Lifestyle medicine – a new promise for shifting the tide of non-communicable diseases

Lifestyle medicine developed as a response to the global burden and consequences of non-communi- cable diseases (NCDs), which dominate epidemiological trends in mortality, morbidity, and disability worldwide during the last couple of decades. Lifestyle medicine includes six pillars, the use of whole food, plant-predominant dietary pattern, regular physical activity, restorative sleep, stress manage- ment, avoidance of risky substances, and positive social connection, as evidence-based and primary therapy modalities aiming for treatment and reversal of chronic diseases. Interest in lifestyle medicine is increasing globally, and it was even further advanced during the COVID-19 pandemic. Addition- ally, professional interest in lifestyle medicine is fueled by the extended learning opportunities based on the findings of recent studies demonstrating the reversible nature of NCDs, especially for diabetes type 2 and obesity. These results request a thorough contemplation of our current understanding of the “uncurable” nature of diabetes type 2, but also for other chronic non-communicable diseases, and de- mand a paradigm shift in medical practice and education. This requires education of medical students and doctors, adaptation of reimbursement and health insurance policies, and forming multidiscipli- nary teams that will be able to deliver lifestyle intervention procedure to all who need it. The future of healthcare and NCDs management is the long-term self-care by patients, assisted by physicians and other professionals, such as nurses, nutritionists, physical therapists or kinesiologists, psychologists, health educators, pharmacists, and social workers, as indicated. The ultimate goal has to be reaching the best possible health in individuals and communities. The time for action is yesterday

Lifestyle medicine – a new promise for shifting the tide of non-communicable diseases

Lifestyle medicine developed as a response to the global burden and consequences of non-communi- cable diseases (NCDs), which dominate epidemiological trends in mortality, morbidity, and disability worldwide during the last couple of decades. Lifestyle medicine includes six pillars, the use of whole food, plant-predominant dietary pattern, regular physical activity, restorative sleep, stress manage- ment, avoidance of risky substances, and positive social connection, as evidence-based and primary therapy modalities aiming for treatment and reversal of chronic diseases. Interest in lifestyle medicine is increasing globally, and it was even further advanced during the COVID-19 pandemic. Addition- ally, professional interest in lifestyle medicine is fueled by the extended learning opportunities based on the findings of recent studies demonstrating the reversible nature of NCDs, especially for diabetes type 2 and obesity. These results request a thorough contemplation of our current understanding of the “uncurable” nature of diabetes type 2, but also for other chronic non-communicable diseases, and de- mand a paradigm shift in medical practice and education. This requires education of medical students and doctors, adaptation of reimbursement and health insurance policies, and forming multidiscipli- nary teams that will be able to deliver lifestyle intervention procedure to all who need it. The future of healthcare and NCDs management is the long-term self-care by patients, assisted by physicians and other professionals, such as nurses, nutritionists, physical therapists or kinesiologists, psychologists, health educators, pharmacists, and social workers, as indicated. The ultimate goal has to be reaching the best possible health in individuals and communities. The time for action is yesterday

Achieving Millennium Development Goals 4 and 5: Do every mother and child really count?

Is there any human experience that could be compared to the kaleidoscope of emotions and thoughts rushing through the soul of every mother just after the birth of her child? What measures would parents be willing to undertake if their child was seriously ill? How could they find consolation if their child died from preventable or easily treatable causes, such as pneumonia or diarrhea? Although I write this from the position of a mother from a developed country, it does not mean that mothers from low- and middle-income countries (LMIC) feel any differently when facing such a threat

The prevalence of overweight, obesity and central obesity in six regions of Croatia: results from the Croatian Adult Health Survey [Prevalencija prekomjerne tjelesne težine, debljine i avdominalne debljine u šest regija Hrvatske]

Our aim was to estimate the prevalence of overweight, obesity and increased waist circumference in the adult population of Croatia and investigate regional differences in six regions of Croatia. Using the data from the 2003 Croatian Adult Health Survey we estimated the overall prevalence of overweight, obesity and increased waist circumference for the entire population of Croatia at 38.11%, 20.34% and 43.52%, respectively. For men, this was 43.2%, 20.1% and 34.98% and for women 33.6%, 20.6% and 51.13%, respectively for the three indicators of increased body weight. We found conflicting evidence as to whether the Mediterranean part of the country, compared with the continental part, bears a lesser degree of cardiovascular risk. Planners should pay particular attention to the Northern region, where the burden of increased body weight was the highest

Breast, colon, and prostate screening in the adult population of Croatia: does rural origin matter?

INTRODUCTION: The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents' rural versus urban origin. ----- METHODS: Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression. ----- RESULTS: One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake. ----- CONCLUSIONS: Opportunistic cancer screening uptake is low in the Croatian adult population, with existing socio-economic differences in breast and prostate screening, and their absence in colon cancer screening. Rural origin was significantly associated with breast screening, even after adjustment to socioeconomic status and problems in access to health care. Lack of rural origin significance in the other screening sites could be related to small sample sizes of people who reported opportunistic utilization. Overall, access to health care is the strongest cancer screening predictor, and this should have a prominent role in the development of a systematic cancer screening program on a national level

Socioeconomic status and psychological distress do not predict mortality risk in the island population of Vis, Croatia

