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Purpose The purpose of this study was to evaluate the clinical relevance of the early postoperative basal cortisol level in assessing the postoperative hypothalamic-pituitary-adrenal (HPA) axis function after pituitary tumor surgery. Methods We performed a prospective observational study that enrolled 83 patients operated for pituitary adenoma or other sellar lesions at the University Hospital Center Zagreb between December 2013 and April 2017 (44 nonfunctioning pituitary adenomas, 28 somatotropinomas, 5 craniopharyngiomas, 2 prolactinomas resistant to medical therapy and 4 other lesions - Rathke's cleft cyst, arachnoid cyst, chondroma and gangliocytoma). Exclusion criteria were Cushing's disease, chronic therapy with glucocorticoids prior to surgery and preoperative adrenal insufficiency. Early postoperative basal cortisol levels (measured on the second postoperative day) and the Synacthen stimulation test (performed 3 months after the surgery with the peak cortisol level of>500 nmol/L considered as a normal response) were analyzed to assess HPA axis function during follow-up. Results ROC analysis showed a cut-off of the basal cortisol level of ≥300 nmol/L measured on the second postoperative day to predict normal postoperative HPA axis function with the sensitivity of 92.31%, specificity of 87.14% and positive predictive value of 57.14%. Conclusion The basal cortisol level on the second postoperative day is a valuable tool to predict integrity of the HPA axis after pituitary tumor surgery. Our data suggest that the cortisol level of ≥300 nmol/L accurately predicts adrenal sufficiency and that in these patients glucocorticoid therapy can be withdrawn. [ABSTRACT FROM AUTHOR]

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Background: Registries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe., Objectives: We aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research., Methods: Survey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017., Results: The 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years., Conclusions: The heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes., Competing Interests: SL is the Director of the RCGP RSC, as part of his academic work. He has received grants through his institution from AstraZeneca, Eli Lilly, Novo, and Sanofi, for diabetes related research. SC is employed by My Digital Health. CI is employed by Serectrix snc. SP was employed by Telemedica Consulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Carinci, Štotl, Cunningham, Poljicanin, Pristas, Traynor, Olympios, Scoutellas, Azzopardi, Doggen, Sandor, Adany, Løvaas, Jarosz-Chobot, Polanska, Pruna, de Lusignan, Monesi, Di Bartolo, Scheidt-Nave, Heidemann, Zucker, Maurina, Lepiksone, Rossing, Arffman, Keskimäki, Gudbjornsdottir, Di Iorio, Dupont, de Sabata, Klazinga and Benedetti.)

Chronic complications of diabetes are the main cause of mortality and disability in people with diabetes, while also leading to growing healthcare system cost burdens. In order to analyze the effects of possible interventions on the health of population and their effectiveness in reducing the cost of the healthcare system, we have made health-economic models of diabetes chronic complications development. The models simulated long-term effect of improving glycemic control, blood pressure and lipid status in patients over a period of 10 years. The simulation results showed that the total savings over the analyzed period could amount to over 2 billion HRK, as effective long term control of risk factors leads to a reduction in the development of complications and death in people with diabetes. Successful treatments of patients provide a variety of savings for each of the chronic complications, and are obtained by simulating the biggest savings in the cost of hospitalization and rehabilitation. The cost-effectiveness analysis leads to the conclusion that the more intensive patient's control and earlier application of a treatment is cost-effective, and change of the healthcare system activities is a necessity.

Croatia has a long tradition of non-communicable disease prevention, but also obstacles to the implementation of preventive programs related to the general attenuation of public health and primary health care sector. The aim of this study was to determine trends in behavioral and biomedical risk factors and evaluate primary non-communicable disease and cardiovascular prevention. Physical inactivity was a leading risk factor with increasing trend and prevalence of 33.9% and 38.9% in men and women in 2008. In 2008, obesity was present in 26.1% and 34.1%, and hypertension in 65.8% and 59.7% of men and women. During the follow-up only smoking and alcohol consumption in men decreased significantly, while alcohol consumption and obesity in women, and hypertension in both sexes significantly increased. In the present situation, with the existing trends and environment it will not be possible to stop negative trends. Revitalization of public health activities and primary health care is essential.

