Search

PTSP je poremećaj čiji je nastanak uvjetovan složenom interakcijom bioloških, psiholoških te socijalnih faktora koji određuju reakciju pojedinca. Dosadašnja istraživanja izdvojila su razne faktore rizika koji pogoduju nastanku ovog poremećaja. Na temelju dosadašnjih spoznaja pretpostavljeno je da u podlozi internaliziranog, odnosno eksternaliziranog tipa PTSP-a koji se razvio nakon proživljene ratne traume, stoje raniji genetski i okolinski rizični faktori. Cilj istraživanja bio je provjeriti prikladnost internaliziranog-eksternaliziranog modela za objašnjenje kliničke slike poremećaja, predisponirajućih rizičnih faktora i zdravstvenih ishoda u uzorku hrvatskih branitelja. Pretpostavljeno je da će veterani s internaliziranim tipom PTSP-a imati više komorbidnih dijagnoza iz skupine depresivnih i anksioznih poremećaja, kao i da će vjerojatnije oboljeti od bolesti dišnog i probavnog sustava, zatim endokrinih bolesti, bolesti prehrane i bolesti metabolizma, te zloćudnih novotvorina. S druge strane, da će veterani s eksternaliziranim tipom PTSP-a imati u komorbiditetu više mentalnih poremećaja i poremećaja ponašanja uzrokovanih upotrebom psihoaktivnih tvari, više bolesti cirkulacijskog sustava kao i bolesti nastalih kao posljedica zlouporabe psihoaktivnih tvari. Ukupno 433 sudionika koji su liječeni pod dijagnozom posttraumatskog stresnog poremećaja i/ili trajnih promjena ličnosti proizašlih iz PTSP-a ispunilo je TSI i MMPI-201 upitnike na temelju kojih je provjerena mogućnost prepoznavanja internaliziranog i eksternaliziranog tipa PTSP-a, a kliničkim intervjuom dobiveni su podaci o sociodemografskim i psihosocijalnim varijablama te tjelesnim bolestima. Rezultati su pokazali da se mogu razlikovati dvije skupine. Skupina sudionika s manje izraženim simptomima PTSP-a također se razlikovala i na MMPI-201 upitniku od skupine s jače izraženim simptomima PTSP-a. Intenzivniji PTSP povezan je s kliničkim ljestvicama MMPI-201 upitnika koje odgovaraju eksternaliziranim simptomima, kao što su agresija, actingout, neprijateljstvo i nepovjerenje, dok je manje intenzivni PTSP bio povezan s anksioznodepresivnim simptomima. Nisu potvrđeni rizični predisponirajući faktori. Potvrđene su razlike u obrazovanju pri čemu su sudionici s tipom 1 PTSP-a češće imali (ne)završenu osnovnu školu u odnosu na tip 2; radnom statusu gdje su sudionici s tipom 1 PTSP češće bili nezaposleni. Pokušaje suicida ili promišljanja o suicidu češće su navodili sudionici s tipom 1 PTSP-a, no među onima koji su pokušali suicid, nema razlika između tipova PTSP-a. Potvrđene su razlike u dvije skupine tjelesnih bolesti. Kod skupine koja pripada tipu 2 bile su češće bolesti živčanog sustava, dok su kod skupine koja pripada tipu 1 češće dijagnosticirane bolesti dišnoga sustava u odnosu na tip 2 PTSP-a. U ostalim skupinama tjelesnih bolesti prema MKB-10 nije bilo razlika. U Hrvatskoj do sada nije provjeravan dvodimenzionalni internalizirani-eksternalizirani model PTSP-a, kao niti pitanje jesu li ta dva podtipa PTSP-a povezana s različitim zdravstvenim ishodima. Iako u ovom istraživanju nisu dobiveni očekivani nalazi o predisponirajućim rizičnim faktorima i posttraumatskim faktorima za internalizirani i eksternalizirani PTSP, potvrđeno je da je i u hrvatskim uvjetima moguće razlikovati dva tipa PTSP-a što je klinički informativno za identificiranje rizičnih ponašanja i predviđanje poremećaja u ponašanju i osobito je korisno za planiranje liječenja, sprečavanje i smanjenje zdravstvenih rizika hrvatskih veterana. PTSD is a disorder whose occurrence is conditioned by the complex interaction of biological, psychological, and social factors that determine an individual's response. Previous research has identified various risk factors that favour the occurrence of this disorder A two-dimensional internalizing/externalizing model could provide a useful frame work from which to examine the co-occurring psychiatric symptoms associated with PTSD. Based on current knowledge, it has been assumed that the underlying internalized or externalized type of PTSD that developed after experiencing war trauma is genetic and environmental risk factors. The aim of this study is to determine the usefulness of a two-dimensional internalizing-externalizing PTSD model for understanding symptoms and health outcomes in the sample of Croatian war veterans. It was assumed that veterans with an internalized type of PTSD will have more comorbid diagnoses from the group of depressive and anxiety disorders, as well as being more likely to suffer from diseases of the respiratory and digestive systems, then endocrine diseases, diseases of nutrition and metabolism, and malignant neoplasms. On the other hand, veterans with externalizing type of PTSD will have more mental and behavioural disorders caused by the use of psychoactive substances in co morbidity, as well as more circulatory system diseases as well as diseases resulting from the abuse of psychoactive substances. A total of 433 participants who were treated under the diagnosis of post-traumatic stress disorder and/or permanent personality changes resulting from PTSD filled out the TSI and MMPI-201 questionnaires, based on which the possibility of recognizing the internalized and externalized type of PTSD was checked, and the clinical interview obtained data on sociodemographic and psychosocial