Malignant Neoplasms of Breast and Female Genital Organs (C50, C51-C58) in the Osijek-Baranja County, Croatia

Breast cancer (C50) and neoplasms of female genital organs (C51-C58) represent one of the most frequent cancer groups among females in economically developed countries. The Institute of Public Health of the Osijek-Baranja County in collaboration with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The aim of this article is to provide information on the tendencies relating to these cancer groups in the OBC during the period from 2001 to 2009, which will be the first report on these cancer sites on a county level in Croatia. This article processes data on cancer incidence and mortality, appertaining age distribution, median age, cancer survival and length of stay in the county hospitals collected in period 1996–2010. In the OBC, the overall incidence rates of breast, cervix uteri, corpus uteri and ovary cancer were, using the EU standard population, 82.9, 13.0, 19.0 and 14.5/100,000, respectively, and are all characterized by a declining tendency in the second period except breast cancer. The overall breast incidence rate resembles the Croatian average and way exceeds the corresponding Central and Eastern Europe incidence rates, but is still bellow the Northern Europe ones. Also, the overall mortality rates of breast, cervix uteri, corpus uteri and ovary cancer were 29.6, 5.0, 8.1 and 9.6/100,000, respectively, and are all featured by a increasing tendency. The cancer 5-year relative survival rate from breast, cervix uteri, corpus uteri and ovary cancer in period 2001–2005 amounted to 64.2%, 66.1%, 57.4% and 43.0%, respectively. The overall median ages at diagnosis of breast, cervix uteri, corpus uteri and ovary cancer totalled 61.9, 56.4, 66.4 and 60.8 years, respectively, while the median ages at death from these cancers were 68.7, 65.7, 70.3 and 67.6 years, respectively. During the entire 9-year period, the average length of stay in hospital due to breast, cervix uteri, corpus uteri and ovary cancer were 12.1, 14.8, 18.5 and 11.3 days, respectively. The length of stay in hospital decreased for all but for ovary cancer. Implementation and consolidation of women’s awareness of these cancers and relating early diagnostic activities within the OBC population seem to be the most effective ways to reduce the appertaining risks and thus to encourage changes in the lifestyle

Malignant Neoplasms of Male Genital Organs (C60-C63) in the Osijek-Baranja County, Croatia

Cancers of male genital organs (C60-C63) and in particular, prostate cancer, represent one of the most frequent cancer groups among males in economically developed countries and growing cancer group in developing countries. The Institute of Public Health of the Osijek-Baranja County in collaborate with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The aim of this article is to provide information on the tendencies relating to this cancer group in the OBC during the period from 2001 to 2009, which will be the first report on these cancer sites on a county level in Croatia. This article processes data on cancer incidence and mortality, appertaining age distribution, median age at diagnosis and at death, cancer survival and length of stay in hospital in the OBC. From 2001 to 2009, a total of 891 males were diagnosed with cancers of male genital organs and treated in either of the two OBC hospitals. These cancers accounted for 6.2% of all registered cancers and for 12.5% of all registered cancers among males. Overall age-standardized incidence rate was 60.9/100,000 and it growing strongly during the nine-year period. Although the mortality rate increased too (overall rate was 30.5/100,000), the increase was not as huge as the one in the rate of incidence. Overall median ages at diagnosis and at death were 67.1 years and 74.6 years, respectively. The 5-year relative survival rate was estimated to be 53.4%. This report reveals weak reduction in the average length of stay in hospital per patient in the 9-years period (from 11.8 to 11.3 days) and at the same time, the number of admissions almost tripled (from 84 to 221), which is a consequence of the same rise in the number of newly registered cases. During the course of the illness, an average patient was hospitalized 1.6 times and the average length of hospital care was 11.0 days. All the indicators of the quality of the health care provided to C60-C63 cancer patients in the OBC suggest that further advancement in raising the level of diagnostics and treatment should and can be expected in order to reach the corresponding EU standards. An increased incidence and mortality rate from C60-C63 cancers leads to the conclusion that great efforts should be invested into raising the awareness of the male population over 45 years of age on the recognition of the first symptoms of this cancer group and on early preventive examination as to decrease the mortality rate and increase the survival rate and the quality of life of patients suffering from this cancer group

