Control of colon cancer: experience with the Osijek program of protection

Rak debelog crijeva u našoj zemlji zauzima drugo mjesto na ljestvici incidencije i mortaliteta zbog malignih bolesti. U razdoblju od 1968. do 1994.godine stopa incidencije na 100.000 stanovnika porasla je od 13,8 do 37,1, a mortaliteta od 8,3 u 1968. na 28,1 u 1997. godini. Mada je kolorektalni karcinom relativno lako dostupan dijagnostici i terapiji, u našoj je zemlji zabilježeno nisko 5-godišnje preživljavanje (u Osijeku 29,6% slučajeva). Cilj istraživanja bio je: a) sažeti iskustva o primjeni zdravstveno-odgojnih aktivnosti u sprečavanju i suzbijanju raka debelog crijeva u općini Osijek, b) prikazati iskustva o valjanosti: osjetljivosti i specifičnosti testa na okultno fekalno krvarenje (Hemoccult testa) kao pokazatelja kvalitete i prihvatljivosti u detekciji kolorektalnog karcinoma, praćenjem pojave kolorektalnog karcinoma kod Hemoccult negativnih ispitanika, te mogućnosti i ograničenja njegove primjene u redovnom radu obiteljskog liječnika i c) prikazati iskustva o praksi primijenjenih mjera rehabilitacije u bolesnika s kolostomom. Zdravstvenoodgojne aktivnosti na sprečavanju i suzbijanju raka na području općine Osijek dobro su prihvaćene od stanovništva i dobile su podršku zdravstva i zajednice. Godine 1998. izdane su brošure "Muškarci i rak" i "Rak prostate" u po 100.000 primjeraka, te knjiga "Bolesti uzrokovane pušenjem" u 20.000 primjeraka. Praćenjem pojave kolorektalnog karcinoma u 11.339 Hemoccult negativnih ispitanika tijekom 8-godišnjeg razdoblja (do 1989. godine) utvrđena je pojava karcinoma debelog crijeva u 22 Hemoccult negativna ispitanika: u prvoj godini kod 1, u drugoj godini kod 4, a u osmoj godini kod 2 Hemoccult negativna ispitanika. Osjetljivost testa procijenjena je sa 92,8% za jednogodišnju pojavu kolorektalnog karcinoma i 72,22% za dvogodišnju. Specifičnost testa procijenjena je sa 99,08%. Dosadašnja iskustva ukazuju na visoku osjetljivost i specifičnost Hemoccult testa ako se kao metoda rane detekcije kod asimptomatske rizične populacije primjenjuje svake ili svake druge godine. Iskustvo ukazuje na potrebu da se detekcija raka debelog crijeva testiranjem okultne krvi u stolici provodi najmanje za osobe s visokim rizikom, te planirano, gdje za to postoje uvjeti, za osobe prosječnog rizika, u dobi iznad 50 godina starosti. Dosadašnje iskustvo ukazalo je i na potrebu primjene rektoskopskih pregleda u obiteljskoj medicini i potrebu edukacije obiteljskih liječnika u primjeni te metode detekcije. Iskustvo o primjeni mjera rehabilitacije u praksi obiteljskih liječnika u bolesnika sa stomom pokazuje da su one potpomogle brže uključivanje oboljelih u puni obiteljski, radni i socijalni život i direktno su utjecale na poboljšanje kvalitete života.It is because of its incidence, that the cancer of the colon ranks second in this country on the scale of disease incidence and mortality caused by malignant diseases. In the period between 1968 and 1994 the incidence per 100 000 inhabitants rose from 13.8 to 37.1 and the rate of mortality increased from 8.3 in 1968 to 28.1 in 1977. Although colorectal carcinoma is fairly easily accessible to diagnosis and therapy, a low 5-year survival rate was recorded in this country (in the City of Osijek only 26.9% of the patients). This research had the following aims: (a) to sum up the previous experience with the application of health-educational activities in the prevention and control of cancer in the Community of Osijek; (b) to report the experience with the validity and specificity of the occult faecal bleeding test (i.e. Hemoccult test) as an indicator of the quality and acceptability for the detection of colorectal carcinoma by way of detecting colorectal carcinoma in Hemoccult negative subjects, as well as to asses the possibilities and limitations of its application in the everyday practice of a family doctor; (c) to show the practical experience with the rehabilitation of patients having colorectal carcinoma. Health-educational activities aimed at the prevention and control of cancer in the Community of Osijek were wellreceived by the population and supported by the health authorities and the general community. In 1998 two booklets were published: "Muškarci i rak" (Men and Cancer) and "Rak prostate" (Prostate Cancer). Each booklet was published in 100 000 copies, and 20 000 copies of the book "Bolesti uzrokovane pušenjem" (Smoking Induced Diseases) were published as well. The observation of colorectal carcinoma in 11 339 Hemoccult negative subjects during an 8-year period (till 1989) revealed colorectal carcinoma in 22 Hemoccult negative subjects: in the first year colorectal carcinoma was detected in 1 Hemoccult negative subject, in the second and third years the respective number of colon cancers was 4, and in the eighth year in 2 Hemoccult negative patients. Test sensitivity was calculated at 92.8% for one-year incidence of colorectal carcinoma and at 72.22% for two-year incidence of colorectal carcinoma. Test specificity was calculated at 99.08%. Research results point to high sensitivity and specificity of the Hemoccult test if it is applied as an early detection method every year or every other year to screen the asymptomatic risk population. The established efficiency of the Hemoccult test points to the need that the detection of colon cancer by means of faecal occult blood testing be carried out at least for the high risk population, and where possible and feasible also for the over-50 age group.This research has shown the need for the application of rectoscopy in family medicine and the need for education of family doctors in the application of this method of colon cancer detection. The experience with the rehabilitation of patients by family doctors shows that it has helped faster inclusion of such patients into family, social life and working environment, and in general to the higher quality of life

