Backgraund and aim:. Modern technology has numerous benefits in daily life . More and more children use modern technology ( cell phone, laptop, tablet, computer) every day. The aim of this study was to explore how many hours a day children of the ages between 6 and 7 use modern technology and how that efects their development. Methods and materials: In this study I examined 146 children of the ages between 6-7 (78 girls and 68 boys), their speech, gross motor skills, fine motor skills, emotional maturity, atteention, concentration and hyperactivity .Their parents filled anonymous questionnaire about using modern tehnology. Data were analyzed by descriptive statistics. Results: Approximately 50% of children use cell phone, laptop,tablet or computer one hour a day, 20% of children two hours a day, and 30% of children more then three hours a day. Approximately 60% of children have their own cell phone, laptop,tablet or computer. Children who use modern technology more then three hours a day have problems with speech (30.3% boys and 5.5% girls ), problems with fine motor skills (50.2% boys and 40.7% girls), problems with gross motor skills (30.4% boys and 20.2% girls), less attention, low concentration and hyperactivity (40.3% boys and 41% girls) , are emotionally immature (30.8% boys and 31.5% girls). More than 90% boys and girls who spend less than one hour a day using modern technology, do not have any difficulties. Conclusion: Childreh of the ages between 6 and 7 , who use modern technology more then three hours a day, have problems mostly with fine and gross motor skills, attention, concentration, hyperactivity, emotions and boys with speech. More than 90% children of the ages between 6 and 7 , who spend less than one hour a day using modern technology, do not have any difficulties. TOMELIĆ ERCEGOVIĆ KATARINA, MD, specialist of school medicine Public health institute of Split and Dalmatian county, Croatia Departmant of school and adolescent medicine e-mail:katarina.tomelic.ercegovic@nzjz-split.hr

AIMS: To develop a guideline for preventive child healthcare (PCHC) professionals in order to improve early detection of pathological disorders associated with short stature (or growth faltering) or tall stature (or accelerated growth). Target groups include primary growth disorders (e.g. dysmorphic syndromes, such as Turner, Noonan, Prader-Willi, Marfan, Sotos, Klinefelter, Fragile X- and Triple-X syndromes) and secondary growth disorders (e.g. growth hormone deficiency or excess, celiac disease and hypothyroidism). MATERIALS AND METHODS: We updated the previous Dutch guideline for short stature in children aged 0-9 years and extended it to adolescents (10-17 years), and added a guideline for tall stature, based on a systematic literature review and input from an expert committee. Specificities were calculated in a cohort of healthy Dutch children aged 0-9 years (n = 970). We investigated the impact of a late onset of puberty on height standard deviation score (SDS) based on the Dutch growth charts. RESULTS: Growth parameters of the guideline include height SDS (HSDS), the distance between HSDS and target height SDS and change of HSDS over time. Other parameters include diagnostic clues from medical history and physical examination, for example behavioral problems, precocious or delayed puberty, body disproportion and dysmorphic features. The guideline also provides information on the causes of short and tall stature. CONCLUSION: PCHC professionals now have an updated guideline for referring short or tall children to specialist care. Several criteria are evidence-based, while others were formulated based on expert opinion and recent literature. The criteria of the guideline are expressed in terms of SDS, so that the guideline can be applied worldwide if any ethnic/country-specific growth references or the WHO standard are used. We recommend a training for PCHC professionals and digital tools in applying the referral criteria.

AIMS: To identify key developmental milestones between 12-45 months in children requiring special education later in life. MATERIALS AND METHODS: Data on 36 milestones (gross and fine motor skills, adaptive/personal/social behavior, communication) from the Dutch Development Instrument, education type and background characteristics were obtained for the years 2008-2016 from the electronic health records of the Youth Health Care of the municipality of Utrecht. Education type was defined by regular primary school (group 1), special needs primary school (group 2), school for children with serious communication problems (deaf, specific language impairment, etc.) (group 3), school for children with cognitive or physical disability, or a chronic illness that makes it difficult to go to a regular primary school (group 4). Descriptive statistics and logistic regression analysis were performed. RESULTS: A total of 30,499 children in group 1, 653 in group 2, 338 in group 3, and 196 in group 4 had scored an average of 21 milestones (standard deviation: 10, range: 1-36). In groups 2 to 4, the adjusted (for visiting age, sex, gestational age and birth weight) odds ratio (adjOR) was ≤0.1 compared to group 1 for passing the milestones ‘Points at 6 parts of a body of a doll (24 months)’ (pass rates: 88%, 54%, 32%, 27% in resp. group 1-4), ‘Says sentences of 3 or more words (36 months)’ (pass rates: 97%, 74%, 38%, 37% in resp. group 1-4), ‘Speech is understood by acquaintances (36 months)’ (pass rates: 97%, 80%, 54%, 49% in resp. group 1-4), ‘Talks spontaneously on daily events (45 months)’ (pass rates: 98%, 85%, 61%, 52% in resp. group 1-4), and ‘Asks questions beginning by who, what, where and how (45 months)’ (pass rates: 98%, 85%, 53%, 40% in resp. group 1-4). Group 3 had 1 (communication) and group 4 had 21 (all domains) additional milestones with an adjOR ≤0.1. CONCLUSION: Early developmental delay, especially in communication, often occurs in children with special educational needs later in life.

AIMS: An important goal of monitoring developmental milestones is the early identification of a wide range of disorders that affect child development. Duchenne muscular dystrophy (DMD) is generally detected late and therefore treated late, but previous research showed that more DMD boys fail to attain certain milestones than the general population. Aim of this study is to develop a short risk assessment tool based on developmental milestones that may contribute to the early detection of DMD. MATERIALS & METHODS: As part of the case-control 4D-DMD study (Detection by Developmental Delay in Dutch boys with DMD), data on developmental milestones, symptoms and therapies for 76 boys with DMD and 12,414 boys from a control group were extracted from the health records of youth health care services and questionnaires. Multiple imputation, diagnostic validity and pooled backward logistic regression analyses with DMD (yes/no) as the dependent variable and attainment of 26 milestones until 36 months of age (yes/no) as the independent variable were performed. Descriptive statistics on symptoms and therapies were provided. RESULTS: A tool with seven milestones (assessed at specific ages between 12-36 months) resulted in a sensitivity of 79% (95%CI: 67-88%), indicating that most boys with DMD would be detected at or below the age of 36 months using this tool. The specificity was 95.8% (95%CI: 95.3-96.2) and the positive predictive value 1:268 boys. In addition, boys with DMD often had physical symptoms (e.g. 43% had calf muscle pseudohypertrophy) and were often referred to therapy (e.g. 59% for physical therapy) before diagnosis. CONCLUSION: The short risk assessment tool may be helpful in detecting DMD in boys aged 12 to 36 months. In addition, the presence of physical symptoms and medical information, such as referrals, may also contribute to determining the risk of DMD.

School health services are bridges between the education and health sectors. Futhermore, they have to fulfill local expectations in public health. However, they depend on political commitment, financial investment, interdisciplinary structures and resources. In respect to a young population with significant health needs like chronic diseases (at least one in five school childen), increasing psychological and social problems (e.g. due to disrupted family structures, migration, etc.), and environmental impacts, their implementation and financial endowment should deserve high recognition. A World Cafe will be used as an interactive format to discuss how to strengthen school health services in view of school childrens’ health and educational needs. The World Cafe is a method which makes use of an informal cafe setting for participants to explore an issue by discussing it in small table groups. Discussion is held in 3 rounds of 20 minutes, with the cafe ambiance intended to allow for more relaxed and open conversations to take place. The target is to make collective knowledge visible: After a short introduction, each of the following questions will be put forward by a moderator: 1. What are the strengths and opportunities of school health services ? 2. What are the recent challenges of school health services ? 3. How can interprofessional teamwork be achieved ? 4. What kind of qualification and skills do health professionals need within the school health service ? 5. How can school health services be strengthened ? At the end the moderators will summarize the findings and lessons learnt.

The study analyses the activities of 18 school nurses at 23 schools (primary and secondary schools during a 3-year period (02/2017- 03/2020), a model project under the umbrella of the AWO Bezirksverband Potsdam e.V., in the German state of Brandenburg (study download: https://schulgesundheitsfachkraft.de/abschlussberichte-dokumente/). The data is extracted of a standardised documentation system encompassing a variety of items related to the school nurse’s core tasks: health care for school children with health disorders, injuries or chronic diseases, health promotion on individual and population level. The second part of the report investigates the type and content of community-based co-operations (network map), if specific health care or psychosocial support for a school child was needed. Main results: school nurses are frequently visited by school children because of mental and physical health problems. School nurses spend an average of 4 hours providing individual health care in schools, in terms of a ratio one SN per 700 school children. 87 % of school children could return to class after school nurse’s visit. Unnecessary emergency operations could be reduced because school nurse could assess the emergency incident. Each school nurse was co-operating with an average of 20 stakeholders in the community and thus could refer to specialized care or psychosocial support, if needed. Conclusion: Whilst improving health of school children, school nurses contribute extremely to their education chances. Community networking is crucial for a successful case management.

BACKROUND: Childhood obesity has become one of the mayor public health concerns around the world. This multisystem and complex disease is seen, not only in adults, but has become frequent in children of early age all of which contributes to the risk of chronic noncommunicable disease in adult age and premature death. Childhood obesity prevention interventions are important assets in forming healthier behaviors in school age children. PETICA-play for health model was designed to promote healthier lifestyle habits and reduce the future risk of obesity development. METHOD: This longitudinal study assessed the impact that education of children, (8 to 9 years, 2nd - 3rd grade, Croatian school system), through PETICA model, has on the formation of healthy lifestyle habits linked to childhood obesity prevention. This model comprises of lessons and workshops (10) regarding nutrition and physical activity implemented during the school year 2016/2017 in 15 Croatian primary schools. Focal points of the PETICA model are the importance of breakfast, water, fruit and vegetable intake, adequate amount of sleep and the importance of regular physical activity. The knowledge and lifestyle habits of children regarding nutrition and physical activity was assessed through a validated questionnaire taken before and after intervention and anthropometric measurements (height, weight, BMI). RESULTS: Data of 1056 pupils was analyzed with Wilcoxon signed-rank test and t-test to determine significant differences (p<0,05) after PETICA education. All pupils enhanced water intake and decreased sweets, cakes or pastries and salty snacks intake linked to overweight and obesity risk. The enhance of PA habits was observed in 2nd graders. Also, correlation was shown between eating breakfast and lower body weight in 3rd graders. CONCLUSIONS: PETICA model gives hope that obesity trends can be reversed through education-focused public health prevention models that enhance nutrition and PA habits at an early age

Aims: Besides the general aim of protecting and promoting children and youth mental health, the activities in the public health project Pretezno vedro for many years specifically aim at improving emotional literacy in primary school children. School and interschool competitions are being held within the project. Through those, pupils gain knowledge and develop skills of recognizing emotions, understanding one’s own and others’ emotional states and reacting in everyday life situations, with emphasis on the development of emotion regulation. Materials and methods For the purpose of evaluating project activities, 6th grade pupils from 18 schools in Split-Dalmatia County filled out The Washoe County School District Social and Emotional Competency Short-Form Assessment. The questionnaire was translated into Croatian by the double translation method. Input was filled out by 678 pupils, and output by 556. Results Results showed that pupils after taking part in project activities (M=53,41; SD=7,82) assessed their competencies as better than before taking part in the mentioned activities (M=51,21; SD=7,22). A Mann-Whitney test indicated that this difference was statistically significant, U(Ninput=527, Noutput=405)=89158,50, z=-4,314, p<0,001. Conclusion These findings speak in favor of the usefulness of project activities when working with youth on emotional literacy skills. Besides, teaching the mentioned skills has a twofold benefit: apart from working on the prevention in mental health, at the same time, it is a chance for experts in school teams to notice those pupils who are in need of additional support in developing socioemotional competencies.

ABSTRACT INTRODUCTION School and adolescent medicine is a branch of preventive medicine that keeps track of, not only physical status, but also psychological development of children and young people. CASE REPORT In February 2022, a 19 year-old female patient came to the Department of School Medicine due to systematic check-up. During examination and interview, the following was found out about our patient: previously studied at the Academy of Arts, former smoker, recreationally consumes marijuana and higher amounts of alcohol in outings. Patient also stated that her sexual orientation was defined as bisexual and that she is currently in a relationship with a girl. Her parents and family do not know about the existing relationship, which makes her feel mournful. As a graduate, the patient has been to an adolescent psychiatrist several times, where she was diagnosed with depression and anxiety and was treated with psychotherapy. Numerous self-injury scars were found on the skinduring the physical examination. Patient claimed starting self-injuring at the age of 13. Patient was last self-injured 6 months ago while feeling under pressure due to rewriting her graduation exam. Also, due to the current pandemic, the patient feels more anxious and depressed. After revealing the questionnaire answers about mental health, it is clear that the patient has extremely low self-esteem, along with symptoms of depression and a disrupted image of herself and her values. Patient admits that it is difficult for her to fight with daily symptoms of depression, anxiety, as well as social phobias. After the check-up was performed and the patient was advised about improvement of mental health, patient was also suggested to turn to a psychiatrist or to the mental health department, since her symptoms were all connected to mental problems and since a depressive episode has occurred. CONCLUSION Despite the counselling and interview, the patient did not decide to seek professional help immediately, although she herself is aware that she is in dire need of help. Unfortunately, we still live in an environment that stigmatises people with mental disabilities, which makes it harder for them to decide to seek much-needed help.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has affected the education and teaching system worldwide. In order to prevent the spread of COVID-19 infection among school children, a decision was made that if there were two or more positive students in one class, the whole class was subject to quarantine. Six primary schools in the city of Split were observed from November 15th 2021 to February 12th 2022 during the 4th wave of the pandemic. The goal was to determine the number of classes that were fully quarantined due to COVID-19 positive students. METHODS AND MATERIALS: We used data from the quarantine records of classes from six primary schools in Split. Data was analyzed by descriptive statistics. RESULTS: Six primary schools with 144 grades and 3346 students were observed. A total of 86 classes with 1707 students were in quarantine at least once, of which 15 classes with 297 students were twice in quarantine, while two classes with 42 students were in quarantine three times. No class has been in quarantine four times or more. In 55 classes quarantine never covered the entire class. CONCLUSION: About 60% of classes in six primary schools in Split were fully quarantined at least once in the period from November 15th 2021 to February 12th 2022. Additionally, in about 15% of the classes several students (but not the whole class) were in quarantine due to one COVID-19 positive student. About 10% of the classes were in quarantine twice, while only about 1% of the classes were in quarantine three times.

Human papillomavirus (HPV), one of the most common sexualy transmitted deseases , represents significant public health problem. Cervical cancer is one of the most preventable cancers. Almost every case can be prevented by available prevention methods. In Croatia, HPV vaccination is part of the regular vaccination calendar for eighth grade primary school students, and, depending on availability, for all persons under the age of 25. The aim of this paper is comparing the views of nurses, as an integral part of primary health care, on HPV vaccination in the School medicine department at the Institutes of Public Health in four Dalmatian counties with the views of nurses from Zagreb County and the City of Zagreb. Material and methods; The study was conducted on a sample of 96 school nurses employed by the Institutes of Public Health in school and adolescent medicine in four Dalmatian and two continental counties, from February 15th to April 10th 2022. The questionnaire consisted of 25 questions. Results: The results of the research showed that there is no difference in the views of school nurses about HPV vaccination in four Dalmatian counties with the views of nurses in the city of Zagreb and Zagreb County. Of the total number of nurses who participated in this study, 40.6% work in Zagreb County , 31.3% in Split , in Zagreb County 11.5%, in Zadar 8.3%, in Dubrovnik, 5.2%, and 3.1% Šibenik. 87% of respondents from Dalmatian counties and 88% from the city of Zagreb and Zagreb County fully agree that vaccination is the best prevention of disease, along with practicing protected sexual intercourse. 95.7% of respondents from Dalmatian counties state that they would like to get vaccinated against HPV, and 94.8% in continental counties would do the same. 95.6% of respondents from Dalmatian counties and 90% from the city of Zagreb and Zagreb County completely agree that HPV vaccine is safe for both boys and girls. Conclusion: Nurses agree that the protection of reproductive health is one of the priority goals of youth health care with the necessary support of educated medical personnel.

The Dutch Heelprick Screening Program (NHS) started in 1974 with screening on PKU disease. In the following years the program expanded slowly. From 2007 onwards the expansion accelerated, mostly with metabolic diseases. The latest added diseases are SCID and SMA. Now a total of 26 diseases are part of the screening. The NHS is continuously expanding; the Ministry of Health, Welfare and Sport (VWS) is in charge of the decision making. This follows after the advice via the Health Council of the Netherlands (GR). The preventive care system for neonates and children is organized through well baby clinics and later on in schools. Youth health care (YHC) is provided voluntarily and with free access, until the age of 18 years. In some circumstances even prenatal and 18+ years. For citizens in the Netherlands there is no direct access to hospitals, only via general practitioners (cure) or youth health care physicians (preventive care). Preventive care is separated from cure. YHC is performed by youth health care physicians and -nurses. The heelprick screening (as a part of YHC) is performed by youth health care assistants, who are mostly connected to the well baby clinics. The NHS is organized by the National Institute for Public Health and the Environment (RIVM). There is an automatic link between the birth system of the municipality and the RIVM, so the heelprick can be performed in time. Parents receive a “good result message” when all results are negative. A positive result leads to a referral by the medical advisor from the RIVM to a (academic) pediatric center via the child’s general practitioner. The Dutch academic hospitals and RIVM and are the main contributors to scientific research on the NHS. Their research papers are published in scientific magazines. After this oral presentation the participants are informed about and inspired by the Dutch Heelprick Program, embedded in the broad preventive YHC system in the Netherlands.

Vaccination against HPV infection started in 2008 and was recommended to 7th grade elementary school students and funded by the county and local governments. It was introduced into the Immunization Program in the Republic of Croatia in 2015. The mentioned vaccine was first recommended to the students of the 8th grade of primary school, and then, due to the expressed interest, to others up to the age of 25. The aim of this research was to collect data on students who have been vaccinated in our office since 2019 and with the help of their proposals to strengthen the vaccination campaign. So far, 215 students from the Faculty of Medicine, the Faculty of Dental Medicine, the Faculty of Health Studies and the Faculty of Maritime Studies at the University of Rijeka have participated in this research. Among them were 182 female students and 33 male students. When arriving for vaccination, they filled out a questionnaire with demographic data and 14 questions, which were focused on previous vaccinations, potential side effects, decisions about vaccination, recommendations to others, media promotion and suggestions for improving youth information about this vaccine. All surveyed students were previously vaccinated in accordance with the Compulsory Immunization Program. Some of them (17,2%)were not vaccinated against HPV at the time when they were 8th grade students because their parents did not give their consent for HPV vaccination. Most of them would recommend vaccination to their friends. 92.1% of them believe that HPV vaccination is insufficiently covered by the media, especially on the channels used by young people. Twenty (9.3%) had side effects after the 1st dose vaccination. The majority of side effects (75%) were related to arm pain. One vaccinated person had local redness or tingling in the hand or headache or fever or weakness, while one student had arm pain and weakness at the same time. All side effects lasted for a short time, up to a maximum of 5 days. The HPV vaccine is safe. Youth recommend it to their friends and believe that it should be better promoted and offer promotion models suitable for their generation.

AIM: HPV vaccination was introduced in the Republic of Croatia in 2007, as optional and recommended, and from the school year 2016/17 it is available free of charge for girls and boys in the eighth grade of primary school. Prior to the COVID-19 pandemic, HPV vaccination was conducted with parental education through parent meetings, lectures, panel discussions, and individual counseling, but with low parental response. At the time of the COVID-19 pandemic, due to the limitation of group activities, parent counseling was conducted during regular health examination of eighth grade students. The aim of this study was to assess the vaccination coverage of boys and girls against HPV in Zagreb County from 2016/17 to 2020/21. MATERIAL AND METHODS: The research included 15435 eighth grade primary school students in Zagreb County, from the school year 2016/17 to 2020/21. Data on HPV vaccination were collected from medical documentation, through regular monthly reports on vaccinated students of all school medicine teams in Zagreb County. Data were analyzed by methods of descriptive and analytical statistics and presented at a significance level of P<0.05. RESULTS: Vaccination of eighth grade primary school students against HPV showed a statistically significant increase from the 2016/17 and 1.86% vaccinated students (1.19% boys and 2.57% girls) to 2020/21 and 28.86% vaccinated students (23.90% boys and 34.25% girls) (t-test = 12.59358; P = 0.001). The highest vaccination coverage was achieved in the 2019/20, with 34.78% of vaccinated students (28.08% of boys and 34.78% of girls). CONCLUSION: Vaccination coverage against HPV in eighth grade primary school students has shown an increasing trend, but still it is bellow recommended levels. Results indicate the need of continuous intervention in a form of individual counseling of parents during the regular check-ups.

Osteogenesis imperfecta (OI) is hereditary disorder that affects collagen type I. It belongs to the group of rare diseases, with a prevalence of 1:10-20000. A child with OI requires adjustment of schooling process in line with the health status, in order to enable conditions and support for achieving the maximum potential of the child, especially in physical education (PE). E.T., seven years old, is a first grade student of primary school. OI was discovered at the age of four after having three fractures of lower leg bones, within six months, following a minor trauma. In line with anamnestic data and clinical findings (square head and blue sclera), the orthopedist suspected on OI. Performed tests (densitometry, X-ray of the left hand) confirmed the diagnosis of OI type 1. Bisphosphonate therapy was introduced. The boy is in regular check-ups of nephrologist, otolaryngologist and dentist. At the beginning of the school year, the boy and mother came to the school health service for schooling process adjustment. According to the latest findings of orthopedist, activities that increase a risk of fracture should be avoided. The first grade PE curriculum has been analyzed in collaboration with the teacher and adjustment was made. Jumping, skipping, running, climbing to heights, participating in contact sports have been prohibited. Passing and catching the ball could be done only using soft ball, and exercises on the mat, shaping exercises, crawling and swiping were allowed. Teachers were educated about the OI, and students are sensitized to the issues. The education of students with disabilities is based on the principles of accepting diversity and equalizing opportunities to achieve the maximum potential. Adjustment of schooling process, and education of teachers, and classmates about the specific difficulty are prerequisite for the successful inclusion of a child with disabilities.

Uvod i cilj: Studentsko doba je period prijelaza od adolescencije u odraslu dob. Uredno mentalno zdravlje studenata preduvjet je za njihov uspješni razvoj, a zdrave životne navike preduvjet za prevenciju kroničnih nezaraznih bolesti. Cilj rada je bio je utvrditi životne navike studenata prve godine privatnog fakulteta u Splitu i njihovo mentalno zdravlje. Metode i materijali: Ispitanici istraživanja su bili studenti prve godine privatnog studija u Splitu. Od ukupno 55 studenata prve godine, sistematskom pregledu je pristupilo 36 studenata, od čega 18 djevojaka i 18 mladića. Ispitanici su ispunili anonimni upitnik Zdravstvena anketa školske djece i mladih. Za potrebe ovog rada analizirani su odgovori na pitanja o životnim navikama studenata i njihovog mentalnog zdravlja. Podaci su analizirani metodama deskriptivne statistike. Rezultati: Oko 70 % mladića i oko 70% djevojaka ne puši, oko 30% mladića i oko 60% djevojaka ne pije alkoholna pića, oko 95% mladića i oko 90% djevojaka ne uzima psihoaktivne droge, oko 45% mladića i oko 77% djevojaka bavi se nekim sportom rekreativno 1-4 puta tjedno, dok se oko 40% mladića aktivno bavi sportom svaki dan. Preko 60% studenata doručkuje svaki dan, dok oko 92% mladića i oko 80% djevojaka ruča kuhani obrok svaki dan. Više od 95% mladića i djevojaka ima pozitivan stav prema sebi, oko 40% mladića i oko 45% djevojaka druži se s prijateljima više od 3 puta tjedno, a čak oko 23% mladića i oko 47% djevojaka i više od pet puta tjedno, svi mladići i sve djevojke uglavnom su zadovoljni sobom. Zaključak: Većina mladića i djevojaka na prvoj godini privatnog fakulteta u Splitu akademske godine 2021/22 ima uredne životne navike, osim što oko 70% mladića pije alkoholna pića te oko 40% studenata i studentica ne doručkuje. Većina mladića i djevojaka na ovom fakultetu često se druže sa svojim prijateljima, zadovoljni su sobom te imaju uredno mentalno zdravlje

Introduction Vaccination is one of the greatest achievements of the 20th century and the most effective method of disease prevention. Mandatory vaccines for school-age children are announced by the Minister of Health and include measles, mumps, rubella (MMR), poliomyelitis (IPV), and diphtheria, tetanus (dT) vaccines. During the COVID-19 pandemic, vaccination rates against these diseases fell below critical levels that ensure curd immunity. AIM: The aim is to compare the rate of mandatory vaccination in school-age in the Region of Istria during the COVID-19 pandemic years (2020 - 2021) to the years preceding the COVID-19 pandemic (2015 - 2019). Materials and methods A retrospective study was conducted in the Department of Public Health in the Region of Istria with insight into annual reports of rates of mandatory vaccinations 2015. – 2021. The included mandatory vaccines were MMR and IPV scheduled in the first grade, and dT and IPV scheduled in the eighth grade of primary school. Results The rate of mandatory vaccination against MMR dropped during the pandemic period by 11,09 %, and IPV by 14,81 %. The decline in immunization against poliomyelitis was also seen in the eighth grade by 9,12 %, and against diphtheria and tetanus by 13,20 %. The greatest decline in mandatory immunization was recorded in 2021. The greatest disruption in vaccination was recorded against poliomyelitis. Conclusion Disruption of mandatory vaccinations at school age was recorded in the Region of Istria, as in many other countries. Since the MMR vaccination rate has dropped below 95 % , it is possible for a measles outbreak to occur. To prevent infections against diseases included in the mandatory immunization plan, it is necessary to catch up on missed doses of immunization.

INTRODUCTION: Obesity is a complex disease that occurs under the influence of genetic and metabolic factors, sociological and cultural enviroment and poor living habits. Increasing of the obesity cases in children and young adolescents is becoming an important risk factor for the development of cronic deseases, leading couse of death in modern Croatia. Obesity is one of the leading public health problems. THE AIM: The aim of this study is to determine if there is a difference in number of obese children in several Dalmatian cities and if so, what is the difference. METHODS: Data were obtained from yearly health screening of 5th grade of elementary school children, betweeen the ages 11-12. It included data of 596 children, 304 boys and 292 girls, approximately 100 children from each Dalmatian citys: Split, Sinj, Solin, Makarska, Omiš and Trogir. RESULTS: Aproximetely 10% of boys and 18 % of girls at the age 11-12 in Sinj are obese, 16% of boys and 18 % of girls in Split are obease, 2% of boys and 4% of girls in Makarska are obease, 17% of boys and 8% of girls in Omiš are obease, 11% of boys and 7% of girls in Solin are obease, and 11% of boys and 13% of girls in Trogir are obease. CONCLUSION: There is a difference in the number of obease children at the age 11-12 in different Dalmatian cities. Split has the most cases, aproximetely 16% of boys and 18% of girls and Makarska the least cases, aproximetely 2% of boys and 4% of girls..

Aim: COVID-19 lockdown caused an increase in children’s body weight. Excess weight in children, if untreated, can affect causing or worsen obesity and its comorbidities, which is an important issue for pediatricians and public health. The aim was to assess the change in nutritional status among schoolchildren during the COVID-19 lockdown regarding the nutrition status before it. Materials and methods: Self-reported physical activity and dietary habits from 1370 schoolchildren (10 to 15 years) from Primorsko-goranska County, Croatia were assessed before and during the COVID-19 lockdown. Physical education teachers measured schoolchildren\'s anthropometrics before and when children returned to school. Diet quality was assessed with the KIDMED index. Children fulfilled a 12-item nutrition knowledge questionnaire. Results: Overweight and obesity prevalence significantly increased from 21 to 24% (p=0.008). Two thirds (67.4%) of children underweight significantly changed their nutrition status to normal BMI (p<0.001). Among children with normal weight, 7.9% of them became overweight and obese (p<0.001). Twice much of children who were overweight (18.2%) changed their status to normal BMI as those who became obese (10.1%, p<0.001). A fifth of children with obesity (19.3%) changed their nutrition status to overweight (p<0.001). All children significantly lowered their physical activity level, children with normal weight and overweight significantly the most (-57.4%, -56.8%; p<0.001, respectively). Children with underweight and normal weight had better diet quality and nutrition knowledge than children with overweight and obesity but not significantly (p=0.536, p=0.413, respectively). Conclusion: This research showed a significant change in the nutrition status of Croatian school children during the COVID-19 lockdown period, showing a significant overweight and obesity prevalence increase. Health care workers should further monitor and evaluate school children’s dietary and physical activity habits along with nutrition status. They also should highlight the risk of obesity and provide effective prevention strategies, ensuring school and parental participation.

Healthy growth and development in young children are essential for their future well-being. Professionals and parents consider it necessary to monitor children’s development. While we can track the child’s physical growth by growth charts to identify children with signs of potential delay, there are no charts for monitoring child development. To create such charts, we need to have a unit of development, similar to units like meters or kilograms. The D-Score translates the results of different developmental milestones into a single unit for age 0-4 [1]. The D-score for child development is comparable with the unit meter for height and kg for weight. The D-score was initially developed to unify the milestones of the Dutch Developmental Instrument into a single score. Recent advances have expanded the use of the D-score by including milestones from over 20 international tools that assess early child development [2]. The expansion of the D-score allows the comparison of development of children, or groups of children, who were measured with these different tools. The D-score will be an important outcome measure in intervention studies. As such, the D-score is used in global projects by the World Health Organization and the Bill and Melinda Gates Foundation. The D-score is a global measure of child development, that represents multiple domains (e.g. fine and gross motor-activity, and communication) over the entire range of the scale and correlates to concurrent measures. The D-score depicts a development trajectory increasing with age similar to growth curves for height and weight. As a result, early development can be easily monitored across time and compared with peers which will also allow the detection of developmental delay. The D-score is an easily interpretable metric that can represent change and is comparable across cultures and contexts. 1. van Buuren S and Eekhout I. Child development with the D-score: turning milestones into measurement. Gates Open Res 2021,5:81 2. Eekhout I and van Buuren S. Child development with the D-score: tuning instruments to unity. Gates Open Res 2021,5:86

Mandatory systematic examination of school medicine according to the program is carried out in the 1st grade primary school and in the eighth grade. We measure body height and weight, and calculate the body mass index. We include the values in the Croatian centile curves. The aim of this paper was to analyze the nutrition of first and eighth graders, to analyze the same generation of students over time (from 1.-8.grade.), and the division and comparison by gender in both urban and rural schools. We include a total of 1473 students. We collected data from medical records in our ambulances Malnourished students are those with a body mass index below 5 centiles. Normally fed from 5 to 85 centiles. Overfed more than 85 to 95 centiles, and obese more than 95 centiles. The 1st grade includes 986 students and 1,051 students in the 8th grade. We calculated the statistical significance with the chi-square test and it was determined that there is a statistically significant difference in nutrition among students who were first grade in 2014/15 and attend the 8th grade in 2021/22. There is a statistically significant difference for students who are in school year 2014/15. were the first grade and who attend the first grade in the school year 2021/22. In students of 8th grade there is no statistically significant difference for school year 2014/15, but for 2021/22 there is statistically significant difference for gender and urban and rural schools . In conclusion, first-graders deviate from normal nutritional values compared to 7 years ago. Over time, differences in the city-village relationship are noticeable, especially in the 8th grade.

Pandemija COVID 19 promijenila je život ljudi u cijelom svijetu. Iako su starije osobe i kronični bolesnici pod najvećim rizikom za obolijevanje od teških oblika bolesti, hospitalizacije i smrti uzrokovanih COVIDOM 19, generacije školske djece će dugoročno osjetiti posljedice koje će pandemija ostaviti u specifičnom razdoblju života u kojem se nalaze. Rad timova školske medicine se pojavom pandemije COVID 19 u Republici Hrvatskoj značajno promijenio. Vrlo brzo nakon početka školske godine 2020/21, Međimurska županija postaje jedna od vodećih po broju oboljelih od COVID 19. Djelatnost školske medicine tada smanjuje opseg svog redovnog rada te većinu radnog vremena djelatnici školske provode u poslovima borbe protiv epidemije. Poseban naglasak u radu je stavljen na kontakt sa školskom djecom i školama. Timovi školske medicine surađuju s ravnateljima i ostalim djelatnicima škola kako bi se smanjilo širenje zaraze u školama. Svi školski liječnici bili su dostupni izvan radnog vremena i vikendom, jer je bilo bitno odrediti bliske kontakte zaražene osobe u razredu i školi, kako bi se na vrijeme odredile protuepidemijske mjere te obavijestili učenici i prosvjetni djelatnici prije početka sljedećeg školskog dana i organizirala nastava. Uvođenjem cijepljenja protiv COVID 19 uključuju se djelatnici školske medicine u organizirano cijepljenje odraslog stanovništva. Kada se indikacija za cijepljenje proširuje na mlađe dobne skupine, cijepljenje školske djece protiv COVID 19 postaje prioritet djelatnika školske medicine. Važnost protuepidemijskih mjera, osim smanjenje broja oboljelih, hospitaliziranih i umrlih, kod školske djece ima još jednu dimenziju, a to je zadržati školsku djecu što duže u školskom okruženju i smanjiti negativne posljedice na zdravlje koje dugotrajno izbivanje iz škole uzrokuje.

Aims: Evaluating adolescents’ experiences with 4 lessons about stress and how to deal with it. Materials: The deterioration of adolescents’ mental health during the COVID crisis required swift response. Together with adolescents and teachers, a group of youth health care (YHC) professionals, health advisors and psychologists developed four lessons freely accessible to all secondary schools in the Netherlands (www.njc.nl/je-brein-de-baas). The objective is to increase insights, stimulate exchange and social support and improve mental health. Four short animated videos based on (neuro)psychological and medical insights contain the theory. With the accompanying guidebook and worksheets, teachers can give the lessons without preliminary training. If they come across students who need more attention, they can refer to the YHC. The lessons are given at schools throughout the country. The videos are also online accessible to all adolescents and can be used in individual consultations. Methods: The University of Applied Sciences Utrecht conducted an evaluation-study at four secondary schools with different educational levels. After finishing the lessons, students and teachers filled out a digital questionnaire with four-point scale statements (disagree/slightly disagree/slightly agree/agree, or never/sometimes/often/always). Results 146 adolescents from six classes, most from 1st or 2nd year, were invited to complete the questionnaire. The response rate was 92,5%. Of the responders 108 had followed the lessons. The content and the set-up were valued with 7,3/10 on average; 73,2% said the videos gave insight in stress-related issues; 44,8% said the videos helped them in talking to classmates; 64,0% said they can understand other people better; 70,5% obtained new ideas on how to deal with stress and 66,0% said they intend to apply them. There was little variation among boys and girls and educational levels. Conclusion Despite the sensitivity of the topic, most adolescents evaluated the lessons positively. The material gave insights enabling them to deal with stress in new ways and stimulated exchange and connection. Your Brain in Control?! is therefore an approach capable of reaching many adolescents: A promising public mental health intervention worth further implementation and research!

Školska medicina je reformom zdravstva 1998. godine iz integrirane zdravstvene zaštite prešla u preventivno-odgojnu djelatnost s ciljem da se zadrže sve preventivne mjere koje su u ovoj dobi od iznimnog značaja. Isto je bilo i s a zdravstvenom zaštitom studenata. Svrha ovog rada je ukazati na probleme u zdravstvenoj zaštiti studenata u Republici Hrvatskoj, posebice onih koji ne studiraju u mjestu prebivališta te koje su trenutne ovlasti nadležnih studentskih liječnika i kako ih je moguće poboljšati. U Primorsko-goranskoj županiji studira oko 16 000 studenata. Većina polazi fakultete Sveučilišta. Svi studenti imaju nadležnog studentskog liječnika i raspoređeni su u 7 timova školske medicine. Naša svakodnevna iskustva, ali i izvješća o radu ukazuju da postoji deficit u zdravstvenoj zaštiti studenata. U periodu od 01.10.2019. do danas smo odradili 3086 sistematskih pregleda, što je manje nego što smo trebali s obzirom na pandemijske uvjete. No, bilo je oko 12 650 savjetovanja u kojima oko 50% čine ona vezana uz očuvanje i unaprjeđenje zdravlja te je izdano gotovo 3000 uputnica, što je više od očekivanog za navedeni period. U vrijeme pandemije su se iskristalizirali prioriteti i potrebe ove populacije, posebno mladih koji ne studiraju u mjestu prebivališta. Radi se o posjetima ili savjetovanju ( telefonski, e-mail, viber, whats up, messenger, sms) s nadležnim studentskim liječnikom zbog akutne bolesti, izdavanja potrebnih uputnica, liječničkih potvrda različitih svrha, ispričnica, izricanja mjera izolacije i mjera samoizolacije, prilagodbi nastavnog procesa, smještaja u dom i dr. Nije se radilo samo o studentima iz Republike Hrvatske, nego i o stranim studentima koji studiraju ovdje, Erasmus studentima i izbjeglicama. Zaključak: Zdravstvena zaštita studenata ne zadovoljava njihove potrebe u ovom trenutku. Školska/studentska medicina treba preuzeti i aktivnu skrb za studente koji studiraju izvan mjesta prebivališta u slučaju akutne potrebe te joj sukladno tome treba omogućiti dio ovlasti iz „kurativne“ medicine (receptura, obrada rane, skidanje šavova…), kako bi im se olakšao život u mjestu studiranja. Postoji potreba i za dentalnom zdravstvenom zaštitom, kao i ginekološkom, koju smo mi premostili kroz Centre za mlade- savjetovalište otvorenih vrata u kojima radi i ginekolog. Također je neophodno riješiti sustav zdravstvenog osiguranja za osiguranike koji dolaze izvan RH.

Introduction: Covid pandemic has significantly affected the mental health of children and adolescents. The number of cases with more severe symptoms of anxiety, social isolation, eating disorders, attention and concentration disorders and even psychotic episodes in adolescents has increased significantly, especially in children with predisposing factors. In this paper, we will present the case of an adolescent with symptoms of auditory and visual hallucinations and her path to recovery. Predisposing factors: always been shy, quiet and obedient, as a child- afraid of the dark, victim of bullying, problems in peer relationships, serious illness in the family, cessation of sports. Clinical Findings: loss of motivation to learn, withdraws, complains of constant fatigue and exhaustion, feelings of sadness and fear attacks with difficulty concentrating, hypervigile attention and hears voices criticizing her and sees black shadows flying in front of her. Occasionally she felt instability, several times with a feeling of heat and nausea she lost consciousness. Mental Status Examination: communicative and cooperative during the examination, orderly flow of thought, low general mood, insecure, low self-confidence, maintains attention and concentration with effort. Diagnostic focus and assessment: The girl was referred to a psychologist, psychiatrist, neurologist and ophthalmologist. EEG and a thyroid hormone test was also performed. Psychiatrist diagnosed F23.9 Acute and transient psychotic disorders unspecified. Therapeutic focus and assessment: goals: reduce disturbing symptoms, increase self-confidence, improve school performance. Interventions: Druga therapy Risset, counselling and assistance with exams at the school. Outcome: Girl is without symptoms, does not take medication, feels confident and successful in school and social relation. What the girl says? “I changed in everything: mental and physical condition, worldview. From an insecure person I became safe. Everything helped but counseling helped the most.” Conclusion: After the acute psychotic disorder, the girl fully recovered. Recovery included not only a reduction in symptoms, but return to functioning with an emphasis on strengthening, self-understanding and self-esteem. Girl has significantly improved her life skills and self-esteem as a protective factor in the possible recurrence of psychiatric disorder. This is especially important in the treatment of first episode psychosis, because early intervention may avoid prolonged dysfunction.

