[Information and communication technologies in nursing]. / Informacijske i komunikacijske tehnologije u sestrinstvu.

The application of information and communication technologies (ICT) in nursing is an integral part of the educational curriculum at the university graduate level of nursing, but also part of scientific and professional meetings on nursing informatics. As part of seminars, students are obliged to choose e-health topics from their working environment, to show them and discuss with colleagues. The same is happening at meeting on nursing informatics. Selected papers on the issue are chosen to cover information literacy of nurses, examples of e-nursing, ICT infrastructure, the possible future developments and organizational aspects of e-health at healthcare institutions. Among others, special attention is paid to improving the quality of work in nursing.

[Virtual communication in nursing--are we ready?]. / Virtualna komunikacija u sestrinstvu--jesmo li spremni?

Electronic correspondence is undeniably important in professional communication, education, research and development of a profession. As for others, it is also crucial for development of the nursing profession. Even though e-mail today is a very important tool in the healthcare system, it has not been given sufficient attention yet. There are numerous examples of poor communication, and the answers are often hidden behind attitudes and knowledge of communicators. Therefore, the aim of this study was to examine the level of knowledge and attitudes of nurses about electronic communication. The research has shown that even though the nurses have positive attitudes about electronic communication and a desire to acquire new knowledge, they do not attend computer science courses nor did they have proper IT training while at school. Only 17% of the interviewees gave satisfactory answers to the survey about the knowledge of e-mail. This result can be indicative of the total knowledge of information and communication technology, signaling the need to implement an organized IT education of nurses, which is a necessary requirement for professional development and better functioning of the healthcare system.

Diversity of metabolic syndrome criteria in association with cardiovascular diseases--a family medicine-based investigation.

BACKGROUND: This study compared the association between the 3 definitions of metabolic syndrome (MetS) suggested by the World Health Organization (WHO), National Cholesterol Education Programme (NCEP ATP III), and International Diabetes Federation (IDF), and the risk of cardiovascular diseases (CVD) and shows the prevalence and characteristics of persons with MetS in continental vs. coastal regions and rural vs. urban residence in Croatia. MATERIAL/METHODS: A prospective multicenter study was conducted on 3245 participants≥40 years, who visited general practices from May to July 2008 for any reason. This was a cross-sectional study of the Cardiovascular Risk and Intervention Study in Croatia-family medicine project (ISRCTN31857696). RESULTS: All analyzed MetS definitions showed an association with CVD, but the strongest was shown by NCEP ATP III; coronary disease OR 2.48 (95% CI 1.80-3.82), cerebrovascular disease OR 2.14 (1.19-3.86), and peripheral artery disease OR 1.55 (1.04-2.32), especially for age and male sex. According to the NCEP ATP III (IDF), the prevalence was 38.7% (45.9%) [15.9% (18.6%) in men, and 22.7% (27.3%) in women, and 28.4% (33.9%) in the continental region, 10.2% (10.9%) in the coastal region, 26.2% (31.5%) in urban areas, and 12.4% (14.4%) in rural areas. Older age, male sex, and residence in the continental area were positively associated with MetS diagnosis according to NCEP ATP III, and current smoking and Mediterranean diet adherence have protective effects. CONCLUSIONS: The NCEP ATP III definition seems to provide the strongest association with CVD and should therefore be preferred for use in this population.

Pseudocholinesterase activity in cerebrospinal fluid as a biomarker of solid central nervous system tumors in children.

