Suchergebnisse

Ispitana je perinatalna smrtnost prijevremeno rođenih blizanaca (do 37. tjedna) u Šibeniku, Zadru i Splitu u razdoblju od 1. siječnja 1988. do 31. prosinca 1990. godine (Period A) i od 1. siječnja 1991. do 30. rujna 1993. godine (Period B). Period A je vrijeme društveno političkih previranja u bivšoj Jugoslaviji, a Period B je vrijeme izravne vojne agresije. U Periodu A je bilo 23826 porođaja, od kojih je 234(0,98%) blizanačkih, a u Periodu B na 22292 porođaja 260(1,17%) su porođaji blizanaca. U periodu A nalazimo 140(29,9%), a u Periodu B 198(38,1%) prijevremeno rođenog blizanca (X 2 = 7,28; P0.05). Da je perinatalna smrtnost blizanaca u Periodu B bila kao u Periodu A, tada bi 14 blizanaca prijevremeno rođenih ostalo u životu. Autori zaključuju da je izravna vojna agresija na područje Šibenika, Zadra i Splita u trudnica sa blizancima prouzročila s jedne strane slabu neonatalnu zaštitu, ili je potpuno onemogućila, a s druge strane prouzročila je fizičke i psihičke traume, što je udruženo dovelo do povećanog prijevremenog rađanja blizanaca, posebice blizanaca do 31. tjedna trudnoće, povećanog rađanja blizanaca porođajne težine do 1499 g, s posljedičnim visokim perinatalnim mortalitetom. Izravna vojna agresija je neizravno prouzročila smrt 14 blizanaca, koji su prijevremeno rođeni. ; Perinatal mortality of preterm twins (up to 37 weeks of gestation) is analyzed, born in Šibenik, Zadar and Split in the two examined periods of time. Period A (1st January 1988 - 31st December 1990) is the time of socio-political turmoil in ex-Yugoslavia, whereas Period B (1st January 1991 - 30th September 1993) is the time of the direct military aggression on the area in question. In the Period A there were 23826 births, 234 (0.98%) of which were twins. Out of 22292 births in the Period B, 260 twins (1.17%) were born. In the Period A 140 twins (29-9%) were born prematurely, compared to 198 (38.1%) in the Period B (X2 = 7.28; pcO.Ol). Twin births before 31 weeks of pregnancy occurred less frequently in the Period A than in the Period B (4.3% :10.1%). Similarly, in the Period A there were less twins of the birthhweight under 1500 g (4.3% -14.7%) (p0.05). Had the perinatal mortality in the Period B been the same as in the Period A (and one should have expected even lower mortality rates), 14 premature twins would have lived. The authors draw a conclusion that the direct military aggression on the regions of Šibenik, Zadar and Split caused on the one hand poor or no antenatal care and on the other hand physical and psychological traumas to pregnant women. This led to an increased number of premature twin births, especially before 31st week of gestation, higher number of twins of birth weight under 1500 g and consequently to a high perinatal mortality. Direct military aggression indirectly caused the death of 14 premature twins.

Budući da su kardiovaskularne bolesti (KVB) i dalje vodeći uzrok pobola i smrtnosti, pokušavamo unaprijediti naša nastojanja u svrhu njihova smanjenja. U svakodnevnom radu implementiramo smjernice kardiovaskularne (KV) prevencije te educiramo pacijente kako bi promijenili loše životne navike i stavili pod kontrolu KV čimbenike rizika. Međutim, sve to nije dovoljno bez potpore cjelokupnoga društva i politike države. Stoga se postavlja pitanje što trebamo još učiniti, kako djelovati. Na primjeru Nizozemske članak upućuje na to kojim su aktivnostima, akcijama i udrugama, ali i reformama uspješno smanjeni KV smrtnost i pobol. ; Since cardiovascular diseases (CVD) are still the leading cause of mortality and morbidity, we have been attempting to increase our efforts to reduce their incidence. In everyday practice we implement cardiovascular (CV) prevention guidelines and educate patients on changing bad lifestyle habits and controling CV risk factors. However, all of that is insufficient without the support of the whole society and public policies. So the question must be asked: what else can we do and how should we act? The example of the Netherlands is used to point out activities, initiatives, associations, and also reforms that have been successful in reducing CV mortality and morbidity.