Introduction Finnish Student Health Service (FSHS) has actively developed digital services since 2000. Student health care should promote students’ health and learning ability and to safeguard and improve the health and safety of the learning environment and wellbeing of the learning community. It should provide health and medical services, including early detection of mental health problems and substance abuse problems, care and follow-up guidance, sexual health services and oral health services; as well as identify students’ special support and health examination needs and refer the student to further tests and treatment if necessary. Since January 2021, in addition to university students, students at universities of applied sciences have access to the primary healthcare services provided by the FSHS. This more than doubled the number of students covered by FSHS, which required service model changes to meet the needs of student health care. The FSHS provides equal student health care services nationwide. The state provides 77% of the funding of healthcare for students in higher education and the rest is covered by the students. FSHS has a nationwide patient data system integrated with other national systems, established operating structures and multidisciplinary collaboration networks to promote health in student communities. Students’ wishes and needs are considered in development of FSHS Digital solutions. FSHS digital services offered more than 350.000 contacts for students in 2021 consisting e.g. from call-back service (300.000), e-chat (6.000), remote doctors’ appointments (20.000) and electronic forms (nn). Discussion Digital solutions for students are welcomed and increasingly desired. However, All healthcare-services cannot be efficiently provided digitally, thus seamless co-operation between professionals is essential in providing services of high quality in various situations. Conclusion Student health care in Finland has faced a historical reform. Digital services and solutions, challenges faced, as well as further development plans are introduced.

Hypoglycemia during exercise in children and adolescents with type I diabetes mellitus Matković B1, Majer M2, Cigrovski Berkovic M3, Petričević Vidović T1 1Teaching Institute of Public Health Dr. Andrija Štampar, Department of School and Adolescent Medicine, Zagreb, Croatia 2University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia 3University of Zagreb, Faculty of Kinesology, Zagreb, Croatia, KB Dubrava, Zagreb, Croatia Recently, there is increase of 2-5% in prevalence of Diabetes mellitus type I (T1DM) worldwide, among adults, and children and adolescents. Besides insulin therapy, nutrition and exercise are important component of treatment. Recent studies suggest that regular physical activity reduces glycosylated hemoglobin (HbA1c), improves cardiovascular health, lipid profile, and psychosocial well-being of children and adolescents with T1DM. During the physical exercise in children and adolescents with T1DM, wide glycemic abnormalities usually occur, which can increase the risk of severe hypoglycemia. In addition, children and adolescents with T1DM have altered antiregulatory hormonal responses, which may further increase the risk of exercise-related hypoglycemia even a few hours after exercise. Hypoglycemia and fear of hypoglycemia limit optimal glycemic control by physical activity in many children and adolescents with T1DM. Fear of hypoglycemia remains a major barrier to achieving the recommended level of physical activity in children and adolescents with T1DM, but can be alleviated by well-defined recommendations for exercise, maintaining normal glucose levels, improved insulin regimens, and educational programs and information. Glycemic management during exercise is facilitated by the availability and use of Continuous Glucose Monitoring (CGM) technology. The most common CGM systems measure glucose in interstitial fluid, providing real-time glucose sensor data (rtCGM) and triggering alerts for hypo and hyperglycemia. Education of children and adolescents and their parents about importance of physical activity in treatment of T1DM, and avoidance, detection, and management of hypoglycemia should be the crucial part of intervention of endocrinologist, pediatricians, and school health service in order to improve their glycemic control, and quality of life.

Aim Conversation between Child Healthcare Professionals (CHPs) and parents and adolescents plays an important role in the quality and success of preventive health care delivery. However, there is no practice guideline on conversation. This study aimed to study 1) the needs of parents, adolescents, and Child Healthcare professionals regarding conversations, and 2) the extent to which available guidelines meet their needs. Method A written needs survey was conducted among parents (n= 302), youth (n=308), and professionals (n=165). In addition to the written survey, focus groups were convened with each target group. To answer the second question, 13 guidelines with a focus on psychosocial problems of youth and/or family problems were analyzed to list all information on conversation management and compare it to the needs. Results The survey showed that parents as well as young people need a listening ear on an equal level, without judgment. Young people find it important that there is room to get acquainted so that trust can be gained. They ask their question sometime indirectly to a CHP, as if it were a friend. Especially then it is important that the professional continues to ask questions. Professionals find it difficult to discuss suspicions of abuse, obesity, smoking, self-harm or depression among young people. Preconditions that can support the conversation are, according to professionals, a pleasant place with privacy and knowledge about intercultural communication or cultural sensitivity. Next, comparison of the results of the needs assessment with 13 CHP guidelines showed that information on conversation management in guidelines is usually implicit. Also, recommendations with regard to dealing with diversity or working interculturally are brief. Conclusion Based on needs survey of parents, youth and professionals, tips and recommendations for conversation were made explicit. In order to make the results of the needs assessment practically applicable, we have developed a tool in which all information from the needs assessment and the guidelines are summarized. This has resulted in a set of 100 conversation cards. Each card contains a tip or recommendation. The card set can be used for training, peer review or reflection on one's own practice.

Background & key results: Future health care nursing professionals have to complete a health promotion and prevention project at the community level in their bachelor studies. This mandatory course led to a collaboration in 2021 with the local school health service to know more about the mental health needs among secondary high-school students. The following study shows the results of three different aspects and approaches highlighted in this endeavor. Mental health is becoming a main issue for school settings and their population. As literature shows, every 5th adolescent in school explores worries in their mental health such as anxiety, exposure to bullying or affective disorder and depression, arising from complex family situations, etc. School teachers have the task to deal with these additional problems of their students. Being proactive and conscious about these issues is one of the key outcomes, which we would like to complement with the adolescent’s perception. First, using a questionnaire to screen psychosocial and general health issues with the student in a confidential setting helps to point out mental health problems. In a second step, a follow-up can arise, including the adolescent, the parental authority and the school setting facilities, to further explore the issues. This collaboration study shows the need for future interventions in a school setting in close collaboration with school health professionals.

Introduction: How to talk about obesity with children and young adolescents? Is it a possible mission for school doctors? These questions are still relevant for every 5th overweight adolescent, with 5% of those presenting declared juvenile obesity (definition for obesity from the growth curves with percentile > 97 using BMI and abdominal circumference). Diverse initiatives in school health education focus on interdisciplinary approaches, which take into account the educational and cultural background of the adolescent as well as the lifestyle in families. Most of them also includes the eating behavior, regular physical activities, and a follow up of the general health status to avoid the risk of further co-morbidities. Aim: As is well known childhood obesity is suspect to become juvenile obesity during puberty and 80% may stay overweight as adults. Health education and the integration of the whole family, especially the parental adult, is essential to start early and continue during school years. School health professionals play here a key role in guiding parents, children and adolescents. They most often work as “case manager of health “coordinating multimodal approaches. In this workshop, we aim to introduce two different programs (one from Slovenia and one from Switzerland) to focus on healthy lifestyle intervention for obese children and adolescents. We highlight the importance of close collaboration with the school setting and the school health doctor and emphasize the necessity to integrate the whole family. We furthermore invite the participants to share their own experiences.

Since the Coronavirus disease pandemic was announced,an unprecedented change affected everyday life as social distancing measures as home quarantine and school closures were implemented to slow down the spread of the infection.It is approximated that school closures affected 862 million children and adolescents worldwide,causing withdrawal from social life and daily activities. According to the WHO database,in the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by 25%,and estimates from the latest Global Burden of Disease study, show that the pandemic has especially affected the mental health of young people and that they are disproportionally at risk of suicidal and self-harming behaviours.Since adolescence is the time of complex transition from childhood to adulthood,the pandemic may have multiple consequences on the lives of adolescents,therefore they require special care to preserve and promote their mental health. Potential stressors causing disruption in children and adolescents\' lives are social isolation,concerns over safety and health,loss of social activities and adjustment to online schooling,causing change in routine.The studies have shown that children from all developmental phases had high rates of depression,anxiety and post-traumatic symptoms.Problems such as worsening school performance ,increased agitation , aggression,and regression may become more pronounced as well. COVID-19 could have immediate and long-term mental health problems ,since it has been shown in the studies that almost half of acute mental health illnesses occur by the age of 14,and 75% manifest by the mid-20s indicating that children and adolescents\' psychological wellbeing is important for mental health later in life. It is important that health professionals and schools partner together to mitigate potentially negative mental health and education impacts on children and adolescents,using effective school-based mental health screening followed by individual counseling and YP-CORE screening for adolescents at risk at the doctor\'s office.

Background Occipitofrontal head circumference is measured in infants during youth health care well-child visits in the first year of life, almost all over the world. There are (almost) no international or local guidelines to support professionals in clinical decision making regarding follow-up frequencies or referral criteria for infants with abnormal head circumference growth (e.g. percentile shifts, (relative) macro- or microcephaly). Literature is reviewed to summarize international evidence and search for answers, leading to a study proposal. Literature review Several (retrospective) studies regarding head circumference and specific diagnoses were found, almost all were conducted from a hospital setting. No studies were found choosing the broad preventive screening goal of public health, similar to the Dutch daily youth health care practice. Only one evidence based referral criterium was found predictive for macrocephaly and hydrocephalus. Several studies show percentile shifting in head circumference is common. Inter- and intra-observer variation in head circumference measurements occur frequently. The diversity in study designs, healthcare systems, countries and populations combined with rarity, diversity, and possible underreporting of prevalences of the diseases(spectrum) complicate bundling and generalization of these individual study outcomes to general advices. Translation to screening in the public health setting with goals in early detection and prevention of a broad spectrum of health and developmental problems, is difficult. Discussion There is a knowledge gap regarding normal variety and predictive value of abnormalities in head circumference growth. Considering the daily practice of youth health care in The Netherlands and well baby clinics in other countries, this leads to both clinical decision making without evidence base, as well as the opportunity to improve head circumference healthcare policy based on large amounts of data. We conduct a retrospective study in which we apply proposed referral criteria on data from a regional birth cohort (n=±8000 infants). Subsequently, we aim to develop a predictive model designed to refer timely considering clinical aims as well as normalization/ reassurance and prevention of over-referral, in close cooperation with local pediatricians and child neurologists.

Aims: The interferon-gamma release assays (IGRA) have been widely used over the last decade for diagnosing latent tuberculosis infection. Although more specific than the tuberculin skin test (TST), the recent political situation regarding refugees from Ukraine, a country with high tuberculosis incidence rates, and their accommodation in congregational settings, put new light on the TST use that is more practical to perform in such conditions. Methods: Review of available literature related to main characteristics of TST. Results: The likelihood that a skin reaction is the result of contact with M. tuberculosis increases with the size of the reaction if the person has been in contact with tuberculosis patient or has a high risk for tuberculosis or comes from a country with high tuberculosis prevalence or the more time that elapsed between vaccination and testing . Reversion has been shown to occur more frequently in the elderly or in those in whom the initial tuberculin reaction was 5-9 mm, 10-14 mm, or in those who had a booster effect. Booster phenomenon is most pronounced when retesting occurs in 1-5 weeks, although it may be present more than a year after the first negative TST. It is generally accepted that boosting efect on IGRA result after TST may occur, mostly more than 3 days after the TST. Thus, it does appear that the optimal time to collect blood for IGRA is at the time of reading the TST. Conclusion: Although TST is a simple test, the further procedure with tuberculin reactors is not simple. Therefore, the result should not be interpreted one-dimensionally, ie depending only on the size of the reaction. For each person, the test result should be interpreted carefully and in the context of the epidemiological and clinical data.

Uvod: Odgovarajuća prehrana ima važnu ulogu u održavanju zdravlja i prevenciji bolesti a mladi ljudi su posebno osjetljivi na učinke loše prehrane, uključujući nedostatke hranjivih tvari. Studenti se mogu razlikovati od opće populacije zbog specifičnog načina života, koji uključuje studiranje, sportske aktivnosti, pušenje i konzumaciju alkohola. Neadekvatna i neredovita prehrana, tjelesna neaktivnost, stres i pušenje su čimbenici rizika za razvoj mnogih kroničnih nezaraznih bolesti (koronarna bolest srca, dijabetes tipa 2, osteoporoza, karcinomi). Cilj istraživanja: Ispitati prehrambene navike studenata Sveučilišta u Rijeci, kao i navike pušenja i tjelesne aktivnosti u cilju poboljšanja i promicanja zdravlja. Ispitanici i metode: Istraživanje je provedeno na Sveučilištu u Rijeci i obuhvaćen je 171 student, 89 studentica (52 %) i 82 studenta (48 %). Anonimnom anketom ispitale su se prehrambene navike, tjelesna aktivnost i druge navike studenata. Rezultati i rasprava: Većina studentica je imala normalni ITM (70,8%) dok je 50% studenata bilo ili preuhranjeno ili pretilo iako su bili tjelesno aktivniji od studentica. Jedna trećina studenata puši cigarete, bez značajne razlike među spolovima. Studenti unose više bjelančevina, zasićenih masnih kiselina i kolesterola od preporučenih vrijednosti, a manje ugljikohidrata. Unos vitamina i minerala bio je statistički značajno višu kod studentica što je posljedica većeg unosa voća i povrća. Rezultati hi-kvadrat testa pokazali su da je najveći unos energije i hranjivih tvari bio u tjelesno najaktivnijoj skupini (37,7%) (p = 0,050). Zaključci: Ova studija je pokazala značajne razlike između unosa određenih hranjivih tvari između mladića i djevojaka te međuovisnosti između indeksa tjelesne mase i tjelesne aktivnosti ukazujući na uzorke ponašanja u životnim navikama studenata ovog područja. Dobiveni rezultati ističu potrebe osmišljanja i uvođenja javnozdravstvenih aktivnosti usmjerenih na pravilnu prehranu i tjelesnu aktivnost.

Aims The COVID-19 pandemic and implemented measures of social distancing challenged the possibilities of maintaining a healthy lifestyle, including physical activity praxis. The aim of this research was to determine the changes in physical activity levels (PAL) in high school students due to the COVID-19 lockdown and to investigate age- and parental-related factors associated with PAL. Materials and methods The research included 859 adolescents aged 14-18 years attending high school. Students were tested on two occasions: before (January 2020) and during (April 2020) the COVID-19 pandemic. PAL was assessed using the Physical Activity Questionnaire for Adolescents. Socio-demographic and parental factors (parental education, parental conflict, and care) were also reported. T-test for independent samples was used to identify differences between younger and older adolescents. Logistic regression evidenced associations between predictors and PAL. Results The results of the research indicate that younger adolescents declined their PAL more than older adolescents (t-test=1.76, p=0.04). Adolescents with better-educated mothers had reduced odds (OR=0.50, 95% CI: 0.21–0.84) for PAL decline due to the COVID-19 pandemic. Conclusion Younger adolescents should be taught about the health benefits of physical activity and should be encouraged to participate in sports activities without focusing on competitive achievement. Adolescents with better-educated mothers are more likely to have higher health literacy and know that PAL should be maintained during the lockdown to preserve their health.

Aims: Overweight among adolescents remains a serious concern in the western world and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School approach was developed to stimulate healthier lifestyles by focusing on health education, school environments, identifying pupils’ health problems and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School characteristics, general school characteristics and the school population. Materials and methods: The design of this study was a cross-sectional multilevel case-control study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10) of seven public health services and combined these with information regarding the school context and Healthy School certification. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, 52,764 adolescents from 191 schools were analyzed. Results: The school level explained 2.49% of the variation in the consumption of sugar-sweetened beverages and 4.63% of the variation in the consumption of water. Healthy School certification did not explain this variation, yet some other school context factors did: the % of adolescents with high educated parents, the educational track of the adolescents and urbanicity (only for water consumption). Conclusion: Our findings did not show associations between Healthy School and the daily consumption of sugar-sweetened beverages and water. However, our results indicated in what school contexts health promotion can be most beneficial. Future research should examine whether Healthy Schools can contribute to healthier lifestyles in different contextual settings. Results based on calculations by Maastricht University using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: microdata@cbs.nl.

Aims –Identification of children with an increased risk of future overweight or obesity enables targeted preventive strategies. The objective of this study is to develop a screening algorithm that can detect young children with a high risk on overweight or obesity at early adolescence (age 10 – 14 years). Materials and methods – We analyzed a subset of data from Generation R (N=3157), a population-based prospective cohort study. The following types of predictive information were considered: 1) Maternal BMI; 2) Maternal age; 3) Paternal BMI; 4) Pregnancy characteristics; 5) Child characteristics; 6) SES-indicators; 7) Family and child’s lifestyle; 8) Child lipid measurements. BMI Z-scores are predicted at age 0.25 years (birth model), 2.5 years (two-year model), 4.5 years (four-year model) and 6.5 years (six-year model). Two models were fitted, one generic model and one restricted to variables currently available in Dutch child care organizations. The data was split into a training and a testing set. We compared a variety of methods on our training data, and found that regularized regression model with lasso consistently performed well. We used multiple imputation to address missing values and fitted our final model on all imputed data sets and averaged predictions. Results – Our best performing model to predict overweight or obesity at 10 – 14 years of age was the model with variables at age 6 (out-of-sample R2=0.568). The most important variables in our models were: child BMI, BMI of both parents, ethnicity of the child and the age at which the child was introduced to eating fruit and vegetables. Conclusion – Our models perform well in predicting overweight or obesity at 10 – 14 years of age. These models can be used at earlier ages by preventive child health care to predict and prevent obesity. During the presentation we will show a live demo of a prediction tool.

INTRODUCTION: Vaccination is one of the most successful and safest medical measures which, in addition to personal protection, ensures community immunity. In the Republic of Croatia, there is a program of compulsory vaccination of children, which is carried out by specialized teams of school and adolescent medicine in the relevant clinics during school age. OBJECTIVE: To investigate the vaccination coverage rate of first graders in secondary schools in the Imotski region and to identify the main reasons for non-vaccination of students who are not fully vaccinated. MATERIALS AND METHODS: Data were collected through retrospective analysis of preventive health records of 282 first graders under the supervision of a school physician at the school medical clinic in Imotski. We analyzed vaccinations against diphtheria and tetanus (Td), polio (IPV) and measles, mumps and rubella (MMR). RESULTS: 269 (95.4%) students were properly vaccinated with MMR vaccine, 276 (97.9%) with Td vaccine and 275 (97.5%) with IPV vaccine. 13 (4.6%) students were not vaccinated with MMR vaccine, 6 (2.1%) were not vaccinated with Td vaccine and 7 (2.5%) were not vaccinated with IPV vaccine. No permanent contraindications to vaccination were identified. Temporary contraindications (acute illness) were noted in 2 students for Td vaccination and 2 for IPV vaccination. Parental refusal as a reason for non-vaccination was noted in 4 students for MMR vaccination, 2 for Td vaccination and 3 for IPV vaccination. Non-vaccination due to parental negligence was noted in 9 students for MMR, 2 for Td and 2 for IPV. CONCLUSION: Most of the students were properly vaccinated. There were no medically justified contraindications to vaccination in the study group. The main reasons for non-vaccination were parental refusal or negligence. To improve vaccination rates, it is necessary to continuously work on educating and improving the health literacy of parents.

Aims: In scientific literature, varying terminology is used when studying the impact of stress on the developing child from conception to adulthood. The absence of a consistent operationalization and conceptual definition of early life stress, adversity and similar concepts causes stress-related terms to be used interchangeably, complicating generalizability of studies. Therefore, our aim was to elucidate the meanings and boundaries of terms used in research on stress in childhood, and to substantiate which term best fits research regarding practical implication in public health and youth health care. Materials and Methods: We conducted a scoping review, searching PubMed, PsycInfo and EMBASE for systematic reviews using the terms: Early Life stress, Early (life) Adversity, Early (life) Trauma, Adverse Childhood Experiences (ACEs), Toxic Stress, Allostatic Load and Chronic Stress. Additionally, reference lists were screened for relevant studies. Two independent reviewers assessed eligibility. Study descriptives (e.g. publication year, field of research, research group) and characteristics of stress terms (use of the term, definition, operationalization, description, variable type) were extracted using standardized extraction forms. Extracted data was synthesized and used to analyze characteristics and examples of the terms, and differences between terms, which were visualized schematically and in Venn diagrams. Results: The full search of databases and reference lists resulted in 264 studies to be screened for eligibility. 124 studies met the inclusion criteria. Analysis and sorting of the characteristics and examples of terms lead to descriptions and visualizations of overlap and differences between the used terminology. A distinction could be made between event-based terms that were well operationalizable in public health (of which ACEs were most studied), and physiology-oriented terms like allostatic load and toxic stress that through its physiological measurements seemed more suitable for clinical settings. Conclusion: We provide an overview of how different terminology is used in research on stress in childhood. This can be used to substantiate the choice for a specific term or construct, stimulating a more standardized use and potentially improving the generalizability of future studies. It is yet to be determined which term is most appropriate for epidemiological and screening purposes in public health and youth health care.

This study aimed to identify differences and similarities among adolescents and parents in various behavioural factors influencing meningococcal ACWY (MenACWY) vaccination acceptance. The impact of the Covid-19 pandemic was assessed as well as resulting organizational adjustments. We conducted a cross-sectional survey among adolescents that attended the appointment for the MenACWY vaccination in South Limburg between May and June 2020, and their parents. We identified differences and similarities in various behavioural factors influencing vaccination acceptance (e.g. attitude, knowledge and barriers), with questionnaires based on a theoretical framework developed by Visser et al. Independent t-tests and X2 test were performed to explore differences in behavioural and organisational factors between adolescents and parents. In total, 592 adolescents (20%) and 1197 parents (38%) filled out the questionnaire. Adolescents scored lower on anticipated negative affect towards MenACWY vaccination refusal (t (985.688) = -9.32; ρ <.001), moral norm towards MenACWY vaccination acceptance (t (942.079) = -10.38; ρ <.001) and knowledge about the MenACWY vaccination and meningococcal disease (t (1059.710) = -11.24; ρ <.001). Both adolescents and parents reported a social norm favouring accepting childhood vaccinations, but adolescent scored higher (t (1122.846)= 23.10; ρ <.001). This indicates that the feeling that important others, such as friends, are positive about vaccination in general is greater among adolescents. Furthermore, 40.1% of the parents in our study indicated that they made the decision together with their child, and 68% of adolescents indicate that they ask their parents for information about vaccinations. The Covid-19 pandemic did barely influence the decision to accept the MenACWY vaccination. Only 6% of the participants indicated that Covid-19 influenced their decision. Parent-child communication about vaccination might increase knowledge about the vaccine and the disease among adolescents, and make adolescents feel empowered about future health-related decisions. Future interventions might focus on parent-child discussions and increasing parents’ confidence in discussion vaccinations with their child.

METABOLIČKI SINDROM U ŠKOLSKE DJECE I MLADIH Batista I1, Čović N 1, Majer M2 Metabolički sindrom definira se kao skup međusobno povezanih čimbenika rizika za razvoj kardiometaboličkih bolesti. Osnovne komponente sindroma su prekomjerna tjelesna masa i/ili pretilost, arterijska hipertenzija, dislipidemija i intolerancija glukoze. S porastom učestalosti debljine, bilježi se i porast učestalosti metaboličkoga sindroma i među školskom djecom i mladima, te se kreće od 1-33% ovisno o dobi, spolu, stanju uhranjenosti i primijenjenim kriterijima. U Republici Hrvatskoj učestalost metaboličkog sindroma među adolescentima u dobi od 18-19 godina iznosi 2,5% prema kriterijima International Diabetes Federation (IDF). Koncept metaboličkog sindroma u djece i mladih važan je jer identificira multipli rizični fenotip u toj populaciji. Iako je klinička prezentacija metaboličkog sindroma rijetka u ranoj školskoj dobi, upravo tada počinje štetan učinak i interakcija između rizičnih čimbenika za njegov razvoj. Znakovi koji mogu upućivati na pojavu metaboličkog sindroma koji se mogu uočiti na sistematskom pregledu djece i mladih u Službi za školsku medicinu su prekomjerna tjelesna masa i/ili pretilost, osobito centralnog tipa, povišene vrijednosti sistoličkog i/ili dijastoličkog tlaka, te na koži acanthosis nigricans, akne i hirzuitizam. Svako dijete zahtijeva individualnu procjenu, ali prisutnost prekomjerne tjelesne mase i povišenoga arterijskog tlaka indikacija je za upućivanje na laboratorijsku analizu lipida, glukoze i urične kiseline u serumu. Prema smjernicama IDF za dijagnozu metaboličkog sindroma, kod djece do 10 godina dijagnoza metaboličkog sindroma se ne postavlja, već one s opsegom struka većim od 90. centile i pozitivnom obiteljskom anamnezom na kardiometaboličke bolesti treba pratiti. Djecu stariju od 10 godina s multiplim rizičnim fenotipom i/ili postavljenom dijagnozom metaboličkog sindroma potrebno je uputiti endokrinologu. Preporučena intervencija za smanjenje učestalosti metaboličkog sindroma jest djelovati na smanjenje učestalosti prekomjerne tjelesne mase i pretilosti među školskom djecom i mladima, djelovanjem na prehrambene navike i povećanjem tjelesne aktivnosti. Prekomjerna tjelesna masa i pretilost su preventabilni čimbenici rizika za razvoj metaboličkog sindroma. Služba za školsku medicinu u mogućnosti je otkriti djecu i mlade s čimbenicima rizika za razvoj metaboličkog sindroma te pravovremeno intervenirati.

Review of satisfaction with the nutrition of female students in the high school dormitory.
In the global saturation of different diets and forms of nutrition with whom young people are faced through the media (television internet, diet applications..), a survey was conducted on eating habits and satisfaction with nutrition of female students aged 14-19 located in the high school dormitory. The aim of this paper is to analyze the satisfaction of female students with the food offered in the dormitory, to present a couple of examples of dormitory menus and connect it with the results of the survey. The survey was designed in collaboration with a school pedagogue and it was adapted to the students. Duration of the survey was just 5-10 minutes. The presentation of the survey results was supplemented with suggestions and comments from students on the existing dormitory menus. There are 120 female students in the dormitory, the survey was completed by 73 students, which makes up 64% of the enrolled female students, and the survey was processed according to the classical principle of counting and calculating percentages. The results and comments facilitate the work of health professionals in the organization of nutrition in the dormitory and serve as a framework for planning health education of students in the dormitory and employees of the kitchen in cooperation and planning work with educators.

Introduction:Covid 19 pandemic has led to concern about the potential outcomes of school closures and movement restriction on the health of children including on the body weight . Aim:evaluate whether there was a change in the body weight of 1st grade high school students in the Covid 19 pandemic and how much the lifestyle of our students changed during the Covid 19 pandemic. Methods: body weight data were obtained from medical records 244 boys and 37 girls of 1st grade of high school .We compared BMI results obtained at screening examinations in the school clinic before pandemic and during pandemic. Data on lifestyle changes were obtained from a questionnaire completed by students in the period from January to March 2022 . Results: at the school year 18/19 8.2% of boys and 10.8% girls had BMI above 85 percentile.At the school year 20/21 14.35% boys and 21.6% girls had BMI above 85 percentile.At the school year 21/22 18.44% of boys and 24.32% girls had BMI above 85 percentile.During pandemic 32.37% of boys and 48.64% girls are less walking in their free time, 22.54% of boys and 18.9% of girls are less engaged in recreational activities, 13.12% of boys and 29.72% of girls have stopped recreational activities, 17.21% of boys and 37.83% of girls have stopped active sports activities. 9.83% of boys and 5.4% of girls have less active sports activities.43.44% of boys and 56.75% of girls spend more free time in sedentary activities . 40.57% of boys and 48.65% of girls spend less time with their friends. Conclusion: Our students have greatly changed their habits, markedly reduced physical activities and increased sedentary activities, which indicates the need for quick intervention in the normalization of lifestyle . The question to be discussed is whether an increase in body weight in our students is associated with a change in lifestyle during pandemic.

INTRODUCTION: Through the plan and program of preventive and educational health care measures for schoolchildren and students, specialists in school and adolescent medicine perform screening for thyroid diseases as part of systematic examinations in primary and secondary schools and in the first year of college. OBJECTIVE: The aim of this study was to investigate the association between a palpable (enlarged) thyroid gland and abnormalities in its laboratory parameters (TSH, T3, fT3, T4, fT4, and/or anti-TG and anti-TPO antibodies). MATERIALS AND METHODS: The study was conducted by retrospective analysis of data collected from screening examinations of children aged 11 to 16 years, who were examined over 3 months in a practice of school and adolescent medicine in Split (Croatia). The study included children who had been examined in regular systematic examinations in the 5th and 8th grades of elementary school and in the 1st grade of secondary school. All patients with palpable thyroid gland ( 0 / I; II) were referred for determination of laboratory parameters of the thyroid gland. Based on deviations from reference values, patients were referred immediately for further endocrinological treatment in case of clinically significant deviations and for rechecking of parameters in 6 months in case of minor deviations. RESULTS: In a sample of 333 patients, 51 patients (15.31%) had a palpably enlarged thyroid gland (findings 0 / I; II). Deviation from reference laboratory values was noted in 21 patients (41.17%) with palpably enlarged thyroid gland. Of these 21 patients, 12 patients had elevated thyroid hormone levels, 6 patients had elevated thyroid antibody levels, 2 patients had both elevated thyroid hormone and antibody levels, while 1 patient had an increase in anti-TG and a decrease in fT4 levels. Of the total number of patients who had abnormalities in laboratory findings, only 4 were ordered for follow-up in 6 months, while all the others were referred to an endocrinologist. CONCLUSION: The study confirmed the association between palpation of the enlarged thyroid gland and deviation of reference values of laboratory parameters thus demonstrating the importance of monitoring clinical and laboratory parameters in screening for thyroid dysfunction.

Anaphylaxis is an acute, life-threatening allergic reaction mediated by IgE antibodies that occurs in previously sensitized individuals when they come into contact with a sensitizing antigen. Food is one of the most commonly responsible allergens. The prevalence of food-induced anaphylaxis is steadily increasing. (1) This paper presents the case of an elementary school student in Zadar County who presents with an anaphylactic reaction following exposure to peanuts. The procedure of the school team in the preparation and education of professional staff, professors and parents for the purpose of prevention and timely adequate response in case of an anaphylactic reaction is presented. The primary prevention is avoiding the known trigger. Education and avoiding food allergens is crucial due to the fact that most of the fatal outcomes have occurred in people with previously known food allergies. Symptoms can affect multiple organ systems and include pruritus, urticaria, angioedema, vomiting, diarrhea, abdominal cramps, respiratory difficulties, wheezing, hypotension, and shock. It is of great importance to quickly identify symptoms and apply adequate procedures and therapy. In the case of anaphylaxis, the drug of choice is epinephrine.

UVOD: Humani papiloma virus (HPV) najčešći je među uzročnicima spolno prenosivih infekcija. Zaraza HPV virusom može dovesti do razvoja novotvorina na vratu maternice, rodnice, muškog genitalnog sustava, kao i pojave genitalnih bradavica, i malignih bolesti drugih sijela, te se stoga nameće kao javnozdravstveni problem. Najdjelotvornije mjere za sprječavanje infekcije su primarna prevencija, edukacija te primjena cjepiva ("Gardasil 9"). CILJ RADA: Cilj ovog istraživanja je ispitati znanje, stavove i spolne navike studenata 1. g ekonomskog fakulteta u Splitu ak. god. 2021/2022. ISPITANICI I METODE: Istraživanje je provedeno u travnju 2022 "survey monkey" anonimnim anketnim upitnikom na uzorku od 90 studenata. Upitnik je sadržavao je 10 pitanja. REZULTATI: Ispitanici su bili u dobi od 18 do 22 g. Od toga 17 (18,89%) M i 73 (81,11%) Ž. U spolne odnose je stupilo 39 (43,33%) ispitanika. Na pitanje da li osoba koja izgleda zdravo može biti zaražena HPV virusom 90 (100%) je odgovorilo pozitivno. Na pitanje koje kontracepcijsko sredstvo štiti od HPVa 12 (13,33%) je odgovorilo vjernost jednom partneru, 9 (10,00%) hormonska kontracepcija i 69 (76,67%) kondom. Mogućnost cijepljenja protiv HPV-a kroz školovanje potvrdno je odgovorilo 31 (34,44%), nije omogućeno 16 (17,78%) i 44(48,89%) se ne sijeća. Od 90 anketiranih studenata 20(22,47%) je cijepljeno protiv HPV-a, a 70 (78,65%) nije. Da li cjepivo štiti od karcinoma reproduktivnih organa 5(5,56%) je odgovorilo da, 7 (7,78%) ne, a 78 (86,67%) ne zna. Da su potrebne bolje informacije o bolesti uzrokovanoj HPV virusom i cjepivu smatra 45 (50,00%) studenata a da ne treba 46 (51,11%). Od anketiranih studenata 23 (26,14%) se želi cijepiti a 67 (76,14%) ne želi. ZAKLJUČAK: Preporučena dob za cijepljenje je od 9. do 25. godine. Obzirom na dobivene rezultate, potrebno je nastaviti sa edukacijom i organiziranjem cijepljenja i na fakultetu, da bi se postigao što bolji obuhvat cijepljenih kao najučinkovitija mjera prevencije upalnih stanja i karcinoma perigenitalne regije.

Youth health care is at its best when all stakeholders are involved, including adolescents, parents, teachers, scientist and policy makers. At the Dutch Centre for Youth Health (NCJ) an interactive drawing has been created inspired by the latest scientific research on adolescents in the Netherlands. Over the past year, this drawing has been succesfully used to create discussion and start conversations on what stakeholders would like to see offered by Youth Health Care. We will present the drawing in our session and through various examples, explain how we use this as a starting point for conversation connecting stakeholders from science, policy and the lived experience.

Nurse leadership is the ability to inspire, influence and motivate healthcare professionals as they work together to achieve their goals according to Mandy T. Bell (DNP, MSN, RN, clinical faculty of graduate nursing at SNHU.13 jul. 2021). In our workshop we will present an example of nursing leadership in the Netherland and how this can be extended to preventative Youth Health Care. Through a guided discussion, we invite you to share experiences from your country/setting and learn from the input of others.

Background: Children growing up in vulnerable neighborhoods often experience setbacks and chronic stress. During the extra sensitive developmental period of adolescence, chronic stress can have major psychological and physical consequences, but damage can also be prevented. There are indications that preventive programs with a cross-domain approach can contribute to the reduction of chronic stress. Big Brother, Big Sister (BBBS) is a preventive neighborhood youth empowerment program (YEP) carried out in neighborhoods with a low socioeconomic status, developed for and by young people who find little connection with school, work or home. The program has four main characteristics: it is peer developed, has low threshold access, has professional facilitated peer groups, and is embedded in local networks. Hardly any multidisciplinary research has been conducted into preventive neighborhood programs using bio-psycho-social outcome measures in young people. Aims: This study aims to investigate changes that occur in young people during participation in the BBBS program in terms of (early life) stress, subjective psychological well-being and social participation. Materials and methods: This exploratory quantitative study has an observational design with three measurements (at the start of the program, after 6 months of participation and at outflow > 9 months). Around 60 young people aged 14 to 27 will participate in this study. Different methods are used to assess outcomes; self-reported questionnaires are filled out (e.g., the Perceived Stress Scale; Basic Psychological Need Satisfaction and Frustration Scale), and hair samples are taken to assess stress levels of the youth (e.g., by cortisol analyses). Results: Preliminary results of the baseline measurement (T0) will be presented (n=35). Conclusion: This study provides insight into what BBBS contributes to reducing stress and promoting well-being of the participants. Strengths and limitations of this study will be discussed.

Mental health care is an important aspect of welfare, particularly in these challenging times. Aim: The aim of this paper is to present the main data on users of Counselling for children and adolescents, by Department for Mental Health of Public Health Institute, Split-Dalmatia County. Sociodemographic data, features of the mental health issues and outcome indicators of the treatment will be presented. The collected data related to users who were in treatment during two calendar years 2020 and 2021. Materials and methods: During the program, while working with children and adolescents, collected data refer to the course of treatment on a monthly basis. Furthermore, treatment outcome were measured by short two-point evaluation questionnaire, before the beginning of the treatment and after the completion, by the users and counsellors. Results: During the observed time, 441 user used counselling services, more than half were female (56.45%). Most users were 15 to18 years old (49.6%), while 30% were under 15 years old. The most common reasons for seeking help were internalized difficulties, such as anxiety (50.3%), difficulties in social relations (37.6%), school problems (35.1%) and depression (32.4%). Out of externalized difficulties, marijuana consumption was the most common (12%). Duration of the counselling program was 2-3 months (31.5%), up to 6 months (16.1%) or longer than 6 months (25.6%). On the basis of self-evaluation and evaluation questionnaire assessments, significantly more positive changes in the observed aspects (school, social, family and emotional functioning, as well as behavioural addictions) were observed by both the users (t=6.560, df=42, p<.001) and the counsellors (t=9.981, df=42, p<.001). Conclusion: Based on the obtained results, we can conclude that the individual psychosocial treatment for children and adolescents has a positive impact on mental health.

Background and aims: The aim was to examine the cognitive abilities as well as health problems, developmental disorders and social difficulties of students who are educated on regular program with customized curriculum and individual approach in 3 elementary school in the city of Split in the school year 2021./2022. Methods: Data was obtained from medical records of 1696 elementary school students. Data was analysed using descriptive statistics. Results: 21 elementary school students are studing on regular program with customized curriculum and individual approach. 8 (23%) of them are listening all subjects in this manner. 4 (19%)of them have customized curriculum for all main subjects, whilst others listen only certain subjects with customized curriculum. Cognitive abilites were mesured by WISC-IV. 3 (14%) students showed an average cognitive abilities, 3 (14%) low average, 2 (9%) borderline, 1 (4%)extremely low. The rest of students showed uneven scores on WISC-IV subtests ( from average to extremely low). All students had multiple dificulties. 11 (52%) students had specific learning disabilities. 7 (33%) students had speech and language disorder. 10 (48%) students had atention deficit disorder. 10 (48%) students had poor visual-motor perception skills. 1 (4%) student had epilepsy. 3(14%) students had ADHD. 7 (33%) students had emotional or psychiatric problems. 5 (24%) students were pedagogical neglected. Conclusion: The results show a need for early diagnosing and treatment of health, developmental and social difficulties in children in order to reduce the need for customized curriculum.

Color disorders or dyschromatopsias can be congenital or acquired. There is two types. Dichromasia, when a person sees only two main colors, while for one it is completely blind and anomalous trichromasia which indicates incorrect tricolor perception . In congenital dyschromatopsies, the mother transmits mutated gene in 50% of her children, and there is an equal chance that the son will inherit the disease or the daughter will transmit gene of her offspring, primarily male children. In school medicine, color vision is tested at the start of the first grade of primary school, in the third grade, fifth and eighth grade. Tests differ according to age, so children in first grade are only required to recognize colors, while older children are tested with Ishiara tables. According to the data of school medicine in the Split-Dalmatia County, in the previous two school years we have seen an increase of this disorder with increasing age. In the first grade, we have only a few cases of this disorder, 72 of them with the fifth-graders, and 88 in the eighth grade, they were mostly boys. We can assume that with increasing age, the reliability of the examination itself increases, because it is logical to assume that older children could more easily understand what is required of them, and also in that age the examination is given more importance because of choice of occupation. This is the reason that children gets this diagnosis mainly in the upper grades of primary school.This approach is completely justified,but question arises about quality of learning for children with this disorder , especially in lower grades when the material is visually costumized to that age and has many more illustrations which is color based. Early detection of color vision disorders provides the child and his family easier adjustment to this condition. It allows them to find the right way for learning and getting knowledge at the right time during the schooling process. The main goal is to avoid occupations that would create difficulties and frustrations for people with this disorder.

