Search

Introduction: Social media are used by more than half of the global population, and for most users they are the primary source of information about various events, news, phenomena, etc. This has been recognized by numerous stakeholders, including the public health sector.1 One of the main advantages of using social media in public health campaigns is their relatively low cost for reaching a large part of the population. In addition, numerous tools are available (primarily on Meta platforms) so that specific groups can be targeted very precisely, which enables greater effectiveness of ads, especially paid ones. Methods: This year, for the third year in a row, the Croatian Institute of Public Health has created a public health campaign on social media on the occasion of World Heart Day. The three most essential items for creating a campaign are identified before creating the campaign – target population (people over 45 years old), communication channel (primarily Facebook), and the format (simple graphics and videos). The objective of this campaign was to raise awareness of the importance of preserving the health of one’s own heart and knowledge about the most common risk factors and heart diseases. The campaign took place from 19th Sep to 5th Oct 2022, and consisted of a total of 8 posts. Three posts were informative (that World Heart Day is being held), three were educational, and two were thematic videos. Five paid ads were created. Results: All posts, except the one on which the largest ad amount was invested, achieved an aboveaverage engagement rate. As expected, posts that were advertised achieved the highest reach and the highest absolute engagement. The results can be improved by creating interaction with users in comments. Conclusion: Public health campaigns on social media represent a simple tool for communicating important messages with the target population. Meta platforms provide good advertising opportunities and analytical data. Although achieving good results without paid ads is difficult, they are still more affordable than traditional media. However, a lot of research is still needed in this area, especially in the context of transferring engagement into actual behavior change.2

Introduction: We know from the literature that socioeconomic variables, such as education and income level, are related to cardiovascular risks and outcomes1 . Our goal was to explore possible differences in prevalence of risk factors for cardiovascular disease (CVD), stroke, myocardial infarction (MI), coronary heart disease (CHD) and raised lipid levels in older people (65+ years of age) population in Croatia, depending on their education and income level. Methods: We used the data from the European Health Interview Survey (EHIS) conducted in 2019. Prevalence of MI, CHD, hypertension, raised blood lipids, overweight and obesity and smoking were calculated, stratified by income groups and education level. EHIS differentiates 5 quintiles/income groups ; for the purpose of this research, we combined quintile 1 and 2 into “lower income” group, and quintiles 4 and 5 into “higher income” group. Education was stratified according to ISCED 2011 classification into lower levels (primary school or less), middle level (secondary school) and high level (tertiary education). Results: Older people with lower income have higher prevalence of stroke, MI and CHD, while prevalence of high lipid levels is higher in people with higher income. Overweight is more prevalent in higher income group, while opposite is found for obesity and smoking. Stroke and raised lipid levels are more prevalent in the low education group, MI in high education group, while no difference is seen in CHD. Smoking and obesity are also higher in people with lower education levels. Results are presented in Table 1. Conclusion: From a simple descriptive analysis, we can see a higher prevalence of some CVD risk factors (obesity and smoking) in people with lower income and lower levels of education in Croatia. Similarly, people with lower levels of education and income have higher self-reported prevalence of stroke and raised lipid levels. More complex analysis and research is needed to establish the relationship and interaction between these variables and targeting these higher risk groups in prevention activities and screening for CVD risk factors could reduce the inequalities.

This study presents mortality indicators for ischemic heart disease in Croatia and compares them with indicators of other countries in Europe and the European Union.

Aim: To determine the prevalence of common somatic comorbidities among coronavirus disease 2019 (COVID-19) positive patients in Croatia in the first pandemic wave, and assess the differences in clinical outcomes depending on the presence of comorbidities. ----- Methods: We analyzed data from patients confirmed to be SARS-CoV-2-positive from February through May 2020. The data were obtained from clinical laboratories, primary health care providers, and hospitals. Previously recorded comorbidities, including diabetes, cancer, circulatory diseases, chronic pulmonary, and kidney disease, were analyzed. ----- Results: Among 2249 patients, 46.0% were men (median age 51 years; median disease duration 27 days). Hospitalization was required for 41.8% patients, mechanical ventilation for 2.5%, while 4.7% of all patients died. Patients who died were significantly older (median 82 vs 50 years, P