The indicators of health condition and providing medical protection are necessary for making assessment of health condition at the level of population, improvement of the healthcare system and making health-related and political decision with an aim to improve the citizens' health. Qualitative and reliable original data is necessary for the preparation of indicators. According to the indicators of mortality and morbidity, cardiovascular diseases (CVD) are the prioritized public health problem in Croatia. They are the major cause of mortality, in men with a share of 42.6% and in women with a share of 56.4% in total mortality. In CVD hospital morbidity, they are represented in men in the first place with a share of 14.9% and in women, they take the second place with a share of 12.5% in total number of hospitalizations. Totally, more women die of CVD and men die of CVD more frequently at younger age, however, women are hospitalized less frequently.

Uvod: U Hrvatskoj, smrtnost od raka debelog crijeva (RDC) viša je u usporedbi s prosjekom država članica Europske unije (EU). U Hrvatskoj se od 2007. godine provodi Nacionalni program ranog otkrivanja raka debelog crijeva (NPRDC), s ciljem smanjenja smrtnosti od RDC, otkrivanja bolesti u ranijem stadiju, poboljšanja mogućnosti liječenja i kvalitete života oboljelih. Prema Europskim smjernicama za osiguranje kvalitete probira i dijagnostike, prihvatljiv odaziv u NPRDC je najmanje 45%, koji u Hrvatskoj do sada nije postignut. Cilj: Cilj ovoga rada je procijeniti učinak javno-zdravstvene intervencije kućnog posjeta studenata medicine osobama uključenim u NPRDC na odaziv na test na okultno krvarenje (Hemocult test). Metode: Uzorak za intervenciju činili su sve žene i muškarci uključeni u NPRDC iz dva naselja (Vetovo i Kaptol) u Požeško-slavonskoj županiji. U Vetovu je provedena intervencija (N=338), a osobe iz Kaptola uzete su kao kontrolna skupina (N=417). Intervenciju kućnim posjetima su provodili studenti završne godine studija medicine uz koordinaciju Zavoda za javno zdravstvo Požeško-slavonske županije. Osobama koje su pristale sudjelovati u intervenciji objašnjen je razlog dolaska, provedeno je informiranje o važnosti sudjelovanja u NP kroz anketom vođeni razgovor te im je ponuđen Hemocult test uz detaljne upute o primjeni. Prikupljeni podatci obrađeni su u programu Microsoft Office Excel metodama deskriptivne statistike. Rezultati: Prije provedbe intervencije u Vetovu je odaziv u sklopu NPRDC (osobe koje su dale suglasnost za Hemocult test/osobe pozvane u NPRDC) bio 14,4%, a u Kaptolu 18,6%; χ2 (1)=1,177, p>0,05. Nakon provedbe intervencije, odaziv u Vetovu bio je 45,7%, a u Kaptolu 21%; χ2 (1)=29,986, p0,05. Nakon provedbe intervencije, odaziv u Vetovu bio je 24,7%, a u Kaptolu 15,1% (bez intervencije); χ2 (1)=6,317, p=0,012. Zaključak: U naselju gdje je provedena intervencija u obliku kućnih posjeta, postignut je značajno veći obuhvat neodazvanih osoba na Hemocult test, u usporedbi sa susjednim naseljem sličnih karakteristika, gdje su provedene uobičajeni postupci pozivanja osoba predviđeni protokolom u sklopu NPRDC. Rezultati rada ukazuju na važnost individualnog pristupa u javno-zdravstvenoj praksi u unapređenju provedbe NPRDC. ; Introduction: Colorectal cancer (CC) mortality in Croatia is higher than average of European Union (EU) member states. From 2007, National Colorectal Cancer Screening Program (NPCC) has been conducted in Croatia, with aim of reducing CC mortality, detecting illness in early stage, better treatment options and life quality improvement. According to European Guidelines for Quality Assurance of Screening and Diagnosis of CC, acceptable response rate to screening is at least 45%, which hasn't been reached in Croatia so far. Aim: The aim of this study was to evaluate impact of public health intervention in form of home visits made by medical students, on Hemoccult test to persons included in NPCC. Methods: The sample for intervention was persons included in NPCC from two settlements, Vetovo and Kaptol in Požega-Slavonia County. Intervention was performed in Vetovo (N=338), while participants from Kaptol served as control group (N=417). Home visits were conducted by final year of study medical students in coordination with Public Health Institute of Požega-Slavonia County. Students explained reason for visit, importance of participation in NP to persons who agreed to participate in intervention, using standardized survey interview, and offered Hemocult test with detailed explanation of how to use it. The data were processed in Microsoft Office Excel using descriptive statistic methods. Results: Before intervention, response rate within NPCC (persons who signed consent for Hemocult test/persons invited to NPCC) in Vetovo was 14.4% and 18.6% in Kaptol; χ2 (1)=1.177, p>0.05. After intervention, response rate in Vetovo was 45.7% and in Kaptol 21.0%; χ2 (1)=29.986, p0.05. After intervention, response rate to Hemocult test in Vetovo was 24.7%, and 15.1% in Kaptol (without intervention); χ2 (1)=6.317, p=0.012. Conclusion: In settlement where home visits intervention was performed, a significantly higher response rates on Hemocult test was achieved, compared with neighbouring settlement of similar characteristics, where usual NPCC protocol was followed. Results of the study implied importance of individual approach in public health practice in improvement of NPCC performance.

