PREVENTIVE WORK IN FAMILY MEDICINE – PROACTIVE APPROACH

Uloga liječnika opće/obiteljske medicine u prevenciji bolesti i promociji zdravlja potvrđena je rezultatima istraživanja te u zdravstvenoj politici. S obzirom na položaj liječnika opće/obiteljske medicine u zdravstvenom sustavu i njegov bliski, trajni kontakt s populacijom koja ga je izabrala te s lokalnom zajednicom u kojoj djeluje, razumljivo je da je liječniku opće/obiteljske medicine preventivni rad uključen kao neodvojivi dio redovitog, uobičajenog rada u praksi. Skrb za bolesnika u općoj medicini je kompleksna i proteže se od intervencija u determinantama zdravlja do palijativne skrbi. Preventivne aktivnosti su više ili manje prisutne na svakom odsječku tog procesa. Postoji značajan raskorak između znanja liječnika opće/obiteljske medicine i postojeće prakse u korištenju na znanstvenim dokazima utemeljenih preporuka za aktivnosti u promociji zdravlja i prevenciji bolesti. Opisali smo ulogu liječnika opće obiteljske medicine u preventivnom radu i prikazali podatke o preventivnima aktivnostima u službi obiteljske medicine u Hrvatskoj. Za pravu ocjenu preventivnog rada obiteljskih liječnika potrebno je raspolagati objektivnim na znanstvenim dokazima utemeljenim podacima koji će pokazati što obiteljski liječnici rade u praksi. Zbog toga je nužno da liječnici sistematski bilježe i evaluiraju relevantne preventivne aktivnosti i aktivnosti koje provode u promociji zdravlja, a da se njihovo izvršenje programa redovito prati, evaluira te profesionalno i financijski vrednuje. Prema tim je principima Stručna radna skupina za koordinaciju, praćenje i usmjeravanje reforme u obiteljskoj medicini Ministarstva zdravstva i socijalne skrbi Republike Hrvatske izradila program preventivnih aktivnosti u obteljskoj medicini koji je prikazan u ovom raduThe role of general practitioner/family physician (GP/FP) in disease prevention and health promotion is strongly supported by research and health policies. The position of GPs/FPs in the health care system and their close, sustained contact with their patients and local community makes preventive care an integral part of GP/FP routine work. The spectrum of caring for patients in general practice/family medicine is actually very large, going from intervention on health care determinants to palliative care. The prevention-related activities are more or less present at each step of this “healthcare continuum”. The significant gaps between GP/FP knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention. We describe the role of GP/FP in preventive care and report data on preventive care activities in the Croatian Family Medicine Service. More objective evidence is needed to see what GPs/FPs actually do in practice. For this reason, it is critical that GPs/FPs systematically record the most relevant preventive and health promotion activities that they perform. Furthermore, their performance of the preventive program should be regularly monitored, evaluated and professionally and financially validated. We present the preventive program based on these principles in Family Medicine Service proposed by the Ministry of Health and Social Welfare Working Group on Reform of Primary Health Care

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

Insights into flexibility of Rhodococci in transformation of PCBs

National audienc

Impact of the different bioremediation treatments on the structure and activity of functinal community involved in PCB-degradation