Bolja informiranost javnosti i edukacij a zdravstvenih djelatnika uz učinkovitij e izvanbolničko i bolničko zbrinjavanje te pravodobna procjena rizika i primjena učinkovitog lij ečenja i mjera prevencij e uzrokom su kontinuiranog smanjenja smrtnosti od srčano-žilnih bolesti (SŽB) u Hrvatskoj. To potvrđuju hrvatski podaci o smrtnosti i bolničkom lij ečenju srčano-žilnih bolesti i akutnog infarkta miokarda (AIM), posebice iz Bjelovarsko-bilogorske županij e, gdje je već godinama prisutna visoka smrtnost od srčano-žilnih bolesti ali je smrtnost od akutnog infarkta miokarda, kao posljedica bolje kvalitete lij ečenja tij ekom zadnjih desetak godina, obuzdana i niža od hrvatskog prosjeka. Da je akutni infarkt miokarda i dalje bolest koja je važan uzrok smrti, uvjeravaju nas dostupni podaci iz populacij skih registara. Oni ukazuju na to da i danas oko 50% bolesnika umire prij e dolaska u bolnicu. Stoga je potrebno nastaviti sve dosadašnje aktivnosti koje mogu učinkovito smanjiti smrtnost od srčanožilnih bolesti i akutnog infarkta miokarda i približiti hrvatske rezultate onima iz razvij enih zemalja Europske unij e., Higher level of information of the public and education of health workers, in addition to bett er and more eff ective outpatient and hospital care, as well as timely risk assessment and implementation of eff ective treatment and preventive measures, have resulted in continual reduction of mortality due to cardiovascular diseases in Croatia. A confi rmation thereof off er Croatian data on the hospital treatment of and mortality due to cardiovascular diseases and acute myocardial infarction, in particular from the Bjelovar-Bilogora County, where high mortality rate due to cardiovascular diseases has been present for years, while mortality due to acute myocardial infarction has been restrained and reduced to a level lower that Croatian average – as a result of an improved quality of treatment during the last decade. Available data from population registers prove that acute myocardial infarction continues to be a disease that represents a signifi cant cause of death. It is indicated that even today, approximately 50 percent of patients die before they reach hospital. It is hence necessary to continue with performing all the existing activities that may eff ectively reduce the mortality due to cardiovascular diseases and acute myocardial infarction, as well as to approximate Croatian results with those from the developed countries of the European Union.

The main aim of Croatia's epidemiological information system is to enable the monitoring of infectious diseases as well as to enable necessary interventions. Its 24-hour epidemiologic alert mechanism made it possible for initial reports of sudden death clusters in haemodialysis units to reach epidemiologists on the night of 12 October 2001. The alert about the sudden deaths among haemodialysis patients in two hospitals has prompted us to do an epidemiological inquiry during that night and early the next morning. It looked at suspicions of a possible link between Baxter Plivadial P-15 lot 2001F075 dialyser and these deaths. As the suspicion was based on a small amount of data, it needed confirmation from a countrywide inquiry involving the other 40 haemodialysis units. A phone inquiry showed that 23 haemodialysis deaths occurred on 8-13 October 2001. It suggested that also dialyser of a different type and lot (P-18 2001B17R) should be incriminated. During the inquiry (October 13), all haemodialysis units were informed of the suspicions regarding incriminated dialysers, and of the necessity of temporary withdrawal of these from use. The withdrawal on 13 October of incriminated dialysers stopped the deaths among haemodialysis patients. No more such sudden deaths have been recorded since that could be linked either to the described period or to this clinical picture.

Summary TBE in Croatia was first discovered in 1953 but its mandatory reporting, as a distinct nosological entity, was instituted in 1987. Data presented here concern the 1989–1998 decade. During this period a total of 500 cases of TBE was recorded, ranging from 23 (1990) to 87 (1994) per year, with an average of 50 cases annually. There is only one natural focus in the northern part of the country, between the rivers Sava and Drava. Alleged cases of TBE, as occurring out of the focus (Zadar and Pula), have not been certified. The seasonal distribution of TBE cases is typical, most cases occurring from May to July (75%). As for the age distribution of TBE, a substantial rise is seen after the age of 20, only some 3% of cases occurring in children younger than 10 years. The first documented cases of human Lyme borreliosis in Croatia were published in 1986, its official compulsory reporting starting in 1991. Since then 1464 cases were recorded with an annual average of some 150 cases, varying from 93 (1992) up to 335 (1996). The age distribution is somewhat different from TBE, since the age group 0–9 years recruits 20% of all cases. Nevertheless, most of the diseased are of adult age. About 92% of the cases occur between May and August. The disease occurs mostly in the inland, above the 45th parallel, and only sporadically on the Adriatic coast.

