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

Primary health care in Osijek- development and achivements

Od prvih početaka organizirane zdravstvene zaštite u Osijeku, početkom 18. st. provode se intervencije na razini primame zdravstvene zaštite. Vojne i civilne vlasti organizirale su zdravstvenu skrb tako da bude usmjerena prema zaštiti zdravlja naroda. Na temelju zamisli dr. Andrije Štampara počinju se stvarati institucije i ustanove koje imaju zadaću organizirati zdravstvenu zaštitu cijele populacije (u narodu - za narod). Današnji Dom zdravlja Osijek počinje raditi u zgradi izgrađenoj 1939. godine na lokaciji na kojoj djeluje i danas. Unatoč nizu organizacijskih oblika koji su uslijedili iza Drugoga svjetskog rata Dom narodnog zdravlja značajno povećava obim djelatnosti, povećava se u broju objekata i lokacija na kojima funkcionira. Za vrijeme Domovinskoga rata djelatnost se održava na visokoj razini, a nakon toga Dom zdravlja Osijek postaje čvrsta poluga pružanja primame zdravstvene zaštite u Osijeku i okolici.From the very beginnings of organized health care in Osijek, at the beginning of the 18th century, interventions based on primary health care have been implemented. Military and civil authorities organized health care in a way that it included health care of the public. With an idea of Dr. Andrija Štampar institutions and facilities, which had the assignment to organize health care of the whole population (in population - for population) started to form. Today\u27s Health Centre Osijek started with work in a building, which was constructed in 1939 on the location where it is today. In spite of many organizational forms that had followed after the World War II, Public Health Centre has been significantly increasing the scope of work and number of buildings and locations. During the War for Croatian Independence work maintained on a high level, and afterwards Health Centre Osijek has become a steady basis for primary health care in Osijek and its surroundings

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

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region

Quality of Life of Patients after Stroke in County Osijek-Baranya

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center. The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients’ physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p<0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (c2-test, p=0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p=0.009) and total SS-QOL (Friedman p=0.014), while in women there was no statistically significant difference between the measurements (Friedman p=0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health

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

Prvi rezultati Nacionalnog programa skrininga raka dojke u Osječko-baranjskoj županiji

The incidence of breast cancer is rising among women in many European countries, affecting up to 1 in 16 women. In 2005 in Croatia, 2,303 women were affected by breast carcinoma with the incidence of 100.1/100,000. In 2006, 830 women, or 36.1/100,000 women died from breast carcinoma. In October 2006, a mammography screening program was launched as the first national-based cancer screening program in Croatia. In our paper, we described the first results of the screening program in the Osijek-Baranja County. The target population was women aged 50-69, about 41,678 women in the Osijek-Baranja County, with a two-year screening interval. All data collected until December 2007 were represented in contingency tables. Until December 2007, nearly 31,638 women were invited, and the participation rate was 51.0%. Based on the number of the reports to the County Public Health Institute, a total of 14,126 women underwent mammography, considering the fact that the reading and analysis of the mammograms takes about 20 days. For women born in 1937, 1954 and 1955, for whom the analysis is completed, the responding rate reaches 60.7%. The reason for non-responding to the screening is known for only 24.1% of all invited women. The most common reason was an incorrect address – 13.7%, and 4.6% of the invited women did not want to undergo screening. There were 204 cases (or 1.47%) of a suspected cancer (classified as BI-RADS 4 and 5), referred to prompt further diagnostics. Fifty-eight new cancer cases were diagnosed until 23 January 2008. Women of an older age responded less compared to women of a younger age. The main difficulty with inviting was a wrong address, which resulted in 2,129 women not responding to the invitation. The knowledge about benefits of all screening programs requires to be strengthened. For better results of the National Program, important are companionships of different sectors and communities (for example NGO).Hrvatska se nalazi na visokom mjestu među europskim državama po proširenosti i smrtnosti od malignih bolesti. Iskustva razvijenih zemalja su pokazala da se implementacijom programa primarne prevencije i ranog otkrivanja raka, na nacionalnoj razini, može značajno smanjiti mortalitet od raka i poboljšati kvaliteta života oboljelih. U Hrvatskoj je 2. studenog 2006. god. započela primjena Programa skrininga raka dojke, kao dio prihvaćenog Nacionalnog programa prevencije i ranog otkrivanja raka najčešćih lokalizacija: dojke, debelog crijeva, vrata maternice i prostate. U Hrvatskoj je rak dojke najčešće sijelo i vodeći uzrok smrti od raka u žena sa stopom incidencije od 100,1/100.000 žena (2005.) i stopom mortaliteta od 36,1/100.000 žena (2006). U Osječko baranjskoj županiji je 2005. incidencija raka dojke iznosila 99,5/100.000, a mortalitet 43,6/100.000 (2006). I incidencija i mortalitet od raka dojke u Hrvatskoj u stalnom su porastu. Linearni trendovi stopa incidencije i mortaliteta, za rak dojke, u Osječko-baranjskoj županiji, viši su od prosjeka za Hrvatsku. Prema stopi mortaliteta Osječko-baranjska županija se nalazi na visokom 4. mjestu među županijama u Hrvatskoj. Zbog toga bi uspješna implementacija Programa ranog otkrivanja raka dojke bila osobito značajna u toj županiji. Cilj ove prezentacije je prikazati prve rezultate (14 mjesečnog razdoblja) implementacije Programa skrininga raka dojke u Osječko-baranjskoj županiji, te razmotriti nedostatke, kao i moguće mjere za poboljšanje implementacije toga Programa. Izvješće zaključno s danom 12. prosinca 2007. god. pokazuje da je mamografiju obavilo ukupno 14.126 žena, odnosno da je toliko pristiglih nalaza u Zavod za javno zdravstvo Osječko baranjske županije, ali treba uzeti u obzir da je za očitanje i obradu nalaza potrebno prosječno 20 dana. Ukupni odaziv je u Osječko-baranjskoj županiji na razini 60%, što je svrstava u županije s boljim odazivom. Za kompletno obrađena godišta, 1937, 1954 i 1955, odaziv je i veći i iznosi 60,7%. Od ukupnog broja snimljenih žena, njih 204 (1,47 %) je imalo nalaz BI-RADS 4 i 5, te su upućene na daljnju dijagnostičku obradu. Do 23. siječnja 2008. u Osječko-baranjskoj županiji je utvrđeno 58 novih slučajeva raka dojke. Analizom odaziva, po godištima, kao i razloga neodazivanja na snimanje, može se uočiti da su žene najstarijeg, 1937. godišta, koje su i prve pozivane na snimanje, postigle najslabiji odaziv, češće su odgovorile da ne žele obaviti pregled, dok se žene mlađih godišta češće nisu javile na pregled. To upućuje na potrebu različitog pristupa motivaciji žena za skrining, s obzirom na dob, kao i vrijeme proteklo od početka primjene Programa. Naknadnim pozivanjem žena koje se nisu odazvale na snimanje, bilo poštom, bilo putem službe patronažnih sestara, povećao se broj žena koje su se odazvale na mamografiju. Važan razlog neodazivanja su i netočne adrese u osnovnom popisu stanovništva. To sve upućuje na potrebu boljih priprema za implementaciju skrining programa, uključujući pomnu pripremu medijske kampanje, ažuriranje popisa stanovništva, te bolju suradnju različitih segmenata zdravstvenog sustava, kao i zajednice u cjelini