National audienceEven though production of polychlorinated biphenyls (PCBs) was banned more than 30 years ago, their persistence, toxicity and potential to accumulate in the food web, makes PCBs still ecological and health issues worldwide. Use of microorganisms for cleaning of PCB-contaminated environments has been proposed as a cost-effective and environmentally friendly strategy in comparison with physical-chemical treatments. Even though microbial strains able to co-metabolize PCBs under aerobic or anaerobic conditions have been isolated, in situ removal rates are exceptionally weak, therefore the challenge is to determine why this is so, and to find a way to realize full potential of PCB degraders. In order to better understand biological processes that facilitate PCB-bioremediation in contaminated soils, a small-scale bioremediation experiment was designed. Soil designated for bioremediation had been contaminated with PCBs for more than 10 years as a consequence of transformer station damaged during war event in Croatia. Small-scale field experiment employed three different strategies: (i) bioaugmentation of soil with PCB-degrading mixed culture TSZ7 (BAM treatment) or PCB-degrading strain Rhodococcus sp. Z6 (BAP treatments) and amendments (xylose, carvone and soya lecithin), and (ii) biostimulation of soil only with the amendments (BS treatment). Only natural compounds for both inducing PCB-degradation pathway and enhancing PCB bioavailability were used in the experiment. Study investigated the impact of the treatments (i) on the diversity and abundance of PCB-degrading bacteria (by quantitative PCR, cloning and sequencing of bphA and bphC sequences), (ii) on the PCB-degrading activity of soil microbiota and (by determining PCB residues using gas chromatography analysis) (iii) on the changes in total bacterial community structure (using soil DNA bar coding). Results showed low phylogenetic diversity among PCB-degraders in soils indicating Rhodococcus genus bacteria as the predominant one in all treated soils with the genetic potential to degrade PCBs. Higher levels of bphA and bphC sequences detected in remediated soils further implied that treatments led to the switch in the soil microbial community favoring the development of PCB-degrading Rhodococcus population, shown to represent up to 0.2 % of the total soil bacterial community. It was shown that treatments enhanced removal of PCBs from the soil with approximately 40% of the PCBs being transformed within first year of the experiment. After reaching this maximum further degradation was shown to be limited. Even thought biostimulation was indicated as a sufficient strategy for bioremediation of the targeted soil, the fact that bioaugmentation accelerated PCB-degradation process suggested that soil inoculation with PCB-degraders played a complementary role in the degradation process. Metabolically active soil bacteria were shown to be efficient in degrading structurally versatile PCB congeners present in soil, even ortho-substituted PCBs, known to be highly resistant to microbial degradation. Bar coding analysis of soil DNA extracts revealed that remediation deeply changed the global genetic structure of soil microbial communities. One could conclude that bioremediation treatments affected (i) the abundance of competent PCB-degraders in soil and/or (ii) the induction of microbial community catabolic genes and/or (iii) the bioavailability of PCBs in soil.Même si la production de biphényles polychlorés (BPC) a été interdit plus de 30 ans, leur persistance, leur toxicité et le potentiel de s'accumuler dans la chaîne alimentaire, les PCB fait encore des questions écologiques et de santé dans le monde entier. L'utilisation des microorganismes pour le nettoyage des environnements contaminés par les BPC a été proposé comme une stratégie rentable et respectueuse de l'environnement en comparaison avec les traitements physico-chimiques. Même si des souches microbiennes capables de co-métaboliser les PCB dans des conditions aérobies ou anaérobies ont été isolées, des taux de retrait in situ sont exceptionnellement faibles, par conséquent, le défi est de déterminer pourquoi c'est ainsi, et à trouver un moyen de réaliser le plein potentiel de PCB dégradeurs . Afin de mieux comprendre les processus biologiques qui facilitent la biorestauration des PCB dans les sols contaminés, une expérience de bioremédiation petite échelle a été conçue. Sols désigné pour la biorestauration avaient été contaminés par les PCB depuis plus de 10 ans comme une conséquence de la station de transformateur endommagé pendant l'événement de guerre en Croatie. Expérience sur le terrain à petite échelle a employé trois stratégies différentes: (i) bioaugmentation de sol avec des PCB dégradants culture mixte TSZ7 (BAM traitement) ou PCB dégradants souche de Rhodococcus sp. Z6 (traitements BAP) et amendements (xylose, carvone et lécithine de soja), et (ii) de biostimulation du sol seulement avec les modifications (traitement BS). Seuls les composés naturels pour les deux voies de dégradation des PCB et de la biodisponibilité induisant l'amélioration des PCB ont été utilisés dans l'expérience. Étude a examiné l'impact des traitements (i) sur la diversité et l'abondance des bactéries dégradant PCB (par PCR quantitative, le clonage et le séquençage de BPHA et des séquences bphC), (ii) sur l'activité des PCB dégradants du microbiote du sol et (par détermination des résidus de BPC en utilisant une analyse chromatographie en phase gazeuse) (iii) sur les changements dans la structure de la communauté bactérienne totale (en utilisant une barre ADN de sol de codage). Les résultats ont montré une grande diversité phylogénétique faible chez les PCB dans les sols dégradeurs indiquant bactéries genre Rhodococcus comme celui prédominant dans tous les sols traités avec le potentiel génétique de dégrader les PCB. Des niveaux élevés de BPHA et des séquences bphC détecté dans les sols assainis encore implicitement que les traitements ont conduit à l'interrupteur de la communauté microbienne du sol en favorisant le développement de la population aux PCB Rhodococcus dégradant, montré pour représenter jusqu'à 0,2% de la communauté bactérienne totale du sol. Il a été montré que les traitements avec suppression améliorée des PCB dans le sol avec environ 40% des PCB se transforme pendant la première année de l'expérience. Après avoir atteint cette dégradation maximale supplémentaire a été montré à être limitée. Même la pensée biostimulation était indiquée comme une stratégie suffisante pour la biorestauration des sols ciblées, le fait que bioaugmentation accéléré la dégradation des PCB processus suggéré que l'inoculation du sol avec des PCB dégradeurs joué un rôle complémentaire dans le processus de dégradation. Métaboliquement actifs bactéries du sol se sont révélés efficaces dans la dégradation congénères de PCB structurellement polyvalent présents dans le sol, même ortho-substitués PCB, connus pour être très résistants à la dégradation microbienne. Le codage à barres de l'analyse des extraits d'ADN a révélé que le sol d'assainissement profondément modifié la structure génétique globale des communautés microbiennes du sol. On pourrait conclure que les traitements de biorestauration touchés (i) l'abondance de la compétence des PCB dans le sol dégradeurs et / ou (ii) l'induction de gènes cataboliques des communautés microbiennes et / ou (iii) de la biodisponibilité des BPC dans le sol

