Pharmacoeconomical Impacts of Crohn’s Disease

Provide an overviewof Crohn’s disease and its cost assessment options, establish the need for implementing Croatian national Crohn’s Disease Registry to precisely quantify the costs and the outcomes, and establish model to evaluate values of treatment options for Crohn’s disease

Primary health care in Osijek- development and achivements

Od prvih početaka organizirane zdravstvene zaštite u Osijeku, početkom 18. st. provode se intervencije na razini primame zdravstvene zaštite. Vojne i civilne vlasti organizirale su zdravstvenu skrb tako da bude usmjerena prema zaštiti zdravlja naroda. Na temelju zamisli dr. Andrije Štampara počinju se stvarati institucije i ustanove koje imaju zadaću organizirati zdravstvenu zaštitu cijele populacije (u narodu - za narod). Današnji Dom zdravlja Osijek počinje raditi u zgradi izgrađenoj 1939. godine na lokaciji na kojoj djeluje i danas. Unatoč nizu organizacijskih oblika koji su uslijedili iza Drugoga svjetskog rata Dom narodnog zdravlja značajno povećava obim djelatnosti, povećava se u broju objekata i lokacija na kojima funkcionira. Za vrijeme Domovinskoga rata djelatnost se održava na visokoj razini, a nakon toga Dom zdravlja Osijek postaje čvrsta poluga pružanja primame zdravstvene zaštite u Osijeku i okolici.From the very beginnings of organized health care in Osijek, at the beginning of the 18th century, interventions based on primary health care have been implemented. Military and civil authorities organized health care in a way that it included health care of the public. With an idea of Dr. Andrija Štampar institutions and facilities, which had the assignment to organize health care of the whole population (in population - for population) started to form. Today\u27s Health Centre Osijek started with work in a building, which was constructed in 1939 on the location where it is today. In spite of many organizational forms that had followed after the World War II, Public Health Centre has been significantly increasing the scope of work and number of buildings and locations. During the War for Croatian Independence work maintained on a high level, and afterwards Health Centre Osijek has become a steady basis for primary health care in Osijek and its surroundings

How to improve teaching in family medicine

The family physician has a specific task and responsibility as the first contact physician. Therefore his/her education needs to be highly specific, oriented towards independent work in real time and evidence-based medical principles. The most important role in educating a family physician belongs to physician practitioners, individuals who work in clinics and need (as much as possible) to transfer knowledge, skills and experiences from their own specific conditions and a wide variety of work methods. Therefore the experience and suggestions of teachers in practical training are considered to be the most significant contribution to improving the quality of teaching. The most important suggestions pertain to reducing the size of seminar groups, including family medicine courses in the fourth and fifth year of studies, and increasing the possibilities for students to do independent work, with supervision by their mentors. For good preparation of future physicians for independent work it is necessary for family medicine departments to be able to organize practical training and seminars in as many courses as possible, with as many classes as possible. A good professional basis in terms of selected teachers and practical training teachers is required to make this possible

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region

The Incidence of Skin Squamous Cell Carcinoma in Osijek-Baranja County – An Epidemiological Study

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registred 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region

Quality of Life of Patients after Stroke in County Osijek-Baranya

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center. The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients’ physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p<0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (c2-test, p=0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p=0.009) and total SS-QOL (Friedman p=0.014), while in women there was no statistically significant difference between the measurements (Friedman p=0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health

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

The leading health problems of persons age 50 and older undergoing preventive medical examination in the Osijek-baranja county 2007-2010

