Search

The aim of this cross-sectional study was to compare occupational burnout in two groups of teachers from the district of Bijeljina (Bosnia and Herzegovina) measured with the Serbian version of the Maslach Burnout Inventory survey for workers in human services (MBI-HSS) at the beginning (group 1) and the end of the school year 2018/2019 (group 2) to see if there are seasonal differences. The questionnaire also included standard sociodemographic data and job description (primary and/or secondary school position, length of service, and overtime work). The prevalence of emotional exhaustion and depersonalisation was low in both groups. However, emotional exhaustion and depersonalisation scores significantly shifted to higher values between the beginning and the end of the school year. We also found a statistically significant association between emotional exhaustion and overtime and between depersonalisation and work in a secondary school (p<0.05). These findings invite further research of occupational burnout seasonality in schoolteachers, preferably by following up cohorts which would be controlled for sociodemographic and work-related variables., U ovom je presječnom istraživanju uspoređena prevalencija sindroma izgaranja na poslu u dvjema skupinama nastavnika na području Bijeljine u Bosni i Hercegovini te je procijenjen njegov sezonski karakter. Sindrom izgaranja na poslu mjeren je na početku (skupina I.) i na kraju školske 2018./2019. godine (skupina II.). Za potrebe ovoga istraživanje korištena je srpska inačica Maslachina upitnika izgaranja na poslu za stručnjake pomagačkih zanimanja (izv. Maslach Burnout Inventory Survey for Workers in Human Services, krat. MBI-HSS). Upitnik je uključivao i standardne sociodemografske podatke, kao i podatke o radnomu mjestu (rad u osnovnoj i/ili srednjoj školi, dužina radnog staža i prekovremeni rad). Prevalencija emocionalne iscrpljenosti i depersonalizacije bila je niska u objema skupinama ispitanika na početku mjerenja, ali se na kraju školske godine povećala. Utvrđena je statistički značajna razlika između emocionalne iscrpljenosti i prekovremenoga rada, kao i između depersonalizacije i rada u srednjim školama (p<0,05). Rezultati istraživanja upućuju na potrebu daljnjeg ispitivanja sezonskoga karaktera sindroma izgaranja na nastavničkom poslu, po mogućnosti kohortnim istraživanjem kojim bi se pratile sociodemografske i radne varijable ispitanika.

Antimikrobna rezistencija predstavlja aktuelni, globalni javnozdravstveni problem, posebno kod enterobakterija. Najvažniji mehanizam rezistencije je produkcija karbapenemaza. Geni za ove enzime se kod karbapenemaza-produkujućih enterobakterija (CPE) nalaze uglavnom na plazmidima, i imaju izuzetan potencijal horizontalnog i vertikalnog transfera, što značajno doprinosi širenju antimikrobne rezistencije. Bolnička sredina se smatra glavnim rezervoarom rezistentnih bakterija, dok su podaci o stečenoj rezistenciji kod vanbolničkih izolata uglavnom nepoznati, iako se najveća potrošnja antibiotika registruje u primarnoj zdravstvenoj zaštiti. CILJEVI: Cilj ovog istraživanja bio je odrediti učestalost, tipove karbapenemaza, kao i klonalnu povezanost i klonalnu distribuciju CPE izolata kod vanbolničkih pacijenata; ispitati osetljivost na antibiotike i mehanizme rezistencije na kolistin, kao rezervnog antibiotka u lečenju infekcija izazvanih CPE; proceniti, na osnovu dobijenih rezultata, potrebu za ciljanom mikrobiološkom detekcijom i praćenjem CPE u vanbolničkoj populaciji na teritoriji Beograda. MATERIJAL I METODE: Od 44.686 ispitanih vanbolničkih izolata enterobakterija, u studiju je uključeno 179 izolata sa pozitivnim skriningom na produkciju karbapenemaza. Identifikacija do nivoa vrste rađena je MALDI-TOF MS metodom. Multiplex PCR je korišćen za detekciju gena za karbapenemaze: blaKPC, blaNDM, blaOXA-48-like, blaVIM i blaIMP. Molekularna tipizacija CPE izolata rađena je metodom ERIC-PCR. Osetljivost na antibiotike određena je disk difuzijom, u automatizovanom sistemu i bujon mikrodilucionom metodom. Za kolistin-rezistentne CPE izolate utvrđivani su mehanizmi rezistencije na kolistin MALDI-TOF MS analizom lipida A i sekvenciranjem celog genoma (WGS). Rezultati dobijeni WGS analizom korišćeni su za in silico MLST tipizaciju kolistin-rezistentnih CPE i karakterizaciju plazmida nosioca gena za karbapenemaze. REZULTATI: Geni za karbapenemaze su dokazani kod 144/179 izolata ent, Antimicrobial resistance is an emerging, global public health problem, especially in enterobacteria. The most important mechanism is production of carbapenemases. Carbapenemase genes are mostly located on plasmids of Carbepenemase-producing Enterobacterales (CPE), and have great potential of horizontal and vertical transfer, which significantly contributes to the spread of antimicrobial resistance. Health-care settings are the major reservoir of resistant bacteria, but the data on antimicrobial resistance in community bacterial isolates remains unknown, despite the fact that the vast majority of the antibiotics have been prescribed in the primary health-care settings. AIMS: The aims of this study were to determine prevalence, types of carbapenemases, clonal relatedness and clonal distribution of community CPE isolates; to examine antimicrobial susceptibility and mechanisms of resistance to colistin, as a reserve antibiotic in the treatment of CPE infections; to estimate the need for laboratory detection and surveillance of community CPE isolates in Belgrade. MATERIALS AND METHODS: Among 44.686 community isolates of enterobacteria, 179 were positive on carbapenemase screening test, and included in the further study. Identification of isolates was performed by MALDI-TOF MS. Carbapenemase genes blaKPC, blaNDM, blaOXA-48-like, blaVIM and blaIMP were detected with multiplex PCR. Molecular typing of CPE was performed by ERIC-PCR. Antimicrobial susceptibility was determined by disk diffusion, automated system and broth microdilution. For colistin-resistant CPE, mechanisms of colistin resistance were examined by MALDI-TOF MS analysis of Lipid A and Whole Genome Sequencing (WGS). WGS data was used for in silico MLST analysis and characterization of carbapenemase genes genomic background on plasmid. RESULTS: Carbapenemase genes were detected in 144/179 isolates of enterobacteria with positive screening for carbapenemases. The prevalence of CPE community isolates in Belgrade w

