Application of a system dynamics model in forecasting the supply and age distribution of physicians.

Aim: To predict the future supply and age distribution of physicians with a simulation model, which can be used as an advising tool for policymakers who decide on enrollment and specialization training (ST) quotas at the national level.

Methods: A simulation model was created using the system dynamics (SD) method. Changes in the number of physicians and their age distribution were projected in the context of the expected future changes of the Croatian population under different scenarios covering the period from 2017 to 2041.

Using Simulation Modeling to Inform Policy Makers for Planning Physician Workforce in Healthcare System in Croatia.

The objective of this paper is to show how a simple but powerful simulation model can be build up using standard spreadsheet program and used to simulate future, needs and supply of physicians in order to inform policy makers at national level when deciding on enrollment to medical schools and immigration quotas for physicians. The Republic of Croatia is facing a serious shortage of physicians in the healthcare system and simulation results have shown that the gap between needs and supply will even increase if current enrollment qoutas to medical schools would persist. Increasing enrollment quotas, adjusting immigration policy, re-directing physicians from other professions to the healthcare system, task shift and skill mix options are just some of the measures needed to be taken promptly in order to prevent a huge deficit of physicians in the future.

Use of System Dynamics Modeling in Medical Education and Research Projects.

The paper reviews experiences and accomplishments in application of system dynamics modeling in education, training and research projects at the Andrija Stampar School of Public Health, a branch of the Zagreb University School of Medicine, Croatia. A number of simulation models developed over the past 40 years are briefly described with regard to real problems concerned, objectives and modeling methods and techniques used. Many of them have been developed as the individual students' projects as a part of their graduation, MSc or PhD theses and subsequently published in journals or conference proceedings.

Training of Students for Critical Evaluation of Mobile Health Applications.

Medical and nursing students need to be trained in critical evaluation of mobile health applications (m-health apps) in order to see their potential and to understand the need for their validation and certification. Students should develop positive attitudes but also critical views on such apps in order to be prepared for responsible and ethical use of m-health in their future professional practice.

New study program: Interdisciplinary Postgraduate Specialist Study in Medical Informatics.

Paper presents an overview of the EU funded Project of Curriculum Development for Interdisciplinary Postgraduate Specialist Study in Medical Informatics named MEDINFO to be introduced in Croatia. The target group for the program is formed by professionals in any of the areas of medicine, IT professionals working on applications of IT for health and researchers and teachers in medical informatics. In addition to Croatian students, the program will also provide opportunity for enrolling students from a wider region of Southeast Europe.

[Anxiety and depression in elderly - prevalence and association with health care].

Objective: To investigate the prevalence of anxiety and depression in the elderly inhabiting Koprivnica-Kri evci, Istria and Dubrovnik-Neretva Counties and their association with socio-demographic characteristics and healthcare utilisation.

Methods: A cross-sectional cluster survey carried out in 2006, encompassing a total of 1,469 examinees aged 70+. The Hospital Anxiety and Depression (HAD) Scale was used to screen for self-reported symptoms of anxiety and depression, which were further associated with socio-demographic characteristics and healthcare utilisation.

Role of Ki-67 as a prognostic factor in gastrointestinal stromal tumors.

Aim: To investigate primarily the prognostic value of Ki-67, as well as other parameters, in gastrointestinal stromal tumors (GISTs).

Methods: Ki-67, c-KIT, platelet-derived growth factor receptor-alpha (PDGFRα), smooth muscle actin (SMA), CD34, S100 were stained for immunohistochemistry which was performed on formalin-fixed, paraffin-embeded sections on representative block from each case. Proliferation index counted by Ki-67 antibody was calculated as a number of positive nuclear reaction over 100 cells.

Objective identification of sexual risk behavior among blood donors in Croatia: is it reality?

Background: The objective of this study is to determine the prevalence of blood donors positive for herpes simplex virus type 2 (HSV-2), to identify the patterns of sexual risk behavior responsible for HSV-2 positivity and to assess the reliability of HSV-2 positivity as a marker of sexual risk behavior in the study population.

Methods: This cross-sectional study included 423 blood donors of both sexes from eastern Croatia. Their blood samples were tested by ELISA IgG test kit for HSV-2 IgG and Western blot.

Analysis of biennial outbreak pattern of respiratory syncytial virus according to subtype (A and B) in the Zagreb region.

Background: The epidemic pattern of respiratory syncytial virus (RSV) in Croatia is biennial. In order to determine if the circulation of different RSV subtypes affects the outbreak cycle, the aim of the present study was to analyze the epidemic pattern of RSV in children in Croatia (Zagreb region) over a period of 3 consecutive years.

Methods: The study group consisted of 696 inpatients, aged 0-5 years, who were hospitalized with acute respiratory tract infections caused by RSV, in Zagreb, in the period 1 January 2006-31 December 2008.

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.

Digital morphometry of cytologic aspirate endometrial samples.

Unlike cervical cytology, morphological cytology criteria in the differential diagnosis of endometrium have not yet been clearly defined, and methods to allow for more precise evaluation of endometrium status have been searched for. The aim of the present study was to assess the value of morphometric nucleus analysis of cytologic aspirate endometrial samples in proliferative, hyperplastic and malignant endometrium by use of digital image analysis. Morphometric analysis was performed on archival cytologic aspirate endometrial samples (at least 10 per group) stained according to Papanicolaou (n = 77) and May-Grünwald-Giemsa (MGG; n = 80) with the following histopathologic diagnoses: proliferative endometrium, hyperplasia simplex, hyperplasia complex, hyperplasia complex atypica, and adenocarcinoma endometriodes endometrii (grade I, II and III).

