Family medicine as a discipline is more than other specialties oriented to holistic approach to patient. The physician has to know and use the possibilities of clinical, first of all somatic but also ...psychosociological medicine, and to continuously evaluate and follow-up results of his/her own work. The aim of the article is to present differences in clinical judgment before and after postgraduate study in family medicine. A 60-year-old woman living with her disabled son is presented. She visited her family physician many times complaining of a number of symptoms: itching, hypertension, sleep disturbance, poor general condition, trembling. It took ten months to diagnose hyperthyroidism and to begin appropriate therapy. Polysymptomatolgy of the disease based on the patient's psychological and family situation was the reason for the long-lasting wandering to definitive diagnosis. Analysis of the case revealed that neither clinical nor holistic approach was properly used in family medicine. The wrong clinical approach could be explained by fact that this physician worked for years without specialization or continuing education in family medicine. The authors conclude that postgraduate education as part of professional training in family medicine enables physicians to recognize and distinguish the interference of psychological, somatic and environmental factors, which is a major characteristic of good family practice.
The aim of the study was to investigate differences in health behavior and life habits between physicians and medical nurses as related to their own health.
Study subjects were health professionals ...from various parts of Croatia attending a scientific meeting, who filled out a special questionnaire (36 males and 178 females). They were divided into two groups according to education and work performed: physicians (n = 125) and medical nurses (n = 89). The questionnaire designed for the study, How medical workers keep their health, was used to estimate the factors influencing their health. The study was performed during 2005.
The results showed that, regardless of education or work, our health professionals did not have healthy life habits. Both physicians and nurses were equally obese (p = 0.423) and physically inactive (p = 0.403). There was a significant difference between these two groups in smoking habits (p = 0.008), occasional alcohol consumption, regularity of breakfast intake (p = 0.019), and number of daily meals (p = 0.047). The following was done for the control of risk factors: laboratory tests of cholesterol and glucose, measurement of blood pressure, dental examination (p = 0.404), prostate examination (p = 0.406), breast self examinations (p = 0.810), mammography (p = 0.289), and Pap test (p = 0.683). None of these factors showed significant between group differences. There was a statistically higher number (64.9%; p < 0.001) of physicians without family physicians than among medical nurses (8.1%).
Medical nurses consulted their family physicians more frequently than doctors, but most physicians were inclined to self treatment. A great proportion of nurses were smokers, whereas many physicians reported alcohol consumption. Physicians used sedatives more than nurses, and their physical activity was better. Nurses had more frequent control laboratory tests of cholesterol and glucose, and measurements of blood pressure. They were also better in the number of daily meals. A vast majority of patients cite their physicians as their primary source of information regarding healthy lifestyle decisions. These findings suggest strategies to improve the physicians' health behavior.
Dispepsija je čest simptom u bolesnika koji posjećuju ordinaciju obiteljske medicine. Prevalencija u odrasloj populaciji iznosi oko 40 %. Dvije trećine bolesnika ima funkcionalnu dispepsiju. Klinička ...procjena, dijagnostički postupak i liječenje bolesnika ovisi o dobi, simptomima i infekciji bakterijom Helicobacter pylori. U bolesnika s dispepsijom neophodno je procijeniti mogući učinak drugih istodobnih bolesti i lijekova koje bolesnik redovito koristi. Promptna ili rana endoskopija preporučuje se bolesnicima sa simptomima alarma i starijima od 50 godina s novonastalom dispepsijom. U mlađih od 50 godina preporučena strategija je „testiraj i tretiraj“. U dijelu bolesnika liječenje se provodi supresijom kiseline. U bolesnika u kojih se ne postiže uspjeh, provodi se daljnja endoskopska dijagnostika. Ultrazvučna dijagnostika na razini primarne zdravstvene zaštite može značajno doprinijeti u dijagnostičkoj procjeni i ranom liječenju bolesnika s bolestima hepatobilijarnog trakta i pankreasa, a koji se prezentiraju simptomima dispepsije. Liječenje istodobnog psihičkog poremećaja može unaprijediti simptome dispepsije. Liječenje bolesnika koji ne odgovaraju na preporučene strategije liječenja izazov je za obiteljskog liječnika. Redoviti posjeti i psihoterapijska potpora u ovih bolesnika mogu reducirati razinu anksioznosti te ohrabriti bolesnika u liječenju prikrivenog psihološkog morbiditeta kao i u njegovim nastojanjima zdravog ponašanja.
Metabolic syndrome in family medicine Marković, Biserka Bergman; Kern, Josipa; Milaković, Sanja Blazeković ...
