Epidemiology of the Sexually Transmitted Infections

Značenje spolno prenosivih infekcija višeznačno je i golemo opterećenje za morbiditet i mortalitet, ne samo u zemljama s ograničenim ekonomskim resursima već i u razvijenim zemljama. Spolno prenosive infekcije su jedan od vodećih uzroka akutnih bolesti, kroničnog oštećenja zdravlja i smrtnosti, s mogućim teškim medicinskim i psihološkim posljedicama za milijune žena, muškaraca i dojenčadi. U radu su prikazani epidemiološka situacija i kretanje spolno prenosivih infekcija u svijetu, Europskoj regiji i Hrvatskoj i opisana je procjena opterećenja bolešću izražena u godinama izgubljenog života i godinama života sa smanjenom kvalitetom zbog sprječivih spolno prenosivih infekcija, kao i HIV/AIDS-a. Temeljem istraživanja u adolescentnoj populaciji opisuje se kompleksnost rizičnih ponašanja mladih te slijedom smjernica Globalne strategije za sprječavanje i kontrolu spolno prenosivih infekcija Svjetske zdravstvene organizacije upozorava se na mjere i aktivnosti koje mogu unaprijediti reproduktivno zdravlje populacije.Sexually transmitted infections have a complex impact and they are a great burden not only in countries with limited economic resources, but in developed countries as well. Sexually transmitted infections are one of the leading causes of acute diseases, chronic health impairment and mortality, and they may have severe medical and psychological consequences for millions of women, men and infants. This article presents the epidemiological situation and trends on the global level, and in Europe and Croatia. The burden of disease assessment is described using Years of Life Lost and Disability Adjusted Life Years due to preventable sexually transmitted infections and HIV/AIDS. The complexity of risk behavior is described on the basis of research findings in adolescents. The measures and activities focusing on reproductive health improvement are given in accordance with the guidelines of the WHO Global Strategy for the Prevention and Control of Sexually Transmitted Infections

MEDICAL USE, NONMEDICAL USE OF PRESCRIPTION MEDICATION AND RISK BEHAVIOUR AMONG CROATIAN ADOLESCENTS

Background: At the drug scene some major shifts were observed, more and more reports highlighted the abuse of prescription medication. Despite the importance of controlled medication in treatment child and adolescent disorders, this increase may be a factor which influence misuse and nonmedical use of prescribed drugs among adolescents. Subject and methods: Croatian data from ESPAD survey in 2003, 2007 and 2011 were used, and variables selected from the international ESPAD questionnaire. Dependent variable was taking tranquilizers or sedatives prescribed by doctor in the past 12 months. Independent variables were nonmedical use of tranquilizers/sedatives, use of other psychoactive substances, school performance, truancy, delinquent behaviour, satisfaction with relationships with parents, friends, health, self-perception, financial situation and symptoms of depression. The respondents were 8849 students (4393 boys and 4456 girls) in three consecutive ESPAD surveys (2003, 2007 and 2011). Results: In multivariate analysis for all three survey years the strongest predictor for prescription medication use was use of sedatives/tranquilizers without prescription (OR 6.14; CI 4.08-9.23; OR 8.16; CI4.65-14.32; OR 9.77; CI5.92-15.13). Frequent drinking and excessive drinking or drunkenness also predicted prescription medication use, (OR 1.85; CI1.10-3.10; OR 2.01: CI 1.20-3.39). Among other problem behaviours lower school performance (OR 2.92; CI 1.41-6.05; OR 2.56; CI 1.12-5.87), missed school days OR 1.59; OR1.01-2.51; OR1.72; CI 1.03-2.87), aggressive behaviour (OR 1.532; CI 1.01-2.28; OR1.65; CI 1.04-2.62), depressive symptoms (OR 2.19; CI 1.24-3.85) and poorer financial situation were connected with prescription medication use. Conclusion: Prescription use of tranquilizers/sedatives was predicted by nonmedical tranquilizers/sedatives use, alcohol abuse, symptoms of depression and variables indicating maladjusted behaviour. Although there is sufficient evidence that prescription medication abuse might went unobserved, the further analysis which could better explain its’ role and impact is still needed

