http://lmhs.snz.hr (http://lmhs.snz.hr)

Ovom prilikom predstavljamo web stranice međunarodnog poslijediplomskog studija Menadžment u zdravstvu, Š kole narodnog zdravlja Andrija Š tampar, Medicinskog fakulteta u Zagrebu.Nakon opsežne analize potreba studija, tvrtka Nivas isporučila je rješenje koje sa tehničkog i funkcionalnog aspekta zadovoljavaju sve relevantne svjetske standarde. Tehnologija proizvodnje oslanja se na semantičko strukturiranje informacija na stranici. Jednostavno rečeno, svaka informacija na stranici opisana je semantičkim programskim kodom.Ovakav način strukturiranja informacija, produkcije dizajna i pozadine stranice omogućava iznimno velike brzine učitavanja kao i pravilnu interpretaciju podataka od strane svih svjetskih pretraživača (google, yahoo idr.). Upotrebom novih tehnologija i svjetskih standarda proizvodnje (w3c.org) zajamčena je trajnost i stabilnost rada stranica

Change in the level of health inequalities in the years 2003 and 2010

Ovaj rad bavi se fenomenom nejednakosti u zdravlju. Rad se fokusirao na razlike u nejednakostima u zdravlju u dvije vremenske točke promatrane na temelju samo procijenjenog zdravlja (u ovom istraživanju zavisna varijabla) i četiri nezavisne dimenzije: psiholoških obilježja, društvene povezanosti, socioekonomskog statusa i dostupnosti zdravstvenih usluga. Cilj rada bio je istražiti utjecaj ekonomskih i psihosocijalnih nejednakosti na zdravstveni status i pristup zdravstvenim uslugama građana Hrvatske, u dobi od 25 do 65 godina, te usporediti povezanosti zdravlja i društvenih nejednakosti u dvije vremenske točke: 2003. godine i 2010. godine. Dodatno, u radu se propituje društvena determiniranost zdravlja, odnosno njegova povezanost s individualnim i skupnim psihosocijalnim obilježjima (optimizam, lokus kontrole i društvena povezanost) te strukturnim ograničenjima (socioekonomski status i dostupnost zdravstvenih usluga). Za potrebe ovoga rada korištena su dva istraživanja: HZA (Hrvatska zdravstvena anketa) 2003. i anketa NUZ 2010. (Nejednakosti u zdravlju). U prvom dijelu analize uspoređuju se rezultati ova dva istraživanja, dok drugi dio obrađuje isključivo rezultate NUZ 2010. Ideja je bila ispitati u jednom dijelu promjene u nejednakostima u zdravlju u dvije vremenske točke, te u drugom dijelu, na uzorku iz 2010. godine detaljnije ispitati odnose nezavisnih dimenzija SES-a, dostupnosti zdravstvenih usluga, društvene povezanosti i psiholoških obilježja sa zavisnom varijablom zdravlje. Također, u radu se istražuje struktura i spolna specifičnost odnosa tih dimenzija. Anketa HZA 2003. provedena je 2003. godine, na uzorku od ukupno 8.806 osoba, a za potrebe ovoga rada od ukupnog broja sudionika izdvojili smo ciljani uzorak – sudionike u dobi od 25 do 65 godina (N=5.143) kako bi se omogućila usporedba uzoraka, te su odabrane određene varijable koje se podudaraju s varijablama u NUZ 2010. Istraživanje NUZ 2010. provedeno je metodom ankete 2010. godine na višeetapnom stratificiranom probabilističkom uzorku iz populacije muškaraca i žena u dobi od 25 do 65 godina (N=1.026). Prva polovina upitnika sadržava indikatore zdravlja (uključujući i indeks tjelesne težine) i zdravstvenih poteškoća, čestice koje opisuju životni stil (pušenje, konzumacija alkohola, fizička aktivnost) te indikatore korištenja zdravstvenih usluga i s tim povezanih prepreka dostupnosti zdravstvenih usluga (udaljenost od liječnika, financijski troškovi itd). U drugome dijelu upitnika ispitivane su osobne karakteristike (sreća, zadovoljstvo, optimizam i lokus kontrole), socijalna povezanost (umreženost i osobni društveni kapital) te sociodemografska obilježja sudionika, njihovih roditelja i kućanstva u kojem žive. Uz korištenje eksploratorne faktorske analize za konstrukciju kompozitnih varijabli, dobiveni podaci analizirani su različitim procedurama koje su uključile deskriptivnu statistiku, bivarijantne analize (jednosmjerna analiza varijance – ANOVA), mutivarijatnu linearnu regresijsku analizu i hijerarhijsku regresijsku analizu. Hijerarhijski pristup korišten je da bismo ustanovili specifičan doprinos SES-a nakon kontrole sociodemografskih karakteristika (dob i spol) u protumačenoj varijanci varijable zdravlje, kao i da se omogući razlikovanje doprinosa SES-a, društvene povezanosti, dostupnosti zdravstvenih usluga i psiholoških obilježja varijabilnosti zdravlja. Nije ustanovljena statistički značajna razlika u razini zdravlja između muškaraca i žena, a dob je, očekivano bila