ZAGREB, May 20, 2019 - An international survey on body-mass index trends among adults in urban and rural areas, which also involved Croatian experts, shows that the likelihood of obesity in Croatian rural areas is 44% higher for men and 40% higher for women, the Croatian Public Health Institute (HZJZ) said.

The survey was conducted by the London-based Imperial College and its results were published on May 9 in the international science journal "Nature". The data analysed referred to the height and weight of more than 112 million adults from urban and rural areas in 200 countries in the period from 1985 to 2017.

The survey shows that in the period from 1985 and 2017, the body mass index (BMI) grew on average by 2 kilograms in women and by 2.2 kilograms in men, namely, people covered by the survey had an extra 5-6 kilograms of body mass.

More than half the global increase in obesity in the 33-year period can be ascribed to the growth of BMI in rural areas.

In some low and medium-income countries, rural areas contributed to the total BMI increase with 80%. Since 1985 the average BMI in rural areas has grown by 2.1 kilograms among both men and women, while in urban areas the average BMI in women has grown by 1.3 kilograms and in men by 1.6 kilograms.

This points to astonishing changes that have happened in the last three decades. In more than three-fourths of the surveyed countries, women and men who lived in urban areas in 1985 had a higher BMI than those living in rural areas and over time that difference has changed or has even been reversed in a large number of countries.

In the high-income countries, the increase in the body mass in rural areas was evident especially among women, and experts attribute this to shortcomings of life outside urban areas - a lower income and lower level of education, limited availability and higher prices of healthy food products, and fewer sports and recreational facilities.

In the period from 1985 to 2017, rural areas in lower and medium-income countries saw an increase in income, improvement of infrastructure, development of agricultural equipment and an increase in the number of cars, which has resulted in less energy consumption but also greater consumption of processed food products and products of lower quality due to lack of adequate legislation. These factors contribute to a faster increase in BMI in rural areas.

In the 1985-2017 period, BMI dropped mildly among women in 12 countries in Europe - Greece, Spain, Lithuania, the Czech Republic, Italy, Portugal, Serbia, France and Malta - and in Asia Pacific - Nauru, Singapore and Japan. Conversely, BMI among women grew by 5 kilograms in Egypt and Honduras. BMI grew in all countries, and the highest increase, of more than 3.1 kilograms, was reported in Saint Lucia, Bahrain, Peru, China, the Dominican Republic and the USA.

Women living in the rural areas of Central and East Europe had, on average, a body mass that was around one kilogram higher than that of women in urban areas, and the increase was reported in Belarus, the Czech Republic and Latvia. That difference has remained almost unchanged since 1985.

In men from rural areas, the greatest difference was recorded in Sweden, the Czech Republic, Ireland, Australia, Austria and the USA. Men in rural areas had a BMI that was around 0.35 kg higher than that of men in urban areas.

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ZAGREB, May 15, 2019 - Doctors at the University Hospital Centre (KBC) Zagreb, who have successfully separated conjoined twins in a complex medical procedure, said on Wednesday that the baby girls were recovering well and that their lives were not in danger.

Preparations for the surgery lasted six weeks and were secret to avoid pressure on the operating team. The 13-hour operation to separate the twins, who were joined at their breast-bone and part of the abdomen, was headed by Tomislav Luetić, chief of the KBC Zagreb's Department of Pediatric Surgery.

The procedure, which included one of the longest times a patient has been under anaesthesia in Croatia, was performed by a team of seven surgeons and seven anaesthesiologists, with 25 people in the operating room and 30 in the intensive care unit.

The babies, born two months before term, have been in the intensive care unit for four months.

"The first surgery was followed by a number of other operations. They all went more or less well and now, two and a half months after the surgery, the girls are in very good condition and we hope they will be better with every new day," Luetić said, adding that more corrective surgery procedures were planned.

After the surgery, doctors monitored if the liver of each baby functioned on its own, if the intestines could take in normal food and whether it would be sufficient for the babies' growth and development, and they also watched out for infections.

Infections are the biggest problem in small babies, especially in cases like this one, because the abdominal wall of both babies was reconstructed using prosthetic material, which is always sensitive to infection.

The head of the Surgery Department, Krešimir Bulić, said that he made simulations to reconstruct what needed to be reconstructed since after their separation each baby was left without 30% of the abdominal wall.

