Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients / Influência de fatores socioeconômicos e de tratamento sobre a fadiga, ansiedade e depressão autorrelatadas em pacientes com artrite reumatoide

Abstract Introduction: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). Goals: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. Method: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. Results: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. Conclusion Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

Resumo Introdução: A fadiga, a ansiedade e a depressão são sintomas muito frequentes em pacientes com artrite reumatoide (AR). Objetivos: Neste estudo, avaliou-se a influência de características socioeconômicas, características de tratamento e comorbidades na elevação na fadiga, ansiedade e depressão autorrelatadas em pacientes com AR. Método: Este estudo transversal multicêntrico foi feito em 22 instituições de saúde na Sérvia de abril a agosto de 2014 na população de pacientes idosos com AR. O status de saúde autorrelatado dos pacientes foi medido pelos instrumentos Fatigue Assessment Scale, Patient Health Questionnaire-9 e Generalized Anxiety Disorder-7. As modalidades de tratamento foram definidas como: 1) anti-inflamatórios não esteroides (AINE) e/ou analgésicos e/ou corticosteroides; 2) fármacos antirreumáticos modificadores da doença sintéticos (DMARD) isoladamente ou em combinação com corticosteroides e/ou AINE e 3) qualquer tratamento para a AR que incluísse DMARD biológicos. Resultados: Houve preditores significativos de depressão elevada: tratamento com DMARD sintéticos em combinação com corticosteroides e/ou AINE, pagamento particular de fisioterapia, uso frequente de serviços de táxi, terapias alternativas e status ocupacional. A necessidade de assistência de outra pessoa, o tratamento suplementar com cálcio e as qualificações profissionais foram os preditores de fadiga elevada. A idade acima de 65 anos teve um efeito protetor sobre a fadiga elevada. A ansiedade foi um preditor independente de fadiga elevada. Os preditores ansiedade elevada foram: gastroproteção com inibidores da bomba de prótons e ocupação do paciente. Conclusão: Os preditores socioeconômicos de níveis elevados de depressão, ansiedade ou fadiga autorrelatadas são diferentes para cada um dos desfechos mencionados; quando acompanhados do tratamento básico para a AR, esses preditores socioeconômicos explicam exclusivamente uma depressão elevada. A ansiedade, associada às variáveis socioeconômicas e ao tratamento complementar, é um importante preditor da fadiga em pacientes com AR.

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients.

INTRODUCTION: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). GOALS: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. METHOD: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. RESULTS: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. CONCLUSION: Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

[Financial sustainability of home care in the health system of the Republic of Serbia].

INTRODUCTION: Over the last several years, during the economic crisis, the Ministry of Health and the Republican Health Insurance Fund (RHIF) have been faced with new challenges in the sphere of healthcare services financing both in the primary as well as other types of health insurance in the Republic of Serbia (RS). OBJECTIVE: Analysis of cost-effectiveness of two models of organization of home treatment and healthcare in the primary insurance, with evaluation of the cost sustainability of a single visit by the in-home therapy team. METHODS: Economic evaluation of the cost of home treatment and healthcare provision in 2011 was performed. In statistical analysis, the methods of descriptive statistics were employed. The structure of fixed costs of home healthcare was developed according to the RS official norms, as well as fixed costs of providing services of home therapy by the Healthcare Centre "New Belgrade". The statement of account for provided home therapy services was made utilizing the RHIF price list. RESULTS: The results showed that the cost of home healthcare and therapy of the heterogeneous population of patients in the Healthcare Centre "New Belgrade" was more cost-effective in relation to the cost of providing home therapy services according to the RS official norms. CONCLUSION: Approved costs utilized when making a contract for services of home therapy and healthcare with the RHIF are not financially sustainable. It was shown that the price of 10 EUR for each home visit by the in-home therapy team enables sustainability of this form of providing healthcare services in RS.

[Do we reach target lipid levels in diabetic and non-diabetic patients with previous myocardial infarction?].