The aim of this study was to examine the social conditioning of health behaviors of adults in Croatia, based on the data from Croatian Adult Health Survey 2003. This cross-sectional study on a representative random sample of 9070 Croatian adults showed that obesity was significantly and socially conditioned in women, whereas for men the indication of social conditioning has not reached a statistically significant level. Health behaviors were socially conditioned in both sexes. Men's living habits were more irregular than those of women. Compared with women, men consumed more cured meat products, consumed alcohol excessivelly and smoked cigarettes more often, whereas they ate less fruits and vegetables. Health promotion strategies based on the behavioral correlates of overweight and obesity are needed to prevent excess weight gain in the Croatian population. While for men a unique educational model is applicable, women require more specialized programs, adapted to their social background.

This prospective study of 1277 participants investigated patient risk self-assessment, motivation for changes in main determinants of the metabolic syndrome and the impact of community nursing intervention on cardiovascular risk reduction. Observed values of metabolic syndrome determinants indicated an elevated cardiovascular risk. Participants showed greatest motivation for positive changes regarding blood pressure, (3.70 +/- 1.26) then hyperglycemia (3.55 +/- 1.28), hyperlipidemia (3.46 +/- 1.30), overweight and obesity (3.43 +/- 1.28), and physical activity habits (3.29 +/- 1.31). Changes in physical activity and nutritional habits were not related to self-reported motivation regardless of the age and sex (p > 0.05). The most pronounced median improvements were observed in cholesterol (men 4.43%, women 4.89%) and triglycerides (men 3.41%, women 1.49%), with only slight changes in BMI (men 1.08%, women 1.18%) and no change in waist-to-hip ratio and glucose. This study revealed that, although aware and motivated, patients often do not succeed in changing habits. Concomitant changes of the environment and multisectoral prevention approach is necessary.

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

The aims of our study were to investigate the prevalence of risk factors in persons with previously known diabetes ("old DM"), persons with diabetes developed during the 2003-2008 period ("new DM") and diabetes-free individuals within the CroHort study. Risk factors were defined as physical inactivity, unhealthy nutritional regimen, smoking and excessive alcohol consumption, while diabetes status was self-reported. The most prevalent risk factor in both "old DM" and "new DM" group was physical inactivity (46.7% and 33.7% in 2003; 46.8% and 46.3% in 2008), then smoking (12.1% and 14.6%; 12.7% and 14.4%), unhealthy diet (8.8% and 13.8; 8.2% and 10.0%) and heavy alcohol consumption (11.1% and 6.0%; 7.8% and 13.8%). Diabetes-free individuals had higher rates of smoking and unhealthy diet, and lower rates of alcohol consumption and physical inactivity than both diabetes groups. These results indicate the need for comprehensive actions oriented towards persons with diabetes concerning physical activity.

This retrospective observational study investigated the prevalence of obesity in persons with type 2 diabetes, trends in obesity resulting from the duration and treatment of diabetes, and treatment-related changes in HbA1c and body mass index (BMI). Data on 1773 type 2 diabetics (802 men and 971 women) were obtained from the CroDiabNET registry. Follow-up included the analysis of patients' age, disease duration, diabetes treatment, BMI and HbA1c values. A significantly higher rate of overweight and obesity was found in persons with type 2 diabetes as compared to the general population. A significant decrease in BMI was observed in the groups treated by diet, and in those treated by oral hypoglycaemic agents (p < 0.05), regardless of their pharmacotherapeutic group, in contrast to a significant increase in BMI observed in the groups treated with insulin (alone or in combination with oral hypoglycaemic agents) (p < 0.05). Persons with type 2 diabetes lost weight only during the first years of the disease, while with diabetes duration and insulin treatment they regained weight. A significant increase in HbA1c was observed in the groups treated with sulfonylureas (p < 0.05), whereas all other groups revealed either a significant decrease (p < 0.05) or no change in HbA1c. Our findings suggest the necessity of an integrated approach to managing type 2 diabetic patients that would simultaneously address both diabetes and obesity. Good glycaemic control is imperative and diabetes treatment should not be postponed. Because of a possible concomitant weight gain, aggressive weight control measures should be applied concurrently in order to achieve maximum treatment benefit.

