Spiritual well-being is a recognized predictor of health-related quality of life in palliative patients. No research in Croatia has yet addressed this field. This study, the first of its kind in ...Croatia, validated a Croatian translation of the EORTC QLQ-SWB32 measure of spiritual well-being with curative Croatian oncology patients and assessed its use and value. The study was conducted between July 2019 and January 2020 at the Department of Radiotherapy and Oncology, University Hospital Rijeka, with 143 cancer patients, using the linguistically validated Croatian version of the measure. All patients found the measure acceptable. Confirmatory factor analysis aligned with the structure found in previous studies. Cronbach's alpha confirmed internal consistency. Female participants scored higher on the RSG (Relationship with Someone or Something Greater), RG (Relationship with God), and EX (Existential) scales, and on Global-SWB. Patients with breast and gynecological tumors scored higher on RG. Older patients scored lower on RSG, RG and EX. Retirees and those with below-average incomes scored lower on EX. Participants who identified as having no religion scored lower on RSG. Stage I cancer patients scored higher on RG. The Croatian version of the EORTC QLQ-SWB32 is an acceptable, valid, and reliable measure of SWB for Croatian cancer patients.
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 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 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.
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).
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.
This paper deliberates on the place and role of informed consent in everyday clinical laboratory practice. Taking into account international 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 aforementioned recommendations and regulations. A distinction between consent to a medical procedure and consent to enrolment in a research 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 represent an important and routine activity within Croatian clinical laboratories.
Background: Breast cancer is one of the most common tumours and one of the leading causes of death among women in all parts of the world. The aim of this study is to investigate the influence of ...Nordic walking on the functional capacity of women who have undergone surgery for breast cancer. Methods: The study involved a cohort of women who exercised through Nordic walking for 10 weeks (from March to May 2022). The subjects trained with a licenced instructor (INWA method), with two training sessions per week of 70–80 min each. We collected information on pain, arm mobility, hand grip strength, shoulder joint range of motion bilaterally, circumference of both arms, body mass index, physical activity, aerobic capacity, and endurance. Results: There were 14 women, median age 63. BMI was significantly lower (28.9/28.1; p = 0.013) after training and a difference in shoulder range of motion was better (anteflexion right (142.5/170, p = 0.002), retroflexion right (40/60, p = 0.005), abduction right (135/180, p = 0.005), abduction left (135/180, p = 0.005)). There was no difference in right hand strength, while there was a significant difference in left hand strength (19/20, p = 0.007). A correlation was found between BMI and the six-minute walk test (r = −0.70; p = 0.005). Conclusions: Considering the multidimensionality of the disease itself and the results of this study, we believe that Nordic walking is a favourable and good choice of physical activity for breast cancer patients.
Cilj: Ispitati procjenu znanja o komunikaciji, emocijama i spolnom zdravlju učenika osmih razreda. Ustvrditi najčešće probleme. Učiniti usporedbu po spolu. Ispitanici i Metode: Ispitanici su 174 ...učenika (Ž = 97 (56 %)), što predstavlja 81 % od ukupne populacije učenika osmih razreda jedne osnovne škole u PGŽ-u (N = 214) kroz tri generacije. Prije početka i po završetku radionica provedena je anonimna anketa. Prva anketa procjenjivala je početno znanje učenika o temama kojima će se radionica baviti. Druga anketa ocjenjivala je korisnost radionica i služila analizi procesa. Rezultati: Prosječna dob iznosila je 14 (13 do 15) godina. Učenici o svojim problemima vrlo često razgovaraju s majkom (45 %), prijateljima (41 %), ocem (19 %) i braćom/sestrama (16,9 %). Većina učenika ne razgovara sa školskim liječnikom (85,8 %), obiteljskim liječnikom (79,2 %), stručnim službama škole (69,1 %) i razrednicima/profesorima (50 %). Učenici vrlo često razgovaraju o školi (45,8 %), prijateljima (31,7 %) i zdravlju (25,8 %). Najmanje razgovaraju o simpatijama (36,5 %), spolnosti (29,1 %) i emocijama (17,8 %). Učenici najčešće smatraju da o seksu posjeduju vrlo dobra (24,7 %) i izvrsna (35,3 %) znanja, kao i o komunikaciji, vrlo dobra (42,2 %) i izvrsna (25,8 %). Dobrim procjenjuju svoje znanje o zdravlju (37 %) i SPB-u (32,2 %). Dječaci smatraju da više znaju o seksu od djevojčica (20,6 % vs. 14,7 %, P = 0,004). Djevojčice smatraju da znaju više o emocijama (15,3 % vs. 3,7 %, P = 0,003). Radionice su ocijenjene kao korisne (92,5 %). Zaključci: Prema iskustvima radionica sadržaje bi trebalo obrađivati kroz zasebnu aktivnost, izvan postojećih predmeta, kontinuirano tijekom cijele godine, koristeći se evokacija/razumijevanje/refleksija okvirom za poučavanje, a kratkoročne ciljeve definirati prema karakteristikama pojedine grupe i rezultatima ankete. Reproduktivno zdravlje djece i mladih kompleksno je područje koje zahtijeva interdisciplinarni pristup.
