[Disease duration, patient compliance and presence of complications in diabetic patients]. / Trajanje bolesti, suradljivost bolesnika i postojanje komplikacija u bolesnika s dijabetesom.

UNLABELLED: Diabetes mellitus (especially type 2) is one of the most common metabolic diseases in care of general/family physician. AIM: The aim of the study was to investigate the duration of the disease, association of the disease duration with the onset of complications, and physician's assessment of patient compliance. The study was a part of the international Health Monitoring Project carried out by the Chair of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, Zagreb, in cooperation with The Netherlands Institute of Primary Health Care (NIVEL). The aim was to assess the value of data on the incidence and prevalence of diabetes mellitus in primary health care. SUBJECTS AND METHODS: Family physicians, general/family practice specialists, teachers and heads of general/family practice practical teaching who were collecting data for the questionnaire structured for this purpose were included in the study. Description and distribution analysis was used on data analysis, and chi2-test on testing of differences. RESULTS: Out of 96 general/family physicians who agreed to participate in the study, 58 (60.4%) collected data on 3065 patients: 1275 (41.6%) men and 1790 (58.4%) women. In 1044 (34.1%) patients the disease lasted for 1-5 years, in 990 (32,3%) for 6-10 years and in 1031 (33.6%) for more than ten years. Complications were recorded in 1521 (49.62%) patients, showing a statistically significant correlation with the duration of the disease (chi2 = 627.889; df = 2; p < 0.001). Physicians estimated that good compliance was established in 1579 (51.52%) patients. There were significantly less complications in these patients (chi2 = 6.098; df =2; p = 0.047). DISCUSSION AND CONCLUSION: The number of complications in diabetes mellitus increased proportionally with the length of the disease, while the number of complications was lower in cases with better patient compliance. In the care for a patient with diabetes mellitus family physician should train the patient in self-care, tending to establish partnership in long lasting treatment, which is a precondition for good compliance.

[Care for terminal cancer patients at general practitioner office]. / Skrb za umiruce od karcinoma u ordinacijama obiteljske medicine.

The final goal of palliative care is symptom relief and improving the quality of life. Around 70% of cencer patients suffer pain. Therapy and care provided for dying cancer patients by general practitioners at Dugave-Travno GP Office were investigated. Medical records of 70 cancer patients were collected and analyzed. Sixty-seven patients had died. A total of 76 cancers at 22 various sites were diagnosed. There were 79 associated diseases diagnosed in 44 patients, along 43 diseases related to malignant disease in 26 patients. Physicians provided home nursing for 30 patients. In 66 cases family provided support. Physicians collaborated with community health nurses in 38 cases. A total of 66 patients were using analgesic therapy, 37 patients continuously, and 48 patients for up to one year. In 56 patients analgesic drugs were administered orally, in 25 parenterally, in 16 rectally, and in 21 patients transdermally. Physicians prescribed opioid therapy in 55 patients: codeine in 2, tramadol in 46, pentazocine in 7, methadone in 5, Kapanol in 15 and fentanyl in 21 patients. Sixty patients received adjuvant drug therapy. A total of 59 patients were hospitalized in terminal stage of the disease. Study results showed a high rate of associated diseases and diseases related to malignant disease in cancer patients. The collaboration between general practitioners and family members was satisfactory. Community health services should be improved, and the World Health Organization guidelines on palliative care, management of malignant pain in particular, should be more thoroughly followed.

[Is family physician concept possible to resume?]. / Je li moguc povratak konceptu obiteljskog lijecnika?

