Prvi rezultati Nacionalnog programa skrininga raka dojke u Osječko-baranjskoj županiji

The incidence of breast cancer is rising among women in many European countries, affecting up to 1 in 16 women. In 2005 in Croatia, 2,303 women were affected by breast carcinoma with the incidence of 100.1/100,000. In 2006, 830 women, or 36.1/100,000 women died from breast carcinoma. In October 2006, a mammography screening program was launched as the first national-based cancer screening program in Croatia. In our paper, we described the first results of the screening program in the Osijek-Baranja County. The target population was women aged 50-69, about 41,678 women in the Osijek-Baranja County, with a two-year screening interval. All data collected until December 2007 were represented in contingency tables. Until December 2007, nearly 31,638 women were invited, and the participation rate was 51.0%. Based on the number of the reports to the County Public Health Institute, a total of 14,126 women underwent mammography, considering the fact that the reading and analysis of the mammograms takes about 20 days. For women born in 1937, 1954 and 1955, for whom the analysis is completed, the responding rate reaches 60.7%. The reason for non-responding to the screening is known for only 24.1% of all invited women. The most common reason was an incorrect address – 13.7%, and 4.6% of the invited women did not want to undergo screening. There were 204 cases (or 1.47%) of a suspected cancer (classified as BI-RADS 4 and 5), referred to prompt further diagnostics. Fifty-eight new cancer cases were diagnosed until 23 January 2008. Women of an older age responded less compared to women of a younger age. The main difficulty with inviting was a wrong address, which resulted in 2,129 women not responding to the invitation. The knowledge about benefits of all screening programs requires to be strengthened. For better results of the National Program, important are companionships of different sectors and communities (for example NGO).Hrvatska se nalazi na visokom mjestu među europskim državama po proširenosti i smrtnosti od malignih bolesti. Iskustva razvijenih zemalja su pokazala da se implementacijom programa primarne prevencije i ranog otkrivanja raka, na nacionalnoj razini, može značajno smanjiti mortalitet od raka i poboljšati kvaliteta života oboljelih. U Hrvatskoj je 2. studenog 2006. god. započela primjena Programa skrininga raka dojke, kao dio prihvaćenog Nacionalnog programa prevencije i ranog otkrivanja raka najčešćih lokalizacija: dojke, debelog crijeva, vrata maternice i prostate. U Hrvatskoj je rak dojke najčešće sijelo i vodeći uzrok smrti od raka u žena sa stopom incidencije od 100,1/100.000 žena (2005.) i stopom mortaliteta od 36,1/100.000 žena (2006). U Osječko baranjskoj županiji je 2005. incidencija raka dojke iznosila 99,5/100.000, a mortalitet 43,6/100.000 (2006). I incidencija i mortalitet od raka dojke u Hrvatskoj u stalnom su porastu. Linearni trendovi stopa incidencije i mortaliteta, za rak dojke, u Osječko-baranjskoj županiji, viši su od prosjeka za Hrvatsku. Prema stopi mortaliteta Osječko-baranjska županija se nalazi na visokom 4. mjestu među županijama u Hrvatskoj. Zbog toga bi uspješna implementacija Programa ranog otkrivanja raka dojke bila osobito značajna u toj županiji. Cilj ove prezentacije je prikazati prve rezultate (14 mjesečnog razdoblja) implementacije Programa skrininga raka dojke u Osječko-baranjskoj županiji, te razmotriti nedostatke, kao i moguće mjere za poboljšanje implementacije toga Programa. Izvješće zaključno s danom 12. prosinca 2007. god. pokazuje da je mamografiju obavilo ukupno 14.126 žena, odnosno da je toliko pristiglih nalaza u Zavod za javno zdravstvo Osječko baranjske županije, ali treba uzeti u obzir da je za očitanje i obradu nalaza potrebno prosječno 20 dana. Ukupni odaziv je u Osječko-baranjskoj županiji na razini 60%, što je svrstava u županije s boljim odazivom. Za kompletno obrađena godišta, 1937, 1954 i 1955, odaziv je i veći i iznosi 60,7%. Od ukupnog broja snimljenih žena, njih 204 (1,47 %) je imalo nalaz BI-RADS 4 i 5, te su upućene na daljnju dijagnostičku obradu. Do 23. siječnja 2008. u Osječko-baranjskoj županiji je utvrđeno 58 novih slučajeva raka dojke. Analizom odaziva, po godištima, kao i razloga neodazivanja na snimanje, može se uočiti da su žene najstarijeg, 1937. godišta, koje su i prve pozivane na snimanje, postigle najslabiji odaziv, češće su odgovorile da ne žele obaviti pregled, dok se žene mlađih godišta češće nisu javile na pregled. To upućuje na potrebu različitog pristupa motivaciji žena za skrining, s obzirom na dob, kao i vrijeme proteklo od početka primjene Programa. Naknadnim pozivanjem žena koje se nisu odazvale na snimanje, bilo poštom, bilo putem službe patronažnih sestara, povećao se broj žena koje su se odazvale na mamografiju. Važan razlog neodazivanja su i netočne adrese u osnovnom popisu stanovništva. To sve upućuje na potrebu boljih priprema za implementaciju skrining programa, uključujući pomnu pripremu medijske kampanje, ažuriranje popisa stanovništva, te bolju suradnju različitih segmenata zdravstvenog sustava, kao i zajednice u cjelini

