Prevalence of risk factors for development of cardiovascular diseases in urban and rural areas of Eastern Croatia: a cross-sectional study.

OBJECTIVE: Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. METHODS: The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. RESULTS: The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). CONCLUSIONS: In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

Risk of Potential Exposure Incident in Non-healthcare Workers in Contact with Infectious and Municipal Waste.

INTRODUCTION: The proper classification of sharp and infectious waste in situ by the healthcare workers is an important measure of prevention of sharps and other exposure incidents in non-healthcare workers, who handle such waste. The aim was to examine the practice of classifying sharp and infectious waste in family and dental practices. METHODS: An analysis of 50 bags of infectious and 50 bags of municipal waste from five family and five dental practices for five days in October 2016 at the Health centre Osijek. RESULTS: Healthcare workers in 70% of the practices deposited sharps in infectious waste. In 56% of infectious waste bags, sharp object were found. More risky bags of infectious waste were produced by family practices (64%), but with no significant differences in relation to dental practices (48%), (P=0.143). Disposing of infectious into municipal waste was the case in 90% of the practitioners, where in 60% of municipal waste bags, infectious waste was disposed. Dental practices produced more risky bags of municipal waste (76%) in relation to family practices (44%), but with no significant difference (P=0.714). CONCLUSIONS: The results of this research point to importance of performing audits of proper disposal of sharps and infectious waste to reduce the risks of injury to non-healthcare workers who come into contact with the said waste. Given results could be used for framing written protocols of proper disposal of sharps and infectious waste that should be visibly available in family and dental practices and for education of healthcare workers.

Awareness and use of evidence-based medicine information among patients in Croatia: a nation-wide cross-sectional study.

AIM: To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia. METHODS: A cross-sectional study was conducted among 987 patients in 10 family medicine practices in Croatia. Patients from both urban (n=496) and rural (n=482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics. RESULTS: Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P<0.001 for both). CONCLUSION: Our finding that patients consider a physician's opinion to be the most reliable source of health-related information could be used for promotion of high-quality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary.

Demographic, anthropometric and socioeconomic characteristics of functional constipation in Eastern Croatia.

Aim of the research is to establish the prevalence of constipation in Osjecko-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 (chi2 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.

Association between socioeconomic status and obesity in children.

The perception of obesity among people has not changed significantly regardless numerous public educational programs. Reasons for obesity pandemics are numerous and complex, but can be mostly resumed to life-style changes. The aim of this research was to determine connection between socioeconomic factors and obesity with children of our region. Study included pupils aged 7-8 from 19 first grades in 8 primary schools in Osijek-Baranya County. Body height and weight were measured and socioeconomic data status were collected. Socioeconomic status included data on marital status, educational level, employment, number of children in the family, kindergarten attendance and urban/rural location and also smoking habits of parents. BMI was calculated as a parameter for obesity assessment according to Croatian reference values. Total of 372 children were measured. There were 6.5% of overweight children (BMI between 90th and 97th percentile) and 2.4% of obese children (BMI above 97th percentile). The prevalence of obese children in our research was 8.9%. Obesity is not influenced by rural/urban residence, marital status of parents, number of children in the family, mother's education, or by parents' smoking habits. Positive correlation between obesity and father's education and parents' unemployment was found. Available literature data, same as our study, did not show consistent association between socioeconomic factors and obesity with children. Contradictory results of different studies can be a result of a small sample, difference in study design and different criteria for defining categories within investigated socioeconomic factor.

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 Osjecko-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.

Assessment of nutritional status in cancer patients in Osijek health area center.

The aim of this research was to perform the nutritional screening and clinical assessment of malnutrition and of cachexia as well as the need for enteral nutritional support. We used an international questionnaire for nutrition screening and clinical assessment of malnutrition. 103 cancer patients participated in the research. The results indicate that 80patients (78%) have recently unintentionally lost weight in the last six months. Of those 80 patients 12 (15%) have lost more than 15 kilograms. Three patients (3%) suffer from hunger because of their inability to eat. Presence of multiple (3 or more) symptoms (nausea, vomiting, diarrhea or anorexia) was reported by 11 patients (11%). Severe work dysfunction was found in 28 patients (27%). 14 patients (14%) experience significant loss of musculature (musculus quadriceps femoris, musculus deltoideus). The obtained results indicate that 15patients (14%) are severely, and 39 patients (38%) are moderately undernourished. This survey confirmed the significance of nutritional screening in cancer patients, as it detected 30 patients (29%) who required introduction of enteral nutrition.

Basic cognitive functions across the menstrual cycle in a controlled female cohort.

