A Cultural Diversity Seen in Croatian Family Medicine: A Lady from Janjevo

The role of cultural diversities in doctor’s everyday work is going more and more important in globalised world, therefore it draws lots of attention in literature. Cultural differences that exist between people, such as language, dress and traditions, are usually distinguished from the term cultural diversity which is mainly understood as having different cultures respect each other’s differences. The great effort is made to educate culturally competent practitioners, nurses or doctors. The presented case of lady from Janjevo was a good role model for work with all patients with culturally different background coming to family practice. This lady example could also help to other colleagues to learn from experience on systematic way

A Role of Croatian Family Doctors in the Provision of Women’s Health Care: A Study Based on Routinely Collected Data

The aim of this study was to investigate how often Croatian FDs are involved in the provision of women’s health, having in mind that women’s health is primarily organized by the gynecological service. Only the data related to women’s health were collected from the Croatian health statistical yearbooks from 1995 to 2012, in which ICD X was used. Results showed that total number of diagnoses are increasing. The greatest increase is observed in the category named as other diseases of female organs, then diagnoses related to the pregnancy, delivery and postpartum and malignant diseases, especially, breast cancer. Contrary, number of menopausal disorders continuing decreased. Diagnoses related to family planning (Z30) are relative small in amount and stabile. Results indicated that policy makers should take in account readiness of FDs to be involved in the provision of women’s health

Diabetes in Elderly

Diabetes is a major public health problem in the world and one of the leading causes of morbidity and mortality from cardiovascular and chronic kidney disease. Aging of the population is expected to further increase the prevalence of type 2 diabetes, particularly in the age group over 65. According to the 2011 census, in Croatia, 17.7% of the population were elderly, and the estimated prevalence of diabetes in this age group is 15–20%. Taking care of elderly diabetics has its own characteristics compared to other age groups, and a particular challenge for the family physician due to comorbidity and polymedication, as well as more frequent complications of the disease and more common side effects of treatment. The aim of this article is to show the treatment of diabetes in elderly, in the light of new studies (ACCORD, ADVANCE and VADT), and to present revised professional societies (ADA, AHA, ACC) recommendations, focusing on the individualized approach

THE ROLE OF GPS IN WOMEN’S HEALTH CARE – THE EU EXPERIENCE

Primarna zdravstvena zaštita žena u Hrvatskoj je tradicionalno bila organizirana kroz dispanzere za žene, s ginekologom kao vođom tima. Liječnici obiteljske medicine (LOM) su znatno rijeđe sudjelovali, a osobito u zadnjih dvadesetak godina. Stoga je cilj ovog rada bio ispitati ulogu LOM-a u zaštiti zdravlja žena u zemljama Europske Unije (EU). Istraživanje je presječno, temeljeno na posebno priređenom anketnom upitniku kojeg su ispunjavali predstavnici svih 27 zemalja EU (osim Hrvatske); sudionici Vasco da Gama Projekta razmjene specijalizanata i mladih specijalista obiteljske medicine, kojeg je Hrvatska bila domaćin u 2013. godini, te Foruma Vasco da Gama u Barceloni 2014. godine. U 24 od 27 zemalja Europske Unije (EU), LOM-ovi su uključeni u provođenje PZZ žena, u 22 zajedno s ginekolozima, a u dvije potpuno samostalno. U 23 države provode preventivne i kurativne mjere zaštite, a u samo jednoj zemlji preventivne mjere. Provode se istovremeno različite preventivne aktivnosti, najčešće kontracepcija, zatim prekoncepcijsko savjetovanje i rano otkrivanje malignih bolesti. Primjenjuju su različite metode kontracepcije, doduše najčešće hormonalna kontracepcijska sredstva, ali i intrauterini ulošci. U 16 zemalja ordinacije LOM-a su opremljene ginekološkom opremom, a u 13 država su LOM dodatno plaćali za brigu o zdravlju žena. U 26 zemalja LOM su tijekom specijalizacije educirani za provođenje zaštite zdravlja žena, najčešće je to kombinacija teoretske i praktične nastave, ali se modeli edukacije razlikuju. Rezultati istraživanja su nedvojbeno pokazali da su LOM-ovi u zemljama EU uključeni u zaštitu zdravlja žena. Rezultatima istraživanja nije moguće obrazložiti zbog čega LOM-ovi u Hrvatskoj nisu uključeni u te aktivnosti, pa su potrebna dodatna istraživanja. Problem je osobito važan u svijetlu prava pacijenata na prekograničnu zdravstvenu zaštitu, jer su pacijenti s prostora EU navikli na taj oblik zaštite unutar djelatnosti obiteljske medicine.Primary health care was traditionally organized through women’s health services having a gynaecologist for the team leader in Croatia. General practitioners (GPs) participated in women’s health care especially during the last twenty years. Therefore the aim of this study was to examine the role of GPs in the countries of the European Union. The study was based on the questionnaire especially prepared for this purpose and answered by representatives from all 27 countries of the European Union (except Croatia); participants of the Vasco de Gama Project on exchange of residents and young specialist in family medicine hosted by Croatia in 2013 as well as from the Vasco de Gama Forum in Barcelona in 2014. In 24 out of 27 countries of the EU GPs are included in women’s primary health care, in 22 countries together with the gynaecologists and in 2 countries they are on their own. In 23 countries they carry out preventive and curative measures while only in one country just preventive measures are carried out. Preventive measures are carried out simultaneously, mostly contraception, then preconceptual consultation and early detection of malignant diseases. Various contraceptive methods are applied, most frequently hormonal contraceptives but intrauterine devices as well. Gynaecological equipment could be found in general practitioner’s offices in 16 countries and in 13 country GPs are additionally paid for women’s health care. GPs are educated for women’s health care during their specialization in 26 countries. It is mostly a combination of theory and practical education, but education models are different. Results of the study undoubtedly showed that GPs are involved in women’s health care in the EU. Those results do not explain the reason why Croatian GPs are not involved in this activity. Therefore additional studies are necessary. This problem is especially important regarding patients’ rights to over-the-border health protection because the patients from the EU are used to this form of service to be included in general practice activities

