| Abstract | Cilj istraživanja. Odrediti predstavlja li laktacijski mastitis dijagnostički i terapijski izazov
LOM-ovima RH. Da bi ispitali navedeno bilo je potrebno odrediti koliko se dojilja s
laktacijskim mastitisom javilo LOM-ovima RH u razdoblju od kolovoza 2012. do kolovoza
2013. godine te koji su najčešći klinički simptomi i znakovi na temelju kojih LOM-ovi RH
postavljaju dijagnozu laktacijskoga mastitisa. Željeli smo ustanoviti koliki postotak LOM-ova
RH pacijenticama s laktacijskim mastitisom preporučuje medikamentozno ili druge oblike
liječenja bolesti te koje im savjete o prehrani djeteta, za vrijeme trajanja bolesti, daju.
Zanimalo nas je jesu li LOM-ovi RH s osobnim iskustvom laktacijskoga mastitisa manje
skloni preporuci antibiotskog liječenja i prekida dojenja za vrijeme trajanja laktacijskog
mastitisa i koliko sigurnima se osjećaju pri postavljanju dijagnoze i liječenju bolesti. U
konačnici, željeli smo doznati misle li LOM-ovi RH da im je potrebno obrazovanje u
području medicine dojenja, bi li željeli sudjelovati u organiziranim događanjima vezanima za
medicinu dojenja i ako da, koji oblik događanja bi im, pri tome, bio najpoželjniji.
Ustroj istraživanja. Presječna studija.
Mjesto istraživanja. Medicinski fakultet u Splitu, Sveučilište u Splitu.
Ispitanici i postupci. U razdoblju od sredine srpnja do kraja kolovoza 2013., među LOMovima
RH (N=2338), provedeno je istraživanje o laktacijskom mastitisu. Istraživanje je
provedeno primjenom Anketnog upitnika o laktacijskom mastitisu za liječnike obiteljske
medicine Republike Hrvatske. Kategorijske varijable prikazane su kao cijeli brojevi i postotci,
a za analizu kvalitativnih vrijednosti upotrijebljen je χ² test. Vrijednosti P<0,05 smatrane su
statistički značajnima.
Rezultati. U odnosu na lokalizaciju ordinacije u kojoj rade, među ispitanicima je postojala
statistički značajna razlika prema: spolu (P=0,033), dobi (P=0,001), razdoblju od
diplomiranja na medicinskom fakultetu (P=0,001), najvišem stupnju medicinskoga
obrazovanja (P=0,001), razdoblju od završavanja specijalizacije iz obiteljske medicine
(P=0,017) i statusu ordinacije u kojoj rade (P=0,002). Među ispitanicima čija su djeca bila
dojena, 136 (72,3%) ispitanika nije imalo osobno iskustvo laktacijskog mastitisa, a njih 51
(27,1%) je imalo osobno iskustvo bolesti. Među ispitanicima s osobnim iskustvom
laktacijskog mastitisa, 19 (37,2%) ispitanika je, tijekom posljednje epizode bolesti, liječeno
antibiotikom a njih 30 (59%) nije liječeno antibiotikom. U istoj skupini ispitanika, dojenje je
privremeno prekinulo 14 (27%) ispitanika dok 36 (72%) ispitanika nije prekidalo dojenje za
vrijeme trajanja bolesti. Među ispitanicima s osobnim iskustvom laktacijskoga mastitisa postojala je statistički značajna razlika u odnosu na antibiotsko liječenje bolesti prema
prehrani djeteta za vrijeme trajanja bolesti (P=0,055). U posljednih godinu dana čak 64%
ispitanika imalo je, u svojoj ordinaciji, pacijenticu s laktacijskim mastitisom (n=376).
Najčešći klinički znakovi i simptomi na temelju kojih su ispitanici postavljali dijagnozu
laktacijskog mastitisa bili su: bol u dojci, crvenilo kože dojke, povišena tjelesna temperatura i
otok dojke. Antibiotsko liječenje bolesti preporučilo je 93% ispitanika. Najčešća klinička
indikacija za preporuku antibiotskoga liječenja bolesti bila je povišena tjelesna temperatura.
Ispitanici s osobnim iskustvom laktacijskog mastitisa bili su manje skloni preporuci
antibiotskog liječenja bolesti. Nemedikamentozne mjere liječenja bolesti preporučilo je 88%
ispitanika, pri čemu su najčešće preporuke bile: primjena hladnih obloga i izdajanje oboljele
dojke. Savjete o prehrani djeteta dalo je 88% ispitanika, pri čemu je najčešća preporuka bila
nastavak dojenja djeteta. Ispitanici s osobnim iskustvom laktacijskog mastitisa bili su skloniji
preporuci nastavka dojenja za vrijeme trajanja bolesti.Većina (63%) ispitanika osjeća se
potpuno sigurnima pri postavljanju dijagnoze laktacijskoga mastitisa. Četrdeset i sedam posto
ispitanika osjeća se potpuno sigurnima pri liječenju laktacijskoga mastitisa, dok se pri
liječenju ostalih bolesnih stanja dojke koja se mogu pojaviti za vrijeme dojenja većina (57%)
ispitanika osjeća djelomično sigurnima. Više od polovice (56%) ispitanika nije imala nastavu
iz područja medicine dojenja. Velika većina (90%) ispitanika misli da bi LOM-ovi RH trebali
biti obrazovani u području medicine dojenja pri čemu bi većina (83%) njih sudjelovala u
organiziranim događanjima vezanima za medicinu dojenja. Najpoželjniji oblici organiziranih
događanja vezanih za medicinu dojenja, za ispitanike koji bi sudjelovali u ovim događanjima
bili bi: klinička praksa/radionice, tečajevi/seminari i on-line tečajevi.
