Jadranka Božikov

Differences in healthcare service utilisation in elderly, registered in eight districts of five European countries

Aims: The aim of the study was to compare and analyse the differences in self-reported frequencies of visits paid to physicians and hospitalisation rates, as well as their association with socio-demographic factors and health status self-rated by elderly. Methods: A cross-sectional study was performed in eight districts of five European countries (Finland, Sweden, Ireland, Croatia, and Greece). A total of 3540 persons aged 70 or more were interviewed by trained interviewers. Healthcare service utilisation and its association with demographic characteristics and self-rated health were analysed using descriptive statistical methods, chi-square test, and logistic regression. Results: Almost 90% of elderly visited a physician in the past year; 50% visited a specialist, while 24% were hospitalised. A visit to a specialist was paid by 70% of the Greek, 50% to 60% of the Croatian, and around 40% of the Irish, the Finnish, and the Swedish elderly. The highest proportion of hospitalisations (32%) was encountered in Greece and the lowest one (20%) in Sweden. Self-rated poor health appears to be the only common denominator associated with increased healthcare utilisation. Younger age stood out as a statistically significant predictor of the likelihood of specialist consults, while older age, male gender, and the synergy of male gender and current single life were disclosed as the predictors of hospitalisation frequency. Conclusions: Healthcare service utilisation exercised by the elderly across European districts was found to be highly variable and showed a clear distinction between north-western and south-eastern Europe; this is in line with differences in self-rated health.

Epidemiology of cardiomyopathies in children and adolescents: a retrospective study over the last 10 years

We conducted a retrospective study at the Department of Paediatric Cardiology of the University Hospital Centre Rebro, Zagreb, over the period from 1988 to 1998, so as to assess the epidemiology of childhood cardiomyopathies. The patients were categorized according to the guidelines of the Task Force on Cardiomyopathies of the World Health Organization and the International Society and Federation of Cardiology. We identified 121 infants, children and adolescents as having cardiomyopathy, giving an average occurrence for all cardiomyopathies of 38.81 for each 10,000 patients examined in our outpatient clinics for paediatric cardiology. Of the patients, 50 were female (41.3%) and 71 were male (58.7%). The cardiomyopathy was of the dilated variant in 52 patients (42.9%), with 43 patients (35.5%) having hypertrophic cardiomyopathy, and 6 patients (4.8%) identified with restrictive cardiomyopathy. We encountered no patients with arrhythmogenic right ventricular cardiomyopathy. In nine patients (7.4%), it proved impossible to classify the cardiomyopathy. We placed 11 patients (9.0%) in the group of specific cardiomyopathies. Most of those with dilated cardiomyopathy had been diagnosed prior to the age of 3 years (RR 1.9, 95% CI 1.4-2.47). There were no statistically significant differences in the incidences of dilated as compared to hypertrophic cardiomyopathy (Z 0.923, p = 0.1779), but we encountered a significantly lower occurrence of restrictive cardiomyopathy (Z 6.044, p < 0.001). Of those with hypertrophic cardiomyopathy, 15 patients (34.8%) had the asymmetric variant, while 28 patients (65.2%) exhibited the concentric form. During the period of follow-up, 10 patients died, 4 with dilated cardiomyopathy, 4 with hypertrophic cardiomyopathy, 1 with restrictive cardiomyopathy, and 1 with a specific cardiomyopathy. We encountered 12 (9.9%) patients who, besides cardiomyopathies, also suffered from neuromuscular disorders. Most of these had dilated cardiomyopathy. Mitochondrial disorders, in contrast, were more frequently found in patients with hypertrophic cardiomyopathy.

Clinical and epidemiological aspects of respiratory syncytial virus lower respiratory tract infections

This paper has analyzed respiratory syncytial virus lower respiratory tract infections in 201 hospitalized children. In children with wheezing, erythrocyte sedimentation rate (ESR) was significantly higher in those with pneumonia than with syndroma pertussis, while the white blood cell (WBC) count was significantly lower in patients with bronchitis than in those with bronchiolitis and syndroma pertussis. Bronchodilatators were applied in 75.6% and corticosteroids in 20% of patients. Ten patients were ventilated. Fatal disease outcome was observed in one infant. Twelve consecutive-year study of respiratory syncytial virus (RSV) infections showed that 27.3% of these diseases were bronchiolitis and pneumonia.