AIM: To investigate the role of sex hormones in the modulation of specific cognitive functions across the menstrual cycle of young healthy women, and to apply improved study design by addressing limitations recognized in previous studies. METHODS: A homogenous group of 16 young healthy women, with no history of health problems related to menstrual cycle, major psychiatric and neurological disorders or addictions was included in study. All participants were medical students of similar age (21.56 ± 0.15 year). They were subjected to various cognitive tasks at three different phases of the menstrual cycle: early follicular phase, proven ovulatory phase and mid-luteal phase. Special concern was taken to validate blood hormone levels and to determine preovulatory luteinizing hormone (LH)-peak. RESULTS: Analysis of blood hormone levels confirmed that the test sessions were performed at appropriate time points. Most women were presented with the above average results on utilized cognitive tasks, with no significant changes in immediate memory, working memory, delayed recall, verbal learning, delayed verbal learning or verbal fluency in any phase of the menstrual cycle. In addition, test results did not correlate to measured hormone levels. CONCLUSIONS: The results suggest that changes in estrogen and progesterone levels during each menstrual cycle did not affect women's everyday functioning to any significant extent.

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.

Influence of health education regarding correct diet on anthropometric indexes in children.

Obesity is one of the leading public health issues in the world whose significance lies, not only in its prevalence, but also in its consequences i.e. diseases that gradually develop in obese people. The aim of the study was to determine obesity prevalence among school children and the influence of health education on its prevalence. Study included pupils of 19 first grades in 8 primary schools of Osijek-Baranja County, Croatia. Body weight and height, waist and hip circumference were measured. Parameters for assessing obesity: body mass index (BMI, according to Croatian referral values), waist circumference (WC), waist and hip circumference ratio (WHR) and waist circumference and height ratio (WHtR) were measured. In order to determine whether the health education of pupils and their parents influences children's anthropometric indexes, health education regarding correct diet, obesity and its consequences and the need for life style changes in terms of daily physical activity was conducted in four primary schools. Pupils of other four primary schools were measured as a control group. Prevalence of overweight children according to BMI before education was 8.9% (6.5% of overweight and 2.4% of obese children). In intervention group of children, according to BMI, there was no decrease in proportion of obese after the health education was conducted and prevalence was 2% before and after the education. On the second measurement, pupils in control group showed increase in proportion of obese from 2.9% to 3.5%. According to weight circumference and height ratio before education there were 10.2% of obese children. After six months, there was an increase in proportion of obese to 11.3%. According to this index there was an increase in proportion of obese in all groups of pupils regardless of gender and conducted education. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; program should be conducted continuously during longer period, otherwise this condition will continue to rise.

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.

Prognostic factors of local recurrence and survival after curative rectal cancer surgery: a single institution experience.

The aim of our study is to evaluate the importance of prognostic factors, both tumor-related and therapy related, and their impact on local recurrence rate of rectal carcinoma. It is also important to evaluate impact of chemoradiotherapy (CRT) on local recurrence rate and survival. We used the data of 514 patients with rectal carcinoma treated at Clinic of surgery at University Hospital Centre in Osijek, during the period from 2000 to 2007. Routine follow-up was carried out until March of 2012 or death. Median life expectancy for all patients who underwent surgery was 98 months. 47% of patients with resection without residual tumor (R0) did not develop local recurrence after median of observation of 90 months. 5-year survival rate for patients with R0 resection was 76.4%. The patients who had preoperative serum levels of carcinoembryonic antigen (CEA) within the normal range (< 5 microg/mL) had a significantly better prognosis with 5-year survival of 75.8%, than patients with elevated levels who had 5-year survival of 46.5%. Tumor stage had great influence on survival and was defined by UICC TNM (International Union against Cancer, Tumor Node Metastases) classification, 7th edition. 5-year survival rate was (93.5% for stage I, 87.4% for stage II, 58.2% for stage III, 8.1% for stage IV). Patients with low grade differentiation tumors had 5-year survival rate of 73.5%, and those with high-grade had 38.2%. We have found that preoperative CRT significantly reduces the rate of local recurrence (5.3% vs. 14.1%), but patients who were treated with preoperative CRT did not appear to benefit significantly in terms of their long-term prognosis, because there was no difference in overall survival between the patients who received preoperative radiochemotherapy and those who did not receive it (66.2% vs. 67.8%). It was found that the R-classification, anatomical extent of tumor described by the TNM classification of the UICC, tumor grade, and preoperative CEA serum level were prognostic factors that influenced survival.

Basilar artery occlusion treated conventionally with good outcome.

