Geographical Locations - Croatia

• (Statistical) Number of Inhabitants per Doctor: 356
• CIA World Factbook : Croatia

Organisations and Networks

UN and Multinational

• WHO
  - WHO Country Profile - Croatia
  - WHO - Tobacco control: Country Profile: Croatia
  - WHO - Environmental Burden of Disease: Country Profile – Croatia
  - WHO – Progress in the Prevention of Injuries in the WHO European Region: Croatia
• WHO Regional Office for Europe (EURO) in Copenhagen (Denmark)

Government

• Government of the Republic of Croatia
• Ministry of Health and Social Welfare - in Croatian
• Office for the Prevention of Drug Abuse
• Office for Human Rights

Non-Government

• City of Rijeka Healthy Cities Project
• Croatian National Institute for Public Health
• Croatian Red Cross
• Office for Cooperation with NGOs

Academic Institutions

• Croatian Academic and Research Network - "The Croatian Academic and Research Network - CARNet was created in 1991 as a project of the Ministry of Science and Technology of the Republic of Croatia.... Its mission includes the development of an advanced information and communication infrastructure for the academic and research community, including fast and safe network, diverse contents and services."
• Institute for Medical Research and Occupational Health
• University of Zagreb School of Medicine
• University of Zagreb, Andrija Štampar School of Public Health