INTRODUCTION: Considering that dyslipidaemia is an important factor for cardiovascular diseases, target lipid levels are rarely reached in everyday clinical practice. OBJECTIVE: The objective of this study was to evaluate how often we achieve the treatment goals for the lipid parameters in the diabetic and non-diabetic patients after the previous myocardial infarction (MI). METHODS: The survey included 118 patients (84 males and 34 females), mean age 59.38 +/- 9.86 years, 34 (28.8%) of them diabetics, with the history of MI in the previous 3 years. The patients were selected from the database of multicentre prospective interventional study "Secondary prevention of coronary heart disease and cerebrovascular diseases", conducted in 2005 on 1,189 patients in Serbia. The patients were further followed in the period from 18 (5th visit) and 36 months (6th visit) after inclusion into the study from 2005-2008. Their lipid status, the use of lipid-lowering drugs, and the independent prognostic factors for major adverse coronary events were identified. In the beginning of the study, all patients were informed about the importance of lifestyle change and active approach to treatment. The accomplishment of secondary preventive measures was estimated on the basis of the European guidelines on secondary prevention of the coronary heart disease. RESULTS: Three years after introduction of the preventive measures, diabetics had a higher prevalence of the target levels of the total cholesterol (21.2% vs. 7.6%) and HDL-cholesterol than non-diabetics (100% vs. 87.3%) (p < 0.05). Non-diabetics had significantly higher prevalence of the target levels of LDL-cholesterol than diabetics (19% vs. 3%) (p < 0.05). No significant differences were found in the prevalence of the treatment goals of triglycerides in diabetic (42.4%) and non-diabetic patients (60.8%) (p > 0.05). At the end of the study, after applying secondary prevention measures, 27.3% of diabetics did not use lipid-lowering drugs. The percentage of non-diabetics using no lipid-lowering drugs was lower (20.3%), but the difference was not statistically significant (p > 0.05). By using the method Enter Cox regression multivariant analysis, the change in the level of triglycerides, total and LDL-cholesterol were singled out as independent prognostic factors for major adverse coronary events. CONCLUSION: Our study has shown high prevalence of increased plasma concentrations in the total, LDL-cholesterol and triglycerides and low plasma concentrations of HDL-cholesterol, as well as the insufficient use of lipid-lowering drugs in diabetic and non-diabetic patients with previous MI. Decreasing the total cholesterol and increasing the HDL-cholesterol are significant, decreasing of triglycerides and LDL-cholesterol does not suffice. Therefore, secondary prevention measures of cardiovascular events should be intensified, especially in patients with diabetes.

[Family health and family physician's influence on prevention psychoactive substances abuse].

The family, as the basic social unit, has a decisive role in the health and disease of its members. It is the primary unit where health needs are formed and solved. By its own resources the family independently resolves about 75% of the total health requirements. In the paper the authors study family characteristics which influence family health and diseases, indicators of family health and the scale of life values. Also, the study evaluates social factors, communication and the influence of the usage of psychoactive substances on family health and the quality of family life. To form the personality of a child three factors are most significant: love, the feeling of safety and the presence of harmonious relationship between the parents. Life harmony in a family also depends on the quality of structural components of the personality and the interaction of motivation of its members. Early childhood determines the future personality of the adult person. At that period, habits and partially attitudes are formed. In harmonious family relationships the parents are the role model to children. Verbal and non-verbal communication enrich the relationship among people and enable efforts in supporting understanding, compassion and care for others by mutual agreement. On the scale of life values of Serbian citizens health holds the first position. Immediately following the health issue is good relationship in the family. As healthcare is not only the task of healthcare services, but also of each individual, family and the society as a whole, it is on healthcare personnel to educate the citizens how to preserve and improve their own health and the health of their family by a continual healthcare and education. Above all, this concerns avoidance of bad habits, such as smoking, immoderate alcohol consumption, narcotic abuse, physical inactivity, hypercaloric nutrition, etc. Also, it is significant to make an early recognition of disease symptoms and to turn for help to the chosen doctor on time. Family medicine and family doctors can in the best way, entirely and continually, prevent and treat numerous diseases occurring as the result of family dysfunction, with active participation of each individual, family, healthcare services and the community.

Health-related quality of life of general practitioners--family physicians in south-eastern Europe.