Tijekom rata 1992. godine, prošlo je u Bosanskoj posavini 6.105 vojnika kroz razne oblike zdravstvene skrbi. Poginulo je u to doba 920, teže ranjeno 3.258, a lakše ranjeno 1.927 vojnika. Oni su zbrinuti na sanitetskim etapama organiziranim na razini borbene linije, borbenog područja i veznog područja. Temelj zdravstvene struke na borbenoj liniji činile su bataljunske postaje, a na razini borbenog područja Medicinski centar Slavonski Brod. Njegova uloga bila je ključna, kako zbog kirurške obrade 5.418 ranjenika, tako i zbog definitivnog zbrinjavanja većine osoba koje su zatražile pomoć. U okolici Slavonskog Broda formirana su oporavilišta, a širom Hrvatske korištene su specijalizirane zdravstvene ustanove i rehabilitacijski centri, u kojima je, po potrebi, završavan proces liječenja. Takvom organizacijom zdravstvene skrbi umro je u Medicinskom centru Slavonski brod tijekom liječenja 161 ranjenik, što predstavlja mortalitet od 3,0%. ; During military operations in Bosanska Posavina in 1992, 6,105 soldiers of the Croatian Defence Council (Bosnian Croats and Mosliems) were treated at various health care levels: 920 soldiers were killed, 3,258 were heavily wounded and 1,927 lightly wounded. The treatment was provided in medical units organized at the front line, in the combat area and in the communication area. At the front line, medical service was organized as battalion units, whereas the area in general was medically covered by the Slavonski Brod Medical Center in Croatia. Slavonski Brod played a key role with surgical treatment of 5,418 wounded and definite care was offered to most subject seeking medical aid. The scarcity of medical personnel at the front front lines and long lines of transportation resulted in a 6.5% death rate (354 patients) during transportation from Bosnian batterfields to Slavonski Brod. By contrast, the mortality rate in Slavonski Brod Hospital was 3.0% (161 patient). Convalescence homes were established and health rehabilitation centers throughout Croatia accommodated those needing advanced treatment.