National Policy and Related Documents

Reports, Guidelines, and Projects

• Autochthonous dengue fever in Croatia, August–September 2010
  After information about a dengue case in Germany acquired in Croatia, health professionals and the public in Croatia were alerted to assess the situation and to enhance mosquito control, resulting in the diagnosis of a second case of autochthonous dengue fever in the same area and the detection of 15 persons with evidence of recent dengue infection. Mosquito control measures were introduced. The circumstances of dengue virus introduction to Croatia remain unresolved. [publication summary] [Euro Surveill. 2011; 16(9): pii=19805]
• Breast, colon, and prostate screening in the adult population of Croatia: does rural origin matter?
  Introduction: The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents’ rural versus urban origin. Methods: Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression. Results: One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake. [author abstract] [Rural and Remote Health 7: 749. (Online), 2007]
• Chronic Respiratory Symptoms in Croatian Adriatic Island Metapopulations
  Aim: To investigate the prevalence of chronic respiratory symptoms in 9 metapopulations on Adriatic islands in Croatia, and the relationship between respiratory symptoms and individual genetic background. Methods: We obtained random sample of 1001 adult inhabitants of 9 Adriatic island villages in Croatia, that also included immigrants to these villages. European Union respiratory health questionnaire and World Health Organization non-communicable diseases questionnaire were used. Personal genetic histories were reconstructed, based on the two-generation ancestral pedigrees. Bivariate and multivariate methods were used in the analysis. Results: Women reported the occurrence of acute dyspnea (P = 0.017), cough (P = 0.002), and asthma (P = 0.002) more often than men. Gender was the strongest predictor for acute and/or chronic cough (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.23-2.33) and asthma (OR, 2.00; 95% CI, 1.00-4.01), whereas smoking was the strongest risk factor for acute and chronic dyspnea (OR, 1.90; 95% CI, 1.21-2.99) and airway narrowing (OR, 1.84; 95% CI, 1.18-2.87). Residence on the northern islands increased the odds of allergy, whereas the highest odds ratio of 3.20 was associated with the interaction of northern residence and immigrant background. Genetic background was a significant predictor only for the occurrence of allergy symptoms. Conclusion: Differences in respiratory findings among the island inhabitants were often associated with smoking prevalence. Interaction of residence on northern Adriatic islands and immigrant background proved to be the strongest predictor for the occurrence of allergy symptoms. This study indicated that environmental factors played a very important role in the occurrence of respiratory symptoms. [author abstract] [Croat Med J. 2006; 47: 627-634]
• Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States
  Aim: To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods: Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results: Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion: The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure. [author abstract] [Croat Med J. 2011; 52: 183-197]
• Croatia Health Finance Study, 2004
  The health system in Croatia developed relatively well among the countries in the region: the system has a well-trained health workforce, a well-established system of public health and health delivery programs, and good health outcomes in relation to countries at comparable income levels. However, these results have been achieved at a high cost, and the growing deficits in the social health insurance fund is a major concern. This World Bank Report examines the implications of this cost.
• Decentralisation of Health Care in Croatia – Teaching Model and Challenges?
  The precondition for implementation of decentralisation in health care is the education and empowerment of medical professionals and local politicians for management and decision-making. The decentralisation in health care has to be planned to suit the needs of regions and population (bottom-up), and not to follow the uniform model devised by the central government. The processes of decentralisation can have a negative effect on the quality of health care, increase prices and emphasise inequity in health. The poorly managed decentralisation can slow down the development and block the changes. [author abstract] [Med glas 2008; 5(1): 6-10]
• Fatality Risk Factors for Bicyclists in Croatia
  Aim: To present the epidemiology of fatal bicyclist injuries in traffic accidents in Croatia. Methods: Between January 1, 1997 and December 31, 2000, there were 253 bicyclist fatalities in Croatia. The data were collected from the police reports of the Department of Traffic Police, Ministry of the Interior, written at the place of the accident. The data were processed by descriptive epidemiology and compared by tests of significance. Results: The percentage of bicyclist fatalities among total road fatalities showed a decreasing trend over the years, from 11.6% in 1998 to 8.2% in 2000. The most frequent type of accident involving bicyclist fatalities were accidents in car-bicycle collisions (lowest: 74.7% in 1998; and highest: 81.3% in 1997). Most accidents occurred at the beginning and at the end of the bicycle season – months of April and October. Elderly people were involved in accidents occurring mainly in the morning hours – from 6 to 12 a.m., whereas the youngest and the middle-aged got injured or killed mainly in the evening – 6 to 9 p.m. This association between the age and the part of day when the accident happened was statistically significant (chi square=36.51, p<0.0001). Conclusion: Bicycle-related fatal injuries as a part of total road fatalities showed a gradual decrease. Regulation of bicycle traffic, more stringent protection measures and their implementation, as well as preventive measures regarding the time of day are needed to further decrease bicyclist fatalities in traffic. [author abstract] [Croat Med J 2003; 44: 610-613]
• Government Spending on Health Care and Education in Croatia: Efficiency and Reform Options
