BORELIOSIS AS A POTENTIAL MENTAL ILLNESS TRIGGER OR NEUROBORRELIOSIS? – a case report

Lyme borelioza je najčešća bolest koju prenose krpelji, a neuroborelioza (LNB) posljedica diseminacije spirohete Borrelie burgdorferi u živčani sustav. Etiološka dijagnoza LNB temelji se na serološkim testovima i određivanju specifičnih protutijela u likvoru, koji se podudaraju s kliničkim i epidemiološkim podacima, uz široki spektar neuroloških poremećaja. Neliječena bolest poprima kronično progredirajući tijek, pa je važno da liječnici obiteljske medicine koji su najčešće prvom kontaktu s pacijentima prepoznaju rane stadije borelioze kako bi se liječenje počelo na vrijeme i prevenirale teške posljedice neprepoznate ili neadekvatno liječene bolesti. Prevenciju i savjete za zaštitu treba osobito provoditi u endemski zahvaćenim područjima. Učinkovito antimikrobno liječenje očituje se oporavkom neurološkog statu-sa i normaliziranjem pleocitoze. Serumska i intratekalna protutijela često dugo perzistiraju pa se za praćenje uspjeha liječenja njihovo daljnje određivanje ne preporučuje. Prikazan je slučaj osamnaestogodišnje bolesnice koja se nakon neprepoznatih simptoma rane borelioze prvi put javlja pod slikom akutne psihoze. Nakon neurološke i psihijatrijske obrade na nekoliko razina, konačno se postavi sumnja na neuroboreliozu. Usprkos pozitivnoj anamnezi,epidemiološkim podacima, kliničkoj slici i serološkim pretragama, LNB se isključuje zbog negativnih nalaza intratekalnih imunoglobulina i bolesnica se dalje vodi kao dekompenzirana psihoza.Lyme disease is the most common tick-borne disease. Neuroborreliosis (LNB) is the result of dissemination of Borrlia burgdorferi to the central nervous system. Etiological diagnosis of LNB is mainly based on detection of specific intrathecal antibodies, which must be interpreted in the light of clinical symptoms and epidemiological evidence since symptoms may be extremely variable. If untreated this disease may result with a deleterious chronic condition. Family physicians have a leading role in adequate prevention and education, especially in endemic areas, and should recognize or at least suspect the early stages of Lyme disease. Effective antibiotic treatment leads to LNB clinical recovery with normalization in cerebrospinal pleocytosis. Serum and intrathecal antibodies often persist for a long period, and their routine follow-up is not recommended. The 18 years old girl with symptoms of acute psychosis after unrecognised erythema migrans is presented. After initial neurological and psychiatric examination and treatment in several institutions, the patient was referred for further evaluation of suspected LNB to the university hospital. Despite her medical history, epidemiological data, clinical presentation and positive serology the diagnosis of LNB was excluded due to the absence of specific intrathecal immunoglobulins, and the patient was treated as a decompensated psychosis

CHRONIC INFLAMMATORY BOWEL DISEASES – SPECIFIC ASPECTS OF FAMILY PHYSICIAN CARE

Kvaliteta života bolesnika s kroničnim upalnim bolestima crijeva niža je u odnosu na opću populaciju. Osim simptoma bolesti, kvalitetu života dodatno snižavaju česti boravci u zdravstvenim ustanovama, učestaliji liječnički pregledi i slično. Dugoročno gledano, problem predstavlja i briga bolesnika za budućnost i konačni ishod bolesti, planiranje obitelji te strah od nastanka maligne bolesti. Namjera ovog članka je prikazati neke posebnosti s kojima se oboljeli od kroničnih upalnih bolesti crijeva susreću, te prikazati suvremene znanstvene spoznaje iz područja pružanja skrbi za osobe oboljele od kroničnih upalnih bolesti crijeva. U članku su obrađeni kao posebni entiteti: kronična upalna bolest crijeva u djece/adolescenata, trudnoća i kronične upalne bolesti crijeva, kronične upalne bolesti crijeva i prehrana, kirurgija, psihosocijalni čimbenici i upalne bolesti crijeva, samopomoć. Važna uloga liječnika obiteljske medicine je osim pomoći da se na vrijeme bolest dijagnosticira i započne liječiti, i upoznavanje bolesnika kako živjeti s tim bolestima, odnosno odgovori na praktična pitanja koja se u svakodnevnome životu neizostavno nameću.Patients with chronic inflammatory bowel diseases have lower quality of life compared to general population. Aside from disease symptoms, the quality of life is additionally lowered by frequent admissions, more frequent follow up, and the like. From a long term perspective, problems also arise in patients worrying about the disease outcome, fear from developing a malignant disease arising from chronic inflammatory bowel disease, and family planning. The purpose of this article is to present some of the specific situations faced by people with chronic inflammatory bowel disease and review the state-of-the-art in the fi eld of providing care for people with chronic infl ammatory bowel disease. The following specifi c problems are tackled: chronic infl ammatory bowel disease in children/ adolescents, pregnancy, chronic infl ammatory bowel disease and nutrition, surgery, psychosocial factors and inflammatory bowel disease, and self-help. The role of family medicine consists not only of helping diagnosing the disease as early as possible in order to enable early treatment, but also to advise patients how to live with the disease and offer answers to their questions arising from everyday life with the disease

Factors related to high and low levels of drug adherence according to patients with type 2 diabetes

Objective Adherence to medication in patients with type 2 diabetes varies widely, yet the factors that influence adherence according to patients are not fully known. The aim of this study is to explore both factors related to high and lower levels of adherence that patients with type 2 diabetes experienced in their medication use. Setting Primary care in the Netherlands. Method Qualitative, semi-structured interviews were performed in 20 patients with type 2 diabetes. Interviews were audio-taped and transcribed verbatim. Transcripts were coded and analysed using content analysis and constant comparison. Main outcome measure experiences and opinions of patients concerning factors related to high and lower levels of adherence. Results Comparable aspects influenced drug adherence in more and less adherent patients. Four aspects that influenced adherence to medication emerged from the interviews: (1) information about the prescribed medication, (2) experience with medication and complications with use, (3) social support for medication behaviour and (4) routines in medication behaviour. Experience with medication and social support for medication behaviour were related to high levels of adherence in some patients, and to lower levels of adherence in others. Complicated medication regimens were mainly related to lower adherence, while social support and routines in medication behaviour were related to higher adherence. Conclusions Routines in medication behaviour were related to higher drug adherence. Patient education should not only address information about the disease and medication, but also more practical issues concerning drug intake. Hence, to improve drug adherence in patients with type 2 diabetes, pharmaceutical care might be aimed at the counselling of patients to organise drug use in their daily schedule

A systematic review of qualitative research on the contributory factors leading to medicine-related problems from the perspectives of adult patients with cardiovascular diseases and diabetes mellitus

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives: To synthesise contributing factors leading to medicine-related problems (MRPs) in adult patients with cardiovascular diseases and/or diabetes mellitus from their perspectives. Design: A systematic literature review of qualitative studies regarding the contributory factors leading to MRPs, medication errors and non-adherence, followed by a thematic synthesis of the studies. Data sources: We screened Pubmed, EMBASE, ISI Web of Knowledge, PsycInfo, International Pharmaceutical Abstract and PsycExtra for qualitative studies (interviews, focus groups and questionnaires of a qualitative nature). Review methods: Thematic synthesis was achieved by coding and developing themes from the findings of qualitative studies. Results: The synthesis yielded 21 studies that satisfied the inclusion and exclusion criteria. Three themes emerged that involved contributing factors to MRPs: patient-related factors including socioeconomic factors (beliefs, feeling victimised, history of the condition, lack of finance, lack of motivation and low self-esteem) and lifestyle factors (diet, lack of exercise/time to see the doctor, obesity, smoking and stress), medicine-related factors (belief in natural remedies, fear of medicine, lack of belief in medicines, lack of knowledge, non-adherence and polypharmacy) and condition-related factors (lack of knowledge/understanding, fear of condition and its complications, and lack of control). Conclusions: MRPs represent a major health threat, especially among adult patients with cardiovascular diseases and/or diabetes mellitus. The patients' perspectives uncovered hidden factors that could cause and/or contribute to MRPs in these groups of patients.Peer reviewedFinal Published versio

