Potterova „globalna“ bitika kao odgovor na potrebu za „specijalnom“ etikom u javnom zdravstvu

Pitanje je li javnom zdravstvu posebna njegova posebna etika? vrlo je kompleksno i na njega se ne može dati jednoznačan odgovor. Kao jedan od pristupa tim kompleksnim pitanjima javnog zdravstva, u kojima se vrlo brzo razvija gradacija iz moralne nesigurnosti, preko moralne dileme u moralnu nepriliku, može se ponuditi upravo Potterova globalna bitka kao ishodište za razvijanje, odnosno javnozdravstveno aktualiziranje, integrativnog modela javnozdravstvene bitke. Integrativna bitka i globalna bitka kao njeno ishodište omogućuje da se ideja personalizirane medicine pojavi na poziciji etike javnog zdravstva, upravo s ciljem da apozicija "personalizirano" ili "javno" postane nebitna i istakne se ono što je bitno. A to je pravo na očuvanje zdravlja! Odnosno, kako bi ga Potter definirao pravo na "prihvatljivo preživljavanje" (u kontekstu cjelokupnog ekosustava - globalno preživljavanje)! Pitanje s kojim je započeo ovaj rad važno je i artikulirati i aktualizirati i smjestiti u adekvatan (znanstveni i stručni) kontekst. Upravo u kontekstu predlaganja integrativnog modela javnozdravstvene bitke valja se podsjetiti kako prema Ashcroftu „medical ethics scholars must take up the challenge of addressing the moral problems of social transition“ (26)

Potterova „globalna“ bitika kao odgovor na potrebu za „specijalnom“ etikom u javnom zdravstvu

Pitanje je li javnom zdravstvu posebna njegova posebna etika? vrlo je kompleksno i na njega se ne može dati jednoznačan odgovor. Kao jedan od pristupa tim kompleksnim pitanjima javnog zdravstva, u kojima se vrlo brzo razvija gradacija iz moralne nesigurnosti, preko moralne dileme u moralnu nepriliku, može se ponuditi upravo Potterova globalna bitka kao ishodište za razvijanje, odnosno javnozdravstveno aktualiziranje, integrativnog modela javnozdravstvene bitke. Integrativna bitka i globalna bitka kao njeno ishodište omogućuje da se ideja personalizirane medicine pojavi na poziciji etike javnog zdravstva, upravo s ciljem da apozicija "personalizirano" ili "javno" postane nebitna i istakne se ono što je bitno. A to je pravo na očuvanje zdravlja! Odnosno, kako bi ga Potter definirao pravo na "prihvatljivo preživljavanje" (u kontekstu cjelokupnog ekosustava - globalno preživljavanje)! Pitanje s kojim je započeo ovaj rad važno je i artikulirati i aktualizirati i smjestiti u adekvatan (znanstveni i stručni) kontekst. Upravo u kontekstu predlaganja integrativnog modela javnozdravstvene bitke valja se podsjetiti kako prema Ashcroftu „medical ethics scholars must take up the challenge of addressing the moral problems of social transition“ (26)