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 cannot ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, approximately half of patients--users of palliative care--have some type of oncological diagnosis; a significant number of patients suffer 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 the 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 from 2014 to 2016". Exactly because we are a decade behind European standards (Recommendation 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.
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.
This paper deliberates on the place and role of informed consent in everyday clinical laboratory practice. Taking into account international 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 aforementioned recommendations and regulations. A distinction between consent to a medical procedure and consent to enrolment in a research 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 represent an important and routine activity within Croatian clinical laboratories. Key words: Informed consent; Biochemistry; Clinical laboratory services; Croatia Rad se bavi mjestom i ulogom informiranog pristanka u svakodnevnoj klinickoj laboratorijskoj praksi. Uzimajuci u obzir medunarodne eticke smjernice kao sto su UNESCO-va Opca deklaracija o bioetici i ljudskim pravima, Helsinska deklaracija Svjetskog medicinskog udruzenja te hrvatske nacionalne zakone i kodekse kao sto su Zakon o zastiti prava pacijenata, Zakon o medicinsko-biokemijskoj djelatnosti, Eticki kodeks medicinskih biokemicara i medicinske deontologije, Zakon o djelatnostima u zdravstvu te Eticki kodeks Hrvatske komore zdravstvenih radnika daje se pregled aktualne primjene navedenih preporuka i propisa. Naglasava se potreba za razlikovanjem pristanka na medicinski postupak od pristanka na sudjelovanje u istrazivanju. Istice se uloga specijalista laboratorijske medicine i magistara medicinske biokemije u procesu informiranog pristanka. Sugerira se kreiranje 'intervjua informiranog pristanka'. Potrebna je daljnja rasprava o mogucnosti uvodenja 'opce suglasnosti'. Zakljucno, informirani pristanak trebao bi predstavljati znacajnu i uobicajenu aktivnost u klinickim laboratorijima u Hrvatskoj. Kljucne rijeci: Obavijesteni pristanak; Biokemija; Klinicke laboratorijske sluzbe; Hrvatska Iva Sorta-Bilajac Turina (1,2) and Vesna Supak Smolcic (3,4) (1) Department of Social Medicine, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Rijeka, Croatia; (2) Department of Environmental Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia; (3) Clinical Department of Laboratory Diagnostics, Rijeka University Hospital Centre, Rijeka, Croatia; (4) Department of Medical Informatics, School of Medicine, University of Rijeka, Rijeka, Croatia Correspondence to: Prof. Iva Sorta-Bilajac Turina, MD, PhD, Department of Social Medicine, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Kresimirova 52a, HR-51000 Rijeka, Croatia E-mail: iva.sorta-bilajac@zzjzpgz.hr Received March 8, 2018, accepted October 30, 2018 doi: 10.20471/acc.2019.58.03.14 Table 1. Interpretation of the normative framework of informed consent in medical biochemistry and clinical laboratory practice International ethical guidelines UNESCO Declaration Declaration Act on the Act on Medical on Bioethics and of Helsinki Protection of Biochemistry Human Rights Patients' Rights (AMB) (APPR) Article 9 Article 24 Articles 25, 28 Article 18 Croatian ethical framework Code of Ethics Act on Healthcare Code of Ethics of the of Medical Services Croatian Chamber of Biochemists and (AHS) Healthcare Workers Medical Deontology (CECCHW) (CEMBMD) Articles 2, 6, 7, 10 Articles 55, 65, 66 Articles 7, 9 Privacy, confidentiality and Confidentiality and privacy stand out in protection of all documents as the fundamental rights of personal data patients/subjects/users, and it is emphasized that the obligation to maintain and implement these rights lies with health professionals and institutions. All documents, with the exception of the Declaration of Helsinki, touch upon the current issue of the protection of personal medical data, with particular attention being paid to the amount of data and the purpose of data collection. APPR and AMB refer to regulations on the protection of personal data and records in the field of healthcare (such as the Act on the Protection of Personal Data), while CEMBMD further draws attention to the problem of the accessibility of data due to computerization in the healthcare system (10) (12). AHS uses a more general formulation of 'keeping a professional secret'. It highlights the responsibility of maintaining proper documentation and data truthfulness (13). The Chamber of Medical Biochemists recognizes the importance of respecting the ethical and legal framework of manipulating medical data. Therefore, it has proposed