KBC Zagreb director Ante Ćorušić said that many had tried to talk him into referring the case to colleagues abroad but that he knew that there were no clinics specialising in conjoined twin surgeries and that he trusted his staff.

This is the second case in the world with such a complex clinical diagnosis and the first one where both twins have survived.

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ZAGREB, May 15, 2019 - Finance Minister Zdravko Marić on Wednesday said that it is obvious that the problem of the health sector debt cannot be resolved only on the revenue side of the health budget but that it requires intervention on the expenditure side too.

Speaking ahead of Thursday's meeting with wholesale pharmaceutical companies convened to discuss hospital debts for delivered medicines, Marić recalled that the Finance Ministry had already on several occasions made a contribution through extraordinary financial injections and by increasing the budget of the Croatian Health Insurance Institute by increasing health contributions on wages.

"The Ministry of Finance will always be a constructive partner in finding systematic solutions. We clearly showed our intentions on three occasions and participated on the revenue side. However, it is evident and being confirmed that the problem cannot be resolved only the revenue side but that it requires intervention on the cost side of the health budget," Marić told reporters.

He added that according to the latest data, the health sector's debts amount to more than seven billion kuna and that some hospitals have very long deadlines for payments.

Marić underscored that the problem of the health sector's debts and payment deadlines have not emerged overnight and need to be observed in the long term, adding that he is convinced that the health sector has certain recommendations and solutions.

"The system needs to be observed as a whole. The financial aspect, the debts and payment deadlines cannot be simply brushed off, and tomorrow, we will discuss that and see whether we can work something out," Marić said.

He added that compared with other countries, Croatia has a fairly high level of accessibility to health services and a very good and quality health service.

"The best confirmation and evidence of how good our doctors, nurses and medical staff are is the fact that they are quite sought after throughout the European Union," he claimed and stressed that an additional problem is how to keep highly qualified staff in the country.

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ZAGREB, May 13, 2019 - Croatians do not know how to cope with stress and almost a third feel a high level of stress, mostly those aged 18-49 who are the most productive and should have the greatest effect on society, a survey reveals.

The survey was conducted by Dr Branka Novosel, the chief executive of the Littera firm, on a sample of 1,000 employees and was presented earlier this week.

It found that as many as 90 percent of respondents felt they were under moderate or high stress, while nearly a third experienced a high level of stress, which ranks Croatia somewhere in the middle compared with other countries.

Last year's Gallup survey revealed that Greece was the most stressed nation in the world as 59 percent of its citizens said they experienced a high level of stress, ahead of Albanians and Americans (both 55 percent).

Novosel said she had used tested scientific methods, but noted that the stress level was subjective. "The greatest source is not outside, but inside us. It's our thoughts and the way in which we experience and interpret events and people around us. The results of the survey conducted in Croatia reflect the state of the nation. In particular, we should be concerned about the fact that generations X and Y are under the greatest stress, and those are people aged 18 to 49 who are now the most productive and who should have the greatest effect on society," Novosel said.

She said that the phenomenon has many negative effects - it affects health, reduces productivity at work, hinders decision making and adversely affects interpersonal relations. Among the main stress factors, she cited a lot of overtime work, little possibility for personal and business growth and development, unclear expectations and instructions from superiors, poor relations in the workplace, low pay and unchallenging work.

"The digital work environment has erased the once clear line between private and work life. We should look to companies that have a Chief Happiness Officer and create so-called happy companies to promote employee satisfaction and reduce stress levels," Novosel said.

In recent years, Novosel has been helping Croatian companies in introducing human resources management techniques used by the biggest global companies.

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ZAGREB, May 13, 2019 - Health Minister Milan Kujundžić on Sunday again warned about insufficient funds in healthcare, which is partly why medical staff are leaving Croatia, saying that for now a price increase of supplemental health insurance was not being considered but that outlays for healthcare must increase.

"We as a nation must decide if we want to keep doctors and nurses, superior medicine and new drugs. We must realise that they entail new costs," he said on Nova TV.

The incumbent government inherited the health sector's debt of 8 billion kuna and it has not increased it, but with outlays of 750 euro per capita, treatment cannot be as good as in countries which set aside 5,000 euro per capita, Kujundžić said.

He reiterated that the fastest effect would be achieved by raising excise taxes on alcohol and cigarettes, which Finance Minister Zdravko Marić has opposed so far.