Acta medica Croatica
61, Številka:
3
Journal Article
To investigate the possibilities of diagnosing metabolic syndrome (MS) based on the data collected from patient records at the level of family health care, and to assess possible sex differences in ...MS prevalence as well as differences between individuals with and without MS.
Data on age, sex, body mass index (BMI), systolic and diastolic blood pressure, and laboratory findings (blood sugar, triglycerides, total cholesterol and HDL cholesterol) were collected during a one-year period (June 2004 - June 2005) from standardized existing records of all patients covered by three general practitioners in Zagreb. MS was defined according to WHO criteria. Statistical analysis was performed with chi2-test for qualitative and t-test for quantitative variables.
The data recorded showed that general practitioners either did not practice some activities or did not take notes of what they did. The overall incidence of MS was 6.64% (6.01% in men and 6.78% in women). Men and women with MS showed statistically significant differences in BMI (p=0.033) and age (p<0.001). Men with MS showed a statistically significant increase in fasting glucose (p<0.001), triglycerides (p=0.005), systolic blood pressure (p<0.001), diastolic blood pressure (p=0.0020), and lower HDL cholesterol (p=0.021). MS men were older than men without MS (p<0.001). Women with MS had a statistically significantly higher level of fasting glucose (p<0.001), triglycerides (p<0.001), BMI (p=0.035), systolic blood pressure (p<0.001), and diastolic blood pressure (p<0.001), and lower HDL cholesterol (p<0.001) than women without MS. MS women were by 18.6 years older (p<0.001).
The data recorded by general practitioners in medical documentation are sufficient for MS diagnosis. However, the low prevalence of MS shows inadequate awareness of the role of MS in cardiovascular disease.
Deklaracija o e-zdravlju - deset godina poslije Kern, Josipa; Belani, Hrvoje; Bergman Marković, Biserka ...
Bilten Hrvatskog društva za medicinsku informatiku (Online),
03/2022, Letnik:
28, Številka:
1
Paper
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Deklaracija o e-zdravlju, projekt Odbora za e-zdravlje Akademije medicinskih znanosti Hrvatske (AMZH), objavljena je 2011. godine na mrežnim stranicama Akademije medicinskih znanosti Hrvatske. Uz ...manje izmjene, tekst Deklaracije na hrvatskom jeziku dostupan je na mrežnim stranicama Akademije medicinskih znanosti Hrvatske i, na engleskom jeziku, u Biltenu Hrvatskog društva za medicinsku informatiku te na društvenoj mreži ResearchGate.net. Da bi se vidjelo što se dogodilo s Deklaracijom nakon 10 godina provelo se je vrednovanje prema OECD-ovom modelu „ulog-odgovor-ishod-učinak“, i to kroz direktne posljedice, tj. službene dokumente koji u potpunosti preuzimaju pojedine njezine navode, i kroz činjenice realizirane nakon objave Deklaracije a koje su u skladu s navodima u njoj. U radu je opisan svaki korak (ulog, odgovor, ishod, učinak). Glavni ishodi su navedeni u tablici s nazivima dokumenata i citata koji potvrđuju usklađenost s navodima Deklaracije. Što se tiče učinka, pet je navoda iz Deklaracije postiglo zamjetljiv učinak, impakt u zdravstvenom sustavu. Iako još nije realizirano u potpunosti (npr. nemaju sve bolnice zadovoljavajući sustav koji se uklapa u centralni zdravstveni informacijski sustav; zdravstveni portal za komunikaciju s građanima postoji ali je otvoreno pitanje koliko ga građana koristi; certifikacija se provodi prema određenim kriterijima i protokolima ali nije u potpunosti usklađena s kriterijima EuroRec-a; medicinsko/zdravstveno informatičko obrazovanje postoji ali nije ujednačeno na svim medicinskim/zdravstvenim obrazovnim ustanovama – ni sadržajno, niti mjestom u obrazovnom kurikulu), postoji niz ishoda koji su usklađeni s Deklaracijom i međunarodnim stremljenjima i koji su na putu da postanu zamjetljiv učinak Deklaracije. Treba uzeti u obzir da i međunarodno gledajući nema konačnog i zadovoljavajućeg rješenja i da još treba i vremena i napora da bi se realizirao digitalizirani zdravstveni sustav u nacionalnim okvirima ali i međunarodno.