13. Kongres Europske Unije za školsku i sveučilišnu medicinu

U Dubrovniku je od 12-15. listopada 2005. godine održan 13. Kongres Europske Unije za školsku i sveučilišnu medicinu (European Union for School and University Health and Medicine - EUSUHM). Kongres je održan pod pokroviteljstvom Ministra zdravstva i socijalne skrbi i Ministra znanosti, obrazovanja i športa. Organizatori kongresa su bili EUSUHM, Hrvatsko društvo za školsku i sveučilišnu medicinu HLZ-a, Hrvatski zavod za javno zdravstvo, Sveučilište u Zagrebu – Medicinski fakultet, ŠNZ „A. Štampar“, Zavod za javno zdravstvo Dubrovačko-neretvanske županije, a suorganizatori Zavodi za javno zdravstvo županija i Grada Zagreba

13. Kongres Europske Unije za školsku i sveučilišnu medicinu

U Dubrovniku je od 12-15. listopada 2005. godine održan 13. Kongres Europske Unije za školsku i sveučilišnu medicinu (European Union for School and University Health and Medicine - EUSUHM). Kongres je održan pod pokroviteljstvom Ministra zdravstva i socijalne skrbi i Ministra znanosti, obrazovanja i športa. Organizatori kongresa su bili EUSUHM, Hrvatsko društvo za školsku i sveučilišnu medicinu HLZ-a, Hrvatski zavod za javno zdravstvo, Sveučilište u Zagrebu – Medicinski fakultet, ŠNZ „A. Štampar“, Zavod za javno zdravstvo Dubrovačko-neretvanske županije, a suorganizatori Zavodi za javno zdravstvo županija i Grada Zagreba

Adolescence, Adolescents and Healthcare

Adolescencija je razdoblje između početka puberteta i odrasle dobi, koje započinje oko 11.-13. godine i traje sve do 18.-20. godine. Često se smatra emocionalno vrlo intenzivnim i nerijetko stresnim razdobljem. U članku su opisane značajke adolescentnog razvoja i karakterističnih ponašanja koja mogu bitno utjecati na zdravlje i stabilnost u odrasloj dobi. Opisuju se značajke spolnog ponašanja adolescenata u Hrvatskoj, koje karakterizira sve ranije započinjanje spolne aktivnosti te neredovita uporaba zaštite. Jedna od temeljnih značajki rizičnih ponašanja u djece i mladih je njihova isprepletenost i međusobna povezanost, što je potvrđeno brojnim nacionalnim i međunarodnim istraživanjima. Tako mladi koji ranije stupaju u spolne odnose češće pokazuju i druga rizična ponašanja kao pijenje, pušenje, uzimanje marihuane te lošiju komunikaciju u obitelji. S druge strane, mladi koji više piju češće se agresivno i nasilno ponašaju i češće konzumiraju marihuanu. Problem prekomjerne tjelesne težine pokazuje da su ne samo čimbenici rizika kao nedovoljna tjelesna aktivnost i nepravilna prehrana ono što utječe na indeks tjelesne mase već i da se mladi u razdoblju adolescencije doživljavaju nerealno u odnosu na objektivnu situaciju njihove uhranjenosti. To ih čini vulnerabilnima te utječe i na doživljavanje sebe, kao i na procjenu zadovoljstva vlastitim životom. Vršnjačko zlostavljanje sve je prisutnije u školskim dvorištima i razredima, a kompleksnost takvog ponašanja pokazuje analiza povezanih čimbenika koji upućuju na to da su u djece uključene u vršnjačko zlostavljanje češći psihosomatski simptomi i lošija je komunikacija u obitelji. Zaključno se upozorava na nužnost specifične zdravstvene zaštite za djecu i mlade školske dobi koja organizacijom i sadržajem treba biti usmjerena upravo njihovim zahtjevima i potrebama.The adolescence is a period in human life between the onset of puberty and the adulthood, starting from 11-13 yrs and lasting till 18.-20. yrs. It is often considered as an emotionally intensive and very stressful period. The adolescence characteristic and behaviour, which could have an ultimate influence to the health and stability in the adulthood, are described. The sexual behaviours in the Croatian adolescents, including early onset of the sexual life and poor protection use, are analyzed. The inter-reactions and mutual influences of the risk behaviours in children and youth are well recognized and confirmed through national and international research. The young people who start sexual intercourses at the early age are often involved in other risk behaviour as drinking, smoking, marijuana use and poor family communication. Young people who drink more are more often aggressive and more often use marijuana. The overweight problem among children and youth indicates that risk factors for high BMI as physical inactivity and unhealthy diet are not the only important issues. Adolescents’ self-perception is not in accordance to the actual weight and height, and that makes them vulnerable regarding self-esteem as well as life satisfaction assessment. Bullying is not an isolated event in the school classrooms and schoolyards. The complexity of this behaviour is analyzed using influencing factors which indicate that among children involved in bullying psychosomatic symptoms and poor family communication are more often registered. In the conclusion the necessities for the appropriate and specific health care for children and youth, aiming at their needs and demands in the organization and content, are discussed