Acute Heart Failure – Pre-Hospital Treatment of Pulmonary Edema

Akutno zatajivanje srca (AZS) definira se „prema smjernicama“ kao brz nastup simptoma i znakova uzrokovanih nenormalnom srčanom funkcijom. Ono je često opasno za život i zahtijeva hitno liječenje. AZS nije klinički entitet ili bolest per se, već klinički sindrom obilježen skupom simptoma i znakova poremećene srčane funkcije s mogućim povoljnim odgovorom na prikladno liječenje. Dobar klinički pregled i poznavanje etiologije AZS-a te terapijskog pristupa vrlo su bitni za preživljavanje takvih bolesnika. Plućni edem kao najteži oblik AZS-a zastrašujući je trenutak i za bolesnika i za liječnika koji se s njim susreće. On nije radiološka dijagnoza, nego klinički entitet koji kada se jednom s njim susretnemo, teško možemo zaboraviti.Acute heart failure (AHF) is “according to the guidelines” a rapid onset of signs and symptoms caused by abnormal cardiac function. It is often a life threatening condition and requires immediate treatment. AHF is not a clinical entity or a disease “per se“, but a clinical syndrome characterized by a set of symptoms and signs of impaired heart function, with possible good response to appropriate treatment. Good physical examination, understanding the AHF etiology and taking an adequate therapeutic approach is very important for the survival of these patients. Pulmonary edema, as the most severe form of AHF, represents a frightening moment for both the patient and the physician. Pulmonary edema is not a radiological diagnosis and once we encounter this condition it is hard to forget it

Usporedba unaprijednih neuronskih mreža s jednim i dva skrivena sloja u modeliranju linearnog dinamičkog sustava

U ovom se radu na primjeru učenja modeliranja linearnog dinamičkog sustava prvog reda (indentifikacija sustava) pokazala se kvaliteta učenja i generalizacije statičke neuronske mreže s jednim i dva skrivena sloja neurona. Za usporedbu se odabralo više različitih topologija jednoslojne i dvoslojne mreže. Uspoređivale su se mreže s jednakim brojem parametara učenja. Metode po kojima su uspoređivane su: brzina učenja do određenog NRMS-a te učenje do određenog koraka. Učenje se izvodilo po uzorku s zamahom prvog i drugog reda, a algoritam učenja je povratno raspostiranje greške. Nakon učenja gledalo se vrijeme potrebno da se dosegne cilj, postignut NRMS učenja te kvaliteta odziva. Nakon usporedba uzele su se mreže koje su se pokazale najbolje u generalizaciji te ih se pobudilo različitim pobudnim funkcijama (sinusnom i nagibnom) koje nisu bile u setu za učenje. Potom su ponovno uspoređene na temelju mogućnosti generalizacije odziva koje nisu učene

Usporedba neuronskih mreža učenih algoritmima rojeva

U ovom radu se obrađuju neuronske mreže učene algoritmima rojeva. Koriste se dva najčešće korištena algoritma rojeva: PSO (Particle Swarm Optimization) i ABC(Artificial Bee Colony). Prvo se istražuje utjecaj parametara učenja pojedinih algoritama na kvalitetu i brzinu učenja, a potom se mreže učene različitim algoritmima rojeva uspoređuju međusobno po kriterijima kvalitete i brzine učenja. Uspoređuju se mreže s koje su imale najbolja generalizacijska svojstva. Na kraju se uspoređuju mreže učene algoritmima rojeva s mrežama učenim algoritmom s povratnim prostiranjem greške

Intubation and basics of mechanical ventilation

Intubacija i mehanička ventilacija agresivni su medicinski postupci, ali u određenim stanjima spašavaju život djeteta. Zadatak je liječnika provesti postupke što nježnije i stručnije, u što kraćem vremenu, kako dijete ne bi imalo akutne ili kronične komplikacije. Svi načini intubacije imaju svoje prednosti i nedostatke te su za pojedini način intubacije indikacije donekle različite. Postoje različiti načini mehaničke ventilacije djeteta, različiti putovi (modovi) za „prevođenje” djeteta preko životno ugrožavajućega stanja. U svakom centru provode se oni načini ventilacije koji daju najbolje rezultate i s kojima tim koji ih provodi ima najviše iskustva.Intubation and mechanical ventilation are very aggressive medical treatments, but in certain situations they can save the life of a child. Physicians must perform medical procedures as gently, quickly and professionally as they can to prevent acute and chronic complications. Different intubation methods have their advantages and disadvantages; therefore, indications for a particular intubation procedure are different to a certain extent. There are various types of mechanical ventilation in children; different modes to overcome a life-threatening condition of a child. The type of ventilation chosen to be implemented in a particular medical center is the one the team is most experienced in, therefore providing the best results

