Milica Katić

Continental-Mediterranean and rural-urban differences in cardiovascular risk factors in Croatian population

Aim To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. Methods A multicenter prospective study was performed on 2467 participants of both sexes ≥40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. Results Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P < 0.001), obesity (P = 0.001), increased waist circumference (P < 0.001), and more intense physical activity (P = 0.020). Participants from coastal rural areas had higher HDL-cholesterol, participants from continental rural and coastal urban areas had higher LDL-cholesterol, and participants from rural continental had significantly higher BMI and waist circumference. Conclusion Prevalence of CVD risk factors in Croatian population is high. Greater burden of risk factors in continental region and rural areas may be partly explained by lifestyle differences.

Association between hyperuricemia, prediabetes, and prehypertension in the Croatian adult population--a cross-sectional study.

BackgroundThe association between hyperuricemia, hypertension, and diabetes has been proved to have strong association with the risk for cardiovascular diseases, but it is not clear whether hyperuricemia is related to the early stages of hypertension and diabetes. Therefore, in this study we investigated the association between hyperuricemia, prediabetes, and prehypertension in Croatian adults, as well as that between purine-rich diet and hyperuricemia, prediabetes, or prehypertension.MethodsA stratified random representative sample of 64 general practitioners (GP) was selected. Each GP systematically chose participants aged ≥ 40 year (up to 55 subjects) . Recruitment occurred between May and September 2008. The medical history, anthropometric, and laboratory measures were obtained for each participant.Results59 physicians agreed to participate and recruited 2485 subjects (response rate 77%; average age (± standard deviation) 59.2 ±10.6; 61.9% women. In bivariate analysis we found a positive association between hyperuricemia and prediabetes (OR 1.66, 95% CI 1.09–2.53), but not for prehypertension (OR 1.68, 95% CI 0.76–3.72). After controlling for known confounders for cardiovascular disease (age, gender, body mass index, alcohol intake, diet, physical activity, waist to hip ratio, total cholesterol, low density lipoprotein, high density lipoprotein, and triglycerides), in multivariate analysis HU ceased to be an independent predictor(OR 1.33, CI 0.98–1.82, p = 0.069) for PreDM. An association between purine-rich food and hyperuricemia was found (p<0.001) and also for prediabetes (p=0.002), but not for prehypertension (p=0.41). The prevalence of hyperuricemia was 10.7% (15.4% male, 7.8% female), 32.5% for prediabetes (35.4% male, 30.8% female), and 26.6% for prehypertension (27.2% male, 26.2% female).ConclusionHyperuricemia seems to be associated with prediabetes but not with prehypertension. Both, hyperuricemia and prediabetes were associated with purine-rich food and patients need to be advised on appropriate diet.Trial registrationCurrent Controlled Trials ISRCTN31857696

How well do anthropometric indices correlate with cardiovascular risk factors? A cross-sectional study in Croati.

Summary Background Usefulness of anthropometric indices (AI) as predictors of CV risk is unclear and remains controversial. Material/Methods To evaluate the correlation between AI and CV risk factors in the Croatian adult population and to observe possible differences between coastal and inland regions and urban and rural settlements. CRISIC-fm (ISRCTN31857696) is a prospective, randomized cohort study conducted in GP (general practitioner) practices in Croatia. Between May and July 2008, 59 GPs each recruited 55 participants aged ≥40 years, who visited a practice for any reason. Height, weight, waist and hip circumference and blood pressure were measured. Blood samples were analyzed in accredited laboratories. Results Out of 2467 participants (61.9% women, 38.1% men), 36.3% were obese, with fewer in coastal than inland areas. More obese people were in rural areas. Logistic regression showed BMI was the most important predictor of hypertension, diabetes and dyslipidemia in both regions (except for diabetes in the coastal area), and for urban and rural settlements (except for diabetes in rural areas). WtHR was a significant predictor for hypertension and dyslipidemia in the coastal (but only for hypertension in the inland area), and in urban settlements (in rural only for hypertension). None of the AI showed significant correlation with total CV risk, but WC and BMI did with stroke risk. Receiver operating curve (ROC) analyses showed that WtHR was a better predictor than all other AI for hypertension and dyslipidemia. Conclusions Results encourage the use of BMI and WtHR as important tools in predicting CV risk in GP’s practice.

