an internal hierarchy that lowers stress at work, there are other formal and informal social processes that can affect (positively or negatively) the cohesion within the work unit. Safety culture of an organisation is a product of individual and group values, opinions, competences, and behavioural patterns that determine how occupational health and safety are implemented. Organisations that nurture positive safety culture understand the importance of health and safety and believe in prevention rather than dealing with consequences. Jobs that are stable, autonomous, and reasonably physically and psychologically demanding are far more likely to lower work-related stress and boost worker satisfaction. In fact, employee empowerment is one of the best ways to achieve good psychosocial health at the workplace.

Occupational exposure to blood among hospital workers in montenegro.

This cross-sectional study was performed in nine Montenegrin hospitals to estimate the burden of occupational exposure to blood among hospital workers in Montenegro in 2010 using a modified Croatian self-reporting questionnaire on exposure to blood-borne infections. Of the 1043 respondents, 517 (49.6 %) reported exposure to blood. Variations between the hospitals were not significant, except for the hospital in Kotor, which stands out with the high percentage of exposed hospital workers (p<0.05). More than 77 % of exposures were not reported through standard hospital protocols at the time of the incident. The most exposed group to blood were nurses (357 of 517; 69.1 %), but the percentage of exposed nurses within the group did not stand out compared to other occupations and was close to that reported by physicians (50.57 % vs. 57.49 %, respectively). The number of hospital workers with appropriate HBV vaccination was surprisingly low (35.7 %) and significantly below the recommended best practice (at least two consecutive doses of HBV vaccine documented for 100 % of employees) (p<0.001). Even with its limitations, our study fills a gap in knowledge about the actual number of sharps incidents and other occupational exposure to blood among hospital workers in Montenegro as well as about the issue of underreporting, which is very common. It also confirms the urgent need for active implementation of special, comprehensive measures to prevent needle-stick and other sharps injuries. Constant staff training, life-long learning, and standardising post-exposure procedures are also recommended.

Physicians' interpersonal relationships and professional standing seen through the eyes of the general public in Croatia.

PURPOSE: Medical professionalism, as a cornerstone of medicine's social contract with society, demands physicians adhere to high professional standards while placing public interest ahead of self-interest. This study's objective was to investigate perceptions of the basic elements of medical professionalism related to physicians' interpersonal relationships and their professional standing in the view of the broader public. METHODS: A field survey was conducted using an independently created questionnaire on a nationally representative three-stage probabilistic sample of 1,008 Croatian citizens. By including weights, the sample became nationally representative in terms of sex, age, education, and regional representation. The survey was carried out from April 17 to May 13, 2012. RESULTS: The Croatian public recognizes the importance of collaboration among physicians, but their everyday experiences tell a different story, in which almost half of the respondents evaluated physicians' collaboration as being mediocre, poor, or nonexistent. The perception of physicians' priorities and their primary interests, where every sixth respondent believes physicians always or almost always puts their own interest in front of that of the patients, as well as the perception of their inadequate adherence to professional standards, is indicative of a disillusioned stance of the public toward the medical profession in Croatia. CONCLUSION: This research offered insight into findings that can have a profound and long-lasting effect on a health care delivery process if they are not further analyzed and rectified.

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.

Are nurse presenteeism and patient safety culture associated: a cross-sectional study.

Working as a nurse involves great dedication and sacrifice: working night shifts, working overtime, and coming to work sick. The last is also known as presenteeism. Research has shown that poor nurse performance can affect both caregiver's and patient's safety. The aim of this cross-sectional study was to investigate whether nurse presenteeism affected patient safety culture and to look deeper into the characteristics of nurse presenteeism and patient safety culture in Croatia. The study was conducted in one general hospital in Croatia over April and May 2012 and specifically targeted medical nurses as one of the largest groups of healthcare professionals. They were asked to fill two questionnaires: the six-item Stanford Presenteeism Scale (SPS-6) and the Hospital Survey on Patient Safety Culture (HSOPSC). We found no association between presenteeism and patient safety culture. Overall positive perception of safety was our sample's strength, but other dimensions were positively rated by less than 65 % of participants. The lowest positive response concerned "nonpunitive response to error", which is consistent with previous studies. Presenteeist nurses did not differ in their characteristics from nurses without presenteeism (gender, age, years of experience, working hours, contact with patients and patient safety grades). Our future research will have to include a broader healthcare population for us to be able to identify weak spots and suggest improvements toward high-quality and cost-effective health care.

Patients and health care professionals: partners in health care in Croatia?

