[USE OF CONTRACEPTION IN WOMEN FROM THE ZAPRESIC AREA AND FACTORS INFLUENCING THE CHOICE OF METHOD: A CROSS-SECTIONAL STUDY]. / KORISTENJE KONTRACEPCIJE U ZENA ZAPRESICA I OKOLICE I CIMBENICI KOJI UTJECU NA IZBOR METODE: PRESJECNO ISTRAZIVANJE.

There have long been no surveys in the field of family planning in Croatia. There were some carried out by commercial agencies and some related to adolescents, but none focused on women of reproductive age. Therefore, we embarked upon this survey including women living in the town of Zapresic and its surroundings. The aims of the study were to investigate how many of them used contraception, which methods prevailed, how they made their choice and whether demographic and health care characteristics had have any influence on it. This cross-sectional survey was conducted at eight family medicine practices from the town of Zapresic town and six practices from nearby rural settings. We used a purposeful sampling method; women aged 18-45 visiting family medicine practices for different reasons were asked to participate in the study. Those that agreed were given a questionnaire designed for this survey and based on literature results. The questions were closed and related to the women's demographic and some health-related characteristics and those related to the usage of contraception, such as the method used, how they made their choice, if they made any changes and why. The STATA/IC 11.2 (license 30110536846) was used on data processing. Descriptive statistics was used with Pearson χ2-test and logistic regression analysis to determine associations between categorical variables and dependent variable, in this case contraception use or non-use. The value of p < 0.05 was considered significant. Out of 283 women having filled in the questionnaire, 44.5% used some contraceptive methods. The most frequently used was condom (24.7%), then pill (24.1%) and combination of several methods (20.0%). The women living in the town used more coitus interruptus, and those living in rural areas used more pills. The most frequently stated reasons for the use of certain methods were as follows: the methods is simple for use (32.9%), it is safe (24.6%), and it is efficient and safe (22.8%). The women with elementary school preferred more efficient and those with high education safer methods. The efficiency of the method was also the main reason for university students. The majority of women made their decision in consultation with gynecologist (48.8%), then in agreement with partner (29.4%) and by her own choice (18.2%). Married and unmarried women made their decision in consultation with gynecologist and partner, unmarried women more with partner than married ones. Only 0.6% of women did consult their family doctors. They did not consider him/her as a professional to consult. In 45.5% of cases, women changed contraceptive methods, more women with high education. Mostly, they wished to use more efficient or safer method. The results of logistic regression analyses indicated that the predictors for contraceptive use were high education, working status, number of abortions and frequency of visits to gynecologist. In conclusion, only 44.5% of surveyed women used contraception, mainly condoms, pills and combination of methods. The efficacy and safety were important reasons, while gynecologists and partners were an important source of help on making decision. The place of living, age, education, married status and working status were associated with some aspects of contraceptive usage.

Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study.

AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.

[Health locus of control assessment in diabetes mellitus type 2 patients]. / Procjena zdravstvenog lokusa kontrole bolesnika sa secernom bolescu tip 2.

UNLABELLED: Health locus of control (LOC) refers to the person beliefs who or what has control over his/her health. A person's LOC orientation is one of several factors that determine which health-related behaviors a person will perform. AIM: To explore LOC of diabetes mellitus type 2 (DMT2) patients, also in relation to patient' socio-demographic characteristics (sex, education, working status, and family status), context (place of birth, experience with chronic diseases in family, economic status), social support and quality of life. METHODS: This cross-sectional study was carried out in 77 DMT2 patients in two family medicine practices. Patients filled out two questionnaires: on patient general data and ZLK-90-2 questionnaire. Statistic analysis was done using Statistica, version 7.1 software, and values of P < 0.05 were considered statistically significant. RESULTS: The patient mean age was 63.4 years +/- 13.1 (M +/- SD), and mean duration of diabetes 10.3 +/- 8.2 years (M +/- SD). The belief ininternal LOC was most common in study patients, followed by the belief in health dependence on circumstances, influence of chance, destiny or God, and finally influence of powerful others. Highly educated patients had a statistically significantly less expressed internal LOC and belief in the influence of chance, destiny or God. The patients that underestimated their quality of life, showed a statistically significantly lower rate of belief in health dependence on circumstances. DISCUSSION: In spite of the small sample size and unfavorable patient distribution according to age, work status, disease duration and education, results of this and other studies on LOC, forcing LOC orientation regarding self-treatment and self-control of DMT2 patients could be of high importance, with the assumption of good internal responsibility and belief in help of other important people. CONCLUSION: Understanding LOC of DMT2 patients is essential for developing more efficient educative and intervention medical programs for care of these patients, since it could help in making the right access to care for every single patient or group of patients that have the same LOC.

