Controversy exists as to whether the deletion/deletion (DD) genotype of angiotensin l-converting enzyme (ACE) gene polymorphism is associated with coronary heart disease (CHD). There are only a few ...studies dealing with this issue in the elderly, also with controversial results. The aim of this study was the assessment of correlation between genetic markers and the risk of CHD in the elderly. The results indicated DD genotype importance for CHD in the elderly as proven by discriminant analysis (chi2 = 25.77; df = 16; p = 0.0620). However, the use of univariate method demonstrated no correlation between DD genotype of ACE gene polymorphism and coronary artery disease. D allele of ACE gene was associated with higher activities of ACE plasma. A weak, but increased risk of MI is associated with high frequency of DD genotype in the elderly. Strong correlation between ACE polymorphism and ACE plasma activities was demonstrated.
Alergijske bolesti dišnih putova sve su učestalije, broj oboljelih sve je veći pa zato čine značajan dio rada liječnika obiteljske medicine (LOM-a). LOM ima vrlo važno mjesto u prepoznavanju i ...pravodobnom dijagnosticiranju ovih bolesti, kreiranju dijagnostičkog postupka i redovitoj kontroli. U zbrinjavanju ovih bolesti osobito je važna suradnja LOM-a i bolesnika te trajna edukacija i poticanje u mjerama samokontrole. Danas su ciljevi u liječenju alergijskih bolesti dišnih putova postavljeni vrlo visoko. S obzirom na vrlo dobre farmakoterapijske mogućnosti želi se postići pun i kvalitetan život bez simptoma bolesti. U većine bolesnika to je i ostvariv cilj. Pri tome je nezaobilazan pun angažman LOM-a.
Eating and lifestyle habits of first (n=169) and sixth (n=272) year students, aged 18 to 26 years, attending a Medical School in Zagreb, were compared related to the years of study. A ...self-administered questionnaire created for this study incorporated a food frequency questionnaire. Both year students reported similar number of meals per day, irregular consumption of meals, skipping breakfast, frequency of vegetables, fruits, cereals, sweets, milk and dairy products consumption, body mass index (BMI) calculated from self-reported weight and height and alcohol consumption. Significant differences between groups were observed in consuming supper (p = 0.001), being on diet (p = 0.032), intake of supplements (p = 0.041), meat (p < 0.001), dried meat (p = 0.027), coffee and tea consumption (p = 0.016), physical activity (p = 0.041; p = 0.016), and smoking (p = 0.029). This study showed non-healthy eating arid lifestyle behavior among Medical School students. We observed association between the year of study, and some of the eating habits and lifestyle factors.
Abstract The aim of this study was to examine specificity of GP's care for elderly depressed patients. Among 17,000 examinees (10 GP-Offices) were extracted 231 patients with diagnosis of depressive ...episode (F32) and 152 with diagnosis of recurrent depressive disorder (F33) classified according to ICD-10. Older than 65 years were 134 depressed patients. Data were tracked longitudinally and obtained retrospectively for a 1-year period from 1st January to 31st December 2008. Questionnaire was designed for this study to estimate the care delivered to depressed patients. Logistic regression analysis showed that GP more often diagnosed depression in older patients, provided medical care for them and changed their therapy. The main therapy for up to 80% of elderly with diagnosis of recurrent depressive disorder was combination of pharmacotherapy and GP's support and psychiatrist psychotherapy, while more than 20% of elderly with diagnosis of depressive episode took only pharmacotherapy. In comparison with younger age group, elderly less frequently received psychotherapy and GP's support. GP has an important role in older depressed patient care, so improvement efforts could focus on GP's clinical skills of depression treatment, as well as therapy effectiveness and depression outcome for understanding treatment specificity within elderly.
Although prevalence of asthma has increased particularly among children, asthma is still underdiagnosed and undertreated or inappropriately treated disease. Most of the health care for patients with ...asthma is provided by family physicians in primary health care. Nowadays recommendations (GINA 2006) are based on assessing asthma control levels, the cornerstone of therapy for persistent asthma of all degrees of severity, both in adults and children, are inhaled corticosteroids (ICS) as monotherapy, while long-acting beta2-agonists (LABA), leukotriene modifiers (LTRA) or theophylline are add-on therapy if the control of disease is not successfully achieved. Fixed combination (ICS + LABA) could be used only for moderate to severe persistent asthma and in cases when satisfactory control is not achieved using ICS alone. Unjustified trend towards initial fixed combination prescribing has become more and more popular, but with potential of overuse.
