Pharmacoeconomical Impacts of Crohn’s Disease

Provide an overviewof Crohn’s disease and its cost assessment options, establish the need for implementing Croatian national Crohn’s Disease Registry to precisely quantify the costs and the outcomes, and establish model to evaluate values of treatment options for Crohn’s disease

How to improve teaching in family medicine

The family physician has a specific task and responsibility as the first contact physician. Therefore his/her education needs to be highly specific, oriented towards independent work in real time and evidence-based medical principles. The most important role in educating a family physician belongs to physician practitioners, individuals who work in clinics and need (as much as possible) to transfer knowledge, skills and experiences from their own specific conditions and a wide variety of work methods. Therefore the experience and suggestions of teachers in practical training are considered to be the most significant contribution to improving the quality of teaching. The most important suggestions pertain to reducing the size of seminar groups, including family medicine courses in the fourth and fifth year of studies, and increasing the possibilities for students to do independent work, with supervision by their mentors. For good preparation of future physicians for independent work it is necessary for family medicine departments to be able to organize practical training and seminars in as many courses as possible, with as many classes as possible. A good professional basis in terms of selected teachers and practical training teachers is required to make this possible

Anthropological, Demographic and Socioeconomic Characteristics of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) in one of the most frequent functional gastrointestinal disorders (FGIDs) with a prevalence in 10 to 20%, of cases in some developed countries. The Rome Foundation has drawn up Rome III criteria, diagnostic questionnaires and scoring algorithm for FGIDs, applicable in clinical practice and population studies. The aim of this research is to determine the presence of IBS in Osje~ko-baranjska County and the effect of anthropometric, demographic and socioeconomic factors. 703 subjects selected in the systematic sample filled in the Rome III diagnostic questionnaire for IBS. Prevalence of IBS was recorded in 29.16%, in men in 21.39%, and in women in 36.69% of cases, anxiety and depression in 26.34% and 25.85%. Persons suffering from IBS were on average shorter, weighed less and had a lower BMI than persons not showing signs of IBS. Women have 2.101 times greater chance of risk of IBS, and with an increase in the number of members in the household the risk of IBS increases 1.139 times. Rome III survey questionnaire is an acceptable method for diagnosing IBS and identifying persons showing signs of structural changes in order to provide further treatment

Screening with Mammography Organized by Family Physicians Teams: What Have We Learnt?

The mammography, recommended as standard method for screening on breast cancer, can reveal suspicious lesions early enough to anable cancer elimination in entirely. Experience with women of the target population, 50–69 years old, included in the mass screening programs, show the reduction in the specific mortality by 30%. One of the main problem in organizing the preventive programs is how to increase responsiveness of subjects to screening. In the study, based on the large sample of over 1000 of subjects and 20 family medicine practices, included in the investigation, we showed that it is possible, by a pro-active involvement of family physicians teams and intensive educational and motivational activities, to achieve high level of over 80% of responsiveness to mammography screening. Analysis of the reasons of nonresponsiveness can contribute to better understanding of the mental processes included in a self-decision making. This, as the final aim, can help family physicians in their efforts to overcome many hidden barriers which obstruct their patients to accept the mammography screening

Cervical Cancer in Osijek-Baranja County – Possibilities for Prevention

In Osijek-Baranja County, there was a rise in the number of non-invasive and fall of invasive cervical cancer in the period 2000–2008, but cervical cancer still represents an important public health problem in Osijek-Baranja County. Cervical cancer in 2008 was the ninth female cancer site and represents 3.5% of all malignant diseases in women. In the same year it was also at the ninth place of all cancer deaths in women with a share of 3.3%. The large number of women cervical cancer was detected at an advanced stage of the disease so that there is an pincrease in mortality from cervical cancer. Although the incidence of cervical cancer is lower in relation to Croatia and other countries in the region, the mortality rate is still higher than in the countries of Western Europe. In order to reduce the incidence and mortality of cervical cancer primary task of the public health system is the introduction of secondary prevention through properly organized screening program. The program should be tailored to the financial and human resources and local specificities, with the agreement on a strategy that will give the best results

Screening with Mammography Organized by Family Physicians Teams: What Have We Learnt?

The mammography, recommended as standard method for screening on breast cancer, can reveal suspicious lesions early enough to anable cancer elimination in entirely. Experience with women of the target population, 50–69 years old, included in the mass screening programs, show the reduction in the specific mortality by 30%. One of the main problem in organizing the preventive programs is how to increase responsiveness of subjects to screening. In the study, based on the large sample of over 1000 of subjects and 20 family medicine practices, included in the investigation, we showed that it is possible, by a pro-active involvement of family physicians teams and intensive educational and motivational activities, to achieve high level of over 80% of responsiveness to mammography screening. Analysis of the reasons of nonresponsiveness can contribute to better understanding of the mental processes included in a self-decision making. This, as the final aim, can help family physicians in their efforts to overcome many hidden barriers which obstruct their patients to accept the mammography screening

Demographic, Anthropometric and Socioeconomic Characteristics of Functional Constipation in Eastern Croatia