AIM: To determine the activity of pseudocholinesterase (PChE) in cerebrospinal fluid (CSF) and serum in children with solid central nervous system (CNS) tumor and to assess whether PChE activity could be a valid biomarker for solid CNS tumors in children. METHODS: The study and control group included 30 children each. Children in the study group had a solid CNS tumor, while those from the control group had never suffered from any tumor diseases. CSF and serum samples were collected from all participants and PChE activity was determined using the Ellman's spectrophotometric method. PChE activity in CSF was shown as a cerebrospinal fluid/serum ratio expressed in percentage, ie, PChE CSF/serum ratio. Receiver operating characteristic (ROC) curve was used to assess whether PChE activity can be used as a biomarker for identifying children with solid CNS tumors. RESULTS: Children with solid CNS tumor had significantly higher PChE activity in CSF and serum, as well as PChE CSF/serum ratio (P=0.001). PChE CSF/serum ratio in the study group was 2.38% (interquartile range [IQR] 1.14-3.97) and 1.09% (IQR 0.95-1.45) in the control group. ROC curve analysis of PChE CSF/serum ratio resulted in an area under the curve (AUC) value of 0.76 (95% confidence interval [CI] 0.63-0.88) and a cut-off of 1.09. Twenty five of 29 patients with elevated PChE CSF/serum ratio had a tumor, corresponding to a sensitivity of 83% and a specificity of 53%. CONCLUSION: PChE CSF/serum ratio may be used as a test or biomarker with good sensitivity for solid CNS tumors in children.

Disc and condylar head position in the temporomandibular joint with and without disc displacement.

The purpose of this study was to evaluate the difference between disc and condyle position between temporomandibular joints (TMJs) without disc displacement (DD) in asymptomatic volunteers, and patients who have DD in contralateral joints, respectively unilateral DD. Secondly, there were two TMJ groups which consisted of measurements from patients' symptomatic DD and volunteers with asymptomatic DD. The study included 79 TMJs of 40 patients with unilateral DD. In the group of 25 asymptomatic volunteers, 20 volunteers were without DD bilaterally (40 joints), while five had DD in at least one TMJ. All subjects were examined clinically and DD was confirmed by magnetic resonance imaging. Left and right TMJs were analysed independently for each participant based on their DD status (symptomatic, asymptomatic, and without DD). All asymptomatic TMJs did not have any clinical signs of TMJ functional abnormalities. There was a significant statistical difference between disc position among TMJs without DD in asymptomatic volunteers and TMJs without DD in patients (p = 0.016). Moreover, no significant differences were found between condyle position in the same groups of joints (p = 0.706). There were no significant differences in the DD position (p = 0.918) or condyle position (p = 0.453) between the group with asymptomatic volunteers' joints and the group with symptomatic patients' joints. There was a significant difference between patient and volunteers' joints without DD: the disc was positioned more anteriorly in patients' joints without DD than in joints of asymptomatic volunteers without DD.

Antibiotic prescription rate for upper respiratory tract infections and risks for unnecessary prescription in Croatia.

Overprescribing of antibiotics in primary care has been recognized as public health problem. We investigated visits prescription rate of antibiotics to patients with upper respiratory tract infections (URTI) and unnecessary prescription for tonsillopharyngitis, in Croatia. In prospective observational study in November 2007. 25 GPs in Croatia recorded all patients' visits with URTI episode according ICPC-2. Clinical status of patients with tonsillopharyngitis were categorized according to Centor Criteria. 689 visits were analysed, 82% of visits were initial. Antibiotics were prescribed in 44.7% visits with URTI. There were no significant differences in antibiotic prescription rates regarding non-clinical factors. Antibiotics were prescribed to patients with tonsillopharyngitis in 62.2% visits. Unnecessary antibiotics were prescribed (Centor 1,2) in 49.6% visits with tonsillopharyngitis. Logistic regression analysis showed significant differences in unnecessary antibiotic prescription rates only with respect to the workday--Wednesday, CI (1.117-2.671), p = 0.0139. Leading antibiotic was amoxicillin + clavulonic acid, second was amoxicillin, the third were macrolides, the fourth was narrow spectrum penicillin and fifth were cephalosporins. This study shows over prescription for URTI. Unnecessary prescription for tonsillopharyngitis depend on non clinical factor--day of the week. This should be further explored and help to improved prescribe antibiotics.

Users' satisfaction with the primary health care information system in Croatia: a cross-sectional study.