REPRODUCTIVE HEALTH ASSESSMENT OF CROATIAN SCHOOLCHILDREN IN THE 2015-2016 ACADEMIC YEAR

Cilj: Prikazati učestalost korištenja zdravstvenih usluga, obuhvat zdravstvenim odgojem, te reproduktivni zdravstveni status školske djece u školskoj godini 2015./2016., po županijama, prema statističkim pokazateljima iz godišnjih izvješća Hrvatskog zavoda za javno zdravstvo i Državnog zavoda za statistiku. Metode: Analizirani su: broj posjeta savjetovalištima službi školske medicine učenika osnovnih i srednjih škola u šk. g. 2015./2016.; broj posjeta zbog planiranja obitelji jelatnostima zdravstvene zaštite žena, po dobnim skupinama, u 2016.; broj učenika osnovnih i srednjih škola obuhvaćenih zdravstvenim odgojem u šk. g. 2015./2016.; broj pobačaja prema prebivalištu žene u 2016., te broj legalno induciranih pobačaja i živorođene djece prema dobnim skupinama za 2015. i 2016. godinu. Za izračun stopa korišteni su: podatci o broju učenika, broju žena fertilne dobi, broju rodilja, te broju živorođene djece. Izračunat je: broj posjeta savjetovalištima službi školske medicine na 1.000 učenika, ukupno i po temama, po županijama, za osnovnu i za srednju školu u šk. g. 2015./2016.; broj posjeta zbog planiranja obitelji u djelatnosti zdravstvene zaštite žena na 1.000 žena fertilne dobi, po dobnim skupinama, po županijama, u 2016.; broj osnovnoškolaca i srednjoškolaca obuhvaćenih zdravstvenim odgojem na 1.000 učenika, ukupno i po temama, po županijama, u šk. g. 2015./2016.; broj legalno induciranih pobačaja na 1.000 žena fertilne dobi, po županijama, za 2016.; te broj legalno induciranih pobačaja na jedno živorođeno dijete, na 100 rodilja, odnosno na 1.000 žena fertilne dobi, po dobnim skupinama, za 2015. i 2016. godinu. Rezultati: Učenici osnovnih škola su 19.653 puta potražili usluge savjetovališta, stopa na 1.000 učenika za Hrvatsku iznosila je 60,57, najniža je bila u Virovitičkopodravskoj županiji (7,52). Savjet o reproduktivnom zdravlju potražili su 794 puta, stopa za Hrvatsku iznosila je 2,45, najviša je bila u Primorsko-goranskoj županiji (9,75). Srednjoškolci su 10 481 put potražili usluge savjetovališta, stopa na 1.000 učenika za Hrvatsku iznosila je 63,05, najniža je bila u Brodsko-posavskoj županiji (1,88). Savjet o reproduktivnom zdravlju potražili su 644 puta, stopa za Hrvatsku iznosila je 3,87, najviša je bila u Ličko-senjskoj županiji (14,06). U djelatnostima zdravstvene zaštite žena među pacijenticama do 16 godina najviša stopa bila je u Sisačko-moslavačkoj županiji (1,88). U Varaždinskoj županiji ni jedna djevojka mlađa od 16 godina nije posjetila ginekologa zbog planiranja obitelji. U dobi 16-19 godina najviša stopa bila je u Virovitičko-podravskoj županiji (21,49), a najniža u Zadarskoj županiji (0,13). Broj osnovnoškolaca obuhvaćenih zdravstvenim odgojem iznosio je 149 768, stopa na 1.000 učenika za Hrvatsku iznosila je 461,59, najviša je bila u Primorsko-goranskoj županiji (800,12). Broj srednjoškolaca obuhvaćenih zdravstvenim odgojem iznosio je 48 426, stopa na 1.000 učenika za Hrvatsku iznosila je 291,32, najviša je bila u Primorsko-goranskoj županiji (554,50). Stopa legalno induciranih pobačaja na 1.000 žena fertilne dobi za Hrvatsku iznosila je 2,59, najviša je bila u Istarskoj (7,13), Međimurskoj (5,59), Varaždinskoj (5,67), Primorsko-goranskoj (4,56) i Ličko-senjskoj županiji (4,02). Stopalegalno induciranih pobačaja u 2016. na 100 rodilja do 19 godina iznosila je 16,84, dok je na 1.000 žena fertilne dobi do19 godina iznosila 1,51. Rasprava: Kultura proaktivnog razmišljanja o vlastitom zdravlju nedovoljno je razvijena među školskom djecom (neujednačenost broja posjeta savjetovalištima, kao i posjeta djelatnostima zdravstvene zaštite žena), što dovodi do pobačaja i poroda, spolno prenosivih bolesti, pa i pojave novotvorina u populaciji do 19 godina. Ističe se potreba njihovog osnaživanja proaktivnim pristupom od strane sustava. Međutim, dosadašnje promicanje zdravstvenog odgoja značajno varira među županijama, te je, s obzirom na prikazane pokazatelje i dobivene rezultate, ili manjkavo ili zahtijeva promjenu metodologije. Mogući pravac budućeg djelovanja može biti jačanje ekstrakurikularnih aktivnosti kojima se unaprjeđuje reproduktivna zdravstvena pismenost školske djece. Zaključak: Navedeni podatci su podloga za razvoj intervencija unaprjeđenja zdravstvene pismenosti sinhronim pristupom stručnjaka iz područja zdravstva i školstva. Spolnost u 21. stoljeću ne smije biti tabu. Upravo zdravstvena pismenost mijenja zdravstveno ponašanje.The aim of the study was to assess the frequency of health service usage, coverage of health education and reproductive health status of schoolchildren in the 2015-2016 academic year by counties according to statistical indicators from annual reports of the Croatian Institute of Public Health and Central Bureau of Statistics. Methods: The following parameters were analyzed: number of elementary and high-school student visits to counseling centers; number of visits to women’s healthcare services by age groups; number of elementary and high-school students enrolled in health education; number of abortions according to permanent residence; and number of legally induced abortions and live births by age groups. On calculation of rates, data on the number of students, number of women of fertile age, number of childbearing women and number of live births were used. The following fi gures were calculated: number of student visits to counseling centers per 1000 students in total and by reason, by counties; number of visits to women’s healthcare services per 1000 women of fertile age, by age groups, by counties; number of students enrolled in health education per 1000 students, in total and by topic, by counties; number of legally induced abortions per 1000 women of fertile age, by counties; and number of legally induced abortions per one live birth per 100 childbearing women, i.e. per 1000 women of fertile age, by age groups. Results: Elementary school students used counseling services on 19,653 occasions; the lowest rate per 1000 students was recorded in the Virovitica-Podravina County (7,52). Advice on reproductive health was requested 794 times; the highest rate was found in the Primorje-Gorski Kotar County (9.75). High-school students sought counseling services on 10,481 occasions; the lowest rate was recorded in the Brod-Posavina County (1,88). Advice on reproductive health was requested 644 times; the highest rate was found in the Lika-Senj County (14.06). Concerning the women’s healthcare services used by the <16 age group, the highest rate was recorded in the Sisak-Moslavina County (1.88). In the Varaždin County, no girl aged <16 visited a gynecologist. In the 16-19 age group, the highest rate was found in the Virovitica-Podravina County (21.49) and lowest in the Zadar County (0.13). The overall number of elementary school students enrolled in health education was 149,768; the highest rate per 1000 students was recorded in the Primorje-Gorski kotar County (800.12). The overall number of high-school students was 48,426; the highest rate was found in the Primorje-Gorski Kotar County (554.50). The highest rate of legally induced abortions per 1000 women of fertile age was found in the Istria (7.13), Međimurje (5.59), Varaždin (5.67), Primorje-Gorski Kotar (4.56) and Lika-Senj (4.02) Counties. The rate of legally induced abortions per 100 childbearing women in the <19 age group was 16.84, and per 1000 women of fertile age in the <19 age group it was 1.51. Discussion: The culture of proactive thinking about one’s own health was found to be insuffi ciently developed among schoolchildren (uneven number of visits to counseling centers and to women’s health care services), resulting in abortions, sexually transmitted diseases, and neoplasms in the population up to 19 years of age. The need of their empowerment through systematic proactive approaches is emphasized. Current promotion of health education varies considerably among counties and, given the presented indicators and the results obtained, is either insuffi cient or requires change in the methodology. The possible direction for future action may be strengthening of extracurricular activities to improve reproductive health literacy among schoolchildren. Conclusion: The data presented provide the basis for health literacy interventions through synchronous approach by healthcare and education professionals. Sexuality in the 21st century should not be a taboo. Health literacy changes health behavior