It presents a case of a 39-year old woman with acute symptomatic occlusion of basilar artery proximal segment, which was manifested by severe neurological symptomatology and deficits. The patient was treated conventionally (anticoagulant, then antiplatelet agent therapy) with excellent short-term and long-term outcome. In spite of serious acute neurological symptomatology of basilar artery occlusion, proximal localization of the occlusion, fluctuating symptomatology flow, younger age and development of collateral circulation can suggest a good outcome in conventionally treated patients.

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 Osjecko-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.

Colorectal cancer early detection program integrated in practice of family physicians.

AIM: To present preliminary results of the colorectal cancer early detection program, a part of the project called "A Model of Early Cancer Detection Integrated in a Practice of a Family Physician", carried out by the Department of Family Medicine of the Osijek University School of Medicine and the Health Centre of Osijek, Croatia. METHODS: The strategy of the project, based on the central role of a family physician in the implementation of the early cancer detection programs, was described and preliminary results of the colorectal cancer early detection program are presented and compared with the same issues of the National Program, centrally conducted and supplied by public services. RESULTS: From the beginning of April unil the end of May 2009, a total number of 516 testing cards on occult faecal blood were delivered to patients from two target groups (aged 45-50 and 75-79). A high responding rate of 69.76% (360) was recorded. This is an advantage in comparison with the low responding rates of about 20% (43 862), obtained by the National Program. In the project, there were in average 2.5% (9) positive tests, with the higher percent in the older than in the younger age group, 3.5% (12) and 1% (4) respectively). CONCLUSION: Data obtained by the Project, and by the National Program--indicate that there could be a need for a more precise definition of risk groups who have to be invited for screening.

The incidence of skin squamous cell carcinoma in Osijek-Baranja County--an epidemiological study.

The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of epidemiological features of squamous cell skin carcinoma in this region. In this period we registered 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region.

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.

Cross-sectional biomonitoring of metals in adult populations in post-war eastern Croatia: differences between areas of moderate and heavy combat.

AIM: To determine differences in metal and metalloid exposure between residents of areas in eastern Croatia exposed to heavy fighting during the war in Croatia and residents of areas exposed to moderate fighting. METHODS: Concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), nickel (Ni), lead (Pb), uranium (U), vanadium (V), and zinc (Zn), reported to be associated with military operations, were determined in hair, serum, and urine samples using inductively-coupled plasma mass spectroscopy. A total of 127 and 46 participants from areas of heavy and moderate fighting, respectively, were included. RESULTS: Compared with participants from areas exposed to moderate fighting, participants from areas exposed to heavy fighting had significantly higher serum concentrations of Al (87.61 vs 42.75 µg/L, P=0.007), As (5.05 ∓ 1.79 vs 4.16 ∓ 1.55 µg/L, P=0.003), Ba (7.12 vs 6.01 µg/L, P=0.044), and V (17.98 vs 16.84 µg/L, P=0.008); significantly higher urine concentrations of As (43.90 vs 11.51 µg/L, P<0.001) and Cd (0.67 vs 0.50 µg/L, P=0.031); and significantly higher hair concentrations of Al (12.61 vs 7.33 µg/L, P<0.001), As (0.32 vs 0.05 µg/L, P<0.001), Cd (0.03 vs 0.02 µg/L, P=0.002), Fe (22.58 vs 12.68 µg/L, P=0.001), Pb (1.04 vs 0.69 µg/L, P=0.006), and V (0.07 vs 0.03 µg/L, P<0.001). CONCLUSION: Differences between populations from eastern Croatian areas exposed to heavy and populations exposed to moderate fighting point to the need for extensive monitoring of metal and metalloid exposure, emphasizing the role of biomonitoring through ecologic and preventive activities.

The effects of gluten-free diet on body weight in children with celiac disease.

This study was aimed at monitoring and controlling of body weight in children with diagnosis of celiac disease when established and after introducing gluten-free diet. Prospective clinical study included 42 children with celiac disease whose body weight was measured before introducing gluten-free diet, and after the period of six and 18 months of introducing gluten-free diet. The children were divided into three age groups. The first group consisted of 16 children, 8 females and 8 males in the age from 6 to 18 months, the second group consisted of 14 children, 8 females and 6 males ranging from the age of 20 to 111 months and the third group consisted of 12 children, 6 females and 6 males ranging from the age of 115 to 204 months. The measured body weight was compared with the centile tables of children of the same age. After introducing gluten-free diet the body weight was significantly higher at first, especially at the second control examination in comparison to the centile table of children of the same age and gender When comparing the results at the time of establishing the diagnosis and at the first and second control examination of the body weight of children the results showed no difference concerning gender and the age of children. In conclusion it can be said that is very important to diagnose celiac disease as soon as possible because the introduction of gluten-free diet prevents the pathological conditions mucosal lesion of small intestine and the physical retardation of children.