The retrospective study was to analyse some characteristics of patients with lower limb amputations due to tumour, as well as the prosthetic rehabilitation. From 2000 to 2004, we observed 46 patients (25 men and 21 women) who were admitted prosthetic rehabilitation after a lower limb amputation due to tumours. We examined their medical documentation and recorded their general clinical status paying a special attention to the local status of the stump. The average age of patients was 51 +/- 17.11 years. Osteosarcoma was the most frequent cause in 26%. The trans-femoral amputation was in 50% and the knee disarticulation was in 8.7%. The average duration of prosthetic rehabilitation was 35 +/- 7.94 days. The average daily use of the prosthesis was 5.5 h. At the time of admission for rehabilitation, 10.9% of patients were using wheelchairs, 8.7% were using walkers and 80.4% were using two crutches to assist their walking abilities, whereas at the time of discharge 89.1% of patients used two crutches and 4.4% used one crutch for assistance, while 6.5% were able to walk unassisted. The adequate prosthetic rehabilitation in patients with lower limb amputations due to tumour is important preconditions for reintegration into the family and community.

Aim To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care.Methods Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100 000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data.Results There was no significant difference in the total number of physicians per 100 000 inhabitants between predominantly urban and predominantly rural counties (206.9 ± 41.0 vs 175.4 ± 30.3; P = 0.067, t test) nor between richer and poorer counties (194.5 ± 49.8 vs 187.7 ± 25.3; P = 0.703, t test). However, there were significantly fewer GPs per 100 000 inhabitants in rural than urban counties (49.0 ± 5.5 vs 56.7 ± 4.6; P = 0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8 ± 172.8 vs 1.540.7 ± 106.3; P = 0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. ConclusionThe lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP. 385Access to health care is achieved by even distribution of health care institutions and health workers across the country (1). Many countries encounter the problem of uneven regional distribution of physicians. In England and Wales, uneven distribution of general practitioners (GP) was found, with minimum changes over the twenty-year period of observation (2). In the USA, almost 20% of population that lives in rural regions is covered by only 9% of physicians, which presents a serious long-lasting problem (3-5). Many other countries have the same problem, such as France, Greece, Australia, Japan, and Chile (6-11). Uneven distribution is mostly a result of migration of physicians (11).In Croati...