Abstract Background Early detection of mental retardation and other epilepsy-associated impairments is essential for successful medical and social care of children with epilepsy; the corresponding ...information for children in Croatia has not yet been known. Aims of the study To obtain the basic information of epilepsy-associated disability in preschool children, and fundamentals of their medical and social care. Methods Data about mental retardation and other associated impairments (motor, speech, seeing, hearing), antiepileptic drug therapy and diurnal residence were collected by means of questionnaires completed by physicians working in primary health care (PHPs). Only children (0–7 years) with active epilepsy confirmed previously by neuropaediatricians were included. Results A total of 37 PHPs provided the required data for 116 children. One or more impairments were found in 56% children; most frequent were motor impairments (47%), speech impairments (42%) and mental retardation (40%). The regular kindergarten attendance rate of children without impairment (33%) was not different from the children without epilepsy, but high proportion (76%) of children with impairment stayed with their families during weekdays. In this subgroup monotherapy was more rarely used (64% vs. 90% in children without impairment ( p < 0.01)). Valproate was predominantly used (56%) in children with and without impairment; lamotrigine was more frequently used in the former subgroup ( p < 0.01). Conclusions Existence of associated impairments has significant impact on medical and social care in preschool children with epilepsy. These children need an early diagnosis and consecutive multidisciplinary care of their intellectual and body impairments, as well as problems in social development.
Podatkovna otvorenost u svjetlu digitalne revolucije Kern, Josipa; Mustajbegović, Jadranka; Bergman Marković, Biserka ...
Ljetopis ... (Akademije medicinskih znanosti Hrvatske),
03/2018, Letnik:
16, Številka:
1
Web Resource
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Početkom 2016. godine Akademija medicinskih znanosti Hrvatske dobila je informaciju o Sporazumu četiriju međunarodnih znanstvenih organizacija (Međunarodni savjet za znanost, Međuakademijsko ...partnerstvo, Svjetska akademija znanosti i Međunarodni savjet za
društvene znanosti) s molbom da ga podrži. Sporazum definira podatkovnu otvorenost kao koncept, kao ideju prema kojoj izvjesni podatci trebaju biti dostupni za uporabu i ponovljeno objavljivanje bez ikakvih ograničenja poput autorskih prava, patenata ili nekih drugih mehanizmima kontrole. Otvoreni pristup se odnosi u prvom redu na podatke iz znanstvenih istraživanja koja su financirana javnim novcem, posebice istraživanja od posebne važnosti za aktualne globalne izazove. Otvorenost pristupa podatcima smatra se temeljnim preduvjetom za rigorozno provođenje znanstvenih istraživanja i maksimiziranje javne koristi od aktualne digitalne revolucije. Sporazum predlaže 12 načela kao vodič u provođenju podatkovne otvorenosti, usmjerenih na uloge znanstvenika, izdavača, knjižnica i drugih zainteresiranih strana, kao i na tehničke zahtjeve na otvorenost podataka, te procjenjuje granice otvorenosti.
Pozadina. Kardiovaskularne bolesti (KVB) su prema podacima WHO vodeći uzrok smrtnosti u suvremenom svijetu pa i u Hrvatskoj, gdje čine 49,6% ukupnog mortaliteta.
Cilj. Istražiti bilježenje čimbenika ...rizika KVB u hipertoničara u skrbi liječnika obiteljske medicine dviju ordinacija grada Splita, kao i postizanje ciljnih vrijednosti arterijskoga tlaka i glikemije u istih.
Ispitanici i metode. Napravljeno je retrospektivno pilot-istraživanje pregledom elektroničke baze podataka. Iz uzorka hipertoničara svake ordinacije, generatorom slučajnih brojeva odabrana je po polovina, te su ispitanici razvrstani u skupinu primarne (PP) i sekundarne prevencije (SP). Zabilježeni su: dob, rod, postojanje podataka o indeksu tjelesne mase (BMI), pušačkom statusu, kolesterolemiji, glikemiji natašte (GUK) i arterijskom tlaku (RR), te postizanje ciljnih vrijednosti arterijskoga tlaka i glikemije.
Rezultati. U ukupnom broju ispitanika (N = 445), BMI je zabilježen u njih 19,8%, pušački status u 19,8%, kolesterolemija u 71,9%, GUK u 72,1%, te RR u 80,9% slučajeva. Glikemija i kolesterolemija su
češće zabilježene u uzorku SP, nego PP. Kod ispitanika koji su imali zabilježen arterijski tlak, ciljna vrijednost u PP je postignuta u 63,8%, a u SP u 40,4% njih. U uzorku SP, od 115 ispitanika kod koji je zabilježena glikemija ciljna vrijednost je postignuta u 53,9% slučajeva.
Zaključak. Naše istraživanje je pokazalo kako je bilježenje i praćenje čimbenika KV rizika, te postizanje ciljnih vrijednosti RR i glikemije u istraživanim ordinacijama bilo neadekvatno.