SCHOOL HEALTH SERVICES IN THE CITY OF ZAGREB – DO WE MEET ADOLESCENTS’ NEEDS?

Background: School health services (SHS) have in Croatia long tradition, established organizational structure, defined program and educated staff. The program is limited to the preventive activities. The aim of the study was to investigate the satisfaction of the children, school staff and parents with existing school health services in the City of Zagreb. Subject and methods: The structured questionnaire was sent to the primary and secondary schools in the City of Zagreb, which were selected using random sample method. The questionnaires were anonymous and filled in supervised by class masters. In the secondary schools the structure of schooling was respected. Questionnaires were filled by 448 pupils from primary, 551 from secondary schools, by 596 parents and 595 teachers. Results: In primary schools pupils rated SHS more available and accessible, staff complaisant and responsible, counselling being useful and justified, confidentiality respected higher than pupils from secondary schools (p<0.001). Teachers from primary and secondary schools perceived SHS as valuable school partners (88.9% and 82.3%). Teachers from primary and secondary schools (88.9% and 88.1%) and parents (78.3% and 67.5%) stated that SHS could not be replaced by GPs or paediatricians. Primary school pupils felt that most common problems were injuries and vocational counselling, secondary school pupils assessed behavioural and sexual related problems as mostly challenging. Satisfaction with the SHS response to the most challenging problems was rated higher by teachers from primary schools (p<0.001 for learning difficulties, chronic diseases, bullying and vocational counselling), by parents for learning difficulties and vocational counselling, but no significance was found for pupils’ satisfactions. Conclusion: SHS in Zagreb are recognized as vital and necessary partners for schools, available and accessible for pupils, teachers and parents, especially for primary schools. Counselling is highly rated by all respondents, confidentiality considered as respected, and the problem of the most common challenges as successfully solved

Confidence and prejudice – are we doing enough for women\u27s health?