variables and physical diseases. The results showed that two groups can be distinguished. The group of participants with less pronounced PTSD symptoms also differed on the MMPI-201 questionnaire from the group with more pronounced PTSD symptoms. More intense PTSD was associated with clinical scales of the MMPI-201 questionnaire corresponding to externalizing symptoms, such as aggression, acting-out, hostility and mistrust, while less intense PTSD was associated with anxietydepressive symptoms. Risk predisposing factors have not been confirmed. Differences in education were confirmed, whereby participants with type 1 PTSD more often had (not) finished primary school compared to type 2; work status, where participants with type 1 PTSD were more likely to be unemployed. Suicide attempts or thoughts about suicide were more often reported by participants with type 1 PTSD, but among those who attempted suicide, there were no differences between PTSD types. Differences in two groups of physical diseases were confirmed. In the group belonging to type 2, diseases of the nervous system were more common, while in the group belonging to type 1, diseases of the respiratory system were diagnosed more often compared to type 2 PTSD. There were no differences in other groups of physical diseases according to ICD-10. In Croatia, the two-dimensional internalized-externalized model of PTSD has not been tested so far, nor has the question whether these two subtypes of PTSD are associated with different health outcomes. Although the expected findings on predisposing risk factors and posttraumatic factors for internalized and externalized PTSD were not obtained in this research, it was confirmed that even in Croatian conditions it is possible to distinguish two types of PTSD, which is clinically informative for identifying risky behaviours and predicting behavioural disorders, and especially is useful for treatment planning, prevention and reduction of health risks of Croatian veterans.

Ljekarnička skrb predstavlja novi modus operandi ljekarnikovog djelovanja koje u svom središtu ima pacijenta i njegove specifične terapijske potrebe i probleme. Kao zdravstveni profesionalac koji ima najveće znanje o lijekovima (kemijski sastav, farmakokinetika, farmakodinamika, nuspojave, interakcije itd.), potrebno je da ljekarnik aktivno sudjeluje u otkrivanju, rješavanju i preveniranju terapijskih problema. Zbog povećanog broja lijekova u medicinskoj uporabi i njihovog sve češćeg propisivanja i neprimjerenog korištenja, potreba za implementacijom ljekarničke skrbi se imperativno nameće. No implementacija ljekarničke skrbi ni na jednoj razini sustava zdravstvene zaštite još uvijek nije zadovoljavajuća, ne samo u Republici Hrvatskoj nego i u zemljama koje su s tom praksom počele mnogo ranije. U Republici Hrvatskoj implementacija ljekarničke skrbi se zasada dijelom odvija u ljekarnama i u bolnicama. Iskustvo drugih zemalja pokazuje, međutim, da je implementacija ljekarničke skrbi od najveće koristi u ordinacijama obiteljske medicine gdje se i najveći broj lijekova propisuje. Ljekarnikovom pravodobnom intervencijom u terapiju može se u značajnoj mjeri smanjiti morbiditet i mortalitet prouzrokovani neprimjerenom uporabom lijekova i koji kao takvi danas predstavljaju ne samo zdravstveno-zaštitni, već i ekonomski problem. Stoga je cilj ovog rada bio ukazati na potencijal koji ljekarnička skrb ima u pružanju zdravstvene zaštite. U radu je pružen detaljan uvid u praksu implementacije ljekarničke skrbi u ambulantno liječenje u nekoliko zemalja. U izradi rada su korišteni znanstveni radovi iz časopisa dostupnih u bazama podataka Medline, PubMed i Mendeley, te udžbenici i ostala dostupna relevantna literatura. Spoznaje o načinima na koje se ljekarnik može uspješno integrirati u tim primarne zdravstvene zaštite mogu biti model njihove implementacije i u naš zdravstveni sustav. Integracija ljekarnika u zdravstveni tim pretpostavlja, međutim, potpuno odvajanje ljekarničke skrbi od procesa pukog izdavanja lijekova. Taj model se sastoji od četiri istodobno zastupljene mjere: ljekarnikova procjena pacijentove terapije; edukacija svih zdravstvenih djelatnika uključenih u zdravstveni tim; unaprjeđivanje suradnje zdravstvenog tima; proširenje opsega ljekarnikovih usluga. U brojnim studijama je dokazano da provođenje ljekarničke skrbi osigurava prikladnu, učinkovitu i sigurnu uporabu lijekova te pridonosi povećanju adherencije pacijenata i poboljšanju njegove sveukupne kvalitete života. Na taj način ljekarnička skrb iskazuje svoj puni potencijal od kojeg korist imaju ne samo pacijenti, već zdravstveno-zaštitni sustav u cjelini. Pharmaceutical care is a new modus operandi of pharmacists' work centered on the patient and his specific therapeutic needs and problems. As a health care professional who has the greatest knowledge about drugs (chemical composition, pharmacokinetics, pharmacodynamics, side effects, interactions, etc.), it is necessary that the pharmacist actively participates in detecting, preventing and solving therapeutic problems. Due to increased number of drugs in medical use and their more frequent prescribing and inappropriate use, a need for the implementation of pharmaceutical care is imperatively imposed. Nevertheless, implementation of pharmaceutical care at all levels of health care system is