The plague epidemics that ravaged the Habsburg Monarchy from 1677 to 1716 strongly influenced the development of health institutions and the organization of a public health system. Primarily, there ...was a need to employ a larger number of educated medical doctors and to establish institutions that would deal with health and epidemiological issues, especially during the epidemics. In 1710, Emperor Joseph I established the Court Sanitary Commission (Sanitäts-Hofkommission), which would soon become the central public health institution in the Habsburg Monarchy. Research of historical documents has shown that two other institutions were especially important for the Croatian-Slavonian lands during the epidemic of 1708-1716: the Court War Council in Vienna, and from 1710 the Hauptdeputation in Contagionssachen in Graz. It is evident from the mentioned documents that the Deputation, as the main (Haupt-) Inner Austrian anti-epidemic institution, also coordinated the anti-epidemic activities in Banal Croatia and the Varaždin Generalate. The plague epidemic in the Habsburg Monarchy from 1708 to 1716 is very important in this sense, because the experience and structure of the anti-epidemic system built at that time were the basis for the establishment of a later permanent system of Sanitary Commissions and Sanitary Cordon, which began in the 1730s and was fully formed with the enactment of the General Health Act (Generale Normativum in Re Sanitatis) in 1770. These experiences proved to be especially useful for Banal Croatia, which was not affected by the plague epidemic of 1708-1716 due to the anti-epidemic measures.
Pandemija COVID-19 otvorila je neka nova pitanja u pružanju zdravstvene zaštite na koja je nužno odgovoriti u suočavanju s ovom pandemijom. Kako se pandemija COVID-19 javila u razdoblju poštivanja ...„ljudskih prava“, u ovom članku uspoređujemo odredbe koje se tiču zaštite zdravlja te ograničavanje prava dviju ranjivih kategorija, osoba s duševnim smetnjama i osoba za koje postoji sumnja da boluju ili boluju od zaraznih bolesti, budući da se radi o kategorijama osoba čija sloboda može biti ograničena bez njihove volje u određenim slučajevima. Članak ukazuje na nedorečenosti Zakona o zaštiti pučanstva od zaraznih bolesti vezano uz (sudsku) kontrolu izrečenih sigurnosnih mjera, poglavito u usporedbi sa Zakonom o zaštiti osoba s duševnim smetnjama. U zaključku navodimo možebitna rješenja uočenih nedorečenosti. Autori analiziraju pravnu zaštitu navedenih kategorija osoba u odnosu na ostvarivanje njihovog prava na zdravlje i u kontekstu čl. 16 Ustava RH koji omogućuje ograničavanje prava i sloboda da bi se zaštitila sloboda i prava drugih ljudi, pravni poredak, javni moral i zdravlje, što mora biti razmjerno naravi potrebe za ograničavanjem.
Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners' (PCPs') clinical ...decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece, Romania).
PCPs participated in an online questionnaire that asked for demographic data, practice characteristics, and information on health system factors. Participants were also asked to make clinical decisions in a vignette of a patient with possible lung cancer.
The survey was completed by 475 PCPs. There were significant national differences in PCPs' direct access to investigations, particularly to advanced imaging. PCPs from Bulgaria, Greece, and Romania were more likely to organise relevant investigations. The highest specialist referral rates were in Bulgaria and Romania. PCPs in Bulgaria were less likely to have access to clinical guidelines, and PCPs from Slovenia and Croatia were more likely to have access to a cancer fast-track specialist appointment system. The PCPs' country had a significant effect on their likelihood of investigating or referring the patient.
There are large differences between Balkan region countries in PCPs' levels of direct access to investigations. When faced with a vignette of a patient with the possibility of having lung cancer, their investigation and referral rates vary considerably. To reduce diagnostic delay in lung cancer, direct PCP access to advanced imaging, availability of relevant clinical guidelines, and fast-track referral systems are needed.
In this article, the author examines the appearance of plague epidemics in the Dalmatian commune of Šibenik in the late medieval period, from the Black Death in 1348 until the end of the fifteenth ...century. The analysis is based on the research of data from Šibenik’s statutory law – statutory decrees and later added novels (reformationes) – of the diplomatic relations and commissions between the Venetian central authorities and the commune of Šibenik, and of various communal published and unpublished sources. Yet, the most valuable data are the communal notary records, primarily last wills and inventories of goods, which enable the punctual examination of places where the plague epidemics raged in certain periods (villages, city, islands in the district). Last wills and inventories of goods are extremely valuable in establishing the beginning and ending of plague epidemics because they contain data on the dates of recording the wills, the death of testators, and the composing of inventories. These sources also allow us to examine the duration of plague epidemics. Thus, we know that some plague epidemics in the commune of Šibenik lasted for several months while others raged for one or even two years. The research has shown that the outbreaks of plague epidemics occurred much more frequently than has been hitherto assumed, either in the city of Šibenik or in the villages of its densely populated district. In any case, the research has shown that plague epidemic in the fifteenth-century commune of Šibenik appeared much more frequent than it has been considered until now. The author also discusses the health protection measures undertaken by the central Venetian and communal Šibenik authorities to prevent the spreading of plague epidemics, particularly within the city walls. The sources, especially last wills and inventories of goods, but also some other types of notary deeds, statutory law and its novels, as well as the ducales issued by the central Venetian government and decrees issued by the communal authorities, clearly show that the commune of Šibenik implemented the same healthy, medical, and hygiene measures available at the time as other European urban-rural societies. Deceased persons, as well as members of their nuclear families, were immediately put into isolation outside the city walls and situated in empty houses in the surrounding villages. The communal authorities, patricians, rich merchants, and members of clergy likewise found refugee in villages within the communal district or in their houses and palaces on communal islands.