AIM: The COVID-19 pandemic is having a profound effect on all aspects of society, including mental health. Studies showed that poor mental health of parents is related to poor physical and mental health in children. The aim of this study was to estimate mental health of parents of pre-school children obliged to attend the medical exam before elementary school admission during the COVID-19 pandemic. MATERIAL AND METHODS: Participants in the research were parents of children aged 6 to 7 years who were obliged to attend the medical exam before elementary school admission in the city of Zaprešić in school year 2021/22. We used validated questionnaire Mental Health Inventory – 5 (MHI-5) which included several mental health items: anxiety (How often have you been very nervous?), depression (How often have you felt discouraged and sad?), general positive affect (How often have you been happy?; How often have you felt calm and peaceful?) and behavioral / emotional control (How often have you felt so depressed that nothing could cheer you up?). The questionnaire also included items about gender, age and level of education of parents. The parents were asked to complete questionnaire anonymously. Data were analyzed by methods of descriptive and analytic statistics, with the significant level of P<0.05. RESULTS: Data analysis included 264 (78.81 %) of total number of respondents (83.3% females), mean age 38.19±5.84. Mean MHI-5 score of respondents were 22.45±3.07. Significantly lower mean MHI-5 score was found in respondents 50-years old and older, comparing to younger respondents (19.4 vs 22.79; P=0.034). There was not significant difference in mean MHI-5 score regarding the parents’ gender or education level. In our sample, Cronbach's alpha measure of internal consistency was 0,802. CONCLUSION: The results showed good mental health of parents of children during pandemic, with the exception of older parents. Parents of schoolchildren are important partner of school health service, and results indicate the need of intervention regarding mental health in older parents.

BACKGROUND Missing school impacts both education and health. The purpose of this study was to address sickness absence in primary schools by adjusting the ‘Medical advice for sick reported students’ intervention for secondary schools. This was necessary because of fundamental differences in relation to the children’s age and in the schools’ organisational structure. METHODS The intervention mapping approach steps 1 through 4 were used to adapt ‘Medical advice for sick reported students’ to primary schools (MASS-PS), including a literature search, stakeholder interviews, establishing a planning group and pre-testing. RESULTS In step 1, a planning group was formed and a logic model of the problem was created. In step 2, a logic model of change was created. In step 3, a theoretical basis and practical strategies were determined. In step 4, practical support materials were designed, and two pre-tests of the materials were performed. CONCLUSIONS Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness absence, consultations between teacher and absenteeism coordinator, and addition of two experts. With MASS-PS, sickness absence can be addressed as a ‘red flag’ for underlying problems.

Introduction: In Croatia, since the start of the Covid-19 pandemic, there have been 1.113.663 reported cases, 134.290 of them in children up to 14 years old. From the start of the pandemic there have been 12.752 deaths, 4 of them being in children aged up to 14 years old (2). Until the registration of vaccines , isolation and safety measures were the only means of prevention of spread, and, by the introduction of Covid vaccines, the majority of the population got vaccinated (3). One of the first vaccines introduced is produced by Pfizer, later known as Comirnaty, which is based on mRNA technology. Discussion: An otherwise healthy girl, aged 8 years old tested positive by PCR in November 2021. She was diagnosed with a mild Covid infection and had to be isolated a couple of times afterwards because of being a close contact. She was vaccinated on 10. February 2022. Next day, she develops pain in her left arm, around the injection site, and in the left axilla. On a physical exam, axillary lymph nodes are palpated, about the size of a walnut, painful on deep palpation. Adjacent skin is intact and without trophic changes. The skin of the left upper arm has no signs of inflammation. Otherwise the girl is in good overall condition, without fever or signs of systemic disease. Upon ultrasound inspection, the lymph node seems reactive, and in the right axilla, another lymph node is observed. A checkup is appointed in 14 days. Drug side effects are reported to HALMED. On checkup, physical exam is without abnormal findings, lymph nodes are not palpable. On ultrasound, also no abnormal findings. Conclusion: One of the possible described side effects of Comirnaty vaccine for children aged 5 to 12 years is lymphadenopathy, which occurs less frequently (more than 1/1000 and less than 1/100). Since the girl is now asymptomatic, it is recommended to continue vaccination and monitor for possible side effects.

We present a poster of a psycho-educative mental health program for Finnish universities. During the covid-19 pandemic the demand for mental health services rapidly grew among university students and quick measures were needed to arrange services to meet them. According to the latest national student health study (2021) a third of university students experienced clinically significant psychological exhaustion during the pandemic. Instead of individual therapeutic services we planned a special program for 2022 directed for a larger audience. In this program we organize approximately 130 educative courses (~12 hours with 10-20 members in each) to strengthen the mental health skills of university students and personnel. The courses include basic concepts concerning mental health as a personal resource, well-being and a skill needed for survival in everyday life. Also contemporary scientific knowledge of psychological symptoms and most common mental health disorders are taught and discussed through sharing personal experiences: depression, anxiety, psychosis, use of intoxicants. We also discuss the means to prevent personal crises and suicide attempts. This helps to lessen the stigma of mental health problems and offers valuable means to face them in everyday settings in the universities; teachers in interaction with students who have mental health challenges, students in their personal lives and working in student organizations (for example tutors). In the poster we present the contents of the courses, the execution of the program and preliminary results and experiences so far.

Uvod: Cijepljenje protiv Humanog papiloma virusa (HPV) školske djece i mladih ima iznimno važno za očuvanje njihova reproduktivnoga zdravlja. Cijepljenje je izniman izazov u vrijeme epidemije Covid-19, posebice protiv bolesti za koje nije obvezno cijepljenje. U Hrvatskoj je cijepljenje protiv HPV dobrovoljno i besplatno za dječaka i djevojčice osnovnih i srednjih škola i redovite studente. Cilj: Cilj rada je procijeniti procijepljenost protiv HPV učenika osmih razreda prije epidemije školske godine 2018./2019, i u epidemiji 2019./2020. i 2020.20/21. u Koprivničko-križevačkoj županiji (KKŽ) i u gradu Koprivnici i 11 općina na području (KOO) u Hrvatskoj. Ispitanici i metode: Istraživanjem je obuhvaćeno 3223 djece osmih razreda tri školske godine u KKŽ i 1530 KOO. Podaci su prikupljeni iz obvezne evidencije procijepljenosti Služba za školsku medicinu Koprivničko-križevačke županije. Prije epidemije cijepljenje se odvijalo u školi, a tijekom epidemije isključivo u ordinacijama školske medicine. Potpuno procijepljenim se smatraju osobe cijepljenje s dvije odnosno tri doze ovisno o dobi kad je započeto cijepljenje. Rezultati: U KKŽ je potpuno procijepljenih: 2018./2019. godine je 54,8% (588/1073) učenika, 63,4% djevojčica i 46,6% dječaka; 2019./2020. 61,9% (685/1107), 71,8% djevojčica i 52,3% dječaka; 2020./21. 51,63% (539/1044), 63,0% djevojčica i 41,9%. Na području KOO je procijepljenost: 2018./2019. godine je 54,2% (277/511) učenika, 63,4% djevojčica i 46,6 % dječaka, 2019./2020. 62,0% (330/532), 71,8% djevojčica i 52,3% dječaka i 2020./2021. 51,5% (251/487), 63,0% djevojčica i 41,9 %. Procijepljenost u KOO je na seoskom području (2018./2019. 61,5%, 2019./2020 68,5% i 2020./2021. 51,9%) u sva tri razdoblja veća u odnosu na gradsko (2018./2019. 48,0%, 2019./2020 56,3% i 2020./2021. 51,3%). Broj nepotpuno cijepljenih u istom razdoblja je 5,14%, 8,8% i 8,4% učenika. Zaključak: U 2019./2020., početkom epidemije u Hrvatskoj, porasla je procijepljenost u KKŽ i KOO u odnosu na 2018./2019. za 7,8%. Zapažen je 2020./2021. pad od 2,7%.u odnosu na 2018./2019. i 10,3% u odnosu na 2019./2020.

Aims Guidelines can be defined as documents with recommendations aimed at improving the quality of care and uniformity. They are based on systematic reviews of evidence and an assessment of the benefits and harms of various care options, complemented by expertise and experiences of professionals and clients. In the Netherlands, there are 35 Youth Health Care (YHC) guidelines. The aim of this study was to investigate the use of these guidelines by YHC-professionals. Materials and methods A digital questionnaire was used, containing questions about which guidelines were used and whether they were used as intended. Results The questionnaire was completed by 183 YHC-professionals. The guideline ‘Detection of visual disorders’ was most often used (85% of professionals). The least used guideline was ‘Supporting a family in the event of a child's death’ (18% of professionals). Use as intended varied from 94% (Low bodyweight) to 14% (ADHD). The barriers that were most often mentioned were not enough time, not enough knowledge and lack of perceived benefits of the guideline. Conclusion The use of the 35 guidelines for YHC-professionals varies and is subject to improvement. Further research is necessary to determine the best strategies to improve the use of the guidelines.

Background: In the Republic of Azerbaijan, primary care is one of the priorities health sectors. Therefore, we conducted the first epidemiological health assessment to understand the burden of diseases and their subsequent risk factors impacting its registered population, to design better services, implement it and allocate resources to respond to the population health needs. Methods: A cross-sectional study design was adopted among all public primary health facilities under the government registered populations between January , 2020, and December, 2020. The study target population was all children residing in Azerbaijan aged 0-5 years and registered at the health centers affiliated with the Mandatory health Insurance. The data were extracted from patients' electronic medical records. Results: Number of children examined – 631,052 Medical examinations were carried out – total - 1,887,417 - 100% Physician-pediatrician - 715,450 - 38% Neurologist - 255,078 - 14% Pediatric Surgeon - 149,323 - 8% Endocrinologist - 48,077 - 3% Dentist - 170,494 - 9% Urologist - 2,279 – 0.1% Ophthalmologist - 226,085 - 12% Otorhinolaryngologist - 205,262 - 11% Dermatologist - 56,618 - 3% Other - 58,751 - 3% The disease detected - in total - 58,561 - 3% Number of children registered in the dispensary - 21,733 - 1% Dispensary is deregistered related with recovery - 24,043 - 1% Number of hospitalized children - 4,720 – 0.3% Additional diagnostic tests were performed – total - 336,130 - 18% laboratory examination - 316,726 - 17% Chest X-Ray - 10,375 - 1% Ultrasound - 5,230 - 0.3% ECG - 3,799 - 0.2% Conclusion: Understanding the patterns of disease in the local population will enable the government health organisations to plan a clear set of services that meet the population’s health needs, which include tailored health education and promotion components.

Aims The Dutch Development Instrument (DDI; in Dutch: Van Wiechenonderzoek) is used in the Dutch Youth Health Care (YHC) to monitor child development from birth to the age of 4 years. Reference values for the DDI, which indicate that approximately 90% of children achieve each milestone at the recommended age, were published in 1981. Aim of this study is to evaluate the reference values of the DDI in a Dutch population, to investigate whether new reference values are needed. Materials and methods Anonymized DDI results, collected from 19,840 children born in the period 2011-2013 in the YHC in The Hague, were compared with reference values from previous research. In addition, it was examined whether there are relevant (≥5%) differences between boys and girls. Results The proportion of children achieving a milestone at the recommended age ranged between 81% and 100%. At approximately half of the milestones (32/71; 45%), ≥98% of the children achieved the milestone at the recommended age. For 8/71 (11%) milestones, <90% of the children achieved the milestone at the recommended age. About a quarter of the milestones showed a relevant difference between boys and girls. In most cases, the proportion of girls achieving a milestone was higher than the proportion of boys. Conclusion There is a wide variation in the proportion of children achieving a milestone at the recommended age. Therefore, it is important to develop (sometimes also sex-specific) reference values for broader age-groups that are available to YHC-professionals.

An estimated 10,000 inhabitants of the Roma national minority live in Medjimurje County, constituting a third of the total Roma population in Croatia. The majority of Roma in Medjimurje live in 12 Roma settlements dislocated from the majority population and from the county's administrative centre. Roma health problems are closely linked to poor living conditions, poverty and social exclusion. According to conducted research on public health indicators of Roma health in Croatia (HZJZ), mental and behavioural disorders, as well as substance abuse, represent a significant Roma health problem. Other available research also points to a worrying trend of increasing use of alcohol and other addictions among Roma school children and youngsters and a high prevalence of abuse of new drugs, especially synthetic cannabinoids. Due to difficult access to health professionals, there is an insufficient request for the professional help from Roma parents living in dislocated Roma settlements. Encouraged by this knowledge and experiences from international projects aimed at protecting the health of vulnerable groups, experts from our Institute of Public Health launched the Mobile Counseling for Mental Health and Addiction in October 2021 in the two largest Roma settlements: Parag and Kuršanec. Once a week, mental health experts from the Department of Mental Health, Prevention and Outpatient Treatment of Addiction, in cooperation with representatives of the Roma community (Roma mentors), are available to Roma people with mental health problems. There were 60 visits to the Mobile Counseling Center, and individual and family counselling, individual psychotherapeutic procedures and urine testing for metabolites of psychoactive substances were conducted. This form of accessibility of mental health professionals has been recognized as a useful model for working with school children and young people with behavioural disorders and substance abuse among residents of Roma settlements.

Aims Preterm-born children are more susceptible to refractive errors like myopia and astigmatism. Lifestyle and digital media play a central part in lives of adolescents; prolonged indoor screen time has adverse visual consequences. Our aim was to measure the prevalence of spectacle wear among preterm-born toddlers and adolescents, and to assess if screen time plays an additional role. Methods We analyzed data from the Longitudinal Preterm Outcome Project (LOLLIPOP) cohort. At age 5, we collected (n=1514) parental information on spectacle wear, screen time (exposure to screens ≥½ hour a day at <30 cm from the monitor), and at age 13-16 adolescent-reported and parent-reported data of a subsample (n=227) on spectacle wear and screen time. Differences between preterm- and full- term-born were assessed using chi-square tests. Results At age 5 the prevalence of spectacle wear among preterm-born (<36 weeks) and full-term born children was 7.7% and 3.2%, respectively (p=0.002). Remarkably, for children who had more screen time the relationship between being preterm and spectacle wear was very significant (p=0.009), whereas this was not significant for children who had lesser screen time (<½ hour a day). We found no association between screen time and spectacle wear in general (p=0.88). In adolescence, the prevalence of spectacle wear was 25.2% and 22.4%, in preterm- and full-term-born, respectively (p=0.66). Conclusions In preterm-born children the risk of spectacle wear at age 5 is increased, and in preterm-born children the relationship with increased screen time is significant. At adolescence we did not find a significant difference between the gestational age groups regarding spectacle wear. Especially in preterm-born children, prevention of increased screen time and early assessment of visual development is warranted to offer timely preventive interventions.

Health risk behaviors, such as smoking, drug use, alcohol consumption, physical inactivity, and obesity, often accumulate during adolescence and are relatively persistent throughout the life course. Moreover, these can make youth vulnerable for developing consequent (mental) health problems. Community pediatric services (in the Netherlands called Preventive Child Healthcare, PCH) are important for the early detection of multiple health risks and mental health problems, because they offer healthcare services to the population as a whole. What do preventive healthcare professionals need to know and what do they need to measure with respect to multiple (mental) health risk behaviors in adolescents in order to detect vulnerable adolescents? How is PCH optimal positioned? And what is an appropriate form of contact with adolescents? Which tools can be used to support PCH in their task regarding identification and targeting health risk behaviors and mental health problems? In order to help PCH organization to answer these questions, a reflection tool was developed. This reflection tool is based on the outcomes of the Dutch HEY (Health Equality Youth) research project on mental health in adolescents. In this study (Wijbenga et al., 2022) individual and social factors have been identified that contribute to the accumulation of health risk behaviors in adolescents. The study revealed how unhealthy behaviors are related to mental problems in adolescents. Additionally, literature was reviewed on adolescents’ perceptions on vulnerability and the role of PCH in this regard. This tool may be used by PCH to obtain more insight into the degree to which their current activities and work method for adolescents fit with the available knowledge regarding multiple risk behaviors and mental health problems of adolescents. This reflection tool consists of 42 questions that can be answered by PCH professionals. These professionals are challenged in the tool to reflect on their own methods and actions. During several sessions/webinars PCH professionals were given the opportunity to try out the reflection tool. These professionals were motivated to start working with the reflection tool. In this contribution, we present the tool and its development.

Introduction: Human papillomavirus (HPV) vaccinations of school children and young people is extremely important for their reproductive health. HPV vaccination as optional vaccination was exceptional challenge during Covid-19 epidemic, especially in rural areas. In Croatia, HPV vaccination is voluntary and free for boys and girls in primary and secondary schools and full-time students.
Objective: The aim of this paper is to compare availability of HPV vaccination of eighth grade students before the epidemic school year 2018/2019, and during epidemic school years 2019/2020. and 2020.20 / 21. in the rural area around Karlovac, Karlovac County (KAO) and around Koprivnica in Koprivnica-Križevci County (KOO) in Croatia.
Respondents and methods: The study included 920 eighth grade children in the three school years in the KAO and 988 in the KOO. Data were collected from the vaccination records of the School Medicine Service of Karlovac County and Koprivnica-Križevci County. Before the epidemic, vaccination took place in schools, and during the epidemic exclusively in school medicine offices. Two or three doses of vaccine, depending on the age of vaccination onset, are considered fully vaccinated.
Results: completely vaccinated: 2018/2019. a total of 24.6% (60/244) of students, 25.7% of girls and 23.7% of boys; 2019/2020 a total of 58.7% (106/232), girls and 34.1% boys; 2020/21 a total of 49.2% (120/244), 63.0% girls and 34.7% boys.
Vaccination is in KOO rural areas 2018/2019. 61.5% of students (144/234), 69.1% of girls and 56.2% of boys, 2019/2020. a total of 68.5% (170/248), 79.4% girls and 57.4% boys, 2020/2021. a total of 51.9% (107/206) students, 59.3% girls and 46.1% boys.
Conclusion: Before the epidemic, vaccination coverage in the rural area of Koprivnica and Koprivnica-Križevci County was 2.5 times higher than in the rural area of Karlovac and Karlovac County, 2019/2020. 1.5 times, and only 2.7% in 2020/2021. The vaccination coverage of boys in KAO is lower in all periods (maximum 2020/2021, 34.7%) compared to KOO (highest 2019/2020, 57.4 %%).

The aim of this study was to examine the mental health problems with YP-CORE test as a part of regular school health periodic examination of first-year secondary school students (ages 15-16) in 2020 before Covid-19 and in 2022. Adolescent mental health problems are a leading health problem in this population and remain unrecognized for a long time. Materials and methods: Study included 113 first-year Zagreb secondary school students (66.4% girls) academic year 2019/2020 and 106 academic year 2021/2022 (66% girls). Data were collected by YP-CORE test ten questions about feeling over the last week. The students provided informed consent, and testing was done during regular periodic examinations. Data were analyzed using descriptive statistics. Results: At risk of mental health problems were 8.2% of girls (6/75) and 0 of 38 of boys academic year 2019/2020. In academic year 2021/2022 at risk were 23.5% of girls (16/68) and 13.2% (5/38) boys. Comparing two periods: positive answer to the question 'I’ve thought of hurting myself'” in 2019/2020 had only 5 (6.7%) girls and none of the boys, in contrary with 10 (14.7%) girls and 3 (7.9%) boys in 2021/2022 All recognized risk students are immediately involved in the counseling of the School and University Medicine Counseling Services provided by every secondary school in Croatia. Conclusion: The results of the study showed that mental health problems have a rise in Covid-19 pandemic period from 5.3% (6/113) of all secondary school students in 2019/2020 to 19.8% (21/106) in 2021/2022. The rise is twofold for girls from 6.7% to 14.7%, and almost 8% for boys. School health service developed a protocol for students at increased risk. The first step is school medicine specialist interview with the student, then with the parents and the student, and second step including school staff and other professionals.

Aims The Dutch Development Instrument (DDI) measures child development with milestones. Videos were developed that allow caregivers to assess these developmental milestones for their child before they go to youth health care (YHC). By involving caregivers in their child's development, they are likely to be better prepared for the visit. The aim of this research is to examine experiences and determinants of current and future use of the videos in YHC practice. Materials and methods A qualitative study with semi-structured interviews was conducted to identify experiences, facilitators and barriers of the use of the videos as experienced by YHC-professionals (n=14) and caregivers (n=10). In a quantitative study data were collected among 4,370 caregivers to study experiences with the videos and the outcomes on their child\'s age-specific milestones. Results The qualitative survey showed that the use of the videos was perceived as positive by most YHC professionals and caregivers. Points of attention were the fact that some groups participated less (eg non-native speakers), lack of time and direct feedback from caregivers and that the outcomes on milestones were not always equal between caregivers and YHC professionals. The quantitative study showed that caregivers gave the videos an average grade of 8.2. About half of the caregivers felt (more) involved in the development of their child and also better prepared for the appointment with the YHC professional. The milestones were understood by 96-100% of the caregivers. Some milestones required the use of materials that were not present in every household, such as a tricycle. Conclusion The videos were positively evaluated by both professionals and caregivers. Improvements in the way of implementation can facilitate and increase the use. Based on the results of this research and other activities, we have developed an implementation plan to support YHC organizations when they want to implement the use of the videos.

Two years after the start of the pandemic, the question arises as to whether the pandemic affected the mental health of adolescents, particularly vulnerable group who are in a challenging period of intense psychological change and at risk for development of mental health disorders. A study conducted in Germany by Kostev et al. in 2021 showed an increase in the anxiety disorder diagnosis among adolescents during the pandemic period compared to the pre-pandemic period. The aim of this study was to examine whether there is a difference in anxiety symptoms in general and its components (cognitive, affective and physiological) among adolescents treated in our mental health centre in pre-pandemic and COVID-19 pandemic period. The study included 129 adolescents, 42 (32,6%) boys and 87 (67,4%) girls, aged 14 to 18 years (M = 16.28, SD = 1.34) treated in the Department of Mental Health and Addiction Prevention at Andrija Stampar Teaching Institute of Public Health from 01.01.2019 to 10.03.2022. The period from 01.01. 2019. to 10.03.2020 was defined as pre-pandemic, while the one from 01.01.2021. to 10.03.2022 as pandemic. Personality Assessment Inventory-Adolescent (PAI-A) questionnaire was used to assess the anxiety symptoms during the psychological evaluation. Fifty one adolescents (M = 16.25, 47.1% boys) treated before the pandemic had statistically significantly lower anxiety level (57.75 ± 14.19) compared to 78 adolescents (M = 16.29, 23.1% boys) evaluated during the pandemic (63.38 ± 13.07), t(127)= -2,317, p = 0,022. The same was true for cognitive component of anxiety (t (127) = -2,283, p = 0,024) and physiological component of anxiety (t (127) = -2,460, p = 0,015). The results of this study indicate increased levels of anxiety in general, cognitive and physiological components in adolescents during the pandemic period. Adolescents were more prone to ruminative worry and concern about issues that resulted in impaired concentration and attention and to overt physical signs of tension and stress.

The impact of COVID-19 infection on mental health of adolescents is in the focus of scientific interest. As the adolescence represents a particularly challenging period of intense psychological change, various investigations of its relation to pandemic have been performed. An American study conducted by Hawes et al. in 2021 showed increased depression symptoms among adolescents during the pandemic period compared to the pre-pandemic period. Research from Iceland conducted by Thorisdottir et al. in 2021 also showed an increase in depressive symptoms among adolescents during the pandemic period compared with same-aged peers from pre-pandemic period. The aim of this study was to examine whether there is a difference in depressive symptoms in general and its components (cognitive, affective and physiological) among adolescents treated in our mental health centre in pre-pandemic and COVID-19 pandemic period. The study included 129 adolescents, 42 boys and 87 girls, aged 14 to 18 years (M = 16.28, SD = 1.34) treated in the Department of Mental Health and Addiction Prevention at Andrija Stampar Teaching Institute of Public Health from 01.01.2019 to 10.03.2022. The period from 01.01. 2019. to 10.03.2020 was defined as pre-pandemic, while the one from 01.01.2021. to 10.03.2022 as pandemic. Personality Assessment Inventory-Adolescent (PAI-A) questionnaire was used to assess depressive symptoms during the psychological evaluation. Fifty one adolescents (M = 16.25, 47.1% boys) treated before the pandemic had statistically significantly lower depression level (62.16 ± 14.89) compared to 78 adolescents (M = 16.29, 23.1% boys) evaluated during the pandemic (69.65 ± 15.46), t(127)= -2,731, p = 0,007. The same was true for cognitive component of depression t(127)= -2,993, p = 0,003) and affective component of depression (t(127)= -2,857, p = 0,005). The results of this study indicate elevated levels of depression in general, cognitive and affective components in adolescents during the pandemic period. Adolescents express more thoughts of worthlessness, hopelessness, and personal failure, as well as indecisiveness and difficulties in concentration and feelings of sadness, loss of interest in normal activities, and anhedonia.

Uvod: Cijepljenje protiv Humanog papiloma virusa (HPV) u djevojčica i dječaka je preporučljivo radi smanjenja rizika od infekcije HPV-om i razvoja karcinoma. U vrijeme epidemije COVID-19 bilo je teže provesti cijepljenje, posebice neobaveznih cijepljenja kao što je protiv HPV-a. U Hrvatskoj je cijepljenje protiv HPV dobrovoljno i besplatno za dječake i djevojčice osnovnih i srednjih škola i redovite studente. Cilj: Cilj rada je procijeniti procijepljenosti protiv HPV-a učenika osmih razreda prije početka epidemije školske godine 2018./2019, početkom 2019./2020. i 2020./2021. u jeku epidemije, s području grada Karlovca i 12 gravitirajućih općina Karlovačke županije. Ispitanici i metode: Istraživanjem je obuhvaćeno 1530 učenika i učenica osmih razreda tri školske godine na području grada Karlovca i gravitirajućih općina. Podaci su prikupljeni iz obveznih izvješća o procijepljenosti Službe za školsku medicinu Zavoda za javno zdravstvo Karlovačke županije. Prije epidemije cijepljenje se provodilo u školi, a tijekom epidemije isključivo u ordinacijama školske medicine. Potpuno procijepljene su osobe cijepljenje s dvije odnosno tri doze ovisno o dobi započetog cijepljenje. Rezultati: Potpuno procijepljenih učenika 2018./2019. godine je 33,52% (294/877), u gradskom 79,59% (234/294) i 20,41% (60/294) u seoskom području. U 2019./2020. godini cijepljeno je 45,03% (376/835) učenika, s gradskog 71,81% (270/376) i 28,19% (106/376) sa seoskog područja. U 2020./2021. procijepljeno je 44,84% (382/852) učenika, 68,59 % (262/382) u gradskom i 31,41% (120/382 ) u seoskom području. Obuhvat potpuno cijepljenih djevojčica 2018./2019. godine je 38,21% (162/424) i 29,14% (132/453) dječaka, 2019./2020. 53,37% (227/410) djevojčica i 35,06% (149/425) dječaka i 2020./2021. 56,69% (237/18) djevojčica i 33,41% (145/434) dječaka. Drugu dozu cjepiva nije primilo 2018./2019. 9,3% učenika, 2019./2020. 9,7% i 2020./2021. 9,9%. Zaključak: Početkom epidemije COVID-19 2019./2020. obuhvat se povećao za 11,51% i epidemijskoj godini 2020./2022. za 11,32% u odnosu na predepidemijsku 2018./2019. Obuhvat djevojčica je u svim razdobljima gotovo dvostruko veći od dječaka.

INTRODUCTION: Pectus excavatum is the most diagnosed chest wall deformity and represents more than 90% of all congenital deformities, with incidence of about 0,1%, or 1 in 400 births. This deformity is caused by improper growth of connective tissue (cartilage) between the ribs and sternum. AIM: To determine the proportion of students with pectus excavatum deformity, the impact on their mental health and the degree of parental awareness regarding the specified impact. METHODS: Collection and retrospective analysis of the data from the digital medical records of the 8th grade students included in the systemic examinations during the 2021-22 school year, performed by the Omiš team of school medicine. Systemic examinations were carried out in the presence of parents. RESULTS: Data from 209 students were analyzed and Pectus excavatum was recorded in 10 (4,78%) of them, all affected students were male. By examining of the family medical history isn't identified a direct genetic inheritance. The impact on mental health is noted in 7 (70%) students diagnosed with deformity. In 5 (50%) students there was comorbidity with scoliosis of varying degrees, two of whom had complications related to the heart and lungs functions. Four parents were aware of the existence of deformities, and only one shared concerns regarding the effect of a body deformity on the child mental health. CONCLUSION: During systemic examinations of the 8th grade students in the Omiš primary schools was found a significantly higher prevalence of Pectus excavatum than it's recorded in the world. Regarding the impact of deformities on the childrens' mental health, it is necessary to strengthen the support of parents and professionals in overcoming the psychosomatic disorders in children.

Introduction According to Article 12 of the United Nations Convention on the Rights of the Child, children have the right to be included in decisions that impact them. That also involves the services conducted by the youth health care departments (JGZ). However, child participation (CP) is not structurally embedded in the JGZ. Aim This qualitative study describes the way children are currently involved in the JGZ, at what level, what the benefits are and what is needed to fully incorporate CP. Methods Semi-structured interviews were conducted with 15 policy makers from 12 JGZ’s. Data were analyzed with ATLAS.ti. (Preliminary) results Definition of CP varies between participants, as well at which level in the organization they should participate. Nevertheless, all participants were aware of the relevance of CP in youth public health. Reasons to initiate CP, examples of CP, methods of implementation, elements of successful CP and possible obstacles were described. Conclusion However JGZ-organizations are aware of the importance of CP, current level of participation varies from decoration to child initiated. CP is possible in the consulting room, in the collaboration with schools, in research and in policy making decisions. CP is mandatory for a better understanding of children’s needs and helps to understand current problems in executing youth health care.

Introduction Child Health Care professionals have a legally-based task to support and advice parents in stimulating a healthy lifestyle for their children, starting from birth. The aim is for children to grow up healthy and gain a healthy weight. In the Netherlands, various guidelines include advice on preventing obesity and promoting a healthy lifestyle. In spite of these guidelines and the support of parents by youth health care, many children have overweight or obesity. Therefore, a participatory project Growing up Healthy Together was conducted in close collaboration with the target group of professionals and parents. Discussion The project was carried out from 2019 to 2021 in four youth health care organisations. The project first focused on literature research into overlap and contradictions in nine guidelines, and an empirical study on experiences of CHC professionals and parents with lifestyle advice. The results have been presented at the Eusuhm congress in Rotterdam 2019. At Eusuhm 2022, I would like to focus on the development and evaluation of adaptations in lifestyle advice practices, by researchers together with CHC professionals and parents. Conclusion CHC professionals and parents want to discuss lifestyle more often with each other, better tailored to parental needs. Researchers, CHC-professionals and parents jointly developed ideas about adjustments in lifestyle advice. Each CHC organisation made a choice for one or more adjustments implementing them in their lifestyle advice practice. The new methods were evaluated for feasibility and satisfaction. We hence increased the chances that parents receive lifestyle advice tailored to their needs, thereby contributing to more healthy children in the future. The aim of this workshop is to show the collaboration between research and practice, and the seven steps taken in the process. Participants will be challenged to discuss their own topics in which such cooperation would be helpful.

Uvod: Prema procjeni stručnih suradnika u školama zadnjih godina uočava se porast broja učenika koja teže funkcioniraju u školi. Također, u školskim ambulantama uočava se porast broja učenika koji se uključuju u postupak procjene psihofizičkog stanja djeteta. Cilj rada: Cilj ovog rada je utvrditi povećava li se broj učenika s teškoćama u razvoju koja se obrazuju u redovnoj osnovnoj školi uz primjereni program odgoja i obrazovanja (PPOO) temeljem Rješenja Ureda državne uprave Dubrovačko-neretvanske županije (DNŽ) na području DNŽ od Primorja do Konavala uspoređujući stanje u školskoj godini 2000./2001. i 2020./2021. Specifični ciljevi rada su utvrditi udio učenika koji se obrazuju u redovnoj osnovnoj školi po PPOO temeljem Rješenja, utvrditi najčešće dijagnoze/teškoće zbog kojih je određen primjereni program/oblik odgoja i obrazovanja, utvrditi udio učenika s teškoćama prema pojedinom primjerenom programu odgoja i obrazovanja i utvrditi u kojem razredu se najčešće donose Rješenja. Materijali i metode: Ispitanici u istraživanju su svi učenici redovnih osnovnih škola na području DNŽ od Primorja do Konavala, koji su se obrazovali temeljem Rješenja Ureda školske godine 2000./2001. (52) i 2020./2021. (250). Podaci su analizirani metodama deskriptivne statistike. Rezultati i rasprava: Promatrajući 2000./2001. šk.g. i 2020./2021. šk.g., uočljiv je porast udjela učenika koji se obrazuju prema PPOO (s 0,9% na 4,6%), te se uočavaju i značajne promjene u udjelima pojedinih oblika PPOO, pri čemu je najveći porast udjela učenika koji se obrazuju po redovitom program uz individualizirani pristup. Najčešće teškoće zbog kojih se učenici obrazuju prema PPOO su iz Skupine 3.i Skupine 7. Uočava se veliki porast broja i udjela učenika (s 0,07% na 0,72%) s dijagnozom F84. U školskoj godini 2020./2021. najčešći razred u kojem je određen primjereni oblik obrazovanja je prvi, dok je u šk.g. 2020./2021. to bio peti. Zaključak: Razloge ovih rezultata osim u promjenama udjela teškoća unutar populacije treba tražiti, međuostalim, i u promjeni Pravilnika o osnovnoškolskom i srednjoškolskom odgoju i obrazovanju učenika s teškoćama u razvoju, boljem dijagnosticiranju blažih teškoća i težnji sustava da se svakom učeniku maksimalno pomogne da ostvari maksimum svojih potencijala.

Introduction In the Netherlands, preventive child health care (CHC) professionals give support and advice on healthy lifestyle to parents with children from birth onwards. In a participatory project Growing up Healthy Together, we asked parents opinion and experiences about four lifestyle topics: nutrition, physical activity, sleep and screen use. Our study showed that parents are very satisfied with the CHC lifestyle advice, giving 8.5 points on a scale of 0-10. However, parents do not always know that CHC can advise and support about lifestyle or do not always recognize the advice. Only 4% of the conversations about lifestyle between CHC professionals and parents with children aged 0-4 are about healthy screen use. Parents were not aware that they could discuss this topic with their CHC professional. Discussion Researchers and CHC professionals of four CHC organizations, developed ideas for lifestyle advice, together with parents. For each CHC organization, a choice was made for one or two adaptations, and these were designed and implemented in lifestyle advice practice. The lifestyle education materials have been partially evaluated for feasibility and satisfaction. Final results are expected at the end of 2022. Conclusion In this workshop, the lifestyle adaptations and materials collected in a toolkit for healthy lifestyle counselling, are shown. The toolkit includes a flyer on a ‘healthy day’ and a manual for professionals to discuss screen use; four posters mentioning a parental dilemma on each lifestyle topic - nutrition, physical activity, sleep, screen use - and a manual for professionals; A manual on asking consent for lifestyle advice; and two educational video’s about healthy lifestyle from pregnancy onwards and about screen use. The toolkit will be discussed, in terms of the contribution to making the lifestyle topic negotiable between parents and CHC professionals, the feasibility and satisfaction of its implementation. Participants in this workshop are challenged to discuss their own adaptations to improve preventive health care counselling.

Uvod: Vršnjačko nasilje je često zastupljeno među mladima. Bilježi se sve veći porast agresije i nasilja kao načina rješavanja problema, velika tolerancija na vršnjačko nasilje, neprepoznavanje nasilja i odsustvo primjerene reakcije na neprimjerene oblike ponašanja među mladima. Cilj: Cilj istraživanja je ispitati prevalenciju vršnjačkog nasilja među učenicima 7. razreda u svim osnovnim školama u dubrovačko-neretvanskoj županiji i na osnovi dobivenih rezultata vidjeti mogućnosti gdje škola može djelovati svojim preventivnim programima. Ispitanici i metode: U suradnji sa školama provedeno je ispitivanje u 27 osnovnih škola tijekom školske godine 2016/2017. Instrument ispitivanja je anketni upitnik sa 27 pitanja. Anketiranje je obavljeno u periodu ožujak-svibanj 2017. godine. Rezultati: U istraživanju je ukupno sudjelovalo 906 učenika, od toga 47,46% dječaka, a 33 (3,64%) učenika nije navelo podatke o spolu. Najveći udio nije nikada bio verbalno zlostavljan (25,83%), 28,14% dječaka i 23,93% djevojčica nikad nisu bili verbalno zlostavljani. 10,47 % dječaka i 6,06% djevojčica su bili verbalno zlostavljani 1-2 puta tjedno. Najveći udio nije nikada bio isključivan od strane vršnjaka (32,12%). 35,58% dječaka i 29,57% djevojčica nikad nisu bili isključivani od strane vršnjaka. 36,97% dječaka i 33,87% djevojčica nisu bili fizički zlostavljani od strane vršnjaka. 4,89% dječaka i 2,94% djevojčica je bilo fizički zlostavljano 1-2 puta. 40,07% je izjavilo kako su u posljednih 12 mjeseci bili prisutni dok je netko od vršnjaka bio izložen nasilju. 44,65% dječaka i 35,66% djevojčica su bili prisutni dok je netko od vršnjaka bio izložen nasilju. Najveći udio je pokušao pomoći (40,36%), dok je najmanji postotak učenika u navedenoj situaciji pobjegao. 45,12 % dječaka i 34,76% djevojčica su pokušali pomoći. Najveći udio je bio izložen nasilju na školskom dvorištu (28,04%), 22,29% učenika su bili izloženi nasilju u učionici kada nije bilo profesora, dok je 21,19% navelo hodnik/stubište u školi kao mjesto nasilja. Najmanji udio učenika je bio izložen nasilju u autobusu (4,85%). Zaključak: Rezultati će omogućiti procjenu prevalencije vršnjačkog nasilja u svim 7. razredima u svim osnovnim školama u dubrovačko-neretvanskoj županiji. Svakoj od škola poslužiti će ne samo kao mjera učinkovitosti primijenjenih programa nego će ukazati i na područja u kojima je potrebna intervencija s ciljem smanjenja vršnjačkog nasilja.

AIM: Early detection of adverse situations for parenting and healthy child development is important for timely primary prevention. The SPARK (Structured Problem Analysis of Raising Kids) is a broad-scope structured interview guide aimed at assessing parenting concerns and needs for support (regarding both the child’s development and parenting skills), using both parental perspective and the professional’s experience. The SPARK was validated for the ages of 18 and 60 months, as well for use during pregnancy in the Netherlands. We adapted this instrument for the age of 36 months and the Flemish context (SPARK36). Feasibility of the SPARK36 during nurse-led consultations with parents of three-year-old children was already demonstrated. The aim of the present research is to determine its known groups validity. MATERIALS AND METHODS: SPARK36-data was collected in a prospective cross-sectional study during the schoolyear 2021-2022. Youth Health Care (YHC) nurses from school health services across Flanders (Belgium) were trained in use of the SPARK. In the absence of a gold standard, the known groups validity was assessed as a measure of construct validity of the SPARK36, which was determined by comparing the SPARK36 outcomes between socio-economic groups with expected differences in risk for parenting and child-development problems. RESULTS AND CONCLUSION: In total, 29 YHC nurses from four school health services performed SPARK36-led consultations with 599 parent-child pairs. The YHC nurses determined the overall risk for parenting and child developmental problems according to the SPARK36. Overall, 83.2% of children were considered as low risk, 14.9% as increased risk and 1.8% as high risk. Differences for socio-economic groups are currently analyzed and will be presented. Confirmation of expected differences would support the suitability of the SPARK36 for improving the early detection of adverse situations for parenting and child development in young children. ACKNOWLEDGMENTS: This study is supported by the Flemish Government.