Sindrom sagorevanja predstavlja stanje fizičke, emocionalne i mentalne iscrpljenosti izazvane dugotrajnim izlaganjem emocionalno zahtevnim situacijama na poslu. Rad sa malom decom može biti veoma stresan, zbog čega medicinske sestre – vaspitači predstavljaju visoko rizičnu grupu za razvoj sindroma sagorevanja na poslu. U ovom istraživanju ispitana je prevalenca sindroma sagorevanja na poslu kod medicinskih sestara - vaspitača u beogradskim predškolskim ustanovama, procenjene su psihometrijske karakteristike opšteg upitnika sagorevanja na poslu (MBI-GS) i ispitani prediktori sindroma sagorevanja, kao i značaj karakteristika ličnosti za razvoj ovog sindroma. METOD: Istraživanje predstavlja studiju preseka sprovedenu u predškolskim ustanovama u Beogradu. Reprezentativni uzorak odabran je po tipu stratifikovanog klaster uzorka. Sindrom sagorevanja procenjen je korišćenjem opšteg upitnika sagorevanja na poslu (MBI-GS). Upitnik je adaptiran za upotrebu na srpskom govornom području, na osnovu međunarodno prihvaćene metodologije za prevod i kulturološku adaptaciju. Psihometrijske karakteristike srpske verzije MBIGS upitnika analizirane su ispitivanjem faktorske strukture i interne konzistentnosti. Za procenu karakteristika ličnosti korišćena je skraćena verzija upitnika „Velikih pet plus dva“. Odobrenje za sprovođenje istraživanja dobijeno je od Sekretarijata za obrazovanje i dečju zaštitu grada Beograda, i Etičkog odbora Medicinskog fakulteta Univerziteta u Beogradu. REZULTATI: Studijom su obuhvaćene 302 medicinske sestre – vaspitači prosečne starosti 38+9.2 godina, ženskog pola. Konfirmatornom faktorskom analizom potvrdjena struktura upitnika sa tri faktora (iscrpljenost, cinizam i profesionalna efikasnost). Kod 251 (83.1%) ispitanice utvrdjeno je prisustvo umerenog stepena sindroma sagorevanja. U multiploj regresionoj analizi, pozitivna valenca i savesnost su bile značajno povezane sa profesionalnom efikasnošću. Agresivnost, neuroticizam, otvorenost i starost bili su zna, Burnout syndrome is a state of physical, emotional and mental exhaustion caused by prolonged exposure to emotionally demanding situations at work. Working with young children can be very stressful, this is why nursery teachers represent a high risk group for the development of burnout syndrome at work. The aim of this study was to examine the prevalence of burnout syndrome among nursery teachers in Belgrade’s preschool institutions, to assess the psychometric characteristics of the general burnout questionnaire (MBI-GS), identify predictors of burnout syndrome, and the role of personality traits in its development. METHODS: A cross-sectional study was conducted in all Belgrade’s preschool institutions. A stratified cluster sampling method was used to obtain a representative sample. Burnout was measured using the Maslach Burnout Inventory- General Survey (MBI-GS). The MBI-GS adaptation was based on an internationally accepted methodology for translation and cultural adaptation. Psychometric properties of the Serbian version of the MBI-GS were analyzed by the confirmatory factorial analysis and measures of internal consistency. A shortened version of Big Five Plus Two questionnaire was used to measure Personality traits. The approval was obtained from the Secretariat for Education and Child Protection of the City of Belgrade, and from the Ethics Committee of the Medical Faculty University of Belgrade. RESULTS: Three hundred two health care professionals were enrolled. The mean age was 38±9.2 years and all were female. Confirmatory factor analysis validated the three-factor structure of the questionnaire (exhaustion, cynicism and professional efficacy). Overall, 251 (83.1%) respondents were found to have moderate burnout. In multiple regression analysis, positive valence and conscientiousness were significantly associated with professional efficacy. Aggressiveness, neuroticism, openness, and age, were significantly associated with exhaustion. Aggressiveness, neuroticis

BackgroundThe aim of this study was to estimate whether the stress, lack of social support, and poor emotional relationships influence the recurrence of AD in adults. MethodsCase-control study comprised 66 outpatients with AD and 132 controls with different skin diseases believed to be slightly influenced by psychosomatic factors. Participants were treated at the Department of Dermatology - Military Medical Academy and City Department for Skin and Venereal Diseases from January to June 2014. Stressful life events were assessed using the Paykel's Interview for Recent Life Events. The attachment relationship and perceived social support were assessed with the Experiences in Close Relationships Scale and with the Multidimensional Scale of Perceived Social Support, respectively. Univariate and multivariate logistic regression analyses were applied. ResultsAD patients had significantly higher anxiety scores when initiating a close emotional relationship and when avoiding an affective attachment (OR = 1.49; CI = 1.13-1.97; P = 0.005 and OR = 1.63; CI = 1.16-2.30; P = 0.005, respectively). Perceived social support from family and friends was significantly lower among cases compared to controls (OR = 0.93; CI = 0.88-0.98; P = 0.009 and UO = 0.94; CI = 0.89-0.99; P = 0.027, respectively). ConclusionsAD patients had higher anxiety scores, and those with low social support tended to have more frequent disease recurrence. The number of stressful life events did not differ between studied groups.