Uvod: Moždani udar ima visoku smrtnost kako u svjetskim okvirima tako i kod nas. Značajno financijski opterećuje kako republički tako i županijske zavode za zdravstveno osiguranje. Glavnina bolesnika ostaje trajnim invalidima, a uz velika financijska izdvajanja i upornu fizikalnu terapiju oporavi se mali broj bolesnika (jedna trećina). Osim medicinskog osoblja koje sudjeluje u tretmanu bolesnika oboljelih od MU, veliku ulogu u oporavku imaju obitelj i bolesnikovo šire i daljnje okruženje. Cilj rada: je utvrditi broj i distribuciju bolesnika liječenih od moždanog udara u 2017. godini, procijeniti ishode liječenja te utvrditi vrstu antikoagulantne terapije na otpustu. Definirati i analizirati faktore rizika s osvrtom na primarnu i sekundarnu prevenciju. Procijeniti postojeću skrb bolesnika, uz definiranje mjesta i uloge medicinske sestre. Metode: Ciljni parametri prikupljeni su iz medicinske dokumentacije koja je nastala tijekom liječenja bolesnika. Varijable, prikupljene iz elektronskih otpusnih pisama unesene su u elektronički zapis ispitanika u program Microsoft Excel, po posebno izrađenoj tablici podataka. Rezultati: Sudjelovalo je 167 bolesnika, 86 žena (51,50%) i 81 muškaraca (48,50%). Najzastupljeniji faktori rizika bili su hiperlipidemija i hipertenzija, fibrilacija atrija i dob iznad 70 godina. Od moždanog udara 2017. god. umrlo je 45 bolesnika (26,90%), više muških (53,30%), s neurološkim deficitom ostalo je 56 bolesnika (33,50%), više muških (53,60%), a djelomično ili potpuno oporavljenih je bilo 66 (27,00%), više kod žena (59,00%). U tretmanu fibrilacije atrija (67,00%), mali dio bolesnika je na Warfarinu i NOACs, 88 njih (52,30%) u odnosu na 134 na acetilsalicilnoj kiselini (80,20%). Postoji statistički značajna razlika u vrsti i broju čimbenika rizika MU u odnosu na dob i spol ispitanika. Stariji bolesnici skloniji su većoj smrtnosti. Muški spol je faktor rizika i među muškarcima veća je ukupna smrtnost. Zaključak: Prepoznavanje i sustavno provođenje politike unaprjeđenja i očuvanja zdravlja uz aktivnosti na području primarne, specijalističke i bolničke zdravstvene zaštite osnovni su preduvjeti postizanja uspjeha u prevenciji moždanog udara. U stvaranju takvog okruženja nužna je suradnja zdravstva s drugim strukturama javnog života. ; Introduction: Stroke has high mortality both in the world and in us. Significantly financially burdens both the republic and county health insurance bureaus. The majority of the patients remain with permanent invalids, and with a small amount of financial resources and persistent physical therapy, a small number of patients (one-third) recover. In addition to the medical staff involved in the treatment of patients with MU, a major role in recovery has the family and the patient's wider and further environment. Aim: The aim of the study was to determine the number and distribution of stroke patients in 2017, to evaluate the outcomes of the treatment and to determine with whom the patients were relieved from the department (antiagregation, new oral anticoagulants, warfarin). Also, risk factors will be defined and analyzed with reference to primary and secondary stroke prevention. Existing patient care will be evaluated, along with the definition of the nurses' place and role in the treatment of this type of patient. Methods: Target parameters were collected from medical documentation that was generated during patient treatment. Variables, collected from electronic resignation letters were submitted to the electronic record of the respondents in the Microsoft Excel program by a specially made data table. Results: A total of 167 patients, 86 women (51.50%) and 81 males (48.50%) participated in the study. The most frequent risk factors were hyperlipidemia and hypertension, more frequent in the male population, while atrial fibrillation and age over 70 were more common in women. From a stroke in 2017, 45 patients (26.90%), more males (53.30%) died, with 56 (33.50%), more male (53.60%), and partially or completely recovered, with a neurological deficit 66 (27.00%), more in women (59.00%). In the atrial fibrillation treatment (67.00%), as the most frequent risk factor, a small part of the patients were on Warfarin and NOAC, 88 (52.30%) versus 134 on acetylsalicylic acid (80.20%). Research has shown that there is a statistically significant difference in the type and number of stroke risk factors in relation to age and sex of respondents. It has been found that elderly patients with greater comorbidity are more likely to be more mortally affected. It was also found that the male gender risk factor in the investigated population and that in the male population the total mortality was higher. Conclusion: Recognizing and systematically implementing a general policy of improving and preserving health as well as activities in the area of primary, specialist and hospital health care are the basic preconditions for achieving success in the prevention of cerebrovascular diseases. In creating such an environment, it is necessary to co-operate with other sectors of public life.