Speaking of hospitals' debt to drug suppliers, which has reached 2.6 billion kuna, Kujundžić said a solution would be found either at state budget or Croatian Health Insurance Fund level.

The minister said that despite the financial problems, many things in Croatia's healthcare worked.

As for the large number of doctors and nurses leaving Croatia, he said the number of residencies had tripled over the past two years. This government has "a sound human resources policy and a significant number of physicians who left are coming back to Croatia."

Kujundžić said one should keep in mind that 85% of hospital revenues went on salaries. "It's difficult to raise salaries without stopping drug purchases," he said, adding the solution was in higher outlays for healthcare.

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ZAGREB, May 8, 2019 - A new Gamma Knife device valued at 45 million kuna was officially presented on Tuesday at the University Hospital Centre Zagreb (KBC), which is a huge technological step forward in radiosurgery in this part of Europe.

This "invisible knife" quickly and painlessly treats pathological processes in the brain. The nearest similar apparatus can be found in Vienna or northern Italy or in Moscow to the east, it was said at the presentation.

"We used to conduct 380 gamma knife procedures a year. With this piece of equipment, we will probably achieve 700 procedures a year," the head of the KBC Zagreb neurology department, Zdravko Heinrich, said.

Gramma Knife treatment is covered by Croatia's Health Insurance Institute (HZZO) while patients referred from neighbouring countries pay the full price. "A lot of patients come from Bosnia and Herzegovina, Montenegro, North Macedonia and Kosovo and we have signed contracts with those countries' health insurance agencies that pay the KBC the full commercial price," the hospital's director, Ante Ćorušić, said.

The KBC Zagreb received support from the Ministry of Health and EU funds to obtain the Gamma Knife and Health Minister Milan Kujundžić and Regional Development and EU Funds Minister Gabrijela Žalac attended the ceremony, expressing their satisfaction with this huge step in Croatia's health system.

Eighty-five percent of the cost of the Gamma Knife was covered by an EU grant from the Competitiveness and Cohesion Fund from which 274 million kuna has been granted for highly sophisticated equipment for Croatian hospitals.

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ZAGREB, May 5, 2019 - Nurses throughout the world are observing their week from 5 to 12 May, and Croatia has joined in the campaign to highlight the importance of the role of nurses and medical technicians in promoting health for all.

The leader of the Croatian National Nursing Association, Adriano Friganović, has issued a press release on the occasion of the start of the International Nursing Week, urging the authorities to make sure that Croatia can follow the example of developed European Union member-states and thus prevent the brain drain of nurses and med techs.

"Croatia has 38,000 nurses and medical technicians, and although they are the largest group of healthcare providers in the system, their status is not satisfactory," reads the press release.

Croatia is experiencing the nursing shortage, and an estimated additional 12,000 nursing professionals are needed in the system, according to the press release.

Friganović also writes about violence to which nurses are being exposed in healthcare institutions.

The Health Ministry in cooperation with nursing professionals' institutions is supposed to create a positive climate and halt the brain drain.

One of the steps is to recognise the qualifications the nursing technicians have acquired, he added.

International Nursing Day is celebrated around the world every May 12, the anniversary of Florence Nightingale's birth. The International Council of Nursing commemorates this important day each year with the production and distribution of the International Nursing Day (IND) resources and evidence. This year the main theme is "Nurses - Voice to Lead: Health for All".

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Permanent contracts, annual salaries ranging from 70,000 to 90,000 pounds, free English language courses, assistance with resettlement and finding a new home, kindergarten, school, bank account opening... – this is the offer which the Paragona agency from Poland has given to Croatian family doctors, inviting them to move to Great Britain despite Brexit, reports Večernji List on April 26, 2019.

They have been invited by the British National Health Service (NHS), the key health institution in the country, which has hired the Polish agency to help them bring family physicians from EU countries.

It has been known for years that Britain, as well as a number of other Western countries, does not have enough physicians. NHS's solution is to import doctors from other countries, which is the reason why they have launched this last drive to bring in family physicians. The number of physicians from all EU countries who can come and compete for jobs is not limited.

The contest will be open permanently until the need for the medical staff is met. In its statement, the NHS says that, regardless of Brexit, there will still be a need for excellent family physicians from Europe. In order to promote the competition and its conditions, the Polish agency’s representatives will visit Croatia next month, says Vikica Krolo, president of the Croatian Family Medicine Coordination (KOHOM).

