Urban-rural differences in a population-based breast cancer screening program in Croatia

Aim To investigate urban-rural differences in the distribution of risk factors for breast cancer. Methods We analyzed the data from the first round of the “Mamma” population based-screening program conducted in Croatia between 2007 and 2009 and self-reported questionnaire results for 924 patients with histologically verified breast cancer. Reproductive and anthropometric characteristics, family history of breast cancer, history of breast disease, and prior breast screening history were compared between participants from the city of Zagreb (n = 270) and participants from 13 counties with more than 50% of rural inhabitants (n = 654). Results The screen-detected breast cancer rate was 4.5 per 1000 mammographies in rural counties and 4.6 in the city of Zagreb, while the participation rate was 61% in rural counties and 59% in Zagreb. Women from Zagreb had significantly more characteristics associated with an increased risk of breast cancer (P < 0.001 in all cases): no pregnancies (15% vs 7%), late age of first pregnancy (≥30 years) (10% vs 4%), and the most recent mammogram conducted 2-3 years ago (32% vs 14%). Women from rural counties were more often obese (41% vs 28%) and had early age of first live birth (<20 years) (20% vs 7%, P < 0.001 for both). Conclusion Identification of rural-urban differences in mammography use and their causes at the population level can be useful in designing and implementing interventions targeted at the reduction of inequalities and modifiable risk factors

Nacionalni program kontrole raka

Nacionalni program kontrole raka prema preporukama Svjetske zdravstvene organizacije (WHO National Cancer Control Programme - Policies and managerial guidelines, 2002) mora biti komprehenzivan u cilju održavanja zdravlja zdrave populacije, redukcije rizika i izbjegavanja raka populacije u riziku, izlječenja i izbjegavanja smrti populacije s rano otkrivenim rakom, poboljšanja preživljavanja populacije s uznapredovalim rakom te umiranja bez patnje oboljelih od raka. Program definira kratkoročne i dugoročne ciljeve te indikatore za evaluaciju programa

Nacionalni program kontrole raka

Nacionalni program kontrole raka prema preporukama Svjetske zdravstvene organizacije (WHO National Cancer Control Programme - Policies and managerial guidelines, 2002) mora biti komprehenzivan u cilju održavanja zdravlja zdrave populacije, redukcije rizika i izbjegavanja raka populacije u riziku, izlječenja i izbjegavanja smrti populacije s rano otkrivenim rakom, poboljšanja preživljavanja populacije s uznapredovalim rakom te umiranja bez patnje oboljelih od raka. Program definira kratkoročne i dugoročne ciljeve te indikatore za evaluaciju programa

Antibiotic Prescription Rate for Upper Respiratory Tract Infections and Risks for Unnecessary Prescription in Croatia

Overprescribing of antibiotics in primary care has been recognized as public health problem. We investigated visits prescription rate of antibiotics to patients with upper respiratory tract infections (URTI) and unnecessary prescribtion for tonsillopharyngitis, in Croatia. In prospective observational study in November 2007. 25 GPs in Croatia recorded all patients’ visits with URTI episode according ICPC-2. Clinical status of patients with tonsillopharyngitis were categorized according to Centor Criteria. 689 visits were analysed, 82% of visits were initial. Antibiotics were prescribed in 44.7% visits with URTI. There were no significant differences in antibiotic prescription rates regarding non–clinical factors. Antibiotics were prescribed to patients with tonsillopharyngitis in 62.2% visits. Unnecessary antibiotics were prescribed (Centor 1,2) in 49.6% visits with tonsillopharyngitis. Logistic regression analysis showed significant differences in unnecessary antibiotic prescription rates only with respect to the workday – Wednesday, CI (1.117–2.671), p=0.0139. Leading antibiotic was amoxicillin + clavulonic acid, second was amoxicillin, the third were macrolides, the fourth was narrow spectrum penicillin and fifth were cephalosporins. This study shows over prescription for URTI. Unnecessary prescription for tonsillopharyngitis depend on non clinical factor – day of the week. This should be futher explored and help to improved prescribe antibiotics

GUIDELINES FOR PREVENTION, CONTROL AND TREATMENT OF INFECTIONS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): Changes and updates of chapter 7.0: Treatment of patients with MRSA infection

