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Background: Hypertension is a significant global public health problem and the data suggest a wide health disparity in hypertension prevalence worldwide. Our objective was to assess some epidemiological determinants in individuals ≥ 50 years influencing blood pressure/hypertension in United States and Croatia and derive some meaningful conclusions and recommendations. Material and methods: We used the American National Health and Nutrition Examination Survey (NHANES) (n = 1,556; 48.9% women) and the Croatian Adult Health Cohort Study (CroHort) (n = 2,182; 66% women), both taken in 2008. The health indicators compared were anthropometries, blood pressure, socioeconomic and marital status, education and lifestyle, including physical activity, alcohol and coffee consumption, smoking and presence of dyslipidemia and diabetes. Results: Prevalence of hypertension based either on medication use or blood pressure values was significantly higher in Croatian men and women compared to American (all p < 0.001). Waist circumference was the main positive predictor and education a negative predictor for blood pressure in CroHort; significance was not reached in NHANES, although the trends were similar. Taking medications for diabetes decreased the odds for hypertension in NHANES, while taking medications for both diabetes and dyslipidemia decreased the odds in CroHort. Conclusions: Croatian people older than 50 years have higher prevalence of hypertension compared to their counterparts in the U.S. The difference in the prevalence of hypertension in two populations cannot be explained by different prevalence of risk factors examined, except education level. Higher prevalence of hypertension diagnosed by medication use indicates a relatively good control of the disease in both populations.

The Croatian Academy of Medical Sciences (CAMS) has published this "Declaration on eHealth" to warn all stakeholders (patients, health professionals, institutions, government agencies, suppliers) to use the huge potential of information and communication technologies (ICT) and solutions to improve health care in Croatia. The Declaration draws attention to areas of infrastructure such as: education, regulation and standardization, medical and health informatics (MHI) as a profession, the obligation of institutions, government bodies and suppliers. In addition to answering the question "what?", the Declaration addresses the most important question "how?". Instead of the existing "atomization" and disconnection of projects and solutions, the Declaration proposes the realization of a common concept of computerization in health and for health by establishing a central body at the state level (agency, office, institute, etc.) in which expertise, decision-making and financing of health informatics projects at the national level will be concentrated. The central body should function on the principles of professionalism, independence and transparency. The purpose of the proposal offered by the Declaration is to improve the management of health system computerization, which would avoid containment within institutions, enable obtaining and purposeful use of available financial resources and experts, and achieve the necessary cooperation, which would bring the results in ICT support to the health system.

Objective: Permanent teeth trauma is most frequent in children aged 7-9 years, and the primary school teachers (PSTs) are often the first to notice it. The aim of this study was to evaluate the competence in tooth avulsion clinical issues and knowledge on dental trauma of PSTs, as they can occasionally take on the role of school nurses. Material and Methods: Questionnaires were handed to 312 PSTs from 24 randomly selected primary schools in Zagreb, Croatia. An algorithm was designed for PST competence assessment. Results: Response rate amounted to 81.37% (N=255). Only 3.14% (N=8) of the PSTs would replant the permanent tooth properly and only 43.92% of them (N=112) would immediately take the child to a doctor of dental medicine. Dry tissue, as a transport medium for an avulsed tooth, was chosen by 50.20% (N=128) of the respondents. Altogether, 4.71% (N=12) of PSTs were graded as competent in case of child’s tooth avulsion. Conclusion: These results provided significant implications for school health, showed the educators’ serious lack of knowledge in cases of dental trauma and stressed a need for continuous education of PSTs on the topic., Cilj: Trauma trajne denticije najčešća je kod djece u dobi od 7 do 9 godina te su učitelji prvi koji je uočavaju. Avulzija je potpuno izbijanje zuba iz zubne alveole i najteži je oblik dentalne traume. S obzirom na to da učitelji osnovnih škola u takvim slučajevima najčešće preuzimaju ulogu školske medicinske sestre, svrha istraživanja bila je procijeniti njihovu sposobnost pri zbrinjavanju te znanje o avulziji zuba. Materijal i metode: Uručeno je 312 anketnih upitnika učiteljima iz 24 nasumično odabrane osnovne škole u Zagrebu. Izrađen je algoritam za procjenu sposobnosti zbrinjavanja djeteta. Rezultati: Odziv ispitanika iznosio je 81,37 % (N = 255). Samo 3,14 % učitelja ispravno bi replantiralo trajni zub, a 49,92 % odvelo bi učenika u najkraćem roku doktoru dentalne medicine. Polovina ispitanika (50,2 %; N = 128) spremila bi izbijeni zub u rupčić. Sveukupno je samo 4,71 % ispitanika (N = 12) ocijenjeno sposobnima za zbrinjavanje avulzije trajnoga zuba kod djece. Zaključak: Rezultati istraživanja otkrili su nedostatke u organizaciji školskog zdravstva, ozbiljan nedostatak znanja učitelja osnovnih škola te upozorili na nužnost kontinuirane izobrazbe učitelja kad je riječ o toj temi.