Trends in Family Planning and Contraception Carried out in Primary Health Care in Croatia: 1995–2012: Study Based on Routinely Collected Data

The lack of objective findings provided the reason to undertake this study with the main aim of exploring the trends in family planning and contraception carried out in primary health care in Croatia. Based on the Croatian health statistical yearbooks from 1995 to 2012, data were collected on the number and structure of visits and the number and type of prescribed contraceptives by public and private gynecological practices, and visits to family practices and school medicine services. The results showed that only a small number of fertile women received primary care for family planning issues, trends that are evident through the entire follow-up period. A trend of »migration« from the public to the private sector is also observed. Family doctors and school medicine are almost entirely excluded from the provision of family planning despite the magnitude of the family planning problem resulting in a waste of human and material resources

Systems Science and Health: Using Analytical Approaches to Evaluate Healthcare Policy Decisions

This collection of presentations is from the mini-symposium entitled Systems Science and Health: Using Analytical Approaches to Evaluate Healthcare Policy Decisions. The focus of this symposium is on systems science applications to health research. Systems science is a collection of analytical computer simulation techniques which are used to evaluate optimize and improve healthcare delivery processes. These techniques account for the complexity of the healthcare system and healthcare processes by modeling nonlinear relationships between variables, the feedback effects, delays and soft variables. The analysis stresses heterogeneity of agents, resistance to change, potential unintended consequences, and behavioral emergence in complex systems. Such models use historical data to simulate the operations of healthcare systems providing an approximation of future outcomes. The presenters will discuss several different types of simulations methods, highlight recent advances, and describe funding opportunities from the National Institutes of Health. Examples from chronic disease patient chains, physician incentive redesign, clinic staffing and Emergency Department redesign will be discussed

Preventive Health Care for Women in Croatia: Ongoing Trends from 1995 to 2012

The privatization of gynecological services and the introduction of additional reimbursements to capitation fees are ongoing mini reforms in Croatia. In order to evaluate the outcomes of this, study was performed with the main aim of determining trends in preventive activities carried out in public and private gynecological practices from 1995 to 2012. The Croatian Health Service Yearbooks served as the basis for data collection. Data were collected on the number of general check-ups, the number of targeted check-ups, and the number of follow-up check-ups. The results indicate a trend of continuous decline in the number of general and follow-up check-ups, as well as breast examinations and Pap smears, in public gynecological practices even after the introduction of contractual obligations and additional reimbursements and fee-for-service payments. One important note is that many resources were invested in general checks-up interventions, which proved to be ineffective, while fewer resources were invested in the more effective Pap smear interventions