Meticilin-rezistentni Staphylococcus aureus (MRSA) važan je bolnički patogen u cijelome svijetu, pa i u Republici Hrvatskoj. Stoga se pristupilo izradi smjernica, kojih je svrha smanjiti broj bolesnika inficiranih/koloniziranih sojevima MRSE u zdravstvenim ustanovama i domovima za starije i nemočne osobe u Republici Hrvatskoj te na taj način smanjiti morbiditet i mortalitet koji uzrokuje ova bakterija. Interdisciplinarni tim stručnjaka načinio je Smjernice, koriste}i se internacionalnim publikacijama i smjernicama koje govore o prevenciji i kontroli MRSE, te liječenju i laboratorijskoj dijagnostici MRSE. Snaga preporuka određena je metodologijom CDC/HICPAC, a kategorizirane su na temelju postojećih znanstvenih podataka, teoretske logične podloge, primjenjivosti i ekonomskog utjecaja. Nakon Široke rasprave u stručnim društvima Smjernice su prihvaćene. Nakon toga došo je do određenih izmjena u mogućnostima liječenja infekcija koje uzrokuje MRSA u Republici Hrvatskoj te je poglavlje 7.0. Liječenje bolesnika s infekcijama koje uzrokuje MRSA izmijenjeno i nadopunjeno prema novim mogućnostima liječenja. Preostali dio Smjernica zasada nije izmijenjen.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and as well in Croatia. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. In the meantime, several new possibilities appeared in the treatment of patients with MRSA infections in Croatia, so the Chapter 7.0 Treatment of patients with MRSA infections is changed and updated according to the new treatment possibilities. The rest of the Guidelines was not changed

GUIDELINES FOR PREVENTION, CONTROL AND TREATMENT OF INFECTIONS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): Changes and updates of chapter 7.0: Treatment of patients with MRSA infection

Meticilin-rezistentni Staphylococcus aureus (MRSA) važan je bolnički patogen u cijelome svijetu, pa i u Republici Hrvatskoj. Stoga se pristupilo izradi smjernica, kojih je svrha smanjiti broj bolesnika inficiranih/koloniziranih sojevima MRSE u zdravstvenim ustanovama i domovima za starije i nemočne osobe u Republici Hrvatskoj te na taj način smanjiti morbiditet i mortalitet koji uzrokuje ova bakterija. Interdisciplinarni tim stručnjaka načinio je Smjernice, koriste}i se internacionalnim publikacijama i smjernicama koje govore o prevenciji i kontroli MRSE, te liječenju i laboratorijskoj dijagnostici MRSE. Snaga preporuka određena je metodologijom CDC/HICPAC, a kategorizirane su na temelju postojećih znanstvenih podataka, teoretske logične podloge, primjenjivosti i ekonomskog utjecaja. Nakon Široke rasprave u stručnim društvima Smjernice su prihvaćene. Nakon toga došo je do određenih izmjena u mogućnostima liječenja infekcija koje uzrokuje MRSA u Republici Hrvatskoj te je poglavlje 7.0. Liječenje bolesnika s infekcijama koje uzrokuje MRSA izmijenjeno i nadopunjeno prema novim mogućnostima liječenja. Preostali dio Smjernica zasada nije izmijenjen.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and as well in Croatia. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. In the meantime, several new possibilities appeared in the treatment of patients with MRSA infections in Croatia, so the Chapter 7.0 Treatment of patients with MRSA infections is changed and updated according to the new treatment possibilities. The rest of the Guidelines was not changed

Breast cancer risk factors among women aged 50-69 in population-based screening program in Croatia