Prema podacima Svjetske zdravstvene organizacije kardiovaskularne bolesti (KVB) uzrok su smrti 17,3 milijuna ljudi na razini svijeta, odnosno 30% ukupne smrtnosti, a na razini Europe odgovorne su za 47% svih smrti. U Hrvatskoj su također vodeći uzrok smrti s udjelom od 48,3% u ukupnom mortalitetu 2012. godine. Uzrok su smrti u 54,5% umrlih žena i 42,1% umrlih muškaraca. U bolničkom morbiditetu KVB su godinama na prvom ili drugom mjestu po broju hospitalizacija, izmjenjujući se s malignim bolestima. Stope hospitalizacija za KVB rastu s dobi i više su u muškaraca nego u žena u svim dobnim skupinama. Intenzivniji porast bolničkog morbiditeta počinje u dobi iznad 40 godina, desetak godina ranije od porasta smrtnosti. Posljednjih deset godina uočava se kontinuirani trend smanjenja smrtnosti zbog KVB, što je izraženije za cerebrovaskularne bolesti, nego za ishemijsku bolest srca i to osobito za dob 0-64 godine, no one su i dalje vodeći uzrok smrtnosti i pobola., According to the data provided by World Health Organization, the cardiovascular diseases (CVD) are the cause of death of 17.3 million of people at an international level, or 30% of total mortality, whereas they account for 47% of all deaths at the European level. Even in Croatia, they are the major cause of death, ac- counting for 48.3% of total mortality in 2012. They are the cause of death of 54.5% of dead women and 42.1% of dead men. In hospital morbidity, CVDs have held the first or second place in the number of hospitalizations for years, alternating with malignant diseases. Hospitalization rates for CVD rise with age and are higher in men than in women in all age groups. Intense rise in hospital morbidity begins at the age of 40, ten years earlier than the rise in mortality. The period of the last ten years shows a continuing downward trend in mortality caused by CVD, which is more pronounced for cerebrovascular diseases, than for ischemic heart disease and especial- ly for the age from 0 to 64, but they are still the major cause of mortality and morbidity.

Background Injuries are the leading cause of death among children in Croatia. In recent decades, the work on monitoring and prevention of injuries has intensified, which led to a reduction of child mortality caused by injuries. Methods The data used in the research was collected from the routine mortality and morbidity statistics, the database of the World Health Organisation: European Detailed Mortality Database (DMDB), as well as from the results of the international project TACTICS (Tools to Address Childhood Trauma, Injury and Children’s Safety). Results In Croatia, in the last ten-year period from 2005 to 2014 has been noted a trend of reducing the mortality rates from total number of injuries (V01-Y98) among children aged 0–19. The highest age-specific death rate from injuries in children in the mentioned period was 14.6/100.000 (2005), and the lowest 7.1/100.000 (2014), which represents almost double reduction in mortality. The reason for this is primarily the trend of reducing the mortality rate due to traffic accidents (V01-V99) in children (8.6/100.000 (2005); 2.6/100.000 (2014)). The leading external causes of death from injury in the observed period were: traffic accidents, suicide, drowning, followed by poisoning and suffocation. According to the European DMDB database, Croatia has been positioned around the middle of the European scale with the standardised mortality rate from injury (0–19 years) 8.8/100 000 (2012). According to the research carried out in the framework of the international project TACTICS, it was noted that Croatia has a medium satisfactory child safety level in the area of unintentional child injury prevention. In the violence prevention area Croatia belongs to the European countries with progressive politics. Conclusions Although in the last few decades Croatia perceives a trend of reducing mortality from child injuries, further efforts in the area of monitoring, treatment and prevention of child injuries are needed.