INTRODUCTION: An insight into the health-related quality of life (HRQL) provides information on the extent of activities and everyday functioning restriction by deteriorated health. OBJECTIVE: The purpose of the paper was to analyze the HRQL of general practitioners-family physicians of the southeastern Europe and compare it with HRQL of controls, the subjects of the same educational background, geographical area, sex and age, but different working activities. METHOD: The study"Health-related quality of life of general practitioners-family physicians in the south-eastern Europe" (HERQUL study) was performed in Serbia, Republic of Srpska, Montenegro, Macedonia and Bulgaria during February-September 2004. Study instrument was a standardized generic questionnaire for the measurement of HRQL SF-36, which subjest's health status assesses across eight different domains. RESULTS: The study included 1141 doctors (337 male and 804 female) and the same number of controls.The deteriorated physical health affected HRQL of controls, but more significantly of physicians. The deteriorated mental health affected HRQL of both physicians and controls regardless of age and sex. The lowest HRQL scores of physicians due to lowered vitality was reported in all studied countries, excluding subjects from Montenegro. Better social functioning HRQL domain was recorded in males regardless of profession. The deteriorated physical and mental health as well as social functioning mostly influenced HRQL of physicians aged 55-59, and in controls this applied to those older than 60, regardless of sex. Emotional health HRQL domain scores were better in the control group than in physicians, regardless of sex. CONCLUSION: Studies of physicians' HRQL, particularly doctors of general practitioners-family physicians, are scarce. The results of the HERQUL study could be the impetus to obtain support for the improvement of HRQL of this important group of health professionals from the relevant government institutions.

[The effect of medicamentous and non-medicamentous therapy on lowering risk factors for cardiovascular and cerebrovascular episodes in an interventional study].

INTRODUCTION: In a chain of cardiovascular episodes, risk factors (RF) and bad habits represent the first link. OBJECTIVE: The purpose of the study was to determine, during six months, on four examinations (the first, and three follow-ups after the second, fourth and sixth month), the following: physical activity (PA) alteration and the number of cigarettes smoked; the effect of antihypertensive beta-blockers and ACE inhibitors on systolic and diastolic arterial tension; the effect of metmorfin therapy on BMI, glycaemia, total cholesterol level (TCL) and triglycerides in diabetics compared to healthy individuals; the effect of hypolipidaemics on blood TCL and triglycerides in patients with angina pectoris (AP); the effect of betablocker therapy on TCL. METHOD: This was a multicentric interventional study. Secondary prevention of coronary disease and cerebrovascular conditions was applied in the first half of 2005. There were 185 general practitioners from 38 health centres in Serbia, and patients of both sexes were included with the verified diagnosis of coronary disease and/or cerebrovascular condition. They had demographic data verified as well as data of being genetically (non)predisposed for AP, hypertension, myocardial infarction, stroke and diabetes mellitus. Descriptive and differential statistical methods were used for study result analysis. RESULTS: Out of 1189 patients, there were 51.4% of women and 48.6% of men. The average age was 59.45 +/- 9.77 years. The population was homogeneous by sex and the factor of being genetically (non)predisposed for AP. There was a significant difference in examinations in four contacts in PA and cigarette smoking (p < 0.0001). Systolic and diastolic pressure, TCL and triglycerides were significantly decreased by medicaments (p < 0.05) and more significantly so associated with nonmedicamentous measures (p < 0.001). Metmorfin significantly decreased the glycaemic level (p < 0.001) both in diabetics and patients with a reduced tolerance level to glucose. In patients who took betablockers, there was lowering of TCL. CONCLUSION: Taking medicaments significantly lowers RF, and more significantly so when associated with a non-medicamentous therapy.

[The effect of metformin on fasting and postprandial insulin secretion in obese patients with diabetes mellitus type 2].