AIM: To evaluate the primary health care information system from the general practitioner's (GP) point of view. METHODS: Sixty-seven Croatian GPs were distributed a questionnaire about characteristics of the GP's office, overall impression of the application, handling of daily routine information, more sophisticated information needs, and data security, and rated their satisfaction with each component from 1 to 5. We also compared two most frequently used applications--application with distantly installed software (DIS) and that with locally installed software (LIS, personal computer-based application). RESULTS: GPs were most satisfied with the daily procedures and the reminder component of the health information system (rating 4.1). The overall impression ranked second (3.5) and flexibility of applications followed closely (3.4). The most questionable aspect of applications was data security (3.0). LIS system received better overall rate than DIS (4.2 vs 3.2). CONCLUSION: Applications received better ratings for daily routine use than for overall impression and ability to get specific information according the GPs' needs. Poor ratings on the capability of the application, complaints about unreliable links, and doubts about data security point to a need for more user-friendly interfaces, more information on the capability of the application, and a valid certificate of assessment for every application.

Study of temporomandibular joint disorder in older patients by magnetic resonance imaging.

OBJECTIVES: To compare characteristics in older patients in a sample of the general population of those with temporomandibular joint disorder (TMJD). MATERIALS AND METHODS: A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0-10). RESULTS: There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months). CONCLUSION: In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients' groups, regardless of shorter pain experience in the older patients.

Five-year cumulative incidence of hypertension in adult Croatian population: the CroHort study.

The aim of this study was to establish a five-year cumulative incidence of arterial hypertension (hereinafter 5-CIAH) and its dependence on initial prehypertension, body weight, age and gender "Croatian Adult Health Cohort Study (CroHort)" data collected during 2003 and 2008 for the 1383 subjects aged 18 + with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication) was analised. Methods of descriptive statistics, Student's t-test, chi2-test and logistic regression were used. The recorded 5-CIAH in male cohort was 36.9% [32.1 to 41.6] and 33.0% [30.1 to 36.0] in women and was higher in subjects with initial prehypertension (men 43.3% [37.5 to 49.0] versus 9.6% [12.1 to 27.2]; women (42 3% [38.1 to 46.6] versus 22.3% [18.5 to 26.1]). The development of arterial hypertension was affected by age (OR = 2.2168), initial prehypertension (OR = 2.1987) and overweight (OR = 1.9399).

Is there any association between blood pressure and education level? The CroHort study.

The aim of this study was to explore how the association of 5-year cumulative incidence of arterial hypertension (further 5-CIAH) and education varies according to body weight, age and sex. The study was conducted on cohort of 1383 subjects aged 18+ with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication). Data were collected in 2003 and repeated in 2008. Methods of descriptive statistics, chi2 test and logistic regression were used. No association between education level and hypertension development was recorded in the group of men and in the group of woman aged 65+. In the group of women with normal body weight, younger than 65 years, significantly higher 5-CIAH values were recorded in those with less than 12 years of education (32.5% [22.0 to 42.9]) compared to those with 12 or more years of education (9.6% [6.1 to 13.1]).

Paving the way for personalised behaviourally based prevention of obesity: systematic search of the literature.

We have identified in the literature variants in 64 genes that may be involved in gene-obesity-behaviour interactions. Personalisation of behaviourally based preventive approaches against obesity seems feasible, however obesity genomics is still in the discovery phase of translational research and abundant replication studies are needed before these largely pioneering findings can be extended to practice and population impact. Automation of search algorithms and development of more efficient tools for knowledge synthesis of genomic research into gene-obesity-behaviour interactions might facilitate the advent of widely available personalised prevention approaches. Our future efforts shall therefore concentrate on developing such tools, as well as a research repository dedicated to the use of public health genomics for obesity control.

Physical inactivity changes in Croatia: the CroHort study.