negativno povezana sa zdravljem u obje godine. Obrazovni status se također pokazao značajnim prediktorom zdravlja kako 2003. tako i 2010. godine. Ono što je donekle iznenadilo bila je povezanost između bračnog statusa i zdravlja – osobe koje nisu u braku iskazale su značajno višu razinu zdravlja u obje godine i od udanih/oženjenih sudionika i od rastavljenih, odnosno udovaca/udovica, što je objašnjeno intervenirajućim utjecajem dobi. Nalazi su pokazali da osobe s najmanjim prihodima obilježava značajno niža razina zdravlja od onih s većim prihodima. Prva hipoteza, kojom smo pretpostavljali da će povezanost SES-a sa zdravljem biti veća 2010. nego 2003. godine nije dokazana, odnosno nalazi upućuju na to da nema pomaka ili razlike u povezanosti SES-a sa zdravljem 2003. godine. i 2010. godine. Istraživanjem druge hipoteze, koja je pretpostavljala povezanost između dostupnosti zdravstvenih usluga i SES-a u uzorku iz 2010. godine pokazana je slaba ali značajna povezanost SES-a i dostupnosti zdravstvenih usluga, pri čemu se prvenstveno misli na fizičku dostupnost zdravstvene usluge. Jedno od objašnjenja može se naći u činjenici da je u Hrvatskoj dostupnost liječnika obiteljske medicine uglavnom vrlo dobra, a dio se može pripisati činjenici da onaj dio populacije koji je boljeg socioekonomskog statusa procjenjuje fizičku udaljenost „dostupnijom“ ukoliko primjerice imaju osobni automobil ili resurse kojima će nadomjestiti udaljenost. Također, pitanje je koliko su u uzorku zastupljene osobe kojima je zdravstvena usluga najudaljenija, a to su osobe koje žive na nekim od hrvatskih otoka i u unutrašnjosti države. Osim toga, osobe iznad 65 godina starosti, kod kojih bi po našoj procjeni ova povezanost bila snažnija, nisu bile uključene u ovo istraživanje. Gledajući dalje treću hipotezu, na uzorku iz 2010. godine rezultati su pokazali statistički značajnu pozitivnu povezanosti između varijabli – psiholoških obilježja i društvenih povezanosti i dimenzije zdravlje. U modelu zdravlja testirali smo odnos između zdravlja i nezavisnih dimenzija psiholoških obilježa i društvene povezanosti te dostupnosti i SES-a. Pokazalo se da su dimenzije SES-a i dostupnosti te psihološka obilježja i društvene povezanosti statistički značajno pozitivno povezane sa zdravljem – što je viši socioekonomski status, što je bolja društvena povezanost, što su pozitivnija psihološka obilježja i što je veća dostupnost zdravstvenih usluga, to je viši stupanj zdravlja. Dodatno, rezultati su pokazali da individualne osobine i društvena povezanost imaju veću težinu za zdravlje od strukturalnih obilježja SES-a i dostupnosti zdravstvenih usluga. Dimenzija dostupnosti nešto je slabije povezana sa zdravljem od ostale tri, te pretpostavljamo da se dio njenog utjecaja može pripisati povezanosti SES-a i zdravlja. Spolna specifičnost ovoga rezultata pokazala je da su SES i psihološka obilježja značajni za žene i muškarce, a društvena povezanost, psihološka obilježja i dostupnost zdravstvenih usluga samo za muškarce. Psihološka obilježja malo su bolje bila povezana sa zdravljem kod žena. Potvrđena je hipoteza o statistički značajnoj ali slaboj pozitivnoj povezanosti dostupnosti zdravstvenih usluga i SES-a, te nema razlike u utjecaju SES-a na zdravlje 2003. godine u odnosu na 2010. godinu. Dokazano je postojanje statistički značajne pozitivne povezanosti dimenzija psiholoških obilježja i društvenih povezanosti, a dob se pokazala značajno povezanom s dimenzijom psiholoških obilježja. SES, društvena povezanost i psihološka obilježja statistički značajnije su pozitivno povezani s varijablom zdravlje od dostupnosti zdravstvenih usluga. Što se tiče spolne strukture, SES i psihološka obilježja pokazali su se značajnijim prediktorima zdravlja kod žena, dok su društvena povezanost i dostupnost zdravstvenih usluga bili važniji za muškarce. Praktične implikacije ukazuju da bi pri planiranju intervencije trebalo načiniti razliku između individualnih i skupnih, odnosno strukturnih odrednica zdravlja. Time bi se mjere intervencije mogle bolje usmjeriti, odnosno procijeniti koja mjera utječe na koji tip odrednica i, što je posebno važno, ne zanemariti niti jedne niti druge. U slijedećim studijama preporuča se podrobnije analizirati spolnu specifičnost odnosa između bolesti i društvene povezanosti. Preporuke za buduća istraživanja uključuju manje, specifične studije fokusirane na odnos naših elemenata u posebno ranjivim skupinama kao što su jednoroditeljske obitelji, te