OBJECTIVES: To explore quality in hospitals from the patients' and health care professionals' perspective in line with Act on the Protection of Patient Rights. DESIGN: A qualitative study using a focus group design and semi-structured interviews. METHODS: Three focus groups among health care professionals were conducted with 51 participants: 24 nurses and medical technicians, 15 physicians, 12 residents, followed by additional interviews (20 nurses and medical technicians, 10 physicians, and 2 residents). Twenty patients were interviewed at the time of their discharge from the hospital. Collected data were analysed using thematic analysis. RESULTS: Patients identified waiting for medical treatments/procedures as the most concerning factor, followed by changes in administration procedures and admission in hospitals. From the physicians' and nurses' perspective, the main topics were inadequate resources to work with and inadequate working environment. Residents emphasized administration and lack of adequate equipment in contrast to other health care professionals. Both patients and health care professionals identified similar organizational and administrative issues impacting on service delivery. CONCLUSIONS: Health care providers and patients equally recognize the factors that impact upon quality of care. This problem is beyond the health care professionals' possibility to solve, which is the main source of stress and burnout that influence the quality of care. These factors cannot be overcome, by either health care professionals or patient organizations working alone. Greater partnership between health providers and patient associations is needed. STATEMENT OF CONTRIBUTION: What is already known on this subject? Healthcare providers and patients have the same goal: good quality of care and safety. Croatia has undergone significant socio-economic and political changes, which have affected the organization of the health care system. The patient experience is positively associated with clinical effectiveness and patient safety. What does this study add? From the perspective of patients and health professionals the main concern regarding quality of care is the organization of work in hospitals. Croatian patients and health professionals show considerable agreement with regard to the administrative problems in hospitals. Solutions that include only efforts on the part of the health care worker will fail.

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.

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.

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.

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.

Respiratory symptoms in fish processing workers on the Adriatic coast of Croatia.

This article describes respiratory symptoms and lung function in 98 fish processing female workers employed in a fish processing plant located on the Croatian Adriatic coast and 95 matching controls. The study included chronic and acute respiratory symptoms which developed during the shifts. Lung function measurements included forced vital capacity (FVC), one-second forced expiratory volume (FEV(1)) and maximal expiratory rates at 50 % and the last 25 % (FEF(50), FEF(25)). Chronic respiratory symptoms were significantly dominant in fish processing workers compared to controls. The most common chronic symptoms were hoarseness (57.1 %), nasal catarrh (51.0 %), chronic cough (42.9 %), chronic phlegm (34.7 %), and frequent chest cold (35.7 %). Exposed smokers and nonsmokers had a similar prevalence of chronic respiratory symptoms. Acute symptoms over the work shift were high, with headache in lead (smokers: 62.5 %; nonsmokers: 56.1 %). Most of the ventilatory capacity parameters were significantly lower than predicted, FEF(25) in particular, indicating obstructive changes predominantly in the smaller airways. These findings suggest that fish processing workers are prone to developing acute and chronic respiratory symptoms as well as to lung function changes. This calls for medical and technical preventive measures to be introduced in the work environment of the fish processing plant.

[Dance as a risk factor for injuries and development of occupational diseases]. / Ples kao cimbenik rizika za ozljede i razvoj profesionalnih bolesti.

Injuries and diseases can significantly affect the creativity and artistic performance. The link between working conditions and artistic performance had been recognised as early as the medieval age. Physically demanding performance arts such as dance can sometimes result in injuries, illnesses, inability to perform, and even end artist's career. Dancers are exposed to specific risks and in need of specific medical care. Many dancers often stretch their physical capabilities and endurance and neglect their physical limitations. Their health problems include a number of work-related illnesses that range from stress and stage fright to metabolic and nutritional disorders. They also include musculoskeletal injuries due to overload training that are often the beginning of chronic health problems.

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.

Work-related stress and work ability among Croatian university hospital midwives.

OBJECTIVE: to explore the sources and levels of stress at work and work ability among Croatian midwives. BACKGROUND: midwives are subjected to multiple stressors. Among health-care professionals, psychological distress for a prolonged period of time has negative effects on the worker's health, work ability and quality of patient care. 'Work ability' is a term describing a worker's resources related to physical, mental and social demands at work. As a measure of work ability in midwifery, the Work Ability Index (WAI) is considered to be a very predictive instrument; midwives with a poor WAI score usually leave their current job within five years. SETTING: university hospitals in Zagreb, Croatia. DESIGN: cross-sectional design survey. PARTICIPANTS: 300 health-care workers (105 qualified midwives and 195 paediatric nurses) were invited to complete the questionnaire. The total response rate was 53% (158/300). The sample included 14.7% of all hospital-based midwives in Zagreb hospitals. METHODS: the Occupational Stress Assessment Questionnaire (OSAQ) for health-care workers and the WAI questionnaire. FINDINGS: over three-quarters of the midwives (46/60, 76.7%) believed that their job was stressful, and considered that insufficient work resources caused the most stress. More than half of the midwives associated an insufficient number of coworkers, unexpected situations, inadequate income, night work, incurable patients and poor organisation at work with a high level of stress. The perceived specific stressors differed between midwives and paediatric nurses in the same hospital. Insufficient work resources and poor organisation at work were more common stressors among midwives than paediatric nurses (p<0.05). Midwives and nurses differed significantly with respect to age (p=0.002). Midwives were younger and had spent fewer years working in their current workplace compared with paediatric nurses (p<0.001). Also, midwives had a lower level of education than paediatric nurses (p=0.044). The mean WAI score for midwives was 40.0 [95% confidence interval (CI) 38.4-41.4], compared with 37.5 (95% CI 36.4-38.8) for paediatric nurses, both indicating good work ability. After adjusting for age, the difference in WAI score between the groups of workers was not significant. CONCLUSIONS: Croatian midwives experienced work-related stress due to: insufficient work resources, insufficient number of coworkers, poor organisation at work, communication with superiors and emotional work. Midwives' work ability in relation to the demands of their job was good. These results confirmed that the WAI score decreases significantly with age. IMPLICATIONS FOR PRACTICE: hospital management needs to improve organisational factors and resources, as well as midwives' education and position in the health-care system.