REPRODUCTIVE HEALTH ASSESSMENT OF CROATIAN SCHOOLCHILDREN IN THE 2015-2016 ACADEMIC YEAR

Cilj: Prikazati učestalost korištenja zdravstvenih usluga, obuhvat zdravstvenim odgojem, te reproduktivni zdravstveni status školske djece u školskoj godini 2015./2016., po županijama, prema statističkim pokazateljima iz godišnjih izvješća Hrvatskog zavoda za javno zdravstvo i Državnog zavoda za statistiku. Metode: Analizirani su: broj posjeta savjetovalištima službi školske medicine učenika osnovnih i srednjih škola u šk. g. 2015./2016.; broj posjeta zbog planiranja obitelji jelatnostima zdravstvene zaštite žena, po dobnim skupinama, u 2016.; broj učenika osnovnih i srednjih škola obuhvaćenih zdravstvenim odgojem u šk. g. 2015./2016.; broj pobačaja prema prebivalištu žene u 2016., te broj legalno induciranih pobačaja i živorođene djece prema dobnim skupinama za 2015. i 2016. godinu. Za izračun stopa korišteni su: podatci o broju učenika, broju žena fertilne dobi, broju rodilja, te broju živorođene djece. Izračunat je: broj posjeta savjetovalištima službi školske medicine na 1.000 učenika, ukupno i po temama, po županijama, za osnovnu i za srednju školu u šk. g. 2015./2016.; broj posjeta zbog planiranja obitelji u djelatnosti zdravstvene zaštite žena na 1.000 žena fertilne dobi, po dobnim skupinama, po županijama, u 2016.; broj osnovnoškolaca i srednjoškolaca obuhvaćenih zdravstvenim odgojem na 1.000 učenika, ukupno i po temama, po županijama, u šk. g. 2015./2016.; broj legalno induciranih pobačaja na 1.000 žena fertilne dobi, po županijama, za 2016.; te broj legalno induciranih pobačaja na jedno živorođeno dijete, na 100 rodilja, odnosno na 1.000 žena fertilne dobi, po dobnim skupinama, za 2015. i 2016. godinu. Rezultati: Učenici osnovnih škola su 19.653 puta potražili usluge savjetovališta, stopa na 1.000 učenika za Hrvatsku iznosila je 60,57, najniža je bila u Virovitičkopodravskoj županiji (7,52). Savjet o reproduktivnom zdravlju potražili su 794 puta, stopa za Hrvatsku iznosila je 2,45, najviša je bila u Primorsko-goranskoj županiji (9,75). Srednjoškolci su 10 481 put potražili usluge savjetovališta, stopa na 1.000 učenika za Hrvatsku iznosila je 63,05, najniža je bila u Brodsko-posavskoj županiji (1,88). Savjet o reproduktivnom zdravlju potražili su 644 puta, stopa za Hrvatsku iznosila je 3,87, najviša je bila u Ličko-senjskoj županiji (14,06). U djelatnostima zdravstvene zaštite žena među pacijenticama do 16 godina najviša stopa bila je u Sisačko-moslavačkoj županiji (1,88). U Varaždinskoj županiji ni jedna djevojka mlađa od 16 godina nije posjetila ginekologa zbog planiranja obitelji. U dobi 16-19 godina najviša stopa bila je u Virovitičko-podravskoj županiji (21,49), a najniža u Zadarskoj županiji (0,13). Broj osnovnoškolaca obuhvaćenih zdravstvenim odgojem iznosio je 149 768, stopa na 1.000 učenika za Hrvatsku iznosila je 461,59, najviša je bila u Primorsko-goranskoj županiji (800,12). Broj srednjoškolaca obuhvaćenih zdravstvenim odgojem iznosio je 48 426, stopa na 1.000 učenika za Hrvatsku iznosila je 291,32, najviša je bila u Primorsko-goranskoj županiji (554,50). Stopa legalno induciranih pobačaja na 1.000 žena fertilne dobi za Hrvatsku iznosila je 2,59, najviša je bila u Istarskoj (7,13), Međimurskoj (5,59), Varaždinskoj (5,67), Primorsko-goranskoj (4,56) i Ličko-senjskoj županiji (4,02). Stopalegalno induciranih pobačaja u 2016. na 100 rodilja do 19 godina iznosila je 16,84, dok je na 1.000 žena fertilne dobi do19 godina iznosila 1,51. Rasprava: Kultura proaktivnog razmišljanja o vlastitom zdravlju nedovoljno je razvijena među školskom djecom (neujednačenost broja posjeta savjetovalištima, kao i posjeta djelatnostima zdravstvene zaštite žena), što dovodi do pobačaja i poroda, spolno prenosivih bolesti, pa i pojave novotvorina u populaciji do 19 godina. Ističe se potreba njihovog osnaživanja proaktivnim pristupom od strane sustava. Međutim, dosadašnje promicanje zdravstvenog odgoja značajno varira među županijama, te je, s obzirom na prikazane pokazatelje i dobivene rezultate, ili manjkavo ili zahtijeva promjenu metodologije. Mogući pravac budućeg djelovanja može biti jačanje ekstrakurikularnih aktivnosti kojima se unaprjeđuje reproduktivna zdravstvena pismenost školske djece. Zaključak: Navedeni podatci su podloga za razvoj intervencija unaprjeđenja zdravstvene pismenosti sinhronim pristupom stručnjaka iz područja zdravstva i školstva. Spolnost u 21. stoljeću ne smije biti tabu. Upravo zdravstvena pismenost mijenja zdravstveno ponašanje.The aim of the study was to assess the frequency of health service usage, coverage of health education and reproductive health status of schoolchildren in the 2015-2016 academic year by counties according to statistical indicators from annual reports of the Croatian Institute of Public Health and Central Bureau of Statistics. Methods: The following parameters were analyzed: number of elementary and high-school student visits to counseling centers; number of visits to women’s healthcare services by age groups; number of elementary and high-school students enrolled in health education; number of abortions according to permanent residence; and number of legally induced abortions and live births by age groups. On calculation of rates, data on the number of students, number of women of fertile age, number of childbearing women and number of live births were used. The following fi gures were calculated: number of student visits to counseling centers per 1000 students in total and by reason, by counties; number of visits to women’s healthcare services per 1000 women of fertile age, by age groups, by counties; number of students enrolled in health education per 1000 students, in total and by topic, by counties; number of legally induced abortions per 1000 women of fertile age, by counties; and number of legally induced abortions per one live birth per 100 childbearing women, i.e. per 1000 women of fertile age, by age groups. Results: Elementary school students used counseling services on 19,653 occasions; the lowest rate per 1000 students was recorded in the Virovitica-Podravina County (7,52). Advice on reproductive health was requested 794 times; the highest rate was found in the Primorje-Gorski Kotar County (9.75). High-school students sought counseling services on 10,481 occasions; the lowest rate was recorded in the Brod-Posavina County (1,88). Advice on reproductive health was requested 644 times; the highest rate was found in the Lika-Senj County (14.06). Concerning the women’s healthcare services used by the <16 age group, the highest rate was recorded in the Sisak-Moslavina County (1.88). In the Varaždin County, no girl aged <16 visited a gynecologist. In the 16-19 age group, the highest rate was found in the Virovitica-Podravina County (21.49) and lowest in the Zadar County (0.13). The overall number of elementary school students enrolled in health education was 149,768; the highest rate per 1000 students was recorded in the Primorje-Gorski kotar County (800.12). The overall number of high-school students was 48,426; the highest rate was found in the Primorje-Gorski Kotar County (554.50). The highest rate of legally induced abortions per 1000 women of fertile age was found in the Istria (7.13), Međimurje (5.59), Varaždin (5.67), Primorje-Gorski Kotar (4.56) and Lika-Senj (4.02) Counties. The rate of legally induced abortions per 100 childbearing women in the <19 age group was 16.84, and per 1000 women of fertile age in the <19 age group it was 1.51. Discussion: The culture of proactive thinking about one’s own health was found to be insuffi ciently developed among schoolchildren (uneven number of visits to counseling centers and to women’s health care services), resulting in abortions, sexually transmitted diseases, and neoplasms in the population up to 19 years of age. The need of their empowerment through systematic proactive approaches is emphasized. Current promotion of health education varies considerably among counties and, given the presented indicators and the results obtained, is either insuffi cient or requires change in the methodology. The possible direction for future action may be strengthening of extracurricular activities to improve reproductive health literacy among schoolchildren. Conclusion: The data presented provide the basis for health literacy interventions through synchronous approach by healthcare and education professionals. Sexuality in the 21st century should not be a taboo. Health literacy changes health behavior