uspoređivanje podataka povezanosti zdravlja i SES-a odnosu na populacijske parametre korištene u ovom radu.This thesis discusses the phenomenon of health inequalities. The focus is on the differences in health inequalities at two points in time considered on the basis of self-assessed health (dependent variable) and four independent dimensions: psychological characteristics, social connectedness, socioeconomic status (SES), and access to health care. The objective was to research the influence of economic and psychosocial inequalities on the health status and access to health care as relating to citizens of Croatia aged between 25 and 65, and to compare the connections between health and social inequalities at two points in time (in the years 2003 and 2010). Moreover, the thesis examines the social determination of health, that is, the connections between health and individual and group psychosocial characteristics (optimism, locus of control, and social connectedness) as well as with structural limitations (socioeconomic status and access to health care). The results of two surveys were used in the thesis: the HZA 2003 (Croatian Health Poll 2003) and the NUZ 2010 (Health Inequalities 2010). In the first part of the analysis, the results of the two surveys are compared, while the second addresses only the results of the NUZ 2010. The idea was to examine the changes in health inequalities at two points in time and proceed to explore in more detail the relationships between the independent dimensions – the SES, access to health care, social connectedness, and psychological characteristics – and the dependent variable of health on the sample used in the NUZ 2010. Additionally, the thesis explores the structure and gender specificity of the relations among the dimensions. The HZA 2003 survey was conducted in the year 2003 on a sample of 8,806 respondents. For the purpose of this thesis, a target sample was selected consisting of respondents aged between 25 and 65 (N=5,143) to allow sample comparison, and variables consistent with the variables in the NUZ 2010 were selected. The NUZ 2010 survey was conducted in the year 2010 using poll method on a multi-stage stratified probability sample of male and female population aged between 25 and 65 (N=1,026). The first half of the survey form includes health indicators (including body weight index) and indicators of health problems, lifestyle components (smoking, alcohol consumption, physical activity), and indicators of use of health services and associated barriers to health care access (distance from health care facilities, financial costs, etc). The second half of the survey form examines personal characteristics (happiness, satisfaction, optimism, and locus of control), social connectedness (networks and personal social capital), and the sociodemographic characteristics of the participants, their parents, and the households in which they live. Using exploratory factor analysis in the construction of composite variables, the obtained data were analyzed in various procedures that included descriptive statistics, bivariate analyses (one-way analysis of variance -- ANOVA), multivariate linear regression analysis, and hierarchy regression analysis. The hierarchy approach was used to establish the specific contribution of the SES following control of sociodemographic characteristics (age and gender) in the interpreted variance of the health variable as well as to differentiate among the contributions of the SES, social connectedness, access to health care, and the psychological characteristics to health variability. No statistically significant difference in the health level of men and women was established, while age was established to have a negative connection to health in both tested years, as had been expected. Educational status was a significant predictor of health both in 2003 and in 2010. A finding that was to some extent unexpected was the connection between marital status and health – the respondents who were single reported a considerably higher level of health in both surveys than did the married, divorced, and widowed respondents, which is accounted for by the intervening influence of age. The findings showed a considerably lower health level in persons with the lowest income than in those with higher income. The first hypothesis, which assumed that the connection between the SES and health would be greater in 2010 than in 2003, was not supported. The