Desmoplastični tumor malih okruglih stanica – DSRCT – prikaz slučaja

Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males with predilection for involvement of the peritoneum. It is an aggressive neoplasm with a poor prognosis. Herein we present a case of a 23 year old man with DSRCT which, at the beginning, has been a diagnostic and clinical problem.Dezmoplastični okrugli malostanični tumor ( DSRCT) je rijedak maligni tumor koji se pojavljuje u mla|ih muškaraca i najčešće zahvaća peritonej. To je agresivan tumor s lošom prognozom. Ovdje ćemo prikazati slučaj 23-godišnjeg muškarca s dijagnosticiranim DSRCT, koji je u početku predstavljao dijagnostički i klinički problem

DEVELOPMENT OF RESEARCH CAPACITIES DURING SPECIALTY TRAINING IN FAMILY MEDICINE: CROATIAN EXPERIENCE

Uvod: Osim osposobljavanja za kvalitetan praktičan rad, jedan od ciljeva specijalizacije iz obiteljske medicine (OM) je i osposobljavanje za istraživanje i publiciranje. To se nastojalo postići kroz kolegij Istraživanje u OM-u, iako je i cjelokupni program specijalizacije usmjeren tom cilju. Cilj: Željeli smo istražiti što su i u kolikom broju publicirali specijalizanti, deset godina prije i deset godina od početka specijalizacije, s ciljem evaluacije uspješnosti programa specijalizacije, a osobito kolegijem Istraživanje u OM-u. Metoda: Povodom 20-godišnjice Hrvatske udružbe obiteljske medicine, HUOM-a, u MFC-u je objavljen popis svih naslova radova publiciranih u MFC-u i Zbornicima HUOM-a u zadnjih 20 godina (1993.-2013.), s imenima autora i godinom publiciranja. Budući da je popis radova završavao s 2013. godinom, pregledani su još i svi radovi objavljeni u MFC-u i Zbornicima u 2014. godini. Za ovo istraživanje odabran je period od deset godina prije početka Projekta specijalizacije, od 1995. do 2004., i deset godina nakon početka specijalizacije, od 2005. do 2014. godine. Prikupljeni su podatci o radovima čiji su autori bili specijalizanti, pri čemu smo koristili popise specijalizanata po Projektu specijalizacije. U analizi sadržaja koristili smo tematsku analizu naslova i sažetaka radova. Rezultati: U dvadesetogodišnjem periodu, 113 radova koje su napisali specijalizanti je publicirano u MFC-u i 251 rad u Zbornicima. Prije početka Projekta specijalizacije (1995.-2004.), specijalizanti su publicirali 42 rada u MFC-u, a 71 rad nakon početka Projekta specijalizacije (2005.-2014.), što predstavlja povećanje broja publiciranih radova za 69%. Prije početka specijalizacije, specijalizanti su publicirali 85 radova u Zbornicima HUOM-a, a nakon početka 166, što predstavlja povećanje za 66,2%. Prije početka projekta specijalizacije, u 50% radova obrađivane su kliničke teme, a nakon početka u 32% radova. U 47.6% radova obrađivani su sadržaji specifični za OM prije početka, a 49% nakon početka Projekta specijalizacije. Zaključci: Rezultati pilot istraživanja su ukazali na veliku vjerojatnost da specijalizacija, u cjelini ili kolegij Istraživanja kao zasebna cjelina, osposobljava LOM, ne samo za praktičan klinički rad, nego i za istraživanje i publiciranje.Introduction: Development of research capacities is one of the aims of the New Croatian Speciality Training (ST) in Family Medicine (FM). The whole speciality curriculum, especially the research module within the postgraduate course, was designed for the achievement of this aim. Aim: In order to evaluate the outcomes of the curriculum and research module, this pilot study was aimed to investigate whether more articles are published by speciality trainees after than before the training. Methods: We analysed the authors, titles and abstracts of articles, written by FM specialty trainees published in the Croatian journal Medicina Familiaris Croatica (MFC) and in the Proceedings of the Croatian Association of Family Medicine (HUOM) conferences from 1995 to 2014, using content analysis method. The new program was introduced in 2003, so we compared the number of published articles and topics in 10 years period before (1995-2004) and 10 years period after (2005-2014) it. Results: During the period of 20 years 90 trainees published 113 articles in MFC and 251 in the Proceedings. Only 42 articles were published by specialist trainees in MFC before the new ST started and 71 after what is 69% increase. Before the New ST 50% of the content related to clinical issues and 32% after. Specific FM topics remained almost the same while other topics increased from 2.8% to 18%. In 66.1% articles published in the Proceedings increase was also noticed after the beginning of New ST. Most of the articles were related to clinical themes (63% before 2005 and 65% after 2005), 21% related to FM topics and cca 14% to the others before and after 2005. Conclusion: The results clearly indicated positive outcomes of New ST curriculum, especially of the research module, in the development of trainees’ research competences and motivation to publish more

