(Dis)organization of Palliative Care as a Potential Quality-of-Life Issue in the Senior Population--Croatian Experiences.

This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building. Although we cannot ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, approximately half of patients--users of palliative care--have some type of oncological diagnosis; a significant number of patients suffer from dementia, stroke, or heart failure. As for the Primorsko-goranska county and the City of Rijeka, they show similar trend, as can be illustrated with data from the 2011 census, when the share of citizens over 65 years in the population of the Primorsko-goranska county reached 18.91%, and in the population of the City of Rijeka 19.74%. Thus, one of the main quality-of-life issues in the Croatian senior population is the (dis)function of the palliative medicine/care system. Practice, namely, shows that there has still been no implementation. In particular, palliative medicine is not yet recognized as a speciality or sub-speciality, standards and norms for this activity are not set, palliative care is still not included in the system of obligatory health insurance, and as far as the national strategy of health policy for the area of palliative care, Croatian Government at its meeting held on 27th December 2013 finally adopted the "Strategic Plan for Palliative Care of the Republic of Croatia for the period from 2014 to 2016". Exactly because we are a decade behind European standards (Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organization of palliative care), it is more than legitimate to place this subject at the centre of the current Croatian gerontology interest.

Refractive errors in children of Primorsko-Goranska County--epidemiological study.

Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association "Albert Einstein" and Eye Clinic "Dr B.Vojnikovid" Rijeka agreed a five-year project to study children's health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50-60 years ago, it was a very rare occurrence of some refractive errors in children.

The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.

OBJECTIVE: To analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists. METHODS: Historical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation. RESULTS: In the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only. CONCLUSION: While actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

Implementation of program of prevention and early detection of osteoporosis among women of Primorsko-goranska County.

The aim of this paper is to present preliminary data of Program of prevention and early detection of osteoporosis among women in Primorsko-goranska County. Osteoporosis is recognized as a public health problem for which clearly preventive measures are defined. Measurement of bone density was done by ultrasound densitometry of the calcaneus among women aged from 45 to 69 years old. 688 women were examined and they were classified in five five-year age groups. The women with the osteoporosis (T-score < or = 2.5) were 141; osteopenia (T-score from -2.5 to -1) were found in 400 women, and those with normal range of T-score were 147. All of five groups of women had T-score in range of osteopenia (T-score < or = 1). A statistically significant difference was between the first and fourth groups of women (p = 0.002) and the second and fourth groups (p = 0.001). After examination, depending on the value of T-score, women were recommended to visit family doctor and they also got educative booklet with advices for healthy nutrition and physical activity. Implementation of this program indicated the importance of proper lifestyle in the prevention of osteoporosis. Average T-scores of all five groups of women show that osteopenia occurs also in the youngest ones. This indicates the need for a systematic approach to preventing osteoporosis through education of women including younger ones and creating conditions for organized physical activities at the community level.

[Review of the program of early detection of cervical cancer in women in Primorsko-Goranska County in 2009]. / Rano otkrivanje raka vrata maternice u zena primorsko-goranske zupanije u 2009. Godini--prikaz programa.

INTRODUCTION: Cervical cancer is the most common cancer in women, the second most frequent malignancy in women and the second most common cause of death in women suffering from cancer worldwide. In 2009, in the Primorje-Goranska County 52 (4.1%) women were hospitalized for the treatment of cervical cancer. AIM: The aim of this paper is to show the methodology and results of the County program in 2009. METHODS: The County Institute of Public Health (IPH) has been conducting this screening program systematically since 2006. In 2009, screening was conducted at six gynecologic practices with coverage of 6000 women. Prior to Program performance, the IPH provide the gynecologists with all necessary logistics (brushes for cytobrush technique, Pap tests, addressed envelopes, invitation letters and patient questionnaires). The gynecologists include women by random choice, each gynecologist around 1000 women of the specified age group. They send invitations to women with specified date and time of testing. Swabs are referred to the Cytology Laboratory, Rijeka University Hospital Center in Rijeka. For the purpose of this Program, IPH has designed a questionnaire for women, containing 13 questions. Patients give the questionnaires back to the gynecologists, who send them to the IPH for statistical analysis. Data collected from the questionnaires and Pap test findings are entered in a specially designed computer program. During Program implementation, the IPH, gynecologists and cytologists work together to improve the quality of testing. For the purpose of education of women about sexual health and to improving the response rate, IPH has created and distributed 10,000 educational brochures entitled Sexual health of women, the knowledge is power. RESULTS: In 2009, the response rate in the Program was 41.9% (n=2514). Cytologic analysis of Pap tests yielded 94.5% of negative results and 5.1% of abnormal findings. Adequacy of 99.6% of Pap smears was satisfactory, while 0.4% of samples were of poor quality that could not be analyzed. Results showed 66.7% of women to undergo gynecologic examination once a year, whereas 17.9% of women had not been for gynecologic examination for more than 3 years. The majority (90.7%) of women that participated in the Program were visiting the chosen gynecologist at primary health care. DISCUSSION: Throughout the Program implementation, the leading problem continued to be low turnout of gynecologists for inclusion in the Program and poor turnout of invited women. The cause of this problem lies in the insufficient number of gynecologic teams and too many women in care of one gynecologist. This problem points to the need of restructuring of primary health care for women with emphasis on the number of health professionals. Results of the analysis of two questions in the questionnaire indicated inadequate knowledge of women about the importance of regular gynecologic control. When planning screening program in the coming years, attention should be focused on the motivation of women of younger age groups as well as those that are irregularly controlled. CONCLUSION: Organized screening can reduce the risk and mortality of cervical cancer. It is also known that with a relatively small investment but with better health care organization, the response of women can increase. Taking into account the threat posed by cervical cancer for women's health and social burden, the need of prevention strategies, primarily screening tests, is clear as a means for early detection of the problem and timely removal of abnormal cells.