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.

Migraine and tension-type headache in medical students: a questionnaire study.

The purpose of our study was to perform an epidemiological study of migraine and tension-type headache (TTH) in medical students (MS) at University of Zagreb Medical School and to determine whether there are differences in prevalence, trigger factors, health care utilization and self-medication between sixth year and first year MS. This study included 314 students who answered a questionnaire from October to November 2003. The prevalence of migraine was 8.86% in first year students and 10.90% in sixth year students while the prevalence of TTH was 60.13% and 57.69% respectively. Female students suffered from migraines significantly more often than male students (p = 0.017). Female students with migraine linked their headaches to their menstrual cycle significantly more often than female students with TTH (p = 0.011). Significantly more first year students have visited a doctor concerning their headaches than sixth year students. Also, there is a significantly higher level of self-medication amongst sixth year students. Our study has shown that a relatively large percent of MS suffers from TTH; a low percent is seeking medical advice for headaches, the majority is self-medicated, and an unacceptably low percentage is taking triptans for migraine.

Employment outcomes among junior researchers in medicine in Croatia.

AIM: To investigate fellowship outcomes among junior researchers in medicine, supported by the Ministry of Science, Education, and Sports of the Republic of Croatia. METHODS: We used the data on junior researchers whose fellowships terminated between 1999 and 2005. Employment outcomes and scientific productivity, measured by the number of published articles indexed in the Web of Science database, were analyzed for every junior researcher. The data were analyzed using chi2 test, Mann-Whitney test, Kruskal-Wallis test, Breslow test, and logistic regression. RESULTS: Only 12% of junior researchers obtained a degree of Doctor of Philosophy (PhD) during fellowship. At the same time, 55% of junior researchers with a Medical Doctor degree terminated the fellowship and got employed in the health system during the same month. Terminating and re-employing in same month was most common among junior researchers who got employed by clinics and hospitals (odds ratio, 7.78; 95% confidence interval, 2.22-27.24). Also, it was less common among female than male junior researchers (odds ratio, 0.50; 95% confidence interval, 0.28-0.90). CONCLUSION: This study suggests that junior researchers in medicine commonly used their fellowship as a short-term employment option. The direct consequence of this is the low percentage of obtained PhD degrees during the fellowship period. Additionally, this article provides an insight into the current status and future of the fellowship programs in medicine, with special emphasis placed on the potential changes that might occur as a consequence of physician shortage in Croatia.

[Computerization and the importance of information in health system, as in health care resources registry]. / Informatizacija i znacenje informacija o zdravstvenom sustavu--primjer registra zdravstvenih izvora.

The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system. Directory service does not follow the history of attribute changes, and is optimized for a large number of authorizing inquiries. With it, one follows the following objects and attributes: persons, groups of people (patients, physicians, other personnel), roles (right of access and administrator permissions), organizational units, unit locations, devices and services (according to the list of services and procedures). One can add to the Health Care Resource Registry such attributes as are nonessential for inclusion in the directory service, but are of public health value. Authentication, authorization and digital signature are done by means of Smart Cards, which are used as protective elements against access to system functions, and simultaneously as a physical medium for the storage of the official certificate with which documents are signed digitally. As FINA (state financial control agency) has completed a system for certificate issuance and verification, the option of official digital signature is also available as a computer network service. Any changes taking place in the directory service are transferred by XML messages to a separate part of the Registry that reads them and automatically modifies records in the relational database. Because data input and data changes are made in health units, this makes the data updated and directly connected with health working operations. This avoids all one-time data collection campaigns using form filling about the devices and equipment in the future. As it is very difficult to monitor from a central standpoint how accurate and update the information is, it is necessary to delegate the permissions and duties associated with making changes to the directory service. By this organizational setup, the time needed to ensure data quality control is reduced. In the case described, the Health Care Resource Registry becomes an indicator of change, acquiring certain characteristics of an analytical system. An analysis of topical data renders possible proactive action and makes more effective the planning and utilization of available resources. Providing answers on the current data quickly could also be important to solution-seeking in emergencies. The present proposal to establish the Registry is intended to facilitate the future process of planning and striking a balance between investments in human and physical resources. For health expenditure control, having reliable information related to the use and purchase of new medical technology is particularly important. World Health Organization and European Union have also emphasized the need to develop new indicators in this area.

[Medical specialists in Croatia: general overview, possibilities in planning and education in the future]. / Lijecnici specijalisti u Hrvatskoj: opci pregled, mogucnost planiranja i izobrazbe u buducnosti.

The paper describes the dynamics of trends in the number of specialists and the differences that have arisen over a 14-year period among individual specialties. Shown and analysed separately is the basic demographic information (obtained from the National Health Workers Registry) about the specialists working in Croatia in 2000. The data were used to illustrate the two options for planning them: by statistical method for analysing a time sequence and by prediction of specialist needs by anticipated old age retirement. At the end of 2000 there were 7,383 specialists, or 65.8% of the physician total employed in Croatian health service. Of these, 3,664 (49.6%) were females, with the median for females and males being 47 and 50 years, respectively. In relation to 1986, there was a twofold increase or greater in the number of maxillofacial surgeons (basic index 260; average rate of annual increase 7.1%), followed by psychiatrists, epidemiolgists, child surgeons and medical cytologists. The paper uses the Holt two-parameter method of exponential smoothing of the time sequence made up of the number of medical specialists per 100,000 population in 1980-99. Assuming maintained average annual growth of three specialists, this prognostic procedure predicted specialist density of 185/100,000 population for 2009. The feasibility of a more direct planning is illustrated with individual specialist sex and age data at certain age of life. It permits estimating the number of specialists to leave the health system for the most common reason, i.e. old-age retirement. On the set criterion of lady doctors reaching the age of 60 and their male colleagues 65 years, we predicted for each medical speciality the annual number of specialists due to retire for old age by the year 2020. In some specialties, the difference in the number of specialists anticipated to go into old-age retirement in two successive years will reach close to 50% or even slightly higher. In this way, the necessary number of replacement specialists for the retired can be estimated for each medical specialty by taking note of the critical years when, because of great variation in age composition, a larger number of specialists could simultaneously leave their posts. For these critical years, a sufficient number of specialists should be ensured by harmonizing our length of education and training curricula with those in force in the EU countries. The number of specialists and their composition will also be changing, depending on the health system's strategic solution to the need for specialist work in the Family Medicine Service.

[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.