Case-control Study of Risk Factors for Lumbar Intervertebral Disc Herniation in Croatian Island Populations

Aim: To investigate the risk factors for lumbar intervertebral disc herniation (L4/L5 or L5/S1) severe enough to require surgery of the lower spine among 9 isolated populations of Croatian islands and to evaluate predictive value, sensitivity, and specificity of a simple screening test based on the understanding of the risk factors in this population. Methods: In a sample of 1001 examinees from Croatian island populations, we identified all subjects who underwent surgery of the lower spine due to lumbar intervertebral disc herniation L4/L5 or L5/S1 and selected 4 controls matched by age, gender, and village of residence for each of them. Odds ratio was computed for the following variables: body mass index, occupation, intensity of physical labor at work, intensity of physical labor at home, smoking index, claudication index, self-assessed limitation in physical activity, level of education, socio-economic status, and family history of lumbar intervertebral disc herniation requiring surgery. Results: Comparison of 67 identified cases with 268 controls revealed the highest odds ratios (OR) for positive family history (OR 4.00; 95% confidence intervals [CI], 1.89-6.11, P<0.001), intensity of physical labor at work defined as “hard” (OR 2.94; 95% CI, 1.07-4.81, P<0.001), and body mass index of 25.7 or more (OR 2.77, 95% CI, 1.05-4.49, P=0.002). A simple screening test based on the presence of any two of these three criteria has 74% sensitivity and 82% specificity to detect persons who underwent lower spine surgery due to lumbar intervertebral disc herniation in the population aged 40 years or more. Conclusion: Occurrence of lumbar disk herniation severe enough to require surgery of the lower spine can be predicted using a very simple set of criteria. This type of screening could reduce the need for surgery in isolated communities through prevention within primary health care

Health of dispaced persons and their adaptation in the xommunity: pilot study

Građani područja županije Osječko-baranjske tijekom Domovinskog rata 1991./1992. godine, izabravši put opstanka napuštanjem ratne zone, proveli su u progonstvu 5-7 godina. Prognanici, a danas povratnici su suočeni s nizom promjena u društvenom i ekonomskom životu, što često prate ozbiljni psihološki problemi koji zahtijevaju vrlo brzu intervenciju. Rad je pilot istraživanje projekta "Ocjena zdravstvene snage i mogućnost adaptacije prognanika" koje provodi Katedra obiteljske medicine, primame zdravstvene zaštite, organizacije zdravstvene zaštite i zdravstvene ekonomike Medicinskog fakulteta u Osijeku, a u kojem sudjeluje i Dom zdravlja Osijek. Cilj je istraživanja utvrditi osnovno zdravstveno stanje (fizičko, psihičko i socijalno) prognaničko-povratničke populacije, korištenje zdravstvene službe i identificirati čimbenike koji utječu na adaptaciju prognanika - povratnika, te izrada programa zdravstvene, psihološke, socijalne i društvene potpore, kojima će se poboljšati ukupno zdravstveno stanje, brža integracija u zajednicu, školovanje i zapošljavanje. U ovom pilot istraživanju ispitanici su randomizirani iz stratificiranog uzorka n=58. Istraživanje je provedeno upitnikom "Hrvatska zdravstvena anketa 2003" i dopunskim strukturiranim upitnikom o specifičnim prognaničko-povratničkim čimbenicima. Stalno i skoro uvijek osjeća se iscrpljenim 22 (38%) i umornim 25 (43%) ispitanika. Prema vlastitom mišljenju, pri povratku se nije uključilo u zajednicu 45 (78%) ispitanika. Prognanici - povratnici su tijekom progonstva i povratništva doživjeli pogoršanje zdravstvenog stanja. U populaciji prognanika - povratnika postoje značajne zdravstvene maladaptacijske poteškoće, koje zahtijevaju zdravstvenu, socijalnu i društvenu intervenciju.Many citizens from the Osijek-Baranya county, in order to survive, left their homes during the homeland war in 1991/92, and spent between 5 and 7 years in asylum. Dispalced persons and returnees are faced now with many changes both in social and economic life, which causes very often difficult psychological and health problems and need immediate interventions. This paper is the pilot research within the project "Health of returnees and possibility of their adaptation" coordinated by the Department of Family Medicine, Primary Health Care, Health Care Organisation and Health Economics of the Faculty of Medicine in Osijek and Health Center Osijek. The aim of the study is to assess the health status (physical, mental and social) of refugee/returnee population, their use of health services and to identify the factors influencing their adaptation. Its aim is also to propose the health programs, psychological and social support which could help faster integration into the social and community life, education and employment. The study was done as a pilot study on the randomised sample of 58 respondents. As a first part of the study the method of the Croatian health survey 2003 with additional questionnaire related to the problems of returnees was used. It was found that 38% of returnees felt exhausted and 40% tyred. According to their own oppinion after return from asylum, 78% of them did not integrate into the community and social life. During asylum and after their return health status of returnees was worse than before. Serious maladaptation problems which need health, medical and social intervention were found