Svrha je ovog rada bila ispitati distribuciju rizičnih čimbenika za rak dojke kod 1538 sučeljenih parova žena u dobi 50-69 godina koje su sudjelovale u I krugu populacijskog probira „Mamma“ u Hrvatskoj od 2006-2009 godine i istražiti prediktore pojavnosti raka dojke prema županijama. Rezultati istraživanja potvrdili su hipotezu da multipli rizični čimbenici za rak dojke kod 1538 sučeljenih parova malo ili umjereno povećavaju rizik za rak dojke kako slijedi: punkcija (OR:4,495; 95% CI:3,053-6,617), čvor u dojci (OR:2,746; 95% CI:1,859-4,058), niti jedna trudnoća (OR:1,678; 95% CI:1,285-2,190); rak u obitelji prvog stupnja srodnosti (majka, sestra, kćer) (OR:1,470; 95% CI: 1,01-1,980), nuliparitet (OR:1,468; 95% CI:1,130-1,906), mamografska gustoća dojke >50% fibrožljezdanog tkiva (OR:1,360; 95% CI:1,088-1,701), BMI ≥30 kg/m² postmenopauzalnih žena (OR:1,272; 95% CI:1,089-1,485), visina (>170 cm) (OR:1,298; 95% CI: 1,072-1,573), dugotrajna (5-9 godina) uporaba HRT-a (OR:1,213: 95% CI:0,782-1,881), dugotrajna (≥ 10 godina) uporaba OC (OR:1,172; 95% CI;0,771-1,781), rak u obitelji drugog stupnja srodnosti (OR:1,170; 95% CI:0,839-1,631), kasna menopauza (>55 godina) (OR:1,155; 95% CI:0,912-1,462) i dob prve donešene trudnoće ≥30 godina (OR:1,134; 95% CI:0,863-1,490). Rezultati istraživanja pokazali su da neki čimbenici smanjuju relativni rizik za rak dojke i djeluju protektivno: ranija mamografija prije 2-3 godine (OR:0,566; 95% CI:0,465-0,688), kasna menarche ≥14 godina (OR:0,800; 95% CI:0,694-0,922), BMI ≥30 kg/m² premenopauzalnih žena (OR:0,887; 95% CI:0,510-1,543), dob prve donešene trudnoće (<20 godina) (OR:0,976; 95% CI:0,806-1,182) i (20-29 godina) (OR:0,881; 95% CI:0,762-1,019), multiparitet (≥2 djece) (OR:0,782; 95% CI:0,659-0,927) i dugotrajno (≥13 mjeseci) dojenje (OR:0,861; 85% CI:0,720-1,029). Županije s višom incidencijom raka dojke imaju i višu prevalenciju rizičnih čimbenika prediktivnih za rak dojke. Najjači prediktori raka dojke (kombinirani na sve ostale varijable u modelu) značajno se razlikuju među županijama. Dvije županije Koprivničko-križevačka i Ličko-senjska županija nemaju značajnih prediktora pojavnosti raka dojke. Najjači prediktor u 14 županija je veća BIRADS kategorija ( 55 godina, dok trendovi incidencije raka dojke u žena <50 i ≥70 godina ostaju slični onima prije uvođenja mamografskog probira. Buduća istraživanja trebalo bi usmjeriti na istraživanje premenopauzalnog i postmenopauzalnog raka dojke i prema mamografskoj gustoći (50% fibrožljezdanog tkiva) te implementirati Gailov model predikcije rizika temeljem utvrđenih čimbenika rizika.The aim of this study was to investigate the distribution of risk factors among 1538 matched pairs aged 50-69 from the first round of the population-based screening program „Mamma“ conducted in Croatia 2006-2009 and to investigate the prevalence of breast cancer predictors at county level. Multiple risk factors associated with slightly or moderate increased risk of breast cancer include: breast punction (OR:4,495; 95% CI:3,053-6,617), lump (OR:2,746; 95% CI:1,859-4,058), no pregnancies (OR:1,678; 95% CI:1,285-2,190); breast cancer in the first degree relatives (mother, sister, daughter) (OR:1,470; 95% CI: 1,01-1,980), nulliparity (OR:1,468; 95% CI:1,130-1,906), breast density >50% fibroglandular tissue (OR:1,360; 95% CI:1,088-1,701), BMI ≥30 kg/m² of postmenopausal women (OR:1,272; 95% CI:1,089-1,485), height (>170 cm) (OR:1,298; 95% CI: 1,072-1,573), long duration (5-9 years) of HRT use (OR:1,213: 95% CI:0,782-1,881), long duration (≥ 10 godina) of OC use (OR:1,172; 95% CI;0,771-1,781), breast cancer in the second degree relatives (OR:1,170; 95% CI:0,839-1,631), late menopause (>55 godina) (OR:1,155; 95% CI:0,912-1,462), late age of first pregnancy (≥30 years) (OR:1,134; 95% CI:0,863-1,490). The results of case-control study showed that some factors associated with decreased risk of breast cancer are protective: early mammography (prior 2-3 years) (OR:0,566;95% CI: 0,465-0,688), late menarhe ≥14 years (OR:0,800; 95% CI:0,694-0,922), BMI ≥30 kg/m² of premenopausal women (OR:0,887; 95% CI:0,510-1,543), early age of first pregnancy (< 20 years) (OR:0,976; 95% CI:0,806-1,182) and between 20-29 years (OR:0,881; 95% CI:0,762-1,019), multiparity (≥2 children) (OR:0,782; 95% CI:0,659-0,927) and long breasfeeding (≥13 months) (OR:0,861; 85% CI:0,720-1,029). The counties with high breast cancer incidence shaw high prevalence of predictive risk factors. The strongest breast cancer predictors (combined for all variables in model) significantly differed among counties. Two counties, Koprivničko-križevačka and Ličko-senjska have no significant breast cancer predictor. The strongest predictor is higher BIRADS category (P55 aged, no changing the incidence trends among women 70 aged. The future studies should investigate the differences between premenopausal and postmenopausal women and regarding mammography breast density (50% fibroglandular tissue) and to implement Gail prediction model based on breast cancer risk factors

