Važnost preferencija pacijenata u osmišljavanju,organizaciji i realizaciji zdravstvenih usluga

Unazad desetak godina došlo je do intenzivnog razvoja područja Ekonomike zdravstva (Health economics) u svijetu. U sklopu te interdisciplinarne znanosti, koja pokušava dati odgovor na pitanje kako najučinkovitije alocirati oskudna sredstva unutar zdravstvenog sustava, usvajaju se i razvijaju znanja i tehnike kojima se služimo u procesu elicitiranja preferencija pacijenata vezanih uz zdravstvene usluge. Iste uzimamo u obzir pri formuliranju zdravstvenih intervencija, unapređenju kvalitete usluga ili, primjerice, odabiru preporučene terapije. Najzanimljivija, primjenjenija i najmodernija inačica Conjoint analize, koja najbolje obuhvaća dinamičnost i heterogenost dobara i usluga u zdravstvenom sustavu, jest metoda „diskretnog, određenog, osebujnog“ izbora ili Discrete choice experiment (DCE). Njome se dolazi do strukturiranih zaključaka o stvarnim preferencijama ispitanika, vezanima uz objekt istraživanja, i o mogućem trade-off između varijabli kojima ga opisujemo. Drugo, dolazimo do odgovora na pitanje: u kojem iznosu bi pacijenti sami bili voljni financirati neke od elemenata (varijabli) zdravstvenog dobra ili usluge (marginal willingness to pay – MWTP) i dobro ili uslugu u cjelini (total willingness to pay – WTP). Trendovi ispitivanja preferencija i njihova integracija u proces odlučivanja ne smiju zaobići ni zdravstveni sustav u Hrvatskoj. Osim što osnova za donošenje odluka u sustavu mora biti temeljena na medicinskoj i ekonomskoj argumentaciji, za kvalitetnu dogradnju potrebno je uvažiti preferencije onih kojima se usluge nude

Effect of Menopause, Anthropometry, Nutriton and Lifestyle on Bone Status of Women in the Northern Mediterranean

The purpose of this study was to explore the influence of age, menopause, anthropometry, nutrition and lifestyle on bone status of women of the Northern Mediterranean Region of Croatia, which is considered the Adriatic Coast of the Southeast Europe. Quantitative ultrasound measurement was performed on the women's right heel, and the values of the primary parameters (BUA and SOS) were obtained. Dietary data were assessed with specially designed semi - quantitative food frequency questionnaire. Multiple regression analysis was employed to examine the influence of age and anthropometry, as well as hormonal and nutritional factors on BUA and SOS. In all female subjects, both primary parameters are predicted by menopause. Among nutrition and lifestyle factors, carbohydrates are significant predictor for BUA (β = -0.151, P < 0.05), and smoking is significant predictor for SOS (β = -0.113, P < 0.05). In premenopausal women, BUA is significantly predicted by body height (β = 0.71, P < 0.05) and body mass index (β = 1.44, P < 0.05). In postmenopausal women, both primary parameters are strongly predicted by age and anthropometric parameters. Besides, SOS is significantly predicted by smoking (β = -0.18, P < 0.01) and alcohol (β = -0.13, P < 0.05). Bone quality in women from the Croatian Mediterranean Region mostly depends on their hormonal status. When the effect of menopause is controlled, bone status becomes dependent on age and anthropometry

Effect of Menopause, Anthropometry, Nutriton and Lifestyle on Bone Status of Women in the Northern Mediterranean

The purpose of this study was to explore the influence of age, menopause, anthropometry, nutrition and lifestyle on bone status of women of the Northern Mediterranean Region of Croatia, which is considered the Adriatic Coast of the Southeast Europe. Quantitative ultrasound measurement was performed on the women's right heel, and the values of the primary parameters (BUA and SOS) were obtained. Dietary data were assessed with specially designed semi - quantitative food frequency questionnaire. Multiple regression analysis was employed to examine the influence of age and anthropometry, as well as hormonal and nutritional factors on BUA and SOS. In all female subjects, both primary parameters are predicted by menopause. Among nutrition and lifestyle factors, carbohydrates are significant predictor for BUA (β = -0.151, P < 0.05), and smoking is significant predictor for SOS (β = -0.113, P < 0.05). In premenopausal women, BUA is significantly predicted by body height (β = 0.71, P < 0.05) and body mass index (β = 1.44, P < 0.05). In postmenopausal women, both primary parameters are strongly predicted by age and anthropometric parameters. Besides, SOS is significantly predicted by smoking (β = -0.18, P < 0.01) and alcohol (β = -0.13, P < 0.05). Bone quality in women from the Croatian Mediterranean Region mostly depends on their hormonal status. When the effect of menopause is controlled, bone status becomes dependent on age and anthropometry