Sindrom sagorevanja na poslu je u fokusu istraživanja od 1970-te godine. Definiše se kao interpersonalna stresogena reakcija na radnom mestu koju karakterišu tri dimenzije: emocionalna iscrpljenost, cinizam ili depersonalizacija i osećaj male lične ostvarenosti. Istraživanje ovog sindroma je u centru pažnje pre svega zbog posledica koje ostavlja na zdravlje zaposlenih i njihove radne performanse što neminovno vodi do ekonomskih opterećenja za poslodavce i samu državu. U Norveškoj je procenjeno da godišnji troškovi povezani sa ovim fenomenom dosežu i do 1,7 milijardi evra. U Nemačkoj se smatra da poremećaji prouzrokovani stresom predstavljaju vodeće uzroke prevremenog penzionisanja. Sindromom sagorevanja na poslu pogođen je širok spektar zanimanja (zdravstveni radnici, psiholozi, socijalni radnici, nastavno osoblje, menadžeri), međutim, nastavničko zanimanje se ističe kao jedno od zanimanja sa velikim socioekonomskim značajem. Istraživanje sindroma sagorevanja na poslu u ovoj populaciji zahteva dodatnu pažnju pre svega zbog posledica koje ostavlja na mentalni i emotivni razvoj dece, njihova akademska postignuća, te samim tim i na celokupan obrazovni sistem. U nastanku ovoga sindroma karakteristike radne sredine su značajni prediktori, zbog čega je i prepoznat kao profesionalno oboljenje u nekoliko zemalja Evrope. Ipak, iako svi zaposleni dele istu radnu sredinu ne razvijaju svi sindrom sagorevanja na poslu, što ukazuje i na značaj ličnih karakteristika (tip ličnosti, temperament, afekat, samopoštovanje i druge) u razvoju ovoga sindroma. U literaturi se nalaze različiti kontradiktorni podaci o uticaju sociodemografskih karakteristika, kao što su pol, polna jednakost, bračni status, nivo obrazovanja i radni staž na sindrom sagorevanja na poslu. Pored njih, istraživani su još sukob poslovnih i porodičnih uloga i socijalna podrška. Neminovno je da podaci o etiološkim faktorima ovoga fenomena i dalje nedostaju, što ukazuje na potrebu za istraživanjima. Ciljevi Cilj ovog i, interpersonal stressful reaction at workplace, characterized through three dimensions: emotional exhaustion, cynicism or depersonalization and the feeling of reduced personal accomplishment. Examining this syndrome is in the center of attention primarily due to the consequences it has on employees’ health and their work performance, which undoubtedly creates the economic burden for both the employer and the country. It is estimated that annual costs of burnout-related phenomenon reach up to 1.7 billion euro in Norway. In Germany, it is believed that stress-related disorders make the leading causes of premature retirement. The burnout syndrome affects a large number of professions (health workers, psychologists, social workers, teachers, managers), but it is the teaching profession that is emphasized as one of the professions with a great socio-economic importance. Conducting research in the field of burnout syndrome among this population requires additional attention mostly due to consequences it has on mental and emotional development of children, their academic achievement and therefore, educational system, as well. Working environment plays an important part in developing this syndrome, which is why the syndrome has been recognized as a occupational disease in several European countries. However, although every employee shares the same working environment, not all of them develop burnout syndrome. This shows how important personal characteristics are (personality type, temper, affect, self-esteem, and some others) in developing this syndrome. There is various contradictory data in literature regarding the influence of socio-demographic characteristics such as gender, gender equality, marital status, education level and length of service onburnout syndrome. Apart from these properties, the conflict of professional and family roles has also been examined, as well as social support. It is clear that the data on etiological factors of this phenomenon still lacks, whi

Prelomi kuka su globalni problem koji često rezultuje lošim zdravstvenim ishodima i visokim troškovima zdravstvene zaštite. Predviđanje rehabilitacionih ishoda kod pacijenata nakon preloma kuka je ključno pitanje za optimizaciju rehabilitacionih protokola, definisanje optimalne raspodele resursa i organizacije nege. Cilj ovog istraživanja je bio određivanje prediktora uspešnosti oporavka starijih pacijenata nakon operativno lečenog preloma kuka. Među ispitivanim prediktorima poseban cilj je bio da se proceni povezanost snage stiska šake merene rano nakon preloma kuka i klasifikovane prema ERGSS2 kriterijumima i drugih ulaznih varijabli, kao i njena uloga u predikciji kratkoročnog i dugoročnog mortaliteta, funkcionalnog oporavka i kvaliteta života u ovoj grupi isptianika. Praćen je 191 pacijent stariji od 65 godina nakon preloma kuka, koji je operisan na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Srbije u periodu od 1.marta 2017. do 1.septembra 2018. godine. Prosečna starost ispitanika je bila 80,3±6,8 godina. Među ispitanicima 35% je imalo slabost snage stiska šake. Ovi pacijenti su bili značajno stariji, češće ženskog pola, imali su manji indeks telesne mase i bili su lošijeg zdravstvenog statusa. Pacijenti sa slabijim stiskom šake su takođe imali lošiji kognitivni status, manje vrednosti Bartelovog indeksa i lošiji kvalitet života pre preloma. Multivarijantna regresiona analiza pokazala je da je slabost snage stiska šake bila nezavisni prediktor aktivnosti dnevnog života 6 meseci nakon preloma kuka. Snaga stiska šake je takođe bila povezana sa nižim tromesečnim vrednostima aktivnosti dnevnog života, kao i tro- i šestomesečnim mortalitetom, vrednostima instrumentalizovanih aktivnosti dnevnog života, kvaliteta života, ali nije bila i njihov nezavisni prediktor. Rezultati našeg istraživanja podržavaju značaj ispitivanja snage stiska šake u akutnoj fazi u sklopu multidimenzionalne procene oporavka pacijenata sa prelomom kuka., Hip fractures are a global concern, often resulting in poor health outcomes and high health care costs. Predicting the rehabilitation outcomes of hip fracture patients is a crucial issue to optimize rehabilitation protocols, define optimal resources allocation and care organization. This investigation aimed to determine predictors of short- and long-term recovery of elderly patients after surgically treated hip fractures. Among the predictors examined, the specific objective was to evaluate the association of handgrip strength measured early after hip fracture and classified according to the EWGSOP2 criteria and other baseline variables, as well as its role in the prediction of short- and long-term mortality, functional recovery, and quality of life. One hundred ninety-one patients older than 65 years with acute hip fractures who were surgically treated at the Clinic for Orthopedic Surgery and Traumatology, Clinical Canter of Serbia in the period 1.3.2017- 1.9.2018. were examined. The mean age of the participants was 80.3±6.8 years. Among the participants, 35% had a weakness of the hand grip strength. These patients were significantly older, more often female, had a lower body mass index, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower quality of life before fracture. Multivariate regression analysis revealed that hand grip weakness was an independent predictor of activites of daily living 6 months after hip fracture. Hand grip strength was also associated with lower indipendence three-month postoperatively regarding activities of daily living, as well as instrumentalized activities of daily living, quality of life, and three- and sixmonth mortality, but was not their independent predictor. The results of our study support the importance of examining hand grip strength in the acute phase as part of a multidimensional assessment of the recovery of patients with hip fractures.