a Statement of Obligation to Respect the Principles of Ethical Behavior, and mentions, among others, the obligation to protect confidential information obtained in the course of one's professional activities and to prevent their misuse (15). CECCHW describes in detail the procedures for protecting the privacy of healthcare service users, from the conditions and patterns of sampling to the protection of the systems transmitting, processing, and storing data for the purpose of preventing misuse. The amount and purpose of information about the user of the services, which the healthcare worker needs to collect, are very clearly defined. Everything he/she learns in the course of his/her work is considered a professional secret. According to the regulations, violation of secret is a punishable offence. The healthcare service user has the right to confidentiality, access to his/her medical data, and to choose who is entitled to information about his/her health (14). Informed consent Right to information to medical treatment / / Articles 8-15 / Article 10 Informed consent to medical treatment / Articles 3, 6, 7, 12 The first problem one faces is that the legislator, in the case of medical treatment, has not specified which information should a healthcare professional give to the patient/user of healthcare services, but they are very specifically stated in the context of the protection of patients' rights (17). Article 8 of APPR stresses that patients have the right to be completely informed about the following: "- their health, including medical assessment of the results and outcomes of a particular diagnostic or therapeutic procedure, - recommended examinations, procedures and planned dates of their performance, - potential benefits and risks of performance or non-performance of examinations and procedures, - their right to decide on the recommended examinations or procedures, - possible alternatives to recommended procedures, - the course of procedures when provided healthcare, - further course of provided healthcare, - recommended lifestyle, and - health insurance rights and procedures for exercising those rights" (10). CECCHW provides in very general terms that every user of the service, among other things, has the right to information, informed consent, and health counseling (14). It is emphasized in Article 9 of the APPR that "notifications referred to in Article 8, paragraph 1 of this Act shall be provided upon the patient's verbal request by a healthcare worker with a university degree, who directly provides the patient with some form of healthcare service" (10). This would mean that upon the patient's request, a specialist in laboratory medicine (SLM) or master of medical biochemistry (MMB) is obliged to give the patient all the information about the state of his/her health and specifically in connection with the type of sample and analysis he/she is conducting (10). In addition, in accordance with Article 10 of the CEMBMD, a SLM/MMB "should warn about unnecessary analyses and refuse to implement those which in his/her conviction and expertise are unacceptable, unethical or harmful to patients. He/she can and should advise the patient/user and/or the physician to conduct additional measurement procedures if he/she in his/her expert knowledge believes they will be useful... A SLM/MMB shall ensure that, in case of a requirement for a particular interpretation, test results are not commu- nicated directly to the patient without the opportunity for an appropriate consultation... A SLM/MMB cannot provide a diagnosis" (12). According to CECCHW, a healthcare professional legally authorized to provide information should provide the patient/user of the service with sufficient information to enable him/her to make a decision about his/her health and well- being. In doing so, he/she must be accurate, i.e. provide accurate information about the nature of the service being provided, as well as the relevant time limits and financial charges (14). A bachelor of medical laboratory diagnostics and medical laboratory technician should not provide a diagnosis, suggest therapy, or interpret the results to the healthcare user. He/she may independently reach conclusions and solutions within the diagnostic procedure in accordance with his/her competences (14). According to Article 13 of PPRA, "the right to information is also granted to the patient with an impaired ability to reason, in accordance with his/her age, physical, mental and psychological condition" (10). In accordance with Articles 14 and 15 of PPRA, "the patient has the right to refuse, by means of a written and signed statement, to be informed about the status of his/her health and the expected outcome of the proposed and/or performed medical procedures and measures" (10). However, "the patient with a full legal capacity cannot waive the