U hrvatskom je zdravstvu informatizacija započela još u drugoj polovini prošlog stoljeća (kompjutorizacija Republičkog registra za rak u Zagrebu; automatska obrada podataka (AOP) zdravstveno neosiguranih osoba; AOP u području izvanbolničke zaštite i medicine rada u Varaždinu; AOP u Domu zdravlja Remetinec; idejni projekt Zajedničkog informacijskog sustava zdravstvenog osiguranja i zdravstva Zagreb, itd.). Razvijen je i niz lokalnih informatičkih rješenja po bolnicama, poliklinikama, ordinacijama, laboratorijima itd. Nepovezivost postojećih rješenja razvijenih na različitim platformama (negativno) i kvalitativni napredak u razvoju suvremenih informacijskih tehnologija u svijetu (pozitivno) izrodili su potrebu za novim sustavnim pristupom. Sustavni pristup u izgradnji zdravstvenog informacijskog sustava u Hrvatskoj koji treba povezati sve informacije relevantne za zdravstveni sustav (o korisniku zdravstvene zaštite, o zdravstvenom osiguranju, poslovanju zdravstvenih ustanova i sl.) započeo je u dvadeset i prvom stoljeću kao projekt informacijskog sustava za primarnu zdravstvenu zaštitu (danas: CEZIH – Centralni zdravstveni informacijski sustav Republike Hrvatske; aktualne informacije o CEZIH-u dostupne su na www.cezih.hr ). Ideja sustava opisana je u radu (Končar, Gvozdanović) objavljenom u međunarodnom medicinskoinformatičkom časopisu 2006. godine. Razgovaramo s jednim od autora Darkom Gvozdanovićem, danas voditeljem poslovnog područja eZdravstva u tvrtki Ericsson Nikola Tesla d.d..

E-zdravlje ima za cilj (1) unaprijediti zdravstvenu zaštitu pojedinca, (2) olakšati i poboljšati rad zdravstvenih radnika kroz bolju organizaciju i upravljanje zdravstvenim sustavom, i (3) omogućiti nadzor društvene zajednice nad zdravstvenim sustavom i njegovo kontinuirano unaprjeđivanje sa svrhom poboljšanja zdravlja populacije. U tom smislu e-zdravlje treba shvatiti kao sredstvo odnosno alat za postizanje navedenih ciljeva, nikako samo sebi svrhom. E-zdravlje doprinosi unaprjeđenju zdravstvene zaštite pojedinca kroz vođenje elektroničkog zdravstvenog zapisa, primjereno zaštićenog i dostupnog ovlaštenim osobama, uvijek i svagdje; kroz elektroničko upućivanje na preglede, pretrage ili u druge zdravstvene ustanove kao i direktno preuzimanje nalaza; kroz elektroničke recepte; kroz osnaživanje pojedinca osiguravajući mu pouzdane informacije o zdravlju i organizaciji kapaciteta unutar zdravstvenog sustava. E-zdravlje doprinosi poboljšanju rada zdravstvenih radnika kao i organizaciji i upravljanju zdravstvenim sustavom kroz povezivost podataka i primjerenu zaštićenost cjelovitog elektroničkog zdravstvenog zapisa dostupnog ovlaštenim osobama; kroz mogućnost filtriranja i usmjeravanja podataka iz elektroničkog zdravstvenog zapisa za potrebe izvještavanja (periodično, ad hoc), istraživanja, pregleda i praćenja rada (zdravstvenih radnika, djelatnosti, ustrojbenih jedinica) i resursa zdravstvene ustanove; Za društvenu zajednicu (koja određuje pravila funkcioniranja zdravstvenog sustava i snosi posljedice takvog funkcioniranja), e-zdravlje je sredstvo koje osigurava korištenje sredstava uloženih u zdravstveni sustav s najboljim učincima u ishodima, i to na razini države, regije i lokalne zajednice. E-zdravlje ovdje omogućuje raspolaganje informacijama za redistribuciju resursa zavisno o stvarnim potrebama u zdravstvenoj zaštiti građana, te „evidence based“ upravljanje kvalitetom.