  This paper assesses the relative efficiency of government spending on health care and education in Croatia by using the so-called Data Envelopment Analysis. The analysis finds evidence of significant inefficiencies in Croatia’s spending on health care and education, related to inadequate cost recovery, weaknesses in the financing mechanisms and institutional arrangements, weak competition in the provision of these services, and weaknesses in targeting public subsidies on health care and education. These inefficiencies suggest that government spending on health and education could be reduced without undue sacrifices in the quality of these services. The paper identifies ways to do that. [publication abstract] [IMF Working Paper WP/08/136, May 2008]
• Hospital services in Croatia - how to recognize professional and educational challenges
  For successful health care reforms, it is necessary to recognize the political, social and administrative issues that affect the operation of Croatian hospitals. Main managerial challenges are in-depth policy analyses and creation of guidelines for the rationalization of hospital services. There is a lack of knowledge for comparisons between problems of Croatian hospitals and international experience.(i.e. how to estimate the appropriateness and applicability of internationally implemented policy interventions). The technologies that could enable professionals to develop policy options, recommend actions and support implementation are not available. [author abstract] [Med glas 2008; 5(1): 33-36]
• Incidence of Betulaceae pollen and pollinosis in Zagreb, Croatia, 2002-2005
  Pollen allergy is characterized by seasonal allergic manifestations affecting patients during the plant pollen season. The aim of this study was to analyze the Betulaceae pollen pattern in Zagreb (2002-2005) and to determine the incidence of sensitization to these pollen types in patients with seasonal respiratory allergy. Twenty-four-hour pollen counts were carried out using volumetric procedure. Skin prick test were performed on a total of 864 patients aged 18-80 in Zagreb between 2 January – 31 December 2004. Pollen of the representatives of the family Betulaceae accounted for a significant proportion of total pollen (34% on an average), predominated by Betula pollen and considerably lower proportion of Alnus sp. and Corylus sp. pollen. Alder and hazel pollen first occurred in the air in February throughout the study period. The highest airborne pollen concentration of these taxa was recorded in February and March. The birch pollen season generally peaked in April. Only 2.67% of patients showed birch pollen monosensitization. The proportion of patients with polysensitization to Betulaceae pollen was considerably greater (12.88%), whereas polysensitization to Betulaceae, Poaceae and Ambrosia pollen was recorded in the highest proportion of patients (26.23%). According to age, the highest and lowest rate of allergy was recorded in the 31-50 and >51 age groups, respectively (46.22% vs 23.12%). Female predominance was observed across all age groups. The patients with monosensitization to birch pollen had the most severe symptoms in April. In the patients with poylsensitization to alder, hazel and birch pollen who developed cross-reaction, initial symptoms occurred as early as February, with abrupt exacerbation in March and April. The most severe condition was observed in the patients allergic to birch, hazel, alder, grass and ragweed pollen, with symptoms present throughout the year and exacerbation in spring and late summer months. [author abstract] [Ann Agric Environ Med 2007, 14, 87-91]
• Monitoring of Chlorinated Hydrocarbon Pollution of Meat and Fish in Croatia
  Four hundred and sixty-six fatty tissue samples of beef, pork, poultry and fish were assayed by the gas and liquid chromatography between 1992 and 1996 for chlorinated hydrocarbons: hexachlorobenzene (HCB), α-hexachlorocyclohexane (α-HCH), γ-hexachlorocyclohexane (lindane), DDT and metabolites, and total polychlorinated biphenyls (PCBs). Samples were divided into two groups, meat and fish imported to Croatia, and meat from Croatian farms and fish from the Adriatic Sea. In domestic meat, the levels of pollution with the compounds studied were considerably lower than in imported meats. The differences were most noticeable in lindane and DDT levels in beef, and those of DDT in pork. The average level of lindane in domestic and imported beef was 0.004 and 0.020 mg/kg, respectively. Domestic beef contained on the average 0.013 mg/kg and the imported beef 0.059 mg/kg DDT, respectively. While the average amount of DDT in local pork was 0.014 mg/kg, the average for imported pork was 0.041 mg/kg. Poultry lindane also showed significant differences, an average of 0.012 mg/kg in domestic and 0.034 mg/kg in imported poultry. HCB and α-HCH displayed a statistically significant difference in beef. There was an average level of 0.001 mg/kg of HCB and 0.001 mg/kg of α-HCH. However, imported beef had an average of 0.004 mg/kg of HCB and 0.002 mg/kg of α-HCH. A significant difference was also found in HCB content in poultry; domestic and imported poultry contained an average of 0.001 and 0.003 mg/kg, respectively. As regards the pollution of fish with polychlorinated biphenyls, this was considerably higher in the fish of domestic origin (average of 0.046 mg/kg) than in imported fish (average level of 0.006 mg/kg). Conversely, in both sample groups the pollution of fish with chlorinated pesticides was similar. Compared with meat and fish of the same origin and standing that were analyzed by our laboratory 10 years ago, the pollution of domestic meat and fish with clorinated [sic] hydrocarbons showed a trend of noticable [sic] decline. [author abstract] [Food Technol. Biotechnol. 40(1): 39–47 (2002)]
• Outbreak of hand, foot and mouth disease caused by Coxsackie A16 virus in a childcare centre in Croatia, February to March 2011
  We describe an outbreak of hand, foot and mouth disease (HFMD) in a childcare centre in a district of Zagreb county, north-west Croatia. A total of eleven cases of HFMD occurred in the childcare centre and another nine were reported from nearby areas in the district. Coxsackie A16 virus was diagnosed in 13 clinical specimens obtained from 11 symptomatic and asymptomatic children. All cases resolved without complications. [publication summary] [Euro Surveill. 2011; 16(21): pii=19875]
• Public health problems in the medieval statutes of Vinodol, Vrbnik and Senj (West Croatia)