The use and exchange of teaching modules published in the series of handbooks prepared within the frame of the „forum for public health in south-eastern Europe“ network

Abstract Aim: Throughout 2004-2010, the series of 6 books entitled “Handbooks for Teachers, Researchers and Health Professionals” were published within the frame of the public health network established in South Eastern Europe (SEE), covering the total of 249 teaching modules. The aim of the study was to assess the use and exchange of these modules between the authors. Methods: Out of 148 identified authors, 106 took part in the cross-sectional study carried out from July to November 2011 (response rate: 71.6%). The primary endpoints were the utilization (use and/or exchange) of the modules in general, the percentage of utilized modules from all volumes, the percentages of utilized modules of each volume separately, and the percentage of utilized modules from all the volumes at different levels of the educational process. Non-parametric statistical methods were used for analysis (e.g. Mann-Whitney and Friedman tests). Results: Module utilization was reported by 80/106 participants (75.5%). The median value of the percentage of utilized modules from all the volumes was 4.8, being much higher among full-time university staff (9.2; p=0.008) and authors/editors (14.7; p=0.010). The respondents most frequently utilized Volume 1 (median value: 7.7) and Volume 6 (median value: 4.2) modules (p=0.002) as part of undergraduate (median value: 1.4) and postgraduate vocational (median value: 1.4) study programmes (p<0.001). Conclusion: The level of module utilization within the group of their authors is good. However, this is only partial information and not representative of the entire target population of SEE public health teachers. Izvleček Namen: V okviru javnozdravstvene mreže za jugovzhodno Evropo (JVE) je bila v obdobju 2004-2010 objavljena serija šestih knjig z naslovom Priročniki za učitelje, raziskovalce in zdravstvene delavce. Skupno je bilo objavljenih 249 učnih modulov. Namen študije je bil oceniti uporabo in izmenjavo modulov med avtorji. Metode: V presečni raziskavi, ki je bila izvedena v obdobju julij-november 2011, je sodelovalo 106 od 148 vabljenih avtorjev (71,6-odstotna odzivnost). Glavni opazovani pojavi so bili: uporaba/izmenjava modulov na splošno, odstotek uporabljanih/izmenjanih modulov iz vseh knjig, odstotek uporabljanih/izmenjanih modulov za vsako knjigo posebej in odstotek uporabljanih/izmenjanih modulov iz vseh knjig na različnih stopnjah izobraževalnega procesa. Za analizo smo uporabili neparametrične statistične metode (Mann Whitney in Friedmanov test). Rezultati: 80/106 udeležencev (75,5 %) je poročalo, da uporabljajo/izmenjujejo module. Med njimi je bila mediana odstotka uporabljanih/izmenjanih modulov iz vseh knjig 4,8. Le-ta je bila precej višja med polno zaposlenim univerzitetnim osebjem (9,2: p = 0,008) in avtorji/uredniki (14,7; p = 0,010). Ti anketiranci najpogosteje uporabljajo/izmenjujejo module prve (mediana: 7,7) in šeste knjige (mediana: 4,2) (p = 0,002). Najpogosteje jih uporabljajo na dodiplomskih (mediana: 1,4) in podiplomskih strokovnih študijskih programih (mediana: 1,4) (p < 0,001). Zaključki: Uporaba modulov v skupini njihovih avtorjev je dobra, vendar pa je to le delna informacija o uporabi modulov v ciljni populaciji učiteljev javnega zdravja v JVE.

Computerized Epidemiometric Model of Shigellosis and Its Use in Assessing Potential Usefulness of New Tools for Disease Control

A computerized prototype of the epidemiometric model of bacillary dysentery was developed in order to study its potential usefulness in public health. The multistate model was built on the basis of the natural history of shigellosis by formulating an appropriate set of difference equations relevant to the flow of population between epidemiological classes. Necessary software was developed for performing interactive simulation games. Simulations included studying the natural course of the disease in a stable endemic situation, the results of the application of different types of vaccines, both real and hypothetical. The epidemiometric model of shigellosis also appears to be useful in the evaluation of the projects aimed at the development of new control measures, such as new vaccines against this disease. Further investigation of shigellosis modelling is needed in order to design realistic models of this disease with complex etiology.

Lessons from Two Decades of Health Reforms in South East Europe

What lessons can be drawn from two decades of health reforms in South East Europe? While countries of the region exhibit many substantial differences, it is intriguing that, in embarking on reforms of their health sectors, they responded to many of the same challenges. These included a challenging socio-economic context in the first years of transition, widespread dissatisfaction with the health systems inherited from the communist or socialist period, and, in many countries, the poor health of the population in the 1990s. Increasingly, the ageing of populations is also becoming a concern for health policymakers.

A microcomputer method for continuous system simulation in health care.

A method for continuous system simulation in biomedicine and health care intended for use with personal computers is described. The method is applicable to multistate deterministic models and based on the use of standard spreadsheet programs used with such computers. It includes features such as model implementation, changes of simulation parameters, execution of simulation experiments as well as tabular and graphic presentation of simulation results. The method can be used for simulation of systems in epidemiology, health-care organization and other biomedical fields where deterministic models are suitable tools for studying phenomena connected with live systems.

A Computer Simulation Program for the Assessment of Multistate Epidemiological Models of Infectious Diseases

The computer simulation of multistate epidemiological models is presented and the conditions for performing simulation experiments are discussed. A general purpose interactive software package for continuous simulation developed on this basis is implemented. Successful tests were made with several models of infectious diseases. The need for the introduction of sensitivity analysis into simulation experiments is emphasized.