Tobacco use continues to be the leading global cause of preventable death. Most of these deaths occur in low and middle-income countries, and this trend is expected to widen further over the next several decades. The overall objective of the study is to describe and analyse the smoking behaviours of adults in Kosova.According to the STEPs methodology, 6,400 respondents, aged 15 - 64 years, are selected randomly within each sex and 10-year age-group. Out of 6,400 participants, 6,117 were selected, which is approximately 95.6%.The prevalence of smoking was higher among males (37.4%) compared with females (19.7%). In all age groups, the prevalence of smoking was higher among males compared with females. Regarding the age group of 15 - 24 years, the prevalence of smoking was 16.0%, but in the age group of 25 - 34 years, it nearly doubled to the rate of 31.9%. We have a smaller increase in the age group of 35 - 44 years, and after the age of 45, it falls gradually.The prevalence of smoking in Kosova is high compared with other countries in Eastern Europe. In future decades, Kosova will face a high probability of an increased burden of smoking-related diseases.Uživanje tobaka je še vedno eden izmed glavnih vzrokov smrti, ki bi jih lahko prepreĉili. Veĉina teh smrti se zgodi v državah z nižjim in srednjim prihodkom, po priĉakovanjih pa se bo ta trend v naslednjih nekaj desetletjih še povečal. Cilj te študije je opis in analiza kadilskega vedenja odraslih na Kosovu.Glede na metodologijo STEPS je bilo nakljuĉno izbranih 6.400 anketirancev obeh spolov, starih med 15 in 64 let; razdeljeni so bili v starostne skupine po10 let. Izmed 6.400 anketirancev jih je bilo v študijo vključenih 6.117, kar je približno 95,6%.Prevalenca kajenja je bila veĉja med odraslimi moškimi (37,4%) v primerjavi z ženskami (19,7%). V vseh starostnih skupinah je bila prevalenca kajenja višja med moškimi kot med ženskami. V starostni skupini med 15 in 24 let je bila prevalenca kajenja 16,9%, v starostni skupini med 25 in 34 let pa se je skoraj podvojila (31,9%). Prav tako je prisotno manjše povišanje v starostni skupini med 35 in 44 let, po 45. letu pa odstotek postopno pada.Prevalenca kajenja na Kosovu je v primerjavi z ostalimi državami v Vzhodni Evropi visoka.V prihodnosti se bo Kosovo sooĉalo z visoko verjetnostjo povišanega bremena zaradi bolezni, povezanih s kajenjem.

Trideset je godina prošlo od osnivanja Hrvatskog društva za medicinsku informatiku (HDMI). Godine 1989. osnovano je pod nazivom Društvo za medicinsku informatiku Hrvatske. Godine 1989. zajedno s društvima iz Slovenije, Bosne i Hercegovine i Srbije udružuje se u Savez društava za medicinsku informatiku Jugoslavije (SDMIJ), a iste godine SDMIJ se učlanjuje u Europsku federaciju za medicinsku informatiku (EFMI) i Međunarodnu asocijaciju za medicinsku informatiku (IMIA). Nakon raspada Socijalističke Federativne Republike Jugoslavije (SFRJ) i SDMIJ prestaje djelovati, a DMIH mijenja ime u HDMI i kao HDMI učlanjuje se u EFMI i IMIA. O djelovanju HDMI-a pišu predsjednici HDMI-a Đuro Deželić (1989-2004), Josipa Kern (2005-2008), Vesna Ilakovac (2009-2016), Marijan Erceg (2017-). Hrvatsko društvo za medicinsku informatiku je organiziralo petnaest simpozija, dvije konferencije posvećene posebnim temama (EFMI STC), poticalo je osnivanje novih društava (HL7, PROREC) surađivalo s nizom društava i organizacija sa sličnim interesima. Od krovnih organizacija preuzima važne dokumente (Preporuke za edukaciju iz medicinske informatike; Etički kodeks za medicinske informatičare). Aktivira radnu grupu u EFMI-u, potiče ustanovljavanje Tehničkog odbora za normizaciju u medicinskoj informatici (TO 215) pri Hrvatskom zavodu za norme (HZN). Članovi HDMI-a intenzivno surađuju s Odborom za e-zdravlje Akademije medicinskih znanosti Hrvatske (Deklaracija o ezdravlju; Smjernice za unaprjeđenje elektroničkog zdravstvenog zapisa), organizirali su, napisali i uredili knjigu Medicinska informatika, surađivali na projektu poslijediplomske edukacije iz medicinske informatike. U međunarodnoj suradnji posebno se ističe suradnja s s Europskim institutom za zdravstvene zapise (EuroRec) čime je HDMI postao službeni partner na projektu EHR-Q-TN: „Thematic Network on Quality Labelling And Certification of EHR“. HDMI izdaje dva časopisa (Bilten Hrvatskog društva za medicinsku informatiku – časopis se objavljuje na Hrčku; Medicinska informatika – objavljuje radove/sažetke radova sa simpozija). HDMI organizira stručne sastanke i sudjeluje u raspravama o zakonima relevantnim za e-zdravlje.

