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.

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.

[Preventive work in family medicine--proactive approach]. / Proaktivni pristup preventivnom radu u obiteljskoj medicini.

The role of general practitioner/family physician (GP/FP) in disease prevention and health promotion is strongly supported by research and health policies. The position of GPs/FPs in the health care system and their close, sustained contact with their patients and local community makes preventive care an integral part of GP/FP routine work. The spectrum of caring for patients in general practice/family medicine is actually very large, going from intervention on health care determinants to palliative care. The prevention-related activities are more or less present at each step of this "healthcare continuum". The significant gaps between GP/FP knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention. We describe the role of GP/FP in preventive care and report data on preventive care activities in the Croatian Family Medicine Service. More objective evidence is needed to see what GPs/FPs actually do in practice. For this reason, it is critical that GPs/FPs systematically record the most relevant preventive and health promotion activities that they perform. Furthermore, their performance of the preventive program should be regularly monitored, evaluated and professionally and financially validated. We present the preventive program based on these principles in Family Medicine Service proposed by the Ministry of Health and Social Welfare Working Group on Reform of Primary Health Care.

Efforts in fighting against cancer in Croatia have to be focused on the primary health care.

This manuscript is a comprehensive review of the long-lasting tradition and the state-of-the-art in the prevention and early detection of cancer in Croatia. Compared with other European countries, Croatia holds a high and unfavourable position in cancer morbidity and mortality. Global experience in implementation of national programmes for the early detection of cancer clearly shows that such approach is the most successful and in the long-term the least expensive method for fighting against cancer. In Croatia, numerous separate actions in cancer care have been taken, but never systematically, nor included in a health care policy. The National Programme for the Prevention and Early Detection of Cancer of the common localizations for which effective screening tests are available (breast, uterine cervix, colon and prostate) has recently been launched. Local long-standing experience of the Osijek-Baranja County in implementation of programmes of cancer care contributed significantly to these initiatives. In this review, draft National Programme and the early results of its implementation were presented. In addition, preparations for the research project "Model of early cancer detection integrated in a practice of family physician", recently set up by the Department of Family Medicine of the School of Medicine, University of Osijek, were described. In this project, the programme of the early detection of cancer in which family physicians take responsibility for the programme implementation is suggested. Possible advantages of this model, compared with the model proposed by the National Programme, centrally directed and mostly supplied by the public services, are pointed out.