Epidemiologija raka jajnika u Hrvatskoj

Ovarian cancer is one of the most lethal malignant cancers in women, mainly because of the late stage at diagnosis. It is the seventh most common cancer in women in the world in incidence (239,000,3.6%) andeighth in mortality (152,000,4.3%). More developed regions have higher incidence and mortality rates than developing countries. In Croatia, ovarian cancer ranks as the sixth most common cancer in women (430 new cases in 2013) and the sixth malignant cause of death (328 deaths in 2013). Research based on the Croatian National Cancer Registry data also shows that trends of standardized incidence and mortality rates for ovarian cancer in Croatia are relatively stable for the period from 1988 to 2008, while recent studies oncancer survival (EUROCARE-5, CONCORD-2) rank Croatia close to the European mean when it comes to ovarian cancer survival. Ovarian cancer is asignifi cant public health burden in Croatia. Eff orts should be put in education about symptoms, and some modifi able risk factors such as tobacco use, obesity and hormone replacement therapy.Rak jajnika jedna je od najsmrtonosnijih malignih bolesti u žena, uglavnom zbog kasnog dijagnosticiranja. To je sedmi najčešći rak po pojavnosti u žena u svijetu (239.000, 3,6%), a osmi po smrtnosti (152.000, 4,3%). Razvijenije regije imaju više stope učestalosti i smrtnosti od zemalja u razvoju. U Hrvatskoj, rak jajnika je 2013. godine bio šesti najčešći rak u žena (430 novih slučajeva), te šesti maligni uzrok smrti (328 smrtnih slučajeva u 2013. godini). Istraživanjatemeljena na podacima Registra za rak Republike Hrvatske također pokazuju da trendovi standardiziranih stopa incidencije i mortaliteta za rak jajnika u Hrvatskoj su relativno stabilni u razdoblju od 1988. do 2008. godine, a nedavna istraživanja koja su pratila preživljenje od raka (EUROCARE-5, CONCORD-2) rangiraju Hrvatska blizu europskog prosjeka po pitanju preživljenjaod raka jajnika. Rak jajnika predstavlja značajan javnozdravstveni teret u Hrvatskoj. Napore treba usmjeriti u edukaciju o simptomima i nekim promjenjivim čimbenicima rizika, kao što su uporaba duhana, pretilost i hormonska nadomjesna terapija

Epidemiologija kolorektalnog raka u Hrvatskoj i svijetu

Colorectal cancer (CRC) is the third most common cancer in men worldwide (746,000; 10%) and second most common in women (614,000 cases; 9.2%). Incidence and mortality are on the rise in many developing countries, closing the gap to the western, industrialized populations. In Croatia it is the second malignant cause of death in both males and females, while it ranks second in female incidence and third in male incidence. Trends in CRC in Croatia still display an increase in the standardized rates of incidence and mortality, however, the data for five-year survival for Croatia from recently published international studies indicate an improvement. The epidemiological data clearly point to CRC as one of the most important health issues of Croatian society. Its increasing incidence and mortality trends need to be tackled with a multidisciplinary approach, ensuring the availability of new treatment options and drugs when necessary, but also insisting on the secondary prevention (population-based screening) and primary prevention (changes in nutritional habits and levels of physical activity with educational activities targeted towards wider audience).Kolorektalni karcinom diljem svijeta zauzima treće mjesto među najčešćim zloćudnim bolestima muškaraca (746.000; 10%) i drugo mjesto učestalosti kod žena (614.000; 9,2%). U zemljama u razvoju incidencija i mortalitet su u porastu, što pridonosi smanjenju raskoraka prema zapadnim, industrijaliziranim populacijama. U Hrvatskoj je kolorektalni karcinom drugi uzrok smrtnosti od zloćudnih bolesti i kod muškaraca i žena. Kod žena se po incidenciji svrstava na drugo mjesto, a kod muškaraca na treće. Trendovi kod kolorektalnog karcinoma u Hrvatskoj još uvijek imaju sklonost porasta u standardiziranim stopama incidencije i mortaliteta, međutim podaci o petogodišnjem preživljenju iz recentno objavljenih međunarodnih studija ukazuju na poboljšanja. Epidemiološki podaci jasno ukazuju kako je kolorektalni karcinom jedna od najvažnijih javnozdravstvenih stavki u Hrvatskoj. Njegova rastuća incidencija i mortalitet upozoravaju na važnost uloge multidisciplinarnog pristupa, osiguranje dostupnosti novih modaliteta liječenja kada je potrebno, kao i inzistiranje na sekundarnoj prevenciji (probir na populacijskoj razini) i primarnoj prevenciji (promjene prehrambenih navika i razine tjelesne aktivnosti, uz edukaciju šire javnosti o problemu kolorektalnog karcinoma)