[Guidelines for diagnostics and treatment of arterial hypertension. Practical recommendations of the Croatian Working Group for Hypertension. Consideration on the ESH-ESC 2007 guidelines]. / Smjernice za dijagnosticiranje i lijecenje arterijske hipertenzije. Prakticne preporuke hrvatske radne skupine i osvrt na smjernice ESH/ESC 2007.

ESH/ECS guidelines for diagnostics and treatment of arterial hypertension 2007 is a basic paper for all physicians who treat hypertensive patients. Since publishing, this article has been the most cited medical paper. According to ESH/ECS guidelines some local peculiarities in each country should be considered when diagnosing and treating hypertensive patients. Practical recommendations of the Croatian working group for the diagnostics and treatment of hypertension are in agreement with ESH/ECS guidelines. However, few additional issues are added and further discussed in this paper (hypertensive crisis, treatment of hypertension in patients undergoing dialysis and in renal transplanted patients, role of family physicians, role of nurse). We believe that this paper will contribute better control of hypertension in Croatia. All medical societies and institutions that took part in writing this document, have to consider this paper as an official statement.

Information systems and the electronic health record in primary health care.

The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.

[Specialization in family medicine--has all the planned been achieved?]. / Specijalizacija iz obiteljske medicine--je li ostvareno ono sto je planirano?

The planned, comprehensive inclusion of general practitioners/family physicians in specialist education has begun with the project entitled Harmonization of Family Medicine Service with European Standards by the Implementation of Compulsory Residency. According to the Project, all physicians working in family medicine practice should have an opportunity to complete the respective residency by 2015. Analysis of the planned and completed family medicine residency in Croatia during the 2002-2006 period is presented. Of the total family medicine residency positions planned during the four-year period, 543 (90.5%) have been completed, with the greatest discrepancy recorded in program A applying to physicians younger than 35 having concluded a contract with the Croatian Institute of Health Insurance. In addition, this relationship varied among different countries. There are a number of obstacles hindering the Project implementation. However, it should be noted that the Project has made a breakthrough in upgrading the quality of family medicine practice, as a pledge of future development and rational performance of the entire health care system in Croatia, in order to promote the health care of the population at large.

Perceived needs for attaining a 'new normality' after surviving myocardial infarction: A qualitative study of patients' experience.

BACKGROUND: A comprehensive understanding of the various aspects of patients' myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many uncertainties they face and help them to stabilize their lives after the disruption they experienced. OBJECTIVES: To explore MI patients' experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals. METHODS: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis. RESULTS: Three main themes and explanatory models emerged from the data analysis: a good adaptation - the 'new normality;' maladjustment - a continuous search for a 'new normality;' and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about 'my MI' in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context. CONCLUSION: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations. [Box: see text].

Ten-Year Trends in the Morbidity of Diabetes Mellitus and Antidiabetic Drug Utilization in Croatia: A Study Based on Routinely Collected Data.

Objectives. To investigate trends of diabetes mellitus (DM) morbidity and antidiabetic drug utilization in Croatian primary health care (PHC) from 2005 to 2014. Method. Routinely collected morbidity data from all PHC units, presented in Croatian health-statistics yearbooks, were retrieved. Data on drug utilization were retrieved from the Annual Reports of the Croatian Agency for Medicinal Products and Medical Devices (ATC/DDD, antidiabetic, A10). Results. Total morbidity increased by 33.3% and DM increased by 65.6%, mostly in patients over age 65 (from 50% to 57%). Estimated DM prevalence in adults increased from 3.9% to 6.4%. Increased morbidity was followed by an even higher increase in drug utilization (120%). Metformin was first, with a constant increase (from 18% to 39%), followed by glimepiride, while glibenclamide use decreased. Total utilization of insulin increased even more, mostly for aspart (600%) and newly introduced glargine and detemir, while human insulin usage sharply decreased. Spending also increased, mostly for aspart (from 21% to 61% of total). Conclusions. Increased DM is followed by a higher increase in antidiabetic drug utilization; this trend will continue in the future. In Croatian PHC, metformin has primacy along with insulin analogues.

Facing the diagnosis of myocardial infarction: a qualitative study.