Objective. Nurses represent the key persons in the process of organ donation, acting as intermediaries between the patient and the family of a potential donor. The aim of this study was to analyze the factors influencing the attitudes of nurses toward bequeathing and organ and tissue donation. Methods. The research was designed as a cross-sectional study from November 2013 to November 2014 and included a sample of 264 nurses employed in the health system of Serbia. Data were collected using a specific questionnaire of 18 questions referring to the information on sociodemographic characteristics and the knowledge of organ donation. Results. The investigation enrolled 264 participants, of which 78% were women. The majority of study subjects had secondary medical education (64.4%), lived in an urban area (82.6%), were married (56.4%), and were predominantly Orthodox (87.1%) with their work experience between 5 and 10 years (29.9%) and 10 to 20 years (29.5%). The average knowledge score concerning organ donation was 29.03 (SD, 2.33; range, 23-34). There was a statistically significant difference in the scores between 2 groups formed according the length of service (P < .001) and the level of education (P ¼ .019), which showed the strongest influence on nurses’ attitudes toward donation. Conclusion. This investigation showed that nurses did not express strong positive attitude toward this issue. Further education of nurses in the Serbian health care system focusing on transplantation and bequeathing of organs and tissues are warranted. N

Shizotipija je konstrukt koji se koristi kako bi se opisala grupa osoba sa simptomima koji ne ispunjavaju kriterijume za postavljanje dijagnoze shizofrenije, ali imaju sličnosti sa ovim kompleksnim i heterogenim psihiajtrijskim oboljenjem. MKB-10 opisuje shizotipiju kao privremeno stanje (shizotipalni poremećaj), dok je DSM-5 opisuje kao trajniji poremećaj (shizotipalni poremećaj ličnosti). S obzirom da se shizotipija prostire kroz normalnu, supkliničku i kliničku populaciju, temeljno teorijsko razumevanje ovog koncepta može biti od pomoći prilikom razvijanja mera procene shizotipije. Do sada, najveći deo psihometrijske evaluacije shizotipije bazirao se na varijetetima individualnih razlika (poremećaja) ličnosti. Ovaj članak se fokusira na evoluciju termina shizotipije, na razumevanje ovog fenomena, mogućnosti psihometrijske procene u skladu sa trenutnim modelima ličnosti i na klinička razmatranja koja bi dovela do poboljšane detekcije i intervencije u ovoj oblasti., Schizotypy is a construct used to describe a group of persons with symptoms which do not fulfill criteria for schizophrenia, but have some similarities with this complex and heterogeneous psychiatric disorder. ICD-10 describes schizotypy as a state (schizotypal disorder), while DSM-5 labels it as a trait marker (schizotypal personality disorder). Considering how schizotypy encompasses through the normal, subclinical and clinical population, a thorough theoretical understanding of this concept could be helpful in developing measures of assessment. So far, most of the tools for psychometric evaluation of schizotypy have focused only on abnormal personality. The present article focuses on the evolution of the term schizotypy, its current understanding, the possibilities of psychometric assessment in relation to contemporary constructs of personality and on clinical considerations for improved detection and intervention in this field.

Uvod. Rak grlića materice (RGM) pripada grupi pet najčešćih malignih tumora kod žena u Beogradu. Ciljevi ove studije su bili: sagledavanje potpunosti podataka o registrovanim slučajevima obolevanja od RGM u odnosu na uzrast, mesto stanovanja i ekonomsku aktivnost; prikazivanje rezultata primene Geografskog informacionog sistema (GIS) u sagledavanju prostorne distribucije obolevanja od RGM. Metod. U ovoj studiji primenjen je deskriptivni epidemiološki metod i tehnologije GIS-a. Uključeni su svi slučajevi RGM kod žena starijih od 15 godine u Beograda u periodu 2000-2014.god. Izvor podataka o obolelima od RGM bio je Registar za rak u Beogradu. Podaci o proceni obezbeđenosti ginekološke zaštite i obuhvata preventivnim ginekološkim pregledima preuzeti su iz Godišnjih izvestaja o izvršenju plana rada Službe za zdravstvenu zaštitu žena beogradskih domova zdravlja. Izračunate su nestandardizovane uzrasnospecifične stope i standardizovan stope incidencije, prema podacima popisa iz 2002. i 2011. i proceni broja stanovnika Republičkog zavoda za statistiku za međupopisne godine. Urađena je indirektna standardizacija stope incidencije, standardni incidentni odnos (SIR) za svaku opštinu Beograda. Kretanje stopa prikazano je linearnim trendovima. Obezbeđenost je izražena kroz broj žena po jednom ginekologu (6500/1) u odnosu na ukupnu populaciju žena starijih od 15 god. opštine na kojoj se nalazi dom zdravlja. Korišćeni su i podaci o broju poseta ginekologu na dnevnom nivou (mera izvršenja je 30 poseta). Posmatran je obuhvat preventivnim ginekološkim pregledima, pristupačnost ginekološke zdravstvene zaštite (izrađena kao razdaljina od adrese stanovanja obolelih do najbliže ginekološke ordinacije. Primenom tehnologija GIS-a razvijene su prostorne baze podataka i kreirana je kartografska osnova za izvođenje prostorne analize. Korišćene su tehnike: prostorno preklapanje objekata analize kombinovanjem slojeva mapa sa različitim sadržajima; osnovne transformacije i analize podataka; pos, Introduction. Cervical cancer (CC) is among the five most common carcinoma in women in the Belgrade area. The goals of this study were to perceive completeness of cancer register data in relation to age groups, place of residence and economic activity for registered cases of CC; to present results of applying Geographic Information System functions (GIS) in consideration of spatial distribution of CC. Methods. In this study were applied a descriptive epidemiological method and GIS technology. The study included cases of CC registered among inhabitants of Belgrade older than 15 years, diagnosed during the period 2000-2014 (International classification of Diseases, Injuries and Causes of Death, 10th revision, code C53). The source of data was database for the Population Cancer Registry for Belgrade. Data of the provision of gynecological health care, including the daily workload of gynaecologist as a accessibility of healthcare use, coverage of preventive gynecological examination at the primary health care level were taken from the Annual report on the plan of work of the Women's Health Belgrade Primary Health Care Centers (PHCCs) for 2000-2014. We used proportions, crude, indirect standardized incidence ratio (SIR) and age-specific incidence rates per 100,000 female inhabitants. Crude and age-specific incidence rates were calculated using census data (2002 and 2011) and estimation of the number of inhabitants of Republic institute for statistics of RS for years outside of the census years. The incidence rates of CC during the observed period are shown by linear trends. Provision of gynecological health care is expressed through the number of women per one gynecologist (6500/1) among the total adult female population (age 15 and over at the municipality of the PHCC), and interpreted according to the Rulebook for providing health services in healthcare institutions. Daily workload of gynecologist is expressed through the number of visits to the gynaecologist on a dail