Control of colon cancer: experience with the Osijek program of protection

Rak debelog crijeva u našoj zemlji zauzima drugo mjesto na ljestvici incidencije i mortaliteta zbog malignih bolesti. U razdoblju od 1968. do 1994.godine stopa incidencije na 100.000 stanovnika porasla je od 13,8 do 37,1, a mortaliteta od 8,3 u 1968. na 28,1 u 1997. godini. Mada je kolorektalni karcinom relativno lako dostupan dijagnostici i terapiji, u našoj je zemlji zabilježeno nisko 5-godišnje preživljavanje (u Osijeku 29,6% slučajeva). Cilj istraživanja bio je: a) sažeti iskustva o primjeni zdravstveno-odgojnih aktivnosti u sprečavanju i suzbijanju raka debelog crijeva u općini Osijek, b) prikazati iskustva o valjanosti: osjetljivosti i specifičnosti testa na okultno fekalno krvarenje (Hemoccult testa) kao pokazatelja kvalitete i prihvatljivosti u detekciji kolorektalnog karcinoma, praćenjem pojave kolorektalnog karcinoma kod Hemoccult negativnih ispitanika, te mogućnosti i ograničenja njegove primjene u redovnom radu obiteljskog liječnika i c) prikazati iskustva o praksi primijenjenih mjera rehabilitacije u bolesnika s kolostomom. Zdravstvenoodgojne aktivnosti na sprečavanju i suzbijanju raka na području općine Osijek dobro su prihvaćene od stanovništva i dobile su podršku zdravstva i zajednice. Godine 1998. izdane su brošure "Muškarci i rak" i "Rak prostate" u po 100.000 primjeraka, te knjiga "Bolesti uzrokovane pušenjem" u 20.000 primjeraka. Praćenjem pojave kolorektalnog karcinoma u 11.339 Hemoccult negativnih ispitanika tijekom 8-godišnjeg razdoblja (do 1989. godine) utvrđena je pojava karcinoma debelog crijeva u 22 Hemoccult negativna ispitanika: u prvoj godini kod 1, u drugoj godini kod 4, a u osmoj godini kod 2 Hemoccult negativna ispitanika. Osjetljivost testa procijenjena je sa 92,8% za jednogodišnju pojavu kolorektalnog karcinoma i 72,22% za dvogodišnju. Specifičnost testa procijenjena je sa 99,08%. Dosadašnja iskustva ukazuju na visoku osjetljivost i specifičnost Hemoccult testa ako se kao metoda rane detekcije kod asimptomatske rizične populacije primjenjuje svake ili svake druge godine. Iskustvo ukazuje na potrebu da se detekcija raka debelog crijeva testiranjem okultne krvi u stolici provodi najmanje za osobe s visokim rizikom, te planirano, gdje za to postoje uvjeti, za osobe prosječnog rizika, u dobi iznad 50 godina starosti. Dosadašnje iskustvo ukazalo je i na potrebu primjene rektoskopskih pregleda u obiteljskoj medicini i potrebu edukacije obiteljskih liječnika u primjeni te metode detekcije. Iskustvo o primjeni mjera rehabilitacije u praksi obiteljskih liječnika u bolesnika sa stomom pokazuje da su one potpomogle brže uključivanje oboljelih u puni obiteljski, radni i socijalni život i direktno su utjecale na poboljšanje kvalitete života.It is because of its incidence, that the cancer of the colon ranks second in this country on the scale of disease incidence and mortality caused by malignant diseases. In the period between 1968 and 1994 the incidence per 100 000 inhabitants rose from 13.8 to 37.1 and the