edicinsko-preventivni pregledi omogućuju rano utvrđivanje sinergističkog djelovanja čimbenika rizika za razvoj kroničnih masovnih bolesti kao i njihovo pravovremeno otkrivanje u definiranoj populaciji. Upravo u današnjem zdravstvenom sustavu model preventivnih pregleda osiguranih osoba starijih od 50 godina koje nisu bile kod izabranog liječnika opće/obiteljske medicine najmanje 2 godine predstavlja dobar put za unapređenje preventivnih aktivnosti u Hrvatskoj. Rezultati dobiveni analizom 2431 individualnog obrasca “Izvješće o provedenim preventivnim pregledima osiguranih osoba starijih od 50 godina” koji su pristigli od 135 ugovorenih doktora opće/obiteljske medicine iz ordinacija na području Osječko-baranjske županije u periodu 2007.-2010. , ukazuju na postojanje brojnih rizičnih čimbenika u navedenoj populaciji, a koja se do pregleda smatrala dobrog zdravlja. U odnosu na spol preventivno pregledanih osiguranika, 53,43% su činile žene, a 46,57% muškarci. Analiza suspektnih novootkrivenih bolesti prema zastupljenosti skupina dijagnoza (MKB – X revizija) ukazuje na najveću zastupljenost skupine endokrinih bolesti (E00-E90) s udjelom od 44,25% i cirkulacijskih bolesti (I00-I99) s udjelom od 23,50%, u ukupno 2515 dijagnoza na koje se posumnjalo prilikom preventivnog pregleda. Palpatorni pregled dojki koji je učinjen u ukupno 1144 osiguranica otkrio je suspektan čvor u njih 3,32%. Od ukupno 2376 osiguranika s izmjerenim sistoličkim tlakom 48,3% ih je imalo vrijednosti iznad 140 mmHg, a 36,2% je imalo dijastolički tlak iznad 90 mmHg. Od laboratorijskih nalaza hiperglikemija je utvrđena u 13,9% od ukupno 2294 preventivno pregledanih osoba kojima je izmjerena glikemija, a gledano u odnosu na spol, oštećen metabolizam glukoze ustanovljen je u 16,5% (173) muškaraca i 11,8% (147) žena. U okviru preventivnih pregleda kod 27,47% osiguranika od ukupno njih 2415 s izračunatim indeksom tjelesne mase (ITM) ustanovljena je debljina, od toga u 367 (28,43%) žena i 296 (26,33%) muškaraca. Od ukupno 1299 osiguranica na preventivnom pregledu njih 511 (39,34%) je učinilo papa test u zadnje tri godine dok 788 (60,66 %) njih to nije učinilo. Na mamografskom pregledu u zadnje tri godine od ukupno 1294 osiguranica bilo je njih 628 (48,53%), a 666 (51,47%) nije to učinilo. Temeljem podataka o pušenju koji su dobiveni od ukupno 2403 preventivno pregledanih osiguranika za koje postoje podaci vidljivo je kako njih 24,68% puši, od toga 36,31% muškaraca i 14,55% žena. Doktori opće/obiteljske medicine nakon preventivnog sistematskog pregleda osigurane osobe poduzeli su ukupno 2101 zdravstvenu mjeru. Od ukupnog broja liječničkih intervencija, savjet je dat u 81,29% slučajeva, 17,52% otpada na dodatne pretrage, a upućivanje na specijalistički pregled čini 20,51%. Sustavna analiza, praćenje i evaluacija rezultata provedenih preventivnih sistematskih pregleda odraslih osoba starijih od 50 godina omogućuje izradbu i provedbu stručnih smjernica i algoritama u prevenciji prioritetnih javnozdravstvenih problema, uz odgovarajuće intervencije. Provedba medicinsko-preventivnih pregleda kod osoba starijih od 50 godina omogućuje pravovremeno utvrđivanje čimbenika rizika za razvoj kroničnih masovnih bolesti, kao i njihovo rano otkrivanje, a što bitno utječe na produljenje trajanja života i na njegovu kvalitetu.Medical-preventive examinations allow early determination of synergistic effects of risk factors for development of chronic diseases and their timely detection among a defined population. In today\u27s health care system a model of preventive examinations of insured persons above 50 years of age who were not examined by a family physician for at least two years is a good way to promote prevention activities in Croatia. The results obtained by analyzing the individual form 2431 "The preventive examinations of insured persons aged 50 years report" that were sent by 135 contracted doctors of general and family medicine practice in the area of Osijek-Baranja County, in the period 2007-2010 indicate the existence of numerous risk factors found among the population that was considered to be in good health before the examinations. In relation to the gender of the examined, 53.43% consisted of women, and 46.57% men. Analysis of the suspected diseases by the presence of newly diagnosed group (ICD - audit) indicates the greatest representation of a group of endocrine diseases (E00-E90) with a share of 44.25% and circulatory diseases (I00-I99) with a share of 23.50% in total of 2515 diagnoses that were suspected of during preventive examination. Palpatory examinations done on the 1144 insured discovered suspicious lumps in 3.32% of the tested. Of the total 2376 insured with the measured systolic pressure, 48.3% had values above 140 mmHg, and 36.2% had a diastolic pressure above 90 mmHg. From the laboratory findings hyperglycemia was found in 13.9% of the total of 2294 persons examined preventively, and in relation to gender, damaged glucose metabolism was detected in 16.5% (173) men and 11.8% (147) women. Within the frame of the preventive examinations, obesity was diagnosed in the 27.47% of the 2415 insured with calculated body mass index (BMI), 367 (28.43%) females and 296 (26.33%) males. Of the total of 1299 insured female patients present on the preventive examination, 511 (39.34%) did pap smear in the last three years, while 788 (60.66%) of them did not. As far as the mammographic examination in the last three years is concerned, 628 (48.53%) of them were examined and 666 (51.47%) were not. Based on data on smoking obtained from a total of the 2403 examined (for which the data were available), 24.68% of them smoke, 36.31% men and 14.55% women. After a systematic review of the preventive examinations, doctors of general practice have taken a total of 2101 health measures. Of the total number of medical interventions, advice was given in 81.29% cases, additional tests were made in 17.52% cases, and a referral to a specialist makes 20.51%. Systematic analysis, monitoring and evaluation of results of preventive systematic examinations of adults over 50 years of age allows the development and implementation of professional guidelines and algorithms in the prevention of public health priorities, with an appropriate intervention. Implementation of the preventive medical examinations for persons over 50 years of age allows timely identification of risk factors for development of chronic diseases and their early detection, which significantly affects the prolongation of life and its quality

Cervical Cancer in Osijek-Baranja County – Possibilities for Prevention

In Osijek-Baranja County, there was a rise in the number of non-invasive and fall of invasive cervical cancer in the period 2000–2008, but cervical cancer still represents an important public health problem in Osijek-Baranja County. Cervical cancer in 2008 was the ninth female cancer site and represents 3.5% of all malignant diseases in women. In the same year it was also at the ninth place of all cancer deaths in women with a share of 3.3%. The large number of women cervical cancer was detected at an advanced stage of the disease so that there is an pincrease in mortality from cervical cancer. Although the incidence of cervical cancer is lower in relation to Croatia and other countries in the region, the mortality rate is still higher than in the countries of Western Europe. In order to reduce the incidence and mortality of cervical cancer primary task of the public health system is the introduction of secondary prevention through properly organized screening program. The program should be tailored to the financial and human resources and local specificities, with the agreement on a strategy that will give the best results