Public health surveillance system (PHSS) serves for continuous and systematic data collection, analysis and interpretation, in order to enable planning, implementation and evaluation of public health practice. PHSS should alert to events (usually unwanted), assist to create public health policy and strategies, document effects and achieving the goals as well as setting public health priorities. Surveillance systems monitor communicable and non-communicable diseases, health resources and public health programs and interventions. The main drawback of the existing PHSS is fragmentation and delay of information, usually not up-to-date. Modern information and communication technology enables getting data from hospitals and other health information systems directly, and use them for surveillance. Our model of surveillance system appeared as not standalone but an integrated system getting data that are by-product of frontline workers. Therefore, the electronic health records should be the source of data for disease surveillance. Medical, nurse and similar schools as well as the Ministry of Health and health institutions could be data sources for health personnel surveillance. Medical devices can be monitored by data coming from institutions and bodies dealing with such devices. Public health programs defined by institutions and bodies can be monitored by them and others taking part in implementation. Therefore, they all can be the source of data for surveillance of public health programs and interventions. Without such systems, any rationalization in health care and better quality is not possible. Therefore, the present public health surveillance system should be improved, as we have suggested, by using current information and communication technology and integrating the data that are by-product of the frontline worker, and by including the end users in system development at the very beginning.

Background and Aim: Diabetes is a complex metabolic disorder regarded as one of the most significant public health issues of the 21S century. Keeping a diabetes registry facilitates monitoring of the epidemiological situation, while a structured approach to the registration of diabetic patients (reporting on an optimum information cluster for the follow-up and improvement of diabetes care) contributes to better regulation of patient risk factors. Active patient reporting at the primary health care level has begun in 2006 with setting up the legislative background. The aim of this study was to establish the effect of the CroDiab registry on metabolic parameters in type 2 diabetic patients treated at primary health care level by comparing diabetes indicators between the regularly annually reported type 2 diabetic patients and those that were only intermittently reported to the registry from 2006 until 2008., Methods: Family physicians submit their reports mainly via CroDiab web, a Croatian web-based system for the collection of data on diabetic patients, which enables analysis of the basic clinical and public health indices. The levels of fasting and postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, and body mass index were analyzed in 2006 and 2008, and compared between the two study groups., Results: At baseline, differences between the intermittently reported (I) and regularly reported (R) groups were only observed in the systolic (I 142.4+/-16.6, R 136.8+/-16.6 mm Hg; p<0.001) and diastolic (1 83.9+/-8.2, R 82.1+/-10.0 mm Hg; P=0.002) blood pressure, while at the end of the study period differences were also recorded in postprandial blood glucose (I 10.63+3.12, R 10.02+/-3.44 mmol/L; P=0.024), HbA1c (I 7.97+/-1.52, R 7.39+/-1.17%; P<0.001), total cholesterol (I 5.60+/-1.15, R 5.25+/-1.13 mmol/L; p<0.001) and LDL-cholesterol (I 3.28+/-0.93, R 2.98+/-0.92 mmol/L; P<0.001). There were no statistically significant differences in body mass index, fasting glucose, HDL-cholesterol and triglycerides., Discussion and Conclusion: Electronic medical records and structured health care are associated with increased benefits and improvement in metabolic indicators at the primary health care level. Regular reporting and monitoring via CroDiab registry lead to a significant improvement in the majority of metabolic indicators, which is less marked with intermittent reporting. The more pronounced effect observed in the group of patients that were regularly covered by the registry could be attributed to a more comprehensive and regular insight and better patient care associated with continuous monitoring. Further efforts are therefore needed to achieve the widest possible implementation of the CroDiab web system to improve diabetes care at the primary health care level.

Background: We aimed to assess health-related quality of life (HRQoL) among people with diabetes or hypertension, estimate the effect of cardiovascular comorbidities on HRQoL as well as compare HRQoL in these groups with that of healthy individuals., Methods: A total of 9,070 respondents aged 18 years and over were assessed for HRQoL. Data were obtained from the Croatian Adult Health Survey. Respondents were divided into five groups according to their medical history: participants with hypertension (RR), hypertension and cardiovascular comorbidities (RR+), diabetes mellitus (DM), diabetes and cardiovascular comorbidities (DM+) and participants free of these conditions (healthy individuals, HI). HRQoL was assessed on 8 dimensions of the SF-36 questionnaire., Results: Participants with diabetes and those with hypertension reported comparably limited (p > 0.05) HRQoL in all dimensions of SF-36, compared with healthy individuals (p < 0.05). If cardiovascular comorbidities were present, both participants with diabetes and participants with hypertension had lower results on all SF-36 scales (p > 0.05) than participants without such comorbidities (p < 0.05). The results remained after adjustment for sociodemographic variables (age, sex, employment, financial status and education)., Conclusion: Diabetes and hypertension seem to comparably impair HRQoL. Cardiovascular comorbidities further reduce HRQoL in participants with both chronic conditions. Future research of interventions aimed at improving these participants' HRQoL is needed.

