[Counseling protocol for early cancer detection at the Women's Health Center in Ruma]. / Protokol rada savetovalista za rano otkrivanje raka dispanzera za zdravstvenu zastitu zena Doma zdravlja Ruma.

INTRODUCTION: Women's health care office in Ruma Health Center provides health care for women of Ruma and Irig communities. According to census in 1991, Ruma community has 55.063 inhabitants; 28.266 women out of which 13.149 are of reproductive age. Irig community, has 11.696 inhabitants, 6.072 women and 2.526 are of reproductive age. PROTOCOL: According to protocol each woman who consults her gynecologist, is thoroughly examined. The overall examination included the following: anamnesis in regard to risk factors for malignant diseases of female genital organs and breast, speculum examination, cytologic smear, colposcopy, palpatory examination of breast gynecological palpatory examination. On the basis of gathered results, further examinations, if necessary, were carried out: cervical biopsy, endocervical curettage, ultrasound examination, mammography and so on. Two groups of patients were formed on the basis of gathered results--high-risk group and "no-risk" group of patients with no risk from malignant disease. The high-risk group of patients has a separate file and is actively controlled; if necessary this group is called for check-ups at intervals from six months to a year periods. The group of "no-risk" patients is controlled once in a three-year period. FORMING THE HIGH-RISK GROUP: High-risk group in regard to a malignant disease of the cervix is formed on the basis of the following findings: 1. Positive family history (mother, aunt, sister, etc.). 2. Positive personal history (positive sexual factor, early sexual relations, early marriage, more sexual partners, more marriages, bad sexual hygiene, human papilloma virus infection (HPV), herpes simplex virus infection, bad living and social conditions, smoking, intra-uterine and oral contraception, immune suppression, and human immune deficiency virus infection (HIV). 3. Positive clinical findings: chronic cervicitis, condylomas. 4. Positive laboratory findings: positive cytological smear, all atypical colposcopic findings, all histopathological findings of precancerous, high oncogenes groups of HPV. 5. Detected cases of malignant disease of the cervix uleri. Cervical biopsy is performed in each woman with positive cytologic and colposcopic findings. Histopathological findings are done according to Bethesda system. HPV classification according to type is done with LSIL changes, and if a high oncogenes HPV type is obtained, women require conisation of the cervix uteri. With HSIL changes, women require cervix conisation. Invasive forms of cervix uteri malignant disease, require treatment in Oncology Institute. High-risk group for endometrial and breast carcinomas is formed on the basis of positive family and personal history, positive clinical and laboratory findings. High-risk women have separate files (marked with "R") and if necessary they are asked for additional check-up. RESULTS: In the framework of the Office for early cancer detection the Cancer Registry (2,3) contains the following: personal data, address, date of disease detection, diagnosis and the disease stage, way of treatment, outcome and a questionnaire on risk factors. Morbidity of precancerous and malignant diseases of female genitalia and breast as well as mortality will be monitored in the forthcoming period. CONCLUSION: We consider the Protocol of work of the Office for early detection of cancer to be an acceptable and compulsory model for protection of women by existing public health services. 1. Each woman who comes to see her gynecologist for examination, should be systematically examined; the risk of malignant disease and necessary further examinations also must be determined. 2. An accurate file on high-risk group must be kept and women should be actively called to come for check-ups, unless they do it in an appointed period--one year at the latest. 3. Women should be kept informed, through local media, about the importance of overall examinations and risk factors for malignant diseases in women. 4.

[Deliveries in the outpatient birthing facility in Ruma during 1989 and between 1992 and 1995]. / Porodaji u vanbolnickom porodilistu Ruma u toku 1989. i u periodu 1992-1995. godine.

INTRODUCTION: The outpatient maternity home in Ruma offers health care to women during normal delivery. On the occasion of patient's admittance into the maternity home, indications for hospitalization during the delivery are strictly observed. Ruma community is a bordering area of SR Yugoslavia and, in the period of the war in ex Yugoslavia, it gave shelter to a great number of refugees and exiles. Health care was offered to pregnant women and to the ones who were giving birth and to the refugees in the Health Centre Ruma. The period from 1992-1996 is characterized by war, migration of people, UN sanctions imposed on Yugoslavia and low standard of living. PURPOSE: The purpose of this paper was to find out if there was a difference in indices regarding pregnancy and course of delivery in 1989 and in the period 1992-1996 in the Ruma and Irig communities population and in refugees and exiles. MATERIAL AND METHODS: The data were collected from the obstetrical records in outpatient maternity home Ruma in 1989 and 1992-1996. By data processing the following parameters were obtained: number of deliveries, percentage of spontaneous miscarriages and premature births, percentage of pregnancy-induced hypertension (PIH) and anemia in pregnancy, the rate of early neonatal morbidity and mortality; weight, length, circumferences of head and chest with the newborn infants. RESULTS: There were 321 deliveries in 1989; 12 women gave birth with PIH (3.73%). 37 women had a spontaneous miscarriage (11.52%). Anemia was corrected with 12 women after delivery (3.73%). There was one premature birth in 1989 (0.3%). 4 newborn infants were hospitalized after delivery (12.46 promiles). There was no mortality of the newborn infants and mothers. The following has been established for women giving birth in the period 1992-1996 from the territory of Ruma and Irig communities: number of deliveries (in 1992--563, in 1993--503, in 1994--481, in 1995--418) constantly falls. The percentage of PIH in pregnancy was 19.54% in 1992 (110 women) and 0.18% eclampsia (1 case), 11.3% (56 women) in 1993, 5.61% (27 women) in 1994, 5.82% (31 women) in 1995. In 1992 80 women giving birth had spontaneous miscarriages in their previous pregnancies (14.2%), in 1993--44 women (8.74%), in 1994--38 women (7.9%) in 1995--45 women (8.45%). An anemia correction after delivery was with 31 women (5.5%) in 1992, in 1993 with 24 women (4.26%), in 1994 with 18 women (3.74%) and in 1995 with 30 women (6.24%). There were 22 premature births in 1992 (3.9%), in 1993--7 (1.39%), in 1994--10 (2.07%) and in 1995--9 (1.69%). 14 children were hospitalized after delivery in 1992 (24.86 promiles), in 1993--20 children (39.76 promiles), in 1994--18 children (37.42 promiles), in 1995--35 children (65.7 promiles). In 1992 one child died after delivery because of left heart hypoplasia and pneumonia; in 1993 one woman delivered fetus mortus: one child died, in 1994, with diaphragmatic hernia and lung hypoplasia; in 1995 there were no deaths after delivery. Mothers' mortality was 0. In the period from 1992-1996, 62 women from Republic of Serb Krajina (hereinafter referred as RSK) were delivered and 67 women from Serb Repubic (hereinafter referred as SR). 5 women from RSK had a spontaneous misciarriage (8.06%), and 4 women from SR (5.97%). 8 women (12%) from RSK had PIH, and 5 women (7.46%) from SR. There were premature births with 3 women (4.82%) from RSK and with 2 women (2.98%) from SR. 2 newborn infants (32.25 promiles) from RSK were hospitalized after delivery and 3 (29.8 promiles) from RS. In 1995 one women delivered fetus mortus in utero (diabetica fetopathy) (14.9 promiles) from RSK. DISCUSSION: By analyzing the deliveries in the course of 1989 and in the period 1. 01. 1992 to 31. 12. 1995 the following has been established: the number of deliveries is greater in the period 1992-1996 in relation 1989, but there is a constant fall from 1992-1996. (ABSTRACT TRUNCATED)