INTRODUCTION: The main causes of reduced glucose levels during metformin therapy appear to be an increase in insulin action in peripheral tissues and reduced hepatic glucose output due to inhibition gluconeogenesis. OBJECTIVE: The purpose of the study was to establish the effect of metformin on fasting and postprandial insulin secretion. METHOD: The study carried out was double blind, controlled, comparative, randomized, multicentric, including two groups of out-patient department (OPD) patients. 43 patients were administered metformin (Tefor ICN Canada), and 46 patients were given placebo. Patients enrolled in the study were newly diagnosed with diabetes mellitus (DM) type 2, glycaemia < 12 mmol/l, and had the Body Mass Index (BMI) > 30 kg/m2. Before treatment, blood biochemistry was done: fasting and postprandial glycaemia, glycosylated haemoglobin (HbA1c) value, fasting and postprandial insulinaemia, blood lipids (total cholesterol, total triglycerides, HDL cholesterol, and LDL cholesterol), and gamma glutaryl transferase (GGT) level. BMI was also established. After 42 days of treatment, fasting and postprandial insulinaemia were tested again. Analysis of the effects of therapy, and identification of co-variants for fasting and postprandial insulinaemia, were done by ANOVA two way and ANCOVA method. RESULTS: It was shown that metformin accompanied by diet, as compared to placebo accompanied by diet, lowered the fasting insulinaemia value during six weeks of therapy in obese patients with DM type 2 (24.392 mU/l vs. 25.667 mU/l), interacting both with BMI pre-therapy, and interacting with fasting insulinaemia pre-therapy (p < 0.001). A significant effect of the interaction of covariants BMI and GGT was defined. As for the effect of therapy on postprandial insulinaemia, it was found that there was a high statistical significance of the effect of BMI interacting with initial values for postprandial insulinaemia before therapy, and interacting with therapy (p < 0.01). Adjusted mean values for postprandial insulinaemia after therapy in the placebo group were lower as compared to the metformin group (44.807 mU/l vs. 47.114 mU/l). CONCLUSION: It can be concluded that, as compared to place- bo, metformin is more efficient in reducing insulin resistance in obese patients with DM type 2. In addition, as compared to placebo, metformin maintains more efficient productive insulin secretion, indicating that metformin protects the pancreas from beta cell depletion.

[The role of pentoxifylline in nitrogen conversion in patients suffering from diabetic phlegmona of the foot].

INTRODUCTION: It is known that pentoxifylline is the only medicament to date which has been clinically proven to lead to nitrogen conversion in uremic patients. Positive results of application of pentoxifylline in prevention of systemic inflammatory response syndrome have also been published, as well as in prevention and treatment of the acute respiratory distress syndrome. OBJECTIVE: The goal of our study was to investigate the effect of four-day treatment with pentoxifylline in a dose of 300 mg dissolved in 500 ml of normal saline, administered as 20-hour intravenous infusion per day, on the conversion of nitrogen in 11 patients suffering from diabetic phlegmona of the foot, and with pathological values of urea and creatinine. METHOD: All patients had 3 repeated negative blood cultures, and at least one positive out of three wound swabs. Seven patients were insulin independent, and 4 insulin dependent. Before treatment, all patients had pathological findings of white blood cells, in the form of granulocytosis, with appearance of young cells. Patients were prescribed adequate antibiotics according to drug susceptibility test, and glycemia was monitored every 6 hours, with correction of diabetes therapy. Patient's dressings were changed once a day, while urea and creatinine were checked immediately before the onset of pentoxifylline therapy, as well as after four days of therapy. Statistical analysis was done using the McNemar test for linked sample. RESULTS: The results showed that pathological values of white blood cells persisted in all patients, and after four days of therapy, blood urea restored to normal in 9 patients (Z = -3; p = 0.003), and blood creatinine in 10 patients (Z = -3, 162; p = 0.002). There was no need to make corrections of diabetes therapy. CONCLUSION: It can be concluded that pentoxifylline can prevent further degradation of nitrogen in patients suffering from phlegmona of the foot, decreasing the catabolic effect of infection, most probably by inhibiting the effect of TNF-alpha, interleukin-1 and interleukin-6, without any significant effect on leukocytosis during four days of treatment.

[Factors influencing general practitioners and specialists of general practice to declare in favor of accepting the role of family doctors].