The aim of this study was to assess the value of the “Health-Plan for It” Program for the capacity of Croatian counties to plan health and implement services based on locally recognized health needs. From 2002 to 2008, the county health teams formed in twenty Croatian counties passed the first set of training modules. First assessment was conducted in 2006. Based on assessment results, in 2008-2009 a new set of training modules was organized and attended by six counties. In second assessment conducted in 2012, three instruments were applied: Local Public Health Practice Performance Measures Instrument and Procedure Chart as self-reporting instruments, and tutorial notes assembled/analyzed by the Faculty. All 13 county health teams that participated in second assessment showed an increase in the 2012 score compared to 0-point. The score change showed statistical significance on both the overall core public health functions and on any of its components (assessment, policy development, assurance). All counties showed improvement in assessment and policy development functions. The assurance function was improved in counties that attended the second set of training modules. The Procedure Charts showed that all counties had developed their own health profiles and health plans, with prioritized health needs and identified actions to address them. Like the first evaluation workshop in 2006, results of the second evaluation workshops in 2012 showed that the Program increased the counties’ public health capacity. Two of the counties that had enrolled late in the Program (2007/2008) achieved much better results than ‘older’ counties, showing that the time spent in the Program was not a key factor contributing to local project success. Different levels of achievement due to ‘institutional or personal capacity to change’, reported by other authors, are in line with our findings that individual county success in the Program depended on the team composition and the level of (regional) political stability. In conclusion, the program showed improvement of all core public health functions in all counties. Assurance function showed generally a higher change in counties that had passed both sets of modules. The counties’ capacity for change differed and the Program was not equally efficient in all of them. The differences in county achievements could be explained by stability of political support at the county level, team composition, and commitment of the team leader., Cilj ovoga istraživanja bio je ocijeniti vrijednost učinaka programa “Rukovođenje i upravljanje za zdravlje” na sposobnost hrvatskih županija da planiraju za zdravlje te implementiraju programe temeljene na lokalno prepoznatim zdravstvenim potrebama u podizanju javnozdravstvene i upravne kompetencije hrvatskih županija dvanaest godina nakon pokretanja toga Programa. U razdoblju od 2002. do 2008. godine svih dvadeset županijskih timova za zdravlje provedeno je kroz prvi set edukacijskih modula. Prva evaluacija Programa napravljena je 2006. godine. Temeljem rezultata evaluacije izrađen je drugi set edukacijskih modula kroz koji je, u razdoblju od 2008. do 2009. godine provedeno šest županijskih timova. U drugoj evaluaciji Programa održanoj 2012. godine primijenjena su tri evaluacijska instrumenta: Matrica temeljnih funkcija javnog zdravstva (Local Public Health Practice Performance Measures Instrument) i hodogram aktivnosti županijskih timova (Procedure Chart) kao instrumenti za samoprocjenu te zabilješke/zapažanja mentora sa Škole narodnog zdravlja “Andrija Štampar”. Rezultati timova za zdravlje trinaest županijskih timova, sudionika u drugom krugu evaluacije u 2012. godini bolji su u usporedbi s njihovim početnim stanjem (0-point). Promjene u rezultatima pokazuju statistički značajnu razliku kako u ukupnom zbroju (sve tri temeljne funkcije zajedno) tako i za svaku funkciju pojedinačno (procjena stanja, oblikovanje zdravstvene politike, osiguravanje resursa). Sve su županije pokazale napredak u funkciji procjene stanja i oblikovanja zdravstvene politike. Funkcija osiguravanja sredstava bila je unaprijeđena kod županija sudionica u drugom setu edukacijskih modula. Hodogrami aktivnosti županijskih timova pokazali su da su sve županije (sudionice u evaluaciji) izradile Županijske slike zdravlja i Planove za zdravlje s jasno definiranim prioritetima i aktivnostima kojima ih namjeravaju riješiti. Rezultati evaluacije provedene 2012. godine, kao i rezultati evaluacije iz 2006. pokazuju da su Programom unaprijeđene javnozdravstvene kompetencije županija. Dvije županije uključene u Program tek 2007./2008. godine postigle su bolje rezultate od „starih“ (ranije uključenih) županija te time pokazale da vrijeme provedeno u programu nije ključni čimbenik uspješnosti projekta lokalno. Razlika u postignućima može se pripisati „institucionalnom ili osobnom kapacitetu za promjenu“ o kojem izvještavaju i drugi autori. Ovdje prikazani rezultati ukazuju na to da je razlika u postignućima u Programu među županijskim timovima bila uvjetovana sastavom tima i političkom stabilnosti lokalno. Programom su unaprijeđene sve temeljne javnozdravstvene funkcije u županijama sudionicama Programa. Funkciju osiguravanja sredstava najviše su unaprijedile županije uključene u oba seta edukacijskih modula. Županije imaju različit kapacitet za uvođenje promjene pa sudjelovanje u Programu nije kod svih polučilo jednako dobre rezultate. Razlike u razini postignuća između županija moguće je objasniti postojanjem (ili odsustvom) kontinuirane političke potpore na županijskoj razini, sastavom tima i predanošću njegovog voditelja.