Response of the PCB-contaminated soil bacterial community to applied bioremediation treatments

International audienc

Evidence for taxonomic and functional drift of an atrazine-degrading culture in response to high atrazine input

International audienceWe evaluated the effects of variations in atrazine input on the evolution of a bacterial culture adapted to a low atrazine concentration. This initial culture (M3-K) was subjected to weekly subculturing in the presence of a high concentration of atrazine as the only N source (100 mg l−1). After four subculturing, M3-K evolved to a new bacterial culture (M3) which exhibited a significant increase in the extent of atrazine mineralization in comparison with the initial culture. Molecular analyses of M3-K and M3 cultures by cloning, restriction analysis, and sequencing of the 16S rRNA genes revealed significant differences in culture structure and composition. M3-K culture comprised mainly Actinobacteria (40%), β-Proteobacteria (26%), and Bacteroidetes (16%). After exposure to a high atrazine concentration, the dominance of Actinobacteria decreased (14%), Bacteroidetes increased (27%), and β-Proteobacteria were replaced by γ-Proteobacteria (32%). Quantitative PCR revealed that the abundance of atzB and atzC genes relative to total bacteria decreased by a factor of 3–4 following the increase in atrazine concentration, while the relative abundance of trzD increased significantly (≈400 times). Presented study shows that variations in atrazine input drive both functional and compositional shifts in the atrazine-degrading bacterial culture

Ecotoxicological impact of low dose herbicide nicosulfuron on soil microbial biodiversity and functioning

International audienc

Insight in the PCB-degrading functional community in long-term contaminated soil under bioremediation

International audiencePurpose : A small-scale bioremediation assay was developed in order to get insight into the functioning of a polychlorinated biphenyl (PCB) degrading community during the time course of bioremediation treatment of a contaminated soil. The study was conducted with the aim to better understand the key mechanisms involved in PCB-removal from soils. Materials and methods : Two bioremediation strategies were applied in the assay: (a) biostimulation (addition of carvone as inducer of biphenyl pathway, soya lecithin for improving PCB bioavailability, and xylose as supplemental carbon source) and (b) bioaugmentation with selected seed cultures TSZ7 or Rhodococcus sp. Z6 originating from the transformer station soil and showing substantial PCB-degrading activity. Functional PCB-degrading community was investigated by using molecular-based approaches (sequencing, qPCR) targeting bphA and bphC genes, coding key enzymes of the upper biphenyl pathway, in soil DNA extracts. In addition, kinetics of PCBs removal during the bioremediation treatment was determined using gas chromatography mass spectrometry analyses. Results and discussion : bphA-based phylogeny revealed that bioremediation affected the structure of the PCB-degrading community in soils, with Rhodococcus-like bacterial populations developing as dominant members. Tracking of this population further indicated that applied bioremediation treatments led to its enrichment within the PCB-degrading community. The abundance of the PCB-degrading community, estimated by quantifying the copy number of bphA and bphC genes, revealed that it represented up to 0.3% of the total bacterial community. All bioremediation treatments were shown to enhance PCB reduction in soils, with approximately 40% of total PCBs being removed during a 1-year period. The faster PCB reduction achieved in bioaugmented soils suggested an important role of the seed cultures in bioremediation processes. Conclusions : The PCBs degrading community was modified in response to bioremediation treatments, leading to partial removal of PCBs from contaminated soil. The abundance of the PCB-degrading community was increased, and Rhodococcus-like bacterial population was identified as its key player. Combination of molecular approaches with chemical analyses is of prime interest to monitor microbial processes involved in the bioremediation treatment. They offer new insight in the managing of PCBs contaminated sites providing the opportunity to design the bioremediation strategy based on on-site evaluation of PCBs degrading ability of the soil microbial community

Evidence for shifts in the structure and abundance of the microbial community in a long-term PCB-contaminated soil under bioremediation

International audienceAlthough the impact of bioremediation of PCB-contaminated sites on the indigenous microbial community is a key question for soil restoration, it remains poorly understood. Therefore, a small-scale bioremediation assay made of (a) a biostimulation treatment with carvone, soya lecithin and xylose and (b) two bioaugmentation treatments, one with a TSZ7 mixed culture and another with a Rhodococcus sp. Z6 pure strain was set up. Changes in the structure of the global soil microbial community and in the abundances of different taxonomic phyla were monitored using ribosomal intergenic spacer analysis (RISA) and real-time PCR. After an 18-month treatment, the structure of the bacterial community in the bioremediated soils was significantly different from that of the native soil. The shift observed in the bacterial community structure using RISA analysis was in accordance with the monitored changes in the abundances of 11 targeted phyla and classes. Actinobacteria, Bacteriodetes and α- and γ-Proteobacteria were more abundant under all three bioremediation treatments, with Actinobacteria representing the dominant phylum. Altogether, our results indicate that bioremediation of PCB-contaminated soil induces significant changes in the structure and abundance of the total microbial community, which must be addressed to implement bioremediation practices in order to restore soil functions