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.

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.

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.

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.

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.

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.

Effect of surgical training course on performance of minor surgical procedures in family medicine physicians' offices: an observational study.

AIM: To examine the influence of a practical surgical course on the number of minor surgical procedures performed by family physicians. METHODS: We compared the number of minor surgical procedures performed by family physicians in 59 offices in the city of Osijek and surrounding rural area during 12 months before and after the 40-hour practical surgical course held in September 2006 by surgeons and family medicine specialists. Minor surgical procedures taught in the course included management of ingrown toenails, abscesses/comedones, and minor wounds, anesthesia application, disinfection, use and sterilization of surgical instruments, and antibiotic treatment. RESULTS: The number of minor surgical procedures performed in family medicine offices almost doubled (503 vs 906 after the course, P<0.001, Wilcoxon test). The median number of abscesses/comedones treatments per physician increased from 1 to 6 (P<0.001, Wilcoxon test), the number of managed wounds increased from 111 to 217 (P<0.001, Wilcoxon test). The increase in ingrown toenail resections was also significant (from 120 to 186, P=0.004, Wilcoxon test). Fifty percent of physicians did not treat patients surgically, irrespective of the training. We found no association between the number of performed procedures and age, length of employment, or location of the physician's office (urban vs rural). However, we found that male physicians performed more surgical treatments both before and after the course (abscesses/comedones: P<0.001 and P=0.108 respectively; ingrown toenail resections: P=0.008 and P=0.008 respectively; minor wounds: P=0.030 and P<0.001; respectively). CONCLUSION: Practical courses can encourage practitioners to treat the patients surgically in their offices and, thus, increase the number of services offered in primary care. Female physicians should be more encouraged to perform minor surgical procedures in their offices.