BACKGROUND: Patient experience is increasingly recognized as one of the three pillars of quality in health care, alongside clinical effectiveness and patient safety. However, little attention has been paid to the patients' experience from the point of view of health care delivery. OBJECTIVE: To explore the initial experience of patients facing a new diagnosis of myocardial infarction (MI). METHODS: Thirty semi-structured, individual interviews were performed. The Grounded Theory method was used. Atlas.ti qualitative data analysis software facilitated the analysis. RESULTS: Three patterns of MI diagnosis experience were found: a close encounter with death, severe pain, and 'silent' MI. Newly-diagnosed MI patients who experienced a close encounter with death expected that, after necessary life-saving measures, their physician would not force immediate conversation, but leave them alone, simply to take pleasure in being alive. Newly-diagnosed MI patients who did not experience a close encounter with death expected that their physician would provide not only medical care but also immediate emotional support and opportunities to discuss in their own words their ideas, thoughts, concerns and fears. Six factors facilitated patients coping with a new diagnosis of MI: stay in hospital, completion of diagnostic tests, trust in physicians, the patient's previous expectation that he/she could have a heart attack, the patient's personality, and the need for solitude. CONCLUSION: Physicians should be aware that different patterns of patient experience when facing MI could indicate patients' differing needs for immediate emotional support and communication.

[International course Training of teachers in general/family practice: 20 years of experience]. / Medunarodni tecaj za nastavnike iz opce medicine: 20-godisnje iskustvo.

Twenty years of experience in organising and participating at the international courses of Training of teachers in general/family practice are presented. The course was for the first time held in 1983 at the Inter-University Centre Dubrovnik. The founders and the first course directors were the members of the Leeuwenhorst group. There were some difficulties in the organisation of the courses during the war, so that two of them were held in Zagreb, while three were not organised at all. Learning from experience in the small groups was the main method of work. During the whole period, 17 topics were discussed. At the beginning they were mostly educational: developing educational module, defining educational objectives and chosing educational methods and methods of evaluation and assessment. Then, the specific GPs' working methods were discussed as a content and opportunity for teaching. In the last period, the current GPs' topics and the topics usually neglected in current medical education, such as sexual problems, addiction problems, alternative medicine and ethical problems as well as professional values were disscused. 432 participants, from 25 different European countries, Egypt, Kuwait and Japan participated at the courses. There were 85 Croatian participants at the course held in Zagreb. The authors' thoughts about their positive and negative experience in the organisation of these courses is also discussed.

[Scientific and research projects of the Department of Family Medicine--contribution to the identity of general practice/family medicine as a scientific discipline]. / Znanstvenoistrazivacki projekti katedre za obiteljsku medicinu--doprinos odredenju opce/obiteljske medicine kao znanstvene discipline.

The main task of an academic department of any medical discipline is an integrated development and improvement of professional, scientific and educational activities. The proces of formulation, establishment and recognition of general practice/family medicine as an academic discipline in Croatia started with postgraduate education and vocational training in 1960 at the Andrija Stampar School of Public Health. In 1980 Department of Family Medicine of the Medical School, University of Zagreb was officially established. The aim of this paper was to describe the characteristics of general practice/family medicine as a scientific discipline with its proper, independent knowledge, acquired in scientific research and applied in practice. Based on literature review, specific areas and methodology of scientific research in general practice/family medicine are presented. Scientific research in general practice/family medicine has traditionally included epidemiological, clinical, organisational and other aspects of work of general practitioners/family physicians comprising activities directed towards patient and community care, as well as towards the position and responsibilities within a health care system. Department of Family Medicine carried out its own scientific projects, participated in international scientific projects and scientific projects implemented with other partners. Some of these projects were presented in this paper with the purpose to give a brief insight into the development and current state of the scientific work within the Department of Family Medicine.

How to deal with a crying patient? A study from a primary care setting in Croatia, using the 'critical incident technique'.

BACKGROUND: Expression of strong emotions by patients is not a rare event in medical practice, however, there are few studies describing general practitioner (GP) communication with a crying patient. OBJECTIVE: The aim of this study was to describe GP behaviour with a patient who cries in a family practice setting. METHODS: A semi-qualitative study was conducted on 127 Croatian GP trainees, 83.5% female, and 16.5% male. The study method used was the 'critical incident technique.' GP trainees described their recent experience with patients who cried in front of them. Textual data were explored inductively using content analysis to generate categories and explanations. RESULTS: All 127 (100.0%) GP trainees initially let patients cry, giving them verbal (81.9%) and/or nonverbal support (25.9%). GP trainees (69.3%) encouraged their patients to verbalize and to describe the problem. Most GP trainees (87.4%) tried to establish mutual problem understanding. Approximately half of the GP trainees (55.1%) made a joint management plan. A minor group (14.2%) tried to maintain contact with the patient by arranging follow-up appointments. The vast majority of GP trainees shared their patient's emotion of sadness (92.9%). Some GP trainees were caught unaware or unprepared for patient's crying and reacted awkwardly (4.7%), some were indifferent (3.9%) or even felt guilty (3.1%). CONCLUSION: GP trainees' patterns of communication with crying patients can be described in five steps: (a) let the patient cry; (b) verbalization of emotions and facilitation to express the problem; (c) mutual understanding and solution finding; (d) evaluation--maintaining contact; and (e) personal experience of great emotional effort.