Informirani pristanak u hrvatskoj kliničkoj laboratorijskoj praksi – aktualna pitanja i buduće perspektive

This paper deliberates on the place and role of informed consent in everyday clinical laboratory practice. Taking into account interna-tional ethical guidelines such as the UNESCO Universal Declaration on Bioethics and Human Rights, the Declaration of Helsinki of the World Medical Association, and Croatian national laws and codes such as the Act on the Protection of Patients’ Rights, the Act on Medical Biochemistry, the Code of Ethics of Medical Biochemists and Medical Deontology, the Act on Healthcare Services, and the Code of Ethics of the Croatian Chamber of Healthcare Workers, an overview is given on the actual implementation of the aforemen-tioned recommendations and regulations. A distinction between consent to a medical procedure and consent to enrolment in a re-search protocol is strongly stressed out. Special emphasis is placed on the role of specialists in laboratory medicine and masters of medical biochemistry in the process of obtaining informed consent. The design of an ‘informed consent interview’ is to be taken into consideration. Additional deliberation is needed on the option of ‘broad consent’. It is concluded that informed consent should repre-sent an important and routine activity within Croatian clinical laboratories.Rad se bavi mjestom i ulogom informiranog pristanka u svakodnevnoj kliničkoj laboratorijskoj praksi. Uzimajući u obzir međunarodne etičke smjernice kao što su UNESCO-va Opća deklaracija o bioetici i ljudskim pravima, Helsinška deklaracija Svjetskog medicinskog udruženja te hrvatske nacionalne zakone i kodekse kao što su Zakon o zaštiti prava pacijenata, Zakon o medicinsko-biokemijskoj djelatnosti, Etički kodeks medicinskih biokemičara i medicinske deontologije, Zakon o djelatnostima u zdravstvu te Etički kodeks Hrvatske komore zdravstvenih radnika daje se pregled aktualne primjene navedenih preporuka i propisa. Naglašava se potreba za razlikovanjem pristanka na medicinski postupak od pristanka na sudjelovanje u istraživanju. Ističe se uloga specijalista laboratorijske medicine i magistara medicinske biokemije u procesu informi-ranog pristanka. Sugerira se kreiranje ‘intervjua informiranog pristanka’. Potrebna je daljnja rasprava o mogućnosti uvođenja ‘opće suglasnos-ti’. Zaključno, informirani pristanak trebao bi predstavljati značajnu i uobičajenu aktivnost u kliničkim laboratorijima u Hrvatskoj

Risk Perception Towards Sexually Transmitted Diseases and HIV, Cyberochondria and Health Literacy at the Time of COVID-19 Pandemic

Cilj ovog rada je prikazati pregled dosadašnjih znanstvenih spoznaja o percepciji rizika zaraze HIV-om i drugim spolno prenosivim bolestima, kiberohondrije i zdravstvene pismenosti s naglaskom na trenutnu situaciju pandemije COVID-19. Republika Hrvatska je još uvijek zemlja niskog rizika epidemije HIV-a, dijelom zahvaljujući osnivanju 10 Centara za dobrovoljno, anonimno i besplatno savjetovanje i testiranje na HIV (CST). Percepcija rizika zaraze spolno prenosivom bolešću se opisuje kao vlastita procjena mogućnosti dobivanja iste. Zdravstvena ponašanja, pa tako i percepcija rizika, mogu se objasniti različitim modelima i teorijama, a jedan od prihvaćenih modela je socijalno-kognitivni model uvjerenja vezanih uz zdravlje (engl. Health Belief Model – HBM). Zdravstvena pismenost se definira kao osobne, kognitivne i socijalne vještine koje određuju sposobnost pojedinca da pristupi podacima o zdravlju, razumije ih i koristi. Kiberohodrija je anksiozni poremećaj karakteriziran ekscesivnim istraživanjem zdravstvenih sadržaja preko interneta. Pandemija COVID-19 je veliki događaj digitalne ere, uzimajući u obzir poremećaj izazvan u svim područjima života širom svijeta. Zbog izazvanog straha predstavlja plodno tlo za kiberohondriju.The aim of this paper is to present an overview of current scientific knowledge on the perception of the risk of contracting HIV and other sexually transmitted diseases, cyberochondria and health literacy with an emphasis on the current situation of the COVID-19 pandemic. Croatia is still a low-risk country for the HIV epidemic, thanks in part to the establishment of 10 Centers for Voluntary, Anonymous and Free HIV Counseling and Testing (VCT). Risk perception of contracting a sexually transmitted disease is described as one\u27s own assessment of the possibility of getting it. Health behaviors, and thus risk perception, can be explained by various models and theories, and one of the accepted models is the socio-cognitive model of health beliefs (Health Belief Model - HBM). Health literacy is defined as personal, cognitive, and social skills that determine an individual’s ability to access, understand, and use health data. Cyberchodria is an anxiety disorder characterized by excessive research of health content over the Internet. The COVID-19 pandemic is a major event of the digital age, taking into account the disorder caused in all areas of life around the world. Due to the fear caused, it is a fertile ground for cyberochondria