U Hrvatskoj ima otprilike sto tisuća orkestralnih glazbenika. Zdravlje glazbenika u odnosu na zahtjeve njihovog posla ozbiljno se razmatra u Hrvatskoj već više od pola stoljeća. Gotovo 75% svih glazbenika, studenata i profesionalaca svira uz tegobe koje su, većinom, posljedica sviranja. Gruba procjena ukazuje da postoji više od 80.000 glazbenika u Hrvatskoj koji nemaju odgovarajuću zdravstvenu skrb. Stoga su za rješavanje zdravstvenih poteškoća profesionalnih i budućih glazbenika, učenika i studenata kao i za prevenciju nastanka zdravstvenih tegoba nužni sustavni multidisciplinski pristupi. Uspostava zdravstvenog središta koje pokriva široki raspon područja poput medicine rada i sportske medicine, fizikalne medicine, reumatologije, ortopedije, neurologije, dermatologije, stomatologije i psihološke medicine može osigurati potrebno sustavno rješenje. Svrha zdravstvenog središta treba biti očuvanje zdravlja profesionalnih glazbenika sadašnjih i budućih kao i primjereno liječenje u slučajevima kada je do zdravstvenih teškoća već došlo., There are about one hundred of thousand orchestral musicians in Croatia. The health of musicians in relation to the demands of their work has been seriously considered in Croatia for over a half of century. Almost 75% of all musicians, students and professionals, play with health problems that are, mostly, the result of the playing. Rough assessment of the problems points to more than 80,000 musicians in Croatia who do not have adequate health care. Therefore, to solve the health problems of professionals and future musicians, as well as to prevent the emergence of health problems, systematic multidisciplinary approaches are necessary. The establishment of a health center covering a wide range of areas such as occupational, sport, and physical medicine, rheumatology, orthopedics, neurology, dermatology, dentistry and psychological medicine can provide a systematic solution. The purpose of the health center should be to preserve the health of current and future professional musicians as well as appropriate treatment in case where health problems have already occurred.