The aim of this paper was to compare the surveys conducted respectively in 2003 and 2008 within the Croatian Adult Health Cohort Study (CroHort) regarding the physical activity/inactivity of the inhabitants of the Republic of Croatia. The collected data show a significant decline in the intensity of physical activity in 2008 with regards to 2003, regarding the way of getting to work (60.7%), the level of physical strain at work (72.2%), and the frequency of physical activity taken in the subjects' spare time (55.8%). In order to prevent the risk of cardiovascular diseases and to raise the public awareness of the potential health threat physical inactivity poses, a number of thoroughly conceived health promotion strategies should be implemented, which would equally encompass all the segments of Croatian society.

The Croatian Adult Health Cohort Study (CroHort) --background, methodology & perspectives.

Health interview surveys are important source of health information. All previous adult population-based health interview surveys in Croatia until CroHort, were one-off projects with very limited possibility of data comparison. CroHort enabled repeated survey of CAHS 2003 respondents with almost identical questionnaire, thus providing comparable data on trends of different risk factors as well as their relation to the specific outcomes. Next follow-up survey of the CroHort cohort is foreseen for 2013. Health interview survey according to Eurostat methodology (EHIS) on the new representative sample of adult Croatian population is planned for 2014. As the data from health interview surveys are valuable in health policy, efforts should be made to increase their use by policymakers in Croatia.

Case oriented approach to co-occurrence of risk lifestyle behavior with overweight, excess abdominal fat and high blood pressure: the CroHort study.

Objective of this paper is to estimate interim risk factors (INTF) proportions and changes within 5-years of groups with at least one risk health behavior (BEHF) in CroHort population. Results show that CroHort 2008 group has higher proportions of excess abdominal fat and overweight. Men older than 65 without any BEHF have smaller proportions of INTF in 2008 than in 2003. Proportion of people with high blood pressure is smaller in 2008 for all groups except for young women who show increase. Analysis of middle age group shows significant increase in all INTF in women smokers while men smokers have the highest increase in abdominal fat. Physical inactivity in women is associated with increase of all INTF, while men have decrease in overweight INTF. Alcohol intake has protective effect on middle aged men, except for increase in waist circumference. Women show constant increase in all INTF with heavy alcohol intake.

Metabolic syndrome--community nursing evaluation and intervention: the CroHort study.

This prospective study of 1277 participants investigated patient risk self-assessment, motivation for changes in main determinants of the metabolic syndrome and the impact of community nursing intervention on cardiovascular risk reduction. Observed values of metabolic syndrome determinants indicated an elevated cardiovascular risk. Participants showed greatest motivation for positive changes regarding blood pressure, (3.70 +/- 1.26) then hyperglycemia (3.55 +/- 1.28), hyperlipidemia (3.46 +/- 1.30), overweight and obesity (3.43 +/- 1.28), and physical activity habits (3.29 +/- 1.31). Changes in physical activity and nutritional habits were not related to self-reported motivation regardless of the age and sex (p > 0.05). The most pronounced median improvements were observed in cholesterol (men 4.43%, women 4.89%) and triglycerides (men 3.41%, women 1.49%), with only slight changes in BMI (men 1.08%, women 1.18%) and no change in waist-to-hip ratio and glucose. This study revealed that, although aware and motivated, patients often do not succeed in changing habits. Concomitant changes of the environment and multisectoral prevention approach is necessary.

Prevalence and five-year cumulative incidence of abdominal obesity in Croatian women of childbearing age: the CroHort study.

Generalised obesity is increasing in prevalence globally, however trends in abdominal obesity are less well known. In 2003, 1,999 women of childbearing age participated in the Croatian Adult Health Survey, of whom 598 (29.9%) participated in the second cycle in 2008. For 2008, the prevalence of abdominal obesity using the International Diabetes Federation (IDF) criterion (waist circumference > or = 80 cm) was estimated at 70.3% (95% CI 61.8% to 75.7%), whereas the prevalence of abdominal obesity using the National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) criterion (waist circumference > or = 88 cm) was estimated at 48.6% (42.6% to 54.7%). The preceding five-year cumulative incidence was 54.3% (44.5% to 64.2%) and 35.2% (28.0% to 42.4%) using the IDF and NCEP ATP III criteria, respectively. The burden of abdominal obesity is high and rapidly increasing in Croatian women of childbearing age, the key population subgroup for obesity control.