rate of mortality increased from 8.3 in 1968 to 28.1 in 1977. Although colorectal carcinoma is fairly easily accessible to diagnosis and therapy, a low 5-year survival rate was recorded in this country (in the City of Osijek only 26.9% of the patients). This research had the following aims: (a) to sum up the previous experience with the application of health-educational activities in the prevention and control of cancer in the Community of Osijek; (b) to report the experience with the validity and specificity of the occult faecal bleeding test (i.e. Hemoccult test) as an indicator of the quality and acceptability for the detection of colorectal carcinoma by way of detecting colorectal carcinoma in Hemoccult negative subjects, as well as to asses the possibilities and limitations of its application in the everyday practice of a family doctor; (c) to show the practical experience with the rehabilitation of patients having colorectal carcinoma. Health-educational activities aimed at the prevention and control of cancer in the Community of Osijek were wellreceived by the population and supported by the health authorities and the general community. In 1998 two booklets were published: "Muškarci i rak" (Men and Cancer) and "Rak prostate" (Prostate Cancer). Each booklet was published in 100 000 copies, and 20 000 copies of the book "Bolesti uzrokovane pušenjem" (Smoking Induced Diseases) were published as well. The observation of colorectal carcinoma in 11 339 Hemoccult negative subjects during an 8-year period (till 1989) revealed colorectal carcinoma in 22 Hemoccult negative subjects: in the first year colorectal carcinoma was detected in 1 Hemoccult negative subject, in the second and third years the respective number of colon cancers was 4, and in the eighth year in 2 Hemoccult negative patients. Test sensitivity was calculated at 92.8% for one-year incidence of colorectal carcinoma and at 72.22% for two-year incidence of colorectal carcinoma. Test specificity was calculated at 99.08%. Research results point to high sensitivity and specificity of the Hemoccult test if it is applied as an early detection method every year or every other year to screen the asymptomatic risk population. The established efficiency of the Hemoccult test points to the need that the detection of colon cancer by means of faecal occult blood testing be carried out at least for the high risk population, and where possible and feasible also for the over-50 age group.This research has shown the need for the application of rectoscopy in family medicine and the need for education of family doctors in the application of this method of colon cancer detection. The experience with the rehabilitation of patients by family doctors shows that it has helped faster inclusion of such patients into family, social life and working environment, and in general to the higher quality of life

CONTRIBUTION OF FAMILY MEDICINE TO COLORECTAL CANCER PREVENTION AND EARLY DETECTION; FORTY-YEAR EXPERIENCE OF FAMILY MEDICINE DEPARTMENT, OSIJEK HEALTH CENTER