Zahtjev za jedinstvenom i cjelovitom zdravstvenom zaštitom kaže da „jedan korisnik zdravstvene zaštite treba imati jedan elektronički zdravstveni zapis“ i „svi relevantni zdravstveni podaci korisnika zdravstvene zaštite moraju biti sastavnim dijelom elektroničkog zdravstvenog zapisa“. Ovlašteni korisnici elektroničkog zdravstvenog zapisa su osobe koje ga stvaraju - zdravstveni profesionalci za vrijeme dok provode zdravstvenu zaštitu korisnika zdravstvene zaštite i korisnici zdravstvene zaštite. Prema podacima Ureda nacionalnog koordinatora za zdravstveno-informacijsku tehnologiju u SAD pokazuje da broj pojedinaca koji mogu pristupiti svom elektroničkom zdravstvenom zapisu sve više raste - od 42% u 2014 do 52% u 2017. Među razlozima pristupa navodi se uvid u laboratorijske podatke, popis lijekova, kratki opis vezano uz posjet, popis problema, alergije, vakcinacije i kliničke zabilješke. Hrvatski građani mogu pristupiti svom elektroničkom zdravstvenom zapisu (eKartonu) putem zdravstvenog portala sustava e-Građani, odnosno Nacionalnog identifikacijskog i autentifikacijskog sustava (NIAS). Čine li to ili ne, o tome nema podataka. Spoznaja o tome bila bi korisna podloga za doradu postojećeg eKartona, a primjerena edukacija i uvid građana u vlastitu medicinsku dokumentaciju mogli bi ih potaknuti na aktivniju ulogu u unapređivanju svoga zdravlja.

Podatci iz literature govore o porastu primjene komplementarnih i alternativnih metoda liječenja (KAM) u onkoloških bolesnika. Cilj je ovog rada istražiti raširenost primjene KAM-a, saznati koje su najčešće upotrebljavane metode, istražiti povezanost primjene KAM-a s demografskim karakteristikama bolesnika te istražiti izvore informiranosti bolesnika o KAM-u. Uzorak je bio prigodni, a u istraživanje su uključena 82 onkološka bolesnika u dobi od 24 do 83 godine, od čega je bilo 60 žena i 22 muškarca. Primijenjen je upitnik od 25 pitanja podijeljenih u tri skupine: pitanja povezana sa sociodemografskim statusom, obilježjima bolesti i terapije te treći dio povezan s primjenom KAM-a. Postotak sudionika koji su bilo kada u svojem životu (prije ili sada) upotrebljavali KAM iznosi 72, 2 %, dok 46, 8 % sada upotrebljava KAM (bez obzira na prije). Od KAM-a očekuju da im poveća imunitet (46, 3 %), poboljša fizičko zdravlje (23, 2 %), ublaži simptome nuspojava kemoterapije (17, 1 %) te poboljša psihičko stanje (14, 6 %). Muškarci se znatno manje koriste KAM-om nego žene, dok se dob i obrazovanje nisu pokazali statistički značajnim čimbenicima. O primjeni KAM-a svojeg je liječnika onkologa obavijestilo 35, 6 % bolesnika, a medicinsku sestru njih 16, 7 %. Kao najčešće razloge zbog kojih nisu obavijestili medicinsko osoblje navode da ih nitko nije pitao i negativan stav zdravstvenih djelatnika prema KAM-u. Prijatelji (36, 6 %), drugi bolesnici (31, 7 %), mediji (28, 0 %) i zdravstveni djelatnici izvan bolnice (12, 2 %) najčešći su izvor informacija o KAM-u, a najmanje informacija o KAM-u bolesnici dobivaju od zdravstvenih djelatnika u bolnici.