Does the viral subtype influence the biennial cycle of respiratory syncytial virus?

Background: The epidemic pattern of respiratory syncytial virus (RSV) is quite different in regions of Europe (biennial epidemics in alternating cycles of approximately 9 and 15 months) than in the Western Hemisphere (annual epidemics). In order to determine if these differences are accounted for by the circulation of different RSV subtypes, we studied the prevalence of RSV subtype A and B strains in Zagreb County from 1 January 2006 to 31 December 2007.

Results: RSV was identified in the nasopharyngeal secretions of 368 inpatients using direct fluorescence assays and/or by virus isolation in cell culture.

[Guidelines for diagnostics and treatment of arterial hypertension. Practical recommendations of the Croatian Working Group for Hypertension. Consideration on the ESH-ESC 2007 guidelines].

ESH/ECS guidelines for diagnostics and treatment of arterial hypertension 2007 is a basic paper for all physicians who treat hypertensive patients. Since publishing, this article has been the most cited medical paper. According to ESH/ECS guidelines some local peculiarities in each country should be considered when diagnosing and treating hypertensive patients.

[Risk factors as prognostic factors of hospital mortality in patients with acute myocardial infarction].

Objective: To determine whether there are any differences in the prevalence of risk factors between survivors and nonsurvivors among acute myocardial infarction (AMI) patients hospitalized in a county hospital.

Methods: Case histories of AMI patients treated at Department of Medicine, Bjelovar General Hospital from July 1, 1996 until December 31, 2000 were retrospectively analyzed. AMI was diagnosed using the World Health Organization definition.

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: a three year prospective study.

Aim: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy.

Methods: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.

The effect of baby friendly hospital initiative and postnatal support on breastfeeding rates--Croatian experience.

The effects of implementation WHO/UNICEF Breastfeeding Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates were examined during and after the breastfeeding promotion campaign in one county of Croatia. Comparison with a control group indicated increase of breastfeeding prevalence in a period of BFHI implementation (1994-1998) - 68% vs. 87% at infant age 1 mo.

Electronic health center (eHC): integration of continuing medical education, information and communication for general practitioners.

The Electronic Health Center (eHC) is aimed as an Internet service for continuing medical education of general practitioners (GPs) at the national level. It integrates education, access to relevant and trusted information sources and group communication in order to meet the needs of both daily work and continuing education at home.

Authorship in a small medical journal: a study of contributorship statements by corresponding authors.

The authorship criteria of the International Committee of Medical Journal Editors (ICMJE) are widely accepted in biomedical journals, but many studies in large and prestigious journals show that a considerable proportion of authors do not fulfill these criteria. We investigated authorship contributions in a small medical journal outside the scientific mainstream, to see if poor adherence to authorship criteria is common in biomedical journals. We analyzed statements on research contribution, as checked by the corresponding author, for individual authors of 114 research articles, representing 475 authors, submitted to the Croatian Medical Journal (CMJ) from 1999 to 2000.

Prognostic value of different factors in breast carcinoma.

Introduction: The aggressive biological behavior of invasive and metastatic cancer is considered to be the most insidious and life-threatening aspect for breast cancer patients. It is mostly the result of changes in many molecular characteristics of tumor cells, including alterations in the mechanisms controlling cell growth and proliferation.

Aim: The aim of this retrospective study was to identify predictors of aggressive biological behavior and metastatic potential in breast carcinoma among a number of intrinsic biomarkers of tumor cells such as steroid receptors and oncogene and tumor suppressor gene products.

Antioxidant enzymes activity in patients with peripheral vascular disease, with and without presence of diabetes mellitus.

The study evaluated antioxidant status in patients with peripheral vascular disease (PVD), with and without concomitant diabetes mellitus (DM). 211 participants were divided into standardized 4 groups: patients with PVD and DM (PVD+DM+), patients with PVD without DM (PVD+DM-), patients without PVD with DM (PVD-DM+) and patients without PVD and DM (PVD-DM-). The diagnosis of PVD was established by Doppler sonography analysis, including determination of the ankle brachial index (ABI), partial pressures along the leg, and CW Doppler sonography at typical locations.

Journal publications from Zagreb University Medical School in 1995-1999.

Aim: To analyze a five-year publication output of the Zagreb University Medical School in scientific journals, especially in the journals covered by the Current Contents (CC), bibliographic database of the Institute for Scientific Information.

Methods: Medical School of the Zagreb University is organized in 10 preclinical, 6 public health, and 17 clinical departments, with 359 faculty members. Research activity is important for the academic promotion, with the number of publications (especially in journals covered by CC) and their impact as a key element.

Dermatoglyphs of digito-palmar complex in autistic disorder: family analysis.

Aim: To examine the role of the genetic component in the quantitative dermatoglyphic traits of autistic patients and their families, and the transmission of the autism.

Methods: Finger and palm prints were taken from 120 autistic patients (92 males and 28 females), their parents (92 mothers and 70 fathers), 32 healthy brothers and 28 sisters, as well as 400 healthy controls (200 males and 200 females). An analysis of quantitative traits of dermatoglyphs on the fingers (FRC - finger ridge count) and palms (a-b, b-c, and c-d ridge count, and atd angle) was performed.

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.

[Journal usage at the Andrija Stampar library].

Development of journal collection in the Andrija Stampar library is presented. Research of loaned and photocopied journals was performed in order to evaluate circulation of journals in 2001. There were 1057 titles of journals in the Library, 77 were secondary journals and they were excluded from the study.