OPPORTUNISTIC SCREENING FOR COLORECTAL CANCER IN HIGH-RISK PATIENTS IN FAMILY MEDICINE PRACTICES IN THE REPUBLIC OF CROATIA.

Colorectal cancer is a malignant neoplasm which has an increasing incidence and represents a global public health problem. The majority of patients are diagnosed after the age of 50, and the risk of developing it over lifetime is 5%. Development of preventive, diagnostic and treatment methods has resulted in a significant reduction in mortality and other negative clinical outcomes. Precisely because of the efficient method of prevention and early detection of this disease, numerous countries, including Croatia, have organized national colorectal cancer screening and monitoring programs. However, these programs are primarily organized for the population with the usual, i.e. average risk of developing colorectal cancer. High-risk groups include persons with endoscopically detected and removed colon polyps, persons surgically treated for colon cancer, persons with a positive family history of colorectal cancer, persons with inflammatory bowel diseases, individuals and families with hereditary disorders or genetic mutations that increase the risk of this disease several fold, persons with acromegaly, and patients who have undergone ureterosigmoidostomy. Recommendations for the detection and monitoring of high-risk groups are often not defined clearly, and some of the existing ones are based mostly on scarce scientific evidence. It is commonly accepted that screening in high-risk groups should start at an earlier age, with shorter intervals between follow-ups. The basic diagnostic method for screening and monitoring in these patient groups is endoscopic monitoring, or colonoscopy. The aim of this review paper is to present the characteristics of the abovementioned risk groups and provide clear screening recommendations.

CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE.

Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.

Depression prevalence and estimation of psychosocial parameters within adult population in city of Zagreb.

BACKGROUND: There is no data on depression prevalence in Croatia. The aim of this study was to establish the prevalence and psychosocial risk factors of depression in the adult population of the Croatian capital Zagreb, particularly in patients suffering from Depressive episode (F32) and Recurrent depressive disorder (F33). SUBJECTS AND METHODS: A cross-sectional study was preformed on a representative sample for city of Zagreb drawn from 10 family physicians' offices with 17290 patients. From standardized medical files, the family physicians sorted out data of patients with depression, both Depressive episodes (F32) and Recurrent depressive disorder (F33), classified according to ICD 10. Psychosocial parameters were assessed according to the core questions for the management of psychosocial risk factors recommended by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. RESULTS: The prevalence of depression was 2.2%. Recognized socioeconomical parameters were: female sex (74.7%), middle age 45-65 years (40.7%), married (55.3%), high school education (59.2%), retired (54.5%), and average economical status (73.6%). As regards social isolation: depressive patients were not living alone (71.5%), they had help in case of illness (80.9%), and had no problems with their partner (36.8%). Work stress parameters were estimated between 5 and 6. Life satisfaction was estimated mean +/- SD=4.57+/-1.72. Logistic regression analysis showed a significant association between higher education and physicians' perception as "more depressed and more difficult" patients with Recurrent depressive disorder (F33). Family physicians were unfamiliar with the genealogical disease burden for 45% of depressive patients, whether they had closed confident for 21.93% and problems with partner for 30.80%. CONCLUSION: Depression had a prevalence of 2.2%. It was poorly recognized, as were some psychosocial factors especially genealogical disease burden. This suggests the need for implementation of special intervention methods of developing the family physicians'skills in adopting the psychosocial approach to depressive patients with a focus on recognized psychosocial risk factors.