Utjecaj okolišnih čimbenika na prenatalni razvoj

A woman is especially sensitive to negative environmental factors during pregnancy, partially because her body needs to perform metabolic functions of two organisms, and partially because most chemically and physically harmful substances have stronger effects on a woman during the perinatal period, and on the fetus because of organ development and growth. Many factors are responsible for the outcome of pregnancy: genetic factors, dietary habits of the mother, uteroplacental bloodstream and placental function. Negative environmental factors can damage the fetus by affecting everything aforementioned. Consequences can be acute and fatal; after a few years they can lead to greater frequency of malignant diseases, and cause chronic changes: permanent tendency to hypertension, obesity, diabetes, and coronary heart disease. Negative environmental factors certainly influence the fetal programming and lead to greater expression of the disease to which the child is genetically predisposed. Reproduction and fertility can be permanently damaged.Žena je naročito osjetljiva na nepovoljne čimbenike okoliša tijekom trudnoće, dijelom zbog toga što njezino tijelo mora obavljati metaboličke funkcije za dva organizma, a dijelom jer većina kemijskih i fizikalnih štetnih tvari ima jači učinak na ženu tijekom trudnoće te na fetus jer je to organizam u razvoju. Na ishod trudnoće djeluju genetski čimbenici, prehrambene navike majke, uteroplacentarni krvotok te funkcija posteljice. Nepovoljni čimbenici okoline mogu oštetiti dijete intrauterino djelujući na sve prethodno navedeno. Posljedice mogu biti akutne i fatalne; nakon nekoliko godina mogu dovesti do veće učestalosti malignih bolesti, a mogu izazvati i kronične promjene: trajnu sklonost djeteta hipertenziji, gojaznosti, dijabetesu, koronarnoj bolesti srca. Štetni čimbenici okoliša sigurno utječu na fetalno programiranje i dovode do veće ekspresije bolesti kojoj je dijete genetski sklono. Mogu trajno utjecati na reprodukciju i plodnost

Intubation and basics of mechanical ventilation

Intubacija i mehanička ventilacija agresivni su medicinski postupci, ali u određenim stanjima spašavaju život djeteta. Zadatak je liječnika provesti postupke što nježnije i stručnije, u što kraćem vremenu, kako dijete ne bi imalo akutne ili kronične komplikacije. Svi načini intubacije imaju svoje prednosti i nedostatke te su za pojedini način intubacije indikacije donekle različite. Postoje različiti načini mehaničke ventilacije djeteta, različiti putovi (modovi) za „prevođenje” djeteta preko životno ugrožavajućega stanja. U svakom centru provode se oni načini ventilacije koji daju najbolje rezultate i s kojima tim koji ih provodi ima najviše iskustva.Intubation and mechanical ventilation are very aggressive medical treatments, but in certain situations they can save the life of a child. Physicians must perform medical procedures as gently, quickly and professionally as they can to prevent acute and chronic complications. Different intubation methods have their advantages and disadvantages; therefore, indications for a particular intubation procedure are different to a certain extent. There are various types of mechanical ventilation in children; different modes to overcome a life-threatening condition of a child. The type of ventilation chosen to be implemented in a particular medical center is the one the team is most experienced in, therefore providing the best results