Spolno prenosive infekcije su globalni javnozdravstveni problem, a za učnkovitu prevenciju, sprječavanje i djelotvorno liječenje nužno je sagledati sve kulturološke i kontekstualne čimbenike. U radu se problematizira potreba povjerenja ženske populacije u djelovanje i učinkovitost zdravstvene službe, ali i ostalih međuresorskih aktivnosti koje bi trebale djelovati na području reproduktivnog zdravlja. U mjerama primarne prevencije raspravlja se o primjeni zdravstvenog odgoja kao redovite kurikularne aktivnosti, potrebi osnivanja savjetovališta za mlade te cijepljenju protiv infekcije humanim papiloma virusom. Analiziraju se značajke populacijske percepcije prednosti i ograničenja cijepljenja, osobito roditelja djevojćica i moguće mjere za smanjenje predrasuda i stjecanje povjerenja. Opisuje se aktualna situacija mjera sekundarne prevencije kao rana dijagnostika i nacionalni probir te prikazuju raspoloživi podatci o oportunističkom probiru danas u Hrvatskoj. Iako se zdravstvena zaštita temelji na načelima dostupnosti, sveobuhvatnosti, kontinuiranosti i cjelovitog pristupa, za unaprjeđenje reproduktivnog zdravlja i još učinkovitije sprječavanje spolno prenosivih infekcija nužno je donošenje i provođenje mjera i primarne i sekundarne prevencije na nacionalnoj razini.Sexually transmitted infections are a global public health problem, and for effective prevention and treatment it is necessary to analyze all the cultural and contextual factors. The paper discusses the need for female population confidence in the activities and effectiveness of health care and other services that should operate in the area of reproductive health. Among primary prevention measures the paper discusses the implementation of health education as a regular curricular activity, the need for organizing youth counseling service and vaccination against human papilloma virus infection. The paper also analyzes the perception of population regarding the advantages and disadvantages of vaccination, particularly among parents of the girls and possible measures for reducing prejudice and gaining confidence. Current situation with secondary prevention measures is described, such as early diagnosis and national screening and the available data on opportunistic screening in Croatia today are demonstrated. Although health care service is based on the principles of accessibility, comprehensiveness, continuity and comprehensive approach, to improve reproductive health and more effective prevention of sexually transmitted infections it is necessary to adopt and implement primary and secondary prevention measures on a national level

Public Health Impact of Sexually Transmitted and Urogenital Infections

Važan javnozdravstveni problem u području spolnog i reproduktivnog zdravlja još uvijek su spolno prenosive i urogenitalne infekcije. Procjenjuje se da svake godine više od 400 milijuna odraslih oboli od spolno prenosivih bolesti, a da se oko 60% infekcija pojavljuje u osoba mlađih od 25 godina. U Hrvatskoj je učestalost klasičnih spolno prenosivih infekcija niska, u 2005. godini registrirano je 38 oboljelih od sifi lisa, 13 od gonoreje, 164 od hepatitisa B. Godišnje se registrira 700– –900 klamidijskih infekcija, no vrlo je vjerojatna podregistracija i nedovoljno prijavljivanje. AIDS se zadržava na niskoj razini, broj novih slučajeva je oko 15 na godinu, do sada je registrirano ukupno 239 oboljelih. U 2002. godini su prema izvještaju SZO sifi lis, gonoreja, klamidijaza i HIV bili odgovorni za 79,6 milijuna godina izgubljenog života. U pristupu liječenju SPI nužno je aktivno provoditi program probira, slijediti postupnike radi odgovarajuće terapije i sprječavanja rezistencije, obuhvata partnera te što manjeg odustajanja od liječenja. Kvalitativni napredak u sprječavanju HPV-infekcije donosi cjepivo, za koje se očekuje da će moći značajno pridonijeti smanjivanju zaražavanja, prijenosa i pojavnosti zloćudnih novotvorina vrata maternice.Sexually transmitted and urogenital infections are still an important public health issue in the sexual and reproductive health. It is estimated that more than 400 million adults become infected annually, and about 60% of them are below the age of 25. The incidence of classical sexually transmitted infections in Croatia is low; in 2005 there were 38 syphilis, 13 gonorrhea and 164 hepatitis B cases reported. 700-900 chlamydial infections are registered annually, but the real number is probably higher taking account of poor registration. AIDS incidence is still low, around 15 cases each year. The number of cases registered so far is 239. According to the WHO report, 79.6 million years of life were lost because of HIV, syphilis, gonorrhea, and chlamydial infections in 2002. It is necessary to adopt a comprehensive approach to STI, including screening program, guidelines for appropriate medical treatment and prevention of resistance development, promotion of partner involvement, and patient compliance. The HPV vaccine will contribute to the prevention of HPV infections. It is expected to considerably reduce HPV incidence and transmission, and incidence of cervical neoplasms