Zaključak. Laktacijski mastitis ne predstavlja značajniji dijagnostički izazov LOM-ovima
RH. Ipak, liječenje ovog bolesnog stanja dojke u ordinacijama LOM-ova RH, još uvijek nije
u potpunom skladu sa suvremenim preporukama o liječenju istoga te, stoga, iziskuje daljnju
izobrazbu. |
| Abstract (english) | Objectives. To determine whether lactational mastitis represents a diagnostic and therapeutic
challenge for Croatian GPs. To define how many breastfeeding mothers with lactational
mastitis consulted Croatian GPs between August 2012 and August 2013 and which were the
most common clinical symptoms and signs used by Croatian GPs to diagnose lactational
mastitis. Furthermore, to determine what percentage of Croatian GPs recommend medications
or other forms of treatment to their patients with lactational mastitis and what advice on child
nutrition is given. We wanted to determine whether Croatian GPs with personal experience of
lactational mastitis were less prone to recommending antibiotic treatment and cessation of
breastfeeding during the episode of lactational mastitis and how confident they feel while
diagnosing and treating lactational mastitis. Ultimately, we wanted to find out whether they
think they need education in the field of breastfeeding medicine, whether they would
participate in organized events related to breastfeeding medicine and if yes, the preferred form
of events.
Design. A cross-sectional study.
Settings. The study was conducted at the School of Medicine, University of Split, Croatia.
Patients and methods. In the period from mid-July to late August 2013th, we conducted a
retrospective study on lactational mastitis among Croatian GPs (N=2338) using a
Questionnaire about lactational mastitis for general practitioners. Categorical variables were
presented as whole numbers and percentages. Comparison of qualitative variables was carried
out using the χ2-test. P <0.05 was considered statistically significant.
Results. In relation to the localization of the office in which they work, there was a
statistically significant difference among the respondents by: gender (P=0.033), age
(P=0.001), period of graduation from medical school (P=0.001), the highest level of medical
education (P=0.001), period from completion of specialization in family medicine (P=0.017)
and their office's status (P=0.002). Among the respondents whose children were breastfed,
136 (72.3%) of the respondents had no personal experience of lactational mastitis during
lactation, and 51 (27,1%) of them had a personal experience of lactational mastitis. Among
respondents with personal experience of lactational mastitis, 19 (37.2%) of the respondents
were treated with antibiotics during the last episode of the disease and 30 (59%) of them were
not treated with antibiotics. In the same group of respondents breastfeeding temporarily
discontinued 14 (27%) of the respondents while 36 (72%) of respondents did not interrupt
breastfeeding during the disease. Among respondents with personal experience of lactational mastitis there was a statistically significant difference by antibiotic treatment in relation to
child nutrition during the disease (P=0.055). In the past year, 64% of respondents had a
patient with lactational mastitis (n=376). The most common clinical signs and symptoms used
by Croatian GPs to diagnose lactational mastitis were: pain in the breast, skin redness, warm
skin, swelling of the breast, palpable lesion within the breast. Antibiotic treatment was
recommended by 93% of the respondents. The most common clinical indication for antibiotic
treatment recommendation was high fever. Respondents with personal experience of
lactational mastitis were less prone to recommend antibiotic treatment of disease compared to
those with no personal experience of the disease. Most frequently recommended measures
were: application of cold compresses and milk expression on the affected breast. Most (88%)
respondents advised their patients on child nutrition during the disease and their most frequent
advice was the continuation of breastfeeding during the disease. Respondents with personal
experience of lactational mastitis were more likely to advise their patients to continue
breastfeeding during the disease compared to those with no personal experience of the
disease. Most (63%) of respondents feel completely confident diagnosing lactational mastitis.
The largest number (47%) of them feel completely confident treating lactational mastitis and
the majority (57%) of them feel partially confident treating other breast conditions that can
occur during breastfeeding. More than half (56%) of the respondents had no education in the
field of breastfeeding medicine during their previous medical education. However, among the
respondents (N=71) who were educated in the field of breastfeeding medicine, as many as
11% of them attended more than 20 hours of theoretical classes. The vast majority (90%) of
respondents thinks Croatian GPs should be educated in the field of breastfeeding medicine
and most of them (83%) would participate in organized events related to breastfeeding
medicine whereby the most preferable forms of theese events would be: clinical
practice/workshops, courses/seminars and online courses.
Conclusion. Lactation mastitis does not represent a significant diagnostic challenge for
Croatian GPs. However, it's treatment is still not in full compliance with current
recommendations and therefore, requires furher training. |