Atopijski dermatitis (AD) je hronična, recidivirajuća, inflamatorna, pruriginozna bolest kože, koja se javlja prvenstveno kod dece i koju karakterišu faze remisije i egzacerbacije. Podaci iz literature jasno ukazuju na veliki uticaj AD na kvalitet života dece. Vrlo često fizički izgled deteta sa AD nailazi na komentare vršnjaka, što može da dovede do osećaja stida. Mnoga deca se osećaju socijalno izolovano, a vršnjaci ih neretko odbacuju ili zlostavljaju, što vodi gubitku samopouzdanja, promenama raspoloženja i depresivnosti. Umor, kao posledica nespavanja zbog svraba kože, utiče na uspeh u školi i smanjenje koncentracije. AD ne samo da menja život obolelom detetu, nego utiče i na fizičko, socijalno i emocionalno funkcionisanje njihovih roditelja. Zbog stalne potrebe za negom obolele dece i brige o njima kod roditelja često dolazi do problema sa spavanjem, iscrpljenosti, ali i finansijskih poteškoća zbog troškova oko topikalnih i sistemskih lekova. Uspešna kontrola AD kod dece zavisi od roditelja, njihovog znanja o bolesti, stava i ponašanja prema obolelom detetu. Ciljevi. 1) Ispitivanje kvaliteta života dece sa AD na inicijalnom pregledu, nakon 6 i nakon 12 meseci. 2) Ispitivanje uticaja AD deteta na kvalitet života njegovih roditelja/negovatelja na inicijalnom pregledu deteta, i nakon 6 i 12 meseci. 3) Ispitivanje prediktora promene kvaliteta života deteta tokom vremenskog perioda od jedne godine. 4) Procena validnosti i pouzdanosti primenjenih upitnika, prethodno lingvistički i kulturološki adaptiranih na srpski jezik, za merenje kvaliteta života dece sa AD i njihovih roditelja/negovatelja. 5) Ispitivanje znanja roditelja o AD, kao i njihovih stavova i ponašanja prema oboleloj deci. Metod. Kvalitet života dece ispitivan je prospektivnom studijom koja je obuhvatila kohortu 98-oro dece sa dijagnozom AD, uzrasta 1-16 godina, koja su lečena na Klinici za dermatovenerologiju Kliničkog centra Srbije, u periodu od januara do juna 2014. godine. U istraživanju je korišćen, Atopic dermatitis (AD) is chronic, recurrent, inflammatory, pruriginous skin disease that occurs mostly in children. It is characterized by periodical remission and exacerbation. According to the literature data, AD has great impact on the quality of life (QoL) of children. It is not uncommon that peers comment on physical appearance of ill child which can lead to the feeling of shame. Many children feel socially isolated, rejected or abused by their peers and that can result with loss of self-confidence, mood changes and depression. Tiredness, as a consequence of sleep deprivation due to skin itching, influences the success in school and leads to concentration impairment. AD changes life not only of ill child, but also affects physical, social and emotional functioning of its parents/guardians. Because of constant need of caring for ill children, parents often report troubles with sleeping and exhaustion, as well as financial difficulties due to local and systemic therapy. Successful management of AD depends on parents, their knowledge, attitudes and behavior toward ill child. Aims. 1) Investigation of QoL of children with AD, initially, after 6 and 12 months. 2) Investigation of the impact of child AD on the QoL of parents/guardians, initially, after 6 and 12 months. 3) Investigation of potential predictors of QoL changes during the period of 1 year. 4) Assessment of validity and reliability of applied QoL questionnaires those are previously linguistically and culturally adapted to Serbian language. 5) Investigating of parents’ knowledge, attitudes and behavior toward children with AD. Methods. QoL was assessed in prospective study that had included the cohort of 98 children with AD, age 1 – 16, who were treated at the Clinic of Dermatovenereology of Clinical Center of Serbia (CCS) in the period of January to June, 2014. General standardized questionnaire which contained the information on children and their parents was applied...