Introduction: According to the World Health Organization, 1.3 billion people have smoking habits and as a result approximately 5 million die each year. The most common beginnings of this addiction date back to adolescence. Many studies show that smoking is widespread among students, and as a type of addiction is a major public health problem. The aim of this research was to determine the smoking habits of first year students of the University of Split: Philosophy, Catholic Theology and Art Academy in the academic year 2021/2022, and to investigate whether there is a difference in smoking habits observed by gender. Material and methods: The research was conducted on a 135 students, 40 male and 95 female. The time period for data collection was from March 1 to April 25, 2022. A questionnaire consists 2 questions and 4 sub-questions on smoking and smoking habits. The survey was voluntary in the School medicine clinic as part of the physical examination of students. Results: The results show that 41% of students both genders ones tried to smoke cigarettes, 50% of male and 38% of female students. 35% of students both genders stated that they had smoked in the last month period, of which 37% are male and 34% are female out of the total number of students surveyed by gender. 50% of male and 62% of female students stated that they had never tried smoking in their lives. 46% of female smoke less than one cigarette, while 47% of male students smoke more than 5 cigarettes a day. Conclusion: 50% of male students have tried to smoke cigarettes, and 75% of them continued to smoke. Although much less, 38% of their female colleagues have tried smoking cigarettes and 89% of them continued to smoke. We can see that the trend of cigarette smoking in the female student population is progressing by increasing the number of female smokers. The conducted analysis also showed a statistically significant difference in the number of cigarettes smoked per day, female students smoke less than their male colleagues.

Introduction: Energy drinks have become extremely popular among adolescents in the last twenty years. Despite a ban on the consumption of these beverages to children and adolescents under the age of 18 as recommended by the American Pediatric Society in 2011, according to the available data, the consumption of some energy drink was reported in 30-50% of adolescents. Adverse health effects may cause: dehydration, harmful effects on the cardiovascular system, anxiety and sleep disorders, and also overweight due to high sugar content. In addition to caffeine, these drinks contain additives and a number of other substances with stimulant effect. High-concerning fact refers to the frequent consumption of alcohol mixed with energy drinks. Aim: The aim of the research is to determine energy drinks consumption habits along with attitudes and knowledge on health risks for school children. Methods: A questionnaire specifically designed for the research was used, on a sample of 230 first and third grade high school students in Split. Results: According to the survey, 81% of adolescents tried some energy drink, most often for the first time in the upper grades of primary school. Energy drinks were consumed by 42% of high school students up to three times a month, about 500 ml of drinks per consumption. Males were reported (58%) to mix alcohol with energy drinks more often than adolescent females (35%), most commonly in the third grade. While 74% of the respondents are aware that energy drinks can be harmful to health, 21% of the respondents find it irrelevant. Only one third are interested in lectures on healthy lifestyle. Conclusion: A trend in modern lifestyle, the easy availability of such drinks and the aggressive marketing activities of producers have contributed to the increase in the number of adolescents who consume energy drinks. Despite being aware of harmful effects of consuming energy drinks, they lack health-protective attitudes regarding significant consumption of alcohol mixed with energy drinks. The role and the responsibility of teachers, nutritionists, medical doctors and the entire society is to promote healthy lifestyles via appropriate public health programs implemented in school curriculum (school health education).

Cilj: Procijeniti mentalno zdravlje učenika srednjih škola u Virovitičko-podravskoj županiji, primjenom YP-CORE upitnikom s deset pitanja. Utvrditi postoje li razlike u indikatorima mentalnog zdravlja u školama s različitim programima školovanja. Ispitanici i metode: Istraživanjem je obuhvaćeno 492 učenika prvih razreda srednjih škola iz Virovitičko-podravske županije iz osam srednjih škola. Srednje škole su podijeljene u tri skupine: 1. gimnazije (dvije gimnazije s 86 učenika, 62,8% djevojaka), 2. tehnička (jedna tehnička škola s 96 učenika, 29,2% djevojaka) i 3. strukovne škole i škole s mješovitim programima (pet škola s 310 učenika, 56,5% djevojaka). Učenici su ispunili anketu kao dio sistematskog pregleda u prvom razredu srednje škole. Rezultati su dio rutinskih izviješća Službe za školsku medicinu Zavoda za javno zdravstvo Virovitičko-podravske županije i obrađeni su metodama deskriptivne statistike. Rezultati: Rizik temeljem rezultat na YP-CORE upitniku utvrđen je u 22,1% (19/86) gimnazijalaca, u 22,9% (22/96) učenika tehničke škole i 22,2% (69/310) učenika strukovnih škola i škola s mješovitim programima. Temeljem dobivenih rezultata upitniku na testu bila je potrebna intervencija stručnog suradnika škole i školske medicine: u gimnaziji za 14 učenika (16,3%), tehničkoj školi 21 učenika (21,8%) i u strukovnim školama i školama s mješovitim programima 63 učenika (20,3%). Zdravstveno stanje zahtijevalo je upućivanje pojedini učenika stručnjacima izvan škole i/ili školske medicine za: pet gimnazijalaca (5,8%), jednog učenika tehničke škole (1,1%) i šest učenika strukovnih škola i škola s mješovitim programima (1,9%). Zaključak: Rizik za poteškoće mentalnog zdravlja gotovo je jednako učestao u sve tri vrste srednjih škola, u gimnazijalaca 22,9%, učenika tehničke škole 22,2% i 22,2% učenika strukovnih škola i škola s mješovitim programima. Najviše gimnazijalaca 5,8% je zahtijevalo upućivanje drugim stručnjacima izvan škole i školske medicine, slijede učenici strukovnih škola i škola s mješovitim programima te učenici 1,9% i tehničke škole 1,1%. Rezultati pokazuju opravdanost ovog skrininga kao dio sistematskih pregleda adolescenata.

ABSTRACT INTRODUCTION: School and adolescent medicine physician monitor student's health condition and professional development during schooling with a series of preventive and specific measures. Chronically ill students and students with disabilities have narrowed choice of profession. Eighth grade students have a systematic examination based on which psychophysical abilities and professional orientation are assessed. Students with developmental disabilities and chronic illnesses are referred for professional orientation. OBJECTIVE: To determine the prevalence and reasons for sending students to professional orientation during the school year 2017/2018. STUDY DESIGN: retrospective cross-sectional study PARTICIPANTS AND METHODS: The study included 1067 eighth grade students from the city of Osijek. After a systematic examination, some students were referred to professional orientation at the Croatian Employment Service (CES). The criteria for referral students to CES were the presence of a serious illness or condition that disrupted regular schooling. "Professional opinion for professional guidance“ was issued to all processed students. Data on the type and degree of difficulty, schooling program and health difficulties were collected from medical documentation and records of students. RESULTS: Out of 1067 students examined on the systematic examination, 108 (10.12%) were referred for professional orientation. According to the type of program, 52.63% of students were educated according to the regular program with individualized procedures. Due to health problems which aggravated for a student to attend school regularly, 25 students (23.15%) received the expert opinion of the school physician for professional orientation. The three leading groups of diagnoses as reasons for referral to professional orientation were: learning difficulties (26.13%), diseases of the musculoskeletal and connective system (10.05%) and behavioral and emotional disorders (9.55%). 11 students (10,19%) did not follow the recommendations of the professional team CONCLUSION: Chronically ill students should have a sufficient number of enrollment places to enroll in high school. It is necessary to ensure continuous monitoring of their professional development in order to gain an insight into their learning outcomes and possible needs for school change. Therefore, cross-sectoral collaboration between school and adolescent physicians with career guidance teams, schools and the County Department of Education and Youth is important.

The job description of a school nurse is hardly known in Germany. For the first time 18 school nurses cared for pupils on the initiative and under the coordination of the AWO Bezirksverband Potsdam e.V. in 23 regular schools in the state of Brandenburg on the initiative and under the coordination of the AWO Bezirksverband Potsdam e.V. over the three-year period from February 2017 to March 2020. This represents a major challenge for the specially trained school nurses due to the very complex German health care system. A systematic and continuous documentation of the fields of activity and measures of the school nurses is a prerequisite for the identification of student and school-related health needs as well as for the initiation and implementation of targeted prevention and health promotion measures with a variety of different local actors. Due to the absolute novelty (in Germany), the scientifically based proof of their everyday work is of great importance. Conscientious documentation is essential, especially for discussions on health policy and for a medically and legally reliable assessment of findings. Furthermore the documentation is important for the introduction of the new job description of the school health worker in Germany. This is the only way to provide structured evidence of the new activities. On the other hand this documentation must be simple and usable for the often stressful everyday life in schools, yet reliable and accepted by the school nurses. The documentation was designed on the basis of professional database structures over a period of more than one year together with a Danish initiative for municipal software solutions. Essential for the realization with very strict German data protection hurdles was above all a continuous cooperation with the school nurses on site over the entire period up to the present day. An originally cloud-based solution had to be adapted simultaneously to a so-called stand-alone computer version. We present technical details and content of the documentation. Results are presented separately by Dr. Ellsäßer.

AIM: COVID-19 pandemic affected all aspects of life, including quality of life. Pre-pandemic studies show that university students report lower quality of life, especially medical students. The aim of this study was to estimate a quality of life of medical students University of Zagreb at the beginning of COVID-19 pandemic. MATERIAL AND METHODS: Participants in the research were medical students University of Zagreb from 1st to 6th year of study in the academic year 2019/20. The survey was conducted online, during the first lock down in Croatia, in May and June 2020, with the Quality of Life‐Brief Version (WHOQOL‐BREF) questionnaire, validated 26-item instrument consisting of four domains: physical health, psychological health, social relations and environmental health. Data were analyzed by methods of descriptive and analytic statistics, with the significant level of P<0.05. RESULTS: Data analysis included 404 medical students (65.6% females), mean age 21.32±1.77. Most of them attended the 1st, 2nd and 3rd year of study (29.5%, 20.5%, and 28.0% respectively). The highest mean score was found in environmental health domain (75.97±15.10), followed by physical health domain (69.18±17.79), social relations (66.46±21.15), and the psychological health (63.11±20.06). Significant negative correlation was found between female gender and physical (rho=-0.126; P=0.011) and psychological domain (rho=0.119; P=0.016), and positive correlation between the year of study and the physical health domain (rho=0.171; P<0.001). In OLS regression, better academic achievement was a predictor of better quality of life in all domains: physical (β= 0.384; P<0.001); psychological (β=0.328; P<0.001), social (β=0.174; P=0.001), and environmental health (β=0.221; P<0.001). Female gender was a predictor of poorer physical functioning (β=-0.102; P=0.027), and poorer psychological functioning (β=-0.113; P=0.016). CONCLUSION: The results showed that at the beginning of COVID-19 pandemic, and the first lock down medical students reported good quality of life in all four domain, even though it was the lowest in psychological domain. At higher risk of poorer quality of life were females and students with poorer academic achievement, which indicate the need of intervention among that part of medical student population.

Uvod: Redoviti sistematski pregledi studenata na 1.godini studija su propisani Planom i programom mjera te se provode u ordinacijama školske medicine. Svaki se sistematski pregled studenata sastoji od nekoliko elemenata, koji uključuju ispunjavanje osobnog lista zdravstvene zaštite, mjera medicinske sestre, pregleda liječnika, zdravstvenog odgoja i prema potrebi savjetovanja. Cilj: Svrha ovog rada je bila prikazati životne navike studenata te najčešće poremećaje zdravlja i moguće mjere intervencije. Materijali i metode: U ovom radu se obrađuju podaci 554 studenta, koji su pregledani u ovoj ordinaciji u šk.g.2018./2019. Radi se o studentima s Medicinskog fakulteta, Fakulteta zdravstvenih studija i Pomorskog fakulteta Sveučilišta u Rijeci. Za izradu ovog rada su korišteni podaci navedenih obrazaca koje su ispunjavali studenti, sestra i liječnik. Rezultati: U navedenoj akademskoj godini je sistematskim pregledima pristupilo 100% studenata sa Medicinskog fakulteta (228) i Fakulteta zdravstvenih studija (86) te 93% studenata sa Pomorskog fakulteta (240). Kada govorimo o njihovim prehrambenim navikama, svakodnevno doručkuje 65% studenata s Fakulteta zdravstvenih studija, 55% njih s Medicinskog fakulteta i 54 % studenata s Pomorskog fakulteta. Nikada ne doručkuju 23 studenta. Kuhani cjeloviti obrok (ručak) svaki dan ima 62% studenata s Fakulteta zdravstvenih studija, 61% njih s Pomorskog fakulteta i 55% studenata s Medicinskog fakulteta. Redovitu nastavu TZK imaju studenti Medicinskog i Pomorskog fakulteta. Aktivno su tjelesno aktivni 5 h i više tjedno: 23% studenata s Pomorskog fakulteta, 12 % njih s Fakulteta zdravstvenih studija i 7% njih s Medicinskog fakulteta. Pet sati i više tjedno hoda 50% studenata s Pomorskog fakulteta, 48% njih s Medicinskog fakulteta i 40% njih s Fakulteta zdravstvenih studija. Izdata je 161 uputnica. Poremećaji mišićnog sustava čine 20-27% pronađenih poremećaja, refrakcijske anomalije 25-35%, dok se pretilost bilježi kod oko 7% njih. Na pregledu je 87 studenata imalo povišenu vrijednost krvnog tlaka, a njih više od 30 je upućeno na savjetovanje vezano uz mentalno zdravlje. Zaključak: Sistematski pregledi su nam pokazali kakve su životne navike naših studenata, da postoje razlike među studentima različitih fakulteta, ali i studijskih grupa. Dio zdravstvenih poremećaja koji su primijećeni je moguće prevenirati promjenom životnih navika te je zdravstveni odgoj jedna od početnih intervencijskih mjera.

ABSTRACT INTRODUCTION: School and adolescent doctors supervise the implementation of student's mastery of the educational program and continuously cooperate with parents, teachers and professional associates of the school in order to preserve the health of children. By determining the psychophysical condition of the child, a school doctor issues an expert opinion on the appropriate form of education and individually adjusts the schooling conditions of each student. OBJECTIVE: To determine the reasons for the introduction of appropriate forms of education and their representation among students of three generations in the school year 2017 / 2018. STUDY DESIGN: retrospective cross-sectional study PARTICIPANTS AND METHODS: Study included 3 686 second, sixth and eighth grade students in 18 town schools in Osijek and 30 out-of-town schools. Schools' and students' data were collected from the CEZIH system. 259 preventive health records of students with an appropriate form of education were analyzed (58 in the second, 106 in the sixth and 95 in the eighth grades). RESULTS: Out of 3 686 students, 7.03% students had an appropriate form of education. According to the gender and grade, regardless of the location of the school, there was a higher percentage of the appropriate form of education for boys: 60% in the second, 72% in the sixth and 66% in the third grade. According to the generation, 4.59% appropriate form of education was found among the children of the second, 8.66% among the children of the sixth and 8.25% among the children of the eighth grade. The most common reasons for determining the appropriate form of schooling in all three generations were group 3 disorders (learning and communication difficulties) and group 7 (existence of several types of difficulties). CONCLUSION: Most common reasons for introducing the program have not changed over the years. Boys have more difficulties mastering the material due to developmental difficulties. Most common reasons for introducing the program in older generations are specific disorders of reading, writing and arithmetic. Younger generations have more programs with content adjustments and speech development disorders, which is increasingly expressed during the examination for enrollment in school.

Direct access physiotherapy was introduced first time in Finnish Student Health Service (FSHS) in September 2020. It is a health care service where patient receives physiotherapy without doctor`s referral. Previous studies have shown that the direct access physiotherapy is beneficial, cost effective and safe way to treat musculoskeletal disorders in adults (Ojha etc. 2014, Karvonen 2020, Mintken etc. 2015). It has also been reported that direct access physiotherapy increases patient satisfaction and access to care (Töytäri 2018, Karppinen etc. 2020, Karvonen 2020). The process of transition from traditional musculoskeletal care model to the direct access physiotherapy in the FSHS required further education of physiotherapists. The education was based on biopsychosocial model which emphasizes early recognition of psychosocial risk factors for prolonged pain as well as better clinical understanding of musculoskeletal disorders. The transition process also required informing the whole organization of the new model. Direct access physiotherapy has been an effective way to treat musculoskeletal disorders in student health care. In 2021 90% of students with musculoskeletal disorders visited primarily physiotherapist in FSHS. Only 12% of these patients were referred to doctor by physiotherapist. Co-operation between physiotherapists and general practitioners has a very important role for safe and adequate care. All of the 8 358 patients managed through direct access physiotherapy in the FSHS with no adverse events in 2021. As organization FSHS has fully supported the new care model to ensure that physiotherapists have the knowledge, the equipment and the medical support they need to implement direct access physiotherapy.

Učenica osmog razreda dolazi na savjetovanje školskoj liječnici-psihoterapeutkinji po preporuci psihijatra. Obrađena od strane psihijatra zbog suicidalne nakane. U nalazu psihijatra izrazita inhibicija u kontaktu, napetost, tjeskobnost, sniženo raspoloženje , uključi se medikamentozna terapija antidepresivom fluvoksaminom. Učenica navodi opterećenje boravkom u školi, nedostatak volje za učenje, nema niti jedan kvalitetan vršnjački odnos, percipira se jako usamljenom. Većinu dana provodi uz mobitel, igrajući virtualne igrice. Otkriva da se povremeno samoozljeđuje zarezivanjem nožićem . Učenica prihvaća psihoterapiju, znatiželjna u osvještavanju očekivanja od sebe i vršnjaka, posebice u terapeutovoj definiciji usamljenosti kao izvora bola, obzirom da isti moždani modul dojavljuje usamljenost i bol. Osvještava i samoozljeđivanje kao pokušaj smanjenja boli zbog percepcije neprihvaćenosti. Spoznaje tijekom procesa da je ona ta koja odbija i ne prihvaća vršnjačko druženje, ne prihvaćajući ideju da smo slobodni dijeliti, a čekanjem da primimo riskiramo usamljenost. Dokaze za bol koju proizvodi usamljenost nalazimo u funkcionalnoj magnetskoj rezonanci mozga kojom su znanstvenici dokazali pojačanu aktivnost u prednjem cingularnom korteksu i desnom ventralnom prefrontalnom korteksu zbog percepcije usamljenosti kao bolnog odbijanja ( Eisenberger i dr.,2003).Učenica se uklapa i u znanstvena istraživanja kojima je dokazano da internetski mediji utječu na povećanje usmljenosti, probleme davanja povjerenja, te gomilanje depresije. Kako je vršnjačka povezanost važan čimbenik za samoostvarenje u školi i osobnom životu, tijekom terapije smo se bavili bazičnim uvjerenjima koja su sadržavala izrazite narcističke elemente. Udaljavanje od vršnjaka bilo je povezano s nerealnim očekivanjima od sebe da može postići da se vršnjaci ponašaju po njenim željama. Osvještavanjem intrinzičnog fokusa i motivacije ponašanja za svoje genske upute, učenica je reprogramirala specifične upute i iskusila ideju vlastitih slobodnih izbora u samoostvarenju u svojim važnim ulogama. Zaključak:Intrinzični motivi uvijek obuhvaćaju privrženost i zajedništvo, kao jedinu mogućnost dugotrajnijeg kvalitetnog samoostvarenja u svojim važnim životnim ulogama. Ostati dulje u patnji zbog percepcije usamljenosti često postane izvor različitih poremećaja.Otkriti upravljačku mogućnost usklađivanja s vršnjacima koji razmišljaju drugačije od njih samih i na taj način mogućnost približavanja svakoj važnoj osobi rješenje je velikog broja patnji .

Uvod: U Hrvatskoj je cijepljenje protiv HPV dobrovoljno i besplatno za dječake i djevojčice osnovnih i srednjih škola i redovite studente. Ovim preventivnim postupkom značajno se smanjuje rizik od infekcije HPV-om i razvoja karcinoma. U vrijeme epidemije COVID-19 bilo je teže provesti cijepljenje, posebice neobaveznih cijepljenja kao što je protiv HPV-a radi manje dostupnosti školske djece i online nastave. Cilj: Cilj rada je procijeniti procijepljenosti protiv HPV-a učenika osmih razreda prije početka epidemije školske godine (šk.god.) od 2016./2017. do 2018./2019, početkom 2019./2020. i 2020./2021. u jeku epidemije, u pet mjesta Krapinsko-zagorske županije. Ispitanici i metode: Istraživanjem je obuhvaćeno 1332 dječaka i djevojčica (učenika) osmih razreda u pet školskih godina od 2016. do 2021. sa područja općina Desinić, Sv. Križ Začretje, Zabok, Krapinske Toplice i Pregrada iz Krapinsko-zagorske županije. Podaci su prikupljeni iz obveznih izvješća o procijepljenosti Službe za školsku medicinu Zavoda za javno zdravstvo Krapinsko-zagorske županije. Potpuno procijepljene su osobe cijepljenje s dvije odnosno tri doze ovisno o dobi započetog cijepljenja. Rezultati: Potpuno procijepljenih učenika u pred-epidemijskom razdoblju bilo je šk.god. 2016./2017. godine 27,9% (74/265),, 2017./2018. 51,3% (147/286), 2018./2019. 68,0% (183/269), početkom epidemije 2019./2020. 70,0% (159/227), u epidemiji 2020./2021. 69,1% (197/285). Obuhvat potpuno cijepljenih djevojčica šk.god. 2016./2017. je 28,36% (38/134), 2017./2018. 65,4 % (87/133), 2018./2019. 77,8 % (105/135), 2019./2020. 76,0% (73/96) i u epidemiji 2020./2021. 74,1% (97/131). U istom razdoblju procijepljenost dječaka je 27,5% (36/131), 39,2% (60/153), 58,2% (78/134), 65,6% (86/131), 64,9% (100/154). Zaključak: Procijepljenost učenika se povećavala od 2016. godine i bila je najveća na početku epidemije 2019./2020. 70,0%. Tijekom epidemije nije došlo do značajnijeg pada procijepljenosti, samo za 1,9%. u odnosu na 2019./2020. Obuhvat cijepljenjem djevojčica u odnosu na dječake je u svim razdobljima bio veći, ali se razlika smanjivala i posljednje dvije godine je svega 4 do 5%, uz visoku procijepljenost dječaka od 65 %.

How much milk do children aged 6-7 drink? Zoretić H.* Del Vechio A.* * Teaching Institute of public health of Primorsko-goranska county, Rijeka, Croatia helena.zoretic@zzjzpgz.hr, anja.delvechio@zzjzpgz.hr Introduction: Milk is an important food in the growth and development of children, and it is rich in vitamins, minerals, proteins and fats. The recommended amount of cow's milk intake in this age group is 2-3 cups or 400-600 ml per day. Recently, it has been noticed that children are consuming less and less of this food which is so important for their upbringing. Objective: The aim of this task was to collect data on the amount of cow's milk that children consume every day, and to prove with objective data whether children really drink too little milk. Materials and methods: 503 children participated in this research task, of which 265 girls and 238 boys from the area of Rijeka and Kostrena. The study was conducted on preschool children aged 6-7 years. When the child arrived for a medical examination, the nurses took the data from the parents and entered them in the health records. Result: The results obtained with this research task are devastating. Of the 503 children surveyed, 8.75% do not consume milk at all, 8.35% drink 100 ml per day, 44.33% consume 200 ml per day, 9.94% of children surveyed drink 300 ml of milk per day, 9.54% drink 400 ml per day and 18.1 of them drink 0.5-1 l per day. Also 1% of children consume other milks such as goat, rice, almond and lactose free milk. Conclusion: More than half of the surveyed children drink too little cow's milk. Since the research showed that the intake of cow's milk is insufficient for the needs of the child's body of the examined age, it is necessary to work on greater promotion of the importance of recommended milk intake in preschool and early school age for both parents and children.

Cilj: Procijeniti učestalost i težinu poteškoća mentalnoga zdravlja učenika prvih razreda srednjih škola iz tri srednjoškolska usmjerenja: gimnazijski, tehnički i strukovni u Zagrebu prije epidemije Covid-19 2019. godine i u epidemiji 2021. godine. Ispitanici i metode: Ispitivanjem su obuhvaćeni učenici (mladići i djevojke) prvih razreda srednje škole iz jedne gimnazije, tehničke škole i strukovne škole u Zagrebu. Učenici su tijekom redovitih sistematskih pregleda u prvom razredu srednje škole ispunili upitnik YP-CORE s deset pitanja. Anketiranje je provedeno u istim školama prije epidemije Covid-19 2019. i u epidemiji 2021. Procjena rizika za poteškoće mentalnoga zdravlja je temeljem kriterija za YP-Core upitnik, za mladiće su ukupni bodovi: =>17, ili =>17 i 1-4 na čestici 4. („palo mi je napamet da si naudim“) ili 1-4 na čestici 4 i za djevojke ukupni bodovi: =>20 ili =>20 i 1-4 na čestici 4. ili 1-4 na čestici 4. Podaci rezultata na YP-CORE su prikupljeni iz rutinskih izviješća Službe za školsku i adolescentnu medicinu. Rezultati: Prije epidemije 2019. u gimnaziji je upitnik ispunio 81 učenik (55 ili 68% djevojke), tehničkoj 137 koju pohađaju samo mladići i strukovnoj 67 učenika (42 ili 63% djevojke). U epidemiji 2021. anketiran je u gimnaziji 88 učenik (58 ili 66% djevojke), tehničkoj 177 svi mladići i strukovnoj 121 učenik (67 ili 55% djevojke). Učestalost učenika s rizikom, prije epidemije, bila je u gimnaziji 7,7% mladića i 16,3% djevojaka, tehničkoj 8,7% mladići i strukovnoj 16% mladića i 28,5% djevojaka. Epidemijske 2021. u riziku je bilo u gimnaziji 33,3% mladića i 46,5% djevojaka, tehničkoj 16,2% mladića i strukovnoj 22,2% mladića i 44,7% djevojaka. Zaključak: U sve tri škole došlo je do značajnog povećanja broja i mladića i djevojaka u riziku za mentalno zdravlje i prisutni su teži oblici poremećaja koji zahtijevaju hitnu intervenciju jer su povezani s intenzitetom poteškoća i rizika da si naude. Rizik u epidemiji u gimnaziji je za mladiće 4,3 puta veći i djevojke 2,9 puta. Dvostruko više je mladića iz tehničke škole u riziku sada nego prije epidemije. U strukovnoj školi je rizik u mladića 1,4 puta veći i djevojaka 1,6 puta.

The Sars Cov 2 pandemic surprised us and completely changed our usual rhythm of life. Life has become a thing of the past, and since we didn’t know the virus, we had to adapt to protect the weakest. The competent school doctors were the coordinators of the implementation of national, county and city anti-epidemic measures in the school environment within the county, which was challenging. With this paper we want to show how school medicine has taken the burden of the pandemic in the school environment. School medicine monitored the situation with the infection in schools within its jurisdiction from day to day. We consolidated the same in weekly COVID reports, and we were available 24/7. We were in regular contact with principals, professional associates, teachers, parents, students, epidemiological service, CZ headquarters, founders and others, and carefully determined measures, sometimes schooling models for individual schools in times of crisis. In the school year 2020/2021. there were 2875 positive students. Due to the implementation of measures in the same period, there were 25,353 students in self-isolation and 1,129 classes in self-isolation. In the first semester of the school year 2021/2022. there were 4,099 positive students, 16,210 of them in self-isolation and 695 classes in self-isolation. All waves of the epidemic had some common features, but also differences. This includes the type of virus, the manner and speed of spread of the infection, the clinical picture, the models of teaching organization and the impact on student health. The pandemic over the past 2 years has greatly affected the lives of students within the school, but also outside it. Classes were held according to 3 models, of which the ONLINE was very common at first. The creativity of teachers has come to full expression. It didn’t always work out from the first. Problems were also hidden in other life segments of students, such as sleeping, attending classes, daily rest, meal planning, maintaining normal hygiene habits, and above all socializing with peers. The pandemic has spurred mechanisms to take action to save lives, and we are better prepared for possible similar challenges.

U ovom prikazu slučaja primjer je učenice osmog razreda osnovne škole 2021/22. školske godine koja od početka školovanja učestalo izostaje s nastave zbog subfebriliteta nepoznatog porijekla. U trećem razredu osnovne škole uvodi se individualizirani pristup u nastavi zbog teškoća u savladavanju gradiva i poremećaja prilagodbe in obs.. Učenica u petom i šestom razredu mijenja školu. Tijekom drugog polugodišta 4. i 5. razreda osnovne škole zbog zdravstvenih teškoća provodila se nastava kod kuće. U kolovozu 2017. godine ( početak 4. razreda osnovne škole) učini se parcijalna resekcija ciste lijevog jajnika i apendektomija, a u siječnju 2018. godine ( 2. polugodište 4. razreda) učini se laparoskopska operacija ciste desnog jajnika. Od 2019. godine u tri navrata se hospitalizira u svrhu multidisciplinarne obrade i utvrđivanja uzroka subfebriliteta i kroničnog umora, koji se prvi put javlja u dobi od dvije godine. Nakon opsežnih obrada ne nađe se uzroka istom. Vodeće dijagnoze su: stanje nakon parcijalne resekcije ciste lijevog i desnog jajnika, apendektomija, mikrovezukularna steatoza jetre, alergijska asthma ( intrizička , blaga), povremeni subfebriliteti, strije, teškoće u učenju. Od 3.2020. se školuje on line zbog proglašavanja vulnerabilnim slučajem tijekom pandemije SARS- CoV -2. Potvrde za ostvarivanje istog se izdaju od strane nadležnog školskog ili obiteljskog liječnika. Tijekom 2020/21. školske godine potvrde o vulnerabilnom slučaju na SARS-Cov -2 izdaje nadležni školski liječnik na kraća vremenska razdoblja uz praćenje zdravstvenog statusa i medicinske obrade učenika. Tijekom 2021/22. školske godine potvrdu o vulnerabilnost izdaje nadležni liječnik obiteljske medicine za cijelu školsku godinu 2021/22., te se učenik školuje on line cijelu školsku godinu, a međusektorskom suradnjom se utvrdi da učenik ne zadovoljava kriterije za ostvarivanje istog. Potvrda se zlouporabila na štetu učenika. Ovakvi slučajevi nisu česti. Sporadično se javljaju slične situacije koje nisu pod adekvatnim nadzorom. Predlaže se da ukoliko se učenik proglasi vulnerabilnim slučajem da se potvrde izdaju na kraća vremenska razdoblja te da se prati cjelokupni psihofizički status učenika i aktualna epidemiološka situacija. U kompleksnijim slučajevima potrebno je ostvariti međusektorsku suradnju, kako bi učenik ostvario pravo na odgoj i obrazovanje s nastavom u školi.

Maternal pertussis vaccination (MPV) is an effective strategy to prevent severe disease, in pregnant women and their infants during the first months of life, leading to a reduction of 91% in pertussis infections among young infants. Notwithstanding the public and individual health benefits of the MPV, coverage among pregnant women remains low (70%). Healthcare professionals, mainly midwives and obstetricians, play a significant role in the decision-making process of pregnant women. It is unclear if and in what way obstetric healthcare professionals take up this role. To better understand their perspective, we conducted both a survey and a qualitative study using semi-structured interviews with midwives and obstetricians. The survey was based on the theoretical framework developed by Visser et al, measuring determinants such as knowledge, social norm and general beliefs regarding vaccination. The interview guide included topics measuring attitudinal factors related to the MPV and practical barriers and facilitators, including time and organisation, regarding MPV counseling. The study is ongoing, currently nine healthcare professionals have been interviewed. Data analysis will include thematic analysis conducted by two researchers independently and final results will be presented at the conference. This study will identify facilitators and barriers related to MPV counseling among midwives and obstetricians. Results will emphasize the importance of interdisciplinary cooperation in raising vaccination coverage.

Objective: To assess the coverage of counseling work and the reasons for counseling primary and secondary school pupils and full-time students in one pre-epidemic (2018/2019) and two epidemic (2018/2019 and 2019/2020) school years in the City of Zagreb, Croatia. Participants and methods: The research included primary and secondary school pupils and full-time students in the City of Zagreb examined in multidisciplinary counseling centers of school-health services during 2018/2019, 2019/2020 and 2020/2021 school years. Data were collected from the regular reports on the work of the Department of School and Adolescent Medicine of the Andrija Štampar Teaching Institute of Public Health . Results:In all three levels of education, there was a reduction in the number of counselings during the epidemic. The number of primary school pupils' counselings in 2019/2020 and 2020/2021 was lower by 39% than in 2018/2019. In comparison with 2018/2019, counseling of secondary school pupils was lower by 33% in 2019/2020, and by 43% in 2020/2021. Counseling of full-time students was lower by 16% in 2019/2020, and by 50% in 2020/2021 in comparison with the pre-epidemic year. The main reasons for counseling of primary school pupils before the epidemic were: health improvement, occupational guidance and learning difficulties. During the years of epidemic, occupational guidance and learning difficulties came first. Before the epidemic, the reasons for counseling of secondary school pupils were: chronic illnesses, health improvement and mental health. In 2019/2020, chronic illnesses remained first, followed by mental health and health improvement. In 2020/2021, the first reason was mental health, followed by chronic illnesses and occupational guidance. Before the epidemic, full-time students had counseling for: chronic disease, health improvement and reproductive health. In 2019/2020 chronic illnesses remained first, followed by reproductive health and health improvement counselings. In 2020/2021 the first reason was mental health, followed by chronic illnesses and health improvement. Conclusion: Multidisciplinary counseling in school-health services provides students and parents with appropriate professional assistance for major health problems during adolescence and schooling, with priorities changing according to the circumstances, as witnessed during the epidemic.

Maternal pertussis vaccination (MPV) is an effective strategy to prevent severe disease, in pregnant women and their infants during the first months of life, leading to a reduction of 91% in pertussis infections among young infants. Notwithstanding the public and individual health benefits of the MPV, coverage among pregnant women remains low (70%). Healthcare professionals (HCP), mainly midwives and obstetricians, play a significant role in the decision-making process of pregnant women. Information regarding the availability of the vaccination sometimes does not reach the pregnant women, incorrect information is provided or the vaccination is even advised against. To assess the extent to which and in what way healthcare professionals influence the acceptance of the MPV, we conducted a cross-sectional survey among pregnant women and mothers of neonates in the Netherlands. The women responded on their main reason for acceptance or refusal of the MPV, if and in what way the MPV was discussed with their HCP, and what role this played in their decision on acceptance or refusal. In total, 1323 women filled out our questionnaire (1268 had accepted the vaccination during pregnancy). Preliminary results showed that 56% of the acceptors received a recommendation from their HCP, versus 38% of the refusers. More than half (52%) of the acceptors, that discussed the MPV with their HCP, indicated that this influenced their decision to accept the vaccination. Frequently stated reasons for accepting the MPV were: protection of the infant in the first weeks (86%) and the fact that the infants needs one shot less (78%). Main reasons for refusing the MPV were: being against vaccination during pregnancy (40%) and fear of side effects for the infant (27%). This study will clarify the perceived role of healthcare professionals regarding MPV decision-making. It will emphasize the importance of interdisciplinary cooperation in raising vaccination coverage.

The methodology of the study is based on a review of the literature. Peer-reviewed evidencebased articles in English have been used, which are cited in the work and are not older than 10 years (2012-2022). Previous studies have shown that the knowledge and attitudes of healthcare professionals about vaccines there is a strong association in the distribution of vaccine recommendations to patients. Conclusions of the study: COVID-19 vaccination is favored by healthcare professionals, including nurses, on the grounds that vaccination is effective and helps to prevent serious illness. Ignorance of the effectiveness of COVID-19 is changing the attitudes and confidence of nurses. At the same time, the ever-evolving and new knowledge about the safety and risks of COVID-19 is contributing to a more positive attitude. The reason why COVID-19 should not be vaccinated is often a big problem, because the disease is new and the rapid development of the vaccine is causing mistrust among nurses. Social, cultural and personal factors influence COVID-19 vaccination. At the same time, the wider impact of the historical, political and socio-cultural context in which vaccination takes place must be taken into account. There are a number of factors that cause hesitation in COVID19 vaccines and, as a result, the attitude is individual. These reasons may include personal knowledge or previous experience, including a state of psychological indecision. These factors, in turn, are affected by a lack of confidence in vaccination policies and the information provided on vaccines. The main factors for refusal are nurses' concerns about the safety, efficacy, side effects, misinformation of the vaccine and the reliability of the experts and the pharma companies involved in the effectiveness and safety of the vaccines. Successful COVID-19 vaccination can be based on taking into account societal attitudes and human concerns.

Uvod i cilj rada: Uvjeti pandemije povezuju se s povećanim rizikom po mentalno zdravlje i odraslih i djece i mladih. Istraživanja upućuju na povećan rizik od razvoja anksioznosti, depresije, simptoma povezanih s tugom, posttraumatskog stresnog poremećaja i zlouporabe sredstava, ali i prekida i promjene načina skrbi za one s već postojećim poremećajima mentalnog zdravlja. Cilj ovog rada bio je istražiti učestalost korištenja Multidisciplinarnog savjetovališta za strane studente zbog poteškoća mentalnog zdravlja prije i tijekom pandemije COVID-19. Ispitanici i metode: Za potrebe ovog rada analizirana je medicinska dokumentacija internacionalnih studenata Sveučilišta u Zagrebu, koji su kontaktirali Multidisciplinarno savjetovalište zbog poteškoća mentalnog zdravlja tijekom 2019., 2020. i 2021. godine, temeljeno na dijagnozama iz područja mentalnog zdravlja prema Međunarodnoj klasifikaciji bolesti. Podatci su analizirani metodama deskriptivne statistike i prikazani na razini značajnosti od P<0,05. Rezultati: Tijekom 2019. godine u savjetovalištu je zdravstvenu zaštitu zatražilo ukupno 515 stranih studenata (57,8% djevojaka), tijekom 2020. godine 455 (67,5% djevojaka), a 2021. godine 462 strana studenta (67,7% djevojaka). Od ukupnog broja konzultacija, 2019. godine 8,7% bilo je zbog poteškoća mentalnog zdravlja (42,2% djevojaka), 2020. godine 5,9% (44,4% djevojaka), a 2021. najviše 14,3% (57,6% djevojaka) i to značajno više u odnosu na prethodne godine (χ2=19,11; P<0,001). Najčešće utvrđene dijagnoze u sve tri promatrane godine bile su iz skupine neurotskih i somatofornih poremećaja i poremećaja izazvanih stresom (51,1%, 79,2% i 72,0%), i to mješoviti anksiozni i depresijski poremećaj te poremećaj prilagođavanja. Zaključak: Rezultati pokazuju da je u Multidisciplinarnom savjetovalištu za internacionalne studente tijekom 2021. godine i pandemije COVID-19 bilo značajno više konzultacija zbog poteškoća mentalnog zdravlja studenata u odnosu na period prije pandemije. Rezultati ukazuju na potrebu kontinuirane dostupnosti i skrbi za studentsku populaciju, uključujući internacionalne studente, posebno u segmentu mentalnog zdravlja.

