Assessment of Nutritional Status of Elderly People in a Practice of Family Medicine in Relation to MNA Test, Comorbidity and Chronic Therapy

Introduction: Nutrition assessment is one of the biggest challenges in family medicine practice because of the increasing number of older people with more comorbidities and chronic therapy. The MNA(Mini Nutritional Assessment) test has proven to be the most sensitive and exact tool for this type of research. The aim of this study was to assess whether there is a difference in the nutritional status of elderly people, over 65 years of age, with respect to sociodemographic characteristics, number and type of chronic diseases, and number of medications used in chronic therapy. Materials and methods: Research subjects were 207 patients at the age of 65 treated at the Medical Centre Slavonski Brod during a period of 3 months. During the visit, the nutritional status was examined by using the MNA test. The information on chronic diseases and number of medications the patients were using has been collected from the Medicus computer program. Results: According to the MNA test results, 62 subjects (30%) showed risk of malnutrition, average age of the subjects was 72 years and the median of MNA test results was 25.50. Also, multimorbidity is present in 64.73% of the subjects and 42% of them take more than three medications in chronic therapy. No statistically significant difference was found in the results of the MNA test regarding the number of chronic diseases (p =0.89) and number of medications (p = 0.87). Conclusion: It is important to regularly monitor the nutritional status in order to prevent progression of chronic diseases and reduce additional cost of treatment. (Bosnić Z, Miškić M, Veselski K, Vučić D, Trtica Majnarić Lj. Assessment of Nutritional Status of Elderly People in a Family Medicine Practice in Relation to MNA Test, Comorbidity and Chronic Therapy. SEEMEDJ 2019; 3(2); 1-10

Specifics of Sex Life and Methods of Birth Control among Students at the University of Osijek

The aim of this study is to define specifics of sex life and methods of birth control among students at University of Osijek. Participants were students who study at Josip Juraj Strossmayer University of Osijek. A newly formed questionnaire containing 31 question was used to for this purpose. The study included 549 voluntairly students, 54,3% of students had first sexual experience between 16 and 18 of age. Most of them were long- term couples, who are managing better with sexual activities then students in short term relationships, who are more stressed because of their studies. When it comes to the type of contraceptives, 71, 9 % of students used some of birth control methods, and most common is condom (75,9 %). However, 27, 9 % of students believe that natural methods of birth are safe enough. There are no significant differences in age at the time of first sexual activity considering gender, year at university and residency. The biggest reason for not using contraception is long-term relationship in which students do not feel fear of sexually transmitted diseases and pregnancy

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

A View at the Future – A Dynamical, Protocol-based and Computationally Intensive Approach in Cardiovascular Risk Assessment

Knowledge of cardiovascular risk factors is increasing. At the same time, risk estimation becomes more and more difficult. The need for a more comprehensive, but more individually based approach is evident. To achieve this aim, we propose a systems biology approach in cardiovascular risk assessment. This means that a large amount of health data, describing many aspects of the health-status of patients, is collected and computed and the results are compared with existing knowledge. Finally, a clinical model is created, which can be the first step in ongoing research protocol, aimed at assessing cardiovascular risk. By using this approach, all potentially relevant risk factors can be identified on a small sample. Moreover, risk groups can be more specifically defined, based on the »natural« clustering of data, according to their predictive load. We tested this possibility on an example of hyperhomocysteinemia which is a well-known complex cardiovascular risk factor