Anthropological, Demographic and Socioeconomic Characteristics of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) in one of the most frequent functional gastrointestinal disorders (FGIDs) with a prevalence in 10 to 20%, of cases in some developed countries. The Rome Foundation has drawn up Rome III criteria, diagnostic questionnaires and scoring algorithm for FGIDs, applicable in clinical practice and population studies. The aim of this research is to determine the presence of IBS in Osje~ko-baranjska County and the effect of anthropometric, demographic and socioeconomic factors. 703 subjects selected in the systematic sample filled in the Rome III diagnostic questionnaire for IBS. Prevalence of IBS was recorded in 29.16%, in men in 21.39%, and in women in 36.69% of cases, anxiety and depression in 26.34% and 25.85%. Persons suffering from IBS were on average shorter, weighed less and had a lower BMI than persons not showing signs of IBS. Women have 2.101 times greater chance of risk of IBS, and with an increase in the number of members in the household the risk of IBS increases 1.139 times. Rome III survey questionnaire is an acceptable method for diagnosing IBS and identifying persons showing signs of structural changes in order to provide further treatment

Health of dispaced persons and their adaptation in the xommunity: pilot study

Građani područja županije Osječko-baranjske tijekom Domovinskog rata 1991./1992. godine, izabravši put opstanka napuštanjem ratne zone, proveli su u progonstvu 5-7 godina. Prognanici, a danas povratnici su suočeni s nizom promjena u društvenom i ekonomskom životu, što često prate ozbiljni psihološki problemi koji zahtijevaju vrlo brzu intervenciju. Rad je pilot istraživanje projekta "Ocjena zdravstvene snage i mogućnost adaptacije prognanika" koje provodi Katedra obiteljske medicine, primame zdravstvene zaštite, organizacije zdravstvene zaštite i zdravstvene ekonomike Medicinskog fakulteta u Osijeku, a u kojem sudjeluje i Dom zdravlja Osijek. Cilj je istraživanja utvrditi osnovno zdravstveno stanje (fizičko, psihičko i socijalno) prognaničko-povratničke populacije, korištenje zdravstvene službe i identificirati čimbenike koji utječu na adaptaciju prognanika - povratnika, te izrada programa zdravstvene, psihološke, socijalne i društvene potpore, kojima će se poboljšati ukupno zdravstveno stanje, brža integracija u zajednicu, školovanje i zapošljavanje. U ovom pilot istraživanju ispitanici su randomizirani iz stratificiranog uzorka n=58. Istraživanje je provedeno upitnikom "Hrvatska zdravstvena anketa 2003" i dopunskim strukturiranim upitnikom o specifičnim prognaničko-povratničkim čimbenicima. Stalno i skoro uvijek osjeća se iscrpljenim 22 (38%) i umornim 25 (43%) ispitanika. Prema vlastitom mišljenju, pri povratku se nije uključilo u zajednicu 45 (78%) ispitanika. Prognanici - povratnici su tijekom progonstva i povratništva doživjeli pogoršanje zdravstvenog stanja. U populaciji prognanika - povratnika postoje značajne zdravstvene maladaptacijske poteškoće, koje zahtijevaju zdravstvenu, socijalnu i društvenu intervenciju.Many citizens from the Osijek-Baranya county, in order to survive, left their homes during the homeland war in 1991/92, and spent between 5 and 7 years in asylum. Dispalced persons and returnees are faced now with many changes both in social and economic life, which causes very often difficult psychological and health problems and need immediate interventions. This paper is the pilot research within the project "Health of returnees and possibility of their adaptation" coordinated by the Department of Family Medicine, Primary Health Care, Health Care Organisation and Health Economics of the Faculty of Medicine in Osijek and Health Center Osijek. The aim of the study is to assess the health status (physical, mental and social) of refugee/returnee population, their use of health services and to identify the factors influencing their adaptation. Its aim is also to propose the health programs, psychological and social support which could help faster integration into the social and community life, education and employment. The study was done as a pilot study on the randomised sample of 58 respondents. As a first part of the study the method of the Croatian health survey 2003 with additional questionnaire related to the problems of returnees was used. It was found that 38% of returnees felt exhausted and 40% tyred. According to their own oppinion after return from asylum, 78% of them did not integrate into the community and social life. During asylum and after their return health status of returnees was worse than before. Serious maladaptation problems which need health, medical and social intervention were found