Uvod. Cilj doktorske disertacije je da sagleda psihološke promene žena nakon saznanja da je rezultat citološkog brisa atipičan i da je potrebno testiranje na prisustvo HPV-a. S obzirom da je HPV infekcija najčešća kod žena reproduktivnog perioda, sagledavanje anksioznosti žena koje su upućene na dodatni ginekološki pregled (kolposkopski i citološki) je od posebnog značaja. Pored toga sagledan je i uticaj nivoa znanja o HPV infekciji na anksioznost žena, kao i promene u kvalitetu života posle dobijanja atipičnog rezultata. Metod. Procena psihološkog uticaja dijagnostikovanja HPV infekcije ispitana je u prospektivnoj kohortnoj studiji otvorenog tipa. Prospektivna kohortna studija je obuhvatila 324 ispitanice, kod kojih je ustanovljen abnormalni PAP nalaz na nivou primarne zdravstvene zaštite i koje su upućene u GAK "Narodni front" radi kolposkopskog i citološkog pregleda. Procena anksioznosti i kvaliteta života žena pri saznanju o bolesti vršena je uz pomoć upitnika. Rezultati. U proceni psihološkog stanja pacijentkinja pre same citologije i kolposkopije, nije uočena značajna razlika u nivou zabrinutosti u vezi sa rezultatima testa (4.09 vs. 4.22, p=0,628) kao ni u nivou zabrinutosti u vezi sa nastankom karcinoma grlića materice (3.99 vs. 4.14, p=0,517), procenjenih pomoću Likertove skale. Međutim, značajno viši stepen anksioznosti (3,83 (7,45) vs.6,13(9,00), p=0,008), veći psihološki distres (1,36 (2,50) vs.1,93(2,79), p=0,017) i lošiji kvalitet života procenjen EQ-5D VAS skalom (77.35±15.63 vs.81.14±16.07, p=0.020) uočeni su kod žena sa pozitivnim rezultatima testa. Nakon druge procene psihološkog stanja pacijentkinja (nakon sprovođenja citologije i kolposkopije) jedino je anksioznost dostigla graničnu statističku značajnost nakog korigovanja za starost i razlike u bazičnim psihološkim parametrima (p=0,053). Samo 144 (44,4%) žena je čulo za HPV. Mlađe žene i one sa višim obrazovanjem pokazale su bolje znanje o HPV infekciji (r=-0,113, p=0,048 and r=0,145, p=0,012)., Introduction. The aim of the doctoral dissertation is to examine the psychological change after knowing that the result of cytological smears are atypical and need to test for the presence of HPV. Given that HPV infection is most common in women of reproductive period, seeing the anxiety of women who were referred for additional gynecological examination (colposcopy and cytology) is of particular importance. In addition and the impact of the level of knowledge about HPV infection in the anxiety of women is reviewed, as well as changes in quality of life after receiving atypical results. Method. Assessment of the psychological impact of diagnosis of HPV infection was studied in an open prospective cohort study. The study included 324 respondents who received abnormal PAP findings at primary health care level and referred to the GAK "Narodni Front" for colposcopic and cytologic examination. Assessment of participants’ anxiety, quality of life and knowledge about the disease were carried out by the means of questionnaires. Results. At the pre-procedural assessment, there was no significant difference in the concern about test results (4.09 vs. 4.22, p=0,628) and the perceived risk of developing cervical cancer (3.99 vs.4.14, p=0,517) using self-assessment by Likart scales. However, women with abnormal test results reported significantly higher level of anxiety (3,83 (7,45) vs.6,13(9,00), p=0,008), worse general health 1,36 (2,50) vs. 1,93 (2,79), p=0,017) and poorer quality of life assessed by EQ-5DVAS score (77.35±15.63 vs.81.14±16.07, p=0.020) than women with normal results. At the post-procedural assessment, only anxiety reached marginal significance after adjustment for age and baseline psychological differences (p=0,053). Only 144 (44,4%) of women have heard of HPV. Younger and more educated women showed better knowledge about HPV infection (r=-0,113, p=0,048 and r=0,145, p=0,012). Regarding the psychological parameters, level of knowledge about HPV infection sign

Uvod. Psihosomatski faktori, prvenstveno emocionlni stres, i karakteristike ličnosti, dovode se u vezu sa nastankom alopecije areate (AA). Iako je uloga stresa u nastanku AA bila predmet ispitivanja brojnih studija, u većini dosadašnjih istraživanja nije posvećena dovoljna pažnja uticaju drugih faktora na individualnu predispoziciju za razvoj bolesti u uslovima pojačanog stresa. To se posebno odnosi na socijalnu podršku i obrasce afektivnog vezivanja u bliskim odnosima. Gubitak kose utiče na predstavu pojedinca o sebi i brojne studije ukazuju da pacijenti, kako sa klinički manifestnim, tako i sa klinički neuočljivim gubitkom kose, mogu imati značajno snižen kvalitet života. Iako se AA smatra potpuno benignim stanjem, bolest može snažno da se odrazi na kvalitet života. Za procenu težine AA, merenje kvaliteta života predstavlja relevantniji kriterijum u odnosu na kliničku evaluaciju, jer se subjektivni doživljaj pacijenta u vezi sa uticajem bolesti na različite aspekte života može u značajnoj meri razlikovati od procene lekara. Ciljevi. 1) Ispitivanje značaja stresogenih životnih događaja, emocionalnih veza sa bliskim osobama i socijalne podrške u nastanku AA. 2) Procena kvaliteta života obolelih od AA i njegovo poređenje sa kvalitetom života osoba iz opšte populacije i obolelih od drugih kožnih bolesti. 3) Merenje kvaliteta života obolelih od AA unutar podgrupa sa različitom težinom bolesti i njihovo međusobno poređenje. 4) Ispitivanje uticaja komobiditeta na kvalitet života obolelih od AA. 5) Ispitivanje validnosti i pouzdanosti primenjenih upitnika za merenje kvaliteta života. Metod. Istraživanje je sprovedeno na Klinici za dermatovenerologiju, Kliničkog centra Srbije, od aprila 2012. do juna 2013. godine. Uloga faktora rizika u nastanku AA ispitivana je primenom studije slučajeva i kontrola. Studijom je obuhvaćeno 60 uzastopnih, ambulantno i hospitalno lečenih pacijenata sa dijagnozom AA, dok su kontrolnu grupu činile 132 osobe obolele od drugih kožnih bolesti, či, Introduction. Psychosomatic factors such as emotional stress and personality traits have been suggested to play a role in triggering alopecia areata (AA). Although an association between stressful life events and the onset of AA has been investigated in many studies, most of them neglected other factors potentially modulating susceptibility to disease, such as social support and attachment style. Hair loss significantly impacts an individual’s self image, and studies indicate that patients with both clinically apparent and clinically imperceptible hair loss may have significantly decreased quality of life (QoL). Although AA is a medically benign condition, it can affect seriously patients’ QoL. Thus, to assess the severity of AA, QoL seems to be a more relevant criterion than clinical evaluation such as AA extension, because the perception of patients may differ significantly from those of their health-care providers. Objectives. The aims of this research were: 1) to examine the role of stressful life events, attachment style and social support in triggering the disease process in AA; 2) to evaluate QoL in AA patients, and to compare the QoL between AA patients and general population, as well as with patients suffering from other skin diseases; 3) to evaluate the QoL in patients with AA according to disease severity; 4) to assess the impact of comorbidity on QoL in AA patients; 5) to test validity and reliability of questionnaires used for QoL assessment. Method. The research was conducted at the Clinic of Dermatovenereology, Clinical Center of Serbia in Belgrade from April 2012 to June 2103. In order to evaluate the role of risk factors in triggering the disease process in AA, the hospital-based, case-control study was designed. The study included 60 consecutive AA patients and 132 comparison subjects affected with other skin conditions commonly believed as having a low psychosomatic component. The severity of hair loss was measured by Severity of Alopecia Tool (SA