data indicate that there is no difference between the connection of the SES and health in 2003 and that in 2010. The testing of the second hypothesis, which assumed that a connection existed between access to health care and the SES in the sample from the year 2010, led to the result that showed a low but significant connection between the SES and health care access, which primarily relates to physical access to health care services. One of the explanations for this lies in the fact that access to family physicians in Croatia is mostly quite good, while another can be attributed to the fact that the part of the population with a higher SES considers physical distance "more accessible" if they own a vehicle or have resources available with which to compensate for the distance. Moreover, the question is to what extent the sample included persons in locations with the greatest distance to health care services, which are some of the Croatian islands and inland. Furthermore, elderly persons (over the age of 65), for whom a stronger connection would be expected, were not included in the surveys. As regards the third hypothesis, the results of the 2010 survey showed a statistically significant positive connection between the variables of psychological characteristics and social connectedness on the one hand and the dimension of health on the other. The relationship between health and the independent dimensions of psychological characteristics, social connectedness, access to health care and the SES was tested in a health model. It was shown that psychological characteristics and social conectedness as well as SES and health care access were statistically significantly positively correlated to health – the higher the socioeconomic status, the better the social conectedness; with more positive psychological characteristics access to health care services is better, and so is health. However, dimensions of psychological characteristics and social connectedness (or support) showed better connection and explained health better than SES and access to health care dimensions. Access to health care was shown to have a somewhat weaker connection to health in relation to the other three dimensions, which is assumed to be partly due to the connectedness of the SES and health. The gender specificity of this result showed that the SES and psychological characteristics were significant for both women and men, while social connectedness, psychological characteristics, and health care access were significant only for men. The connection between health and psychological characteristics was somewhat stronger in women. The thesis on statistically significant but weak positive connection between health care access and the SES was confirmed. There is no difference between the impact of the SES on health in the year 2003 and that in the year 2010. A statistically significant positive connection between the dimensions of psychological characteristics and social connectedness was established, with age proving to be significantly connected to the dimension of psychological characteristics. The positive connection between the SES, social connectedness, and psychological characteristics on the one hand and the health variable on the other hand is statistically more significant than the connection between health care access and health. As far as gender structure is concerned, the SES and psychological characteristics were shown to be more significant predictors of health in women, while social connectedness and health care access were more important for men. Practical implications indicate that, in intervention planning, a distinction should be made between individual health determinants and group health determinants, that is, structural health determinants. This would facilitate a better intervention focus, that is, a better assessment of which measures influence which type of determinant and, very importantly, including both. It is recommended that further studies analyze in more detail the gender specificity of the relationship between disease and social connectedness. Recommendations for further research also include smaller, specific studies focused on the relationships among the elements included in this thesis, in particularly vulnerable groups such as single-parent families, as well as on comparison of data on connections between health and the SES on the one hand and the population parameters used in this thesis on the other