Uzroci smrti osoba sa šećernom bolešću u Republici Hrvatskoj [Causes of death in persons with diabetes mellitus in Croatia]

The hypothesis of this dissertation was that diabetes mellitus is insufficiently recognized as a cause of death and that, in deceased persons in Croatia, it is mentioned on death certificates three times more often than it is coded as an underlying cause of death. It was also hypothesized that, in deceased persons with previously diagnosed diabetes mellitus, diabetes is rarely mentioned as an underlying cause of death and that it is mentioned on less than a half of those death certificates. The aims of this dissertation were to establish the recognition of diabetes on death certificates in the general population both as the underlying cause of death and one of the multiple causes of death; to explore the causes of death in persons with diagnosed diabetes mellitus (from the CroDiab registry) in Croatia; and to establish the factors that are associated with more frequent citing of diabetes as one of the causes of death, both in the general population and in the population of persons with diabetes from the CroDiab registry. In the first part of the study, death certificates for all deceased persons in Croatia for the year 2010 were examined (N=52,096). Based on this data, mortality fractions for diabetes as underlying cause of death and as one of multiple causes of death were established. In the second part of the study, these data were combined with data on the cohort of persons with diabetes from the CroDiab registry (N=66,329). The causes of death for persons with diabetes who had deceased in 2010 were established (N=2,593, crude mortality rate 3,909/100,000), as were the proportion of death certificates mentioning diabetes in these patients, and the factors associated with citing diabetes on these death certificates. The data on the frequency of reporting of diabetes on death certificates and the causes of death were presented by descriptive statistics. The prediction of citing of diabetes on death certificates and the factors of risk were determined by bivariate and multivariate logistic regression models. In the general population, diabetes was recognized as the underlying cause of death in 3% of deceased women and 2.5% of deceased men (p<0.001), and as one of multiple causes of death in 12.3% of deceased women and 10.6% of deceased men (p<0.001). The odds of diabetes appearing on the death certificate were 7% higher in women, 13% higher if death had occurred in a health institution, and 51% lower if the cause of death was determined by a pathologist. Diabetes was the underlying cause of death in 14.9% of deceased persons with diabetes mellitus (without sex differences), and the most common cause of death in these persons were cardiovascular diseases (48.4%). Among all deceased persons with diabetes from the CroDiab registry, diabetes was cited on 51.8% of death certificates (without sex differences). In the multivariate model, significant predictors were the cause of death assigned by a pathologist (60% lesser odds) and diabetes duration longer than 15 years (89% greater odds). In conclusion, diabetes is recognized as the underlying cause of death in one in seven persons with diabetes, and it is recognized as one of multiple causes of death in just above one half of all deaths in persons with diabetes. Therefore, the reliance on official mortality statistics significantly underestimates the burden of diabetes in Croatia, which should be taken into consideration when planning population-based public health interventions. The official mortality statistics in Croatia is still based on the underlying causes of death only, which significantly underestimates the burden of disease associated with certain diseases that are often mentioned as one of the multiple causes of death, such as diabetes. Therefore, the implementation of mortality statistics coding system which codes multiple causes of death should be considered. This system, operating in many European countries, provides a better insight in the public health importance and mortality fractions attributable to various diseases, including diabetes

Lifestyle Habits of People with Self-Reported Diabetes: Changes during a Five-Year Period

The aims of our study were to investigate the prevalence of risk factors in persons with previously known diabetes (»old DM«), persons with diabetes developed during the 2003–2008 period (»new DM«) and diabetes-free individuals within the CroHort study. Risk factors were defined as physical inactivity, unhealthy nutritional regimen, smoking and excessive alcohol consumption, while diabetes status was self-reported. The most prevalent risk factor in both »old DM« and »new DM« group was physical inactivity (46.7% and 33.7% in 2003; 46.8% and 46.3% in 2008), then smoking (12.1% and 14.6%; 12.7% and 14.4%), unhealthy diet (8.8% and 13.8; 8.2% and 10.0%) and heavy alcohol consumption (11.1% and 6.0%; 7.8% and 13.8%). Diabetes-free individuals had higher rates of smoking and unhealthy diet, and lower rates of alcohol consumption and physical inactivity than both diabetes groups. These results indicate the need for comprehensive actions oriented towards persons with diabetes concerning physical activit