Can a place of living of elementary school students determine their health habit?

Aim To determine dietary habits of elementary school students in relation to a place of living and socio-economic status of the family. Methods A prospective study conducted in the Primary Health Center Zenica involved five family medicine teams in urban and five in rural settlement during 2015. Elementary school students aged 10-16 were interviewed by random selection using a questionnaire on the socio-economic status of parents and nutritional habits of adolescents. Results The survey involved 199 respondents, 103 from rural and 96 from urban area. There were significantly more pupils from employed parents who consumed non-carbonated drinks. Students from urban areas more likely consumed fruit every day than children from rural areas. More than half of the respondents did not or rarely consumed vegetables, in this case the village pupils, who consumed much less milk. It would be expected that rural students were more likely to consume fruits, vegetables and milk due to easier access to these foods in the countryside, but the results of this research did not confirm this assumption. Conclusion Changes in traditional family functioning (lower income, unemployment) could be linked with lifestyle changes (low consumption of fruits and vegetables, low consumption of milk both in rural and urban areas, consumption of carbonated drinks), especially in families in rural areas

Missing risks in opportunistic screening for type 2 diabetes - CroDiabGP study

Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record (EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients’ data using Wonca International Classification Committee (WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients (aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM’s assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p<.001). Conclusion Two methods of extraction could not detect data for episodes of the disease. In the list of personal information, FMs could not assess overweight for one in six patients and family history for every other patient. The study can stimulate improving coded and structured data in EMR

Klinička revizija lipidnog statusa kod tipa 2 dijabetesa na nivou timova porodične/obiteljske medicine u općini Zenica, Bosna i Hercegovina

Cilj Cilj ove studije jeste istražiti da li su timovi porodične/obiteljskemedicine (TOM) u općini Zenica, nakon uvođenja posebnog kartonaza dijabetes (PKD), mogli dovesti do poboljšanja kontrolenivoa lipida za pacijente oboljele od dijabetes melitusa (DM) tipa2, prema preporučenim smjernicama.Metode Klinička revizija prakse bila je izvedena pregledom kartonapacijenata oboljelih od DM-a tipa 2, starijih od 18 godina, za19 timova porodične/obiteljske medicine u Zenici, dvije godineprije (2003-2005) i dvije godine poslije (2005-2007) implementacijevodiča za DM. Podijelili smo sve zabilježene vrijednosti lipidai sve TOM na one koji su dostigli optimalni nivo (UK < 4.5mmol/l; LDL- kolesterol < 2.5 mmol/l; TG < 1.7 mmol/l) i onekoji to nisu (neoptimalni nivo UK > 4.5 mmol/l; LDL- kolesterol> 2.5 mmol/l; trigliceride > 1.7 mmol/l).Rezultati Pregledana su 853 kartona pacijenata oboljelih od DMtipa 2, 46 po jednom TOM-u. Od 19 voditelja TOM-a, četiri (21%)su bili muškog i 15 (79%) ženskog spola. Prosječna starosna dobiznosila je 46,6 godina. Ustanovljen je statistički značajan napredakza optimalni nivo za LDL - kolesterol (19 u odnosu na 531; p <0.0001), kolesterol (67 u odnosu na 212; p < 0.0001) i trigliceride(227 u odnosu na 463; p < 0.0001) u periodu prije implementacijePKD-a u odnosu na period poslije. Statistički značajan napredakoptimalnog nivoa za trigliceride po timovima nađen je za 10 od 19TOM (P < 0.0001).Zaključak Nakon implementacije vodiča za kontrolu lipida kodDM tip 2 pacijenata, većina TOM-a unaprijedila je optimalni nivolipida

Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding

The most of the known effects of selective serotonin reuptake inhibitors, beneficial or harmful, are associated with the inhibitory action of the serotonin reuptake transporter. This mechanism is present not only in neurons, but also in other cells such as platelets. Serotoninergic mechanism seems to have an important role in hemostasis, which has long been underestimated. Abnormal activation may lead to a prothrombotic state in patients treated with selective serotonin reuptake inhibitors. On one hand there may be an increased risk of bleeding, and on the other hand reduction in thrombotic risk may be possible. Serotonin is critical to maintain a platelet haemostatic function, such as platelet aggregation. Evidences from the studies support the hypothesis that antidepressants with a relevant blockade of action of serotonin reuptake mechanism may increase the risk of bleeding, which can occur anywhere in the body. Epidemiological evidences are, however, the most robust for upper gastrointestinal bleeding. It is estimated that this bleeding can occur in 1 in 100 to 1 in 1.000 patient-years of exposure to the high-affinity selective serotonin reuptake inhibitors, with very old patients at the highest risk. The increased risk may be of particular relevance when selective serotonin reuptake inhibitors are taken simultaneously with nonsteroidal anti-inflammatory drugs, low dose of aspirin or warfarin

A better level of HbA1c control achieved by Family Medicine Teams, Bosnia and Herzegovina, by using Diabetes Mellitus type 2 recommended guidelines

Aim To evaluate HbA1c level for diabetic type 2 patients after the implementation of guidelines for diabetes mellitus (GDM) in primary health care settings. According to recommendations of the European Society of Cardiology and European Association for the Study of Diabetes, HbA1c ? 6.5 % is considered as optimal level. Methodology A retrospective analysis randomly selected medical records of DM type 2 patients who were older than 18 before and after the review. Nineteen Family Medicine Teams (FMT) reviewed every second record (46 per FMT) in the family medicine facilities in Zenica two years prior and after the introduction of the Diabetes Mellitus 2 Guidelines. All noted values of HbA1c and all FMTs have been divided to those which reached an optimal level of HbA1c ? 6.5 % and those with an inadequate level (non-optimal level of HbA1c > 6.5 %). Results Records of 853 patients with type 2 diabetes were analyzed.A total number of HbA1c recorded in the FMT medical records increased significantly after the GDM implementation from 103 (12.1%) to 318 (37.3%). A significant improvement towards an optimal level of HbA1c was noted after the implementation GDM by all FMTs together (7 vs. 92; 6.7% vs. 28.9%; p<0.0001). Only FMT 4 and FMT 14 (2 vs.19; P<0.05) reached the optimal level of HbA1c. Conclusion Family medicine teams improved the level of HbA1c according to the recommended guidelines for diabetes mellitus after their application. Quality variations of care extended to diabetics have been noted in individual family medicine teams