U radu su sažeto prikazana 40-godišnja iskustva liječnika obiteljske medicine (LOM) Doma zdravlja Osijek na prevenciji i ranom otkrivanju raka debelog crijeva. Sustavni rad na prevenciji i ranom otkrivanju raka obuhvaća zdravstveno prosvjećivanje stanovništva, izobrazbu zdravstvenih profesionalaca, znanstvena istraživanja te doprinos u razvoju i implementaciji Nacionalnog programa ranog otkrivanja raka. U suradnji Ministarstva zdravstva i Doma zdravlja (DZ) Osijek tiskano je 100.000 primjeraka brošura “Muškarci i rak” i “Žene i rak”, a u 20.000 primjeraka, knjiga “Bolesti uzrokovane pušenjem”. Analizom operiranih od raka debelog i završnog crijeva (engl. ColoRectal Cancer - CRC) na Kirurškom odjelu Opće bolnice u Osijeku u razdoblju od 1973. do 1984. godine utvrđeno je nisko 5- i 10-godišnje preživljenje bolesnika. U istraživanju ranog otkrivanja CRC korištenjem testa okultnog fekalnog krvarenja (engl Fecal Occult Blood Test - FOBT) rovedenom u Osijeku u razdoblju od 1980. do 1984. godine ukupno je obuhvaćen 11.431 ispitanik. Rezultati istraživanja potvrdili su FOBT kao prikladnu metodu za rano otkrivanje raka debelog crijeva zbog jednostavnosti primjene, prihvaćenosti od stanovništva i relativno niskih troškova metode. Sistematske preglede radi otkrivanja CRC primjenom FOBT treba provoditi planirano sistematski kod osoba s povećanim rizikom (kod starijih od 50 godina). U skladu sa rezultatima tog istraživanja 1993. godine objavljene su smjernice za suzbijanje raka u timovima primarne zaštite, posebice u obiteljskoj medicini. DZ Osijek odnosno Odjel obiteljske medicine podržao je izradu te sudjelovao u Nacionalnom programu prevencije i ranog otkrivanja raka debelog crijeva koji je za započeo 2007. godine. U Nacionalnom programu ranog otkrivanja raka debelog crijeva zabilježen je odaziv na program po županijama do 37 %. Projekt „Model ranog otkrivanja raka integriran u praksu obiteljske medicine“, proveden u Osijeku, obuhvatio je ispitanike u rizičnim skupinama od 45 do 49 i od 75 do 84 godina te pokazao da su timovi LOM motivirani za uključivanje u Nacionalne programe ranog otkrivanja raka u Hrvatskoj. Iskustva obiteljske medicine u DZ Osijek u prevenciji i ranom otkrivanju CRC pokazuju da su obiteljski liječnici bili jedni od preteča aktivnosti koje su u konačnici dovele do uspostave Nacionalnog programa prevencije i ranog otkrivanja raka debelog crijeva u Hrvatskoj.The paper gives a short presentation of 40 years of experience of Osijek Health Center family physicians in colorectal cancer (CRC) prevention and early detection. Systematic work in the prevention and early detection of cancer includes raising public awareness and knowledge of healthcare issues, educating health professionals, conducting scientifi c research and contributing to the development and implementation of the National Program for Early Detection of Cancer. Cooperation of the Ministry of Health and Osijek Health Center resulted in issuing brochures entitled Men and Cancer and Women and Cancer in 100,000 copies, and later 20,000 copies of a book entitled Smoking Induced Diseases. Analysis of patients undergoing surgery for CRC at Department of Surgery, Osijek General Hospital during the 1973-1984 period showed a low 5-year and 10-year survival rate. A study of early CRC detection by using fecal occult blood test (FOBT), conducted in Osijek between 1980 and 1984, included 11,431 subjects. Results of the study confi rmed FOBT to be an acceptable and reliable method for early CRC detection because of its simple use, general level of acceptance by the population and relatively low cost. Physical examinations aimed at detecting CRC by using FOBT were to be implemented in a planned, systematic manner in high-risk persons (those older than 50). Based on the results of this study, guidelines on cancer control were published in 1993 by teams of primary care physicians, especially family physicians. The Osijek Health Center, specifi cally its Family Medicine Department, participated in the development and implementation of the National Program for Colorectal Cancer Prevention and Early Detection, which started in 2007. Response to the National Program for Early Detection of Colorectal Cancer in individual counties was under 37%. A project called Early Cancer Detection Model Integrated in Family Medicine Practice, which was implemented in Osijek and included subjects from the 45-49 and 75-84 age groups at risk, revealed that teams of family physicians were motivated to join the national programs for early detection of cancer in Croatia. Experiences of the Osijek Health Center Family Medicine Department in the prevention and early detection of CRC indicated that family physicians were pioneers in activities that had ultimately led to the establishment of a National Program for Colorectal Cancer Prevention and Early Detection in Croatia