“KOHOM wants as many of our physicians as possible to stay here, but this sounds very appealing, and it is an opportunity for people to go to a well-organised state for a well-paid job. We concessionaires are more or less retiring in five to ten years, so I am not interested, but I know how this sounds to younger doctors. People have been informed, they have received invitations, which have been shared on social networks and forums. We educate physicians who then leave to work in other countries. The world is open, and this call demonstrates it,” says Krolo, who is a family physician herself, adding that the number of her colleagues has been decreasing in the last few years and is now around 2,100.

The work of family physicians in the UK differs from the Croatian system. The key difference is in diagnosis segment and treatment of all age groups, as well as the fact that nurses do some of the medical jobs which are done exclusively by doctors in many other European countries.

Family medicine offices in Great Britain are equipped for smaller surgeries, which are usually done in hospitals in other European countries, including Croatia. Referrals to specialists are very strictly limited to cases when this is a real need because a family physician does not have the necessary equipment or the patient has a serious condition. Family doctors in Great Britain also deal with the health of children and mothers, prevention and rehabilitation. “We would all be happy to do this as well,” adds Krolo.

The agency hired for recruiting physicians has already successfully completed a pilot project and has placed family physicians from Europe to various parts of the United Kingdom.

Translated from Večernji List (reported by Ivana Rimac Lesički).

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More than 28 million kuna were collected in mass fundraisers in March for the treatment of Mila Rončević, a two-year-old girl suffering from a rare type of leukaemia. In early April, she and her parents travelled to Philadelphia to start the treatment. And now, her father Marin Rončević reported that the treatment was progressing exceptionally well, reports 24sata.hr on April 23, 2019.

“The MRD, the percentage of leukaemic blasts in the bone marrow, is less than 0.1%. What is important is that no one expected such a response to treatment. Everything under 10% would be good, below 5% great, and this is incredible. This is the power of prayer and love of hundreds of thousands of people who support the best children's doctors,” said Marin.

Before starting treatment, the MRD was at 88 per cent, then 50 per cent, and now only 0.1 per cent. Mila's condition is getting better and what follows is a bone marrow transplantation. “This is better than any prognosis, but we still have a long way to go. Transplantation is dangerous, and the illness can find a new route in the next five years, but this is beyond all expectations and is a great result after only half the initial cycle. Mila looks great, and her condition is good,” said the father.

On Tuesday, the girl turned two. Surrounded by her mother, father and the medical team, Mila has been in the children's hospital in Philadelphia since April 3. The payments and donations in the humanitarian drive for Mila far exceeded the amount needed for treatment costs. More than 37 million kuna was collected.

“As I have already said, we do not have time or knowledge to run such a fund, but we will not leave this money to the politicians. Politicians can only give, as I have already proposed, five lipa per a litre of gasoline sold to pay into the fund for sick children. But politicians, just like us, must not manage this money. There should be a team of medical and other experts who are in a position to assess medical records and the needs of individuals in the shortest possible time,” he wrote.

Marin Rončević has also written that state institutions do not have, do not know or do not want to provide answers to existing problems, although solutions do exist and are available. “There is another girl who is playing the lottery of life, waiting whether a drug is going to be approved in time. The price of the drug is unknown to almost anyone. An additional paradox is that the same drug was approved for another girl,” Rončević noted.

Translated from 24sata.hr (reported by Anita Anić-Božić, Andro Bernardić).

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ZAGREB, April 16, 2019 - Prime Minister Andrej Plenković and Zagreb Mayor Milan Bandić on Monday signed a framework agreement on cooperation in preparing the project "Building the national children's hospital," which is the first step in implementing the project for the construction of the hospital in Zagreb's Blato neighbourhood.

The government-sponsored project is worth 42.3 million kuna, of which 85% will be financed by the European Regional Development Fund. The rest of the funds will be secured from the state and Zagreb city budgets.

The new children's hospital will also provide care in gynaecology and obstetrics.

After signing the framework agreement, Plenković said this strategic government project was aimed at providing the youngest patients with the best possible care.

Health Minister Milan Kujundžić said the new national children's hospital would provide all forms of treatment of children's diseases in one place.

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