Background The objective of this paper was to analyse mortality and morbidity from road traffic injuries in Croatia, as a contribution to the awareness of this public health. Methods The data used in the research was collected from the routine mortality and morbidity statistics, Ministry of Interior Data, European Health for All Database, as well as from the results of the Global Status Report on Road Safety 2015 (GSRRS). Results Traffic accidents and their consequences are still a serious public health problem in Croatia. They are the leading cause of child and youth mortality and the leading cause of premature deaths within the injuries group. Croatia has lately reported a noteworthy drop in road fatalities, despite the increase in number of drivers, motor vehicles and roads. According to the Ministry of Interior data, the road traffic injury (RTI) mortality rate for Croatia in 2005 was 13.4/100.000, only to drop to 7.3/100.000 in 2014. Injuries incurred in traffic accidents account for 21.3% of all injury-related hospitalizations in 2014. Croatia has achieved sustained reductions in traffic-related injuries and fatalities through effective road safety program and good level of enforcement of legislative related to the five key risk factors for road traffic injuries which was investigated in GSRRS: speed, drink–driving, failure to use motorcycle helmets, seat-belts and child restraints. Since 1994, Croatia has implemented the National Road Safety Program, and in April of 2011 the same national draft program was adopted for the 2011–2020 period. The primary objective of the National Road Safety Program is to halve the number of road deaths by 2020. Conclusions Though significant progress has been achieved in road safety, more systematic work will be dedicated to elevating the level of road safety in line with international initiatives and national guidelines.

Smoking among pupils of secondary medical schools is of particular public health interest because of their role in the health system in the future. The study was part of the survey of smoking among students of Croatian medium medical schools. Data of 3 survey periods were available (1990-2002-2006). Specific smoking trends among 14-18 year olds were examined using odds ratios and multiple regressions. Sex ratios were calculated for each survey period. Daily smoking prevalence in 1990 was 15.9% in boys and 14.1% among girls. Occasional smoking in 1990 occurred among 8.9% of boys and 15.0% of girls. Twelve years after, smoking prevalence increased for daily smoking in boys to 32.9% and among girls to 30.4%. Occasional smoking decreased to 6.3% in boys, and increased to 17.8% among girls. There were no remarkable changes in prevalence from 2002 to 2006. Among adolescents in Croatia, there was high risk for smoking among adolescent population. High smoking rate among pupils of medical schools predicts not only high mortality due to smoking over 20-30 years, but also implicates for bad habit among professional health workers, if no policy interventions were taken.

The indicators of health condition and providing medical protection are necessary for making assessment of health condition at the level of population, improvement of the healthcare system and making health-related and political decision with an aim to improve the citizens’ health. Qualitative and reliable original data is necessary for the preparation of indicators. According to the indicators of mortality and morbidity, cardiovascular diseases (CVD) are the prioritized public health problem in Croatia. They are the major cause of mortality, in men with a share of 42.6% and in women with a share of 56.4% in total mortality. In CVD hospital morbidity, they are represented in men in the first place with a share of 14.9% and in women, they take the second place with a share of 12.5% in total number of hospitalizations. Totally, more women die of CVD and men die of CVD more frequently at younger age, however, women are hospitalized less frequently.

Cardiologia CROATICA Aim: In the last few decades, mortality from ischemic heart disease has been decreasing in many countries. The aim of this study was to analyze trends in ischemic heart disease mortality rates in Croatia between 1995 and 2011. Materials and methods: The data on deaths from ischemic heart diseases in Croatia were extracted from the WHO mortality database, and estimates of the Croatian population were derived from the Population Division of the Department of Economic and Social Affairs of the United Nations. Ischaemic heart diseases were defined as I20-I25 diagnoses in ICD-10. We used Joinpoint Regression analysis to describe mortality time trends, with up to 4 joinpoints and a Monte Carlo simulation to calculate p-values for a series of permutation tests. The joinpoint analysis was applied to the age-standardised rates (world population) and their standard errors, separately for each sex. Results: There were 165,432 deaths due to ischemic heart disease in Croatia in this 17-year period (51.2% females). The age-standardized ischemic heart disease mortality rates declined from 139.9/100,000 in men and 79.4/100,000 in women in 1995 to 118.9/100,000 and 67.6/100,000 in 2011, respectively. The trends showed a constant decrease, without any joinpoints in both men and women. In men, the best fitting model showed that in the period from 1995-2011 mortality rates significantly decreased (annual percent change (APC) of -1.0%; 95% CI -1.4 to -0.6), while in women trends were also decreasing (APC of -0.8%;95% CI -1.3 to -0.3) throughout the entire study period. Conclusion: Mortality rates for ischaemic heart disease showed a continuous decrease during this period, especially in men. However, it is still the leading cause of death, and it is important to monitor trends and focus on reduction of preventable risk factors.

