Transitioning from face-to-face to distance education. Part 1: A cross-sectional study in the former Yugoslavia during COVID-19.

BACKGROUND: The countries of the former Yugoslavia have health and education systems with the same tradition but these have changed over the years. Little is known about how family medicine teaching transitioned from face-to-face to distance education during the COVID-19 pandemic. OBJECTIVES: to investigate student/teacher experience in transitioning from face-to-face to distance education. METHODS: A cross-sectional, online survey was conducted among 21 medical schools of the former Yugoslavia between December 2021 and March 2022. Under/postgraduate teachers and students who taught/studied family medicine during the academic year 2020/2021 were invited to participate. Of 31 questions for students and 35 for teachers, all but nine open questions were analysed using descriptive statistics. RESULTS: Seventeen of 21 medical schools contributed data involving 117 participants representing all countries of the former Yugoslavia. At the beginning of the pandemic, 30%, 26% and 15% of teachers, students and trainees, respectively, received formal preparation in distance education. Of these, 92% of teachers and 58% of students/trainees felt they were not adequately prepared. Synchronous teaching was the main method used, with a third using hybrid methods. All participants were least confident about online assessment. More than 75% of respondents agreed that lectures could be kept online, not patient consultations or practical skills' classes. CONCLUSION: Teachers used various old and new methods to provide learning opportunities despite COVID-19 constraints. Effective technology-based strategies are essential to ensure assessment integrity and enhance the learning environment.

Despite limited preparedness, teachers and students/trainees transitioned to distance education.Students/trainees believed synchronous delivery of lectures and small group work can be conducted online but not practical skills' classes.Online assessments and practical work with patients were considered the most challenging aspects of distance education.

Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study.

AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.

Burnout in European family doctors: the EGPRN study.

INTRODUCTION: The aim of this study was to determine the prevalence of burnout, and of associated factors, amongst family doctors (FDs) in European countries. Methodology. A cross-sectional survey of FDs was conducted using a custom-designed and validated questionnaire which incorporated the Maslach Burnout Inventory Human Services Survey (MBI-HSS) as well as questions about demographic factors, working experience, health, lifestyle and job satisfaction. MBI-HSS scores were analysed in the three dimensions of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). RESULTS: Almost 3500 questionnaires were distributed in 12 European countries, and 1393 were returned to give a response rate of 41%. In terms of burnout, 43% of respondents scored high for EE burnout, 35% for DP and 32% for PA, with 12% scoring high burnout in all three dimensions. Just over one-third of doctors did not score high for burnout in any dimension. High burnout was found to be strongly associated with several of the variables under study, especially those relative to respondents' country of residence and European region, job satisfaction, intention to change job, sick leave utilization, the (ab)use of alcohol, tobacco and psychotropic medication, younger age and male sex. CONCLUSIONS: Burnout seems to be a common problem in FDs across Europe and is associated with personal and workload indicators, and especially job satisfaction, intention to change job and the (ab)use of alcohol, tobacco and medication. The study questionnaire appears to be a valid tool to measure burnout in FDs. Recommendations for employment conditions of FDs and future research are made, and suggestions for improving the instrument are listed.

Information systems and the electronic health record in primary health care.

The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.

[GP's intervention in changing lifestyle behavior of adipose patients]. / Utjecaj lijecnika obiteljske medicine na promjene zivotnih navika pretilih pacijenata.