Is Burnout in Family Physicians in Croatia Related to Interpersonal Quality of Care

The impact of physician burnout on the quality of patient care is unclear. This cross-sectional study aimed to investigate the prevalence of burnout in family physicians in Croatia and its association with physician and practice characteristics, and patient enablement as a consultation outcome measure. Hundred and twenty-five out of 350 family physicians responded to our invitation to participate in the study. They were asked to collect data from 50 consecutive consultations with their adult patients who had to provide information on patient enablement (Patient Enablement Instrument). Physicians themselves provided their demographic and professional data, including workload, job satisfaction, consultation length, and burnout [Maslach Burnout Inventory - Human Services Survey (MBI-HSS )]. MBI-HSS scores were analysed in three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA). Of the responding physicians, 42.4 % scored high for EE burnout, 16.0 % for DP, and 15.2 % for PA. Multiple regression analysis showed that low job satisfaction and more patients per day predicted high EE scores. Low job satisfaction, working more years at a current workplace, and younger age predicted high DP scores. Lack of engagement in education and academic work, shorter consultations, and working more years at current workplace predicted low PA scores, respectively (P<0.05 for each). Burnout is common among family physicians in Croatia yet burnout in our physicians was not associated with patient enablement, suggesting that it did not affect the quality of interpersonal care. Job satisfaction, participation in educational or academic activities and sufficient consultation time seem to reduce the likelihood of burnout. Sažetak Povezanost sindroma izgaranja liječnika i kvalitete skrbi nije potpuno jasna. Cilj rada bio je istražiti učestalost sindroma izgaranja u liječnika obiteljske medicine (LOM) u Hrvatskoj te povezanost sindroma izgaranja i obilježja liječnika i njegove prakse te osposobljenosti bolesnika kao mjere ishoda konzultacije. Provedeno je presječno istraživanje na nacionalnom stratificiranom slučajnom uzorku od 350 LOM koji su prikupili podatke od 50 odraslih bolesnika tijekom 50 susljednih konzultacija. Za bolesnike su prikupljeni podaci o osposobljenosti bolesnika (Upitnik za procjenu osposobljenosti bolesnika, PEI), duljini konzultacije, a za liječnike podaci o demografskim i profesionalnim značajkama, opterećenju poslom, zadovoljstvu poslom, prisutnosti sindroma izgaranja na poslu (Maslach Burnout Inventory - MBI-HSS). Vrijednosti MBI-HSS analizirane su u tri dimenzije: emocionalna iscrpljenost (EI), depersonalizacija (DP) i osobno postignuće (OP). Među 125 liječnika, EI visokog stupnja zabilježena je kod 42,4 %, DP visokog stupnja kod 16,0 % te OP visokog stupnja kod 15,2 % liječnika. U regresijskoj analizi visoke vrijednosti EI su predviđali manje zadovoljstvo poslom i veći broj bolesnika dnevno. Visoke vrijednosti DP su predviđali manje zadovoljstvo poslom, više godina na sadašnjem radnom mjestu i mlađa dob. Niske vrijednosti OP su predviđale izostanak sudjelovanja u nastavnim ili akademskim aktivnostima, kraće konzultacije te više godina na sadašnjem radnom mjestu (P<0.05 za svaki). Sindrom izgaranja prisutan je među LOM u Hrvatskoj. Nismo utvrdili povezanost sindroma izgaranja liječnika i osposobljenosti bolesnika, odnosno prisutnost sindroma izgaranja nije bila povezana s kvalitetom komunikacijske skrbi. Zadovoljstvo poslom, sudjelovanje u nastavnim ili akademskim aktivnostima te dostatno vrijeme konzultacije mogli bi imati zaštitni učinak u nastanku sindroma izgaranja u liječnika.