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

The Results after Transrectal Prostate Biopsy with 12 Biopsy Cores Taken

This report describes the clinical value of transrectal prostate biopsy during which 12 biopsy cores are taken in comparison to the classical sextant method. There were 106 patients included in the study, who had transrectal prostate biopsy (TRB) due to abnormal finding after digitorectal examination (DRE) and/or values of PSA > 4 ng/ml in the period from 4 October 2001 till 14 August 2002. There were 117 biopsies with 12 biopsy cores taken, 6 cores from each lobe. Prostate cancer was confirmed in 49 patients (46%). Out of total number of confirmed cancer cases, initial biopsy detected 94%. There were three patients who had suspicious DRE finding, with PSA value of < 4 ng/ml, but cancer was not detected in any of them. In the patient group with PSA value between 4–10 ng/ml, cancer was detected in 26% of them and in the group with PSA value > 10 ng/ml cancer was detected in 58%. The most common Gleason score in the case of cancer was 7 (43%). During the biopsy procedure, 3 patients experienced strong vasovagal reactions, meaning that out of 117 biopsies incidence of complications was 2.6%. Few days after the biopsy, two patients developed urogenital tract infections (1.7%) and right after the procedure, there was one case of strong hematuria (0.8%) and strong rectal bleeding (0,8%) that needed hospitalization. Our results regarding the incidence of complications do not differ much from the results in the literature. According to data in the literature regarding sextant biopsy, 15–34% of cancer cases remain undiagnosed at initial biopsy. The method of 12 biopsy cores fails to diagnose only 6% of all cancers, but it is important to note that in the mentioned period, re-biopsy was indicated only in 11 from 60 patients with negative biopsies

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

The Results after Transrectal Prostate Biopsy with 12 Biopsy Cores Taken

This report describes the clinical value of transrectal prostate biopsy during which 12 biopsy cores are taken in comparison to the classical sextant method. There were 106 patients included in the study, who had transrectal prostate biopsy (TRB) due to abnormal finding after digitorectal examination (DRE) and/or values of PSA > 4 ng/ml in the period from 4 October 2001 till 14 August 2002. There were 117 biopsies with 12 biopsy cores taken, 6 cores from each lobe. Prostate cancer was confirmed in 49 patients (46%). Out of total number of confirmed cancer cases, initial biopsy detected 94%. There were three patients who had suspicious DRE finding, with PSA value of < 4 ng/ml, but cancer was not detected in any of them. In the patient group with PSA value between 4–10 ng/ml, cancer was detected in 26% of them and in the group with PSA value > 10 ng/ml cancer was detected in 58%. The most common Gleason score in the case of cancer was 7 (43%). During the biopsy procedure, 3 patients experienced strong vasovagal reactions, meaning that out of 117 biopsies incidence of complications was 2.6%. Few days after the biopsy, two patients developed urogenital tract infections (1.7%) and right after the procedure, there was one case of strong hematuria (0.8%) and strong rectal bleeding (0,8%) that needed hospitalization. Our results regarding the incidence of complications do not differ much from the results in the literature. According to data in the literature regarding sextant biopsy, 15–34% of cancer cases remain undiagnosed at initial biopsy. The method of 12 biopsy cores fails to diagnose only 6% of all cancers, but it is important to note that in the mentioned period, re-biopsy was indicated only in 11 from 60 patients with negative biopsies