Čimbenici rizika za rak dojke u populacijskom probiru žena u dobi 50-69 godina u Republici Hrvatskoj [Breast cancer risk factors among women aged 50-69 in population-based screening program in Croatia]

The aim of this study was to investigate the distribution of risk factors among 1538 matched pairs aged 50-69 from the first round of the population-based screening program „Mamma“ conducted in Croatia 2006-2009 and to investigate the prevalence of breast cancer predictors at county level. Multiple risk factors associated with slightly or moderate increased risk of breast cancer include: breast punction (OR:4,495; 95% CI:3,053-6,617), lump (OR:2,746; 95% CI:1,859-4,058), no pregnancies (OR:1,678; 95% CI:1,285-2,190); breast cancer in the first degree relatives (mother, sister, daughter) (OR:1,470; 95% CI: 1,01-1,980), nulliparity (OR:1,468; 95% CI:1,130-1,906), breast density >50% fibroglandular tissue (OR:1,360; 95% CI:1,088-1,701), BMI ≥30 kg/m² of postmenopausal women (OR:1,272; 95% CI:1,089-1,485), height (>170 cm) (OR:1,298; 95% CI: 1,072-1,573), long duration (5-9 years) of HRT use (OR:1,213: 95% CI:0,782-1,881), long duration (≥ 10 godina) of OC use (OR:1,172; 95% CI;0,771-1,781), breast cancer in the second degree relatives (OR:1,170; 95% CI:0,839-1,631), late menopause (>55 godina) (OR:1,155; 95% CI:0,912-1,462), late age of first pregnancy (≥30 years) (OR:1,134; 95% CI:0,863-1,490). The results of case-control study showed that some factors associated with decreased risk of breast cancer are protective: early mammography (prior 2-3 years) (OR:0,566;95% CI: 0,465-0,688), late menarhe ≥14 years (OR:0,800; 95% CI:0,694-0,922), BMI ≥30 kg/m² of premenopausal women (OR:0,887; 95% CI:0,510-1,543), early age of first pregnancy (< 20 years) (OR:0,976; 95% CI:0,806-1,182) and between 20-29 years (OR:0,881; 95% CI:0,762-1,019), multiparity (≥2 children) (OR:0,782; 95% CI:0,659-0,927) and long breasfeeding (≥13 months) (OR:0,861; 85% CI:0,720-1,029). The counties with high breast cancer incidence shaw high prevalence of predictive risk factors. The strongest breast cancer predictors (combined for all variables in model) significantly differed among counties. Two counties, Koprivničko-križevačka and Ličko-senjska have no significant breast cancer predictor. The strongest predictor is higher BIRADS category (P55 aged, no changing the incidence trends among women 70 aged. The future studies should investigate the differences between premenopausal and postmenopausal women and regarding mammography breast density (50% fibroglandular tissue) and to implement Gail prediction model based on breast cancer risk factors