Mood disorders in later life and challenges of care in general/family medicine

Poremećaji raspoloženja se tradicionalno smatraju problemom adolescentne i mlađe odrasle dobi. Novije spoznaje stavljaju naglasak na poremećaje raspoloženja u starijoj životnoj dobi zbog njihovog devastirajućeg učinka na zdravlje i funkcionalnu sposobnost starijih osoba. Ipak, te poremećaje, uključujući i one najčešće, kao što je generalizirani anksiozni poremećaj i depresija velikih depresivnih epizoda, obiteljski doktori često ne prepoznaju. Glavni razlozi su česti komorbiditet sa somatskim stanjima i kognitivnim poremećajima te shvaćanje pacijenata da su mentalni poremećaji normalan dio procesa starenja. Probir osoba starih 60 i više godina na anksiozne poremećaje i depresiju pomoću standardiziranih upitnika, prilagođenih za primjenu u starijoj populaciji, mogao bi biti koristan za poboljšanje prepoznavanja tih poremećaja. Postavljanje konačne dijagnoze bi se trebalo temeljiti na primjeni dijagnostičkih kriterija koje preporučuju najnovije DSM i ICD klasifikacije te detaljnom postupku kliničke evaluacije, a na osnovi intervjua s pacijentom ili njegovim skrbnikom. Iako se obiteljskim doktorima nalaze na raspolaganju djelotvorni lijekovi za liječenje poremećaja raspoloženja, njihova primjena u osoba starije dobi može biti ograničena zbog povećanog rizika od interakcija među lijekovima i neželjenih reakcija na lijekove. Psihosocijalne intervencije su od posebnog značaja u toj populacijskoj skupini, ali nema dovoljno dokaza o tome koji postupak kome primijeniti. Način kako poboljšati skrb za osobe starije dobi s poremećajima raspoloženja u općoj/obiteljskoj medicini bi bio putem intenziviranja istraživanja, s ciljem stjecanja boljih dokaza, te putem davanja veće pozornosti praktičnoj edukaciji obiteljskih doktora iz područja psihijatrije, kao i putem strategija usmjerenih na povećanje svjesnosti javnosti o poremećajima raspoloženja u starijoj životnoj dobi i načinu njihove prezentacije.Mood disorders have been traditionally considered a problem of adolescenthood and early adulthood. Recent findings are pointing to mood disorders in later life due to their devastating effects on health and functional capabilities of older adults. However, those disorders, including those most common such as generalized anxiety disorder and major depressive disorder, are frequently unrecognised by family doctors. Main reasons for that are frequent comorbidities with medical conditions and cognitive disorders and patients’ treating mental disorders as normal aspects of aging. Screening 60 years old patients and older for anxiety and depression by standardised questionnaires, adapted for the use in older population, could be helpful in improving recognition rates. Definite diagnosis should combine the latest update of the DSM or the ICD classification criteria and a thorough clinical evaluation based on responses drown from a patient or a caregiver. Although effective medications for mood disorders are available to family doctors, their application in older adults may be compromised by the increased risk of medication interaction and adverse reaction. Psychosocial interventions are particularly important in this population group but evidence is insufficient regarding who should receive which treatment. The way of improving management of mood disorders in older adults, in family medicine, would be by intensifying research, in order to gain more evidence. More attention should be given to formal psychiatric training of family doctors, as well as to the strategies aimed at increasing the public awareness of mood disorders in later life and their modes of presentation

The Relationship Between Appearance Satisfaction and Self-Esteem Among High School Students in Eastern Croatia

Due to the imposition of social media, a large number of adolescents face problems related to physical appearance and social contact. The research objectives were to examine the degree of satisfaction of high school students in Eastern Croatia, Vinkovci, regarding their physical appearance and self-esteem based on their gender, type of high school and the differences in socioeconomic status. The study was designed as a cross-sectional research and included 278 students from medical schools and high schools. Data was collected using a survey on the demographic and socio-economic status of participants. The Body Image Questionnaire was used in a modified and validated version in Croatia and contained fourteen questions to examine the level of satisfaction with the body image. Using Rosenberg’s ten-question test, the level of self-esteem was examined. The Median age of students was 18 years. The female students in high school were significantly more concerned about their physical appearance than the male students in the same school (χ² = 23.6, p < 0.001). The linear correlation between the degree of satisfaction regarding physical appearance and self-esteem confirmed the association between body image satisfaction and gender of students in medical schools (r = 0,157; p = 0,04) and students in high school (r = 0,371; p < 0,001). Adolescents in this region of Croatia are not overly concerned about their physical appearance despite relatively decreased self-esteem. Alcohol consumption has proven to be a big problem especially for high school students, which can be a result of stress due to maintaining excellent grades