INFORMIERTHEIT DER VERTRETER ÖRTLICHER BEHÖRDEN ÜBER VERWALTUNGSINSTRUMENTE IM ÖFFENTLICHEN GESUNDHEITS- UND SOZIALWESEN

Uporaba točnih podataka i informacija na temelju kojih se donose fiskalne i strateške odluke osnovno je uporište upravljanja zdravstvom, kako na razini države tako i na lokalnoj razini. Istraživanjem HZA, te kasnijim analizama utvrđeno je da postoje značajne razlike u zdravlju između regija Republike Hrvatske. Za strateški menadžment i upravljanje zdravljem i zdravstvom metoda usporedbe regionalnih, državnih i međudržavnih standardiziranih pokazatelja nudi neophodne informacije potrebne za postavljanje težišta, odabir prioriteta i uspostavu dobre »makropolitike na mikrorazini«. Svrha rada bila je provjeriti korištenje rezultata istraživanja Hrvatske zdravstvene ankete u planiranju resursa na razini županijskih zavoda za javno zdravstvo. Rezultati su pokazali da je samo 32% ispitanika koristilo rezultate HZA u svojim planiranjima. Zaključak je da s 32% ispitanika teško je doći do učinkovitog planiranja na lokalnoj razini, a još teže do ušteda planiranim u proračunu. Osim toga, ne prepoznavanje regionalnih razlika nije moguće uspostaviti niti jednu kvalitetnu politiku koja će biti istinski učinkovita i održiva. Prepoznatost važnosti korištenja podataka tipa HZA izuzetno je važan faktor u lokalnom i nacionalnom planiranju za zdravstvo, faktor koji omogućuje znatne uštede u proračunu predviđenom za zdravstvo.The use of correct data and information, on the basis of which financial and strategic decisions are made, is the basis for health care management, at government and local level. HZA research as well as later analyses have found that there are significant differences in health between Croatian regions. For strategic management of health and health methods the comparisons between regional, state and inter-state standardized indicators offer crucial information necessary for determining what is important, choosing priorities and establishing good “macro policies on micro level”. The purpose of this work was to examine how the results of Croatian health survey are used in resource planning in health care institutes in the Counties. The results have shown that only 32% of respondents used the results of HZA in their planning. The conclusion is that it is difficult to have an efficient planning on the local level with only 32% of respondents, and even more difficult to save as planned by the budget.Die Verwendung von genauen Daten und Informationen, auf Grund deren fiskalpolitische und strategische Entscheidungen getroffen werden, ist ein grundlegender Stützpunkt der Verwaltung des Gesundheitswesens, sowohl auf der staatlichen als auch auf der lokalen Ebene. Durch Forschung von HZA (Kroatische Gesundheitsumfragen) und spätere Analysen hat man festgestellt, dass wesentliche Unterschiede im Gesundheitsstand in verschiedenen Regien der Republik Kroatien bestehen. Für das strategische Management und die Verwaltung von Gesundheit und Gesundheitswesen bietet die Methode des Vergleiches von regionalen, staatlichen und zwischenstaatlichen standardisierten Kennzahlen Informationen, die notwendig für Schwerpunktsetzung, Auswahl der Prioritäten und Aufbau einer guten „Makropolitik auf Mikroebene” sind. Der Zweck der Arbeit war es zu prüfen, wie die Forschungsergebnisse der kroatischen Gesundheitsenquete bei der Planung der Ressourcenutzung von öffentlichen Gesundheitsbehörden auf der Ebene der Gespanschaften benutzt werden. Es hat sich gezeigt, dass nur 32% der Befragten in ihren Planungen die Ergebnisse der HZA benutzt haben. Man schließt daraus, dass es sich mit 32% der Befragten schwer zu einer effizienten Planung auf der lokalen Ebene kommen lässt, noch schwieriger können Einsparungen im geplanten Haushalt erreicht werden

http://lmhs.snz.hr (http://lmhs.snz.hr)

Ovom prilikom predstavljamo web stranice međunarodnog poslijediplomskog studija Menadžment u zdravstvu, Š kole narodnog zdravlja Andrija Š tampar, Medicinskog fakulteta u Zagrebu.Nakon opsežne analize potreba studija, tvrtka Nivas isporučila je rješenje koje sa tehničkog i funkcionalnog aspekta zadovoljavaju sve relevantne svjetske standarde. Tehnologija proizvodnje oslanja se na semantičko strukturiranje informacija na stranici. Jednostavno rečeno, svaka informacija na stranici opisana je semantičkim programskim kodom.Ovakav način strukturiranja informacija, produkcije dizajna i pozadine stranice omogućava iznimno velike brzine učitavanja kao i pravilnu interpretaciju podataka od strane svih svjetskih pretraživača (google, yahoo idr.). Upotrebom novih tehnologija i svjetskih standarda proizvodnje (w3c.org) zajamčena je trajnost i stabilnost rada stranica

Health care issues in Croatian elections 2005-2009: series of public opinion surveys

Aim To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. Methods The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Results Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Conclusion Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking

Analiza sadržaja najposjećenijih hrvatskih internetskih portala

Metodom analize sadržaja utvrđene su glavne sadržajne odrednice triju najpo-sjećenijih hrvatskih internetskih portala. Sadržaj priloga je analiziran kroz sljedeće kategorije: tematike, vrijednosni sudovi, teritorijalna orijentiranost radnje priloga, aktualnost, dubina obrade priloga, te autorstvo nad sadržajem. Analizom su obuhvaćeni i elementi karakteristični za internetski medij poput multimedijalnosti ili hipertekstualnosti. Najposjećeniji hrvatski portali svoj prostor uglavnom posvećuju informacijama iz područja zabave i šoubiznisa, sporta, kriminaliteta ili crne kronike, kulture i umjetnosti, politike te prenoše-nju informacija o raznim neobičnim i bizarnim situacijama. S druge strane, vrlo malo prostora se daje sadržajima iz područja gospodarstva, znanosti, re-ligije te socijalne problematike. Vrlo malo se koriste tehnološke mogućnosti interneta poput multimedijalnosti i povezanosti sadržaja, a radnja priloga u jednakoj je mjeri okrenuta inozemnim, kao i domaćim događajima, pojavama ili osobama. Sadržaj objavljen na portalima uglavnom je obrađen površinski, bez dublje analize predmeta i radnje priloga, ne koristeći mnogo multimedi-jalne mogućnosti interneta. Uglavnom, može se zaključiti da je preferirani sa-držaj najposjećenijih hrvatskih dnevno informativnih internetskih portala (news portals) vrlo sličan preferiranom sadržaju u tabloidnom tisku, s pristu¬pom za osobe mlađe životne dobi (neobične i bizarne situacije, zanimljivosti, šoubiznis i sport)

Medijatizacija rizika – primjer televizijskog izvještavanja o pandemiji gripe

U radu se polazi od pretpostavke da su masovni mediji čimbenik koji utječe na kulturu i društvo, ali da su ujedno i proizvod iste te kulture i društva. U tom smislu, a putem analize sadržaja televizijskog izvještavanja o pandemiji svinjske gripe analizira se medijska prezentacija zdravstvenog rizika te se propituje utjecaj kulturnog i društvenog konteksta na medijsko izvještavanje o riziku, ali i povratni utjecaj takvog izvještavanja na kulturu i društvo. Obrasci medijskog izvještavanja razmatraju se kroz teoriju medijatizacije koja pretpostavlja da se logika koju su pri izvještavanju imali masovni mediji proširila na sve društvene strukture, ali i da su same institucije svoje djelovanje uvelike prilagodile logici izvještavanja masovnih medija. U radu se propituje vrijedi li spomenuta medijska logika, koja u sebi uvelike sadržava i elemente senzacionalizma, i u situacijama kad mediji izvještavaju o rizičnim situacijama. Rezultati analize potvrdili su da mediji i pri izvještavanju o rizičnim situacijama slijede istu logiku izvještavanja kao i pri informiranju javnosti o drugim, manje opasnim, fenomenima. Naša analiza ne može dati odgovor u kojoj mjeri mediji sudjeluju u konstrukciji pojedinog rizika i šire kulturu koja je u sve većoj mjeri definirana rizikom i nesigurnošću, ali rezultati analize potvrdili su da medijski sadržaj uvelike odražava vrijednosne obrasce i društvene strukture koje je Beck svrstao pod pojam »društvo rizika«

Health and economic burden of skin melanoma in Croatia – cost-of-illness study

Melanoma incidence is increasing, especially in the younger population. The aim of this study was to investigate the cost of this disease in the Croatian population and to identify costs through types of care and types of costs. The secondary goal was to estimate the prevalence of certain types of melanoma (as well as staging distribution) and to connect each stage and its prevalence in Croatia to related costs. A cost-of-illness analysis was performed, mainly including direct costs (monitoring, drugs, primary health care services, hospitalizations, and diagnostics). The calculations were based on data collected from Sestre milosrdnice University Hospital Center in Zagreb and from Cancer Registry Data. The number of patients with melanoma was calculated using the Markov model for melanoma staging and 5-year survival. The estimated total prevalence of melanoma in 2011 in Croatia was 2,180. The total cost of melanoma was estimated to 1,063,488 EUR, with 46% used for hospitalization and chemotherapy, 10% for dermatoscopy, and the remaining 17% being monitoring costs. The average cost per patient was estimated to range between 98 and 4,333 EUR depending on the stage of the disease. The cost of melanoma in the adult population in Croatia in a one-year timeframe accounted for as much as 0.04% of the total Croatian national health care budget for 2011. Study findings indicate the need for a clear strategy to achieve regular screening in order to detect the disease at an early stage.  </p