Podatci iz literature govore o porastu primjene komplementarnih i alternativnih metoda liječenja (KAM) u onkoloških bolesnika. Cilj je ovog rada istražiti raširenost primjene KAM-a, saznati koje su najčešće upotrebljavane metode, istražiti povezanost primjene KAM-a s demografskim karakteristikama bolesnika te istražiti izvore informiranosti bolesnika o KAM-u. Uzorak je bio prigodni, a u istraživanje su uključena 82 onkološka bolesnika u dobi od 24 do 83 godine, od čega je bilo 60 žena i 22 muškarca. Primijenjen je upitnik od 25 pitanja podijeljenih u tri skupine: pitanja povezana sa sociodemografskim statusom, obilježjima bolesti i terapije te treći dio povezan s primjenom KAM-a. Postotak sudionika koji su bilo kada u svojem životu (prije ili sada) upotrebljavali KAM iznosi 72,2%, dok 46,8% sada upotrebljava KAM (bez obzira na prije). Od KAM-a očekuju da im poveća imunitet (46,3%), poboljša fizičko zdravlje (23,2%), ublaži simptome nuspojava kemoterapije (17,1%) te poboljša psihičko stanje (14,6%). Muškarci se znatno manje koriste KAM-om nego žene, dok se dob i obrazovanje nisu pokazali statistički značajnim čimbenicima. O primjeni KAM-a svojeg je liječnika onkologa obavijestilo 35,6% bolesnika, a medicinsku sestru njih 16,7%. Kao najčešće razloge zbog kojih nisu obavijestili medicinsko osoblje navode da ih nitko nije pitao i negativan stav zdravstvenih djelatnika prema KAM-u. Prijatelji (36,6%), drugi bolesnici (31,7%), mediji (28,0%) i zdravstveni djelatnici izvan bolnice (12,2%) najčešći su izvor informacija o KAM-u, a najmanje informacija o KAM-u bolesnici dobivaju od zdravstvenih djelatnika u bolnici., Complementary and alternative medicine use among cancer patients has increased in recent years. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients, and to find out which are the most commonly used methods. Furthermore, the aim was also to explore the connection between the use of CAM and the demographic characteristics of the patients and to investigate the sources of information about CAM. The study included 82 patients from one oncology ward, 60 women and 22 men, within the age range of 24-83 years. A survey was constructed with 25 questions divided in three groups: sociodemographic status, questions about illness and therapy, and questions about using CAM. The results show that more than two-thirds (72.2%) of the cancer patients reported using some form of CAM at least once in their lives („life” prevalence), and in the time of the study the prevalence of CAM use was 46.8%. Most patients were using CAM because they wanted to boost the immune system (46.3%), improve their physical well-being (23.2%), relieve side-effects of chemotherapy or improve their emotional well-being (14.6%). In terms of gender, women tend to use more CAM than men. Age and educational level are not significant factors in CAM use. Regarding the current data, communication between patients and their health providers (oncologist and nurses) is critical. This study showed that almost 65% of the participants had not disclosed their use of CAM to their oncologists, nor had 85% of them disclosed the information to nurses. The reasons for not reporting CAM use to their nurses or oncologists include „they never asked” or „they would disapprove”. Friends were the most common source of information (36.6%), followed by media (31.7%) and the external health care professionals. This number is even lower for doctors and nurses as a support-group: only 2.4% of them were identified as the source of information for patients.

Pediatric solid central nervous system (CNS) tumors are rarely detected at an early stage. The reasons for this include the tumor site, acute intracranial bleeding, unavailable imaging tests, inconsistent conduct of clinical diagnostic procedures, etc (1). CNS tumors account for 20% of all childhood cancers, and their incidence rates are rising (2). Treatment results are better if the disease is detected early, which requires sufficiently sensitive and specific diagnostic methods. This is why new biomarkers indicating the presence of CNS tumors are needed. One of the biological materials used for biomarker testing is cerebrospinal fluid (CSF) (3). CSF washes the structures of the CNS including the tumors present there, enabling the detection of tumor proteins in the CSF. PChE has a role in tumorogenesis and oncogenesis and has been proven to be a good indicator of the presence of tumors (4-6). PChE in serum has already been recognized and confirmed as a good diagnostic and prognostic marker for head and neck tumors (7). Studies of PChE in tumor tissue showed that its concentration in some tumor samples was high, eg, in glioma tissue samples (4). In tissue samples, PChE has higher activity levels in astrocytomas than in meduloblastomas, neuromas, or meningeomas (4). It is included in the myelin metabolism of, eg, the corpus callosum, nervus opticus, and spinal cord. Subcortical white matter has much greater PChE activity than gray matter (8) and PChE activity decreases as we descend from the cerebrum toward the spinal cord. After blood removal, PChE activity is present in the vessels of the brain and it is higher in arteries than in veins (4) PChE is an enzyme (EC 3.1.1.8) synthesized in the liver and distributed to body tissue and fluids. Cholinesterases (acetylcholinesterase – AChE and PChE) activity changes in an abnormal tissue metabolism and/or they become part of the oncogenic process (7). Cholinesterase genes are amplified, aberrant, and mutated in numerous types of human tumors. The PChE and AChE found in these tumors contain the peptide motif S/T-P-X-Z found in many cdc2 gene-dependent protein kinase substrates (5). Phosphorylation of cdc2-dependent protein kinases is a possible molecular mechanism that connects cholinesterases with tumor proliferation. Moreover, the inhibition or reduction of AChE, PChE, and some other enzymes especially with organophosphorous and perhaps carbamate poisons used as insecticides in home and local environment may result in the formation of brain tumors in children partially depending on the genetic polymorphisms that affect insecticide metabolism (9,10). PChE activity in CSF in healthy people is rarely investigated, most often as a part of studies on specific diseases or anesthetics (11-13). Lumbar puncture is an invasive procedure and for ethical reasons the number of healthy participants in studies is always small, especially in case of children. For this reason the information about the normal values of PChE activity in CSF in relation to age at all ages is scarce. In adults, PChE activity in CSF ranges from 1/20 to 1/100 of the value of serum (13). In children, the values are age-dependent (14). PChE activity in serum is low at birth, which is followed by a sudden increase in activity over the next three weeks, with values exceeding those in adulthood. This remains unchanged until the age of three. Between three and six years, PChE activity is 30% above the adult level and it begins to slowly drop between the age of five and puberty, when it reaches the adulthood value, which remains relatively stable (14). In this study, we tested whether PChE could be used as a potential biomarker for solid CNS tumors in children.