Aim of the research is to establish the prevalence of constipation in Osječko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (χ2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health status by self-assessment. According to t-test persons with constipation on average are older, have higher average BMI and lower average grade valued financial status of households and their health. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. Functional constipation presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosing this functional disorder in clinical-consilliary and primary health care, and for persons showing signs of alarm and needing further diagnostic treatment

Irritable Bowel Syndrome in Croatia

There are three epidemiological studies of irritable bowel syndrome (IBS) that were conducted in Croatia (in the area of Zagreb in 2002, Bjelovarsko-bilogorska County in 2008, and finally in Osječko-baranjska County in 2011). The aim of this study is to analyze the anthropometric, demographic and socioeconomic characteristics of IBS in Croatia comparing these three studies. The studies included a questionnaire based on Rome criteria. Study population matched the adult population of Croatia according last available census (1991, 2001 resp.). Studies showed a high prevalence of IBS and some common factors relevant for development of IBS were determined such as gender, body mass index and lower level of education. There is a need for further investigations in coastal Croatia applying a uniform questionnaire on anthropometric, demographic and socioeconomic characteristics of IBS and Rome III criteria, diagnostic questionnaires and scoring algorithm for functional gastrointestinal disorders developed by Rome Foundation applicable in clinical practice and population studies, regarding the significant high prevalence of IBS in our country

Breast Cancer Detection: Role of Family Physicians

Croatia started implementing the national programs for early breast cancer detection in 2006, early detection of colon cancer and early detection of cervical cancer. A possible way to improve the adherence of the women to the screening on breast cancer could be by transferring the responsibility for the program implementation from the public health institutes to family physicians. The Project: »Model of early cancer detection integrated in a practice of family physician«, was carried out by the Department of Family Medicine of the Osijek University School of Medicine. The results have shown that responsiveness of women invited to do preventive mammography was significantly higher in the experimental than in the control group. The central role of FM in the implementation of preventive programmes has already been recognized in many countries as an advantage from the organizational aspects and by means of decreased expenditure, compared to the vertical programmes with strict formal control centered to the public institutions

Functional disorders of anorectal region

Funkcionalni poremećaji anorektalne regije definirani su različitim simptomima koji se razlikuju od pacijenta do pacijenta, a determinirani su različitim lokalizacijama vezanim uz anatomske strukture i obilježja funkcionalnih poremećaja. Postavljanje dijagnoze može biti otežano obzirom da uzročna veza između strukturalnih poremećaja i anorektalne disfunkcije ili nejasnih crijevnih simptoma ne mora biti jasno izražena, pri čemu se svaki poremećaj može pratiti i kod asimptomatskih pacijenata. Klinička obrada pacijenata može otkriti strukturne i funkcionalne poremećaje koji ne moraju nužno objasniti postojanje prisutnih simptoma. Iako postoje značajne razlike u lokalizaciji i simptomima, poremećaji imaju i dosta zajedničkih elemenata, kao npr. u odnosu na motoričku i osjetnu funkciju, odnosa prema CNS-u te pristupu liječenju. Funkcionalni poremećaji anorektalne regije sukladno Rimskim III kriterijima mogu biti uzrokovani poremećenom funkcijom normalno inerviranih i strukturno neoštećenih mišića, psihološkim poremećajem, odnosno neobjašnjivi na neki drugi način, kao što su minimalni poremećaji mišićne inervacije uz prisustvo minimalnih strukturnih oštećenja ili uz njihovu potpunu odsutnost. Ostali uzroci su: poremećaj inervacije uzrokovan centralnim oštećenjem mozga, kralježnične moždine ili oštećenja živaca ili mješovitog oštećenja autonomnog perifernog živčanog sustava, oštećenja analanog sfinketra povezanog s multisistemskim bolestima i strukturalna oštećenja za koja se vjeruje da su najveći uzročnik fekalne inkontinencije.Functional disorders of anorectal region are characterized by different symptoms that vary from patient to patient and are determined by different localization of disorders related to anatomical structure and characteristics of disorder. Diagnosis can be difficult in some patients, because the causual connection between structural disorder and anorectal dysfunction or unclear bowels symptoms isn’t clearly expressed and noticealbe, because every disorder can be found even in asymptomatic patients. Structural and functional disorders can be detected by clinical analysis of the patients which does not necessary explain the presence of the symptoms. Although there are significant difference in localization and symptoms disorders have meny common elements, as for example regarding motoric and sensory function, attitude towards CNS and in the treatment approach. Functional disorder of anorectal region according to Rome III criteria can be caused by dysfunction of normaly inervated and structurally undamaged muscle, psychological disorder or by some unexplained cause such as minimal disorders of muscle innervation with the presence of minimal structural damage or with their complete absence. Other causes are: innervation disorder caused by central brain damage, spinal cord or nerve damage or mixed damage of autonomic peripheral nervous system, or damage of anal sphincter connected with mult-systemic diseases and structural damage which are believed to be major causes of fecal incontinence. Diagnostic and treatment, as individual functional disorders of anorectal region, depends on symptomatology, longlasting and recurring symptoms which indicate the functional disorders