Health of dispaced persons and their adaptation in the xommunity: pilot study

Građani područja županije Osječko-baranjske tijekom Domovinskog rata 1991./1992. godine, izabravši put opstanka napuštanjem ratne zone, proveli su u progonstvu 5-7 godina. Prognanici, a danas povratnici su suočeni s nizom promjena u društvenom i ekonomskom životu, što često prate ozbiljni psihološki problemi koji zahtijevaju vrlo brzu intervenciju. Rad je pilot istraživanje projekta "Ocjena zdravstvene snage i mogućnost adaptacije prognanika" koje provodi Katedra obiteljske medicine, primame zdravstvene zaštite, organizacije zdravstvene zaštite i zdravstvene ekonomike Medicinskog fakulteta u Osijeku, a u kojem sudjeluje i Dom zdravlja Osijek. Cilj je istraživanja utvrditi osnovno zdravstveno stanje (fizičko, psihičko i socijalno) prognaničko-povratničke populacije, korištenje zdravstvene službe i identificirati čimbenike koji utječu na adaptaciju prognanika - povratnika, te izrada programa zdravstvene, psihološke, socijalne i društvene potpore, kojima će se poboljšati ukupno zdravstveno stanje, brža integracija u zajednicu, školovanje i zapošljavanje. U ovom pilot istraživanju ispitanici su randomizirani iz stratificiranog uzorka n=58. Istraživanje je provedeno upitnikom "Hrvatska zdravstvena anketa 2003" i dopunskim strukturiranim upitnikom o specifičnim prognaničko-povratničkim čimbenicima. Stalno i skoro uvijek osjeća se iscrpljenim 22 (38%) i umornim 25 (43%) ispitanika. Prema vlastitom mišljenju, pri povratku se nije uključilo u zajednicu 45 (78%) ispitanika. Prognanici - povratnici su tijekom progonstva i povratništva doživjeli pogoršanje zdravstvenog stanja. U populaciji prognanika - povratnika postoje značajne zdravstvene maladaptacijske poteškoće, koje zahtijevaju zdravstvenu, socijalnu i društvenu intervenciju.Many citizens from the Osijek-Baranya county, in order to survive, left their homes during the homeland war in 1991/92, and spent between 5 and 7 years in asylum. Dispalced persons and returnees are faced now with many changes both in social and economic life, which causes very often difficult psychological and health problems and need immediate interventions. This paper is the pilot research within the project "Health of returnees and possibility of their adaptation" coordinated by the Department of Family Medicine, Primary Health Care, Health Care Organisation and Health Economics of the Faculty of Medicine in Osijek and Health Center Osijek. The aim of the study is to assess the health status (physical, mental and social) of refugee/returnee population, their use of health services and to identify the factors influencing their adaptation. Its aim is also to propose the health programs, psychological and social support which could help faster integration into the social and community life, education and employment. The study was done as a pilot study on the randomised sample of 58 respondents. As a first part of the study the method of the Croatian health survey 2003 with additional questionnaire related to the problems of returnees was used. It was found that 38% of returnees felt exhausted and 40% tyred. According to their own oppinion after return from asylum, 78% of them did not integrate into the community and social life. During asylum and after their return health status of returnees was worse than before. Serious maladaptation problems which need health, medical and social intervention were found