The aim of this study was to assess the behavioural risk factors in Croatian diabetic population and to compare them with the lifestyle habits of individuals with no known history of diabetes. The study was a part of the Croatian Adult Health Survey (CAHS), a cross-sectional survey that provided comprehensive health assessment of the Croatian adult population. Risk factors were defined as an unhealthy nutritional regimen, excessive alcohol consumption, smoking and lack of physical activity. Physical inactivity was the most prevalent risk factor observed in a significant number of both diabetic and non-diabetic subjects (44.8% and 29.1%). It was also the only behavioural risk factor that was more prevalent in the diabetic individuals as compared to those without diabetes. Alcohol consumption did not vary significantly between the two groups (5.8% vs. 6.3%), while unhealthy dietary pattern and smoking were less frequent in respondents with diabetes (10.0% vs. 16.5% and 14.3% vs. 23.2%, respectively). Among diabetic patients, a significantly larger proportion of men than women reported smoking (19.2% vs. 10.0%), whereas no such sex-related differences were observed in other behavioural risk factors. Although the most prominent risk factor in diabetic patients was physical inactivity, a significant proportion of respondents with diabetes also reported the presence of other risk factors investigated in this survey. Since the majority of diabetic patients do not reach their treatment goals, there is a substantial need for curative and preventive interventions. Given the importance of physical activity in the treatment and prevention of diabetes and the high proportion of inactive diabetic patients, any future preventive programme in Croatia should address that risk as well.

Although first knowledge on the joint onset of cardiovascular risk factors had been gained earlier, the first systematic review of this condition was made by G. Reaven in 1988 with his thesis on syndrome X, today known as the metabolic syndrome, with insulin resistance as the common denominator. Four elements have been identified: central obesity, dyslipoproteinemia (increased triglycerides, reduced HDL cholesterol), hypertension and glucose intolerance. There are two most influential definitions: one by the National Cholesterol Education Program (NCEP) and the other by the International Diabetes Federation (/IDF). NCEP requires the presence of at least three of the following factors: abdominal obesity as assessed by waist circumference >102 cm (m) or >88 cm (f), dyslipoproteinemia defined as triglyceridemia > or =1.7 mmol/L and/or HDL cholesterol <1.03 mmol/L (m); <1.29 mmol/L (f), hypertension (blood pressure > or =30/85 mmHg) and fasting glycemia > or =5.6 mmol/L (previously 6.1). IDF focuses on central obesity defined as waist circumference, taking into consideration sex and ethnic group specificities, with the presence of at least two additional factors (dyslipoproteinemia, hypertension, or increased fasting glycemia - all criteria virtually the same as in NCEP definition). Both IDF and NCEP define abdominal obesity by waist circumference, taking account of sex differences, and, in case of IDF, ethnic ones as well. The idea is to identify the simplest measure to indirectly determine the accumulation of visceral fat, which is, contrary to subcutaneous fat, a significant cardiovascular risk factor. However, waist circumference as the only criterion seems to be less specific than the waist-to-hip circumference ratio, which defines the risk more specifically and also better reflects insulin resistance. There is broad discussion as to whether the term metabolic syndrome contributes to the identification of persons at risk of cardiovascular disease better than its components, and, if so, which is the right set of components. It is being recommended that the discussion on the metabolic syndrome be limited to persons without diabetes or already diagnosed cardiovascular disease, as the primary goal for these individuals is to prevent these diseases. It has already been shown that this was possible, primarily by intensive change in lifestyle - healthy diet and exercise. In conclusion, further basic research is necessary to explain the pathophysiologic mechanisms, which might serve to develop new therapies. Moreover, epidemiological and public health aspects are extremely important in the creation of a prevention program. Preliminary results of the Croatian Health Survey (2003) indicate that the metabolic syndrome according to the IDF criteria is present even in the youngest age group, with expected age-dependent increase in both men and women. This is even an underestimate since in this survey only blood pressure and waist circumference were actually measured, and data on dislipidemia and blood glucose were based on a questionnaire. It is already obvious that a wide action with two main goals aimed primarily at the youngest population is necessary: an increase in regular physical activity and the promotion of healthy and energy-adequate diet in the population at large.