AIM: An anonymous survey was performed in a sample of 454 adult patients from the catchment population of eight family medicine teams at Dugave-Travno Clinic in Zagreb to assess their attitudes towards the family physician concept, its advantages and shortcomings. These family medicine teams providing care for 16,077 insures also the number of families with all their members receiving care from these teams. METHOD: The method of descriptive statistics was used. RESULTS: Data were obtained on the number of families where only some members received care at the same physician's office and on the proportion of individual family members receiving care at family medicine offices. The sample indicated that more than half of patients received care from the same family physician, and that only one tenth of patients were without their family medical file. Study subjects considered that the family doctor institution contributed to improved care and were aware of the advantages of the family doctor concept. The concept of comprehensive family treatment could currently be implemented in half of the patients. However, the other half are broken up, receiving medical care at offices of different teams. CONCLUSION: The family physician concept could be implemented in two ways: exchange of the insures among the teams at a particular clinic providing care for defined populations, and in administrative way. The family physician concept would require two strategic decisions: establishment and development of group practice, and virtual linkage of the family member medical data through an integrated primary health care information system.

[Acute infections of the upper respiratory tract--factors that contribute to diagnosis and antibiotic prescription decisions]. / Akutne infekcijev gornjeg disnog sustava--sto pridonosi dijagnozi, a sto odluci o propisivanju antibiotika?

UNLABELLED: Acute infections of the upper respiratory tract contribute to over 20% of the morbidity of the population in ambulatory care, with the highest incidence in children. A noted problem in the treatment of these diseases is overprescription of antibiotics. In addition, there is a high degree of variability among physicians in the frequency and cost of antibiotic prescription. AIM: The aim of this study was to evaluate the factors that contribute to the diagnosis, and those that affect the decision of a family care physician or otolaryngologist to prescribe an antibiotic to a patient suffering from an upper respiratory tract infection. PATIENTS AND METHODS: In this prospective study, data were collected on 75 patients with acute middle ear infection, 49 with acute tonsillitis, 57 with acute sore throat, and 39 with a streptococcal sore throat and tonsillitis, in 6 family physician offices and otolaryngological practices in Zagreb University Hospital and Osijek University Hospital, Osijek. The questionnaire included general patient data, data on the current disease (patient history and the relevant clinical status), diagnostic and therapeutic procedures and patient follow-up. Doctors noted patients' symptoms and rated (from one to five) the influence of a particular symptom to arriving at the diagnosis, and to deciding to prescribe antibiotics. The physicians also noted any additional factors that influenced antibiotic prescription. The data were analysed using appropriate statistical measures, such as chi2-test, chi2-test using the hypothesis of rectangular distribution and t-test for independent samples. RESULTS AND CONCLUSION: The results show that diagnostic criteria for these diseases and decisions for prescribing antibiotics are based on clinical criteria and in concordance with current guidelines. Otolaryngologists recommended microbiological analyses for 54% of patients, while GPs did so for only 4.2% of the patients. While the clinical status is the most important factor for antibiotic prescription, the results of this study indicate that other additional factors such as familiarity with the patient, likelihood of complications, and knowing the patient's living circumstances and his/her ability to use health care facilities should be considered in the complex process of antibiotic prescribing.

[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.

Cytological detection of lymphoma in Douglas aspirate.

Except in primary effusion lymphoma (PEL), serous effusions with lymphomatous cells in non-Hodgkin lymphoma (NHL) are not frequently seen as first manifestation of disease. In NHL lymphoplasmacytic lymphoma (LPL) the spleen, lymph nodes, and bone marrow are frequently sites of disease and this type of NHL is usually associated with a serum paraprotein of IgM type accompanied by the clinical syndrome of Waldenström macroglobulinemia. Our patient with NHL LPL type presented in this report had less frequently seen involvement of gastrointestinal tract and clinically was first manifested as effusion in Douglas space. Cytological evaluation as well immunoanalyses of effusion in such cases is essential, and various ancillary studies, because of differential diagnostic problems of lymphomas in serous effusions, first include reactive lymphocytoses and small round-cell tumors (SRCT). In our patient, cytology of effusion revealed cytomorphologically atypical lymphomatous cells with plasmocytoid differentiation. Immunocytochemical and flow cytometry analysis confirmed lymphoid cell differentiation and pathohistological diagnosis of CD20(+) LPL was set after pathohistological analysis of resected ileum.