The Child Health Care System of Croatia.

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children.

[Epidemiology of allergic diseases]. / Epidemiologija alergijskih bolesti.

The article gives a critical review of the main epidemiological features of allergic diseases, their frequency, distribution and etiologic background as well as the possibilities of prevention and control, based on current literature. Statistical data for Croatia, collected by the Croatian National Institute of Public Health, are used to present actual epidemiological situation in Croatia. Basic descriptive epidemiological methods were used to express age and sex distribution, etc. In comments and review of preventive measures, our own epidemiological experiences and experience acquired on creating the national programs of health measures were used. The genesis of allergies usually implies the influence of various potent environmental allergens such as proteins or smaller molecules attached to proteins (haptens) through repeat or continuous exposure by contact, alimentary or respiratory route, and parenteral route as most efficient (mucous membrane exposure is similar to parenteral exposure). In addition, almost all substances from our environment may, under certain circumstances, become allergens and produce allergic reaction. Individual constitution that is inherited also plays a role. Allergic diseases are present all over the world, however, with variable frequency. Response to an allergen is generally the same, causing distinct allergic diseases like urticaria, anaphylactic shock, asthma, etc., while the main allergens can be different. It is estimated that 30%-40% of all people have some type or manifestation of allergy. According to our Institute data, in Croatia hospitalization was mostly required for allergic urticaria and allergic asthma, followed by Quincke's edema. Optimal treatment and appropriate healthcare structure are essential for efficient control and prevention of allergic diseases. The main direct elements are as follows: well organized emergency service for anaphylactic and other severe conditions; health education expected from all levels of healthcare system; allergology outpatient services available; and sufficient hospital capacities. An indirect yet important element is optimal drug prescribing and usage practice. Other specific public health measures include: pollen air concentration monitoring by public health institutes; information on particular allergen presence and intensity via public media; and control of potential allergen emission into the environment, especially air. People will, as always, find ways to adapt themselves and cope with allergies, with medical profession helping them by identifying the reasons causing allergic diseases and developing successful measures of treatment, prevention and control.

[Incidence and prevalence of asbestos-related diseases in Croatia]. / Pojavnost bolesti uzrokovanih azbestom u Republici Hrvatskoj u razdoblju od 2002. do 2007.

The aim of this study was to identify the incidence and prevalence of asbestos-related diseases in Croatia, based on the Hospital Morbidity Database and General Mortality Database of the Croatian National Institute of Public Health. Both databases cover a period from 2002 to 2007), and include information from the Register of Occupational Diseases. Diagnoses in focus were mesothelioma (C45), asbestosis, and pleural plaque (J61 and J92). Yearly rates of inpatients treated for mesothelioma, asbestosis, or pleural plaque that were higher than the Croatian average (2.1) were recorded in the Counties of Split-Dalmatia (5.0), Dubrovnik-Neretva (3.9), Istria (3.7), and Primorje-Gorski kotar (3.1 per 100,000 people). From 2002 to 2007, 649 occupational diseases were reported, out of which 11.7% were asbestos-related. The most frequent were pleural plaque with asbestosis (38 cases, 50.0%), pleural plaque (23 cases, 30.3%), and mesothelioma (6 cases, 7.9%). Mortality attributable to asbestos was assessed using official Croatian National Statistics Bureau reports for 2002 to 2007 at the county and national level. During that period, Croatia recorded 312 deaths with the average yearly rate of 1.2 per 100.000 people. Four counties had higher rates than the national average: Primorje-Gorski kotar (3.4), Split-Dalmatia (2.8), Istria (2.8), and S1. Brod-Posavina (1.5). The number of inpatients treated for asbestos-related diseases was higher than the national average in the counties of Split-Dalmatia, Dubrovnik-Neretva, and Primorje-Gorski Kotar. Mesothelioma incidence was above the national average in the counties of Split-Dalmatia, Primorje-Gorski Kotar, and Istria. The rates of occupational, asbestos-related diseases were higher than the national average in the counties of Split-Dalmatia and Primorje-Gorski Kotar. We were aware that the interpretation of data is somewhat limited by the relatively small absolute number of treated persons and deaths for the observed period, by the fact that crude rates have not been adjusted for total numbers and for regional differences in population distribution by age and gender. The real extent of asbestos-related burden in Croatian general population remains unknown, because only occupational exposure has been monitored. Therefore, the National Public Health Institute and county public health institutes should implement a specific monitoring programme in collaboration with government environmental bodies to assess asbestos exposure of the population living in the vicinity of asbestos plants. It is also necessary to establish the number of exposed persons who have developed an asbestos-related disease. Their health should be monitored and their environment inspected on a regular basis.

[Demographic and educational characteristics of physicians in the health care system in Croatia: overview] ]. / Demografske i izobrazbene znacajke lijecnika zaposlenih u sustavu zdravstva Hrvatske: opci pregled.

The structure of 10,146 physicians working in Croatia's health system in 1990 and that of 11,103 working in 1999 are compared in terms of age, sex and level of training (intern, unspecialized doctor, resident, and specialist). Comparison of the same 5-year groups with reference to 1990 uncovered a reduction in the share of the two youngest 5-year physician groups (ages 25-29 and 30-34 years) in the total physician population working in 1999. Between 1990 and 1999, the average age of working physicians increased from 44.2 to 46.5 years and from 39.2 to 42.4 years in male and female doctors, respectively. In the same period the lady doctors' share of the physician total increased from 50.8 to 55.6%. By the criterion of the number of physicians per 100,000 population in 1980-99, Croatia was below selected group averages of the European countries. From 1991 to 1995 the generally rising trend of the number of physicians was interrupted due to the war in Croatia. Because of unequal numbers of physicians at individual years of age, we emphasized the need for demographic approach both in the planning of physician employment and advanced medical training. This necessity was reinforced by the fact that in 1999, at 35-44 years of age 1,147 (29%) physicians neither possessed a specialty degree nor started on any such course.