DEVELOPMENT OF RESEARCH CAPACITIES DURING SPECIALTY TRAINING IN FAMILY MEDICINE: CROATIAN EXPERIENCE

Uvod: Osim osposobljavanja za kvalitetan praktičan rad, jedan od ciljeva specijalizacije iz obiteljske medicine (OM) je i osposobljavanje za istraživanje i publiciranje. To se nastojalo postići kroz kolegij Istraživanje u OM-u, iako je i cjelokupni program specijalizacije usmjeren tom cilju. Cilj: Željeli smo istražiti što su i u kolikom broju publicirali specijalizanti, deset godina prije i deset godina od početka specijalizacije, s ciljem evaluacije uspješnosti programa specijalizacije, a osobito kolegijem Istraživanje u OM-u. Metoda: Povodom 20-godišnjice Hrvatske udružbe obiteljske medicine, HUOM-a, u MFC-u je objavljen popis svih naslova radova publiciranih u MFC-u i Zbornicima HUOM-a u zadnjih 20 godina (1993.-2013.), s imenima autora i godinom publiciranja. Budući da je popis radova završavao s 2013. godinom, pregledani su još i svi radovi objavljeni u MFC-u i Zbornicima u 2014. godini. Za ovo istraživanje odabran je period od deset godina prije početka Projekta specijalizacije, od 1995. do 2004., i deset godina nakon početka specijalizacije, od 2005. do 2014. godine. Prikupljeni su podatci o radovima čiji su autori bili specijalizanti, pri čemu smo koristili popise specijalizanata po Projektu specijalizacije. U analizi sadržaja koristili smo tematsku analizu naslova i sažetaka radova. Rezultati: U dvadesetogodišnjem periodu, 113 radova koje su napisali specijalizanti je publicirano u MFC-u i 251 rad u Zbornicima. Prije početka Projekta specijalizacije (1995.-2004.), specijalizanti su publicirali 42 rada u MFC-u, a 71 rad nakon početka Projekta specijalizacije (2005.-2014.), što predstavlja povećanje broja publiciranih radova za 69%. Prije početka specijalizacije, specijalizanti su publicirali 85 radova u Zbornicima HUOM-a, a nakon početka 166, što predstavlja povećanje za 66,2%. Prije početka projekta specijalizacije, u 50% radova obrađivane su kliničke teme, a nakon početka u 32% radova. U 47.6% radova obrađivani su sadržaji specifični za OM prije početka, a 49% nakon početka Projekta specijalizacije. Zaključci: Rezultati pilot istraživanja su ukazali na veliku vjerojatnost da specijalizacija, u cjelini ili kolegij Istraživanja kao zasebna cjelina, osposobljava LOM, ne samo za praktičan klinički rad, nego i za istraživanje i publiciranje.Introduction: Development of research capacities is one of the aims of the New Croatian Speciality Training (ST) in Family Medicine (FM). The whole speciality curriculum, especially the research module within the postgraduate course, was designed for the achievement of this aim. Aim: In order to evaluate the outcomes of the curriculum and research module, this pilot study was aimed to investigate whether more articles are published by speciality trainees after than before the training. Methods: We analysed the authors, titles and abstracts of articles, written by FM specialty trainees published in the Croatian journal Medicina Familiaris Croatica (MFC) and in the Proceedings of the Croatian Association of Family Medicine (HUOM) conferences from 1995 to 2014, using content analysis method. The new program was introduced in 2003, so we compared the number of published articles and topics in 10 years period before (1995-2004) and 10 years period after (2005-2014) it. Results: During the period of 20 years 90 trainees published 113 articles in MFC and 251 in the Proceedings. Only 42 articles were published by specialist trainees in MFC before the new ST started and 71 after what is 69% increase. Before the New ST 50% of the content related to clinical issues and 32% after. Specific FM topics remained almost the same while other topics increased from 2.8% to 18%. In 66.1% articles published in the Proceedings increase was also noticed after the beginning of New ST. Most of the articles were related to clinical themes (63% before 2005 and 65% after 2005), 21% related to FM topics and cca 14% to the others before and after 2005. Conclusion: The results clearly indicated positive outcomes of New ST curriculum, especially of the research module, in the development of trainees’ research competences and motivation to publish more