HEALTH STATUS, LIFESTYLE, USE OF HEALTH SERVICES, SOCIAL CAPITAL AND LIFE SATISFACTION AS PREDICTORS OF MENTAL HEALTH - COMPARATIVE ANALYSIS OF WOMEN THAT RECEIVE AND DO NOT RECEIVE PUBLIC ASSISTANCE IN CROATIA

Background: The connection between socio-economic status and health is documented, yet not fully understood. The goal of this research was to analyze the relationship between socio-economic status, lifestyle and health status, availability of health-care, social capital, and satisfaction with life. Subjects and methods: Subjects were 1117 women aged 25-65 years divided in two groups. Group 1 consisted of women who receive public assistance (N1=591), while Group 2 consisted of women who do not (N2=526). The sample was stratified by random choice into multiple stages based on six regions of Croatia, residential area size, and the age of respondents. Visiting nurses surveyed the deprived population, while in Group 2 self-interviewing was conducted. A questionnaire entitled “Inequalities in health” was used. The respondents participated in this research voluntarily and anonymously. Results: Socially deprived women consume spirits and wine more often (p<0.001). There is no difference between groups regarding tobacco consummation. Working women perform significantly less strenuous physical tasks (p<0.001). Deprived women are significantly less engaged in physical activities (p<0.001). Health conditions in deprived women more commonly limit their physical activity (p<0.001). There is a significant difference in utilization of health-care among groups (p<0.001). Younger women who are married, with a higher number of household members, a larger income, and with higher education are generally more satisfied with life (p<0.001). Although deprived women are significantly less satisfied with their lives, feel less free, are less physically active, and less likely to consume spirits or beer, they are significantly happier than working women (p<0.001). Conclusions: Personal health status and lifestyle, access to health-care services, and life satisfaction have a high importance as predictors and protective factors of mental health in women - recipients of state-provided financial welfare

Klinička etika u hrvatskoj: pregled izobrazbe, konzultacija i istraživanja (apel za promjene)

The aim of this paper is to delineate current position of clinical ethics in the Croatian healthcare system by analyzing the following: representation of clinical ethics contents in the curricula of medical and associated schools; composition and role of clinical ethics consultations; and establishment of an ethical/legal framework for the conduct of research. Curriculum investigation, literature review, and analysis of the Croatian Act on the Protection of Patients’ Rights were performed. The contents of clinical ethics are offered through 63 obligatory and elective subjects at 12 institutions. It is wrongly placed either too early or too late within the curriculum. Continuity at all levels of health professional education is needed. Croatian experience with clinical ethics consultations is shaped only by ethics committees. Problematic is the review of research protocols indicated as their main activity. Inclusion of team and individual consultations would increase the availability and facilitate the usage of ethics support services. The Act on the Protection of Patients’ Rights is based on the principles of humanity and availability, ensuring the right to protection when participating in clinical trials. Unfortunately, the outdated paradigm of paternalistic medicine aggravates the respect for patients’ rights in cure, care and research. A shift towards the patient/person-centered healthcare system would put the Act into everyday practice. Although clinical ethics has entered the Croatian healthcare system in a formal and practical way, the authors wish to emphasize the need to approach the European and other international standards regarding the recent Croatian accession to the European Union.Cilj je ovoga rada utvrditi sadašnji položaj kliničke etike unutar hrvatskog zdravstvenog sustava analizirajući sadržaj iz kliničke etike u kurikulumima medicinskih fakulteta i srodnih institucija, sastav i ulogu kliničkih etičkih konzultacija, te uspostavu etičko/pravnog okvira za provođenje istraživanja. Korištene su metode pretraživanje kurikuluma, pregled literature, analiza Zakona o zaštiti prava pacijenata. Sadržaj iz kliničke etike poučava se kroz 63 obvezna i izborna kolegija na 12 institucija. Pogrešno je pozicioniran na početku ili na kraju kurikuluma. Potreban je kontinuitet na svim razinama izobrazbe zdravstvenih djelatnika. Hrvatska iskustva u kliničkim etičkim konzultacijama oblikovana su isključivo kroz etička povjerenstva. Problematična je činjenica što je analiza znanstveno-istraživačkih protokola identificirana kao njihova glavna aktivnost. Uključivanje timskih i individualnih konzultacija povećalo bi raspoloživost i olakšalo korištenje sustava etičke potpore. Zakon o zaštiti prava pacijenata Republike Hrvatske temelji se na načelima humanosti i dostupnosti, osiguravajući poštivanje prava na zaštitu pacijenta nad kojim se obavlja znanstveno istraživanje. Nažalost, zastarjela paradigma paternalističke medicine otežava poštivanje prava pacijenata pri njezi, liječenju i istraživanju. Pomak ka zdravstvenom sustavu usmjerenom na pacijenta/osobu aktivirao bi Zakon u svakodnevnoj praksi. Premda je klinička etika i formalno i sadržajno ušla u hrvatski zdravstveni sustav, autori naglašavaju potrebu za približavanjem europskim i drugim međunarodnim standardima povodom ulaska Hrvatske u Europsku Uniju