Influenza vaccination prevalence and demographic factors of patients and GPs in primary care in Austria and Croatia: a cross-sectional comparative study in the framework of the APRES project

BACKGROUND The aim of this study was to compare influenza vaccination coverage rates in Austria and Croatia, countries with missing data in the Eurosurveillance and European Centre for Disease Prevention and Control reports. In addition, we assessed demographic factors of GPs and patients and calculated associations regarding vaccination rates. METHODS This cross-sectional study was conducted within the context of thethe appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance (APRES) project. Between November 2010 and July 2011, 40 GP practices attempted to recruit 200 patients to complete questionnaires about their influenza vaccination status and demographics. Statistical analyses included subgroup analyses and logistic regression models. RESULTS Data from 7269 patient questionnaires could be analyzed (3309 Austria and 3960 Croatia). The vaccination coverage rates were low (2009/2010: A 18.2 vs. C 20.9%, P < 0.001; 2010/2011: A 13.7 vs. C 18.6%; P < 0.001). The rates were found to be highest in persons aged 65 years and older (2009/2010: A 35.1 vs. C 49.5%, P < 0.001; 2010/2011: A 31.1 vs. C 45.7%, P < 0.001) and lowest in children (2009/2010: A 8.5 vs. C 2.0%, P < 0.001; 2010/2011: A 4.3 vs. C 1.6%, P = 0.002). Besides, demographics in the adjusted regression model for Austria being vaccinated was associated with consulting a female GP (OR, 4.20; P < 0.001) and in Croatia with five or more GP consultations per year (OR, 4.41; P < 0.001). CONCLUSION The vaccination coverage rates for Austria and Croatia were low, with the highest rates found in persons aged 65 years and older, showing that public coverage of the vaccination costs might increase vaccination rates. However, other factors seem to be relevant, including the engagement of GPs.

International textbook of family medicine: the application of EURACT teaching agenda.

UNLABELLED The paper describes experiences in the development of an international textbook of family medicine. The process of its development has started in Slovenia, where the Slovenian authors have written a textbook, adhering strictly to the European definition of family medicine and its core competencies. The format and the approach were also adopted by Croatian authors, who have used most of the material from the Slovenian book, but have modified some of the chapters according to the situation in the country and have added some of their own. This activity has created an opportunity for a truly international collaboration in the area of education of family medicine, with a creation of an international consortium, which would be responsible for the core content of the book and local adaptations of the book according to the specificities and needs of different countries. CONCLUSION This innovative approach in the development of teaching material may be interesting for a variety of smaller countries in Europe and worldwide.

The Combined Way of Paying Family Medicine in Croatia

The profound political, social, and economic reforms carried out in Croatia and other countries of transition in the 1990s brought about substantial changes in every sector, including the health system (Oreskovic 1998). Main changes in Croatia included the introduction of market principles and the strengthening of private initiatives and responsibilities of health care users. Major goals of health reform were halting the increase in costs, improving health system planning and management, reorganizing health financing and payment modalities, improving efficacy and quality of health services, and reinforcing preventive and primary care (Katic et al. 2004a).

Validation of the Croatian version of CIVIQ quality of life questionnaire in patients with chronic venous disorders

Aim To test the psychometric properties of the Croatian version of the Chronic Venous Insufficiency Quality of Life (CIVIQ) Questionnaire and to assess the quality of life in patients with chronic venous disorders of all stages. Methods This cross-sectional study performed between 2014 and 2015 in a private family practice assessed the factorial validity, cross-sectional validity, and reliability of the Croatian CIVIQ 20-item questionnaire completed by 428 adult patients (78% women) with chronic venous disorders classified according to the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) C classification as stages C1-C6. Results Median patient age was 52 years (5th-95th percentile, 30-77). The distribution according to the clinical stages of chronic venous disorders was as follows: C1 (n = 78, 18%), C2 (n = 192, 45%), C3 (n = 53, 12%), C4 (n = 44, 10%), C5 (n = 13, 3%), and C6 (n = 48, 11%). The CIVIQ-20 factorial structure was unstable, and six items were excluded from the analysis to test the psychometric properties of the shortened version (CIVIQ-14). CIVIQ-14 has three dimensions (physical, psychological, and pain). Internal consistency reliability is high for the entire CIVIQ-14 (Cronbach α = 0.92) and for all CIVIQ-14 dimensions (α≥0.80). The median quality of life significantly decreased with higher CEAP C stages as follows: C1/C2 (86, 50-100); C3/C4 (75, 36-98); C5/C6 (67, 31-95) (P < 0.001). Post-hoc analysis showed a higher quality of life in C1/C2 than in other groups (P < 0.001). Conclusion The shortened CIVIQ-14 version is useful for assessing the quality of life in patients with chronic venous disorders in everyday clinical practice. To achieve a stable validated instrument, we recommend a cross-cultural validation of items that have loadings on more than one factor.