BACKGROUND: Obesity and physical inactivity (silent epidemic) are the dominant causes of insulin resistance. Obesity is a major public health concern, associated with high morbidity and mortality. The disease is the result of an increased energy intake in relation to its expenditure. Lifestyle modification is the main goal of primary and secondary prevention of chronic diseases including obesity. Although changing an individual's lifestyle may be perceived difficult, evidence suggests that intensive and repeated counseling by general practitioners (GP) can stimulate patients to become more physically active and to switch to healthy diet. According to WHO data, 300 million people with body mass index (BMI) 30 were recorded in the world in 2005. AIM: To investigate the efficiency of GP intervention for lifestyle modification in adipose patients from the respective catchment population. METHOD: During the 2001-2004 period, 135 obese patients (BMI 30) from a GP practice attended educational program for lifestyle modification. The program lasted for 6 months, was based on a small group work and used behaviorism as a key element in therapy for obesity. Each group session took about one hour, started with a short physician's lecture on healthy lifestyle, and continued with group discussion in which every participant showed his/her own dietary and physical activity diary for the last week and received advice on how to improve and achieve better results. At the end of the session, every participant set his/her own priorities for the next week. Outpatient control of the parameters of BMI, waist circumference, nutrition and physical activity personal records was performed on a weekly basis. RESULTS: There were 135 patients, 94 (70%) women and 41 (30%) men, mean age was 48 years. The heaviest man had 160 kg and lost 18 kg during the intervention period. The heaviest woman had 129 kg and lost 15 kg during the intervention period. BMI decreased in men by 9% (from 34.6 kg/m2 to 31.7 kg/m2; p < 0.001), and in women by 8.1% (from 34.9 kg/m2 to 32.1 kg/m2; p < 0.001). Thus, 42. 2% of the extreme obesity group (BMI > 40) and obesity group subjects switched to a lower group. Waist circumference decreased by 7.5 cm in men and by 8.4 cm in women (p < 0.001). The highest cholesterol level was 8.8 mmol/L in men and 8.6 mmol/L in women. Cholesterol decreased by 0.8 mmol/L in both men and women. Fasting blood glucose was 8.3 mmol/L in men and 8.6 mmol/L in women, and decreased by 1.4 mmol/L in men and by 0.5 mmol/L (p < 0.001) in women. CONCLUSION: GPs are familiar with their patients and have a critical role in the assessment and advising of an appropriate lifestyle. GP recommendations can be a valuable source of motivation for the patient. Small group work coordinated by GP is more effective in changing lifestyle. Lifestyle modification program is a suitable therapeutic choice in the GP management of obesity. Medically based education in the form of small group work based on behaviorism proved its efficiency in treating obese patients in a GP practice.

[Characteristics of depression in Otocac ten years after the war]. / Obiljezja depresije u Otoccu deset godina nakon zavrsetka domovinskog rata.

BACKGROUND: Depression is an important public health problem today. In the primary care setting, a high percentage of patients with depression present exclusively with physical symptoms; depression can often go undiagnosed in these patients. Another challenge for primary care doctors is the treatment of patients with depression and somatic comorbidity. When faced with demands to treat multiple chronic diseases, physicians may give depression less priority. The consequences of exposure to war stress on mental health have been constantly explored. Posttraumatic stress disorder and depression have been identified as the most common psychopathological consequences of exposure to war stressors. The 1991-1995 war in Croatia left deep psychosocial scars and affected self-perceived health, physical ability and mental health of the entire Croatian population stricken by war. Otocac is one of the areas that were more severely affected by war. OBJECTIVES: The aim of the study was to evaluate the prevalence and characteristics of depression in general practice patients in Otocac, Croatia, ten years after the war in Croatia. METHODS: In March 2005, 300 patients aged 18 and older were systematically selected from the patient list of a general practitioner in Otocac, Croatia. These patients were assessed for depression and classified as having a mild, moderate, severe or severe depressive episode with psychotic elements, according to the criteria of the ICD-10 classification of Mental and Behavioral Disorders, Croatian edition. Data were also collected on psychosomatic complaints, chronic diseases, sociodemographic characteristics, participation in war actions, refugee status, comorbid psychiatric diseases in patients and their family members. Differences in the characteristics of depressive and non-depressive patients were tested by chi2-test and Fisher's test. The level of significance was set at p < 0.05. The collected data were analyzed using the SPSS statistical software package, version 12.0.0. RESULTS: A total of 147 (49.0%) patients (65 male and 82 female) met ICD-10 criteria for depressive episode. Distribution of severity of depression showed the majority of depressive patients to meet the criteria for moderate (38.8%) and severe (39.5%) depressive episode. There was a statistically significant difference in the presence of all psychosomatic complaints between depressive and nondepressive patients. Unemployed patients were more often depressed (p = 0.002), and so were divorced and widowed patients (p < 0.001). There was no statistically significant sex difference in the frequency of depressive symptoms. Depression showed no correlation with the patient refugee status, but there was significant correlation with the presence of psychiatric diseases in a patient family member (p = 0.0001). Correlation between depression and the patient chronic somatic diseases was statistically significant for hypertension, cardiac diseases and malignant diseases. CONCLUSION: The results of our study indicated a high prevalence of depression in the group of general practice patients in Otocac, Croatia, ten years after the war in Croatia. Severe and moderate depressive episodes predominated, without sex difference in the frequency of depressive symptoms. Long-term psychological consequences of exposure to war stress as well as other characteristics of the post-war period in the area affected by war may in part explain these findings.

[Specialization in family medicine--has all the planned been achieved?]. / Specijalizacija iz obiteljske medicine--je li ostvareno ono sto je planirano?