The Health centre Osijek in homeland war

U raduje prikazana organizacija rada Doma zdravlja Osijek u domovinskom ratu. Učinjena je analiza provedenih priprema za rad u ratnim uvjetima i ocijenjena je efikasnost rada u tim uvjetima. Utvrđena je dobra pripremljenost i organizacija ove službe koja se provodila na osnovi uputa Ministarstva zdravstva Republike Hrvatske i na iskustvima iz prošlih ratova. Provedena je edukacija svih zdravstvenih radnika iz područja ratne medicine, a stanovništvo općine u pružanju prve i uzajamne pomoći i samopomoći. Utvrđene su mirnodopske i ratne lokacije zdravstvenih stanica, utvrđena je medicinska doktrina za sve postupke u ratnim uvjetima, način rukovođenja i informiranja, vrste i količine potrebnih lijekova. Određeni su stacionari za zbrinjavanje stanovništva pri masovnom ranjavanju. Uz uvažavanje svih elemenata medicinske doktrine, zdravstvena zaštita za cjelokupno stanovništvo općine Osijek organizirana je u skloništima i suterenskim prostorijama. Za više od 20 000 izbjeglica zdravstvena zaštita je posebno organizirana. Zdravstvena je služba stalno raspolagala dovoljnom količinom lijekova i sanitetskog materijala. Dom zdravlja Osijek zbog ratnih uvjeta napustilo je 195 zdravstvenih radnika. Više zdravstvenih stanica je teško oštećeno, a materijalna šteta procijenjena je na 12,5 milijuna DM. U Domu zdravlja Osijek u 1991. godini zabilježeno je 558 000 posjeta liječniku i 197 000 novih slučajeva bolesti ili 38,77% i 36,9% manje u odnosu na 1990. godinu. U strukturi pobola u 1991. godini značajan porast novih slučajeva zabilježen je u skupini II, III i XI MBK za 35,5%, 30,1% i 27,1%. Unatoč ratnim uvjetima u Domu zdravlja Osijek osim pružanja zdravstvene zaštite građanima i ranjenicima odvijale svi se zdravstvenoistraživačke i nastavne aktivnosti Katedre Opće medicine i primarne zdravstvene zaštite Medicinskog fakulteta u Zagrebu, Stvidija Osijek.This article deals with organization of the Osijek Health Center during the war for Homeland. This institution, the biggest of that kind, namely a Center for primary health protection in the municipality of Osijek, coveres the health protection of about 150 000 inhabitants in 10 health Stations, 55 maternity houses, with more than 110 dispensaries. The conducted preparations for operating in the conditions of war were analysed and efficacy of these services evaluated. The authors found that the preparations and organization were good and in accordance with the instructions of the Ministry of Health of the Republic of Croatia and based on experiences of the former war. At the beginning of aggression against the Republic of Croatia in May 1991, a Crisis Staff was formed in the Osijek Health Center in to do the management in the war conditions. At that time the locations of the health stations and maternity houses for both the war and peace conditions were established, then the medical doctrine for all medical activities, kinds and quantities of medicines, system of mutual communications, as well as mode of management within the health service of the Osijek town and collaboration with the Ministry of Health of the Republic of Croatia. The reserve locations of health stations in case the first ones fail due to destruction or any other reason were also suggested. The first aid stations, a kind of stationaries, for offering the general medical care, i.e. practice, in case of mass casulties, were equiped on 5 locations within the very town and 3 out of it. The staff working in such stations was specially trained. The medical war literature thorougfully studied, the seminars held for all the doctors and medical sisters with subjects on the war surgery in case of mass casulties and health protection in shelters and other cases. The courses on first aid were organized for inhabilitants in various quarters of the town, namely how to take care of the wounded and ill and to know something about hygienic epidemiological protection. The war reserves of medicines and sanitary material were provided and thoroughully checked in all health station and the medical staff was vaccinated against tetanus. Due to the violence of the attacks on Osijek, medical care was performed in the basemert of Health Center and in other working organizations and private houses, so that complete health protection could be given at one place. In the Čepin health station the duty hours were organized for a 24 h service. Because of almost daily general alerts and risks to reach the working place, the employees in medical activities took over 12 h shift of working, namely should come every second day. Speciality - polyclinic service was organized in the major building of the Health Center Osijek. In all the bigger shelters a daily health protection Service was organized for endangered inhabitants. For staff, working in such conditions a special training was also organized. Lodging in the shelters for a period of several months was well organized, communication between the citizens and health workers was timely accorded, spontaneous in both directions and no bigger health troubles were noted with this people. For the whole war period disposed the Osijek Health Center with sufficient quantities of medicines, sanitary material. The maternity hospital was regularly provided with sanitary material and napkins. In addition to regular provisions, a part of necessary medicines was obtained from the Main Sanitary Headquarters of Croatia, as well as from the Board for donations of the Osijek Municipal Assembly. Collaboration with the Health Protection Institute was on a daily basis, and once a week the reports were made on occurrences of infective diseases. In spite of lodging in shelters for a longer period of time, great number of refugees and wounded, there were only unysignificant occurrences of the infective diseases. For over 20 000 refugees the health protection was specially organized. The Osijek Health Center was left i.e., it may be said, deserted by 195 employees during the war time. Several health stations were heavily damaged and the cost of material damages reaches 12,5 milions DM. In 1991. the Osijek Health Center registered 558 000 visits to the doctors and 197 000 new cases of diseases or by 38,7% and 36,9% less than in 1990. As of the structure of health troubles a significont increase in 1991. was registered for the groups II, III and XI (of International Diseases Classification), by 35,5%, 30,1% and 27,1% respectively. In spite of the war, the Osijek Health Center did not only take over the health care of the citizens and the wounded, but dealt also with some scientific research and teaching within the frames of the Cathedra for general practice and primary health care of the Zagreb Medical faculty, Study in Osijek. A teaching program on the subject general medicine and primary health care was completed and the medial doctors trainees practitioned according to the program. Psycho-physical troubles of the refugees were scientifically researched. Organization of the life in shelters during the war was filmed by the employees of the Osijek Health Center to serve later as educational material