Tijekom istraživanja povijesti zdravstva grada Bjelovara pronađeni su podatci o šesnaest liječnika Židova koji su radili u Bjelovaru tijekom 19. i 20. stoljeća. Neki od njih čitav su radni vijek ...proveli u Bjelovaru (primjerice dr. Herman Fischer, dr. Dragutin Ländler, dr. Bela Milhofer), dok su neki radili kraće ili dulje vrijeme kao privatni, bolnički, kotarski ili vojni liječnici prema tadašnjem ustrojstvu zdravstvene skrbi i nastavili karijere diljem svijeta. Medicinski i povijesni izvori govore o njihovu djelovanju i trajnoj ostavštini za bjelovarsko zdravstvo i kulturu, što se inače rijetko spominje u postojećoj literaturi.
Usluge od općeg gospodarskog interesa složena su sfera prava. Predstavljaju iznimno važan dio trgovine na unutarnjem tržištu Europske unije te gospodarstva EU-a u cjelini. One obuhvaćaju vrlo širok ...spektar ljudskih djelatnosti i prisutne su u svim sferama naših života. Meðu njih pripadaju usluge oko čije gospodarske prirode nema nikakvih dilema, ali i one čiji je način organiziranja i financiranja specifičan te je podložan posebnim pravnim režimima, poput zdravstva, obrazovanja, javnog prijevoza i slično. Ta posebna uloga odreðenih vrsta usluga dovela je do definiranja koncepta "usluga od općeg gospodarskog interesa" u pravnom okviru Europske unije, s neizbježnim posljedicama na pravni okvir država članica EU-a, uključujući i Hrvatsku. One nisu u potpunosti definirane primarnim pravom EU-a, već je konkretno odreðivanje što predmetni pojam obuhvaća prepušteno autonomiji država članica. Navedena autonomija, meðutim, nije apsolutna, već su okviri definirani pravom Unije, a ključan faktor pri odreðivanju ovih usluga predstavlja njihova gospodarska, odnosno negospodarska priroda, jer su usluge od općeg gospodarskog interesa podvrgnute tržišnim pravilima EU-a, za razliku od onih negospodarskih. Sudska praksa u ovom dijelu vrlo je složena te se primjenjivost tržišnih pravila utvrðuje kazuistički. U slučaju gospodarskih usluga kod kojih su zadovoljeni uvjeti iz predmeta Altmark, tržišna pravila EU-a uopće nisu primjenjiva i država može ovlastiti poduzetnika za pružanje usluge od općeg gospodarskog interesa i dati mu financijsku potporu u tu svrhu. Drugo, ako tržišna pravila jesu primjenjiva, odstupanje nacionalnih pravila od tržišta ipak će se moći opravdati ako je to odstupanje nužno za ostvarenje cilja od općeg interesa radi kojeg se odreðena usluga pruža. Cilj ovog rada je analizirati pravni okvir Europske unije koji ureðuje usluge od općeg gospodarskog interesa, odnos ovog koncepta prema pravilima o slobodi kretanja, zaštiti tržišnog natjecanja i državnim potporama na unutarnjem tržištu EU-a te utvrditi poštuje li Republika Hrvatska navedeni okvir i postoje li prijepori u domaćem upravnom pravu koje je potrebno pravno razriješiti. Analiza odnosa pravnog okvira EU-a i hrvatskog upravnopravnog okvira u pojedinim područjima pokazuje visok stupanj usklaðenosti nacionalnog prava s tržišnim pravilima Unije. To je posebno slučaj u područjima koja su ureðena detaljnijim pravilima (primjerice, o državnim potporama) sadržanim u sekundarnom zakonodavstvu EU-a. S druge strane, u područjima koja pripadaju u primarnu nadležnost država članica, poput zdravstva i obrazovanja, postoje odreðene dileme o usklaðenosti nacionalnog i europskog prava. U nacionalnom zakonodavstvu koje ureðuje potonje potrebno je napraviti jasnu distinkciju izmeðu gospodarskih i negospodarskih usluga od općeg interesa kako bi se povećala pravna sigurnost i izbjegle sumnje o nelegalnom državnom favoriziranju javnih ustanova na štetu privatnih.
