Željko Metelko

Bio: Željko Metelko is an academic researcher. The author has contributed to research in topics: Quality of life (healthcare) & Population. The author has an hindex of 5, co-authored 14 publications receiving 4630 citations.

Lifestyle habits of Croatian diabetic population: observations from the Croatian Adult Health Survey [Životne navike osoba sa šećernom bolepću u Republici Hrvatskoj: zapažanja iz Hrvatske zdravstvene ankete]

Abstract: 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.

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Abstract: Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes.

Peripheral arterial disease and diabetes mellitus.

Abstract: The aim of this study was to establish clinical characteristics and consequences of peripheral arterial disease in diabetic patients. The study included 350 inpatients, 54.6% men and 45.4% women. Women were statistically significantly older than men (67.2±9.1 vs. 61.7±9.8 years; p<0.0001). There were no statistically significant differences in diabetes duration (15.1±9.4 and 16.0±8.2 years in men and women, respectively; χ2-test=3.2; df=2; NS). Among study patients, 87.2% had lower leg peripheral arterial disease, 27.3% had an isolated form, and 59.9% had changes in proximal arteries. Asymptomatic stage of the disease was found in 12.6%, intermittent claudication in 38.9%, chronic critical ischemia in 25.7%, and foot ulcer or gangrene in 22.8% of patients. A total of 36 bypasses, 20 percutaneous transluminal angioplasties and 10 lumbar sympathectomies were performed in 15.7% of patients. A hundred and seven amputations, 70.1% minor and 29.9% major, were performed in 22.8% of patients. Early detection and regular ultrasound check-ups can increase the number of surgical or endovascular interventions, thus reducing the rate of amputations.

CroDiab web I UNAPRJEĐENJE DIJABETOLOŠKE SKRBI U PRIMARNOJ ZDRAVSTVENOJ ZAŠTITI

Abstract: Vođenje registra za šećernu bolest doprinosi sagledavanju epidemiološke situacije, a strukturirani pristup prijavama osoba sa šećernom bolešću (prijavljivanje optimalnog skupa informacija za praćenje i unaprjeđenje kvalitete dijabetološke skrbi) doprinosi poboljšanju regulacije rizičnih čimbenika. Cilj istraživanja bio je odrediti učinak registra CroDiab na metaboličke pokazatelje u bolesnika sa šećernom bolešću tipa 2 u primarnoj zdravstvenoj zaštiti te usporediti učinke kod bolesnika redovito prijavljivanih u registar svake godine u odnosu na povremeno prijavljivane bolesnike. Analizirane su vrijednosti glukoze u krvi natašte i postprandijalno, HbA1c, lipidograma, krvnog tlaka i indeksa tjelesne mase 2006. i 2008. godine te su uspoređene skupine bolesnika s redovitim i bolesnika s povremenim prijavljivanjem. U početku su se povremena i redovita skupina razlikovale u sistoličkom (142,4±16,6 naspram 136,8±16,6 mm Hg; p<0,001) i dijastoličkom krvnom tlaku (83,9±8,2 naspram 82,1±10,0 mm Hg; p=0,002), dok su se na kraju mjerenja pojavile i razlike u glukozi poslije obroka (10,63±3,12 naspram 10,02±3,44 mmol/L; p=0,024), HbA1c (7,97±1,52 naspram 7,39±1,17%; p<0001), ukupnom kolesterolu (5.60±1.15 naspram 5,25±1,13 mmol/L; p<0,001) i LDL-kolesterolu (3,28±0,93 naspram 2,98±0,92 mmol/L; p<0,001). Indeks tjelesne mase, glukoza natašte, HDL-kolesterol i trigliceridi nisu pokazali statistički značajnih razlika. Redovito prijavljivanje i nadziranje u registru CroDiab dovodi do značajnog poboljšanja glavnine metaboličkih pokazatelja, koje je u slučaju povremenog prijavljivanja zbog manjeg učinka registra na nadzor bolesnika manje izraženo.

Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment

Abstract: Background. The paper reports on the development of the WHOQOL-BREF, an abbreviated version of the WHOQOL-100 quality of life assessment. Method. The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health. Results. Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability. Conclusion. These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy. [References: 9]

Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group.

Abstract: Background. The paper reports on the development of the WHOQOL-BREF, an abbreviated version of the WHOQOL-100 quality of life assessment. Method. The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health. Results. Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability. Conclusion. These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy. [References: 9]

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.

Abstract: Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Depression and Quality of Life in Older Persons: A Review

Abstract: Background: Depression is a prevalent and disabling condition in older persons (≥60 years) that increases the risk of mortality and negatively influences quality