Psycho-Social Aspects of Measures Aimed at Decreasing Prevalence of Chronic Diseases in the Population of Returnees in the Osijek Region, Croatia

Recognizing high prevalence of Diabetes mellitus and cardiovascular disorders and low coverage by preventive examinations in the population of returnees, in Osijek Region, we initiated activities for early detection and better managing of chronic diseases. Measures done, were based on public health working methods, such as: education, solidarity and self-responsibility. A special attention was put on psychosocial aspects of the health-related matters. Exactly, free glucose tests were organized with subsequent healthy lifestyles advice session. It was brought to our attention that such intervention should be as much as possible individually oriented, considering many personal and social characteristics of an individual. Gynecological examinations for all women interested in were also organized. On that occasion, women were interviewed in order to get information about their motivation and obstacles for doing preventive examinations and difficulties in adaptation as well. Finally, outcomes of the Project were summarized and put in a larger social context

Screening with Mammography Organized by Family Physicians Teams: What Have We Learnt?

The mammography, recommended as standard method for screening on breast cancer, can reveal suspicious lesions early enough to anable cancer elimination in entirely. Experience with women of the target population, 50–69 years old, included in the mass screening programs, show the reduction in the specific mortality by 30%. One of the main problem in organizing the preventive programs is how to increase responsiveness of subjects to screening. In the study, based on the large sample of over 1000 of subjects and 20 family medicine practices, included in the investigation, we showed that it is possible, by a pro-active involvement of family physicians teams and intensive educational and motivational activities, to achieve high level of over 80% of responsiveness to mammography screening. Analysis of the reasons of nonresponsiveness can contribute to better understanding of the mental processes included in a self-decision making. This, as the final aim, can help family physicians in their efforts to overcome many hidden barriers which obstruct their patients to accept the mammography screening

Present State and Possibilities for Improvement of Cancer Prevention and Early Detection in the Osijek-Baranya County

Cancer morbidity and mortality are on a steady increase in Croatia. Technologic possibilities for appropriate managementare available for four cancer sites, i.e. cancer of the breast, cervix uteri, colorectum and prostate, and includecancer prevention and early detection in individuals yet free from manifest signs of the disease. The magnitude of the problem, the experience acquired to date, health care personnel available, and additional resources required to launch a systematic program of early detection of the disease are presented. The program should be initially launched in a county with greatest experience in early detection of cancer, where health care service is ready to immediately start its implementation. The role of family physician, gynecologic service at primary health care level, and polyclinic-consultation hospital service in program implementation is described. The following three possible options for early detection of cancer are analyzed and proposed: minimal program (early detection every 3 years), medium program (the same individuals examined every 2 years), and optimal program proposed by the American Cancer Society and other national and international organizations

Clinical and Anorectal Motility Features in Chronically Constipated Children

Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan

Clinical and Anorectal Motility Features in Chronically Constipated Children

Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan