Silvije Vuletić

Evaluation of Croatian model of polycentric health planning and decision making.

OBJECTIVE To determine the progress in the development and implementation of health policies on a county level resulting from the learning-by-doing training provided through the County Public Health Capacity Building Program started in 2001 in Croatia. METHODS Modular training using management tools, public health theory and practice, and SMDPs Healthy Plan-it tool, followed by the self-evaluation of the progress made by county teams in health needs assessment and health policy development, implementation, and assurance. Fifteen county teams consisting of politicians, executive officers, public health professionals, and community members. RESULTS Twelve of 15 county teams completed the program. The teams made progress in the evaluated areas, although to a different extent, which did not depend on the amount of time they had or the governance experience. The differences in improvement depended on the differences in the strength of political, executive, and professional components of the teams. Teams with a strong political and/or executive component, but weak public health professional and community components made major improvements in policy development and/or assurance function, but performed less well in the health needs assessment and constituency building. The reversed was also true. CONCLUSION Learning-by-doing training program improved public health practices on a county level in Croatia.

Modeling metabolic syndrome through structural equations of metabolic traits, comorbid diseases, and GWAS variants.

To provide a quantitative map of relationships between metabolic traits, genome‐wide association studies (GWAS) variants, metabolic syndrome (MetS), and metabolic diseases through factor analysis and structural equation modeling (SEM).

Scale and Dynamics of Overweight and Obesity Epidemic in Croatia

The prevalence of overweight and obesity is showing a strong increasing trend in most countries. We aimed to investigate the scale and dynamics of the overweight and obesity epidemic in Croatia, by comparing the data from the Croatian Health Survey (CHS) from 1997-1999 (N=5, 048) with the Croatian Adult Health Survey (CAHS) from 2003 (N=9, 070). Weighted data from the CAHS were used, based on a complex seven steps scheme employed to ensure the creation of representative sample of the adult Croatian population in terms of regional, urban-rural and household characteristics and in order to adjust for nonresponders [1]. Both surveys were previously shown to be representative for the Croatian adult population, compared to the 2001 official Census data [2]. Gender and age groups (18-34, 35-49, 50-64 and 65 and more) stratified prevalence of overweight and obesity were calculated in both surveys. Interestingly, the prevalence of overweight (BMI≥25 kg/m2) in men of all ages decreased from 45.7% in 1997-1999 to 43.3% in 2003 (-5.3% of percent change), while the prevalence of obesity (BMI≥30 kg/m2) increased from 12.6% to 20.2% (+60.3%). In women the prevalence of overweight increased from 31.6% to 33.6% (+6.3%), while the prevalence of obesity increased from 14.9% to 20.6% (+38.3%). However, the age stratified prevalence of obesity showed the highest increase in the youngest age group (18-34), where the increase in men was 83.6%, while in women the prevalence of obesity increased 320%, from 1.5% to 6.3%. Notably, the estimates for the youngest age groups were based on the sufficient sample sizes (a total of 1, 398 in the CHS and 1, 414 respondents in the CAHS), thus reducing the possibility that these changes were the consequence of the small sample size. In contrast to commonly referred lack of information for policy on cardiovascular diseases [3], the results of this study suggest that the youngest adults (especially women) should be treated as a priority population group that requires substantial public health intervention aiming to reduce the epidemic of overweight and obesity. Without such an intervention, we are most likely to expect substantial increase in the prevalence of obesity in the years to come. However, it should be pointed out that in some countries obesity rates have recently seemingly plateaued at a high level.

Decision Support System (DSS) in Managing Health Centers

Decision support system (DSS) for the manager of a health center has beendeveloped. DSS is based on some internal and external information. Instaled on apersonal computer it serves as an assistant to the manager, giving him a basis fordecision making and some warnings about not allowed and/or not expected situations.

Recipe from the past for the future: public health intervention represent a process for century

In the poor Bosnia, in the early 20th century endemic syphilis was widespread. Combating this disease entailed the necessity of etiology research, diagnosis and clinical nature of the disease, as well as the insight into the epidemiological image of this unresolved health problem. Thanks to the visionary, the enthusiasm and persistence of the expert team of doctors from that time in Croatia, School of Public Health and the Rockefeller Foundation as financial support, conditions were created to conduct population monitoring and research called “survey”. The team of experts from Croatia and Bosnia led by Dr. Ante Vuletic began this important public health intervention in Central Bosnia underneath the mountain Vlasic 1934. In villages of mountain Vlasic people were living in very difficult social and unsanitary conditions. “Interviewers” worked in makeshift clinics in the rural schools Opare, Rankovici, Vitovlje Mehorica, Turbe, Bila and Gornji Vakuf. A hundred years later, a team of university professors from the School of Public Health “Andrija Stampar” led by Professor Silvije Viletic followed the footsteps of century “survey” on Vlasic in the summer of 2014. They determined that with the integrated approach to population monitoring and testing endemic syphilis in Bosnia was successfully suppressed.

Smoking behaviors in Kosova: Results of steps survey

Abstract Introduction Tobacco use continues to be the leading global cause of preventable death. Most of these deaths occur in low and middle-income countries, and this trend is expected to widen further over the next several decades. The overall objective of the study is to describe and analyse the smoking behaviours of adults in Kosova. Methods According to the STEPs methodology, 6,400 respondents, aged 15 - 64 years, are selected randomly within each sex and 10-year age-group. Out of 6,400 participants, 6,117 were selected, which is approximately 95.6%. Results The prevalence of smoking was higher among males (37.4%) compared with females (19.7%). In all age groups, the prevalence of smoking was higher among males compared with females. Regarding the age group of 15 - 24 years, the prevalence of smoking was 16.0%, but in the age group of 25 - 34 years, it nearly doubled to the rate of 31.9%. We have a smaller increase in the age group of 35 - 44 years, and after the age of 45, it falls gradually. Conclusions The prevalence of smoking in Kosova is high compared with other countries in Eastern Europe. In future decades, Kosova will face a high probability of an increased burden of smoking-related diseases.

P2P in public health: From particles to populations

Despite numerous changes introduced by the new technologies, the role and the meaning of public health within health has remained stable and important. Public health is also expanding from the strictly population-focus to genetics and nano-technology. This means that the fundaments of public health need to be supplemented by the additional expertise in areas such as medical informatics, bioinformatics, genetic epidemiology and public health genomics. The first step in integration is to develop the means of joining these ideas and experts in the solving of multidisciplinary problems, aiming to supplement public health with the emerging new technologies, ideas and concepts.