  Background: The ancient Croatian statutes were written in the thirteenth and fourteenth centuries. The aim of this study was to seek out regulations concerning public health in the oldest medieval statutes of the towns on the northern Adriatic coast (W Croatia). Methods: All translated text editions of the statutes of the three towns were examined. The statutes were written in the thirteenth and fourteenth centuries. Results: The research of the materials revealed the examples of direct and indirect ways of protecting public health. Regulations on keeping towns clean and the rules for dealing with animal products were found. Additionally, witches and fortunetellers were found to be treated as a negative force and defined as the embodiment of evil: they were thus considered to be heavily connected to illness and misfortune. Conclusion: The aforementioned rules are not only important from the historical point of view, but also as a reflection of people’s awareness of public health as a condition of survival and the progress of the community as a whole. Furthermore, since those statutes were created from people’s customs that were to eventually become a law, they show substantial progress in medical history for that particular part of Croatia. [author abstract] [Journal of Public Health, Vol. 28, No. 2, pp. 166–167, 2006]
• Serosurvey of Human Metapneumovirus Infection in Croatia
  Aim: To assess the seroprevalence of human metapneumovirus (hMPV) in Croatia. Methods: During 2005, a total of 137 serum specimens from Croatian patients aged from 6 days to 51 years, without respiratory symptoms, were collected at the Croatian National Institute of Public Health. The sera were examined using the indirect immunofluorescent assay. Results: The overall hMPV seropositivity rate in the samples tested was 77.4% (106/137). The seropositivity rate increased from 18.7% in children aged between 6 months and 1 year to 100% in people older than 20 years of age. The highest proportion of titers ≥1:512 was found in children aged from 1 to 2 years. Conclusion: Our results suggest that hMPV infection is present in Croatia, with primary infection occurring in early childhood. This is the first study that indicates the circulation of hMPV in Croatia. [author abstract] [Croat Med J. 2006; 47: 878-881]
• UNGASS Country Progress Report: Croatia – Reporting period: January 2008 – December 2009
  "The HIV/AIDS situation has been monitored in Croatia since 1985, when the first AIDS cases were documented here. Between 1985 and 2009, there were 792 documented cases of HIV infection, 301 of which progressed to AIDS. During the same period of time, of the 792 diagnosed HIV 164 patients died. Four fifths of HIV/AIDS cases are male, who are mostly infected between the age[s] of 25 – 49. With respect to probable transmission routes 7.7% of all HIV infections occurred through injecting drug use, while the majority of cases are attributed to sex between men, of which there is 48.5% among all HIV cases. Also, 24.2% HIV infections occurred through heterosexual route outside a stable relationship and 1.9% through a heterosexual route of transmission from a steady partner. When we consider the receiving blood products as a transmission route, 0.4% of all infections occurred in this way. Additionally, 1.8% of all infections were found among hemophiliacs. Also, 1.4% of the HIV infections cases were cases of mother to child transmission. Finally 4.2% were of unknown mode of transmission.” [The Republic of Croatia, The Ministry of Health and Social Welfare, March 2010]
• Use of Preventive Health Care Services among the Unemployed in Croatia
  Aim: To analyze the association between unemployment and the use of preventive health care services in Croatia. Methods: Data on the use of preventive health care services and employment status were taken from the 2003 Croatia Adult Health Survey. A multistage stratified sample design was used to define a representative sample (n = 9070 individuals) of the Croatian general adult population. Binary logistic regression was used for analysis. Odds ratios were estimated for the association between employment status and preventive health care services, controlling for age, sex, region, marital status, level of education, occupation, and distance from general practitioner (GP) facilities. Results: Our sample comprised 1356 men and 1932 women. Out of them, 382 men (28.2%) and 472 women (24.4%) were unemployed. Unemployment was negatively associated with the use of some preventive health care services in the year before the study among healthy individuals (regular blood pressure control odds ratio [OR], 0.738, 95% CI, 0.576-0.945; blood glucose control OR, 0.751, 95% CI, 0.565-0.999; attending general preventive examinations OR, 0.563, 95% CI, 0.410-0.772) as well as among individuals who reported cardiovascular and/or metabolic diseases (attending general preventive examinations OR, 0.661, 95% CI, 0.456-0.959; receiving doctor’s advice for food habit change and influenza immunizations OR, 0.627, 95% CI, 0.424-0.928). Conclusion: Both the unemployed who had cardiovascular and metabolic diseases and those who did not, used less preventive health services than respective subgroups of the employed. In order to achieve a more equitable distribution of preventive health care services, the Croatian health care system should provide additional attention to the unemployed; for instance by developing a program of preventive health examinations targeting this vulnerable population. [author abstract] [Croat Med J. 2007; 48: 667-674]

Educational Resources

• CDC - Travel Information : Eastern Europe and the NIS
• Croatia Health Briefing Paper - This profile has been produced by the DFID Health Systems Resource Centre as one element of a project undertaken in 2003 by the London School of Hygiene and Tropical Medicine (LSHTM), the Open Society Institute (OSI), the UK Department for International Development (DFID) and the United Nations Children’s Fund Regional Office for the CEE/CIS Baltic States.
• Croatian Medical Journal Online
• Medicina - "Journal of the Croatian Medical Association - Rijeka Branch publishes original articles, reviews, case reports, preliminary communications, special articles, editorials and letters to the editors, book reviews and reports of scientific meetings, pertaining to the broad field of medicine and organized in thematically."