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

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

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

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

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

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

Demographic, Anthropometric and Socioeconomic Characteristics of Functional Constipation in Eastern Croatia

Aim of the research is to establish the prevalence of constipation in Osječko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (χ2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health status by self-assessment. According to t-test persons with constipation on average are older, have higher average BMI and lower average grade valued financial status of households and their health. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. Functional constipation presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosing this functional disorder in clinical-consilliary and primary health care, and for persons showing signs of alarm and needing further diagnostic treatment

Irritable Bowel Syndrome in Croatia

There are three epidemiological studies of irritable bowel syndrome (IBS) that were conducted in Croatia (in the area of Zagreb in 2002, Bjelovarsko-bilogorska County in 2008, and finally in Osječko-baranjska County in 2011). The aim of this study is to analyze the anthropometric, demographic and socioeconomic characteristics of IBS in Croatia comparing these three studies. The studies included a questionnaire based on Rome criteria. Study population matched the adult population of Croatia according last available census (1991, 2001 resp.). Studies showed a high prevalence of IBS and some common factors relevant for development of IBS were determined such as gender, body mass index and lower level of education. There is a need for further investigations in coastal Croatia applying a uniform questionnaire on anthropometric, demographic and socioeconomic characteristics of IBS and Rome III criteria, diagnostic questionnaires and scoring algorithm for functional gastrointestinal disorders developed by Rome Foundation applicable in clinical practice and population studies, regarding the significant high prevalence of IBS in our country

Breast Cancer Detection: Role of Family Physicians

Croatia started implementing the national programs for early breast cancer detection in 2006, early detection of colon cancer and early detection of cervical cancer. A possible way to improve the adherence of the women to the screening on breast cancer could be by transferring the responsibility for the program implementation from the public health institutes to family physicians. The Project: »Model of early cancer detection integrated in a practice of family physician«, was carried out by the Department of Family Medicine of the Osijek University School of Medicine. The results have shown that responsiveness of women invited to do preventive mammography was significantly higher in the experimental than in the control group. The central role of FM in the implementation of preventive programmes has already been recognized in many countries as an advantage from the organizational aspects and by means of decreased expenditure, compared to the vertical programmes with strict formal control centered to the public institutions