CHRONIC INFLAMMATORY BOWEL DISEASES – SPECIFIC ASPECTS OF FAMILY PHYSICIAN CARE

Kvaliteta života bolesnika s kroničnim upalnim bolestima crijeva niža je u odnosu na opću populaciju. Osim simptoma bolesti, kvalitetu života dodatno snižavaju česti boravci u zdravstvenim ustanovama, učestaliji liječnički pregledi i slično. Dugoročno gledano, problem predstavlja i briga bolesnika za budućnost i konačni ishod bolesti, planiranje obitelji te strah od nastanka maligne bolesti. Namjera ovog članka je prikazati neke posebnosti s kojima se oboljeli od kroničnih upalnih bolesti crijeva susreću, te prikazati suvremene znanstvene spoznaje iz područja pružanja skrbi za osobe oboljele od kroničnih upalnih bolesti crijeva. U članku su obrađeni kao posebni entiteti: kronična upalna bolest crijeva u djece/adolescenata, trudnoća i kronične upalne bolesti crijeva, kronične upalne bolesti crijeva i prehrana, kirurgija, psihosocijalni čimbenici i upalne bolesti crijeva, samopomoć. Važna uloga liječnika obiteljske medicine je osim pomoći da se na vrijeme bolest dijagnosticira i započne liječiti, i upoznavanje bolesnika kako živjeti s tim bolestima, odnosno odgovori na praktična pitanja koja se u svakodnevnome životu neizostavno nameću.Patients with chronic inflammatory bowel diseases have lower quality of life compared to general population. Aside from disease symptoms, the quality of life is additionally lowered by frequent admissions, more frequent follow up, and the like. From a long term perspective, problems also arise in patients worrying about the disease outcome, fear from developing a malignant disease arising from chronic inflammatory bowel disease, and family planning. The purpose of this article is to present some of the specific situations faced by people with chronic inflammatory bowel disease and review the state-of-the-art in the fi eld of providing care for people with chronic infl ammatory bowel disease. The following specifi c problems are tackled: chronic infl ammatory bowel disease in children/ adolescents, pregnancy, chronic infl ammatory bowel disease and nutrition, surgery, psychosocial factors and inflammatory bowel disease, and self-help. The role of family medicine consists not only of helping diagnosing the disease as early as possible in order to enable early treatment, but also to advise patients how to live with the disease and offer answers to their questions arising from everyday life with the disease

CLINICAL SCIENCES Obstacles which Patients with Type 2 Diabetes Meet while Adhering to the Therapeutic Regimen in Everyday Life: Qualitative Study

Aim. To explore type 2 diabetic patients' attitudes, thoughts, and fears connected with their illness; their expectations of the health care system; and the problems they encountered while adhering to the therapeutic regimen. Method. Explanatory descriptive focus groups were held with 49 type 2 diabetic patients. Patients were recruited by their general/family practitioners and divided into seven focus groups. The group discussions were audio taped and transcribed, then analyzed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Hypotheses were derived from the qualitative content analysis. Results. Eight major themes and explanatory models of patient's perspective emerged out of the data: confronting the diagnosis, illness-related changes, treatment of illness, social context, relation to the health professionals, self-control, knowledge about the illness, and expectations from health professionals. Health beliefs, quality of the doctor-patient relationship, social environment of the family, workplace, health care system, and quality of the information they receive from health professionals and media were all important factors in patient adherence. Conclusions. There were many obstacles for bettering patients adhering to the therapeutic regimen, as from the patients' socio-economical aspect, and in the existing health system of Croatia as well. Providing of updated information about the disease, empathy and support of physicians can improve adherence to treatment