There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all ...parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy.
This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania.
A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.'
The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.
Italy is the main recipient of asylum seekers in the European region, and Sicily is their first point of arrival. This geographical position creates a large job for Health Authorities to identify and ...deal with the health of immigrants. This study evaluates the prevalence of disease among asylum seekers, assessing which are associated factors.
A cross-sectional study was conducted to analyse demographic and clinical data in an Acceptance Centres for Asylum Seekers from February 2012 to May 2013. All variables that were found to be significant on unvariable analysis for the most frequent pathologies were included in a multivariable logistic regression model.
Post-traumatic stress disorders with 17.4% and major depression with 7.3% were the most frequent diseases. The factors associated with post-traumatic stress disorders among asylum seekers were: major depression diagnosis (OR=2.91, p=0.004), Pakistan as a country of origin (OR=3.88, p<0.001), the largest number of medical visits (OR=1.02, p=0.033) and refugee status (OR=1.97, p=0.036). The variables linked with the diagnosis of major depression from the multivariable analysis were: suffering from post-traumatic stress disorders (OR=3.83, p<0.001), Pakistan as a country of origin (OR=3.45, p=0.004) and the highest number of visits to psychologist (OR=1.15, p<0.001).
The mental wellbeing of asylum seekers needs special attention, and interventions should be done to prevent the consolidation of psychiatric morbidity. A short psychological screening after the arrival might prove helpful here. Moreover, carefully designed longitudinal studies should be carried out when political recommendations try to change the organization of psychological and healthcare services.
U radu se razmatra utjecaj običaja oko dojenja i modernizacije javnog zdravstva na dojenačku smrtnost u Dubrovniku uspoređivanjem podataka o smrtnosti iz 1870-1879. s onima iz 1900-1909. godine. ...Najvažnija promjena koju je donijela austrijska administracija u dobro razvijen dubrovački sustav medicinske i socijalne skrbi iz vremena Dubrovačke Republike bila je obaveza školovanja i licenciranja primalja. Krajem 19. stoljeća porastao je broj licenciranih primalja i pismenih žena, a medicinski stručnjaci su u popularno-stručnoj literaturi namijenjenoj mladim majkama snažno zagovarali dojenje. Dodir školovanih primalja s majkama i liječnička popularizacija dojenja utjecali su na pozitivne promjene u kretanju dojenačke smrtnosti početkom 20. stoljeća na dubrovačkom području.
Stavovi prema različitim manjinskim skupinama ponekad se formiraju na osnovi premalog broja pojednostavljenih, pristranih i neopravdanih generalizacija. Iako zadnjih godina postaju pozitivniji, prema ...osobama istospolne orijentacije još prevladavaju negativni stavovi (Buck i sur., 2013.). Osnovni cilj rada bio je ispitati stavove prema istospolno orijentiranim osobama među učenicima i zaposlenicima u sektorima zdravstva i policije. Sudjelovalo je 990 sudionika (501 učenika i 489 zaposlenika). Primijenjena je Skala za mjerenje stavova prema homoseksualnim osobama sastavljena na Odsjeku za psihologiju Filozofskog fakulteta u Zagrebu (prema Parmač, 2005.). Rezultati provedenih analiza varijance i regresijskih analiza pokazali su da su prosječni stavovi sudionika u području neutralnih, ali postoje razlike s obzirom na to jesu li objekt stava muške ili ženske istospolno orijentirane osobe. Kad su objekt stava ženske istospolno orijentirane osobe, sudionici iz sektora zdravstva pokazuju statistički značajno pozitivniji stav u odnosu na sudionike iz sektora policije, iako je razlika u iskazanim stavovima vrlo mala. Kad su objekt stava muškarci istospolne orijentacije, stavovi sudionica statistički su značajno pozitivniji u odnosu na stavove muških sudionika, kao i stavovi zaposlenika u odnosu na učenike. Dodatno, negativni stavovi se relativno dobro mogu predvidjeti i na osnovi uvjerenja sudionika o mogućnosti voljnog odabira vlastite seksualne orijentacije, izostanka prethodnog kontakta s osobom istospolne orijentacije te religioznosti u skladu s crkvenim učenjem. Rezultati pridonose boljem razumijevanju stavova prema istospolno orijentiranim osobama u specifičnom kontekstu zdravstvenih i policijskog zanimanja u Hrvatskoj. Ukazuju na potrebu za dodatnim radom na razumijevanju, prihvaćanju različitosti i povećanju tolerancije osobito kod učenika koji se školuju za ova zanimanja.
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