SAŽETAK UVOD: Sve je veći broj studenata koji studiraju izvan mjesta stalnog prebivališta. Osijek,sveučilišni grad s približno 11000 studenata, pruža zdravstvenu zaštitu studentima putem timova školske medicine, koji obavljaju preventivne sistematske preglede, ali i savjetovališni rad, čime se doprinosi cjelokupnom očuvanju njihovog psiho-fizičkog zdravlja, koje je posebno bitno sačuvati s obzirom na pandemiju SARS-Cov2 virusa. CILJ: Procjeniti i ispitati postoji li razlika u statusu uhranjenosti u odrabranoj studentskoj populaciji u odnosu na razdoblje prije i za vrijeme pandemije SARS-CoV2 virusom. USTROJ STUDIJE: retrospektivna presječna studija ISPITANICI I METODE: U istraživanje su uključeni studenti prve godine odabranih fakulteta Osječkog sveučilišta (Medicinski fakultet, Prehrambeno-tehnološki fakultet, Građevinski i arhitektonski fakultet te Akademija za umjetnost i kulturu u Osijeku) koji su pristupili sistematskom pregledu, tijekom dvije akademske godine: 2018./2019. (N=431) i 2021./2022. (N=427). Ukupno je analizirano 858 zdravstvenih kartona, s većim udjelom studentica u obje promatrane godine ( 62,2% i 62,8%). Podatci o studentima prikupljeni su iz njihovih zdravstvenih kartona i anketnog upitnika ispunjenog prilikom sistematskog pregleda. REZULTATI: U 2018./2019. godini udio pretilih (7,98%) i prekomjerno uhranjenih (12,88%) studenata bio je viši u odnosu na udio pretilih (5,97%) i prekomjerno uhranjenih (10,88%) studentica, dok je udio pothranjenih studentica (4,10%) bio viši u odnosu na pothranjene studente (0,61%). U 2021./2022. godini udio pretilih (8,63%) i pothranjenih (5,04%) studenata bio je niži u odnosu na udio pretilih (9,72%) i pothranjenih (8,33%) studentica, dok je udio prekomjerno uhranjenih (12,95%) studenata bio viši u odnosu na studentice (7,64%). Porast pretilosti (+0,65% vs +3,75%) izraženiji je kod studentica, dok je porast pothranjenosti (+4,43% vs +4,23%) izraženiji kod studenata. Kod studenata došlo je do porasta (+0,07%), a kod studentica do pada (-3,18%) prekomjerne uhranjenosti. Zbirno gledano, došlo je do porasta pretilosti (+2,64%) i pothranjenosti (+5,18%) te pada prekomjerne uhranjenosti (-2,23%) kod studenata oba spola. ZAKLJUČAK: Iako postoji promjena u statusu uhranjenosti, gledano i prema spolu i prema generaciji, teško je sa sigurnošću tvrditi da li je navedeni rezultat posljedica pandemije. Stoga je bitno raditi na poboljšanju zdravstvene zaštite studenata, čime bi se dovelo do bolje kontrole, ali i prevencije ekstrema: pretilosti i pothranjenosti.

BUBANJ I., MIKLOŠEVIĆ S. NZZJZ „Dr. Andrija Štampar“, Zagreb, Croatia ivana.bubanj@stampar.hr INTRODUCTION In the last two years COVID 19 pandemic has led to taking restrictive measures to control the spread of the virus. Studies have suggested that health related pandemic disasters may lead to post traumatic stress disorder (PTSD) symptomatology, while patients with COVID 19 have shown a higher incidence of an altered mental status, mood disorders, insomnia and anxiety. AIM Aim of this paper is to show results on YP-CORE which students have filled out during medical examination in the first grade of high school, depending on student's COVID-19 status. MATERIALS AND METHODS Medical records, of 175 students from first grade of two high schools in Zagreb who have participated in medical examination during which students have filled out YP-CORE have been collected. Data was collected during April and May of 2022. Students who recovered from COVID-19 infection had to have laboratory confirmed (PCR or rapid antigen test) COVID-19 infection. Results on YP-CORE have been interpreted as following: „risk is detected“ if result for male students was ≥17 or 1-4 on 4th question and for female students ≥20 or 1-4 on 4th question. Result ≤16 and 0 on 4th question in male students and ≤19 and 0 on 4th question in female students was interpreted as „risk is not detected“. RESULTS Out of total 175 students who had been on medical examination and had filled out YP-CORE, 88 students have had COVID-19 infection and 87 students haven't had. Out of 88 students who have had COVID-19 infection, risk on YP-CORE is detected for 19 students and for 69 students is not detected. Out of 87 students who haven't had COVID-19 infection, for 18 students risk is detected and for 69 is not detected. CONCLUSION Results of this research does not show any difference between results on YP-CORE based on COVID-19 status, but research shows that for 21% of students risk on YP-CORE is detected. It is necessary to identify students with detected risk and include them in counseling with school medicine specialist, school psychologist or address them to psychiatrist.

How awareness on Early Life Stress (ELS) can facilitate and create opportunities to improve service delivery by youth health care professionals. Healthcare professionals can share information on Early Life Stress and the biological effects of the toxic stress response in conversation with parents and children. Combined with experience and knowledge of attachment and parent-child interaction, these conversations are of great importance for the self regulating skills of parents require to help their children develop their own self regulation skills. In this workshop we present the preliminairy results of the first dutch clinical pilot on ACE screening among children with asthma, diabetes and obesity. The workshop shall focus on the association between adversity and obesity and engage the audience in a lively and interactive discussion on new insights on this topic using and an example of an initiative from the Caribbean. Research on screening for adversity is a crucial in improving personalized and stepped care. This can be of help on all levels of prevention; it empowers resilience and strength based approaches in health care. Leading articles will be shared and discussed.

Professional information of students is provided during the systematic examination in the eighth grade of primary school.Students with health problems, developmental difficulties and other health disorders are referred to vocational guidance at the Croatian Employment Service.This research is showing the reasons for referring students to vocational guidance, and gain insight into the prevalence of health and developmental difficulties when enrolling in high school.It included a total of 1,029 students attending the eighth grade in the city of Rijeka (a total of 25 primary schools),in the school year 2020/2021.Data on diseases, conditions, developmental difficulties and other health disorders were collected during regular systematic examinations in the eighth grade, and from preventive health records and accompanying medical documentation.From the general data on the child, the following were used: sex of the child, year of birth completed school of mother and father, marital status of parents. The others data are presented according to: developmental and health difficulties due to which students are referred professionally routing,leading diagnoses that were the reason for referral to vocational guidance,appropriate, education program and form of education for children with disabilities and determining the type of developmental difficulties and the frequency of occurrence according to the definition of the orientation group and subgroups of difficulties.From 1,029 students that were examined,178 students were referred for vocational guidance - 89 students referred due to health difficulties, 81 students due to developmental difficulties and 8 students due to developmental and health difficulties.Most of the students with health problems has eye and adnexa diseases. From all the students with disabilities the leading reason for referral is a specific developmental disorder speech and language Students with disabilities are mostly educated according to the regular curriculum with an individualized approach and have an educational rehabilitation program, most often with the help of a speech therapist.The role of school medicine is important in the process of choosing the appropriate profession.The goal of conducting professional guidance of students is to provide conditions and support for achievement maximum development of the potential of each individual student and equalize the opportunities for achievement the highest possible level of education.

Iako se o temi maloljetničkih trudnoća ne govori puno u školama, obiteljima i društvu općenito, problem maloljetnih majki je i dalje prisutan kod nas tako i u svijetu. Maloljetničke trudnoće nisu samo zdravstveni problem, već i problem seksualnog odgoja mladih i javnozdravstvenog sustava. Često ih se povezuje s nedovoljnim znanjem o kontracepciji, željom mladih za eksperimentiranjem sa svojom seksualnošću, lakoj dostupnosti alkohola, a nerijetko je riječ o pritisku vršnjaka vezanom uz stupanje u spolni odnos na koji mladi nisu spremni. Potaknuta petim slučajem maloljetničke trudnoće u jednoj strukovnoj školi tijekom jedne školske godine, odlučila sam prikazati slučaj jedne trudne učenice i navesti koje su sve prepreke s kojima se morala suočiti. Majka trudne petnaestogodišnje učenice prvog razreda srednje strukovne škole je uputila mail u školsku ambulantu i navela kako je njezina kćer rodila i moli ispričnicu za njezine izostanke s nastave i potvrdu za oslobođenje od nastave tjelesno zdravstvene kulture. Roditelji navedene učenice nisu znali da im je kćer trudna iako žive u istom kućanstvu i navode u mailu da je djevojka cijelo vrijeme imala ravan trbuh i redovite menstrualne cikluse te da ništa nije upućivalo na trudnoću. Maloljetna trudnica je rodila zdravo dijete u terminu ali se postporođajni period komplicirao nastankom anafilaktičke reakcije trudnice nakon primitka transfuzije krvi uslijed teže anemije. Otac rođenog djeteta, također maloljetni učenik, nije u kontaktu s navedenom mladom majkom. Učenica navodi da je voljna nastaviti školovanje i da će nadoknaditi propuštene ispite na predmetnim ispitima na jesen. Kontaktirala sam Stručnu službu u njezinoj školi i upoznala ih s situacijom navedene učenice te su pokazali susretljivost i spremnost na pružanje podrške. Začudili su se kako je učenica iznijela cijelu trudnoću na način da nitko u školi nije znao za njezino stanje i da nije tražila ispriku za izvršavanje školskih obveza. Učenica je upoznata sa svim zakonima i propisima koje sustav nudi kako bi zaštitio maloljetne majke no hoće li to biti dovoljno da uspije prebroditi sve izazove koji su ispred nje, to će pokazati vrijeme.

Cilj: 1. Istražiti povezanost vremena provedenog učeći i pišući domaće zadaće s pojavnošću poremećaja vida. 2. Istražiti povezanost vremena provedenog u radu za računalom, gledanju sadržaja na mobitelu i gledanju televizije s poremećajem vida. 3. Istražiti povezanost vremena provedenog u sportskim aktivnostima s poremećajem vida. 4. Istražiti povezanost boravka u otvorenom prostoru s pojavnošću poremećaja vida. 5. Istražiti povezanost između postojanja refrakcijskih anomalija u roditelja i pojavnosti refrakcijskih anomalija u učenika. Ispitanici i metode: Istraživanje je provedeno među učenicima osmih razreda u trinaest zagrebačkih osnovnih škola na područjima gradskih četvrti Trnje, Trešnjevka Jug, Trešnjevka Sjever i Peščenica-Žitnjak. U istraživanju je sudjelovalo 165 učenika osmih razreda osnovne škole, 71 dječak, 94 djevojčice, i njihovih roditelja. Uspoređeni su podaci dobiveni anketom s nalazima pregleda vida tijekom sistematskih pregleda i probira vida u školskim ambulantama učenika osmih razreda 2017. godine. Učenici i roditelji su u anketi procjenjivali vrijeme koje je učenik proveo u učenju, radu na računalu, gledanju mobitela, gledanju televizije, bavljenju sportom, rekreacijom, šetnjama, te boravku u otvorenom i u zatvorenom prostoru. U obradi rezultata se za svako od pitanja u kojem se procjenjivalo vrijeme provedeno u pojedinoj aktivnosti, koristila se prosječna vrijednost procjene vremena učenika i roditelja. Rezultati: Učenici i učenice s urednim vidom značajno više vremena provedu pred ekranima (računalo, mobitel i televizija) u odnosu na učenike i učenice s poremećajima vida. Učenici i učenice s urednim vidom provode značajno više vremena na otvorenom u odnosu na učenike i učenice s poremećajem vida. Ne postoji značajna razlika u vremenu provedenom u sportskim aktivnostima između učenika i učenica s urednim i učenika i učenica s poremećajem vida. Nije pronađena značajna povezanost između roditelja s refrakcijskim anomalijama i učenika i učenica s poremećajima vida. Nije uočena povezanost između vremena provedenog učeći i pišući domaće zadaće s pojavnošću poremećaja vida učenika i učenica.

Ciljevi: Svjetska zdravstvena organizacija mentalno zdravlje definira kao stanje dobrobiti u kojem pojedinac može iskazati svoje sposobnosti, nositi se sa svakodnevnim životnim stresorima, produktivno raditi i doprinositi vlastitoj zajednici. Nacionalni probir mentalnog zdravlja među mladima u Republici Hrvatskoj počeo se provoditi pri sistematskom pregledima učenika 1.r.SŠ u školskoj godini 2019./2020. Cilj istraživanja bio je učiniti probir rizika u mentalnom zdravlju učenika prvih razreda srednjih škola. Materijali i metode: Za probir se koristio YP-CORE upitnik u sklopu sistematskog pregleda liječnika specijalista školske medicine. Upitnik ispituje kako su se učenici osjećali u posljednjih tjedan dana, te se pozitivnim na probir smatra ukupan broj bodova ≥20 kod djevojčica, ≥17 kod dječaka ili potvrdni odgovor na 4. pitanje (“Palo mi je napamet da si naudim”), neovisno o odgovorima na druga pitanja. Rezultati: Istraživanje je obuhvatilo 249 učenika tri srednje škole na području Rijeke i okolice. Ukupno je 28 (11.2%) učenika bilo pozitivno na probiru, od toga 21 učenica (75%) i 7 učenika (25%). Pozitivan probir na temelju ukupnog broja bodova zabilježen je u 24 (85.7%) učenika, dok je 13 učenika (46.4%) dalo potvrdni odgovor na 4. pitanje. Prosječan broj bodova na YP-CORE testu u učenika s pozitivnim probirom iznosio je 22.1 (±5.2), s rasponom od 9 do 36. Nije bilo razlike u bodovima između dječaka (22.0±4.32) i djevojčica (22.14±5.56), p=0.95. Postojala je statistički značajna korelacija između pozitivnog odgovora na 4. pitanje i pozitivnog probira na ukupni broj bodova (r=0.43, p<0.05), no čak 30.7% (4/13) djece koje su dala pozitivan odgovor na 4. pitanje, nisu imala pozitivan probir na ukupni broj bodova. Zaključak: Rano otkrivanje rizika u mentalnom zdravlju kritična je komponenta u uspješnom liječenju i potpori učenika srednjih škola. Velikom postotku mladih potrebna je stručna pomoć i podrška u procesu prevladavanja teškoća u području mentalnog zdravlja, no potrebna je i daljnja analiza najprimjerenijeg upitnika za probir u mentalnom zdravlju.

Behavioral disorder is a term that encompasses various forms of unacceptable behavior. According to ICD-10, it is defined as a group of disorders characterized by a combination of constant aggression, unsociability or defiance with obvious and visible symptoms of depressed mood, fear and emotional arousal. Although they can occur in preschool and school age, they most commonly occur during adolescence. Family and school are cited as the main causes of behavioral disorders. Insufficient emotional connection, inappropriate educational methods, abuse and various forms of risky behaviors of adult members stand out in the family. In the school environment, the cause may be social isolation of peers, disciplinary actions and insufficient support from teachers. In order to reduce the risk of behavioral disorders, a multidisciplinary approach, teamwork and timely action are important so that such a pattern of behavior does not become established. It includes school medicine doctors, nurses and the school's professional service. CASE REPORT In a seventeen-year-old student, behavioral problems have been present since the beginning of school. From the 1st grade of primary school, schooling is carried out according to the regular curriculum with the application of individualized procedures and family psychotherapy is carried out due to the emotional difficulties of students. During the 4th grade of primary school, after the incident at school, for which a warning measure was issued, it was recommended to be included in individual psychotherapy. In the 6th grade, a teaching assistant is included. In the 7th grade, due to the persistence of behavioral problems, an interdisciplinary meeting was organized with the Center for Social Welfare. Treatment continued through the day hospital. During high school, problematic behavior continued, culminating in situations that required involvement in addition to the welfare center and the police. In order to prevent the exclusion of students from the educational process and the imposition of pedagogical measures, more intensive treatment, psychotherapy and, if necessary, pharmacotherapy and monitoring by a psychiatrist are needed. The school needs to include teaching assistants, individual work with the student and the implementation of other necessary activities by the professional service.

A seven-year-old girl comes for a systematic examination before enrolling in the first grade. In the waiting room, she shows resistance to the examination by complaining, crying and shouting. The examination is postponed for two hours. Hetero-data show that she was born from a regular pregnancy and term delivery. Early psychomotor development went smoothly, she did not suffer from any serious illness. She has been attending preschool for three years.The somatic examination of the child could not be performed due to anxiety and refusal to cooperate. The doctor's office managed to perform auscultation of the heart and lungs. The examination is interrupted when trying to examine the oral cavity girl starts crying and running around the office.The child has difficulty developing speech, difficulty articulating voices, not understanding more complex instructions and echolalia. There is constant psychomotor restlessness and lack of eye contact. The drawing of a man (Goodenough test) is scarcer (6 details), the given characters (perceptual-motor ability test) are not crossed out according to the schedule. Parents bring the opinion of the expert team of the kindergarten that the girl attends, which describes the difficulties of communication, speech, and socio-emotional development.They do not attach medical documentation. From the interviews with the parents, it is established that they have not received a recommendation for the treatment of the child in a medical institution and that they believe that the existing difficulty will be overcome without additional examinations and interventions.Parents were advised about the need for specialist team treatment and were referred to the Psychiatric Hospital for Children and Adolescents, with a note on the possible postponement of the schooling by the School Professional Committee.Children with disabilities without accompanying medical documentation often come for check-ups before enrolling in the first grade of primary school, and the reason is insufficient education of parents about the need to process and include a child with disabilities in timely rehabilitation.It is extremely important that professionals involved in preschool education and monitoring the health status of children with disabilities educate parents about this problem to ensure the child's right to an appropriate form of education.

Background The health status of children and adolescents has significantly improved in recent decades. Due to their low morbidity and mortality rates, adolescents are considered the healthiest part of the overall population. On the other hand, data in our school clinics show that the past time has brought a change in the morbidity of this group of patients by putting psychosocial problems first. Aims The aim of this research was to gain insight into their own picture of mental health seen by adolescents themselves. We investigated how often, when and where young people go in search of help for their mental health and tried to gain insight into our position from their perspective. Methods The research included 332 high school students from Rijeka (Croatia) aged 15 to 18. An anonymous questionnaire was prepared for this study. The questionnaire included questions related to the psychosocial environment of young people, their age and gender, and questions about their own health and what they think about mental health in general. Results Although more than half of the respondents (56%) stated that they are very or quite satisfied with their school success, school is the most common cause of stress. The most common mental health problems are tension and anxiety (45% of respondents), followed by low motivation (37% of respondents) and apathy (33% of respondents). Among those who have never sought professional help related to their mental health, as many as 21.9% would like it.V The top three changes that young people want to happen in terms of solving their mental health problems are better education of parents, teachers and health professionals. Conclusion The results show that young people know how to recognize and describe mental health problems and that they are mostly connected to school. As they believe that parents, teachers, and unfortunately, health professionals have insufficient knowledge about these difficulties, it is necessary to intensify educational and preventive activities that would help empower and raise awareness about these problems. It is also important that we who are educated to help them become more accessible and recognizable by young people.

The aim of the research was to determine the health problems of school children and youth seeking health-care in the prehospital emergency medical service (PEMS) and to compare differences before and during the COVID-19 pandemic. The research was conducted in the Institute of emergency medicine of the Vukovar-Srijem County. Data including number of examinations, number of out-patient clinic examinations, number of field interventions, emergency priorities and main diagnoses for patients aged 7 to 19 years in the years 2018 and 2021 were collected, compared and analyzed. Results showed that school children and youth accounted for 5,5% of patients in the PEMS in the pandemic period and for 6,8% of patients in the prepandemic period (p<0,001). Number of examinations dropped significantly in the pandemic period since patients avoided unnecessary health examinations. This is supported by significant decrease of unurgent patients of school age (third priority) (56,5% vs. 64,1%) and significant increase of urgent patients of school age (first priority) (10,8% vs. 8,8%) during the pandemic period (p<0,001). Furthermore, there was a significant drop of out-patient clinic examinations (70,4% vs. 75,7%) and the increase of field emergency medical interventions (29,6% vs. 24,3%) in the pandemic period (p=0,001). The highest share of examinations of school children and youth in PEMS are related to injuries, accounting for 19,8% in pandemic period and 18,9% in prepandemic period (p=0,558). During the pandemic period, there was an increase in the number of examinations of school children and youth related to psychiatric disorders (5,9% vs. 5,0%), abuse of addictive substances (2,8% vs. 2,1%), alcohol abuse (2,0% vs. 1,7%), illegal drug abuse (0,4% vs. 0,1%) and medication abuse (0,4% vs. 0,2%), but these were not significant. However, the pandemic brought significant increase in the number of examinations of school children and youth related to psychotic disorders (0,5% vs. 0,06%, p=0,009) and physical violence (0,4% vs. 0,06%, p=0,040), while there was no significant difference for anxiety/depression disorders, stress reactions and disorders of conduct. In conclusion, attention should be brought upon mental health and physical violence that showed significant increase in emergency medical conditions of school children and youth.

INTRODUCTION: Self-image, self-perception, is an extremely important construct of research from the aspect of psychological, sociological and educational sciences. Dissatisfaction with the body can be defined as the discrepancy that lies between what is perceived and what is considered an ideal physical appearance. OBJECTIVE: to gain insight into the subjective feeling of (dis) satisfaction with the physical appearance of the respondents, depending on age and gender. METHODS: A total of N = 265 respondents participated in the study. Of the stated number of respondents, the share of male respondents was 39.2%, while the share of female respondents was 60.8%. 51.03% of respondents attend the 8th grade of primary school, while 48.7% of respondents attend high school. RESULTS: When asked about satisfaction with physical appearance, there is a statistically significant difference between the observed groups in terms of age and gender. In the total number of respondents, 39.8% believe that boys are more satisfied with their appearance than girls. There was also a statistically significant difference in relation to the sex of the respondents in terms of feelings of depression, depression due to physical appearance. As many as 44.1% of respondents state that they sometimes feel depressed because of their appearance, while only 7.7% of male respondents answer the same question. According to the literature, there is a great influence of peers, according to empirical research, the relationship between criticism of peer appearance and the development of dissatisfaction with physical appearance has been identified. Likewise, the influence of peers is cited by adolescents as the most important factor in the perception of their own appearance. With this in mind, school-age children should also be involved in programs of acceptance of diversity and sensitization to peers from an early age. CONCLUSION: Perception and experience of oneself is an extremely important part of the daily life of each of us. Preoccupation with physical appearance in adolescence is more pronounced due to psychophysical changes, which is reflected in the results of research. The importance of the environment, especially peers, can greatly affect the perception of physical appearance.

Uvod i cilj: Primjereni oblici školovanja određuju se učenicima s teškoćama u razvoju kod kojih su u procesu procjene psihofizičkog stanja prije upisa u 1.razred OŠ ili tijekom školovanja uočene teškoće koje ih onemogućavaju u ravnopravnom sudjelovanju u odgojno-obrazovnom procesu s ostalim učenicima. Cilj rada bio je prikazati i analizirati broj učenika s primjerenim oblicima školovanja u redovitim razrednim odjeljenjima školske godine 2021./22. Ispitanici i metode: Za potrebe ovog rada analizirana je medicinska dokumentacija učenika s primjerenim oblicima školovanja svih osnovnih škola u Gradu Samoboru i Svetoj Nedjelji u Službi za školsku medicinu Zavoda za javno zdravstvo Zagrebačke županije. Podatci su uneseni u Microsoft Excel datoteku i analizirani metodama deskriptivne statistike, te prikazani na razini značajnosti od P< 0,05. Rezultati: Od ukupnog broja učenika (N=4456) u školskoj godini 2021./22. u osnovnim školama bilo je 347 (7,8%) učenika s primjerenim oblikom školovanja, od toga značajno više učenika u odnosu na učenice (66,6% vs 33,4%, P<0,001). Najviše učenika s primjerenim oblikom školovanja bilo je u sedmom razredu OŠ (20,5%), slijede osmi (19,6%) pa peti razred (15,9%), dok je najmanje učenika bilo je u prvom razredu (2,3%). Najveći broj učenika s teškoćama školovao se po redovitom programu uz individualizirane postupke (79,0%,), zatim po redovitom programu uz prilagodbu sadržaja (10,1% ) a 11.0% po kombinaciji oba programa. Najviše učenika imalo je oštećenja jezično-govorne glasovne komunikacije i specifične teškoće u učenju (46.7%), zatim kombinaciju s poremećajima u ponašanju i oštećenjima mentalnog zdravlja (21%) te kombinaciju s oštećenjima organa i organskih sustava (13,5%). Najveći broj učenika je rješenje o primjerenom obliku školovanja dobilo u prvom razredu (21,0%), zatim u drugom i trećem (19,6%), te četvrtom razredu osnovne škole (15,3%). Pomoćnika u nastavi imalo je 16,4% učenika s teškoćama. Zaključak: Značajan broj učenika ulazi u proces školovanja s primjerenim oblikom školovanja ili se rješenja donose tijekom razredne nastave što je dobar pokazatelj ranog prepoznavanja teškoća i omogućavanja adekvatne pomoći i uspješnog školovanja. Obzirom da su oštećenja jezično govorne komunikacije uz oštećenja mentalnog zdravlja najčešće poteškoće pri određivanju primjerenih oblika školovanja potrebno je pojačati dijagnostiku i intervencije tih poremećaja u predškolskoj dobi.

Introduction When supporting the health of students and preventing illness, it is important that the school nurse also takes care of their own health, thereby setting an example. That includes their workspace. In many Estonian schools works paces are not designed ergonomically, affecting the physical health of students, teachers and support staff in the long run. Discussion School nurses identified postural disorders (8.4%) and decreased visual acuity (20.5%) in Tallinn schoolchildren. Nearly half of the students use smart devices 4.5 hours a day and 23.2% of students use them 6 or more hours a day, often forgetting the health-promoting posture and/or the recommended distance between the screen and the eyes. A risk analysis conducted in 2021 also identified the presence of ergonomic risk factors in the school nurses' office. Objective: The effects of work environment risk factors on health have been recognized by school nurses and active intervention has been launched. Methods: expert analysis, observations, training. The following activities are planned: 1. mapping the working conditions of all school nurses (92); 2. spreading awareness of occupational safety and health requirements; 3. instructing school nurses on creating an ergonomic work environment; 4. organizing practical training for school nurses to monitor the school environment and advise the school family; 5. discussions on the basis of case studies. Between the autumn of 2021 and the spring of 2022, a risk analysis of the work environment was carried out and the adequacy of occupational safety and work healthcare (placement of work equipment, sitting position, factors affecting vision, microclimate, etc.) was mapped in the nurses' offices providing services in Tallinn schools (86). Additionally a work environment specialist was there to instruct and give recommendations. Conclusion In August of 2022, practical training, with presentations of case studies, is planned to teach school nurses the monitoring of school environment and the counseling of students and school staff. Recognizing and intervening with health risks in the school environment immediately may be a more effective method of prevention than merely giving spoken instructions on posture and eye health and environmental risk factors during a health check.

Mental ill-health is the leading cause of disability and poor life outcomes in young people aged 10-24 years, contributing up to 45% of the overall burden of disease in this age-group. Young people around the world have the worst access to mental health services. Only 2% of the healthcare budget is spent on meantal health which indicates clearly that there is a crisis of action towards mental health activities in the world. (World Economic Forum 2020) The aim is to create opportunities and necessary tools so that the mental health problems of Tallinn schoolchildren are noticed early and the necessary help is provided. The main activities: - launching a mental health nurse reception in schools as part of the school healthcare service; - developing and implementing a patient's journey from a school nurse to a mental health nurse; - creation of appropriate developments in the e-school health information system, where a standardized assessment tool is used in the process of early detection and assistance of school students with mental health problems; - increasing the competence of school nurses to identify and assess mental health problems and to teach students self-help and coping skills. The assessment of students` mental health based on the Likert scale and the corresponding algorithm makes it possible to identify students' psychosocial abnormalities more objectively and, consequently, to make a decision on the need for further assistance. Results of the activities: - school nurses have a common tool for assessing students' mental health, which allows integration between different IT systems; - mental health nurse service is available to all Tallinn schoolchildren (54,000); - use of a mental health nurse in school health care reduces the excessive burden on psychiatrists and clinical psychologists; - adolescents' mental health awareness and ability to help themselves has increased. Conclusions Improving the skills of school nurses and the involvment of mental health nurses in school health care will increase the professionality of the primary care sector and leaves time for psychiatrists and clinical psychologists to provide mental health care where it is most needed.

Introduction: Examination for enrollment in school is mandatory in Croatia for all children 6 years old by April 1 of the current year. The purpose is to assess the psychophysical development of the child to enable timely elimination of difficulties and rehabilitation. After the review school committee of four members obligatory including school doctor, the decision to postpone enrollment is made at the local level. Objective: To determine the reasons and outcomes of delaying school enrollment from the school year 2013/2014. to 2021/2022 Respondents and methods: All 1475 school-age children who were examined during nine years in two Zagreb elementary schools. Data collected from the records and routine reports of the enrollment committee were analyzed by descriptive statistics methods. Results: Out of 1475 reviewed children (49% of girls): 146 children (9.9%), 12.4% of boys (93/752) and 7.3% of girls (53/723) were postponed from school enrollment. The percentage of delayed boys ranged from 7.5% to 22.8% and girls from 3.3% to 11.1%, only in two years were higher in girls. Boys have a higher number of difficulties than girls: every fourth boy had two, three and four 51% difficulties and one 2%. Girls with one difficulty was 11%, 36% have two and 38% have three and four. The most common difficulties are in the specter of language-speech-voice communication and learning and it is represented by at least one in 74% of boys and in 79% of girls. 51% of boys and 55% of girls, 5 girls and 15 boys have psychomotor and/or cognitive development difficulty. 65% of boys and 75% of girls were in the youngest enrollment group. After a next year/during schooling re-examination 26/93 delayed boys and 14/53 girls continued according to the regular program with individualization 18 boys and 9 girls, according to the adapted program 2 boys and 3 girls, according to the special program 6 boys and 2 girls. Conclusion: The number of delays has increased with more boys than girls in 7/9 years. Boys have a higher average number and severity of difficulties than girls. Many children will be ready next year.

Uvod: Zdravstvena zaštita studenta u Hrvatskoj se do 2001. godine provodila u okviru službi školske medicine, prvenstveno u Zagrebu, Rijeci, Splitu i Osijeku i drugim većim sveučilišnim središtima. Razdvajanjem preventivne i kurativne zaštite i privatizacijom tadašnjih studentskih ambulanti, u nadležnosti školske medicine ostale su preventivne i specifične mjere zdravstvene zaštite redovitih studenta. Rasprava: Sadašnji ustroj školske i sveučilišne medicine omogućio je nadležnost nad fakultetima (veleučilištima) i imenovanje nadležnih školskih timova za provedbu preventivno-odgojnih i specifičnih mjera za studente, ali bez (na žalost) mogućnosti kurativne zdravstvene zaštite. U Hrvatskoj imamo oko 155000 studenta, većinom u velikim sveučilišnim centrima, što znači da veći broj studenta živi izvan mjesta gdje su im izabrani liječnici. Za vrijeme epidemije Covid-19 došle su do izražaja poteškoće koje su proizašle iz postojećeg modela zdravstvene zaštite. Višekratno smo kao struka predlagali, uz svesrdnu podršku studenata, model u kojem bi pri Medicinskim fakultetima trebali organizirati ambulante za zdravstvenu zaštitu studenata s mogućnošću pružanja i kurativne zdravstvene zaštite. Ove ambulante ili centri za zdravstvenu zaštitu bi osiguravali (npr. Stomatološki fakultet) skrb o oralnom zdravlju studenta, programe tjelovježbe, uključujući programe za osobe s invaliditetom (npr. Kineziološki fakultet ), psihološku potporu (npr. Studij psihologije). Podržavali smo da se pri sastavnicama organizira rad savjetovališta obzirom na specifičnosti pojedinih studija, kao i rad ureda za studente pri sveučilištima, prije svega radi sveobuhvatnog informiranja studenata što im sve pruža Sveučilište i njegove sastavnice od smještaja, akademskog, karijernog, psihološkog savjetovanja i informiranje, podrške podzastupljenim i ranjivim skupinama studenata, studentima s poteškoćama u učenju, invalidnošću i zdravstvenoj zaštiti. Na Simpoziju „Zdravstvena zaštita studenata u RH u trećem tisućljeću“ u Rijeci 2008. zaključili smo: 1. u postojećim kampusima/fakultetima osigurati prostor i opremu za ambulante; 2. Dogovoriti model financiranja s HZZO. Kako bi se svim studentima osigurala primjerena zdravstvena zaštita, osobito u slučaju akutnih oboljenja, hitnosti, liječenja radi sprečavanja širenja zaraznih bolesti; 3. Ambulante za studente pri fakultetima/kampusima uobičajene su u svijetu i dio su djelatnosti školske i sveučilišne medicine. Zaključak: Zašto nismo do sada uspjeli? Dio odgovora je u poznavanju specifičnosti organizacije i provedbe zdravstvene zaštite studenata, načinu financiranja i zajedničkom djelovanju obrazovanja, zdravstvo, struka i studenti.

Introduction According to World Health Organization ''Sexual health is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity.'' The average age for first sexual relations is 18.4 years. In Croatia the average age is 17.3 years. The aim of this study is to determine sexual activities among students at the University of Split. We will be comparing three colleges; Philosophy, Art Academy and Catholic Theology, in the academic year 2021/2022. Discussion Data for the research is collected from the voluntary survey in School Medicine Clinic. 135 students, 40 (30%) males and 95 (70%) females were interviewed through the use of a 7-item questionnaire related to sexual activities. The hypothesis is that the most used contraceptive methods are condoms, oral contraceptives and ‘’pull-out method’. We expect that male students begin sexual relationships at a younger age than females, and have more partners in one year. Also, we expect higher sexual activities among Art Academy and Philosophy students, then among students from Catholic Theology college.

AIM: Physical activity organized in schools as Physical education (PE) promotes healthy habits of exercise. Teaching content and methodologically appropriate PE provides an opportunity for all students to gain benefit of exercise. The aim of this paper was to determine the number, type, forms and medical conditions for the exemption from PE among primary and secondary school students in the school year 2017/18. in Zagreb County. Materials and methods: Study included all students (N=31890) from 49 primary (N=25720), and 13 secondary schools (N=6170) in Zagreb County, in 2017/18. Data were collected from medical documentation of 11 School Health Service of the Zagreb County Institute of Public Health, and included: sex, grade, school, diagnosis, and medical certificate by period (permanent or temporary exemption) and by type (exemption of a part or all activities). Data were analyzed by descriptive statistics at the significance level of P <0.05. Results: Out of total number of students, 1.76% had adjustment or exemption from PE, significantly more in secondary schools compared to primary schools (3.76% vs. 1.28%; P<0.001), and significantly more girls than boys in secondary schools (2.7% vs 1.1%; P<0.001). The highest number of issued certificate in primary schools was exemption from part of the activities (57.1%), while in secondary schools it was exemption from all activities (57.8%). Most certificates in primary and secondary schools were issued for permanent exemption of a part of the activities (46.2% and 39.2%, respectively). The most common diagnoses of issued certificates for PE exemption in primary and secondary schools were from the group of Diseases of the musculoskeletal system and connective tissue (23.9%), Injury, poisoning and certain other consequences of external causes (21.0%), Diseases of the respiratory system (13.2%), and Diseases of the nervous system (8.7%). Conclusion: Results showed that small number of students had exemption of PE, but most of certificates in secondary schools were exemptions of all activities. Physical activity is a crucial for healthy life, physical, social, and mental, and it is important to include every students in PE in line with his ability.

Uvod: Temeljna svrha liječničkog pregleda prije upisa u školu je procjena psihofizičkih sposobnosti djeteta. Odgodom upisa želi se, kad je moguće, otkloniti teškoće koje ima dijete i omogućiti, kroz odgovarajuću pripremu ili rehabilitaciju, uspješnije školovanje. Cilj: Procijeniti učestalost i razloge odgoda u prvi razred djece iz osnovnih škola sjeverozapadnog dijela Varaždinske županije u razdoblju od četiri školske godine (šk.god.), od 2017./2018. do 2020./2021. Ispitanici i metode: Istraživanjem su obuhvaćena sva djeca koja su odgođena od upisa u školu, a bili su obveznici za upis u prvi razred, iz sedam osnovnih škola sjeverozapadnog dijela Varaždinske županije u razdoblju od šk. god. 2017./2018. do 2010./2021. Podaci su prikupljeni iz medicinske dokumentacije učenika i obrađeni metodama deskriptive statistike. Rezultati: U razdoblju od šk.god. 2017./2018. do 2020./2021. odgođeno je od upisa u školu 59 djece, 46 dječaka (78%) i 13 djevojčica (22%). Odgođeno je od upisa 12 djece šk. god. 2017./2018., 13 šk.god. 2018./2019., 15 šk.god. 2019./2020. i 19 šk.god. 2020./2021. U četiri promatrana razdoblja specifični poremećaj izgovora (F80.0) utvrđen je u 34 % djece (20/59). Ovaj poremećaj najčešće je bio udružen s izostankom očekivanog normalnog fiziološkog razvoja (R62.9) i utvrđen je u 17 djece od 59 odgođenih (29%). Poremećaj razvoja govora i jezika (F80 i F80.9) udružen s drugim smetnjama utvrđen je u 6 djece (10%), a udružen s izostankom očekivanoga normalnog fiziološkog razvoja (R62.9) u 10 djece (17%). Trinaestoro djece (22%) imalo je veće teškoće u psihofizičkom razvoju, kao što su Down sy, cerebralna paraliza, pervazivni poremećaj i druge. Veće teškoće u psihofizičkom razvoju imalo je svako četvrto dijete, 3/12, šk.god 2017./2018. i, 3/13, šk.god 2018./2019., a svako peto dijete, 3/15, šk.god. 2019./2020. i, 4/19, šk.god. 2020./2021. Zaključak: U razdoblju od 2017. do 2021. godine rastao je broj djece koja su odgođena od upisa u prvi razred osnovne škole i u svim šk.god. bilo je više odgođenih dječaka nego djevojčica, od 8:5 najmanje šk.god. 2018./2019. do najviše 13:2 šk.god. 2019./2020. Povećao se udio djece s lakšim i višestrukim lakšim teškoćama u odnosu na djecu s većim poteškoćama u razvoju.

