Vesna Jureša

Croatia has reached iodine sufficiency.

This study was performed in 2002, 6 yr after the introduction of a new regulation on salt iodination with 25 mg KI/kg of salt. The aim of the study was to evaluate whether further significant positive results of improved iodine intake could be observed among schoolchildren in Croatia. A total of 927 schoolchildren of both sexes, aged 6–12 yr, were included in the study. In Croatia, with a population of 4,437,460 the research was implemented in four major geographical regions: the Northwestern, Slavonia, Northern Adriatic and Dalmatian regions. Investigations included randomly selected pupils from regional centers and neighboring smaller towns or villages. The results have revealed that thyroid volumes were within the normal range according to the provisional WHO/ICCIDD reference values for sonographic thyroid volume in iodinereplete school-age children, updated in 2001. A significant improvement in medians of urinary iodine excretion was detected in 2002: from 9 gMg/dl in 1991 to 14.6 gMg/dl in Zagreb, from 4.3 gMg/dl in1995 to 13.1 gMg/dl in Split, from 9.4 gMg/dl in 1997 to 14.2 gMg/dl in Rijeka and from 13.4 gMg/dl in 1997 to 14.7 gMg/dl in Osijek. An overall median of 14.0 gMg/dl of urinary iodine excretion was detected in Croatian schoolchildren. The control of salt at different levels, from production to consumption, including salt produced in all three Croatian salt plants and imported salt, revealed that Croatian salt is adequately iodized. From severe iodine deficiency before the 1950s, through mild-to-moderate iodine deficiency in the 1990s, Croatia has now reached iodine sufficiency.

Endemic goiter in Croatia

In the early nineties, 40 years after the introduction of iodine prophylaxis in Croatia (10 mg KI/kg salt), a nationwide study was initiated with the aim to determine the real prevalence of goiter in the country. A total of 2436 schoolchildren of both sexes, aged 7-15 years, were included in the study. Investigations were designed in a way to cover most of geographical regions in Croatia and subjects were randomly selected. The prevalence of goiter in schoolchildren was assessed by palpation and in part by ultrasonography of the neck. At the same time urinary iodine excretion was measured and potassium iodide content in salt samples was determined. The results revealed the persistence of mild endemic goiter in the inland parts of Croatia with the prevalence of 6-29% in the age group 7-11 years and 10-43% among the age group 12-15 years. The overall goiter prevalence in schoolchildren in Croatia fluctuates from 8% to 35%. The urinary iodine excretion in Zagreb varied from 1.6 to 24.4 micrograms/dL with a median of 9.0, while in 14% it was below 5 micrograms/dL. The urinary iodine excretion in Samobor varied between 0.5 and 19 micrograms/dL with a median of 7.4 micrograms/dL, while in 30% it was below 5 micrograms/dL. Examination of salt from all three salt plants in Croatia showed iodine contents between 0.0 and 12.73 mg/kg with the average value of 5.39 mg/kg. Such prevalence, most probably due to less than optimum iodine intake, is unlikely to change until potassium iodide content of salt is increased from its present level of 10 mg of KI per kg of salt, with concomitant stricter observance of legal regulations.

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).

The cross-cultural (transcultural) adaptation and validation of the nursing image questionnaire

Education of nurses in the Republic of Croatia is being developed as a result of compliance with education in the European Union and the implementation of nursing research that leads to the growth of the whole profession. However, prejudice against the nursing profession is still present and therefore it is necessary to explore the attitudes of the general population and the population of nurses in the nursing profession in order to discover the causes of such prejudices and act on them. Therefore, the aim of this paper was to present transcultural adaptation and validation of the Nursing Image Questionnaire, which was created by Toth and associates (1998). The questionnaire, which includes 30 items and measures how an individual looks at the roles, values, and professional activities of nurses, was conducted as part of a preliminary study and was culturally adapted. The final study included 905 students who in 2011 and 2012 enrolled in the first year of full-time and part-time nursing study; the questionnaire was completed by 725 students. Toth and associates assumed that the attitude toward nursing is expressed as the sum of the responses of all the items, which would mean a factor structure with high item intercorrelation, but they also split the questionnaire into five thematic units. Results showed that, contrary to expectations, intercorrelations of items were extremely low and that following the completion of factor analysis, no satisfactory construct validity was established. From the obtained results, it can be concluded that it is not justified to create a latent dimension as established by research of Toth and associates, and the items, although there is a correlation between some of them, should be interpreted and analysed as independent constructs.

Changes in Nursing Students’ Attitudes Towards Nursing During Undergraduate Study

The aim of this study was to determine the attitudes of nursing students towards nursing, and changes in their attitudes during the study. A quantitative study with pre-post survey was conducted among nursing students enrolled in first study year in the academic year 2012/2013 (N=115) and third study year in the academic year 2014/2015 (N=106). Students voluntarily and anonymously completed a questionnaire consisting of demographic information and the Nursing Image Questionnaire, which includes 30 items that assess how an individual looks at the roles and tasks, values, social stereotypes of nursing, professionalism and performance of nurses. The results indicated that students had positive attitude towards nursing at the beginning and during the study. During the study, there was a positive change in attitudes in the majority of items of the questionnaire, whereas at the end of the study lower attitude was expressed in only four items. The study conducted among nursing students indicated that students’ attitudes changed during the study, influenced by the acquisition of knowledge and skills. During the study, students acquire a more realistic perception of nursing, and adoption of professional values emerges.