Uvod: Hipertenzijauzrokujeoko6% smrti u svijetu i sve je učestalija i u odraslihi u djece. Dugo se smatralo da je hipertenzija među djecom uzrokovana sekundarno, uglavnom bolešću bubrega, no u stvarnosti je ona mnogo rjeđa nego ona primarnoga uzroka. Ukoliko se u djece otkrije i utvrdi hipertenzija i dijagnostičkom obradom se ne utvrdi uzrok, smatra se da je hipertenzija primarna. Povišene vrijednosti arterijskoga tlaka u djetinjstvu imaju tendenciju zadržavanja do odrasle dobi. S vremenom nastaju oštećenja ciljnih organa kao što su hiper trofijalijeve klijetke i zadebljanje stijenke karotidnih arterija. Osim oštećenja ciljnih organa, rezultati istraživanja ukazali su i na pridružene čimbenike rizika: preuhranjenost, pozitivnu obiteljska anamneza za kardiovaskularne rizike, nisku porođajnu tjelesnu masu, prehranu s velikim unosom soli, zasićenih masnih kiselina i visokim udjelom šećera, pijenje alkohola, pušenje duhana te sedentarni način života. Materijali i metode: Povišeni arterijski tlak u djetinjstvu se definira prema međunarodno prihvaćenim kriterijima i centilnoj distribuciji arterijskoga tlaka, objavljenim u četvrtom izvješću Task Force on Blood Pressure Controlin Children, premadobi, spolu i tjelesnoj visini. Rezultati: Primjenom međunarodno prihvaćenih kriterija, objavljenih u četvrtom izvješću Task Force on Blood Pressure Controlin Children, rezultati dosadašnjih istraživanja u svijetu pokazali su da se učestalost povišenoga arterijskog tlaka u djece kreće u rasponu od manje od jedan do 35%. U Hrvatskoj je primjenom navedenih kriterija zabilježena učestalost povišenoga arterijskog tlaka od 20,3% djece u prvom razredu osnovne škole, 39,5% u osmom i u 56,9% u trećem razredu srednje škole. Zaključak: Rezultati dosadašnjih istraživanja provednihu svijetu i u Hrvatskoj među školskom djecom, ukazali su na potrebu razvoja i implementacije preventivnih programa za kardiovaksularne rizike,prije nego što se usvoje rizične navike i ponašanja. Bolje razumijevanje kardiovaskularnih rizika u školske djece i mladih polazište je u unapređenju znanja o društvenom utemeljenju zdravlja školske djece, podizanju svijesti znanstvene i stručne javnosti o visokoj razini prisutnog kardiovaskularnog rizika u djetinjstvu i mladosti i razvoju znanstveno utemeljenih specifičnih mjera u okviru javno-zdravstvene politike kako bi se u budućnosti smanjio morbiditet i mortalitet od kardiovaskularnih bolesti. ; Introduction: Hypertension causes about 6% of all death worldwide and prevalence of hypertension is increasing in adults and in children. It has been considered that hypertension among children has secondary cause, mostly kidney disease, but it has been less common than the primary cause. If hypertension is detected in children and the cause is not revealed, hypertension is considered to be primary. Elevated blood pressure has a tendency to track from childhood to adulthood. Over time, damage to target organs, such as left ventricular hypertrophy and carotid artery wall thickening, occur. In addition, the results of the study also pointed to the associated risk factors such asoverweight, positive family history of cardiovascular risks, low birth weight, eating habits with high salt intake, saturated fatty acids and sugar, alcohol consumption, tobacco 10 smoking and sedentary lifestyle. Materials and methods: Elevated blood pressurein childhood is defined according to internationally accepted criteria and percentile distribution, by age, sex and body height,developed and published in fourth report of the Task Force on Blood Pressure Control in Children. Results: Using criteria published in fourth report of the Task Force on Blood Pressure Control in Children, the results of the studies conducted among childrenand adolescents worldwide have shown prevalence of elevated blood pressure from less than 1% to 35%. Using internationally accepted criteria, the prevalence of elevated blood pressure in Croatia from 20.3% children in first grade, 39.5% in eighth grade of elementary school to 56.9% in third grade of high school, has been reported. Conclusion: The results of the studies in school children worldwide and in Croatia have point to the need of development and implementation of preventive programs for cardiovascular risks, before acceptance of risk behaviours. Better understanding of cardiovascular risks in school-aged children is a starting point for improvement of knowledge about the social foundations of youngster's health. It raises awareness of scientists and health professionals about the high level of cardiovascular risks in school age and need for development of evidence-based specific measures within public health policy that could help to reduce morbidity and mortality of cardiovascular diseases in the future.