The planned, comprehensive inclusion of general practitioners/family physicians in specialist education has begun with the project entitled Harmonization of Family Medicine Service with European Standards by the Implementation of Compulsory Residency. According to the Project, all physicians working in family medicine practice should have an opportunity to complete the respective residency by 2015. Analysis of the planned and completed family medicine residency in Croatia during the 2002-2006 period is presented. Of the total family medicine residency positions planned during the four-year period, 543 (90.5%) have been completed, with the greatest discrepancy recorded in program A applying to physicians younger than 35 having concluded a contract with the Croatian Institute of Health Insurance. In addition, this relationship varied among different countries. There are a number of obstacles hindering the Project implementation. However, it should be noted that the Project has made a breakthrough in upgrading the quality of family medicine practice, as a pledge of future development and rational performance of the entire health care system in Croatia, in order to promote the health care of the population at large.

[Underestimation of varicella incidence--frequency of requests for medical assistance]. / Podcijenjenost incidencije varicele--ucestalost zahtjeva za lijecnickom pomoci.

INTRODUCTION: The Netherlands Institute of Primary Health Care (NIVEL), University of Utrecht, conducted an international scientific project "Health Monitoring in Primary Care Based Sentinel Practice Network" in 10 European countries, based upon regular and continuous observations of one or more diseases. Sentinel practice networks have been established to provide data on incidence and other health indicators of the diseases managed predominantly in primary care. Department of Family Medicine of the "Andrija Stampar" School of Public Health, Zagreb Medical School, participated in the research. Information from primary health care is especially useful for diseases mainly diagnosed and treated in primary health care. For self-limiting diseases, varicella for example, there are no other information sources that would include professional judgement and would be available for estimation of incidence and limits of the disease in the community. Varicella is a notifiable disease in Croatia; however, every infected person does not consult a physician due to a mild or uncomplicated nature of the disease, which may cause underestimation of disease incidence in the community. AIM: Of this research was to establish incidence of varicella as well as incidence of varicella in other family members not seeking help from a physician. METHODS: Data on patients with varicella were retrospectively collected from medical records (incident cases). A prospective data collection registered every new case of varicella in the families related to the incident case during the period of three weeks before or after the incident case (secondary cases). Data on age, gender, and seeking help from a physician were collected. Another prospective data collection registered cases of varicella in the families with children under 15 years of age and with no information on varicella infection in their medical records. Data on age, gender, and seeking help from a physician were collected. RESULTS: From January 1 to June 30, 2000, 19 out of 50 contacted family physicians collected data on 182 children (52.7% boys) suffering from varicella. Most of them, 84 (46.1%), were in the age group 4-6 years; 70 (38.5%) were in the age group 7-15 years, and 28 (15.4%) were between 1-3 years of age. Another 103 children were registered in the families in the period from three weeks before to three weeks after the first case: 43 (41.7%) in the age group 4-6 years, 32 (31.1%) in the age group 7-15 years, and 28 (27.2%) between 1-3 years of age. Thirteen families had 2 diseased children during that period. In 31 (30.1%) secondary cases no physician was consulted. In 95 investigated families, there were 139 children under 15 years of age with no registered varicella infection; 69 (49%) of these children had had varicella and 38 (27%) consulted a physician but had not been registered. Most of them, 37 (53.6%), were in the age group 4-6 years; 19 (27.5%) were in the age group 7-15 years, and 13 (18.9%) between 1-3 years of age. CONCLUSION: Results of this study indicate that a family physician should always actively search for secondary cases of varicella in the families with one reported case of the disease, and register them in medical records. Such records would provide better morbidity registration of the population for which a family physician provides care, especially for uncomplicated, self-limiting diseases.

[Scientific and research projects of the Department of Family Medicine--contribution to the identity of general practice/family medicine as a scientific discipline]. / Znanstvenoistrazivacki projekti katedre za obiteljsku medicinu--doprinos odredenju opce/obiteljske medicine kao znanstvene discipline.

The main task of an academic department of any medical discipline is an integrated development and improvement of professional, scientific and educational activities. The proces of formulation, establishment and recognition of general practice/family medicine as an academic discipline in Croatia started with postgraduate education and vocational training in 1960 at the Andrija Stampar School of Public Health. In 1980 Department of Family Medicine of the Medical School, University of Zagreb was officially established. The aim of this paper was to describe the characteristics of general practice/family medicine as a scientific discipline with its proper, independent knowledge, acquired in scientific research and applied in practice. Based on literature review, specific areas and methodology of scientific research in general practice/family medicine are presented. Scientific research in general practice/family medicine has traditionally included epidemiological, clinical, organisational and other aspects of work of general practitioners/family physicians comprising activities directed towards patient and community care, as well as towards the position and responsibilities within a health care system. Department of Family Medicine carried out its own scientific projects, participated in international scientific projects and scientific projects implemented with other partners. Some of these projects were presented in this paper with the purpose to give a brief insight into the development and current state of the scientific work within the Department of Family Medicine.