still not satisfactory, not only in Croatia but also in the countries that began with this practice much earlier. At the moment, the implementation of pharmaceutical care in Croatia is partly taking place in pharmacies and hospitals. However, experience suggests that the implementation of pharmaceutical care shows the greatest benefit in general practice, where the largest number of drugs is prescribed. The pharmacist's timely therapy intervention can significantly reduce the morbidity and mortality caused by the inappropriate use of drugs, which nowadays represent not only a health problem but also an economic problem. Therefore, the aim of this study was to point out the potential that pharmaceutical care has in the providing health care. The paper provide a detailed insight into the practice of implementing pharmaceutical care in outpatient treatment in several countries. The research for this work have been conducted through academic research papers published in professional journals and available for review through the following databases: Medline, PubMed and Mendeley, textbooks and other available relevant literature. Understanding the way pharmacist can successfully integrate into the team of primary health care can be a model for their implementation in our health care system. However, the integration of pharmacists into the health care team assumes the complete separation of the pharmaceutical care from the process of mere drug dispensing. This model consists of four simultaneously represented measures: the pharmacist's assessment of the patient's drug therapy; education of all health professionals in the health care team; improving cooperation of the health care team; expanding the range of pharmacy services. It has been shown in many studies that the implementation of pharmaceutical care ensures appropriate, effective and safe use of drugs, and contributes to increasing adherence of patients and improving their overall quality of life. In this way pharmaceutical care expresses it's full potential, which benefits not only the patients, but the whole health care system.

Cilj je ovog rada ispitati odnos dimenzija ličnosti petofaktorskog modela (ekstraverzije, ugodnosti, savjesnosti, neuroticizma i otvorenosti) i nekih stavova prema radu i organizaciji (zadovoljstva poslom, organizacijske odanosti i zaokupljenosti poslom) s ukupnim tjelesnim simptomima, te pojedinim skupinama tjelesnih simptoma (muskuloskeletalnim, pseudoneurološkim, gastrointestinalnim, simptomima alergije i simptomima gripe). Istraživanje je provedeno na uzorku od 214 bolničkih medicinskih sestara u Rijeci. Hijerarhijske regresijske analize u kojima su kao prediktori ukupnih i pojedinih skupina tjelesnih simptoma u prvom koraku korištene crte ličnosti, a u drugom organizacijski stavovi pokazale su da crte ličnosti kao skup varijabli možemo smatrati prediktorima svih mjera tjelesnih simptoma osim simptoma alergije i gripe, te da organizacijski stavovi dodatno, nakon kontrole efekata crta ličnosti značajno povećavaju koeficijent multiple korelacije pri predikciji muskuloskeletalnih i pseudoneuroloških simptoma, simptoma gripe i ukupnih tjelesnih simptoma, povećavajući količinu objašnjene varijance za dodatnih 5 do 9%. Iako crte ličnosti značajno prediciraju većinu mjera tjelesnih simptoma, dobiveni rezultati pokazuju da je značajan pozitivan prediktor jedino neuroticizam. Od stavova prema radu i organizaciji najvažniji je prediktor zadovoljstvo poslom, koje značajno negativno predicira muskuloskeletalne i pseudoneurološke simptome, simptome gripe i ukupne tjelesne simptome, a pored njega, značajnim pozitivnim prediktorom pokazala se i instrumentalna odanost koja značajno pozitivno predicira pseudoneurološke simptome te simptome alergije., The aim of this article was to examine relationships of Five-factor personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) and some job and organizational attitudes (job satisfaction, organizational commitment, and job involvement) with various groups (musculoskeletal, pseudo neurological, gastrointestinal, allergies and flu health complaints) and with overall physical symptoms. Research was conducted on the sample of 214 hospital nurses in Rijeka. The results of hierarchical regression analyses in which personality traits were included as predictor variables in the first and job and organizational attitudes in the second step show that personality traits significantly predicted all measures of physical symptoms except symptoms of allergies and flu health complaints, and that after controlling for personality traits job and organizational attitudes significantly increase the coefficient of multiple correlation in prediction of musculoskeletal, pseudo neurological, flu health complaints and overall physical symptoms, increasing accounted variance for additional 5 to 9 %. Although personality traits significantly predicted various groups of physical symptoms, the results obtained show that only neuroticism is significant positive predictor. Considering job and organizational attitudes, job satisfaction is significant negative predictor of musculoskeletal, pseudo neurological, flu health complaints and overall physical symptoms, while instrumental commitment is significant positive predictor of pseudo neurological symptoms and symptoms of allergies.