INTRODUCTION: Protection and promotion of health of an individual, family and society as the whole depends on the organization and efficiency of the public health service. Modern health service is focused on the health prevention and improvement of the family which is the basic unit of society. The life cycle of the family indicates crisis related to development and underdevelopment as well as some expected and unexpected life situations and this is very important when discussing about many somatic and mental diseases. OBJECTIVE: The objective of our project which included 473 specialists of general practice and 355 general practitioners was to determine the factors which influence the positive attitude of the general practitioners about becoming a family doctor. METHOD: A total of 828 doctors in Serbia were required to answer the set of eight questions. Statistical analysis included Pearson chi square test with contingency tables and logistic regression, while dependent variable was doctor's attitude about becoming a family doctor in a certain situation. The answer 'no' or 'I don't know' was scored 1 point and the 'yes' answer was graded 2 points. Eight questions mentioned above were independent variables. RESULTS: Logistic model accounting for 79.3% of dependent variable was obtained. Positive attitude of doctors was very much affected by family problems and great majority of these doctors were specialists of general practice. Other questions were not so important for our results. CONCLUSION: Specialists of general practice, regardless of their working experience and years of practice, gave significantly more positive answers, and the situation was quite opposite with general practitioners. Family medicine supported by modern information systems provides ideal model of comprehensive and complete health prevention with high level of rationalism, quality, efficiency and cost-effectiveness.

[Rating on life valuation scale].

INTRODUCTION: World Health Organization (WHO) Articles of Association defines health as the state of complete physical, mental and social well-being and not merely the absence of disease. According to this definition, the concept of health is enlarged and consists of public and personal needs, motives and psychological nature of a person, education, culture, tradition, religion, etc. All these needs do not have the same rank on life valuation scale. OBJECTIVE: The objective of our study was ranking 6 most important values of life out of 12 suggested. METHOD: Questionnaire about Life Valuation Scale was used as method in our study. This questionnaire was created by the Serbian Medical Association and Department of General Medicine, School of Medicine, University of Belgrade. It analyzed 10% of all citizens in 18 places in Serbia, aged from 25 to 64 years, including Belgrade commune Vozdovac. Survey was performed in health institutions and in citizens' residencies in 1995/96 by doctors, nurses and field nurses. RESULTS: A total of 14,801 citizens was questioned in Serbia (42.57% of men, 57.25% of women), and 852 citizens in Vozdovac commune (34.62% of men, 65.38% of women). People differently value things in their lives. On the basis of life values scoring, the most important thing in people's life was health. In Serbia, public rank of health was 4.79%, and 4.4% in Vozdovac commune. Relations in family were on the second place, and engagement in politics was on the last place. CONCLUSION: The results of our study in the whole Serbia and in Vozdovac commune do not differ significantly from each other, and all of them demonstrated that people attached the greatest importance to health on the scale of proposed values. Relationships in family were on the second place, and political activity was on the last place. High ranking of health and relationships in family generally shows that general practitioners in Serbia take important part in primary health care and promotion of health care management. They have responsibility to preserve and enhance health of a person, family and society as a whole.

[Relationship between respiratory symptoms and satisfaction with inhaled asthma medication].

INTRODUCTION: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. OBJECTIVE: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. METHOD: In 124 patients, (39 males; mean age 45 +/- 18 years; mean forced expiratory volume in one second (FEV) 71.8 +/- 23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms--cough, wheezing, dyspnea and chest tightness (all of them graded from 1--without symptoms, 2--mild, 3--moderate, and 4--severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms--the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients' satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. RESULTS: The highest degree of correlation with overall satisfaction scores was found (using the Pearson's coefficient of linear correlation) for the scores of wheezing (r = -0.271; p = 0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. CONCLUSION: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms results in enhancement of their satisfaction with inhaled medication and compliance.

[Autoimmune thyroid disease and associated diseases].

Autoimmune thyroid disease (ATD) is a multifactorial, genetic disease. It is the sequelae of the impaired immunoregulation, tolerance and poor recognition of one's own proteins, oligopolysaccharides and polypeptides, due to development of somatic lymphocyte mutations. It is manifested by different clinical and morphological entities, inter-related by etiopathogenetic association, i.e., all of them are caused by disorder of immune system regulation. Chronic autoimmune thyroidism (Thyreoiditis lymphocytaria Hashimoto, HT), as well as immunogenic hyperthyroidism (Morbus Graves Basedow, MGB) are frequently associated with autoimmune diseases of other organs, such as: chronic insufficiency of salivary glands (Sy Sjögren), autoimmune hemolytic anemia, megalocytic pernicious anemia, thrombocytopenia, Rheumatoid arthritis, Diabetes mellitus (more often type 2, but also type 1), Morbus Addison, Coeliakia, and other autoimmune diseases such as systemic diseases of connecting tissue (Lupus erythematosus-SLE, Sclerodermia, Vasculitis superficialis). The incidence of autoimmune diseases has been at increase in all age groups of our population. The prevalence of organ-specific and organ-nonspecific antibodies increases with the age. Antigenicity of thyroid epithelial cell may be triggered by different chemical and biological agents (repeated viral infections), repeated stress, and in individuals with genetic propensity. Unrecognized ATD progressively leads to hypothyroidism with hyperlipidemia, blood vessel changes, osteoporosis, deformities, invalidity which substantially reduces the quality of life of patient and requires medical attention and expensive treatment on what account it is medically and socio-economically significant. Multiple diagnostic procedures contribute to faster recognition of this condition. The goal of the primary health care physician (given that preclinical phase of ATD and other associated diseases have different duration) and other specialists is to recognize ATD and, by early diagnosis and multidisciplinary treatment, to take secondary preventive measures of manifestation of above-mentioned associated autoimmune diseases, and in that way, to avoid the development of comorbidity and complications. It is particularly supported by medical doctrine based on evidence of application of corticosteroids, cytostatics, thyro-suppressive and substitution therapy, antilipemics, bisphosphonates and other drugs, significant for autoimmune diseases.

[Risk factors for chronic noncontiguous diseases: twelve-week prospective study]. / Faktori rizika za hronicna nezarazna oboljenja: dvansestonediljna prospektivna studija.

Risk factors (RF) of chronic noncontiguous diseases (CND) are mutual and cannot be observed individually since there is an inter-reaction (interaction of RF in various combinations), what makes so-called personality risk profile for development of particular disease. Almost all CND belong to the group of preventable diseases, because their course may be influenced and changed through RF modification and reduction. Bad habits also contribute to CND incidence. CND prevention is the first priority of primary health care physicians. The main objective of our study was to detect RF in patients during everyday activities of general practitioner, to estimate the risk of CND within the existing RF combination, to show the results of 12-week active monitoring of population with RF of CND, and with already present CND; while the secondary goal was to assess how much population is interested in active collaboration as well as to evaluate the qualification of general medicine teams for work based on defined methodology. The study was multicentric, prospective and interventional. The study included 2086 subjects, aged from 25-64 years, and it was carried out in 17 health centers throughout Serbia in the period January-April 2002. The subjects were selected by method of open clinical experiment. Thereafter, 12-week medical intervention was initiated involving non-pharmacological and pharmacological treatment. The first control was scheduled after 8, and the second after 12 months of intervention. Congruence chi2 test, ANOVA for repeated measurements and Logistic regression were used for statistical data processing. Out of a total of 2086 subjects, the following proportion of them reported specific diagnosis in their medical histories: 77% of them reported arterial hypertension (HTA), 68%--increased body mass (BMI > or = 27Kg/m2), 66%--hyperlipoproteinemia (HLP), 34%--diabetes mellitus (DM), 56%--inadequate physical activity (PA), and 23%--cigarette smoking (CS). On the basis of RF number and combination for genesis and development of CND in our sample, 74.7% of variability (development or risk) may be accounted for angina pectoris (AP), 74.2% for DM+HTA, 70.0% for DM, 79.9% for HTA, 80.8% for myocardial infarction (MI), and 85.8% of variability (development or risk) for cerebrovascular insult (CVI). Twelve-week intervention resulted in reduction of HTA, HLP, glucose, and PC (p<0.001) levels as well as lower BMI and PA (p<0.5). To accomplish the aforementioned goals, continuous mutual activity of an individual, his/her family, health service and community is required, along with occasional evaluation of the obtained results.