Aims. To investigate the association between socioeconomic status and psychological distress measured by the General health questionnaire (GHQ-30) with all-cause mortality, cardiovascular mortality and cancer mortality on the Croatian island of Vis. Methods. This population-based cohort consisted of 1,025 subjects (426 men and 599 women), who were followed up for 18 years or a total of 5.8 million days. The causes of death were extracted from the Croatian National Institute of Public Health database. We calculated the adjusted hazard ratios, with subjective material status, years of schooling and a composite household material status used as estimates of socioeconomic status. Results. There were 279 cases of death (27.2%). Socioeconomic status and psychological distress did not predict either the specific or the all-cause mortality risk. In addition, the interaction between socioeconomic variables and psychological distress also did not yield a significant hazard ratio in all three instances (all-cause, cardiovascular or tumour mortality). Conclusions. These results confirm previous reports of the high level of social equality in the population of the island of Vis. Small and isolated communities may experience a lesser extent of social inequalities in health

An estimate of the prevalence of epilepsy in Sub-Saharan Africa:A systematic analysis

Epilepsy is a leading serious neurological condition worldwide and has particularly significant physical, economic and social consequences in Sub–Saharan Africa. This paper aims to contribute to the understanding of epilepsy prevalence in this region and how this varies by age and sex so as to inform understanding of the disease characteristics as well as the development of infrastructure, services and policies

Scientific Production of Research Fellows at the Zagreb University School of Medicine, Croatia

Aim: To evaluate scientific production among research fellows employed at the Zagreb University School of Medicine and identify factors associated with their scientific output. Method: We conducted a survey among research fellows and their mentors during June 2005. The main outcome measure was publication success, defined for each fellow as publishing at least 0.5 articles per employment year in journals indexed in the Current Contents bibliographic database. Bivariate methods and binary logistic regression were used in data analysis. Results: A total of 117 fellows (response rate 95%) and 83 mentors (100%) were surveyed. The highest scientific production was recorded among research fellows employed in public health departments (median 3.0 articles, interquartile range 4.0), compared with those from pre-clinical (median 0.0, interquartile range 2.0) and clinical departments (median 1.0, interquartile range 2.0) (Kruskal-Wallis, P = 0.003). A total of 36 (29%) research fellows published at least 0.5 articles per employment year and were considered successful. Three variables were associated with fellows’ publication success: mentor’s scientific production (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.31-7.53), positive mentor’s assessment (OR, 3.15; 95% CI, 1.10-9.05), and fellows’ undergraduate publication in journals indexed in the Current Contents bibliographic database (OR, 4.05; 95% CI, 1.07-15.34). Conclusion: Undergraduate publication could be used as one of the main criteria in selecting research fellows. One of the crucial factors in a fellow’s scientific production and career advancement is mentor’s input, which is why research fellows would benefit most from working with scientifically productive mentors

Mortality patterns in Southern Adriatic islands of Croatia: a registry-based study

Aim To investigate the mortality patterns on the Southern Adriatic islands of Croatia and compare them with those in two, mainly coastal, mainland counties. Methods In this registry-based study we used the official mortality register data to analyze the mortality patterns on seven Croatian islands (Brač, Hvar, Korčula, Lastovo, Mljet, Šolta, and Vis) and Pelješac peninsula in the 1998-2013 period and calculated the average lifespan, life expectancy, and standardized mortality ratios (SMR). We compared the leading causes of death with those in the mainland population of two southernmost Croatian counties. Results The average lifespan of the island population was 3-10 years longer for men and 2-7 years longer for women than that on the mainland. All-cause SMRs were significantly lower for both men and women on Korčula, Brač, Mljet, and Pelješac but significantly higher for women on Šolta (1.22; 95% confidence intervals 1.07-1.38). The leading causes of death on the islands were cardiovascular diseases, with higher percentages in men and lower in women in comparison with those on the mainland. There were no substantial differences in the life expectancy at birth. Conclusions Despite longer lifespan, lack of differences in life expectancy at birth suggests that the recent generations of islanders no longer show beneficial mortality patterns, possibly due to diminishing adherence to the Mediterranean diet and lifestyle. Restoring the traditional lifestyles is a public health priority, with the ultimate aim of reducing inequalities and improving the health of island inhabitants

Impact Analysis of a Regional Scientific Journal (1980–2000): Supporting Promising Local Researchers Pays the Greatest Dividends

During the past 28 years, the journal »Collegium Antropologicum« has continuously served as one of the main disseminators of anthropological scientific production in Central and Eastern Europe. The journal was committed to its role of a multidisciplinary platform for presenting wide range of research topics relevant to anthropology, from investigations within social and cultural anthropology and archaeology to those covering contemporary population genetics, human evolution and biomedical issues. Two key strategies aimed at sustaining and increasing the impact of this journal were oriented towards: i) identification of promising local groups of researchers who were at disadvantageby many aspects (e.g. educational curricula, financial supports, language barriers etc.) when trying to publish their research internationally, and ii) invitation and encouragement of already established international scientists to make contributions for »Collegium Antropologicum«. From 1980–2000, 89 articles (or 6.3% of all published papers duringthat period) were cited 6 or more times, contributing disproportionately to journal’s impact (nearly a third of all citations received). In an attempt to identify such papers more readily among the submissions to the journal in the future, we analyzed research topics and affiliations of the authors among the 89 papers receiving most citations in comparison to all papers published. Among the papers most frequently cited, we found greater-than-expected prevalence of Croatian researchers (especially when publishing in collaboration with international scientists) and studies of special populations. Several papers received more than 25 citations or had overall citation intensity greater than 2 per year.This implies that an interesting article from a local group of researchers can still resonate with international audience although published in a regional journal. Present analysis supports current editorial strategy that with a help of the international .consulting editorial board continuously improves international recognition of this journal. The results imply that a balanced encouragement to promising local groups of researchers and to contributions of already established international scientists is a strategy superior to others in maintaining and increasing the impact of this regional journal