Implementation of the program of preventive examinations at primary health care in the city of Zagreb 2009-2013.

BACKGROUND: The program covered all persons who had not been in contact with a physician for two years or had failed to notice symptoms themselves or to timely respond to the symptoms observed. The aim of the present study was to analyze the results of the program and try to draw conclusions regarding the necessity further implementation. SUBJECTS AND METHODS: This paper analyzes data on a cohort of 1375 subjects aged 45+, collected on preventive examinations by family physicians during the 2009-2013 period. RESULTS: Results show 24.4% smokers and 15.5% former smokers. Up to three alcoholic drinks per week consumed 18.5% respondents (27.8% male and 11.2% female). Overweight (body mass index 25-30) was recorded in 50.6% and 38.6%, obesity (body mass index >30) in 30.1% and 29.4%, hypertension in 14.6% and 11.8%, isolated systolic hypertension in 20.5% and 17.4%, and isolated diastolic hypertension in 3.3% and 3.0% of male and female subjects, respectively. Suspicion of one or more newly diagnosed disease was recorded in 52.9% (95% CI 50.2-55.5) of study subjects. Fifty-four subjects (7.4%; 95% CI 5.5-9.3) were suspected to have neoplasm and they were immediately referred for further diagnostic evaluation. CONCLUSIONS: Timely manner suspicion of malignant disease is of crucial influence on the course of treatment and outcome of the disease. The study results confirm the importance of continuing the implementation of prevention programs.

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

The aim of this study was to analyze gender and age differences in physical inactivity in Croatia and physical inactivity pattern changes during the five-year period. The study is based on the data obtained from the Croatian Adult Health Cohort Study which was carried out in 2003 and 2008. The prevalence of physical inactivity in 2008 was 37.7%, 36.8% in men and 38.1% in women. In both study waves the prevalence was increasing with age in both men and women. The prevalence is statistically significantly higher in subjects older than 64 years than in younger age groups. The incidence of physical inactivity in the five-year period in total was 29.9%, 27.2% in men and 31.1% in women. The increase in prevalence of physical inactivity despite the number of preventive activities carried out periodically emphasizes the need for systematic and comprehensive approach in increasing the number of regularly physically active individuals.

Correlation of cognitive functions with some aspects of illness, treatment and social functioning in recurrently hospitalized schizophrenic patients.

Cognitive deficits are found to be contributors to poorer psychosocial functioning, rehabilitation outcome and lack of treatment success in schizophrenia. Aim of the study was to examine correlation of cognitive functions with some aspects of illness, treatment and social functioning in a group of recurrently hospitalized schizophrenic patients (N=60). Deficient results on psychomotor processing speed, verbal fluency and verbal learning correlated with the longer duration of illness, higher number of hospitalizations and shorter duration of regular antipsychotic treatment. Deficient results on verbal fluency correlated with the younger age of onset, poor functional autonomy and organizational skills, whereas deficient results on psychomotor processing and verbal learning correlated with poor organizational skills alone. Score on verbal fluency was predictive of social skills impairment, whereas score on psychomotor processing was predictive of functional autonomy and organizational skills impairment. Functioning of different cognitive domains could be predictive of functioning in different social domains. Interplay of specific cognitive deficit and social functioning could be responsible for recurrent hospitalizations and unfavorable treatment choices.

Changes in brain metabolites measured with magnetic resonance spectroscopy in antidepressant responders with comorbid major depression and posttraumatic stress disorder.

In a present pilot study, performed on 11 subjects, we studied proton magnetic resonance spectroscopy (1H-MRS) changes in early to intermediate (3-6 weeks) responders to antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs). All subjects had diagnosis of major recurrent depression comorbid to posttraumatic stress disorder (PTSD). Magnetic spectroscopy was done in the region of dorsolateral prefrontal cortex on a 3T MRI-unit. Participants were selected out of the larger sample due to an early response to antidepressant treatment within 3-6 weeks, measured with Beck Depression Inventory (BDI). We measured levels of neuronal marker N-acetyl-aspartate (NAA), choline (CHO) and creatine (Cr). There was no difference in NAA/Cr ratios between the first and the second spectroscopic scans (p= 0.751). However, CHO/Cr ratios showed increasing trend with mean value at the first scan of 1.09 (SD =0.22) while mean value at second scan was 1.25 (SD=0.24), displaying statistically significant difference (p=0.015). In conclusion, significant increase in choline to creatine ratio from the first to the second spectroscopic scan during the antidepressant treatment, compared to almost identical values of NAA to creatine ratio, suggests increased turnover of cell membranes as a mechanism of the early response to the antidepressant drug therapy.

1-H MRS changes in dorsolateral prefrontal cortex after donepezil treatment in patients with mild to moderate Alzheimer's disease.