Entwurf und Evaluierung eines pluridimensionalen Instruments zur Einschätzung von Ursachen, die den Gebrauch von Kondomen behindern

U radu se opisuju postupci izradbe i provjere metrijskih svojstava višedimenzionalnog instrumenta za mjerenje zapreka uporabi muškoga kondoma. Konstrukcija i validacija provedena je na online uzorku osoba, poglavito studenata, između 18 i 30 godina (N=754). Provedene analize glavnih komponenata pokazale su postojanje pet međusobno povezanih dimenzija zapreka uporabi kondoma: (1) problemi vezani uz pregovaranje o uporabi kondoma i otpor partnera; (2) antierotski aspekti uporabe kondoma; (3) društvena (ne)poželjnost uporabe kondoma; (4) manjak samopouzdanja vezanog uz uporabu kondoma i (5) poteškoće vezane uz nabavku i nošenje kondoma. Višedimenzionalnost skale testirana je i konfirmacijskom faktorskom analizom. Skalu prepreka uporabi kondoma (SPUK; k=27) i njezine komponente obilježava zadovoljavajuća pouzdanost, neovisna o spolu. Valjanost skale utvrđena je analizom povezanosti sa srodnim konstruktima. Autori vjeruju kako bi primjena skale mogla unaprijediti razumijevanje sporadične (nesustavne) upotrebe kondoma i tako poslužiti u izradbi programa prevencije HIV-a i drugih spolno prenosivih bolesti.This paper presents the development and validation of a composite measure of barriers to male condom use. The scale construction and validation was carried out using an online sample of individuals, mostly college students, aged 18-30 (n=754). Principal component analysis (PCA) suggested a 5-dimensional structure of the Barriers to Condom Use Scale, consisting of the following components: (1) problems with negotiating condom use and partner’s resistance to condom use; (2) anti-sexual aspects of condom use; (3) normative issues; (4) condom self-efficacy issues and (5) difficulties with purchasing condoms and carrying them around. Only minor differences in the overall structure were found when PCA was carried out separately for female and male participants. Confirmatory factor analysis provided support for the 5-component structure of the new scale. Reliability of the scale (k=27) and its components was acceptable in both male and female subsamples. The scale was characterized by satisfactory construct validity. The new measure of barriers to condom use seems a useful tool for the analysis of inconsistent condom use, particularly among young people. It holds a potential of providing insights instrumental for HIV and STI prevention and intervention programs.Die Verfasser der vorliegenden Forschungsarbeit beschreiben ihre Arbeit an Entwurf und Kontrolle von metrischen Eigenschaften eines pluridimensionalen Instruments, das Ursachen ermitteln soll, die den Gebrauch von Kondomen behindern. Zur Entstehung des entsprechenden Fragebogens wurde eine Online-Umfrage durchgeführt, an der junge Menschen, überwiegend Studenten, zwischen 18 und 30 teilnahmen (N = 754). Analysen der wichtigsten Komponenten verwiesen auf das Bestehen von fünf miteinander korrelierenden Dimensionen, die den Hindernissen beim Gebrauch von Kondomen gemeinsam sind: (1) Schwierigkeiten bei Absprachen mit dem Partner und Scheitern an dessen Widerstand; (2) anti-erotische Aspekte der Verwendung von Kondomen; (3) gesellschaftliche (Un-)Erwünschtheit von Kondomen; (4) mangelndes Selbstbewusstsein bei der Handhabung von Kondomen sowie (5) Schwierigkeiten beim Beschaffen und Tragen von Kondomen. Die Pluridimensionalität der Skala wurde auch mittels eines Faktorenanalyse bestätigt. Der erarbeitete Fragebogen zur Ermittlung von Hindernissen bei der Verwendung von Kondomen (SPUK; k = 27) ist hinreichend zuverlässig und für beide Geschlechter geeignet. Seine Gültigkeit wurde im Vergleich mit ähnlichen Konstrukten bestätigt. Nach Ansicht der Verfasser könnte seine Anwendung das Verständnis für die Gründe des sporadischen (nichtsystematischen) Einsatzes von Kondomen vertiefen und somit beitragen zur Umsetzung eines Präventionsprogramms gegen AIDS und andere Geschlechtskrankheiten

Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP).</p> <p>Methods</p> <p>A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering.</p> <p>Results</p> <p>The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator.</p> <p>Conclusions</p> <p>The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.</p