Uvod: Onihomikoza predstavlja gljivičnu infekciju jednog ili više noktiju koja je izazvana bilo kojom vrstom gljiva: dermatofitima, kvasnicama ili nedermatofitnim plesnima. Oboljenje može da zahvati bilo koji deo nokta, uključujući matriks, nokatno ležište i/ili nokatnu ploču. Procene su da oko 5% svetske populacije ima neki oblik onihomikoze i zbog toga ova bolest predstavlja značajan zdravstveni problem. Novije studije ukazuju da je u zemljama zapadne i centralne Evrope prevalencija onihomikoza 3 – 22%. Kada je u pitanju Srbija, ne postoje podaci o učestalosti onihomikoza niti o najčešćim uzročnicima ovog oboljenja kod naših pacijenata. Ciljevi: Određivanje učestalosti javljanja onihomikoza, kao i najčešćih uzročnika onihomikoza kod pacijenata sa kliničkom sumnjom na onihomikozu, analiziranje validnosti različitih laboratorijskih metoda za dijagnozu onihomikoza, ispitivanje uticaja primene tripsina na bolju identifikaciju uzročnika onihomikoza, identifikovanje faktora koji doprinose nastajanju onihomikoza. Materijal i metode: Studija slučajeva obuhvatila je 374 pacijenata sa kliničkom sumnjom na onihomikozu iz šest ustanova: Institut za Mikrobiologiju i imunologiju, Medicinski fakultet Univerziteta u Beogradu; Zavod za javno zdravlje, Pančevo; Opšta bolnica „Dr Đorđe Joanović“, Zrenjanin; Opšta bolnica, Užice; Zavod za javno zdravlje „Timok“, Zaječar; Zavod za javno zdravlje, Kraljevo. Podaci od pacijenata su prikupljeni odgovarajućim anketnim upitnikom. Od svakog pacijenta uzet je uzorak nokta u zavisnosti od kliničkog tipa onihomikoze i poslat u Institut za mikrobiologiju i imunologiju, Medicinskog fakulteta Univerziteta u Beogradu gde je vršena dalja obrada materijala. U cilju identifikovanja uzročnog faktora onihomikoze za svaki uzorak nokta urađeni su sledeći laboratorijski testovi, sa i bez prethodnog tretiranja tripsinom: direktan mikroskopski preparat sa KOH, direktan mikroskopski preparat sa Blankophor-om, kultivisanje na neselektivnim mikološkim podlogam, Background: Onychomycosis represents fungal infection of one or more nails caused by any type of fungi: dermatophytes, yeasts or nondermatophyte molds. The disease can affect any part of the nail, including matrix, nail bed and/or nail plate. It is estimated that about 5% of the world's population has some form of onychomycosis which makes it a significant health problem. Recent studies indicate that in the countries of Western and Central Europe, the prevalence of onychomycosis is 3-22%. Regarding Serbia, there are no data on frequency of onychomycosis nor about the most common causes of this disease in our patients. Aims: Determination of frequency of onychomycosis, as well as the most common causes of onychomycosis in patients with clinical suspicion of onychomycosis, analyzing the validity of the different laboratory methods in the diagnosis of onychomycosis, investigation of the impact of application of trypsin in better identification of causativ agents of onychomycosis, identification of risk factors associated with onychomycosis. Material and methods: The case study included 374 patients with clinical suspicion of onychomycosis from six institutions: Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade; Department of Public Health, Pančevo; General Hospital 'Dr Đorđe Joanović", Zrenjanin; General Hospital Užice; Public Health Institute "Timok", Zaječar; Department of Public Health, Kraljevo. Data from patients was collected by appropriate questionnaire. From each patient a nail sample was taken according to clinical type of onychomycosis and was sent to the Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, where further processing of the material was done. In order to identify the causative agent of onychomycosis each nail sample underwent the following laboratory tests, with and without previous treatment with trypsin: direct microscopic examination with KOH, direct microscopic examinatio