Magnetic resonance spectroscopy (MRS) noninvasively provides information on the concentration of some cerebral metabolites in vivo. Among those measurable by proton magnetic resonance spectroscopy (1H-MRS), N-acetyl-aspartate (NAA) is decreased, and myo-inositol (ml) and choline (Cho) levels are increased in patients with Alzheimer's disease (AD). Donepezil, an acetylcholinesteraze inhibitor, has proven effect on cognitive symptoms in patients with AD. In previous studies, treatment response was associated with an increase of NAA and NAA/Cr in the parietal lobe and hippocampi. Correlation of longitudinal changes of 1H-MRS detectable metabolites in dorsolateral prefrontal cortex (DLPFC) with clinically observable changes is a poorly researched topic. The objective of this non-interventional study is to assess whether changes in 1H-MRS measurable metabolites correlate with clinical outcome after donepezil treatment. Twelve patients with mild to moderate AD were evaluated during 26 weeks of donepezil treatment. 1H-MRS parameters in DLPFC were assessed before and after 26 weeks of donepezil treatment. Cognition was assessed with Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog). A significant increase in NAA/Cr ratio and significantly lower decrease in mI/Cr ratio were found in AD patients with positive treatment response. The results of this study indicate possible modest donepezil effect on prevention of neuronal functional deterioration in DLPFC which correlates with clinical outcome and point the use of 1HMRS as technique of help in assessment of drug effect.

[Capacity to consent to research in patients with mental illness]. / Sposobnost osoba s mentalnim poremecajem za davanje informiranog pristanka u biomedicinskim istrazivanjima.

Informed consent is a legal procedure when including a person in the treatment, diagnostics or research which includes information, voluntarism and capacity to consent of the participant. Capacity to consent is related to decision-making process and could be influenced by various factors. Assessment of capacity to consent is still clinical, because there are no widely accepted standards and assessment instruments. Persons with mental disorders could have some deficits in capacity for decision-making that could be temporary or permanent. Ethical considerations in the research with participants not able to consent are related to benefit vs. non-benefit studies and risk assessment. Finding of the better methods for capacity assessment and capacity enhancement could improve selection of the research participants. Legal recommendations, including international declarations and conventions, as well as the related Croatian laws are important mechanisms for safeguards of the persons with mental illness in biomedical research.

Cognitive functions in the involuntary hospitalized schizophrenic patients.

OBJECTIVE: Objective of the study was to investigate differences in some important cognitive functions in the schizophrenic patients that were either involuntary or voluntary hospitalized in psychiatric hospital. METHOD: 30 involuntary hospitalized patients with schizophrenia were evaluated with neurocognitive battery and compared with a group of 30 voluntary hospitalized patients with schizophrenia. Demographic and medical data were also analyzed RESULTS: Involuntary hospitalized patients showed significantly poorer performance in some cognitive tests and no difference in the other cognitive tests in comparison with voluntary hospitalized patients. Involuntary hospitalized patients also had earlier onset of illness, higher number of psychiatric hospitalizations and involuntary psychiatric hospitalizations, and less regular psychiatric treatment. More often the reason for involuntary hospitalization was aggressive behavior. CONCLUSION: Deficit of cognitive functioning could influence treatment decisions in schizophrenic patients, leading to poorer compliance and coping with illness and resulting in less favorable treatment options, like involuntary hospitalization.

Pathways to psychiatric care in Eastern Europe.

BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.

Change of diagnosis of post-traumatic stress disorder related to compensation-seeking.

AIM: To explore the change in the diagnosis of posttraumatic stress disorder (PTSD) related to the implementation of the new national regulation on compensation-seeking by war veterans in Croatia. METHODS: The study included 225 compensation-seeking war veterans who were psychiatrically assessed and diagnosed on three different occasions. The first diagnosis was made by a local psychiatrist when a veteran sought psychiatric help for the first time. The second psychiatric diagnosis was established during the veteran's psychiatric treatment, and the third one was made by an independent expert team in charge of the psychiatric assessment for compensation purposes. The expert examination included structured diagnostic procedure and analysis of military service data. The diagnoses established on three different points were compared. RESULTS: There were significant differences between the diagnoses of mental disorders made at three different occasions in compensation-seeking war veterans. Six different diagnostic categories of mental disorders were confirmed. The diagnosis changed in 134 (59.5%) out of 225 veterans, mainly in the categories of PTSD and personality changes due to catastrophic experience, during their psychiatric treatment in the 2000-2002 period, when the new regulation for compensation was implemented. PTSD diagnosis remained unchanged at all three psychiatric assessments in only 7.5% of the veterans, whereas the diagnosis of a mental disorder remained unchanged in 37 (16.4%) veterans. Experts' confirmation of PTSD or PTSD comorbid with other mental disorders positively correlated with the number of hospitalizations. CONCLUSION: Inconsistencies in the diagnosis of PTSD could be related to the different diagnostic criteria and the course of illness. Psychiatric examination for compensation purposes should be independent and integrate all relevant data for making a complete assessment. Compensation-seeking policy, represented by new regulations, could be a source of bias in diagnostic outcome.