The aim of this study was to investigate statin prescription by family doctors (GP) in primary (PP) and secondary (SP) prevention of cardiovascular diseases (CVDs). Patients' socio-demographic data, ...total cholesterol (TC) and LDL-cholesterol (LDL-C) thresholds for statin prescription, indications, data on GP and practices were registered. Statins were prescribed in 11.2% enlisted patients (64.11% PP, 35.88% SP), mostly aged 70+. In PP, thresholds were TC 6.2 +/- 1.09 mmol/L, LDL-C 3.6 mmol/L, in SP 5.4 +/- 1.26 mmol/L, 2,7 mmol/L, respectively. Most frequently prescribed statin in PP was 10 mg atorvastatin (49.28%), in SP it was 20 mg simvastatin (48.36%). Participating GPs were women, aged 39 +/ 5.49, working for 13 +/- 6 years, the average number of enlisted patients per GP 1562 +/- 299. There was statistically significant difference in statin prescription in PP (chi2 = 752.9; p < 0.001) and SP (chi2 = 64; p < 0.001). Statin prescription in PP is due to pharmaceutical marketing and lack of independent continuing medical education. The fact that statins are most frequently prescribed in patients aged 70+ (35.28% in PP 49.35% SP) reveals lack of preventive proactive CVDs approach in younger age groups, which is concerning.
The use of complementary and alternative medicine (CAM) is widespread around the world including Croatia. The number of studies that investigate both quantitative and qualitative use of CAM in ...Croatia is limited. The aim of this study was to investigate the use of CAM among family medicine patients in the town of Čakovec and the rate they report it to their family doctor. This was a cross-sectional study in a sample of 300 patients that visited primary health center for any reason. We used anonymous questionnaire already employed in a previous investigation (Čižmešija et al. 2008), which describes socioeconomic characteristics, modalities of CAM use, and reasons for use. We also added questions on the type of herbs used and use of over-the-counter vitamin and mineral supplements. On data analysis we used descriptive statistics, χ2-test and Fisher's exact test, while the level of statistical significance was set at p ≤ 0.05. The response rate was 76%. Out of the total number of patients, 82% used some modality of CAM. Women, patients with secondary school education, employed and retired persons used CAM more often. Students and pupils reported least use of CAM. The most commonly used were herbs (87%), bioenergy (29%), diet therapy (28%), chiropractics (22%), and homeopathy and acupuncture (11% each). Vitamin and mineral supplements were used by 77% of study subjects. CAM was most frequently used for respiratory, urinary and musculoskeletal problems, as well as to improve overall health condition. Of the respondents that reported CAM use, 55% believed it would help them, 43% used it because they wanted to try something new, while only 2% indicated dissatisfaction with their physician as the reason for using CAM. Statistically, there were more subjects that used CAM and did not notify their family doctor about it, which could indicate poor communication between family doctors and health care users. Our results are consistent with a previous quantitative study conducted in Croatia and with literature data on the countries with a predominant use of western medicine. Qualitative data from previous studies in Croatia could explain the cultural and socioeconomic context of CAM use. Dissatisfaction with their physician as the reason for using CAM was rarely indicated, suggesting that CAM most probably fills the gap between successful and unsuccessful treatment, and perception that evidence based medicine has its own limitations. The arguments to turn to CAM therapy could involve poor doctor to patient ratio, i.e. 1750 patients per family medicine doctor on average, and the 20% increase in the number of diseases and conditions diagnosed by family medicine units. In conclusion, these results suggest that the use of CAM is common among patients in family medicine. When taking patient history, doctors should ask about CAM use and be aware of the patient beliefs and lifestyle. When patients strongly believe in CAM methods, there is the need of making compromise in therapy, with explanation of the possible side effects and at the same time continuous follow up. There is the need of additional education of family doctors and population about good and bad effects of CAM. In Croatia, accent should be on herbalism because this modality is most widespread.
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.
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