Utjecaj okolišnih čimbenika na prenatalni razvoj

A woman is especially sensitive to negative environmental factors during pregnancy, partially because her body needs to perform metabolic functions of two organisms, and partially because most chemically and physically harmful substances have stronger effects on a woman during the perinatal period, and on the fetus because of organ development and growth. Many factors are responsible for the outcome of pregnancy: genetic factors, dietary habits of the mother, uteroplacental bloodstream and placental function. Negative environmental factors can damage the fetus by affecting everything aforementioned. Consequences can be acute and fatal; after a few years they can lead to greater frequency of malignant diseases, and cause chronic changes: permanent tendency to hypertension, obesity, diabetes, and coronary heart disease. Negative environmental factors certainly influence the fetal programming and lead to greater expression of the disease to which the child is genetically predisposed. Reproduction and fertility can be permanently damaged.Žena je naročito osjetljiva na nepovoljne čimbenike okoliša tijekom trudnoće, dijelom zbog toga što njezino tijelo mora obavljati metaboličke funkcije za dva organizma, a dijelom jer većina kemijskih i fizikalnih štetnih tvari ima jači učinak na ženu tijekom trudnoće te na fetus jer je to organizam u razvoju. Na ishod trudnoće djeluju genetski čimbenici, prehrambene navike majke, uteroplacentarni krvotok te funkcija posteljice. Nepovoljni čimbenici okoline mogu oštetiti dijete intrauterino djelujući na sve prethodno navedeno. Posljedice mogu biti akutne i fatalne; nakon nekoliko godina mogu dovesti do veće učestalosti malignih bolesti, a mogu izazvati i kronične promjene: trajnu sklonost djeteta hipertenziji, gojaznosti, dijabetesu, koronarnoj bolesti srca. Štetni čimbenici okoliša sigurno utječu na fetalno programiranje i dovode do veće ekspresije bolesti kojoj je dijete genetski sklono. Mogu trajno utjecati na reprodukciju i plodnost

Impact of early rehabilitation on the outcome of a chronic disease in children

Djecu rođenu s neurorizicima i djecu koja se ne razvijaju po očekivanim psihosocijalnim i neuromotornim obrascima treba uključiti u ranu intervenciju i rehabilitaciju. Nakon otpusta iz rodilišta djece s neurorizicima, neonatolog upoznaje roditelje s mogućnostima rane intervencije i rehabilitacije u mjestu stanovanja ili najbližem rehabilitacijskom centru. U Republici Hrvatskoj ne postoje standardizirani instrumenti i protokoli probira za odstupanja u psihosocijalnom i neuromotornom razvoju djece, što uvelike otežava rad pedijatrima u primarnoj zdravstvenoj zaštiti. Pedijatrijskim praćenjem psihosocijalnoga i neuromotornoga razvoja djece trebalo bi otkriti djecu koja se ne razvijaju po očekivanim obrascima. Djecu s neujednačenim neuromotornim i psihosocijalnim razvojem treba uključiti u ranu intervenciju i rehabilitaciju. U Udruzi za pomoć osobama s mentalnom retardacijom Đakovo (Udruga) koristimo razvojne probire prema Münchener Funktionelle Entwicklungsdiagnostik (MFED) i Guide for Monitoring Child Development (GMCD). Oba probira provode se do kraja treće godine života djeteta. Udruga provodi razvojnu neuromotornu rehabilitaciju po Vojti i Bobathu. Za ranu intervenciju i psihosocijalnu rehabilitaciju postoje educirani timovi. Timovi za psihosocijalnu rehabilitaciju i ranu intervenciju rade s djecom i njihovim roditeljima u kući i individualno u prostorima Udruge. Uz pomoć razvojnih probira MFED-a i GMCD-a te razgovorom s roditeljima kontrolira se napredak djece u neuromotornom i psihosocijalnom razvoju.Children born with neurorisks and children who do not develop according to the expected psychosocial and neuromotor patterns should be included in an early intervention and rehabilitation scheme. As soon as babies at neurological risk are discharged from a maternity hospital, a neonatologist informs the parents about the possibilities of early intervention and rehabilitation in their place of living or the nearest rehabilitation center. In the Republic of Croatia there are no standard instruments or screening protocols for deviations in the psychosocial and neuromotor development of children, which greatly affects and complicates the work of pediatricians in primary health care. Monitoring the psychosocial and neuromotor development of children, pediatricians should detect children who show deviations from the expected patterns. Children who show inconsistent and uneven neuromotor and psychosocial development should be included in early intervention and rehabilitation. In the Association for Assistance to Mentally Disabled in Đakovo (hereinafter referred to as the “Association”) the following developmental diagnostic procedures are used: the Münchener Funktionelle Entwicklungsdiagnostik (MFED) and the Guide for Monitoring Child Development (GMCD). Both diagnostic procedures are being carried out until the child turns three. The Association offers and provides developmental neuromotor rehabilitation using the Bobath and the Vojta method. There are trained teams that are responsible for early intervention and providing psychosocial rehabilitation. Those teams work with children and their parents at their homes and individually at the premises of the Association. Correspondingly, by using the developmental diagnostic procedures MFED and GMCD, and by communicating with parents, the children’s progress in their neuromotor and psychosocial development is being successfully monitored