Cilj istraživanja je procijeniti učestalost mentalnih poteškoća u učenika prvih razreda srednje škole primjenom YP-CORE upitnika s deset pitanja. Ispitanici i metode: Ispitivanjem su obuhvaćeni učenici prvih razreda srednje škole iz dvije srednje škole iz Varaždina i tri iz Ivanca. Podaci su prikupljeni tijekom redovitih sistematskih pregleda 2020.godine. Učenici su u prikladnim uvjetima individualno ispunjavali upitnik i nakon toga je liječnik sa svakim učenikom proveo savjetovanje sukladno rezultatima testa. Podaci su obrađeni metodama deskriptivne statistike. Rezultati: U istraživanje je uključeno 482 učenika iz pet srednjih škola, od toga 279 (57,9%) mladića i 203 (42,1%) djevojaka. U 8,1% (39/482) učenika je utvrđen rizik temeljem rezultata na YP-CORE upitniku, od toga u 4,7% (13/279) mladića i 12,8% (26/203) djevojaka. Kod svih učenika u riziku učinjena je intervencija: savjetovanje u školskoj medicini, sa stručnim suradnikom škole ili upućivanje dalje na preglede. Ovaj probir na mentalno zdravlje doprinio je kvaliteti sistematskog pregleda i omogućio bolje upoznavanje sa učenicima. Poteškoće u provedbi ovog programa: nesuradnja roditelja u pojedinom slučaju, posebice kad roditelj smatra da nema potrebe za daljnjom intervencijom, usprkos utvrđenom riziku; produljenje vremena trajanja pregleda kada se utvrdi učenik sa rizikom; organizacijske poteškoće, kao uskladiti i unaprijediti suradnju sa stručnom službom škole te drugim profesionalcima (psiholozima, psihijatrima). Zaključak: Obzirom na dobivene rezultate i učestalost rizika u YP-CORE upitniku, u gotovo 13 % djevojaka i 4,7% mladića, prepoznata je važnost rane intervencije u području mentalnog zdravlja učenika.

Aims. In school health care, follow-up of growth can detect pathological growth but positive feedback of suitable growth for the individual child is also important. Variation in growth and development of healthy children is considerably. Screening for abnormal growth velocity catches children with an acquired illness earlier than if the screening is only done for abnormal size. There is not much knowledge of how unusually growing healthy children grow because few children grow at the extreme centiles. We investigated how assessing previous growth, simultaneous growth in height and weight, and parental heights describes growth of unusually growing healthy children. Materials and methods. Longitudinal growth data for healthy Finnish children is available for two cohorts: 1096 children born in 1954–1962 and followed from birth to approximately age 19.0 and 1209 children born in 1968–1972 followed to age 12.5. As an example of pathological growth to be distinguished from healthy growth in health surveillance, we used growth before the start of treatment for hyperthyroidism in 41 children with autoimmune hyperthyroidism. The patients were born in 1953–1983. School children were measured often, at least once a year in that time-period. Non-parametric quantile regression methods — that do not rely on Gaussian assumption — were applied to compare growth in patients and in healthy children. Results. Screening limits for abnormal growth velocity were set to below 0.5 centile or above 99.5 centile. When screening was performed for height and for weight-for-height, half yearly between 2 and 14 years, 23% of the girls and 21% of the boys were screened at least once. Although 71% of the patients had a clear upward bend in height SDS curve or a downward bend in weight-for-height curve, 24% of them were screened for abnormal growth velocity between birth and start of therapy. When applying quantile regression and incorporating prior growth and parental heights as covariates, screening was more efficient. Conclusion. Distinguishing pathological growth from unusual but healthy growth is difficult. Using non-parametric methods and incorporating various covariates that explain growth gives information on how exceptionally growing but healthy children grow.

Introduction and aim: Switch to online education during the COVID-19 pandemic had strong impact on medical students’ who, in a very short period, had to face numerous challenges. This kind of education could have negative influence on students’ health if they were not able to adapt to sudden change. The aim of this paper was to examine impact of online education on medical students’ health. Methods: Web of Science Core Collection database was searched and 25 articles in English were identified during 2020 and 2021. Those articles discussed impact of online education on medical students’ health during the pandemic. Results: Research showed that during the Covid-19 pandemic students had to face increased stress of mild to high intensity, and mild level of anxiety, which was partially influenced by studying at home (lack of motivation and concentration), poor academic self-organisation, lack of experience with online studying and technical difficulties (bad equipment quality and bad Internet connectivity). Other important factors were physical distance from colleagues (lack of social life), lack of physical activity, sleep disorder, as well as physical and mental fatigue. Using smartphones and computers in awkward positions causes frequent neck and back pain. Spending too much time in front of the computer leads to high prevalence of headaches. Conclusion: Online education during the COVID-19 pandemic has set new challenges not only in educational process and social interaction, but also on mental and physical health of medical students. Due to the uncertain course of the pandemic, and possibility of new ones emerging, it is necessary to reconcile academic learning opportunities with social, emotional and behavioral support.

Introduction and aim Sleep disorders are a common problem among children and may be associated with impaired school performance and behavioural problems. The aim of this study was to investigate sleep hygiene in children beginning school. Materials and Methods Cross sectional study was conducted on sample of children beginning school (N=400, 46.8% girls) 2022./23. Before entering educational system, all children are examined by school doctor. Parents signed informed consent and fill anonymous questionnaire about child’s sleeping hygiene. For the purpose of this paper, we analysed data obtained in two doctor offices in Zagreb from March 1st to April 30th 2022 (N=196, 45.4% girls). Data were analysed using descriptive statistics. Results Boys and girls sleep 10 hours during the night. Activities to help fall asleep were used by 57% boys and 64% girls, mostly reading stories (62.3% boys, 61.4% girls), one boy used bottle. Most boys (55.1%) and girls (53.9%) fall asleep on their own and process goes easily (92.5% boys, 89.9% girls). Alone in bed sleep 72.3% boys and 60.7% girls. Peacefully sleep 81.3% boys and 79.8% girls. Sound phenomena during sleep produced 36.5% boys and 38.2% girls. Among boys, the most common were teeth grinding, snoring, and speaking (two boys had apnea) and among girls, speaking, snoring and teeth grinding. The most common emotional disorder were fears, in girls 40.5% in boys 28.9%. Behavioural disorders were reported in 22.4% boys and 19.1% girls, the most common was explosive outbursts of anger. Before going to bed, 71% of boys and 70% of girls used the screen device. Conclusion The results showed the presence of not healthy sleeping habits among children school beginners, emphasising use of screen devices near bedtime. The results implies necessity of further investigation, monitoring and improving of sleep hygiene in school children.

Background: Risk sexual behaviour in adolescence could have immediate and long-term consequences, and university students are at increased risk. The aim of this study was to determine the trend of sexual behaviour among first year students at School of Medicine, University of Zagreb, Croatia. Methods: Retrospective study included first year medical students, from academic year 2008/2009 to 2018/2019. Data were collected by anonymous questionnaire each academic year, and analysed by descriptive (χ2 test, Fisher's exact test) and analytical statistics (simple linear regression model using the least squares method, t-test) with a significance level of α = 0.05. Results: Data analysis included a total of 3155 medical students (96.7%), 62.6% girls. The number of students who had sexual intercourse varied across generation from 47.9% in 2008/2009 to 42.5% in 2018/2019, with significant difference between 2011/2012 and 2016/2017 (49.6% vs 37.1%; P=0.004). The mean age of the first intercourse showed stable trend across generation, and ranges from 16.93±1.34 years in 2008/2009 to 17.23±1.12 years in 2018/2019. Mean number of sexual partners ranges from 1.76±1.42 in 2008/2009 to 2.00±2.54 in 2018/2019, without statistically significant difference among generations of students from the academic year 2008/2009 to 2018/2019. The highest number of sexually active students in all generations from 2008/2009 to 2018/2019 used contraception always, and showed stable trend across generations, without significant difference. Conclusion: Results showed stable trend of responsible sexual behaviour among first-year medical students in the eleven-year period. Further studies are needed in order to estimate risk behaviour among non-medical students.

Introduction Being overweight and obese is a risk factor for cardiovascular disease, diabetes and malignancies. The problem of overweight and obesity is widespread in all age groups. It is often present in several members of the same family. The National Health Development Plan of the Republic of Croatia 2021 - 2027 predicts the establishment of a new model of care for key health challenges such as cardiovascular, cerebrovascular and oncological diseases. It is planned to establish a network of health work sites, which will coordinate the activities of cardiovascular prevention, from primary to tertiary, and would include the population of school children up to 65 years of age. When conducting systematic examinations in the field of school and adolescent medicine, it is possible in case of need for intervention to recommend parents and children to visit a counselling service where the cooperation of public health and school medicine teams would cover the whole family. The approach to the problem of overweight and obesity in the family, including all members, strengthens the community, facilitates the adoption and maintenance of healthier eating habits and physical activity. Discussion Retrospective analysis of the routine data collected on systematic examination before enrolment in first grade of elementary school, already point out to the need of family approach to the problem of overweight and obesity. Subject in the study were school beginners in the school year 2015/16 (N = 769) aged 6 to 7.5 years. A retrospective analysis included 743 (coverage 96.62%) children (55.5% boys). Overweight were 7.8% boys and 9.4% girls. Obese were significantly more boys 9.9% than girls 3.9% (P = 0.016). Conclusion Through a network of counselling service for prevention and treatment of overweight and obesity in public health institutions, with an active population approach, individual assessment of cardiovascular risk would be enabled, according to internationally defined procedures / scorers and the main goal would be to modify individual risk in a positive direction. The direct providers of services within the national network of cardiovascular prevention would be, in addition to physicians, experts of other profiles.

FREQUENCY OF SEA FISH CONSUMPTION ON A WEEKLY BASIS IN CHILDREN AGED YEARS OVER A PERIOD OF 8 YEARS DEL VECHIO A.*, Špoljarić I. * * Teaching Institute for Public Health of Primorje-Gorski Kotar County, Rijeka, Croatia anja.delvechio@zzjzpgz.hr, ines.spoljaric@zzjzpgz.hr Introduction: The nutritional composition of sea fish is extremely important for the proper growth and development of the child's body. Given that Rijeka is a city near the sea, it is to be expected that children aged 6-7 have sea fish on the menu 1-2 times a week, as recommended for their age. Objective: To determine how many meals per week of sea fish have children aged 6-7 years and to determine whether there is a difference in the number of weekly meals of sea fish depending on whether they attend kindergarten or not. Materials and methods: The research was conducted by inspecting medical documentation and data provided by parents as part of a examination when enrolling in school. Taken from all 8 generations, 251 students of the elementary school "Vežica". Results: Out of 251 students, 2.8% do not eat fish at all, 69.7% have one fish meal per week, 23.5% have two fish meals per week. 90.8% attended kindergarten and 9.2% did not. Of those who attended kindergarten, most had one fish meal per week (71.5%) and 24.6% had two fish meals per week. 21.7% do not eat fish at all and did not attend kindergarten, 52.1% eat it once a week. Conclusion: Most children who attend kindergarten eat fish meal once per week in kindergarten. Of those who do not attend kindergarten, a fifth of them do not eat fish at all. It is necessary to work on promoting the importance of sea fish consumption in preschool and early school age, and to include parents and children in education.

Van der Born, C. Youth health care physician at GGD Kennemerland Haarlem The Netherlands cjpvdborn@ggdkennemerland.nl Aims: In 2016 the Dutch Food Centre has updated its dietary guidelines. One of the changes is the recommendation ‘more plant-based, less meat’. In this advice not only health aspects have been considered, but also aspects concerning the environment and sustainability. The aim of this study is to estimate to what extent youth health care professionals can advise in accordance with this guideline after a minimal implementation-intervention. And in addition, if there is a difference compared to professionals who haven’t been reached by the intervention. Materials and methods: The intervention was developed by following the steps of the protocol of Intervention Mapping [1]. The intervention consisted of a presentation for the youth health care professionals at GGD Kennemerland. It aimed at addressing change objectives in knowledge, attitude, social environment, and self-efficacy. About half a year after the intervention, the professionals were asked to fill in a questionnaire. With the help of the measurement instrument for determinants of innovations (MIDI) [2] it was evaluated to what extent the change objectives have been achieved. Results: The response rate was 72%. The research group consisted of 45 people, the control group of 19 people. The results of the research group were more favorable regarding the knowledge, the experienced social support, the descriptive norm and the perceived complexity. Conclusion: The minimal implementation-intervention seems to have several favorable results, especially regarding the knowledge. The attitude of the youth health care professionals towards ‘more plant-based, less meat’ seems to be moderately positive, regardless of the intervention. 1. Bartholomew LK , Parcel GS, Kok G. Intervention mapping: a process for developing theory- and evidence-based health education programs. Health Educ Behav.1998;25(5):545-63. doi: 10.1177/109019819802500502 2. Fleuren MAH, Paulussen TGWM, Van Dommelen P, Van Buuren S. Towards a measurement Instrument for determinants of innovations. International Journal for Quality in Health Care 2014;26(5),501-510. doi: 10.1093/intqhc/mzu060

Background and aim Mental health is essential part of well-being. Mental health problems could affect student's mental capability, attention, reliability, optimism, energy level and hindering academic performance and achievement. The aim of this study was to investigate mental health of first year medical students. Subjects and methods Cross-sectional study was conducted among first year medical students at University of Zagreb. Generation in academic year 2008/09 comprised 242 participants (70.7% female) and in 2018/19, 274 (62.2% female). Data was collecting using anonymous questionnaire. For the purpose of this study, we compared answers about mental health of two generations using descriptive statistics. Results Sense of apathy (m 5.7%, f 2%), feeling irritable (m 4.3%, f 3%), nervousness (m 8.6%, f 5%) and sleeping difficulties (m 1.4%, f <1%) were present daily more among male than female in generation 2008/08. In generation 2018/19, sense of apathy (F 14%, M 7%), feeling irritable (F 10%, M 4%), nervousness (F 11%, M 5%) and sleeping difficulties (F 5%, M 4%) were present more among female. Sleeping pills were used more often among male students in 2008/09 (m 4.4%, f 1%) and in 2018/19 more among female (F 4%, M 1%). Anti-anxiety medications were used more often among male students of both generations (m 2.9%, f 2%; M 6%, F 2%). Conclusion The results of this study showed presence and increase in daily mental health problems in later generation of medical students that may affect student’s ability to involve with their studies, make contacts and create the most of their university involvement. Results of the study implies necessity for mental health screening and increase of counselling and mental health service availability for students.

INTRODUCTION: Childhood and adolescence are crucial times for recognizing mental health problems. Everyday interaction at school allows teachers to observate students with behavioral and emotional problems and school success that may be sign of mental health problems. AIM: To establish teachers ' personal confidence and approach to students with mental health problems and their competence to provide support and help to these students MATERIALS AND METHODS: Anonymous survey of 60 primary school teachers from one primary school. The questions are divided into 4 parts: 1. general questions (age, gender, work experience); 2. personal confidence to talk to a student with a mental health problem; 3. type of an approach; 4. a personal abbility. RESULTS: Teachers - 30-39 years old have shown the most personal engagement to approach a student with a mental health problem. Teachers with -16-20 years of school work have had the most adequate approach. 72% of teachers said that their personal insecurity would make their approach more difficult. Almost the most teachers (88%) would check students' condition by talking to them. If the student doesn't want to talk, 53% of the teachers would let the student know that he/she can come to them whenever student is ready. To the question „What do you need to be more confident in approaching student“ 76% of them pointed out the importance of the education of students ' mental health. CONCLUSION: The school is perfect place to identify studnets' mental health problems . It is important to educate teachers about the students' mental health problems so that they feel more comfortable in approaching, supporting and helping students with mental health problems.

Introduction Mental health difficulties belong to special needs, such as developmental difficulties, disability and other medical conditions. Mental health difficulties could affect children’s functioning in family, in school and among friends. The aim of this paper was to analyse education of children with mental health difficulties in Croatian educational system. Discussion Children with mental health disorders are candidates for education according to Regulation on Primary and Secondary Education of Students with Difficulties, depending on their individual’s capacities and capabilities, Suitable education program could be applied as complete inclusion, incomplete inclusion, in special classes in regular school or in special school. If necessary, students could be supported by personal assistant/professional communication mediator. Prevalence of disability in Croatia in 2019 was 12.4% (N=511281, 60% male). Mental health disorders 26.1%, intellectual disability 5.4% and autism in 0.5% were reason of disability. About 66% of people with disabilities, according to available data on education, have not completed primary school or have only primary education. About 25% have a high school diploma while 3% have a university degree or higher education. Special education was recorded in 6% of persons with disabilities. In age group 0-19, prevalence of disability was 5.5% (N=45314, 62.8% boys). Appropriate form of education had 55537 students in primary and secondary school (64% boys). Impairments in speech-language communication and specific learning difficulties are the most common specified causes that determine the need for an appropriate form of education. Regular program with the adjustment of content and individualized procedures was the most common form of its specified implementation. Conclusion The analysis showed the significance of inter-sectoral cooperation - health, education and social, in care and upkeep of children with mental health disorders. Alongside the therapy, it is needed to ensure preservation and improvement of cognitive, social, emotional and physical needs.

Introduction and goal: The COVID-19 pandemic has set challenges in classroom teaching and online teaching, especially for students with learning difficulties. The aim of this paper was to compare the number of students with learning difficulties educational programs in secondary schools in the City of Samobor, in the school year 2017/18. and 2021/22. Participants and methods: We analyzed the medical documentation of students with learning difficulties educational programs of all secondary schools in the City of Samobor through the School Medicine Service of the Zagreb County Institute of Public Health Data were entered into a Microsoft Excel file and analyzed by descriptive statistics methods, and presented at a significance level of P <0.05. Results: From the total number of students in secondary schools in Samobor, school year 2017/18. (N = 1145) there were 89 (7.77%) students with learning difficulties educational programs, and in 2012/22. (N = 1238) significantly more, 167 of them (13.49%; P <0.001). In both school years, there were significantly more boys with learning difficulties educational programs compared to girls, 2017/18. 67.4% vs 32.6%; P = 0.01 and 2021/22. 64.7% vs 35.3%; P = 0.01. The largest number of students with learning difficulties educational programs in both school years were educated through individualized education regular program (69.7% and 73.1%) and through the regular program with content adjustment (29.2% and 24.6% of students). In both observed school years, most students with learning disabilities were in three-year vocational school (76.4% and 62.9%), followed by four-year vocational school (21.3% and 31.1%), while the least were in high school (2.2% and 6.0%). Conclusion: The results showed a significant increase in the number of students with learning difficulties educational programs in secondary schools in Samobor, in the school year 2021/22. compared to 2017/18 which can be linked to current multiple life and schooling crisis issues. These results indicate an increased need for care and learning assistance for students with learning difficulties, with an emphasis on early detection, intervention and on time support and treatment of existing learning difficulties.

Introduction: Federal law in Germany requires a physical examination and developmental assessment for every child before school entry. Due to general distancing rules and social contact restrictions in addition to reduced attendance in kindergarten, pre-schoolers had less possibilities of interaction with other children and less access to early childhood support in kindergarten and other facilities. The consequences of the pandemic can be seen in the school entry data in the Hanover region. In addition a voluntary parent survey was conducted. Method: School entry data of the Hanover Region of the children starting school in the summer of 2019 are compared with the results of the corresponding cohort of 2021. A voluntary parent survey is conducted since 2020 concerning daily activities and wellbeing of children and their families during the pandemic. Results: The data of the school entry examination of the 2021 cohort show an increase of overweight or obesity (14, 4 %) to the cohort of 2019 (10,4 %). The rise of overweight and obesity was especially marked in socially disadvantaged children. There is also a shift from mild to severe language deficiencies between 2019 and 2021 (12,2 % severe language deficiencies in 2019, 15,1% in 2021). More children receive speech therapy in 2021. Additionally an increase of media consumption and a decrease in general sport activities and swimming can be noted. In the voluntary survey, taken during the COVID-19 pandemic, parents observed an increase of sadness and rage attacks in their children. Children more often had sleeping disorders, stomach-ache, headache or loss of appetite. The longer the COVID-19 pandemic lasted, the higher the share of effected children became. Discussion: Mandatory school entry examinations are valuable in detecting special needs in individual children. The results of the school entry examinations deliver precious insights between the cohorts especially during unforeseen events like the COVID-19 pandemic. Children´s health and developmental possibilities had suffered during the COVID-19 pandemic. These findings are a strong call for action. Prevention programs targeting at more sports, healthier nutrition, better language development and less media consumption should be started for preschool children, preferably focussing socially disadvantaged children.

Introduction: The physiologic features of vitamin D (VD) are primarily related to the functions of the musculoskeletal system, also plays an important role in the pathophysiology of various diseases. Living in the Mediterranean area with abundant sunshine and a Mediterranean diet should be a positive predictor of regular serum VD (25 (OH)D) levels. Aim: To determine the levels of VD in preschool children in Split-Dalmatia County (SDC) and the association between VD levels and the Mediterranean diet. Methods: The study included 260 subjects aged 5-6 years whose intake of serum VD levels was measured in the area of SDC, the relationship VD levels with the principles of the MD via KIDMED Index calculated on the basis of KIDMED questionnaire. Results: The study included 50.7% boys and 49.3% girls aged 5-6 years. Sufficient levels for VD were reported only in 17% of boys and 8% of girls (χ2: 9.97, p <0.02). Based on the KIDMED questionnaire, the most significant difference between girls and boys was found for eating fresh and cooked vegetables once a day (65% and 50% , Chi-square: 6.03, p = 0.01), for eating another meal of fruit every day (48% and 35%, Chi-square: 4.21, p = 0.04) and consumption of legumes (15% and 7%, Chi-square: 4.72, p = 0.03). Higher levels of vitamin D were found in children with KIDMED index greater than 7 and thus better adhered to the principles of the Mediterranean diet, Mann Witheney, P = 0.001. Breakfast skipping was reported by 4% of girls and 3% of boys, while 48% of girls and 35% of boys consumed more fruit meals, and 77% of girls and 76% of boys consumed olive oil. Using the Bayesian model selection, it was found that more frequent consumption of fruit meals and olive oil is a positive factor, while skipping breakfast is a negative factor in vitamin D status. Conclusion: VD deficiency can be prevented and easily treated by promoting dietary guidelines, physical activity, reasonable sun exposure and enriching food by adding VD with national, cultural and dietary habits taken into consideration.

Introduction and goal: Students with psychophysical difficulties preventing them from participating in equal educational process with other students are offered learning difficulties educational programs at time of enrolling 1st grade of primary school or anytime during education. The goal was to analyze number of students with learning difficulties educational programs in regular classes in primary and secondary schools in Samobor and Sveta Nedelja. Participants and methods: We analyzed medical documentation of students with learning difficulties educational programs of all primary and secondary schools in Samobor and Sveta Nedjelja through School Medicine Service. Data were analyzed by descriptive statistics methods, and presented at a significance level of P <0.05. Results: From total number of students in school year 2021/22. in primary schools (N = 4456) there were 347 (7.8%) and in secondary schools (N=1238) 167 (13,49%) students with learning difficulties educational programs. In both primary and secondary schools significantly more boys than girls (66.6% vs. 33.4%, P <0.001; and 64,7% vs 35,3%; P=0.01). Most students with learning difficulties educational programs in both primary and secondary school were educated through individualized education regular program (79.0% and 73,1%), followed by the regular program with content adjustment (21,1% students in primary and 24,6% in secondary school). Most students had speech-language, communication and specific learning difficulties (46.7% in primary, 54,5% in secondary), followed by a combination of behavioral and mental health disorders (21% in primary, 12,6% in secondary) and physical health disorders (13.5% in primary, 13,8% in secondary). The largest number of students were offered learning difficulties educational programs in first grade (21.0%), followed by second and third grade (19.6%), fourth grade (15,3%), fifth grade (10,7%). Conclusion: Significant number of students already enter the school with learning difficulties educational program or are offered one in early years of education, which is a good sign of early detection of difficulties and providing adequate assistance and successful schooling. Regarding language-speech, communication difficulties and mental health disorders are the most common difficulties in students with learning educational programs, it is necessary to strengthen diagnosis and interventions of these disorders in preschool age.

Ovaj slučaj je važan radi naglaska o pristupačnost skrbi liječnika školske medicine djeci s teškim psihomotornim zaostajanjem. Na svu sreću, radi se o malenom postotku djece. Ovaj prikaz slučaja ima jasnu poruku da se omogući zadovoljavajuća skrb takvoj djeci. Radi prostorne nepristupačnosti ambulante i epidemiološke situacije vezan uz Covid-19 pandemiju, nije bilo moguće pregledati dijete u ambulanti radi upisa u prvi razred, nego je otac dostavio nalaze i pokazao slike teško bolesnog djeteta na mobitelu. Iz razgovora s ocem i uvidom u opsežnu medicinsku dokumentaciju vidljivo je da je dječak u multidisciplinarnom praćenju radi teškog psihomotornog zaostajanja, epileptičke encefalopatije, kongenitalne hipotonije, razvojnih anomalija mozga, smetnji ventilacije, učestalih respiratornih infekcija i osteoporoze. Živi u cjelovitoj obitelji kao najmlađe od četvero djece. Dječak je u potpunosti ovisan o pomoći drugih, odnosno majke koja ga hrani, održava higijenu, daje medikamentoznu terapiju, zbrinjava PEG, mijenja kanilu traheostome jednom mjesečno i redovito ju aspirira. Otac financijski brine o obitelji i komplementira u drugim potrebama za dječaka. Trudnoća praćena radi gestacijskog dijabetesa. Porod terminski s Apgarom 8/8; loše boje i hipotoničan,te opseg glave na 5.centili. Liječen na neonatologiji radi kongenitalne upale pluća. U dobi 1 mjeseca, radi suspektne kongenitalne CMV infekcije, obradom utvrđene: polimikrogirija, kalcifikacija periventrikularno i u bazalnim ganglijima, hipotrofija corpus calosuma. U dobi 2 mjeseca hospitaliziran radi sumnje na cerebralni napad. Uz dotad prisutne dijagnoze utvrđene još Primarna mikrocefalija, Kongenitalna hipotonija, Dizmorfija lica i Cerebralni napad u afebrilnom stanju. U dobi 8 mjeseci, hospitaliziran zbog teških recidivirajućih epileptičkih napada te utvrđeno progresivno propadanje duboke bijele tvari i ventikulomegalija. U dobi 9 mjeseci utvrđena obostrana slabovidnost, a s jednom godinom perceptivna obostrana nagluhost. 7/2016. genetičar utvrdio deleciju broja kopija 7q31.1, koja zahvaća IMMP2L gen, i uzrokuje neurorazvojni poremećaj. 9/2016. dijagnosticirani retinirani testisa obostrano, koji nisu operirani radi komorbiditeta. 10/2017. verificirana subluksacija humeroskapularnog zgloba desno sa stanjem po frakturi humerusa, luksacija desnog kuka i teška osteoporoza, te uvedena terapija bifosfonatima. Mišljenje Povjerenstva škole je da se odgodi upis šk god 2021./22.,a roditelji savjetovani u vezi traženja budućih privremenih odgoda školovanja. Potrebno zalaganje za omogućiti prostornu pristupačnost djeci s invaliditetom te, s pravne strane, trajna odgoda upisa.

Introduction: During COVID-19 pandemic we faced many challenges, including challenges in teaching, online classes and problems with learning for all school children, especially for children with disabilities. Our experience shows an increase in the number of students with learning difficulties and an increase in the number of students who were entitled to appropriate forms of education during COVID-19 pandemic. The aim of this paper was to compare the number of students with appropriate forms of education in primary schools in the City of Samobor in the school years 2017/18 and 2021/22. Materials and methods: We performed retrospective analysis of medical documentation of students with appropriate forms of education of all primary schools in the City of Samobor. Results: From the total number of students in primary schools in Samobor, in school year 2017/18 there were 277 of 4369 (6.34%) students with an appropriate form of education, while in 2021/22 there were significantly more students with an appropriate form of education, 347 of 4472 (7.76%). After the statistical analysis was done, it was shown that in the period of 4 years, the number of primary school students attending classes with the appropriate form of education increased significantly (X2 = 6,786, p <0.01, df = 1). In both school years, significantly more boys had an appropriate form of education compared to girls. Also, the largest number of students with disabilities were educated according to the regular program with individualized procedures. Conclusion: The results showed that in 4 years, from the school year 2017/2018 until 2021/2022, there was a significant increase in the number of students with appropriate forms of education in primary schools in Samobor. Stressful living and schooling conditions, primarily caused by the COVID-19 pandemic, can be related to presented results.

AIMS: Systematically addressing the healthcare necessities of the population based on the analyses of the state of health is a good basis for healthy development of children and adolescents. MATERIALS AND METHODES: To discovered the influence of epidemics on School children and adolescent’s health we compared the data from a base of National Institute of Public Health, collected at regular preventive health checks, the data from Sports Education Card and the HBSC surveys. RESULTS: We noted significant improvements regarding obesity and disorders of the locomotor system in the years leading up to the epidemic. During the epidemic, however, we noted a distinct increase in the levels of obesity, alongside a deterioration of locomotory efficacy in schoolchildren and youths. A recently published study HBSC 2020 revealed that predisposition towards unhealthy dietary habits, mental disorders, a poor body image, and high-risk behaviour is higher in youths that come from families with a lower self-assessment of prosperity and non-traditional families. CONCLUSIONS: The findings set numerous challenges regarding preventive and curative healthcare, which need to be addressed as soon as possible. Ensuring a healthy lifestyle with a family-centred approach, and the creation of mental health centres for children and youths are both important systemic measures that have already been put into practice in Slovenia. The universal mental health screening should be included in battery of regular preventive health checks to reach most vulnerable children.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted everyday life. In oreder to prevent the spread of COVID-19 infection, Croatian government urged schools to close for almost 2 months in 2020, and during 2020 and 2021 urged schools to put classes to quarantine if there were infected students in class. I wanted to compare the trends in weight changes in children during the pandemic period and prepandemic period to investigate whether and how reducing movement and outdoor play during a pandemic affected the BMI (the body mass index). Materials and methods: In this retrospective study I compared two groups of children which visited ambulant od School and adolescent medicine Lucac in Split. The children underwent a systematic examination, which is mandatory in Croatia before starting school. Prepandemic group included 194 children and children were examined in 2019. Pandemic group included 178 children and children were examined in 2021. The body mass index (BMI) changes were analyzed by descriptive statistics. Results: In prepandemic groupe there were 100 boys and 94 girls. Average BMI of boys was 16,18. Average BMI of girls was 16,14. In pandemic group there were 82 boys with average BMI 16,17 and 96 girls with average BMI 15,73. Conclusions: The COVID-19-related lockdown and measures did not resulted in significant weight gain in children. It is possible that there was no significant increase in BMI because the children were more oriented towards food cooked at home and consumed less bakery products and fast food which should certainly be further explored. The sample of the surveyed population should certainly be increased

Dobra komunikacija u zdravstvenom timu je preduvjet i osnova kvalitetne zdravstvene skrbi. U edukaciji i liječnika i sestara/tehničara se posvećuje pažnja i educira ih se vještinama komunikacije s pacijentima. Na žalost, o vještini komunikacije između liječnika i sestre/tehničara koja je iznimno je važna za krajnji rezultat rada odnosno kvalitetno pružanja usluge ili skrbi o pacijentu studenti ne uče. Tek kad se zateknemo u rutinskom radu postanemo svjesni koliko je važno znati i imati i te vještine. Komunikacija je proces, stvaranje značenja i prijenos informacija ili poruka. (Miller) Ona je neizbježna, nepovratna i neponovljiva i kao takva je iznimno važna za jasnu raspodjelu rada. Za stvaranje dobrog radnog ozračja koje olakšava protok informacija i jasnoću odnosa potrebne su vještine vođenja dijaloga i rješavanja sukoba kroz dijalog. Što je čija odgovornost i kako je prebacujemo i ne preuzimamo te kako koristimo moć u odnosu sa suradnicima biti će prezentirano kroz interaktivne vježbe. Osvijestiti ćemo verbalne i neverbalne poruke koje često nesvjesno šaljemo i kako ih druga strana tumači.

The closure of schools and workplaces during the COVID-19 pandemic made us study and work remotely from our homes. This seemingly convenient solution increased our dependency on our screens. In addition to hours of schoolwork or meetings daily, entertainment and keeping in touch with our family and friends mainly took place online. This resulted in sitting in front of our computers without noticing that many hours have passed without moving an inch. Conducted health checkups were based on Students’ Health Behaviour questionnaire approved by the Tallinn School Health Foundation. In the academic year of 2021/2022 the results of students health chekups at Tallinn 21st School indicate that increased screeen time has had negative effects on their mental and physical health. Average daily screen time on schooldays varied from 2-3 hours to 4-5 hours. 28% of students admitted being online for 6 and more hours. Frequent findings include impaired vision, poor eating habits, bad posture, less sleep, decrease in phisycal activity and weight gain. A long period of socialicing online has resulted in communication difficulties – students struggle with self-expression and lack to be consistent and attentive during the conversation. In conclusion, for the sake of our well-being it is important to maintain personal routines that support positive and healthy habits.

Pandemija proteklih godina obilježena karantenom i socijalnom izolacijom, online nastavom, gubitkom dnevne strukture, sportskih i zabavnih sadržaja, te opetovanim samoizolacijama bila je kontinuirani izvor stresa i izazov za prilagođavanje mladih u čemu ih je značajan broj narušenog mentalnog zdravlja. Problemi mentalnog zdravlja su najstigmatiziraniji zbog predrasuda utemeljenih na nedovoljnom znanju, a što je prepreka traženju pomoći. Služba za mentalno zdravlje i prevenciju ovisnosti zavoda za javno zdravstvo je na primarnoj razini mjesto prevencije, rane detekcije i ranih intervencija te početka liječenja problema mentalnog zdravlja mladih uz rad prema standardiziranim protokolima. Prikazani su podatci iz medicinske dokumentacije osoba od 18 - 25 godina Odjela za mentalno zdravlje djece i mladih za prije pandemijski i pandemijski period od 2017.- 2021. U dijagnostici su korišteni MKB-10 kriteriji, HAM-A i BDI II upitnici probira, psihologijsko testiranje, test urina na metabolite droga. Od ukupno 1095 osoba do 25 godina, 58% je bilo djevojaka (ranije 39%), a 75% je bilo u dobnoj skupini od 18 – 25 godina. 60% je ušlo u liječenje samoinicijativno ili na poticaj obitelj (ranije 51%), 25% od zdravstvenih i obrazovnih ustanova (ranije 13%) i 15% na poticaj suda/CZSS (ranije 39%). Prvih psihijatrijskih pregleda bilo je 547 (ranije 1199) od čega 13% depresivnih (ranije 3%) i 39% anksioznih (ranije 24%) uz 30% porast depresivnih i 50% anksioznih osoba od 18 - 25 godina. Mentalno zdravlje mladih uslijed pandemije je promijenjenih trendova uz porast anksioznih i depresivnih stanja što ide u prilog potrebe rane detekcije i intervencija. Podizanje razine znanja uz antistigma programe, jačanje otpornosti mladih i osnaživanje roditelja te jačanje kompetencija obrazovnih djelatnika načini su dobre prevencije i značajan čimbenik oporavka.

The pandemic of recent years marked by quarantine and social isolation, online teaching, loss of daily structure and repeated self-isolations has been a continuous source of stress and a challenge for minors adaptation. Mental health problems are the most stigmatized due to prejudices based on insufficient knowledge, which is an obstacle to seeking help. Public health institutes are the places of prevention, early detection, early interventions and the beginning of treatment. We will present data from the medical documentation of minors of the Department of Mental Health of Children and Youth for the pre-pandemic and pandemic period. In diagnostics we use ICD10 criteria, in assessing the severity of the clinical picture BDI II and HAM-A questionnaires, and for parental assessment Vanderbilt questionnaire. Out of a total of 1,095 people under the age of 25, 58% were girls (previously 39%) and 25% were under the age of 18. 60% entered treatment on their own initiative or at the initiative of families (prev. 51%), 25% health/educational institution (prev. 13%) and 15% court/CSW (prev. 39%). The first psychiatric examinations were 547 (prev. 1199), of which 13% depressed (prev. 3%) and 39% anxious (prev. 24%). In minors it is noticed 80% increase in depressed and 30% in anxious, the severity of the clinical picture is worrying (39% severe depression, 33% severe anxiety) as well as parental non-recognition of minors mental health problems (56% noticed problems, 42% externalizing, 33% internalizing). The mental health of minors is the wealth of the nation. It is recommended to prevent problems and treat them as soon as possible. Raising the level of knowledge of the population and anti-stigma, raising the resilience of young people by empowering parents and strengthening the competencies of school staff are ways of early detection, intervention and recovery.

Introduction and aim of the research Human papilloma virus (HPV) is a highly transmissible virus and it is associated with the occurrence of several cancers. The aim of this study was to investigate the characteristics of students vaccinated against human papilloma virus. Subjects and methods Answers to the questions were collected by the questionnaire answerd by students (N = 272, 79% of female students) who voluntarily responded to free vaccination against HPV in the Institute of Public Health \\\\\\\"Dr. Andrija Štampar ”, academic year 2016/17, for the purposes of this study. Anonymized data were processed by methods of descriptive statistics and interpreted at a significance level of P <0.05. results The majority of respondents did not have chronic diseases (79.4%) and did not take medication (80.1%). 18.8% had a positive family history of cervical disease. Those (76.1%) who did not have a positive family history (P <0.001) were significantly more vaccinated. 80.8% of respondents were sexually active, and more than half had a permanent partner and had information on how many sexual partners the partner had before them. Female students had significantly more than male two sexual partners (22.2% peer 6.4%, P = 0.03), and male students had four or more (48.9% peer 33.3%, P = 0, 03). The majority of respondents received all mandatory vaccines (97.8%), and 1.5% had adverse reactions. Most of the female students had a gynecological examination and had a PAPA test. Most of them heard about HPV vaccination from friends (28.1%) and family members (25.2%). Conclusion The results showed a significant correlation between the number of sexual partners and the decision to vaccinate against HPV, also indicate the need for greater involvement and availability of the health system in providing relevant information on HPV infection, with emphasis on doctors and nurses / technicians in schools and adolescent medicine services, who are most involved in the implementation of HPV vaccination.

The Covid-19 pandemic presented Tallinn School Nurses with a major challenge, as school nurses needed to be able to react quickly and adapt their work organisation. Based on the guidelines of the Ministry of Education and Research, the school nurses priority is to deal first with the prevention of COVID-19, related vaccinations and the provision of advice and information to students, parents and school staff. Purpose: Provide an overview of the additional duties of school nurses related to the spread of Covid-19. Methods: This work is a qualitative study that is carried out as a literature and statistical research. Statistical data was used. Analysis of the results are presented. Participants in the study were students from Tallinn Schools. Activities: 1. Advice, testing and vaccination of school staff and students against Covid-19.2.Identification of close contacts and transmission of the data to the health department. 3. Control of the school environment according to the instructions of the health department. Results: Number of students recorded: 40421. Those infected with Covid-19 among school staff and students were quickly identified and isolated. From September 2021 to May 2022, 844 rapid Covid-19 tests were carried out, representing 20.8% of the total number of students. 3. Out of a total of 4 schools, 173 were vaccinated against Covid-19, which corresponds to 4.2% of the number of students.Identification of close contacts: mapping of students who have been vaccinated against Covid-19 and who have experienced Covid-19 in the last 6 months, making tables and submitting data to the health department. The total number of close contacts is 1320, which is 33% of the total number of students. The school nurses check the school environment daily according to the instructions of the health department. Due to the COVID-19 pandemic, the number and scope of school nurses\\\' workloads have increased: testing for Covid-19, vaccinations, identifying close contacts and mapping students who have been vaccinated or who have had Covid. School nurses paid more attention to controlling the school environment, which helped slow the spread of Covid-19 at school.