U radu se prvo prikazuje studija mortaliteta od bolesti srca i krvnih žila ukupno i cerebrovaskularnih bolesti u muškaraca i žena, u dobi 45-74 godine, u 30-ak europskih zemalja od 1990. do 1992. godine Sansa i suradnika. Slijedi epidemiološka analiza općih stopa smrtnosti za bolesti srca i krvnih žila i cerebrovaskularne bolesti u Hrvatskoj u razdoblju od 1985. do 1999. godine. Posebno se ističe da su bolesti srca i krvnih žila vodeći uzrok smrti u Hrvatskoj, a moždani udar (I 64) kao pojedinačna dijagnoza na vrhu ljestvice uzroka smrti s udjelom od 10,9% u ukupnom mortalitetu muškaraca i 15,8% u ukupnom mortalitetu žena 1999. godine u Hrvatskoj. Slijedi usporedna analiza dobno standardiziranih stopa smrtnosti od cerebrovaskularnih bolesti za Hrvatsku, zemlje Središnje i Istočne Europe i Europu ukupno, i to za dobnu skupinu 0-64 godine i sve dobi ukupno. U prikazu morbiditeta analiziraju se bolesti srca i krvnih žila kao vodeći uzrok bolničkog liječenja u Hrvatskoj, pri čemu su u četvrtini slučajeva uzrok hospitalizacije cerebrovaskularne bolesti te prikazuju cerebrovaskularne bolesti zabilježene u općoj medicini., In the paper is first presented the study of mortality caused by heart and blood vessels diseases in total, and by cerebrovascular diseases in men and women, aged 45-75 years, in about 30 European countries. The study was performed by Sans and his collaborators in the period 1990- 1992. Then follows the epidemiological analysis of general mortality rates for heart and blood vessels diseases, as well as for cerebrovascular diseases in Croatia in the period 1985- 1999. Particularly stressed is the fact that cerebrovascular diseases are the leading cause of death in Croatia, with the rate of 10.9% of the total mortality of men and with the rate of 15.8% in the total mortality of women in 1999. After that is presented the analysis of age standardized mortality rates of cerebrovascular diseases for Croatia, for countries of Central and Eastern Europe, and for the whole Europe, for the age group of 0-64 years, and all ages together. In the presentation of morbidity, heart and blood vessels diseases are analyzed as the leading cause of hospitalization in Croatia, where in the quarter of all cases the cause of hospitalization are cerebrovascular diseases. Cerebrovascular diseases registered in the general practice are described as well.

Objective The objective of this paper was to show the analysis of mortality and morbidity from injuries by external causes (V01-Y98; ICD-10) in Croatia in the period 2004–2008, as a contribution to the knowledge of this public health problem. Materials and Methods Routine health morbidity and mortality statistics and WHO/HFA database were used and expressed as percentage shares, PYLLs as well as crude and standardised rates. Results On Croatias mortality scale in period 2004–2008 injuries with an average share of 5.7% in total mortality ranked third (2006 and 2008) or fourth (2004 and 2005) behind cardiovascular diseases, neoplasms and respiratory diseases. General mortality (average rate: 65.3/100 000) for injuries did not change significantly between 2004 and 2008. Given the premature mortality indicator potential years of life lost (age: 1–75) injuries ranked third, following after neoplasms and cardiovascular diseases. Suicides, traffic accidents and falls are the leading external causes of death. The standardised injury mortality for all ages was 53.3/100 000 in Croatia in 2006 (last available comparative data from WHO/HFA-DB). It surpassed the EU average (40.4/100 000), but remained lower than the European region average (76/100 000). With an average share of 7.9% in the causes of hospital treatment, injuries ranked sixth. Falls accounted for one third of the causes of injury-related hospitalisations, most commonly in persons older than 65. Conclusion Because they account for a large part of total mortality and morbidity, injuries represent a major public health problem in Croatia. A systematic implementation of preventive programmes is thus required.