Uvod: Osobe zaposlene u zdravstvenim ustanovama predstavljaju kohortu visokog rizika za nastanak infekcije izazvane virusom hepatitisa B (HBV). Procenjuje se da se, na globalnom nivou, svake godine 600.000-800.000 osoba zaposlenih u zdravstvenim ustanovama poseče ili ubode iglom na radnom mestu. Takođe, prema ovim procenama, oko 5,9% zdravstvenih radnika biva izloženo HBV što rezulira sa oko 66.000 novoinficiranih. U zemljama u razvoju za 40-60% svih HBV infekcija u grupi zdravstvenih radnika odgovorna je profesionalna ekspozicija. U razvijenim zemljama je nešto manje od 10% slučajeva hepatitisa B u grupi zdravstvenih radanika povezano sa kontaktom sa krvlju i krvnim derivatima na radnom mestu, što se dovodi u vezu sa značajno većim vakcinalnim obuhvatom. Iako je bezbedna i efektivna vakcina dostupna od 1982. godine, veliki broj zdravstvenih radnika na globalnom nivou se ne vakciniše protiv ove bolesti. Istraživanja na nivou svetske populacije su pokazala da je oko 90% zdravstvenih radnika svesno činjenice da je potrebno da se vakcinišu, ali da samo nešto više od 50% to i uradi. Stoga, danas se smatra da se u pozadini prijemčivosti vakcine protiv hepatitisa B u grupi zdravstvenih radnika nalazi čitav niz psiholoških, profesionalnih i bihejvioralnih faktora koji potencijalno utiču na ovu komplesnu sliku. Ciljevi: (I) Procena prevalencije vakcinacije protiv hepatitisa B u grupi osoba zaposlenih u ustanovama tercijarnog nivoa zdravstvene zaštite u Beogradu; (II) Ispitivanje znanja, stavova i ponašanja osoba zaposlenih u zdravstvenim ustanovama u vezi sa vakcinacijom protiv hepatitisa B; (III) Ispitivanje prediktora vakcinalnog statusa povezanog sa imunizacijom protiv hepatitisa B kod osoba zaposlenih u zdravstvenim ustanovama. Materijal i metod: Istraživanje je dizajnirano po tipu studije preseka. Target grupu činili su svi zaposleni u Kliničkom centru Srbije (KCS) u Beogradu, koji su metodom slučajnog izbora, po principu formiranja višefaznog uzorka, selektovani za uk, Introduction: Hepatitis B infection is a major cause of occupational disease among health-care workers (HCWs) worldwide. It has been estimated that every year approximately 600-800,000 cut and puncture injures occur in this professional group. Furthermore, the global annual proportion of the HCWs exposed to hepatitis B virus (HBV) has been estimated at 5.9%, corresponding to about 66,000 HBV infections. In developing countries, 40-60% of HBV infections in HCWs was attributed to professional hazard, while in developed countries the attributed fraction was less than 10% due to greater vaccination coverage. In spite of availability of the safe and effective vaccine since 1982, the overall prevalence of hepatitis B vaccination, in this susceptible cohort, has not reached satisfactory level. While approximately 90% of the HCWs are aware of the necessity of the hepatitis B vaccination at workplace, only half of them completed their vaccination program against HBV. Apparently, there are numerous psychological, occupational and behavioral factors that should be taken into consideration when predicting the hepatitis B vaccine acceptance in this susceptible cohort. Aims: (I) to estimate the prevalence of hepatitis B vaccination among HCWs of a national health care centre in Serbia; (II) to analyze the knowledge, attitudes and behaviors regarding hepatitis B vaccination among HCWs; (III) to assess the independent predictors of hepatitis B vaccination status in this susceptible cohort. Material and methods: A cross-sectional study design was applied in order to explore predictors of hepatitis B vaccine status among HCWs in the largest clinical centre in Serbia. A random sample of HCWs stratified by occupation was selected from the list of employees during December 2015, with the sample structure reflecting the occupational distribution in the Clinical Centre of Serbia. The sample comprised 7.1% of the employees at the Clinical Centre of Serbia. The relevant data in this study w

Pneumonije povezane sa mehaničkom ventilacijom predstavljaju jednu od najčešćih formi intrahospitalnih infekcija u jedinicama intenzivnog lečenja. Ciljevi ove disertacije su bili da se sagledaju faktori rizika vezani za karakteristike pacijenta kao i za karakteristike i stanje na prijemu koji su od značaja za pojavu pneumonija povezanih sa mehaničkom ventilacijom. Takođe je cilj bio da se sagleda incidencija multirezistentnih sojeva patogena u bolničkim uslovima kao i efikasnost empirijske antibiotske terapije. Praćeno je 363 pacijenata koji su lečeni u Urgentnom centru Kliničkog Centra Srbije, u dve jedinice intenzivnog lečenja i koji su zahtevali mehaničku ventilaciju duže od 48 sati u periodu od 1.1.2013. do 31.12.2014. godine. Ispitivan je uticaj demografskih karakteristika, uzroka hospitalizacije i pratećih bolesti, kao i karakteristika pacijenata na prijemu u jedinice intenzivnog lečenja. Nezavisni prediktori za nastanak pneumonija povezanih sa mehaničkom ventilacijm prema multivarijantnoj regresionoj analizi su: primena masivne transfuzije na prijemu, koma, GKS manjeg od 8 i veći APACHE II skor. Pacijenti koji su razvili pneumoniju duže su boravili na mehaničkoj ventilaciji i imali su duži boravak u jedinicama intenzivnog lečenja. Intrahospitalni mortalitet je bio u ovoj grupi značajno veći kao i mortalitet 28 dana. U multivarijantnoj logističko regresionoj analizi faktor rizika za nastanak prošireno rezistentnih bakterija kao uzročnika VAP-a izdvaja se neadekvatna empirijska antibiotska terapija. Gram negativne bakterije bili su najčešće izolovani patogeni. Na osnovu rezultata ove disertacije predlaže se uvođenje protokola i mera kojima bi se delovalo na preventibilne faktore rizika radi redukcije incidencije pneumonija povezanih sa mehaničkom ventilacijom sa ciljem sprečavanja komplikacija i samanjenje mortaliteta kod traumatizovanih pacijenata u jedinicama intenzivnog lečenja., Ventilator associated pneumonia are most common intrahospital infections in intensive care units. The aims of this dissertation were to examine the patient-related caracteristics, as well as admission caracteristics and their influence on ventilator associated pneumonia incidence. We also studied multidrug resistant pathogens incidence and initial empiric antimicrobal therapy. There were 363 patients treated in Emergency center of Clinical centre of Serbia in two intensive care units requiring mechanical ventilation more than 48 hours in the period between 1.1.2013-31.12.2014. On admission sociodemographic data, cause for hospitalization and concomitant diseases as well as patients caracteristics due to trauma were evaluated. According to multivariate regression analysis independent predictors for ventilator associated pneumonia were: massive transfusion, coma, high value of APACHE II score on admissin. Patients who developed ventilator associated pneumonia spent more days on mechanical ventilation and in intensive care unit and their mortality was higher. Our results show the importance of guidelines and preventive measures reducing incidence of ventilator associated pneumonia, especially in early phase of treatment. We aslo shown that there are no difference in isolated pathogens between early and late form of ventilator associated pneumonia.

Hepatitis C virusna (HCV) infekcija predstavlja globalni zdravstveni problem..., Hepatitis C virus (HCV) infection represents global health issue...