Aims: During the COVID-19 pandemic university students commonly used the internet for different purposes and prolonged time spent online during the pandemic posed itself as a significant risk factor for the development of internet addiction. This study aimed to investigate the prevalence and features of internet addiction in Croatian university students during the COVID-19 pandemic. Materials and Methods: In April 2022 a cross-sectional study that employed a validated, anonymous questionnaire containing questions regarding demographic data, as well as Young’s Internet Addiction Test, was conducted in a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. Results: The study sample included 792 university students, the median age was 21 years (interquartile range 20-22), 40.3% males, and 59.7% females. The overall prevalence of internet addiction was 71.7%. There were 48.7%, 20.7%, and 2.3%, students with mild, moderate, and severe internet addiction, respectively. The main reasons for internet usage were learning and faculty assignments (23.2%), social networking and entertainment (72.0%), and online gaming (4.8%). There were no statistically significant differences in internet addiction considering students' gender, faculty subject area, type of student housing, and students’ status of employment (p=0.574; p=0.070; p=0.864; and p=0.121, respectively). However, there was a statistically significant difference in internet addiction regarding the main reason for internet usage, where online gaming was much riskier in that sense in comparison to other observed reasons for internet usage (p<0.001). Conclusion: Internet addiction is a significant public health issue among Croatian university students, and the COVID-19 pandemic made this problem even more prominent in this vulnerable population. To be able to adequately respond to this challenge with appropriate preventative measures a better understanding of risk factors for internet addiction among university students during the COVID-19 pandemic is needed.

Aims: The attitudes regarding vaccination are significant for predicting individuals' vaccination behavior and are connected with one's knowledge about vaccines. This study aimed to explore associations between the attitudes regarding vaccination and HPV vaccine uptake among Croatian university students. Materials and Methods: From the February to May 2021 period a cross-sectional questionnaire study was conducted in a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. A validated, anonymous, self-administered questionnaire that contained questions regarding demographic data, data about HPV vaccine uptake, data regarding knowledge about the HPV virus and the vaccination as well as the Vaccination Attitudes Examination Scale (VAX scale) served as a research tool. The lower scores on the VAX scale reflect more positive vaccination attitudes. Results: The study sample included 840 subjects with, median age of 20 years (interquartile range 20-21), 45.8% males, and 54.2% females. The median VAX scale score was 39.0 (interquartile range 32.0-46.0). The prevalence of HPV vaccination uptake was 20.8%. Regarding the knowledge about the HPV virus and the vaccination among all study participants, there were 25.6% of those with poor, 26.4% of those with good, and 48.0% of those with very good knowledge. The participants who were vaccinated with the HPV vaccine had significantly more positive vaccination attitudes in comparison to non-vaccinated participants (p<0.001). The participants with very good knowledge about the HPV virus and the vaccination had significantly more positive vaccination attitudes in comparison to other participants (p<0.001). Conclusion: Present study confirmed the existence of associations between vaccination attitudes, knowledge about the HPV virus, and the HPV vaccination uptake in Croatian university students. A better understanding of the attitudes that underlie vaccine hesitancy and factors that modify these attitudes are important for developing specific public health interventions that will increase HPV vaccine uptake in the studied population.

Early detection of neurodevelopmental disorders is a critical task of youth health care. Early detection offers the opportunity for early intervention leading to health gain for child and family. Intervention that starts at early age promotes families’ well-being and families’ capacities to cope with the situation of an infant with special needs. Moreover, intervention at early age may exploit the young brain’s high neuroplasticity. Recently the Standardized Infant NeuroDevelopmental Assessment (SINDA) has been developed. SINDA is an instrument for infants aged 6 weeks to 12 months corrected age. It aims at detecting infants at high risk of neurodevelopmental disability and to counsel parents. SINDA has three scales: a neurological, developmental and socio-emotional scale. The neurological scale has 28 dichotomous items and each item is scored as typical (1 point) or atypical (0 points). An atypical score is defined as ≤21 points; in high risk infants it has high sensitivities and specificities to detect cerebral palsy and intellectual disability (predictive values 81-100%). The developmental scale has 15 dichotomous items per month of age. An at risk score (≤7) assists the prediction of intellectual disability (in high risk infants: sensitivity 77%; specificity 92%). The socio-emotional scale consists of 6 items resulting in scores on four types of behaviour (interaction, emotionality, self-regulation, reactivity). Reliability of the three scales has been shown to be good to excellent. SINDA is complementary to other developmental milestones instruments applied in youth health care, such as the ‘Van Wiechen Scheme’ (commonly used in the Netherlands). It serves as an additional in-depth assessment of the child’s current neurodevelopmental condition but is also predictive of developmental disability. SINDA’s design makes it highly suitable for application in youth health care. It takes relatively little time to complete and no expensive equipment is required. A manual is available with video-illustrations allowing for self-training. The items on the neurological and socio-emotional scale are age-independent and thus easy to perform on indication. In our workshop we will present SINDA with practical illustrations. In addition we will discuss how SINDA may be implemented in youth health care practice.

Prekid psihijatrijske skrbi tijekom prijelaza iz adolescencije u odraslu dob često dovodi do značajnih odgoda u liječenju, visoke stope odustajanja od liječenja i povećanja rizika od rane kronifikacije, naročito kod težih poremećaja mentalnog zdravlja mlađe populacije. Psihijatrija i psihoterapija tog razdoblja se razlikuju u pristupu koji koristi klasična psihijatrija odraslih u odnosu na dječju i adolescentnu psihijatriju. Dok je psihijatrija odraslih većinom fenomenološka i usmjerana na farmakoterapiju, dječja i adolescentna je usmjerena na sagledvanje razvojnih procesa, odnosno psihodinamskih razrješavanja te zaokruživanja identiteta i slike o sebi, a što je dalje usmjerno ka potpunoj indiviualizaciji i autonomiji. Izazovi dječje i adolescentne psihijatrije i psihoterapije ne staju sa navršenih 18 godina jer se razvojne specifičnosti kao i sadašnji stilovi življenja u smislu produljenog procesa sazrijevanja mladih, vezuju uz već započete tretmane u maloljetničkoj dobi. Prelaskom, tranzicijom u odraslu dob nužan je kontinuitet skrbi koji često nije osiguran na način koji bi bio prihvatljiv društvima 21. stoljeća. Ordinacije školske medicine su stoga ovdje važne kao premosnica u komunikaciji sa stručnim timovima škola i fakulteta kako bih se optimizirao pristup mladim osobama u procesu odrastanja praćeno poteškoćama mentalnog zdravlja. Više godina unazad u Slavonskom Brodu, na razini županijske opće bolnice, razvijan je rad s adolescentima i postadolescentima do dobi od 25 god. individualnim razgovorima i grupnim radom kao i radom u Parcijalnoj dnevnoj skrbi u dvije smjene. Sličan pristup je korišten u radu Poliklinike za dječju i adolescentnu psihijatriju u NPB u Popovači, a potom i u sklopu Klinike za psihijatriju KB Dubrava, gdje nedavno je osnovana Ambulanta za zaštitu mentalnog zdravlja mladih posvećena problematici tranzicije. Kroz prikaz rada ovih ambulanti, kliničke slučajeve i pregled literature pokušava se apostrofirati problematika psihijatrije tranzicije, odnosno istaknuti ulogu školske medicine u ostvarivanju cjelokupne skrbi mentalnog zdravlja mladih.

In the Service for School and Adolescent Medicine of the Teaching Institute for Public Health "Dr. Andrija Štampar ”, a Youth Counseling Center has been operating since 2004, where a team approach and cooperation provides health care to school children and students related to the need to preserve sexual and reproductive health. The nurse is a person of first contact with a specific role to conduct the triage, provides further guidance, information and counseling about the risks and consequences of irresponsible sexual behavior. In addition to the nurse, the counseling center is staffed with a specialist of school medicine and a gynecologist, as well as with experts from other specialties if necessary. The aim was to present the work of the largest multidisciplinary counseling center for sexual and reproductive health in Croatia before the pandemic. In 2019, a total of 839 beneficiaries applied to the Reproductive Health Counseling Center for gynecological examinations, as well as 739 girls and 81 boys for consultation with a school doctor. A total of 314 consultations related to HPV vaccination were also conducted. Out of a total of 499 first / annual PAPA tests performed in 2019, out of which 54% normal findings and 56% pathological findings were recorded. All users with pathological PAPA test findings underwent microbiological diagnosis by taking cervical swabs. The Counseling Center strives to follow all the guidelines of the World Health Organization for Youth Counseling, which includes: "open door" (entrance without a referral), accessibility, confidentiality, specific approach, comprehensive treatment and therapy in one place.

According to WHO, the majority of adolescents do not meet the current guidelines of physical activity. Since physical inactivity and sedentary behaviour are the culprit for many noncommunicable diseses, the project „Scoliosis of the heart“ was designed to entice the girls to incorporate healthy habits during 66 days (the average for a new behaviour to become automatic). This project involved 90 adolescent girls in Girl's dormitory Split. Baseline evaluation of physical activity indicated that 15.5% of girls were excluded from mandatory physical education in school. School medicine specialists performed clinical evaluation of posture in 95.5% (n = 86) of girls. Among these girls they detected: abnormal posture in 59.3% (40 discrete postural assimetries, 8 postural kyphosis, 3 moderate to severe kyphoscoliotic postures), suspected scoliosis in 2.3%, while 2.3% had previously confirmed scoliosis and wore braces, and 1.2% had previously confirmed kyphosis and wore brace. All the parents received information about the posture and recommendations. Girls with suspected scoliosis and kyphoscoliotic postures were referred to physiatrist/orthopedist for further evaluation, along with those who wore braces for re-evaluation. All the girls received guidelines on requirements of at least 60 minutes of physical activity daily for this age group. Additionaly, 5.8% of girls received guidelines for healthy diet because of obesity. Five physiotherapists trained in DNS and Schroth therapy demonstrated body flow exercises in Girl's dormitory on three occasions, and supervised them to assure they used correct techniques. Coordinator of activities in Girl's dormitory held interactive workshops in order to encourage the girls to tackle their problems with physical inactivity and „routinitis“. They were presented with strategies on how to reinvent their life and daily routine through theory of small steps to their goals. In conclusion, using small, measurable goals and positive attitude, designated goals become achievable, thus contributing to physical, mental and social well-being.

Background: Infections caused by chlamydia are among the most common sexually transmitted diseases, especially in age below 25 years. They are often asymptomatic, so infection remains unrecognized and untreated. Control of chlamydial infection is a public health responsibility, and implementation of chlamydial screening allows timely detection, early treatment of infection and prevention of complications. The aim of this study was to determine incidence of Chlamydia trachomatis infection in Split-Dalmatia County, to analyze incidence regarding to age and gender, and based on the results to conclude is it time for Croatia to introduce chlamydia screening in the adolescent population. Methods: For the purposes of this study, seven-year data from routine testing for C. trachomatis at the Teaching Institute for Public Health of Split-Dalmatia County (TIPH-SDC) were analyzed. Tests were performed by PCR method on the Cobas 4800 system (Roche). Results: In seven-year period (2015–2021), a total of 51,864 patients were tested for C.trachomatis, and 1,155 (2.2%) were positive. In the group younger than 25 years, only 6,739 samples were taken (13.0% of the total number tested). Among them 419 (6.2%) were positive for chlamydia (5.8% of tested women and 9.3% of tested men, younger than 25 years). In age group older than 25 years, a total of 45,125 patients were tested and only 736 (1.6%) of them were positive for chlamydia (1.4% of women and 3.3% of tested men). Conclusion: According to the results of our study, the prevalence of chlamydial infection in adolescent population is significantly higher than 3.0%, which indicates the necessity and cost-effectiveness for introduction of chlamydia screening in adolescent population in Croatia.

ABSTRACT INTRODUCTION: The COVID-19 pandemic has affected people’s daily lives and habits all around the world. The introduction of sudden restrictions, quarantine, and travel bans had primarily affected the younger, student population, which was accustomed to their specific lifestyle and habits. In addition to mental and physical health, and the possible consequences for them, it is important to consider the influence of the pandemic on another important segment of young people's lives – sexuality. OBJECTIVE: To compare students’ sexual behavior before and during the COVID-19 pandemic and to determine the influence of the COVID-19 pandemic on the sexual behavior and sexual activity of students at the University of Osijek. STUDY DESIGN: Cross-sectional study PARTICIPANTS AND METHODS: The study included 765 students, who participated in the online survey, designed for this study. Participants were recruited through social media in the period from mid-May to mid-June 2020. The exclusion criteria were being a minor and studying outside the University of Osijek. The survey was completely anonymous and voluntary and consisted of 27 questions. RESULTS: Students’ median age was 23 (range 21 – 24) years. There were 23.8% male and 76.2% female students. The study revealed a statistically significant connection between the influence of pandemics on sexual activities and the increase in the need for sex during a pandemic (χ2-test; p<0.001) and between the existence of sexual frustrations during a pandemic and an increase in the need to watch pornographic content during a pandemic (χ2-test; p<0.001). Moreover, a significant connection was found between the existence of sexual frustration and the increased frequency of sexual intercourse during a pandemic (χ2-test; p<0.001). CONCLUSION: The results obtained in this study suggested the negative influence of the COVID-19 pandemic on students' sexual behavior and activities. Due to the relatively short time of data collection and the limited number of participants, further studies are needed to determine the real influence of the COVID-19 pandemic on students' sexual behavior and activities.

Introduction Adolescents have many questions about their development and their changing bodies, most of which Youth Health Care can answer. Timely help may prevent negative consequences for their mental well-being, which is particular important as it can have serious knock-on effects, such as school absenteeism or psychological problems. The aim of this research is to identify where improvements can be made to enhance the connection between Youth Health Care and adolescents and support early intervention. Method Field research, including a problem analysis, involving adolescents, parents and stakeholders was combined with a literature review. Results Knowledge was identified to be the most important factor that influenced if adolescents asked for help on health-related matters. The proposed intervention is a microlearning approach known as ‘Kwistet’, an interactive quiz that can be offered via Instagram. Adolescents are invited to gain knowledge about puberty, healthy lifestyle, mental well-being and where to find help in a quiz format. A tailor-made Kwistet version for adolescents will be designed, implemented and evaluated. Conclusion Kwistet will give adolescents answers to their questions through a familiar social media communication platform, Instagram. This will help them formulate their questions and, if they need more help, provide pathways to Youth Health Care and preventive help. With this oral presentation you will be taken through every step of this implementation research and end up with a great idea to launch in your own country!

Context : The lack of medical doctors, financial restrictions and political decisions in governance at the community level force to rethink perspectives of tackling school health issues with children and adolescents in public schools while school health visits with adolescents are required by law in each canton in Switzerland. In the Canton of Fribourg, with 350’000 habitants the role of public health and preventing care offers to school health educations has recently been reviewed. Implementation of a large screening program with a better access to public health care services for high-school aged adolescents was voted before Covid-19. School-nurses may take up a key role, present in the school setting addressing a regular school health surveys to all young adolescents (12-13y), mandatory from 2023 onwards. The community of Fribourg city is enrolled in a pilot project exploring options to implement the new ordinance. Aim and methods: This study evaluates the position and possible collaboration services of a school-nurse based in the school setting promoting health check-up to adolescents. In an adolescents health’s questionnaire, the school nurses interviewed and examined in a confidential setting more than 350 students aged 12-13 y old, out of 1279 invited, registered the results and decided with the school health doctor about further investigations. Results : The preliminary results show that all adolescents seem to be concerned about their own health, 1/3 was addressed to the GP or specialist, about 45 % reclaimed sleeping disorder 40% emotional problems, 34% related stress, 25% mobbying and 30% problems in posture 23 % were overweighed or had a negative body image. All of them appreciate da dedicated moment in a confidential setting with the school nurse. Conclusion: The presence of a school nurse located in the school seems to be required even when general health check-ups are not declared as priority of the school direction. The majority of requests concerned psycho-social related health worries for the adolescents, valorizes the autonomy thinking in adolescents and may confirm the importance of the role for health care givers directly connected with the school setting.

AIM: HPV vaccination in Croatia is recommended, and available free of charge for girls and boys in the eighth grade of primary school. During the COVID-19 pandemic, in line with the COVID-19 vaccine hesitance, a vaccine hesitance against other optional vaccine appeared. The aim of this study was to assess the vaccination coverage of boys and girls against HPV in Požega-Slavonia County, before and during the COVID-19 pandemic, in school year 2019/20 and 2021/22. MATERIAL AND METHODS: The research included a total of 1440 eighth grade primary school students in Požega-Slavonia County, 728 in a school year 2019/20, and 712 in 2021/22. Data on HPV vaccination were collected from medical documentation, through regular monthly reports on vaccinated students of all school medicine teams in the County. Data were analyzed by methods of descriptive and analytical statistics and presented at a significance level of P<0.05. RESULTS: Out of total number of students, in 2019/20, 48.8% was vaccinated against HPV, significantly higher than 39.2% in 2021/22 (χ2=13.40; P<0.001). In 2019/20 there was a significantly higher number of vaccinated girls than boys (54.4% vs. 44.0%; χ2=8.69; P=0.003, respectively), as well as in 2021/22 (46.6% vs. 31.8%; χ2=16.29; P<0.001, respectively). CONCLUSION: Vaccination coverage against HPV in eighth grade primary school students significantly decreased during the COVID-19 pandemic in Požega-Slavonia County, with higher number of vaccinated girls before and during the pandemic. Results indicate the need of continuous intervention in achieving a recommended vaccination coverage, in both, girls and boys.

Prevencija razvoja problema mentalnog zdravlja u adolescenciji i mlađoj odrasloj dobi započinje s većom svijesti i razumijevanjem ranih znakova i simptoma koji se često pojavljuju već tijekom osnovne škole. Prvi znakovi problema mogu biti sasvim blagi te se dio njih uz pravovremenu podršku brižnih odraslih može relativno lako ukloniti. Skup znanja i vještina koji čine mentalnozdravstvenu pismenost mogu pomoći odraslima, ali i djeci i mladima, u prepoznavanju i razumijevanju psihičkih smetnji, spremnosti na primjereno reagiranje te pružanje ili traženje pomoći utemeljene na dokazima. Na primjeru prepoznavanja anksioznih smetnji prikazat će se aktivnosti te ciljevi i definirani ishodi programa PoMoZi Da kojeg od 2020. pilotira Hrvatski zavod za javno zdravstvo u sklopu projekta Živjeti zdravo u suradnji s Agencijom za odgoj i obrazovanje. Program provode educirani 3P edukatori, među njima i školski liječnici, te se u sklopu programa razvija i standard kompetencija edukatora potrebnih za što kvalitetniju provedbu edukacija. U radionici će biti demonstriran izabrani set aktivnosti iz radionice usmjerene na usvajanje vještine pružanja psihološke prve pomoći kod anksioznih smetnji. Pružanje prve pomoći i podrške kod anksioznih stanja važno je u prevenciji i prepoznavanju pogoršavanja anksioznih smetnji i razvoja drugih problema mentalnog zdravlja kod djece i mladih te njihovoj destigmatizaciji, posebno u školskom okruženju. Istraživanja pokazuju da mentalnozdravstvena pismenost u tom području povećava šansu traženja i stručne pomoći.

The school health service in Hungary provides two-yearly health checks in the schools for children and adolescents. In the school year of 2020-21 due to the pandemic live examinations were not possible amongst the 10th graders (age 16-17y) in two big secondary schools in the 2nd district of Budapest due to online education and closure of the schools. To adapt to the new situation locally, a screening questionnaire was sent by email to 259 10th graders with a letter, and all who have responded received an individual answer, with medical or practical advice when it was considered necessary or useful. The primary aim of this study is to present and analyse the method itself, and secondary aim to analyse the answers of the students. Materials: email conversations with the students and some parents; summarised charts of the answers on the questionnaire. Results: 146 students (56 %) have participated by answering the questionnaire. Participation was likely linked to stronger engagement with online education generally. The 44% who did not answer, was out of our reach during the closures. It can only be assumed that either they had taken online school attendance altogether less strictly or felt it rather overwhelming, perhaps in some cases access to online communication was limited. Participating students showed variable interest from „limited” - strictly answering the questions, or „medium” - sending a short letter with it; to „active” – going into email conversation. This was more frequently a sign of how much they appreciated this way of healthcare, than a correlation to their objective need of attention. Some students spontaneously added kind remarks, some others only answered follow up questions after repeated email. On the provider side emphasis was given to personalising the conversation, but links and templates were used as well for the advice. Despite efforts to keep up interest in the individual student and his or her problems, it was clearly more monotonous and less rewarding work than live screenings. Conclusion: although questionnaires might have a role in the health screening of students, they cannot replace and should not redeem conversations and live examinations.

Introduction: The Netherlands has a unique system to promote Child and youth Health, The Preventive Child and youth health care (CYH). The CYH makes an important contribution to the development and health of children and young people by offering information, immunisation and screening, identifying care needs and providing preventive support to children and their families, from birth up to the age of 18 years. The CYH is offered free of charge and has a high reach, offering basic preventive care to all children supported by 35 evidence-based guidelines and special preventive care to children who grow up in a disadvantaged situation. Examples of such special care interventions include the Nurse Family Partnership, ‘VoorZorg’, for very vulnerable and first time mothers or MASS ‘Medical Advice for Sick-reported Students’, in order to prevent young people from dropping out of school. Discussion: The impact of the CYH is high. According to increasing insight, early intervention during childhood is an effective strategy to prevent problems later on in life as well as intergenerational inequality. The earlier the intervention is implemented, the higher are the expected returns. Lessons learned during the Covid epidemy showed that although the Dutch CYH is a solid public health system, the reach could be further improved by giving more attention to effective strategies to support children in vulnerable positions and by improving care coordination. Outreaching programs, digitization of care and e-health are important strategies in this respect. In addition, the generation of nationwide data can help to show the impact of CYH, and will direct and prioritise the necessary care. Conclusion: By continuously developing care on the basis of new (scientific) insights and societal issues, the CYH will continue to offer all children in the Netherlands the best preventive healthcare and can serve as a model for other countries.

Introduction: Mental health literacy is a set of knowledge, skills and beliefs about mental health or mental ill-health that have proven to be important factors in maintaining mental health and recognizing, preventing, or managing mental health problems (Jorm et al. 1997). In addition, the knowledge and skills of helping and supporting conversation and behavior in a situation when a person near us is going through an emotional crisis and suffering have also proved to be crucial. Mental health literacy has been especially important for adults working with children and adolescents to increase their competence, self-confidence, and efficiency in approaching children and adolescents in an empowering way that promotes psychological resilience. Discussion: As part of the national health promotion program Living Healthy, the Croatian Institute of Public Health, in cooperation with the professional and academic community and county public health institutes, developed the educational program PoMoZi Da – a mental health literacy program for teachers. School health professionals have been part of the development and implementation of the program. The role of school medicine in mental health literacy promotion and mental health first aid provision will be discussed according to the program of measures for prevention and education within the health protection of school children. Conclusion: The program for improving mental health literacy opens the possibility of empowering the role of school medicine with mental health education and psychological first aid competencies as well as the training competencies necessary for program implementation. School health professionals are working on the professional training of teachers and other educators to improve the solution to specific health problems. Therefore, school health professionals are called upon to promote mental health and mental health literacy in schools.

In December 2019, a new illness named COVID-19 and caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged in China. Soon after, infection spread worldwide and was declared as pandemic. COVID-19 affects most severely elderly people and, so far, is responsible for more than 6.2 million deaths. The first case in Croatia was reported in February 2020 leading to closure of educational institutions on March 16, 2020. A few days later a total lockdown was implemented. Since then, various measures were used to prevent spreading of COVID-19. So far, five waves of infections were observed causing more than 15,000 deaths in Croatia. The aim of this study is to present the data about children (aged 0-18 years) who tested positive to SARS-CoV-2 on PCR in Split-Dalmatia Country, from the beginning of the pandemic, until March 31, 2022. During this time, among all tested persons, a total number of positive children was 26.995 (18.4%). Most of them (13.205, 48.9%) tested positive in the fifth wave. When analyzing all waves, the highest number of positive tests was found among children aged between 7 and 14, and it ranged from 37.9% in the first wave to 54.7% in the fifth wave. According to the 2021 census, the prevalence of SARS-CoV-2 positive children in Split-Dalmatia County is 33.5%. The prevalence in males is 32.7% and in females 34.4% which is not significant. The lowest prevalence was found in the age group 0-4 and 5-9 years (16.5% and 29.9%, respectively), while the highest was in the age groups 10-14, and 15-19 years (42.8% and 42.5%, respectively). Although the clinical presentation of COVID-19 in children is usually mild, the high prevalence of SARS-CoV-2 positive minors should not be neglected. The health system should be prepared to deal with post-COVID-19 consequences, among which the mental problems and multisystem inflammatory syndrome in children should be outlined. Also, closure of schools, especially for children > 10 years should be considered as part of the regular non-pharmaceutical interventions when dealing with similar pandemics or when normal functioning of the healthy system might be jeopardized.

Purpose: Our aim was to look at the trend of visual acuity disorders in schoolchildren over the last ten years both at the national level and at the Idrija Health Centre. Methods: We reviewed data on visual impairment available on the National Institute of Public Health (NIJZ) Data Portal. For the Idrija Health Centre, the data were sent to us by the NIJZ Statistical Office, but they differed from the data in our reports sent to the NIJZ, so we used archived reports. We also reviewed the medical records of one generation of schoolchildren from school entry to grade 8. If we did not have information on the type of visual acuity disorder, we classified them as unspecified visual acuity disorders. A referral to an ophthalmologist is required if the visual acuity is less than 5/5. At the Idrija Health Centre, we referred to an ophthalmologist those schoolchildren who had a visual acuity level less than 5/6. Results: We found large variations in the proportion of schoolchildren with visual acuity impairment between years at the national and regional levels. Based on these data, we note that the proportion of primary school pupils with visual acuity impairment in Slovenia has not increased in the last ten years. The analysis of the Idrija Health Centre data has not shown an increasing trend either. The pandemic period also did not have a negative impact, although we found a marked increase in the proportion of visual acuity impairment among first graders, which may be due to fluctuations observed in other years. Conclusion: The results of the systematic check-ups are recorded manually by nurses and sent to the NIJZ, where they are again manually entered into their electronic system. Errors can occur along the way, which can also be reflected in the published data. The results should be analysed to find the reasons for any differences. Based on the analyses, appropriate measures could be proposed in the event of a change in the trend. Therefore, modern technology based approaches are needed in Slovenia to record and send the results of systematic reviews.

Aims Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children. Materials and Methods We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6,934 6-year-olds from the Generation R study, and 2,974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Results The prevalence of spectacle wear increased from 1.5% to 11.8% between 3 to 7 years with no significant sex differences. Among children with spectacle wear at 6 years (N=583) and 7 years (N=351) 29.8% and 34.6% had myopia respectively, of which 21.1% and 21.6% combined with astigmatism; 19.6% and 6.8% had hyperopia, 37.2% and 11.1% hyperopia and astigmatism, and 12.5% and 32.7% astigmatism only. Conclusions Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life.

Aims Early detection of parenting and developmental problems is a major task of Preventive Child Healthcare (PCHC) Services. The Structured Problem Analysis of Raising Kids (SPARK) is a broad-scoped structured interview for children aged 18-months (SPARK18), using both the perspective of parents and the experience of PCHC professionals. Research showed that using the SPARK-method leads to a valid and reliable risk assessment in dialogue with parents, that is usable in daily practice. This study reports the cost-effectiveness and long-term outcomes of the SPARK18-method. This knowledge is important for organizations and municipalities to be able to make an informed decision about the implementation of the SPARK-method. Methods A cluster randomized controlled trial on 2360 18-month-old children, with a 1.5-year follow-up. Children either received care-as-usual (loosely structured regular consultations at the well-baby clinic) or a home visit using the SPARK18-method. Follow-up was assessed with the aid of parent-reported surveys at four different time-points. Questions included user experience, caregiver strain and strengths, toddler’s health-outcome and healthcare use and parents’ productivity loss. In addition healthcare use was retrieved from registrations of the PCHC organization. Results 1688 Families received care-as-usual, informed consent was obtained in 29.2%. 672 Families received the SPARK-method, with 52.5% informed consent. The SPARK-method provided PCHC-nurses more information on child’s development and parenting approach, whereas in care-as-usual there was often no information available regarding family, support and environment. Using the SPARK-method identified significantly more increased- and high-risk children compared to care-as-usual (9.5% vs. 5.1%; p=0.016). In both intervention groups care experience was generally rated good. Child’s health outcomes, costs and benefits of implementing the SPARK-method compared to care-as-usual, are currently in analysis. Conclusion First results show that implementing the SPARK-method improves early detection. How this improvement relates to total costs and cost-effectiveness, will be presented at EUSUHM congress 2022. Acknowledgement This study was possible thanks to the efforts of the Dutch PCHC organization, their professionals and ‘their’ parents in Zaanstreek-Waterland. And financially supported by a ZonMw grant (Grant Number 531002022).

Objectives: The aim of this study was to explore how university students’ participation in a two-staged health screening at the beginning of university studies associates with student health care utilization in a six-year follow-up. Design: Nationwide, observational, register-based cohort study with a six-year follow-up. Setting: Student health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The two-staged health screening of FSHS includes the electronic health questionnaire (eHQ) provided annually to university entrants and a subsequent health check, when necessary, based on students eHQ response. Participants: A national cohort of university entrants from the 2011¬–2012 academic year (N=15 723) was assessed. After exclusions the study population consisted of 12 972 students, n(female)=7368, n(male)=5604. Outcome measures: The primary outcome measures were students’ health service utilization pattern obtained by clustering analyses method and the students’ participation in different stages of the health examination process. Results: Four distinguishable health care utilization patterns were identified: 1) constant low use, 2) constant high use, 3) increasing use and 4) decreasing use. The students’ odds ratio (OR) for belonging to the constant high use group was significantly higher among females (OR 4.0, 95% CI 3.5–4.6) and students who attended the health check (OR 4.7, 95% CI 3.9–5.6). Conclusions: Participating in the two-staged health screening was associated with increase in health care utilization. The process detects students with health problems.

Introduction There are approximately 160,000 students studying in Croatia, and the Croatian Academic Sports Federation directly impacts 3,000 and 1.8% of students through its programmes. Currently, no health-oriented physical activity programmes are systematically implemented in the higher education system. The number of teaching hours for physical and health culture is insufficient, with a tendency to decrease further. On the other hand, the strategic documents of the Republic of Croatia in the field of sport and health emphasise the importance of physical activity and healthy lifestyle habits. Discourse The UniSport health programme aims to: To enable all students to participate in health-oriented physical activity programmes at universities free of charge. Raise awareness of the importance of physical activity and strengthen positive attitudes towards it. To monitor the health indicators of students participating in the project and compare them with those who are not physically active in order to scientifically confirm the benefits of physical activity in maintaining and improving health. To have a preventive effect on the development of diseases, to maintain and improve the health of individuals and the community in the long term. The target group is primarily students, but other stakeholders in academic life (staff and others working in the higher education system) are not excluded. The beneficiaries of the programme can apply the acquired habits even after they have completed their academic education, which gives the project additional positive value and meaning. Conclusion The UniHealth model was developed in collaboration with experienced kinesiologists and licenced trainers/managers. With minimal material investment, it can be implemented at any higher education institution in the Republic of Croatia, regardless of the number of components and number of students, existing sports infrastructure, human resources or experience in implementing similar programmes. This project will achieve greater participation of everyone in regular physical activity, which will have a positive impact on the prevention of overweight and obesity, thus reducing the risk factors for cardiovascular diseases.

Uvod: Zlouporaba sredstava ovisnosti ozbiljan je društveni problem. Prisutan je stalni trend porasta pušenja, konzumacije alkohola i psihoaktivnih sredstava, te novih droga kako u svijetu tako i u Republici Hrvatskoj. U ovom radu ispitivali smo učestalost i vrstu korištenih sredstava ovisnosti među studentima Veleučilišta Lavoslava Ružičke u Vukovaru kao i socijalne i psihološke čimbenike koji su u osnovi uzimanja sredstava ovisnosti. Ciljevi istraživanja: Cilj istraživanja bio je prikupiti podatke o prevalenciji i osobitostima uzimanja različitih sredstava ovisnosti u studentskoj populaciji u Vukovaru, te stavove i mišljenja studenata o drogama, sklonost kockanju, ovisnosti o internetu i osobine ispitanika. Materijali i metode: U istraživanju je korišten anketni upitnik, anketa je bila anonimna, odobrena od nadležnih tijela Veleučilišta i provodila se na veleučilištu Vukovar tijekom perioda lipanj-srpanj 2018. Uzorak je bio prigodni. Ukupan broj ispitanih studenata je 152. Rezultati: Više od polovice anketiranih studenata ne puši, trećine redovito puši duhan, a glavni razlog tome je utjecaj društva, dok mali broj puši marihuanu, što nije u skladu s percepcijom u odnosu na ostale studente koja pokazuje kako više od dvije trećine smatra kako im prijatelji koriste razna sredstva ovisnosti. Ispitani studenti počinju rano s konzumiranjem cigareta, najviše njih u 17. i 15. godini života. U studentskoj populaciji 85,53 % pije alkoholna pića ponekad ili tjedno. Djevojke provode više vremena na internetu od mladića. Ukupno gledajući mladići više kockaju od djevojaka. Zaključak: Potrebno je nastaviti pratiti trendove u cilju sprječavanja, te smanjivanja ovisnosti i razvijati sveobuhvatne programe prevencije jer velik broj ispitanih studenata konzumira razna sredstva ovisnosti, posebno alkohol. Isto tako problem su nesupstancijalne ovisnosti koje se odnose na određene oblike ponašanja i ovisnost o novim tehnologijama (Internet, društvene mreže, videoigre) i ovisnost o kockanju.

In children with complex needs, the primary circle of care includes parents/caregivers, health care, social care, and (pre)school system, local community, and non-governmental organizations. The necessity of integration and coordination of this wide range of stakeholders of different profiles was recognized not only by children, families, and stakeholders in care but also by the European Academy of Paediatrics. To achieve this, all elements, steps, and stakeholders in the care process must be clearly defined, and their relationship, temporal and spatial dynamics in the real context analysed. The methodology of analysis and mapping of care processes and stakeholders is very timely and based on Donabedian's model of quality, which defines inputs, processes, and outcomes of care. For example, under the guidance of the PUB HUB program of the School of Medicine in Zagreb, the methodology of mapping processes and needs was used throughout the European Commission's "Health infrastructure mapping - Slovenia, Croatia, Bulgaria" project, and served, per European request, as a guide for the new Croatian strategic framework for health. Care processes are shaped by the interrelationship, temporal, and spatial dynamics of inputs (people, equipment, space) in real, and - for each child and stakeholder - specific socioeconomic, infrastructural, and technical-administrative contexts. Mapping analyses the process of care following the child’s needs and the care stakeholders’ availability, accessibility, and capacity to respond to the child's complex needs in a 24/7/365 timeframe. Thus, gaps in care which result in a child's unmet needs can be identified. This forms the basis for a deeper cause-and-effect analysis that enables the planning and implementation of quality and child-specific interventions, which are feasible for stakeholders. The stakeholders involved in care for a child with complex needs should cooperate in a timely, integrated and coordinated multidisciplinary manner, basing their decisions on the specific needs of the child. Achieving this goal must begin with creating a clear map of processes and interrelationships within the care system through the 24/7/365 timeframe.

INTRODUCTION: In the last few years, we have noticed that children enrolling in the 1st grade of elementary school have incomplete pediatric vaccinations, mostly missing the last pediatric revaccination of DiTePer and often other ones from the required vaccines. In the period between 2014. and 2022. we recorded an increase in number of preschoolers who have incomplete vaccination status. AIM: Our goal is to compare the vaccination statuses of preschoolers enrolled in 2014. and 2022. in Solin area and parts of the Dalmatian inland to show the observed decline in the vaccination of children in our area between these two generations. METHODS: Analysis of data from medical records of Department of school medicine. The analysis included data from 385 preschoolers in 2014. and 264 preschoolers in 2022. RESULTS: The results of the analysis show the percentage of 59.5% preschoolers of 2022./23. generation who have an incomplete vaccination status compared to the 18.2% preschoolers of 2014./15 . CONCLUSION: The results show a significant difference in the incomplete vaccination status of preschoolers in 2022. compared to preschoolers in 2014. There is an increasing number of preschoolers who need to make up for missed vaccines from pediatric age, which requires additional work of the Department of school medicine. This is often delayed by the parents for several years during school age, which causes the necessity to invite children more often for vaccination and informing parents about the importance of vaccination, possibly referring them to further consultation with an epidemiologist.

Increase in vaccination against infections caused by the human papilloma virus during the COVID 19 pandemic in the city of Zagreb Neda Ferenčić Vrban, Tatjana Petričević Vidović, Marija Posavec, Enida Sičaja, Kristina Klanfar Institute of Public Health Dr. Andrija Štampar Long-term efforts to increase vaccination coverage since 2007 have helped us increase vaccination coverage in the city of Zagreb during the second year of the pandemic by 23% - 38% ??? . With the application of all the benefits we have (free for the target population, gender neutral, included in the National Plan and Program on immunization, and increasing awareness and importance of HPV vaccination in 8th grade. Infections caused by HPV lead to the development of premalignant and malignant changes in the cervix, vulva and vagina, precancerous lesions and cancer of the anus and genital warts in men and women. This vaccine can be considered as vaccine against cancer, therefore our goal is to first reach global then European recommendations for the elimination of cervical cancer. In 2019., The World Health Organization issued Recommendations for the elimination of cervical cancer and in 2020 the organisation adopted a Global Strategy to accelerate the elimination cervical cancer (incidence rate <4 / 100,000 women). Strategy are 90-70-90 https://www.who.int/news-room/fact-sheets/detail/cervical-cancer The European Commission adopts Recommendations strategy for the elimination of cervical cancer, which are 90-95-90,https://ec.europa.eu/commission/presscorner/detail/hr/ip_22_702 We must also emphasize the work of specialist doctors in combating the epidemic in schools (imposing measures of isolation and self-isolation),. In addition to working on the prevention of the spread of COVID 19 infections in schools in the city of Zagreb, Vaccinated students in 8th grade 2020/2021 / number of students ? total / vaccinated Vaccinated students in 8th grade 2021/2022 / number of students - total / vaccinated Through both school and academic years, a catch-up program for young people up to the age of 25 is provided in the competent school clinics. Conclusion: The availability of vaccinations and the additional involvement of school physicians has led to a positive response from the population and trust in the vaccinator and thus to an increase in vaccination.

The definition of health has changed from „absence of disease and infirmity” to a „state of complete physical, mental and social well-being”; by now the concept of health depicts a dynamic state of resilience and balance, attributed as „Positive Health”. With it, the focus of attention shifts from curing diseases to prevention and even further to the strengthening of health. Two different but indicative examples of it are the Institute for Positive Health (IPS) in the Netherlands, and the Positive Health initiative, supported by the Robert Wood Johnson Foundation (RWJF) at the University of Pennsylvania. When considering the role of school healthcare, we should also keep in mind Positive Health. Relatively small part of our work is curative, providing basic ambulatory care in school setting; multilevel prevention is the most significant, with health education, immunisations, and facilitating a healthy school environment; screening examinations to detect diseases in the earliest stages; helping the integration of students living with handicap or chronic disease. The concept of Positive Health teaches us not to look only for symptoms of disease, but the resources of health in different dimensions of life, and it also indicates that health might be improved by strengthening likely health assets. Involving it in our practice puts much bigger emphasis on the medical interview. It should not only try to identify possible symptoms of an existing disease, but to pin-point strengths and weaknesses that might have significant influence on health in the future; it should facilitate positive tendencies and motivate advantegous alteration. Doing preventive screenings school healthcare also monitors the health of the future generation and might provide data for public health strategy in case the administration is done precisely and definitions are clear. School healthcare has the potential to contribute significantly to improving the health of the future generations.