Aktualno sagledavanje Potterove globalne bioetike kao mosta između kliničke (personalizirane) i javnozdravstvene etike

In the context of modern scientific and technological developments in biomedicine and health care, and the potential consequences of their application on humans and the environment, Potter’s global bioethics concept resurfaces. By actualizing Potter’s original thoughts on individual bioethical issues, the universality of two of his books, which today represent the backbone of the world bioethical literature, “Bioethics – Bridge to the Future” and “Global Bioethics: Building on the Leopold Legacy”, is emphasized. Potter’s global bioethics today can legitimately be viewed as a bridge between clinical personalized ethics on the one hand and ethics of public health on the other.U kontekstu suvremenih znanstveno-tehnoloških dostignuća u biomedicini i zdravstvu i potencijalnih posljedica primjene za čovjeka i okoliš na površinu isplivava Potterov globalni bioetički koncept. Aktualizirajući izvorne Potterove misli na pojedine bioetičke teme ukazuje se na svevremenost dviju njegovih knjiga koje i danas predstavljaju okosnicu svjetske bioetičke literure: “Bioethics – Bridge to the Future” te “Global Bioethics: Building on the Leopold Legacy”. Potterova globalna bioetika danas se legitimno može promatrati kao most između kliničke personalizirane etike s jedne strane odnosno etike javnog zdravstva s druge

(Dis)organization of Palliative Care as a Potential Quality-of-Life Issue in the Senior Population – Croatian Experiences

This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building. Although we can not ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, aproximately half of patients - users of palliative care - have some type of oncological diagnosis, a significant number of patients suffers from dementia, stroke or heart failure. As for the Primorsko-goranska county and the City of Rijeka, they show similar trend, as can be illustrated with data from the 2011 census, when the share of citizens over 65 years in the population of Primorsko-goranska county reached 18,91%, and in the population of the City of Rijeka 19,74%. Thus, one of the main quality-of-life issues in the Croatian senior population is the (dis)function of the palliative medicine/care system. Practice, namely, shows that there has still been no implementation. In particular, palliative medicine is not yet recognized as a speciality or sub-speciality, standards and norms for this activity are not set, palliative care is still not included in the system of obligatory health insurance, and as far as the national strategy of health policy for the area of palliative care, Croatian Government at its meeting held on 27th December 2013 finally adopted the "Strategic Plan for Palliative Care of the Republic of Croatia for the Period 2014-2016". Exactly because we are a decade behind European standards (Reccommendation Rec (2003) 24 of the Committee of Ministers to member states on the organization of palliative care), it is more than legitimate to place this subject at the centre of the current Croatian gerontology interest