Introduction: There is an increasing number of diabetics in the population. Care of diabetes mellitus type 2 has been transferred from specialist care to the level of general practice. Collecting data and making database of diabetic care are set as quality indicators of diabetic care., Aim: The aim is to present the electronic CroDiab GP program as a tool for collecting data on diabetics in family practice in Croatia. Another aim is to track diabetic quality care and include patients in the national registry of diabetics., Methods: The program was demonstrated on a sample of 10 family practice units with approximately 18,000 patients from four districts in north Croatia. These units are involved in the project of tracking diabetic care quality in family medicine. The core population for data collection is set by the basic diagnostic unit according to ICD-10: E10-E14. The program mainframe is the CroDiab NET computer system. The central module of CroDiab NET is BIS (Basic Information Sheet). It is set as optimal data collection that allows tracking diabetic care quality. Sixteen diabetic variables were analyzed. These variables refer to the type of disease, duration, treatment, and procedure for early detection of complications., Results: In the population of 18,0000 patients there were 822 (4.6%) diabetics. There were 6.3% of patients with type 1 diabetes and 87.4% with type 2 diabetes; 6.3% were unknown. There were 16.0% diabetics on diet therapy, 60.7% on oral medication (1 to 3 medications), and 13.4% on insulin therapy, 8.4 diabetics were on both insulin and oral medication., Conclusion: Family medicine should present parameters of the quality of diabetic care. It is possible to collect data in electronic media, make statistical analysis and present data. The next step is entering patient data in the national registry of diabetics.

Although the physiological function of serum butyrylcholinesterase (BuChE) has not yet been clarified, there is evidence that this enzyme is involved in serum lipoprotein metabolism. It has been suggested that serum BuChE is positively correlated with LDL (low-density lipoprotein) and negatively with HDL (high-density lipoprotein) levels. The objective of this study was to determine whether the activity of BuChE changes during treatment with simvastatin (CAS 79902-63-9). The effects of simvastatin therapy on serum lipoproteins and plasma BuChE activity were studied in 15 patients with type IIa and 17 patients with type IIb hyperlipoproteinemia. Beside the expected influence on serum lipid concentration, a statistically significant decrease in BuChE activity in patients with hyperlipoproteinemia type IIa and IIb during treatment with simvastatin was not observed.

Introduction and Aim: National diabetes registry has been an important aim of Croatian diabetology for a long time. Currently, efforts are made to define a national registry based upon Cro Diab NET, a computer software designed as a patient record form and suitable for automatic extraction of data for the registry., Methods: Diagnostic entities captured are defined by the International Classification of Diseases and Related Health Problems, 10th rev. (E10--E14, G63.2, and H36) and ICF (b540, b279, b298, b2108). Central CroDiabNET module is BIS (Basic Informatic Sheet), recognized by the international diabetology community as optimal data collection form for the follow-up and improvement of diabetes care. There are several ways of data collection: secondary and tertiary health centers with diabetes care within their scope of activities send BIS on their patients to the central base by a modem, other secondary and tertiary health centers as well as primary health care will send data on their diabetic patients either via the Internet or by mail (interactive BIS will be available on the registry www page). The preferred method of data collection is the electronic one. The central base automatically links records of uniquely identified patients. Other records are checked separately, compared with the existing records and linked manually. Data confidentiality is ensured by double password protection of excess at the level of both users and registry. Unauthorised access is highly unlikely., Results: So far, most of the secondary and tertiary health centers dealing with diabetology have been active in data collection. Inclusion of primary care (family physicians) is in progress. The last report covered data from 13 centers. Besides data on the number of patients, the reports contained analyses of BIS patient data availability. This is a tool for the analysis of the quality of registry and it can also provide basic data for planned actions aimed at quality of care improvement. Regular data collection from all levels of health care with concomitant connection of the registry to the national death registry started in 2004. With complete implementation of these processes a unique national diabetes database will be defined., Conclusion: Results of the use of CroDiabNET so far confirm its potency as a valuable tool for population registry of diabetes as well as for improvement of diabetes health care. Regular periodic reports reveal an increasing number of centers involved. With continuation of this trend the registry will become a national, population-based database.