The CroHort study: cardiovascular behavioral risk factors in adults, school children and adolescents, hospitalized coronary heart disease patients, and cardio rehabilitation groups in Croatia.

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

Osteoarthritic temporomandibular joint changes confirmed by magnetic resonance imaging.

Clinical and radiological findings were compared between the patients with osteoarthritis (OA) of temporomandibularjoint (TMJ) with or without disc displacement (DD), and asymptomatic volunteers. This study included 30 patients with OA of TMJs (mean age 52.6). All the patients were examined clinically by manual functional analysis and using magnetic resonance imaging. The inclusion criteria for patients comprised: pain referred to the TMJ and/or crepitation in the TMJ. A second group consisted of 20 asymptomatic dental school students (mean age 23.5). There is a statistically significant difference between degenerative changes of the condyle of TMJs with and without clinical signs of OA of patients (p=0.009). In 28% of osteoarthritic joints, flattening of condylar joint surfaces was observed and 17.4% of the joints were without clinical signs of OA. Osteophyte formations were found in 8% of asymptomatic and 25.7% of osteoarthritic patients' joints. There is a statistically significant difference between patients' TMJs with and without OA (p=0.0003): pronounced shape loss and severe sclerosation of the articular eminence were found in 12% of the joints without OA, and 42.9% of joints with OA. There is no difference between students' joints and patients' TMJs without OA (p=0.804). The most common imaging findings of osteoarthritic TMJs were sclerosis of the condyle and osteophyte formation.

Impact of environmental factors on marijuana use in 11 European countries.

AIM: To investigate the association between environmental factors (perceived availability of marijuana, perceived use among friends and siblings, use of alcohol and tobacco, family structure, parental control, school performance) and lifetime prevalence and frequent and early marijuana use in high school students. METHODS: We used self-reported data from 15-16 years old participants of the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 11 countries: Denmark, Estonia, Norway, Croatia, Slovenia, Germany, Switzerland, Bulgaria, Czech Republic, Russian Federation, and Ukraine. Multivariate logistic regression was used for data analysis. RESULTS: Countries varied according to lifetime prevalence (8.7%-47.8%) and frequent (8.7%-23.9%) and early (3.0%-13.0%) marijuana use. Daily tobacco smoking was most strongly associated with lifetime marijuana use for boys in 7 and for girls in 5 countries, with highest odds ratio (OR, 95% and confidence interval - CI) for boys in Denmark (OR, 13.52; 95% CI, 8.16-22.4), and for girls in the Czech Republic (OR, 21.21; 95% CI, 12.99-34.62). Perceived marijuana availability was most strongly associated with frequent marijuana use for boys in 4 countries (highest in Slovenia: OR, 19.28; 95% CI, 6.52-57.02) and girls in 5 (highest in Slovenia: OR, 19.05; 95% CI, 5.18-70.04). Perceived use of marijuana among friends was most strongly associated with frequent marijuana use in 5 countries, both for boys (highest in Norway: OR, 23.91; 95% CI, 4.16-137.48) and girls (highest in Denmark: OR, 75.42; 95% CI, 13.11-433.90). Perceived use of marijuana among friends was most strongly associated with early marijuana use in 8 countries for boys (highest in Norway: OR, 54.03; 95% CI, 3.34-875.19) and 3 countries for girls (highest in Denmark: OR, 7.29; 95%CI, 1.77-30.12). CONCLUSION: In each country, marijuana use was associated with similar factors, regardless of marijuana use prevalence in that country.The influence of peer group and perceived availability of marijuana seemed more important than parental control and family structure.