Background: Psychoactive drug use is often associated with other risky behaviors and / or addictions such as smoking, alcoholism, gambling, unnecessary and inappropriate medication use, but also with a range of medical, social and psychological problems. Young people, exposed to all the stressful situations and problems that come with growing up, reach out to various ways of self-help, one of them being the psychoactive drug use. Methods: Since 1978, the Croatian Institute of Public Health has been holding a Registry of Treated Psychoactive Drug Abusers. The Registry records and analyzes data on minors in treatment for psychoactive drug abuse. Results: According to the preliminary data from the Registry of Treated Psychoactive Drug Abusers for 2021, 110 persons under the age of 18 were in treatment for psychoactive drug abuse, of which 81 were boys and 29 girls. The trend of decreasing the number of minors in treatment continues. Prior to the COVID-19 pandemic, most young people were referred to the treatment from the police, and the court, but this number decreased significantly during the pandemic. Most minors are referred by the social welfare centers or their family. The age of the treated minors in 2021 was from 12 to 17 years, and the primary drug in 93% of cases (102 of 110) were cannabinoids, while for other primary drugs were amphetamines (6), cocaine (1) or heroin 1). Conclusion: The COVID-19 pandemic has affected the mental health of young people, their drug use and entering the drug treatment. When analyzing the drug consumption, it should always be kept in mind that it is not an isolated problem but is associated with a number of other medical, social and psychological problems.

New tobacco product is tobacco product which does not belong to any of the following categories: cigarettes, self-rolling tobacco, pipe tobacco, cigars, cigarillos, chewing tobacco, snuff tobacco or oral tobacco, and placed on the market after 19052014. EU proposes that they be regulated, such as cigarettes and rolling tobacco, and that flavorings should not be used in production. It will have to be labeled in accordance with the provisions relating to cigarettes and rolling tobacco, and each MS will be able to decide for itself whether the tobacco products in question are defined as smokeless or smoking, depending on the health warning. According to the current law, heated tobacco products are not defined, but in Croatia they are treated as smokeless and marked with the warning "this tobacco product harms your health and addiction." The basis for the adoption of novelties is based on data from the EU-CEG database and data from Euromonitor. There was an increase in sales by product category by at least 10% in at least 5 Member States and an increase in sales by retail category in which the level exceeded 2.5% of total sales tobacco products at EU level. E-cigarettes are the most common form and product from the ENDS group. Since its inception, it has been the subject of public health debates and controversy among tobacco control advocates, who are increasingly divided in their views with the increasing use of these products. While some see them as a chance to help quit smoking, others see them as products that could pose a threat and undermine efforts to neutralize tobacco use. Further research is needed to find out whether young people first started smoking e-cigarettes/htp or replaced classic cigarettes with e-cigarettes/htp. The issue of harmfulness or less harmfulness of them is the subject of additional research in our country and in the world. Researchers have warned that nicotine pouches are especially popular with young. Nicotine pouches are subject to various regulations around the world, depending on how they are defined and classified, and in many case there is no legislation, as is in the RH.

Adolescence is a particularly vulnerable period, and it is necessary to implement measures to reduce risk and increase adolescents' resistance to stress. Family, parents, peers, and the community play a key role in the adolescent's life. It is important to develop their protective role in the life of the adolescent. According to scientific research, the most effective measure in protecting the mental health of children and adolescents has proven to be the strengthening of social and emotional competencies through lifelong social and emotional learning (SEL) in the community and school. These interventions strengthen social and emotional functioning, improve academic achievement, reduce risky behaviors including smoking, drinking, and risky sexual behavior. Providers of these interventions should be peers, teachers, professional associates in schools. Programs to strengthen social and emotional competencies should be integrated into the school curriculum. As a precondition for the implementation of such interventions in the school environment, it is necessary to conduct teacher education, ensure community support and establish professional supervision. Cost-effective analyzes have shown that interventions to strengthen social and emotional competencies are the most cost-effective, because in addition to reducing costs within the health system, they also reduce the costs of the justice and social system.

Implementing health interventions in schools has always posed a significant organizational and managerial challenge. An additional challenge is the introduction of individual interventions or innovations to improve health. One of the key determinants for the success of these interventions is the characteristics of the school and among them the number of students, class groups and teachers. In this paper, we will assess the advantages and disadvantages of small schools for the implementation of innovative health interventions. The example of the Elementary School Trnjanska, Zagreb, Croatia was used. The collected data were analyzed using SWOT analysis. The results show that it is easier to achieve good communication in small schools, to cooperate with parents and launch various initiatives. Also, it is easier to react to possible unforeseen problems in project implementation and to conduct evaluations. Deficiencies are limited human, spatial and material resources and the risk of overloading employees. There is also a risk to the long-term sustainability of the project due to limited resources Conclusion: Small school organizations provide a favourable environment for piloting innovation and evaluating new interventions, especially individual programs, but the risks of resource constraints and the long-term sustainability of interventions need to be considered.

U društvu koje postaje sve deblje i gdje su informacije široko dostupne, bilo one istinite ili lažne, poticanje studenata na učenje o prehrani i usvajanje zdravih životnih navika postaje jedan od glavnih ciljeva javnog zdravstva. Imajući na umu da studenti puno bolje uče sadržaje prezentirane na društvenim mrežama i da prezentirani sadržaj bude zanimljiv, osmislili smo projekt kojim nastojimo potaknuti studente na odabir zdrave prehrane i implementaciju naučenih znanja u njihov stil života. Koristeći se metodom vršnjačkog učenja, razvili smo projekt Vitamini u sredini. Projekt “Vitamini u centru” zamišljen je kao edukativni projekt koji nastoji educirati studente o vitaminima. Primjerice, naučiti ih u kojoj hrani se nalazi pojedini vitamin, koliko je potrebno za normalno funkcioniranje, što se događa u slučaju hipervitaminoze i što se događa u slučaju hipovitaminoza. Kampanja je provedena tijekom akademske godine 2020./2021. Cijeli projekt se može podijeliti na izravni ili aktivnu edukaciju vršnjaka te na neizravnu ili pasivnu edukaciju. U izravnom dijelu studenti iz različitih obrazovnih područja zajedno surađuju i sudjeluju u stvaranju kampanje i materijala, pri čemu studenti medicine imaju glavnu ulogu u prenošenju znanja o vitaminima. U drugom, pasivnom dijelu, nema izravne interakcije između studenata medicine i ciljane publike. Edukacija se ostvaruje putem postera, videa i objava na društvenim mrežama nastalih suradnjom studenata medicine, dizajna i umjetnosti. Projekt je praćen i evaluiran različitim metodama ovisno o fazi razvoja projekta. Evaluacija je provedena na tri razine, kvalitativnom evaluacijom u obliku intervjua sa studentima nemedicinskih struka, a koji su radili na projektu, evaluacijom radionica i evaluacijom aktivnosti društvenih mreža. Ovaj projekt je pokazao da višedimenzionalni pristup temeljen na modelu učenja od vršnjaka može rezultirati javnozdravstvenom kampanjom koja privlači pozornost studenata s različitom pozadinom i obrazovanjem. Također, pozitivna evaluacija projekta ukazuje da je model međuvršnjačkog učenja učinkovit i da su potrebna daljnja istraživanja.

The Croatian Institute of Public Health has been conducting HBSC Survey (Health Behaviour in school-aged children, WHO International Survey) since 2002. The last wave of research was conducted in the spring of 2022. The survey is conducted by anonymous and voluntary self-administrated questioner of more than 4,500 pupils 5th and 7th grade of primary school and 1st grade of secondary school. Life satisfaction was continuously growing from 2002 to 2018, in 2018 92% 15-year-old-boys and 82% 15-year-old-girls are satisfied with life. In 2022 this trend discontinued, the share of girls and boys satisfied with life has slightly decreased. In 2018, as well as 2022 only 5% of pupils of both genders at the age of 13 answered that they love school very much. From 2010 to 2018, there was a slight downward trend in smoking in the last 30 days (current smoking), from 38% pupils both genders at age 15 in 2010 to 26.5% boys and 24% girls in 2018. The downward trend in 2022 continued for the boys, while the share of girls is slightly higher than in 2018. The highest share of students who got drunk two or more times in their lives (risky drunkenness) was recorded in 2006 (48% of boys and 29% of girls aged 15). Since 2006 to 2022, there is a trend of declining drunkenness that continued for the boys, while the share of girls has slightly increased compared to 2018. There were no significant changes in the use of marijuana in lifetime since 2002 to 2022 for girls (11-14%), while the share of boys who used marijuana in lifetime has decreased (16-19% in 2002-2018, 12 % in 2022). This is the first time the share of pupils who used marijuana in lifetime is higher for the girls than the boys. Preliminary data from the HBSC survey for 2022 provide a unique insight into the current health and health behaviour of pupils. Additionally, a comparison with the 2018 pre-pandemic year offers a comprehensive picture of the impact of the pandemic and epidemiological restrictions on students.

Access to healthy water, hygiene, sanitation, clean air and ventilation is recognized as a prerequisite for health, whose significance is particularly evident during the COVID-19 and in other school epidemics such as the spring 2022 Hepatitis A epidemic. During 2020, 149,607 COVID-19 quarantines were imposed at the age 0-14 (25.4% of total quarantines in 2020) and 62,730 at the age of 15-19 (10.6%). During 2021, 269007 quarantines were imposed at the age 0- 14 (37.3%) and 62,730 at the age of 15-19 (12.0%). In 2022, 49,130 quarantines were imposed at the age 0-14 (38.6%) and 9,999 at the age of 15-19 (7.85%). During 2020, 18,354 positive PCR tests under the age of 18 were identified (8.6% of the total positive tests), during 2021, 87,603 positive PCR tests (17.2%), and in 2022, 8524 positive PCR tests under age 18 (20.46%). COVID-19 led to 11 deaths under the age of 18 and 15 at age 18-24. To ensure insight into the access to water, sanitation and hygiene (WASH), the Croatian Institute of Public Health in 2022 conducted a WASH survey in schools. The estimates for basic water availability (source protected from contamination and available water) are 99.8%, for basic sanitary conditions (toilets separate excreta from human contact, usable and sex-separated toilets) are 96.7%, and estimates for the availability of basic hygiene (soap and water facilities) are 99.5%. In conclusion, children and young people in all three pandemic years contributed to positivity and mortality rate with a smaller share compared to adults while with a higher share were quarantined. However, mortality of children and young people from COVID-19 is high in comparison to other infectious diseases. Even with the abolition of all epidemiological measures for educational institutions on April 8, 2022, recommendations on hand and space hygiene and room ventilation remain in place. The WASH project shows good preconditions in schools in terms of water availability and sanitation. This together with continuous efforts and education on hand hygiene, sneezing and coughing hygiene, stay home when you are sick policy and ventilation should remain the foundation of everyday school life regardless of the COVID-19.

In the Republic of Croatia, through the network of services for mental health protection, prevention, and outpatient treatment of addiction of county public health institutes, there is an appropriate branched infrastructure and resources for providing integrated comprehensive services in mental health protection, prevention, and treatment of addiction. These services operate in direct contact with users. They provide comprehensive services for the prevention, diagnosis and treatment of mental disorders and addiction disorders, at the primary level of health care. Within the services for mental health, prevention and outpatient treatment of addiction, there are teams composed of specialist psychiatrists, psychologists, and nurses. The teams are paid by the Croatian Health Insurance Fund, and there are currently 48 of them, most of them in the City of Zagreb. As part of preventive activities in the protection of mental health and addiction prevention, these services mostly work with the at-risk population, and the goal of effective targeted prevention is to strengthen social and emotional competencies, ie the adoption of effective behaviors. As part of preventive activities, these services work closely with other services of the Institute of Public Health, especially the School Medicine Service. Also, mental health services should be closely linked to civil society organizations carrying out mental health and addiction prevention activities, as well as to other stakeholders within the health system.

Aim: To present data from self-reported HPV vaccination status and vaccine hesitancy from the national-level cross-sectional bio-behavioral survey on sexuality-related attitudes, knowledge, and behaviors among people aged 18-25 years. To present data on self-reported vaccination status against HPV and characteristics of vaccine hesitancy among people aged 18-25 years in Croatia. Materials and methods: The participants were chosen from two-stage stratified sampling approach, a random sample from a commercial national online panel to be broadly representative of the emerging adult population in Croatia. Data was analyzed from self-reported HPV vaccination status and vaccine hesitancy from the national-level cross-sectional bio-behavioral survey on sexuality-related attitudes, knowledge, and behaviors among people aged 18-25 years, collected from November 2021 to February 2022. The data was post-hoc weighted for gender and age and adjusted for clustering effects to better reflect the respective population. The questionnaire was online and contained questions about knowledge about STIs, attitudes toward sex, and sexual behaviors. Results were presented using descriptive statistics and multivariate analyzes (those who chose not to be vaccinated are compared to others). Results: The survey included 1197 persons, of whom 48.3% were women. Of total number, 59.3% has not been vaccinated against HPV and 22.1% didn\'t remember. Among 974 unvaccinated individuals or those who didn’t remember, 56.2% reported that they did not want to get vaccinated against HPV (61.0% of men and 50.2% of women). In multivariable analysis, men (OR = 1.62 95% CI: 1.28-2.05), those who were from Adriatic Croatia (OR = 1.76 95% CI: 1.24-2.49) and those who reported to go to church more often (OR= 1.10, 95% CI: 1.03-1.18) had higher odds of vaccine hesitancy. Conclusion: HPV vaccination uptake rate is low, so efforts to increase the uptake of vaccination against HPV should be intensified, especially target the Croatian coastal counties.

INTRODUCTION: The Sars-CoV-2 disease pandemic highlights the importance of high vaccination coverage of population in combating infectious diseases that are a significant factor in morbidity and mortality. Vaccination as “the crown of modern medicine” helps protect the population from infectious diseases and their consequences and reduces the cost of treatment in health care. AIM: The aim of this study was to investigate trends in vaccination of school-aged children in Osijek-Baranja County over a period of 10 years from 2012 to 2021. SUBJECTS AND METHODS: Data about mandatory vaccination in school aged were obtained from medical records in school health service. The study comprised 70 primary schools in Osijek – Baranja County, The total number of respondents ranged from 2279 to 3333 students per year, depending on the year and the vaccine. RESULTS: The total vaccination coverage with all school vaccines (diphtheria, tetanus in 8th grade; poliomyelitis in 1st and 8th grade; measles, parotitis and rubella in 1st grade) was the highest in the first observed year 2012 when vaccination rates for these vaccines were 98.4 to 98.8%. In the following years, there is a slight but continuous trend of declining vaccination rates, which in 2019 reached 93.8 to 94.8%. A sharp decline in vaccination coverage was recorded in the pandemic year of 2020 when the vaccination rate for compulsory school-age vaccines reached 84.2 to 87.8%. In 2021, the vaccination rate have increased again. CONCLUSION: Results of the study showed decline in 2019 and 2020 that could be explained by restrictions caused by the pandemic. After the end of the pandemic peak, vaccination trends are moving in the pre-pandemic direction, although further monitoring is still needed.

Uvod: Preventivnim sistematskim pregledima koji se obavljaju na prvoj godini studija stječe se uvid u predominantne zdravstvene smetnje studentske populacije, što pridonosi kreiranju potrebnih preventivnih programa. Cilj: Cilj ovoga rada bio je istražiti zdravstvene teškoće studenata Sveučilišta Josipa Jurja Strossmayera u Osijeku. Ispitanici i metode: Za potrebe ovoga rada, analizirani su podaci iz zdravstvenih kartona specifične zdravstvene zaštite, studenata prve godine 2018./2019. (N=1927 studenata, 59,40% studentica). Rezultati: Sistematski pregled na prvoj godini studija obavilo je 1857 studenata (obuhvat 96,37%, 59,34% studentica). Kao najčešće zdravstvene teškoće u oba spola zabilježene su: poremećaj refrakcije (M 16,95%, Ž 27,28%), kratkovidnost (M 7,28%, Ž 29,14%) i astigmatizam (M 2,65%, Ž 9,93%). Slijede nepravilno držanje (M 8,87%, Ž 19,74%), skolioza (M 9,14%, Ž 18,54%) i prekomjerna tjelesna masa (M 10,60%, Ž 15,76%). Među rizičnim navikama dominira pušenje (M 20,13% , Ž 25,03%). Vezano za teškoće reproduktivnog zdravlja, kod 13,25% studentica zabilježena je dismenoreja. Zaključak: Rezultati istraživanja pokazali su prisutnost preventabilnih čimbenika rizika za razvoj kroničnih nezaraznih bolesti, kao što su pušenje i prekomjerna tjelesna masa. Rezultati ukazuju na potrebu kontinuirane provedbe promicanja zdravlja i preventivnih programa tijekom razdoblja studiranja u okviru rada školske i adolescentne medicine.

We present the use of online interactive platform and mobile application “Sexual health” and the results of European social fund (ESF) project funded “Volim zdravlje”, an e-learning platform with the aim of preserving and promoting sexual and reproductive health. The central task of the project “Volim zdravlje”, conducted from 22. October 2019 until 21. October 2020, was the development of e-learning courses for pupils, students, experts of health fields, and laymen. Until the end of the project, more than 20 experts compiled 15 e-learning courses, and until the end of 2020 a total of 28 e-learning courses were finished. From September until December 2020, the web site had 23.619 visits and 1.677 courses enrollments passed successfully by 94% respondents. The results of application “Sexual health”, during the period of 5 years (from 15. November 2016 until 15. May 2022), showed 14.147 downloads (GooglePlay (Android): 11.035 (78%): AppStore (iOS): 3.112 (22%)). Among all users (16.523) 45% of them were new and 55% repeated users. Web version was viewed 2.332.051 times by 1.792.469 users (including 86% new users) and with 3.671.174 page views. The application and web platform users were more often men than women (54% vs. 46% respectively), and more often (61%) in an age range 18-34 (most often, in 33.5% of users, the age range was 25-34). The most searched terms were risk calculator, dermatological changes on penis, ureaplasma, gonorrhea, HPV, chlamydia, syphilis, HIV/AIDS, Gardnerella vaginalis, PAPA and HPV tests. Through the section “Ask the expert” 969 questions were answered. In 27% cases, participants were motivated to continue the communication for more information and/or support. Digital media and mobile technologies are tools which could enhance the young people’s knowledge on STDs and sexual and reproductive health and improve their responsible sexual behavior.

Introduction: In the Student health centre of the University of Ljubljana we take care of the health of students. Students are a vulnerable population that needs a good healthcare service: curative and preventive care. Discussion: We perform the systematic preventive medical examinations of first and final-year students. According to the higher education law a preventive medical examination is mandatory in the first year of study, but not in the final year. In the last ten years we have observed a decline in the number of preventive medical examinations performed, especialy of final-year students, and even a further decrease was observed during the COVID-19 epidemic. The number of performed preventive medical examinations decreased by 74%. Two main reasons for that were on-line studies and impaired overall preventive activities during the epidemic. There is also a poor health awareness level among students and faculties. Conclusions: In the future we want to motivate students to attend medical check-ups. Therefore we reorganized the process of medical check-ups and updated the health education workshops. In cooperation with the Faculty of social sciences of the University of Ljubljana we have started the student project: » How to promote health and preventive medical examinations among students«. In the project students exposed poor communication: health centre - faculty – students. Students wish for social media to be a main communication tool. It is necessary to establish a coordinated preventive practice for students and a promotion of students health at the national level.

Introduction: In the Student health centre of the University of Ljubljana we take care of the health of students. Students are a vulnerable population that needs a good healthcare service: curative and preventive care. The systematic preventive medical examinations of students are important to detect health problems, to promote a healthy lifestyle and to increase awareness of risk factors for developing diseases. Discussion: We perform the systematic preventive medical examinations of first and final-year students. According to the Higher education act a preventive medical examination is mandatory in the first year of study, but not in the final year. In the last ten years we have observed a decline in the number of preventive medical examinations performed, especialy of final-year students, and even a further decrease was observed during the COVID-19 epidemic. The number of performed preventive medical examinations decreased by 74%. Two main reasons for that were on-line studies and impaired overall preventive activities during the epidemic. There is also a poor health awareness level among students and faculties. Conclusions: In the future we want to motivate students to attend medical check-ups. Therefore we reorganized the process of preventive medical examinations and updated the health education workshops. In cooperation with the Faculty of social sciences of the University of Ljubljana we have started the student project: » How to promote health and preventive medical examinations among students«. In the project students exposed poor communication: health centre - faculty – students. Students wish for social media to be a main communication tool. It is necessary to establish a coordinated preventive practice for students and a promotion of students health at the national level.

There are many milestones available to measure child development in the first years of life. For less experienced professionals it is difficult to select the most relevant milestones to assess the developmental status of a child. Moreover, using the milestones separately makes is difficult to get a global impression of the developmental status. The D-score can assist professionals in obtaining a global sense of early child development, because milestones are unified into one scale. The D-score is created by using the Rasch model, which has many advantageous properties, one of which is to enable more efficient administration by means of adaptive testing. An adaptive test does not use a fixed set of questions, but instead tailors the questions to the child. Therefore, adaptive testing can substantially reduce test length, and thus administrative burden while maintaining almost equivalent precision as compared to a traditional sequence-based administration of the test. Adaptive tests are widely used in education and tailor the next question to the individual child based on the responses to the previous questions. The adaptive test selects a first item (i.e., starting item) based on the age of the child. After recording the response to that item, the underlying algorithm calculates the D-score for the child and determines whether the result is precise enough to meet the stopping criterion. If the stopping criterion is not met, the computer selects the next item, such that it provides maximal information given all previous responses of the child, and the cycle continues. Adaptive testing is an efficient measurement technique that can improve the practical measurement of early child development. The D-score can support professionals in selecting milestones for children at any age and can quickly provide a global sense of the developmental status. In the presentation a demonstration will be given of an adaptive test to measure child development.

COVID -19 epidemic changed the way of medical health services for preschool, school children and adolescents. The schools in Slovenia were closed for 41 weeks. The measures in place included the restriction of preventive check-ups for all children. On the basis of the opinion of the Extended Expert Council for Paediatrics, delayed check-ups were allowed, for the pre-school and school children, especially when vaccination was administered. Thus, preventive check-ups were carried out for school children in the 3rd grade and also in the 6th grade, where the first dose of the HPV vaccine (human papillomavirus) was administered. Under strong restrictions the medical check-ups were individual accompanied by parents. Until 2021 the schedule of vaccination of HPV was obligatory only for girls in the 6th grade, free of charge. In the new school year 2021/22, boys were as well included in the national programme. Some school doctors and paediatricians in certain regions have been very successful in vaccinating boys for many years with funding from other sources, and some doctors have vaccinated on a self-payment. A survey was conducted to assess the effectiveness of the check-ups and vaccinations during the epidemic. Methods: A survey of school doctors and paediatricians was carried out in March 2022, on the implementation of preventive check-ups during the epidemic. 61 school doctors and paediatricians responded. We will only present the part of the results related to HPV vaccination. The results showed that slightly over 60% answered that preventive check-ups and vaccinations were within the expected, planned range. The rest were distributed on fewer check-ups and vaccinations performed or on better vaccination and more preventive check-ups to compensate for the deficit from 2020/21. Conclusion: Despite restrictions, preventive medical examinations and HPV vaccinations were conducted during the COVID 19 epidemic. During the epidemic school year 2021/2022 HPV vaccination programme was confirmed for girls and boys 6th grade.

The 2019 EUSUHM declaration on Early Life Stress (ELS) has resulted in creating a national collaboration in the Netherlands. Members of national professional associations for youth health care physicians and nurses formed a committee on ELS. This committee focusses on 8 goals: (1) to increase knowledge and awareness of physiology and pathology associated with ELS, (2) create a national expertise group and offer unambiguous terminology, (3) stimulate implementation of knowledge and tools to address ELS, (4) promote normalization of positive and beareable stress, (5) provide tools to recognize ELS and intervene if necessary, (6) follow and join (inter)national developments, (7) advize the boards of associated professional organizations, (8) and collaborate with academic organization and knowledge institutes. In our workshop we will like to show our experience and exchange ideas between countries. Together we can discuss how to reach the goals from the declaration.

Food craving is defined as an intensedesire to consume food that is not intended to satisfy hunger and it is very hard to resist that need. Cravings are positively associated with Body Mass Index (BMI) and get worst with dieting. Fad diets prevail as a weight control practice among youth. Fad diets alter eating behaviour, increase the risk for developing an eating disorder and many more health risks. Cravings are more common in women, who are particularly sensitive regarding their body image. An online observational study was conducted to analyse fad dieting practices and food cravings. The Food Cravings Questionnaire – State (FCQ-S)was used to analyse food cravings. 43% of participants said they are currently dieting, 80.5% said they tried at least two different restrictive diets while even 34.1% said they tried 10 or more fad diets. Personal dissatisfaction is the main reason behind the decision to go on a diet (64.5%). Women who are currently dieting are two times more likely to say that they have excess weight in comparison to women who are currently not dieting (86.9% vs 48.7%). Food cravings are higher among those currently dieting and among those with higher BMI. The results show clear need for interventions with youth to broaden their knowledge of the traps behind very restrictive fad diets.

Introduction: Children and youth with special healthcare needs (CYSHCN) require more health care than their typically developing peers. Theirs healthcare need can include physical, intellectual, and developmental disabilities, as well as long-standing medical conditions, such as asthma, diabetes, blood disorder, or muscular dystrophy. Hence the aim of the annual check-up (systematic preventative screening) is holistic management of CYSCN’s condition, tailored health education and close cooperation with family (counselling and information about their health and social care rights, services, access to aids) as well as close cooperation with other medical and educational institutions. Methods: We describe the population of CYSHCN we work with and provide strategies to optimize medical and health outcomes. We present initial health assessment and annual check-up we perform regularly at CIRIUS Kamnik. We analyze the data of realisation of preventative programme during last 3 years from 3 sources: our own database, voluntary anonymous online survey conducted among the members of the Association for Adolescent Medicine and Primary Care Paediatrics, and a review of data in Slovenian Health Statistical Yearbook. Results: We provide the contents of child’s primary care doctor\\\'s assessment and the strategies we use in everyday practice. During COVID-19 pandemic, implementation of the prevention programme has been reduced according to all three analyses, most markedly in the school year 2020/21, when the uptake of preventive examinations at CIRIUS Kamnik was only 23%. According to Health Statistical Yearbook 2020 of Slovenia, 20% fewer individuals enrolled in schools with special programmes were screened that year than in previous years. Even more than implementation of preventive screening itself, implementation of health education has been curtailed. Conclusion: Addressing needs of this population to achieve high-value health care requires optimizing care. During COVID pandemics screening was reduced by 20%, though its long-term and non-urgent consequences cannot be evaluated yet. Opportunities exist for health care providers to develop strategies to enhance care delivery and to decrease costs, too. Important outcomes include decreasing unplanned hospital admissions, decreasing emergency department use, ensuring access to health services, limiting out-of-pocket expenses for families, and improving patient and family experiences, quality of life, and satisfaction with care.

The health care needs of older children and adolescents has evolved a lot over the last two decennia’s, with a gradual shift from transmissible diseases or pure somatic disorders or defects towards so-called non-communicable diseases (NCDs) and behavioral problems. This shift influences heavily the objectives and the content of school health programs and activities, including a reduced number of screening procedures and an emphasis on educational and environmental measures. The experience gained from the COVID pandemic illustrates the need for a global and sustainable appraisal of school health procedures and strategies. As can be understood, this evolution of the school “ landscape” affects the training of school health professionals. Based on a series of recent international reports, the presentation will focus on the different roles of school health specialists, whose activities should go beyond the mere delivery of health care and health education. According to the World Health Organization, the standards driving the education of these professionals can be based on the well-known CanMEDS framework of the Ottawa: Royal College of Physicians and Surgeons of Canada. The pedagogic approach and content of this training must be tailored by the challenges brought by current state of adolescent health and well-being and incorporate responses to topics as various as mental health, sexual and reproductive health and rights, substance misuse, eating dysfunctions, misuse of social media as well as injuries and self-harm. In addition, the training should address urgent broader issues such as the increase of migration and multiculturalism, or the global menace to the climate and the environment.

In European countries, there is significant heterogeneity of child health care services. The number of European pediatricians is calculated at around 200,000 pediatricians working in 53 different countries and caring for approximately 200 million children below 18 years of age. The models in primary paediatric health care in Europe involve paediatric system of primary care, a general practitioner/ family doctor system and combined system. Most general practitioners have a lack of training in dealing with community paediatrics concerns such as mental health, immunizations, and other preventive measures. Unfortunately, many European countries have reduced or eliminated primary care paediatrics, justifying it by the need for savings in the health care system. Children in the modern world are exposed to “new diseases” in the circumstances of globalization, industrialization and urbanization. Most of the new diseases in children refer to adolescents. Adolescents are at high risk of tobacco, alcohol, and substance use, drunk driving, suicide, smoking, violence, early unintended pregnancy and sexually transmitted infections as the primary causes of morbidity and mortality. This is why it is decisive that children are cared for by multidisciplinary teams offering complex child health care by paediatricians, nurse practitioners, psychologists and others. Croatia has a great tradition and experience of specialization in school and adolescent medicine. This is the reason for good preventive and educational work with adolescents. It is all heritage of Andrija Štampar, the author of the Constitution of WHO and his main directions for the future: 1) child protection is one of the main concerns of the state 2) it is a condition for improving public health in general, 3)It must not depend on private initiative.

Increasing trend in the prevalence of chronic diseases and complex symptomatology in children and adolescents age emphasizes the clinical and public health importance of transitional medicine. Primary goals of a successeful transition are to empower the young people to take responsibility for their own health, that is, to take responsibility for treatment and control of chronic disease, if it exists. Secondary goals are to prevent the development of comorbidity and disability and to achieve best possible quality of life. The transition of health care is a complex, long-lasting and structural process which includes the preparation of the patient, written report on the treatment and health status, as well as further treatment plan and direct communication between the doctor, mainly pediatrician, and the school medicine and family medicine specialists, internal medicine specialists and related professions. In practice, a simplified transfer from one activity to another is most often carried out which causes insecurity and frustration especially among chronically ill adolescent patient. The transitional medicine barriers result from the peculiarities of the developmental age of the patient, the specificities of basic and associated diseases, functioning of the health system, availability of sophisticated diagnostic and interventional procedures as well as population health education. Perception of health care transition is different if observed from the perspective of a healthy adolescent who is burdened by physiological maturation itself and who mostly minorizes and denies health problems, or parents who are worried about the uncertainty of the outcome of the separation of the independent functioning of their chronically ill child. Exactly at that sensitive adolescent age the discontinuity of health supervision is often observed and time gap in patient follow-up as recommended by the profession is recorded. The starting point is in understanding the need of the chronically ill children and adolescents, the education of the patient about the peculiarities of the disease but also professional readiness of the adult medicine doctor to accept a child with complex symptomatology into care. Education of health care users and families of especially chronically ill children as well as sensitization of employees of the health and educational system to the issue of transitional medicine is a prerequisite for its successful implementation in practice.

INTRODUCTION: Before entering 1st class of primary school up to March 31st of the current year, each child aged 6 years is provided with medical examination by School Health Specialist for the psychophysical maturity assessment before school enrolment. AIM: To present data on psychomotor development in children and respective treatment at pre-school age. SUBJECTS AND METHODS: Using retrospective analysis, data on psychomotor development of 1123 children from preventive health records in 6 school health care facilities of SDC were analysed. RESULTS: From 1123 children mature for entering 1st class of the primary school, there were 50.2% boys and 49.8% girls. It was reported that 88.7% of children resulted from healthy pregnancy and 94.5% from regular delivery. At pre-school age, 3.8% of children were provided with speech therapist treatment, 1.2% with psychology treatment, 0.7% with treatment provided by educational rehabilitator, 3.0% by physiotherapist and 0.2% by psychiatrist. On school admission, speech disorders were established in 13.2% of children and thus given the overall number of the examined children, 5.8% of children were referred for speech therapist, 1.6% for educational rehabilitation, 2.4% for psychologist, 1.5% for psychiatrist and 0.2% for physiotherapist. 1.3 % of children with psychomotor disorders were processed for an appropriate form of schooling, and 5.5% of the children were in the observation process. CONCLUSION: The significance of early detection and treatment of psychomotor disorders in children along with parental and professional support is highly important for attaining developmental potentials in children.

AIMS: Systematically addressing the healthcare necessities of the population based on the analyses of the state of health, is a good foundation for healthy development of children and adolescents. MATERIALS AND METHODES: To discover the influence of epidemics on the health of School children and adolescents we compared the data from regular preventative checks from the database of the National Institute of Public Health, the data from the Sports Education Card (SLOfit) and the HBSC study -2020. RESULTS: In the years leading up to the epidemic the response to regular preventive checks was up to 98% for school children and adolescents. This decreased by 26% during the 2020/2021 school year. During the epidemic years 2020 and 2021, however, we noted a distinct increase in the levels of obesity (up to 30%), alongside a deterioration of locomotory efficacy (by 16 %) in schoolchildren and adolescents. A recently published study HBSC 2020 revealed that predisposition towards mental disorders is higher in adolescents that come from families with a lower self-assessment of prosperity as well as non-traditional families. The likelihood of depression was 18,8% vs. 37,7% and suicidal ideation was 13% vs. 39,7% when comparing the general population of adolescents to adolescents that come from families with a lower self-assessment of prosperity. CONCLUSIONS: These findings set numerous challenges regarding preventative and curative healthcare, which need to be addressed as soon as possible. Ensuring a healthy lifestyle with a family-centred approach, and the creation of mental health centres for children and youths are both important systemic measures that have already been put into practice in Slovenia.

U godini mladih 2022. naglasak je na cjelovitoj zaštiti školske djece i omladine te adolescenata. Za provedbu ovakove zdravstvene zaštite potrebno je nadopuna znanja i vještina profesionalaca koji pružaju zdravstvenu zaštitu ovoj populaciji. Potrebno je jasno definirati ulogu adolescentne medicine i znanosti koja prati potrebe populacije. U pandemiji Covid-19 bilo je otežano ili onemogućeno provođenje preventivne zdravstvene zaštite školske djece, mladih i studenta, radi provedbe mjera protiv širenja epidemije 19 (ograničenje kretanja, školovanje na daljinu, strah od zaraze...). Brojne zdravstvene teškoće školske djece i mladih nije bilo moguće primjereno rješavati u ovoj izvanrednoj situaciji. Posebice je to došlo do izražaja u zdravstvenoj zaštiti studenata koja se pruža u Studentskom dispanzeru u Ljubljani, gdje je bio slab odaziv studenata pozvanih na preventivne preglede za vrijeme pandemije. U epidemiji Covid-19 pokazali su se i nedostaci pravilnika za izvođenje preventivne zdravstvene zaštite škoslke djece i maldih, uključujući studenate. U cilju poboljšanja predstavljeno i osnivanje instituta za adolescentnu medicinu i prventivnu pedijatriju na Medicinskom fakultetu Univerziteta u Mariboru.

Long-term efforts to increase vaccination coverage since 2007 have helped us increase vaccination coverage in the city of Zagreb during the second year of the pandemic by 23% - 38% . With the application of all the benefits we have (free for the target population, gender neutral, included in the National Plan and Program on immunization, and increasing awareness and importance of HPV vaccination in 8th grade. Infections caused by HPV lead to the development of premalignant and malignant changes in the cervix, vulva and vagina, precancerous lesions and cancer of the anus and genital warts in men and women. This vaccine can be considered as vaccine against cancer, therefore our goal is to first reach global then European recommendations for the elimination of cervical cancer. In 2019., The World Health Organization issued Recommendations for the elimination of cervical cancer and in 2020 the organisation adopted a Global Strategy to accelerate the elimination cervical cancer (incidence rate <4 / 100,000 women). Strategy are 90-70-90 https://www.who.int/news-room/fact-sheets/detail/cervical-cancer The European Commission adopts Recommendations strategy for the elimination of cervical cancer, which are 90-95-90,https://ec.europa.eu/commission/presscorner/detail/hr/ip_22_702 We must also emphasize the work of specialist doctors in combating the epidemic in schools (imposing measures of isolation and self-isolation),. In addition to working on the prevention of the spread of COVID 19 infections in schools in the city of Zagreb, Vaccinated students in 8th grade 2020/2021 / number of students 7490 / vaccinated 2907 Vaccinated students in 8th grade 2021/2022 / number of students - 7931 / vaccinated 2912 Through both school and academic years, a catch-up program for young people up to the age of 25 is provided in the competent school clinics. Conclusion: The availability of vaccinations and the additional involvement of school physicians has led to a positive response from the population and trust in the vaccinator and thus to an increase vaccination coverage In Croatia.

Traditional nursing practice has been known since ancient times, however, it can be said that the beginnings of professional nursing date back to the end of the 19th century with the establishment of the first nursing schools. at the end of the 19th century, the entire Western world began to introduce formal nursing education into its national programs. This trend in the education of nurses is also happening in Croatia when the doctor Dr. Andrija Štampar founded the first health institutions in the field of public health and recognized the need for educated nurses. nursing is integrated into all levels of health care. Public health is a social and political concept whose goal is to improve health, extend and improve the quality of life of the population through health education, disease prevention and other forms of health and other interventions, where it is unthinkable to implement measures without a nurse as an equal member of the team. The nurse / technician represents an essential role in the professional team of school medicine. In his work, he cooperates and complements himself with the school medicine doctor. Before the medical examination, he takes a social history, performs anthropometric measurements (body height, weight, body mass index), examines vision and measures blood pressure and pulse. A very important task of a nurse is communication and health education, which are part of her daily work. The knowledge and skills of this work are acquired through competences, knowledge and training. In a large part of the health system in the world, there is a school nurse profile. In the Republic of Croatia, there is no school nurse profile, but health-educational work is integrated into the daily work of a nurse. There is a need for specific postgraduate training programs in school health, especially for school doctors and school nurses. It is the duty of all healthcare professionals to carry out health promotion. In July 2022, the Croatian Chamber of Nurses submitted to the government a proposal on amendments to the Ordinance on the additional training of nurses in so-called specializations.

Importance of adolescent-friendly health services is recognized among public health experts and encouraged in WHO health strategies and Croatian health promotion programs. Due to specifics of physical, emotional and psycho-social development, adolescents require specific health care approach. Youth friendly services should be recognizable, accessible, confidential, comprehensive and low cost/free of charge. Setting should be acceptable, without stigma and time limits, approach should be holistic. Aim of the review is to present fifteen years’ experience in developing the largest Youth Friendly Service in Croatia. Youth Friendly Service must be responsive and up to date to adolescent needs in order to fulfill its primary goals – health preservation and health promotion.

Introduction Children with major motor difficulties or chronic illnesses are candidates for temporary forms of education, regulated by Act on Education in Primary and Secondary Schools and Regulation on Primary and Secondary Education of Students with Difficulties. Temporary forms of education could be organized at home, in health care facility or virtual (distance learning). Distance learning is appropriate for students who due to health reasons not allowed being in direct contact with the teacher. Discussion During coronavirus pandemic (COVID-19) numbers of students were locked out of their schools. They had access to some form of in-person learning, from the traditional five days a week to hybrid models. In Croatia, the schools had choice between three models of teaching depending on the epidemiological situation (A - teaching in school, B - mixed model, C - online teaching). Online teaching was conducted in cases of student’s isolation due to the COVID 19 disease or self-isolation and for students with an increased risk of developing complications due to contracting the disease COVID 19. Temporary forms of education have come in focus despite the introduced models of teaching during the pandemic years. There was an increase of application numbers for individual distance learning. In school year 2018/19, there was seven applications, 10 in 2019/20, 21 in 2020/21 and 27 in 2021/22. Conclusion Pandemic years were exclusively challenging for teachers and students. Development of digital skills could be considered as a positive impact, but growth and development in common social environment, emphasising school setting, unquestionable have been negatively affected.