The impact of physician burnout on the quality of patient care is unclear. This cross-sectional study aimed to investigate the prevalence of burnout in family physicians in Croatia and its association with physician and practice characteristics, and patient enablement as a consultation outcome measure.Hundred and twenty-five out of 350 family physicians responded to our invitation to participate in the study. They were asked to collect data from 50 consecutive consultations with their adult patients who had to provide information on patient enablement (Patient Enablement Instrument). Physicians themselves provided their demographic and professional data, including workload, job satisfaction, consultation length, and burnout [Maslach Burnout Inventory - Human Services Survey (MBI-HSS )]. MBI-HSS scores were analysed in three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA).Of the responding physicians, 42.4 % scored high for EE burnout, 16.0 % for DP, and 15.2 % for PA. Multiple regression analysis showed that low job satisfaction and more patients per day predicted high EE scores. Low job satisfaction, working more years at a current workplace, and younger age predicted high DP scores. Lack of engagement in education and academic work, shorter consultations, and working more years at current workplace predicted low PA scores, respectively (PBurnout is common among family physicians in Croatia yet burnout in our physicians was not associated with patient enablement, suggesting that it did not affect the quality of interpersonal care. Job satisfaction, participation in educational or academic activities and sufficient consultation time seem to reduce the likelihood of burnout.

Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record.We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years.First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation.Prevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41-3.15, P .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78-.61, P .001).Total yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.

Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record (EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients’ data using Wonca International Classification Committee (WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients (aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM’s assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p

doi: 10.1111/j.1741-2358.2011.00552.x Study of temporomandibular joint disorder in older patients by magnetic resonance imaging (MRI) 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.

AIM: To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. ----- METHODS: A multicenter prospective study was performed on 2467 participants of both sexes ≥40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. ----- RESULTS: Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P

OBJECTIVES: The effects of the Michigan splint on the change in disc displacement (DD) as well as the position of the condyles were determined by metrical analysis using magnetic resonance imaging (MRI). ----- METHODS: Twenty-five patients with clinical DD symptoms were treated by means of the Michigan splint, and an assessment of the effects of the splint was conducted or verified by MRI before and during the period of therapy, 5 months follow-up. The positions of the condyles and the disc were calculated from the MRI in the parasagittal plane. ----- RESULTS: There were no changes in the positions of the disc and condyles in the physiological joints of the patients (n=23) prior to and during the time the splint was in place (p>0.05). The splint achieved a DD decrease (p0.05). ----- CONCLUSIONS: The evaluation of the Michigan splint therapy showed that it has no influence in the repositioning of the DD joints without reduction, but the DD joints with reduction have a limited positive effect. In both forms of these displacements, conditions for the elimination of the clinical symptoms are created.

AIM: To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. ----- METHODS: A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. ----- RESULTS: In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P < 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P < 0.05 for each). ----- CONCLUSION: Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice.