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Cilj istraživanja: Cilj istraživanja bio je istražit učestalost sindroma sagorijevanja na poslu i umora u zdravstvenih djelatnika na Klinici za neurologiju KBC Split te moguću povezanost sindroma sagorijevanja na poslu i umora. Materijali i metode: U ovo presječno istraživanje bilo je uključeno 75 ispitanika. Ispitanici su zdravstveni djelatnici na Klinici za neurologiju KBC Split. Prikupljanje podataka provodilo se u travnju 2023. godine. Ispitanici su anketirani koristeći dva upitnika. Prvi upitnik je upitnik intenziteta sagorijevanja na poslu, a drugi upitnik je MFI-20. Obrazac općih podataka uključivao je spol, dob, stručnu spremu, radno mjesto, godine radnog staža te broj dežurstava na mjesec (prosjek). Rezultati: Ispitanici su u primjedbama najčešće naveli da ih najviše smeta neravnomjerna opterećenost poslom među zaposlenicima (73%), nedostatna edukacija i uvođenje novih postupaka (52%), rad na 2-3 radilišta (47%), broj dežurstava (41%), ignorancija nadređenih (39%). Rezultati su pokazali da 44 % ispitanika pripada u skupinu visokog stupnja sagorijevanja na poslu. Medijan podljestvice općenitog umora najviši je i iznosi 13, dok je najniži kod podljestvice smanjene aktivnosti i iznosi 8. Sagorijevanje na poslu je umjereno pozitivno povezano sa općenitim umorom (r = 0,678; P < 0,001), tjelesnim umorom (r = 0,670; P < 0,001), smanjenom aktivnosti (r = 0,437; P < 0,001) i psihičkim umorom (r = 0,623; P < 0,001) te visoko pozitivno sa smanjenom motivacijom (r = 0,748; P < 0,001). Uvidom u β koeficijent vidljivo je kako općeniti umor (P = 0,002) i smanjena motivacija (P = 0,011) značajno pozitivno doprinose sagorijevanju na poslu zdravstvenih radnika. Zaključak: Gotovo tri četvrtine zdravstvenih djelatnika na Klinici za neurologiju ima neki stupanj sagorijevanja na poslu, a čak 44% njih pokazalo je visoki stupanj sagorijevanja. Općeniti umor je najizraženija dimenzija umora u ispitanika, a zajedno sa smanjenom motivacijom ima značajan pozitivan utjecaj na izgaranje u zdravstvenih djelatnika., Objectives: The aim of the research is to examine the frequency of burnout syndrome and fatigue in health workers at the Neurology Department of University Hospital of Split and the possible connection between burnout syndrome and fatigue. Materials and methods: In this cross-sectional study 75 healthcare workers were included. The respondents are healthcare workers at the Neurology Department of University Hospital of Split. Data collection was carried out in April 2023. Respondents were surveyed using two questionnaires. The first questionnaire is the burnout intensity questionnaire, and the second questionnaire is the MFI-20. The general data form included gender, age, professional qualification, workplace, years of service and number of on-call hours per month (average). Results: In their remarks, the respondents most often stated that the uneven workload among employees (73%), insufficient education and the introduction of new procedures (52%), working at 2-3 workplaces (47%), the number of on-calls (41%), ignorance of superiors (39%) bothers them the most. The results showed that 44% of respondents belong to the group with a high degree of burnout at work. The median of the subscale of general fatigue is the highest and it is 13, while the lowest is the subscale of reduced activity and it is 8. Burnout at work is moderately positively related to general fatigue (r = 0,678; P < 0,001), physical fatigue (r = 0,670; P < 0,001), reduced activity (r = 0,437; P < 0,001) and mental fatigue (r = 0,623; P < 0,001) and highly positive with reduced motivation (r = 0,748; P < 0,001). By looking at the β coefficient, it is evident that general fatigue (P = 0,002) and reduced motivation (P = 0,011) significantly positively contributed to the burnout at work of healthcare workers. Conclusions: Almost three quarters of healthcare workers at the Neurology Department have some degree of burnout at work, and even 44% of them showed a high degree of burnout. General fatigue is the most pronounced dimension of fatigue among respondents, and together with reduced motivation has a significant positive impact on burnout among healthcare professionals.

Prispevek se osredotoča na transformacijo antičnega mitološkega lika Medeje v libretu Vinka Möderndorferja Medeja: glasbena drama iz vsakdanjega življenja glede na Evripidovo tragedijo Medeja, ki od vseh mitoloških različic prva problematizira namerni umor otrok. Pozornost je usmerjena predvsem na zgodbo, obdobje in namen ustvarjanja, motiv umora otrok, vlogo moškega lika ter žensko kot nosilko demoničnih in božanskih lastnosti. The article focuses on the transformation of the antique mythological character Medea in the libretto by Vinko Möderndorfer: Medea: A Musical Drama from Everyday life2 in comparison with Euripides’ tragedy Medea, which is the first among all mythological versions to problematize a deliberate filicide. Attention is primarily focused on the story, time period and purpose, the theme of filicide, the role of the male character and the woman as a carrier of demonic and divine characteristics.

Umor je progresivna i lokalizirana pojava postupnog oštećivanja materijala uslijed dugotrajnih ciklički promjenjivih naprezanja. U slučaju zavarenih čeličnih konstrukcija, oštećenja umorom nastaju unutar zavarenih detalja, koji predstavljaju geometrijske i materijalne diskontinuitete. Nagle promjene geometrije uzrokuju visoke koncentracije naprezanja, čime se skraćuje životni vijek zavarenih detalja izloženih djelovanju umora. Proces zavarivanja uzrokuje vlačna zaostala naprezanja u području zavara, koja mogu dodatno skratiti njihov životni vijek. Unatoč brojnim smjernicama i preporukama za projektiranje, zadovoljavajući životni vijek zavarenih detalja izloženih umoru nije uvijek moguće postići. Zbog toga su razvijene metode obrade zavara poput metode mehaničkoga udara visokom frekvencijom koja omogućuje produljenje njihovog životnog vijeka. To se postiže promjenom lokalne geometrije zavara, unošenjem tlačnih zaostalih naprezanja i povećanjem tvrdoće na mjestu obrade. U okviru ovoga istraživanja su razvijeni i kalibrirani deterministički i stohastički proračunski modeli koji omogućuju pouzdanu procjenu životnoga vijeka neobrađenih i obrađenih zavarenih detalja izloženih umoru. Laboratorijskim ispitivanjima i numeričkim analizama su određeni i analizirani parametri poboljšanja životnoga vijeka zavarenih detalja, a kalibracija modela je provedena na temelju laboratorijskih cikličkih ispitivanja.

Uvod: Reumatoidni artritis (RA) je hronična progresivna sistemska bolest koju karakteriše simetrični perzistirajući sinovitis perifernih zglobova. Patološki proces, praćen upalom i posledičnim uništavanjem hrskavice i kostiju, prate u daljem toku oštećenja različitih tkiva uključujući tetive, ligamente i krvne sudove. Reumatoidni artritis mogu da prate i vanzglobne manifestacije koje predstavljaju faktore loše prognoze. Zabeležena je incidenca od približno 3 slučaja na 10000 stanovnika, a stopa prevalencije iznosi od 0,46% - 1%. Mnogi od odgovora imunog sistema koji su povezani sa RA su povezani sa depresivnom simptomatologijom koja je kod ovih pacijenata višestruko češća nego u opštoj populaciji. Odnos između depresije i RA je multifaktorski bilo da je depresija posredovana socioekonomskim faktorima vezanim za RA ili je posledica bola, funkcionalnih ograničenja ili je povezana sa dejstvom proinflamatornih citokina. Ova hronična autoimuna bolest koju karakteriše postepeno pogoršanje funkcije zglobova može dovesti do smanjenja adaptivnih sposobnosti osobe, samim tim se smanjuje kvalitet života, a gubitak funkcionalnosti umanjuje njihove radne sposobnosti. Glavni cilj lečenja RA je zaustavljanje upale, ublažavanje simptoma, sprečavanje oštećenja zglobova i organa, poboljšanje fizičkog funkcionisanja i sprečavanje ili smanjenje dugoročnih komplikacija. Optimalno lečenje pacijenata sa RA sastoji se od integrisanog pristupa koji uključuje nefarmakološku i farmakološku terapiju. Primena nebioloških i bioloških DMARD, bilo kao monoterapija ili u kombinovanoj terapiji, predstavlja najvažniju meru u uspešnom lečenju RA. Navodi se da depresija smanjuje odgovor na biološku terapiju kod RA i može ili pojačati bol ili samu aktivnost bolesti ili smanjiti verovatnoću za remisiju RA.Cilj: Cilj 1. Ispitati učestalost i stepen depresivne simptomatologije kod bolesnika sa RA. Cilj 2. Ispitati povezanost serumskih nivoa TNF-α i IL-6 sa pojavom i stepenom depresivne simptomatologije kod bolesnika sa RA. Cilj 3. Ispitati povezanost serumskih nivoa TNF-α i IL-6 sa funkcionalnim statusom, stepenom aktivnosti bolesti, stepenom umora i kvalitetom sna kod bolesnika sa RA. Cilj 4. Uporediti uticaj različitih terapijskih pristupa (konvencionalni sintetski lekovi koji modifikuju tok bolesti i biološki lekovi koji modifikuju tok bolesti) primenjenih u tretmanu bolesnika sa RA na stepen aktivnosti bolesti, funkcionalni status, stepen hroničnog umora, kvalitet sna i stepen depresivne simptomatologije. Cilj 5. Uporediti uticaj različitih bioloških lekova (TNF-α inhibitori i IL-6 receptor antagonisti) na funkcionalni status bolesnika i učestalost depresivne simptomatologije. Materijali i metode: Istraživanje je sprovedeno kao studija preseka, prospektivnog karaktera i obuhvatila je 84 bolesnika koji su bili hospitalizovani ili se ambulantno prate na Klinici za nefrologiju i kliničku imunologiju, Univerzitetskog Kliničkog centra Vojvodine. Od ukupnog broja ispitanika ženskog pola je bilo 95,2%, dok je preostalih 4,8 % ispitanika bilo muškog pola. Starost se kretala u intervalu od 19-75 godina, pri čemu je prosečna starost celokupnog uzorka iznosila M=53,19 godina (SD=13,09). Kod svih bolesnika je prethodno postavljena dijagnoza RA prema kriterijumima Američkog koledža za reumatologiju i Evropske lige protiv reumatizma. Svi bolesnici su ispitivani u odnosu na prisustvo i stepen depresivne simptomatologije korišćenjem standardizovanog upitnika Bekova skala depresivnosti (Beck Depression Inventory – BDI), funkcionalnog statusa upotrebom Upitnika o proceni zdravstvenog stanja-indeks onesposobljenosti (HAQ-QI), stepena hroničnog umora korišćenjem Upitnika za procenu zamora u hroničnim bolestima (FACIT-F- Functional Asessment of Chronic Illness Therapy-Fatigue), kvaliteta sna putem Pitsburškog indeksa kvaliteta spavanja (Pittsburgh Sleep Quality Index – PSQI) i stepena aktivnosti bolesti kroz Indeks aktivnosti bolesti koji inkorporira sedimentaciju eritrocita (Disease Activity Score-28 for Rheumatoid Arthritis with ESR -DAS28-ESR), Indeksa aktivnosti bolestikoji inkorporira CRP - DAS28-CRP indeks, i Klinički indeks aktivnosti bolesti (Clinical Disease Activity Index- CDAI). Takođe je jednokratno određena koncentracija IL-6 i TNF-α u serumu svih bolesnika koji su najmanje 6 meseci od momenta uključivanja u istraživanje na stabilnim dozama aktuelne terapije (isključivo konvencionalnim sintetskim lekovima koji modifikuju tok bolesti ili kombinacijom ovih lekova sa biološkim lekom koji se ispituje). Rezultati: Od celokupnog uzorka, 82% obolelih od RA je bilo seropozitivno, a od pridruženih bolesti, kao najčešći komorbiditet je navođena hipertenzija, koja je prisutna kod oko 31% ispitanika Bez komorbiditeta je bilo oko 30% ispitanog uzorka. Prosečna dužina trajanja bolesti iznosi M=12,74 godine (SD=7,38). Kada su u pitanju konvencionalni sistemski lekovi najveći procenat ispitanika koristi metotreksat (oko 47%), dok u vrlo sličnom procentu uzimaju sulfasalazin i antimalarik. NJih oko 18% ne uzima konvencionalnu terapiju. Najfrekventnija terapija iz grupe biološke prema dobijenim podacima je terapija koja uključuje TNF-α inhibitore, a koju dobija oko 48% ispitanika, naspram 33% koji dobijaju IL-6 receptor antagoniste. Iz grupe ispitanika koja se leči biološkim lekovima, jedan medikament uzima oko 84% ispitanih, dok preostalih 16% uzima dva. Kada je u pitanju dužina trajanja aktuelne biološke terapije ona u proseku iznosi M= 5,37 godina, dok je raspon korišćenja od 0,5 do12 godina. Jutarnju ukočenost kao simptom nema oko 40% ispitanih. U odnosu na kategorije ukupnog skora na Indeksu aktivnosti bolesti, može se uočiti da je u remisiji oko 40% ispitanog uzorka, dok kada je bolest aktivna, najveći procenat ispitanika ima umeren stepen aktivnosti bolesti 42%. Prema drugom pokazatelju aktivnosti bolesti, Kliničkom indeksu aktivnosti bolesti - CDAI, u remisiji je oko 18% ispitanog uzorka, a najveći broj ispitanika se nalazi u kategorijama umerenog i niskog stepena aktivnosti bolesti (redom, 36% i 40%). Prema Upitniku o proceni zdravstvenog stanja najveći procenat ispitanika pripada kategoriji koja funkcioniše bez ograničenja (oko 60%), a zatim sledi kategorija umereno ograničenog funkcionisanja (oko 34%). Procene aktivnosti bolesti na osnovu CRP i SE statistički se značajno razlikuju te je vrednost DAS28 skora veća u slučaju kada se u proceni koristi SE u odnosu na procenu u kojoj se koristi CRP parametar. Najveći procenat ispitanika nema simptome depresije (75%) procenjene Bekovom skalom depresije. S druge strane, među onima koji ispoljavaju simptome depresije relativno ujednačen broj ispitanika ispoljava znake blage depresije i depresije koja se po intenzitetu svrstava u smetnje umerenog stepena (13% i 11%). U odnosu na kategorije ukupnog skora na Bekovoj skali anksioznosti, može se uočiti da najveći procenat ispitanih, njih oko 82%, pripada kategoriji niske anksioznosti, dok oko 2% ispitanih izveštava o visokom stepenu prisutne anksioznosti. Najveći procenat ispitanika (47%) pripada kategoriji umerenog stepena zamora odnosno ekstremnog zamora (34%). Najveći procenat ispitanika (70%) navodi simptome koji ih svrstavaju u kategoriju lošeg kvaliteta sna. Beleži se statistički značajna korelacija pozitivnog smera i visokog intenziteta (r=0,842 i r=0,634) između serumskog nivoa interleukina 6 i stepena depresivnosti i anksioznosti. Postoje statistički značajne korelacije koje su po intenzitetu visoke ( 0,535 do 0,732) dok su po smeru i pozitivne i negativne između visine serumskog nivoa interleukina 6 i različitih parametara koji se tiču stepena aktivnosti bolesti, stepena umora i kvaliteta sna. Ispitanici koji imaju umeren i visok stepen aktivnosti bolesti, umereno i teško ograničenje funkcionisanja, loš kvalitet sna imaju više vrednosti faktora nekroze tumora alfa. S druge strane, ispitanici koji imaju lak zamor procenjen FACIT upitnikom imaju više vrednosti tumor nekrozis faktora alfa. Statistički značajne razlike postoje između ispitanika koji uzimaju konvencionalnu terapiju sa dodatkom TNF-α inhibitora u odnosu na ispitanike koji uzimaju konvencionalnu terapiju sa dodatkom IL-6 receptor antagonista. Osobe koje imaju prisutne simptome depresivnosti imaju viši nivo aktivnosti bolesti, viši nivo onesposobljenosti, kao i veći broj bolnih zglobova, viši stepen bola procenjen od strane i pacijenta i lekara. Sve dobijene razlike govore u prilog tome da osobe koje imaju prisutne simptome depresivnosti imaju viši nivo aktivnosti bolesti, veći stepen anksioznosti, lošiji kvalitet sna i viši stepen hroničnog umora u odnosu na pacijente koji nemaju depresiju u okviru kliničke slike.U predviđanju ishoda depresivnosti značajni prediktori pokazali su se DAS 28 CRP (p=0,009) i dužina trajanja bolesti (p=0,025). Zaključak: Rezultati ovog istraživanja pokazuju da najveći broj pacijenata sa RA (75%) nema simptome depresije procenjene pomoću BDI upitnika, dok je kod preostalih ispitanika podjednako zastupljena blaga depresija i depresija umerenog intenziteta. Hronični zamor, umerenog stepena ima skoro polovina ispitanika. Čak dve trećine ispitanika ima loš kvalitet sna, a jedna trećina ispitanika ima umereni stepen onesposobljenosti. Najveći broj ispitanika prijavljuje nizak stepen anksioznosti. Pacijenti koji imaju dokazano prisustvo depresivne simptomatologije imaju viši stepen aktivnosti bolesti, veći stepen anksioznosti, lošiji kvalitet sna i viši stepen hroničnog umora i onesposobljenosti. Prisustvo depresivne simptomatologije kod pacijenata sa RA povezano je sa većim brojem bolnih zglobova, višim stepenom bola izraženim na vizuelno analognoj skali kako od strane pacijenta, tako i od strane lekara. Dužina trajanja bolesti i stepen aktivnosti bolesti iskazan kroz DAS-28 CRP predstavljaju moguće prediktore nastanka depresivne simptomatologije kod pacijenata sa RA. Postoji povezanost između vrednosti IL-6 i TNF-α u serumu sa stepenom depresivne simptomatologije. Povišene serumske vrednosti IL-6 i TNF-α povezane su takođe sa većim stepenom aktivnosti bolesti, prisustvom anksioznosti, izraženijim umorom, smanjenom funkcionalnošću i lošijim kvalitetom sna. Terapija konvencionalnim sintetskim lekovima koji modifikuju tok bolesti se pokazala jednako efikasnom u odnosu na biološku u pogledu kontrole stepena aktivnosti bolesti, funkcionalnog statusa, umora i pojave depresivne simptomatologije. Primena IL-6 receptor antagonista i TNF-α inhibitora u lečenju pacijenata sa RA dovodi do postizanja boljeg funkcionalnog statusa, smanjenja hroničnog umora, boljeg kvaliteta sna, manjeg stepena kako depresivne simptomatologije tako i anksioznosti, i smanjenja aktivnosti osnovne bolesti. U odnosu na tip biološke terapije IL-6 receptor antagonisti su se pokazali efikasnijim u kontroli osnovne bolesti, ostvarivanju boljeg funkcionalnog statusa, manjeg stepena hroničnog umora, boljeg kvaliteta sna i ređe pojave depresivne simptomatologije u odnosu na TNF-α inhibitore., Introduction: Rheumatoid arthritis is a chronic progressive systemic disease characterized by symmetrical persistent synovitis of peripheral joints. The pathological process accompanied by inflammation and consequent destruction of cartilage and bones is followed, in further course, by damage to various tissues, including tendons, ligaments and blood vessels. Rheumatoid arthritis can be accompanied by extra-articular manifestations, which are poor prognostic factors. An incidence of approximately 3 cases per 10,000 inhabitants was recorded, and the prevalence rate was 0.46% - 1%. Many of the immune system responses which occur in RA, are associated with depressive symptoms that are much more common in these patients than in the general population. The relationship between depression and RA was multifactorial, on the one hand that depression is mediated by socioeconomic factors related to RA and could be a consequence of pain, functional limitations, or is associated with the action of proinflammatory cytokines. This chronic autoimmune disease, which is characterized by a gradual deterioration of joint function, can lead to a decrease in the adaptive abilities of persons, thus reducing the quality of life, whereby the loss of functionality reduces their working abilities. The main goal of RA treatment is to stop inflammation, alleviate symptoms, prevent damage to joints and organs, improve physical functioning and prevent or reduce long-term complications. The optimal treatment of patients with RA consists of an integrated approach that includes non-pharmacological and pharmacological therapy. The use of non-biological and biological DMARDs, whether as monotherapy or in combination therapy, is the most important action in the successful treatment of RA. Depression is said to reduce the response to biologic therapy in RA and may either increase pain or disease activity itself or reduce the likelihood of RA remission. The goal: Objective 1. To examine the frequency and degree of depressive symptoms in patients with RA. Objective 2. To investigate the association of serum levels of TNF-α and IL-6 with the occurrence and degree of depressive symptoms in patients with RA. Objective 3. To investigate the association of serum levels of TNF-α and IL-6 with functional status, degree of disease activity, degree of fatigue and quality in patients with RA. Objective 4. To compare the impact of different therapeutic approaches (conventional synthetic drugs that modify the course of the disease and biological drugs that modify the course of the disease) used in the treatment of patients with RA on disease activity, functional status, chronic fatigue, sleep quality and depressive symptoms. Objective 5. Compare the influence of different biological drugs (TNF-α inhibitors and IL-6 receptor antagonists) on the functional status of patients and frequency of depressive symptoms. Materials and methods: The study was conducted as a cross-sectional study, prospective in nature and included 84 patients who were hospitalized or monitored on an outpatient basis at the Clinic of Nephrology and Clinical Immunology, University Clinical Center of Vojvodina. Of the total number of respondents, 95.2% were female, while the remaining 4.8% were male. The age ranged from 19-75 years, with the average age of the entire sample being M = 53.19 years (SD = 13.09). All patients were previously diagnosed with RA according to the criteria of the American College of Rheumatology and the European League Against Rheumatism. All patients were examined for the presence and degree of depressive symptomatology using the standardized Beck Depression Inventory (BDI), functional status using the Health Assessment Questionnaire (HAQ-QI), chronic fatigue rate using the Assessment Questionnaire. fatigue in chronic diseases (FACIT-F-Functional Assessment of Chronic Illness Therapy-Fatigue), sleep quality through the Pittsburgh Sleep Quality Index (PSQI) and the degree of disease activity through the Index of Disease Activity Incorporating Sedimentation Eng. Disease Activity Score-28 for Rheumatoid Arthritis with ESR-DAS28-ESR), the Index of Disease Activity Incorporating CRP - DAS28-CRP Index, and the Clinical Disease Activity Index (CDAI). The serum IL-6 and TNF-α concentrations were also determined singlehanded in all patients who were at least 6 months from the time of enrollment on stable doses of current therapy (exclusively conventional disease-modifying synthetic drugs or a combination of these drugs with a biologics). Results: Of the total sample, 82% of RA patients were seropositive, and of the associated diseases, the most common comorbidity was hypertension, which is present in about 31% of subjects. About 30% of the sample was free of comorbidities. The average duration of the disease was M = 12.74 years (SD = 7.38). When it comes to conventional synthetic drugs which modify the course of the disease, the largest percentage of respondents use methotrexate (about 47%), while a very similar percentage take sulfasalazine and antimalarials. About 18% of them do not take conventional therapy. The most frequent therapy from the biological group according to the obtained data is TNF-α inhibitors, which was received by about 48% of the subjects, compared to 33% who receive IL-6 receptor antagonists. From the group of respondents who are treated with biological drugs, about 84% of the respondents take one medication, while the remaining 16% take two. When it comes to the duration of current biological therapy, it averages M = (5.37 years), while the range of use is from 0.5 to 12 years. About 40% of respondents do not have morning stiffness as a symptom. In relation to the categories of the total score on the Disease Activity Index, it can be noticed that about 40% of the examined sample is in remission, while, when the disease is active, the largest percentage of respondents has a moderate degree of disease activity 42%. According to the second indicator of disease activity, the Clinical Index of Disease Activity - CDAI, about 18% of the examined sample is in remission, and the largest number of respondents is in the categories of moderate and low degree of disease activity (36% and 40%, respectively). According to the Questionnaire on Health Assessment, the largest percentage of respondents belongs to the category that functions without restrictions (about 60%), followed by the category of moderately limited functioning (about 34%). Estimates of disease activity based on CRP and SE differ statistically significantly, and the value of DAS28 is almost always higher in the case when SE is used in the assessment compared to the assessment in which the CRP parameter is used. The largest percentage of respondents do not have symptoms of depression (75%) as assessed by the Beck Depression Scale. On the other hand, among those who show symptoms of depression, a relatively uniform number of respondents show signs of mild depression and depression, which is classified as moderate in severity (13% and 11%). In relation to the categories of the total score on the Beck anxiety scale, it can be noticed that the largest percentage of respondents, about 82%, belong to the category of low anxiety, while about 2% of respondents report a high degree of anxiety. The largest percentage of respondents (47%) belong to the category of moderate fatigue or extreme fatigue (34%). The highest percentage of respondents (70%) cite symptoms that place them in the category of poor sleep quality. There were statistically significant correlations of positive direction and high intensity (r = 0.842 and r = 0.634) between serum interleukin 6 levels and the degree of depression and anxiety. There are statistically significant correlations that are high in intensity (0.535 to 0.732) while in direction both positive and negative between the level of serum interleukin 6 and various parameters concerning the degree of disease activity, fatigue and sleep quality. Subjects who have moderate and high levels of disease activity, moderate and severe limitation of functioning, poor sleep quality, have higher values of tumor necrosis factor alpha. On the other hand, subjects who have mild fatigue assessed by the FACIT questionnaire have higher values of tumor necrosis factor alpha. There are statistically significant differences between subjects taking conventional therapy with the addition of TNF-α inhibitors compared to subjects taking conventional therapy with the addition of IL-6 receptor antagonists. People who have symptoms of depression have a higher level of disease activity, a higher level of disability, as well as a higher number of painful joints, a higher degree of pain assessed by both the patient and the doctor. All the differences suggest that people who have symptoms of depression have a higher level of anxiety activity, poorer quality of sleep and a higher degree of chronic fatigue compared to patients who do not have depression within the clinical picture. DAS28-CRP (p=0,009) and disease duration (p=0,025) have been identified as significant predictors of depression outcome. Conclusion: The results of this study show that the largest number of patients with RA (75%) do not have symptoms of depression assessed using the BDI questionnaire, while the remaining subjects have equally mild depression and depression of moderate intensity. Almost half of the respondents have chronic fatigue of a moderate degree. As many as two thirds of respondents have poor sleep quality, and one third of respondents have a moderate degree of disability. Most respondents report low levels of anxiety. Patients who have a proven presence of depressive symptoms have a higher degree of disease activity, a higher degree of anxiety, poorer quality of sleep and a higher degree of chronic fatigue and disability. The presence of depressive symptoms in patients with RA is associated with a greater number of painful joints, a higher degree of pain expressed on a visually analogoue scale by both the patient and the physician. The duration of the disease and the degree of disease activity expressed through DAS-28 CRP are possible predictors of the development of depressive symptoms in patients with RA. There is an association between serum IL-6 and TNF-α values with the degree of depressive symptomatology. Elevated serum levels of IL-6 and TNF-α are also associated with higher disease activity, the presence of anxiety, more pronounced fatigue, decreased functionality, and poorer sleep quality. Therapy with conventional synthetic drugs that modify the course of the disease has proven to be equally effective in relation to biological in terms of controlling the degree of disease activity, functional status, fatigue and the occurrence of depressive symptoms, better functional status, reduction of chronic fatigue, better quality of sleep, lower degree of both depressive symptoms and anxiety, and reduced activity of the underlying disease. Compared to the type of biological therapy, IL-6 receptor antagonists have been shown to be more effective in controlling the underlying disease, achieving better functional status, lower chronic fatigue, better sleep quality and less frequent depressive symptoms compared to TNF-α inhibitors.

Uvod: Reumatoidni artritis (RA) je hronična progresivna sistemska bolest koju karakteriše simetrični perzistirajući sinovitis perifernih zglobova. Patološki proces, praćen upalom i posledičnim uništavanjem hrskavice i kostiju, prate u daljem toku oštećenja različitih tkiva uključujući tetive, ligamente i krvne sudove. Reumatoidni artritis mogu da prate i vanzglobne manifestacije koje predstavljaju faktore loše prognoze. Zabeležena je incidenca od približno 3 slučaja na 10000 stanovnika, a stopa prevalencije iznosi od 0,46% - 1%. Mnogi od odgovora imunog sistema koji su povezani sa RA su povezani sa depresivnom simptomatologijom koja je kod ovih pacijenata višestruko češća nego u opštoj populaciji. Odnos između depresije i RA je multifaktorski bilo da je depresija posredovana socioekonomskim faktorima vezanim za RA ili je posledica bola, funkcionalnih ograničenja ili je povezana sa dejstvom proinflamatornih citokina. Ova hronična autoimuna bolest koju karakteriše postepeno pogoršanje funkcije zglobova može dovesti do smanjenja adaptivnih sposobnosti osobe, samim tim se smanjuje kvalitet života, a gubitak funkcionalnosti umanjuje njihove radne sposobnosti. Glavni cilj lečenja RA je zaustavljanje upale, ublažavanje simptoma, sprečavanje oštećenja zglobova i organa, poboljšanje fizičkog funkcionisanja i sprečavanje ili smanjenje dugoročnih komplikacija. Optimalno lečenje pacijenata sa RA sastoji se od integrisanog pristupa koji uključuje nefarmakološku i farmakološku terapiju. Primena nebioloških i bioloških DMARD, bilo kao monoterapija ili u kombinovanoj terapiji, predstavlja najvažniju meru u uspešnom lečenju RA. Navodi se da depresija smanjuje odgovor na biološku terapiju kod RA i može ili pojačati bol ili samu aktivnost bolesti ili smanjiti verovatnoću za remisiju RA.Cilj: Cilj 1. Ispitati učestalost i stepen depresivne simptomatologije kod bolesnika sa RA. Cilj 2. Ispitati povezanost serumskih nivoa TNF-α i IL-6 sa pojavom i stepenom depresivne simptomatologije kod bolesnika sa RA. Cilj 3. Ispitati povezanost serumskih nivoa TNF-α i IL-6 sa funkcionalnim statusom, stepenom aktivnosti bolesti, stepenom umora i kvalitetom sna kod bolesnika sa RA. Cilj 4. Uporediti uticaj različitih terapijskih pristupa (konvencionalni sintetski lekovi koji modifikuju tok bolesti i biološki lekovi koji modifikuju tok bolesti) primenjenih u tretmanu bolesnika sa RA na stepen aktivnosti bolesti, funkcionalni status, stepen hroničnog umora, kvalitet sna i stepen depresivne simptomatologije. Cilj 5. Uporediti uticaj različitih bioloških lekova (TNF-α inhibitori i IL-6 receptor antagonisti) na funkcionalni status bolesnika i učestalost depresivne simptomatologije. Materijali i metode: Istraživanje je sprovedeno kao studija preseka, prospektivnog karaktera i obuhvatila je 84 bolesnika koji su bili hospitalizovani ili se ambulantno prate na Klinici za nefrologiju i kliničku imunologiju, Univerzitetskog Kliničkog centra Vojvodine. Od ukupnog broja ispitanika ženskog pola je bilo 95,2%, dok je preostalih 4,8 % ispitanika bilo muškog pola. Starost se kretala u intervalu od 19-75 godina, pri čemu je prosečna starost celokupnog uzorka iznosila M=53,19 godina (SD=13,09). Kod svih bolesnika je prethodno postavljena dijagnoza RA prema kriterijumima Američkog koledža za reumatologiju i Evropske lige protiv reumatizma. Svi bolesnici su ispitivani u odnosu na prisustvo i stepen depresivne simptomatologije korišćenjem standardizovanog upitnika Bekova skala depresivnosti (Beck Depression Inventory – BDI), funkcionalnog statusa upotrebom Upitnika o proceni zdravstvenog stanja-indeks onesposobljenosti (HAQ-QI), stepena hroničnog umora korišćenjem Upitnika za procenu zamora u hroničnim bolestima (FACIT-F- Functional Asessment of Chronic Illness Therapy-Fatigue), kvaliteta sna putem Pitsburškog indeksa kvaliteta spavanja (Pittsburgh Sleep Quality Index – PSQI) i stepena aktivnosti bolesti kroz Indeks aktivnosti bolesti koji inkorporira sedimentaciju eritrocita (Disease Activity Score-28 for Rheumatoid Arthritis with ESR -DAS28-ESR), Indeksa aktivnosti bolestikoji inkorporira CRP - DAS28-CRP indeks, i Klinički indeks aktivnosti bolesti (Clinical Disease Activity Index- CDAI). Takođe je jednokratno određena koncentracija IL-6 i TNF-α u serumu svih bolesnika koji su najmanje 6 meseci od momenta uključivanja u istraživanje na stabilnim dozama aktuelne terapije (isključivo konvencionalnim sintetskim lekovima koji modifikuju tok bolesti ili kombinacijom ovih lekova sa biološkim lekom koji se ispituje). Rezultati: Od celokupnog uzorka, 82% obolelih od RA je bilo seropozitivno, a od pridruženih bolesti, kao najčešći komorbiditet je navođena hipertenzija, koja je prisutna kod oko 31% ispitanika Bez komorbiditeta je bilo oko 30% ispitanog uzorka. Prosečna dužina trajanja bolesti iznosi M=12,74 godine (SD=7,38). Kada su u pitanju konvencionalni sistemski lekovi najveći procenat ispitanika koristi metotreksat (oko 47%), dok u vrlo sličnom procentu uzimaju sulfasalazin i antimalarik. NJih oko 18% ne uzima konvencionalnu terapiju. Najfrekventnija terapija iz grupe biološke prema dobijenim podacima je terapija koja uključuje TNF-α inhibitore, a koju dobija oko 48% ispitanika, naspram 33% koji dobijaju IL-6 receptor antagoniste. Iz grupe ispitanika koja se leči biološkim lekovima, jedan medikament uzima oko 84% ispitanih, dok preostalih 16% uzima dva. Kada je u pitanju dužina trajanja aktuelne biološke terapije ona u proseku iznosi M= 5,37 godina, dok je raspon korišćenja od 0,5 do12 godina. Jutarnju ukočenost kao simptom nema oko 40% ispitanih. U odnosu na kategorije ukupnog skora na Indeksu aktivnosti bolesti, može se uočiti da je u remisiji oko 40% ispitanog uzorka, dok kada je bolest aktivna, najveći procenat ispitanika ima umeren stepen aktivnosti bolesti 42%. Prema drugom pokazatelju aktivnosti bolesti, Kliničkom indeksu aktivnosti bolesti - CDAI, u remisiji je oko 18% ispitanog uzorka, a najveći broj ispitanika se nalazi u kategorijama umerenog i niskog stepena aktivnosti bolesti (redom, 36% i 40%). Prema Upitniku o proceni zdravstvenog stanja najveći procenat ispitanika pripada kategoriji koja funkcioniše bez ograničenja (oko 60%), a zatim sledi kategorija umereno ograničenog funkcionisanja (oko 34%). Procene aktivnosti bolesti na osnovu CRP i SE statistički se značajno razlikuju te je vrednost DAS28 skora veća u slučaju kada se u proceni koristi SE u odnosu na procenu u kojoj se koristi CRP parametar. Najveći procenat ispitanika nema simptome depresije (75%) procenjene Bekovom skalom depresije. S druge strane, među onima koji ispoljavaju simptome depresije relativno ujednačen broj ispitanika ispoljava znake blage depresije i depresije koja se po intenzitetu svrstava u smetnje umerenog stepena (13% i 11%). U odnosu na kategorije ukupnog skora na Bekovoj skali anksioznosti, može se uočiti da najveći procenat ispitanih, njih oko 82%, pripada kategoriji niske anksioznosti, dok oko 2% ispitanih izveštava o visokom stepenu prisutne anksioznosti. Najveći procenat ispitanika (47%) pripada kategoriji umerenog stepena zamora odnosno ekstremnog zamora (34%). Najveći procenat ispitanika (70%) navodi simptome koji ih svrstavaju u kategoriju lošeg kvaliteta sna. Beleži se statistički značajna korelacija pozitivnog smera i visokog intenziteta (r=0,842 i r=0,634) između serumskog nivoa interleukina 6 i stepena depresivnosti i anksioznosti. Postoje statistički značajne korelacije koje su po intenzitetu visoke ( 0,535 do 0,732) dok su po smeru i pozitivne i negativne između visine serumskog nivoa interleukina 6 i različitih parametara koji se tiču stepena aktivnosti bolesti, stepena umora i kvaliteta sna. Ispitanici koji imaju umeren i visok stepen aktivnosti bolesti, umereno i teško ograničenje funkcionisanja, loš kvalitet sna imaju više vrednosti faktora nekroze tumora alfa. S druge strane, ispitanici koji imaju lak zamor procenjen FACIT upitnikom imaju više vrednosti tumor nekrozis faktora alfa. Statistički značajne razlike postoje između ispitanika koji uzimaju konvencionalnu terapiju sa dodatkom TNF-α inhibitora u odnosu na ispitanike koji uzimaju konvencionalnu terapiju sa dodatkom IL-6 receptor antagonista. Osobe koje imaju prisutne simptome depresivnosti imaju viši nivo aktivnosti bolesti, viši nivo onesposobljenosti, kao i veći broj bolnih zglobova, viši stepen bola procenjen od strane i pacijenta i lekara. Sve dobijene razlike govore u prilog tome da osobe koje imaju prisutne simptome depresivnosti imaju viši nivo aktivnosti bolesti, veći stepen anksioznosti, lošiji kvalitet sna i viši stepen hroničnog umora u odnosu na pacijente koji nemaju depresiju u okviru kliničke slike.U predviđanju ishoda depresivnosti značajni prediktori pokazali su se DAS 28 CRP (p=0,009) i dužina trajanja bolesti (p=0,025). Zaključak: Rezultati ovog istraživanja pokazuju da najveći broj pacijenata sa RA (75%) nema simptome depresije procenjene pomoću BDI upitnika, dok je kod preostalih ispitanika podjednako zastupljena blaga depresija i depresija umerenog intenziteta. Hronični zamor, umerenog stepena ima skoro polovina ispitanika. Čak dve trećine ispitanika ima loš kvalitet sna, a jedna trećina ispitanika ima umereni stepen onesposobljenosti. Najveći broj ispitanika prijavljuje nizak stepen anksioznosti. Pacijenti koji imaju dokazano prisustvo depresivne simptomatologije imaju viši stepen aktivnosti bolesti, veći stepen anksioznosti, lošiji kvalitet sna i viši stepen hroničnog umora i onesposobljenosti. Prisustvo depresivne simptomatologije kod pacijenata sa RA povezano je sa većim brojem bolnih zglobova, višim stepenom bola izraženim na vizuelno analognoj skali kako od strane pacijenta, tako i od strane lekara. Dužina trajanja bolesti i stepen aktivnosti bolesti iskazan kroz DAS-28 CRP predstavljaju moguće prediktore nastanka depresivne simptomatologije kod pacijenata sa RA. Postoji povezanost između vrednosti IL-6 i TNF-α u serumu sa stepenom depresivne simptomatologije. Povišene serumske vrednosti IL-6 i TNF-α povezane su takođe sa većim stepenom aktivnosti bolesti, prisustvom anksioznosti, izraženijim umorom, smanjenom funkcionalnošću i lošijim kvalitetom sna. Terapija konvencionalnim sintetskim lekovima koji modifikuju tok bolesti se pokazala jednako efikasnom u odnosu na biološku u pogledu kontrole stepena aktivnosti bolesti, funkcionalnog statusa, umora i pojave depresivne simptomatologije. Primena IL-6 receptor antagonista i TNF-α inhibitora u lečenju pacijenata sa RA dovodi do postizanja boljeg funkcionalnog statusa, smanjenja hroničnog umora, boljeg kvaliteta sna, manjeg stepena kako depresivne simptomatologije tako i anksioznosti, i smanjenja aktivnosti osnovne bolesti. U odnosu na tip biološke terapije IL-6 receptor antagonisti su se pokazali efikasnijim u kontroli osnovne bolesti, ostvarivanju boljeg funkcionalnog statusa, manjeg stepena hroničnog umora, boljeg kvaliteta sna i ređe pojave depresivne simptomatologije u odnosu na TNF-α inhibitore. Introduction: Rheumatoid arthritis is a chronic progressive systemic disease characterized by symmetrical persistent synovitis of peripheral joints. The pathological process accompanied by inflammation and consequent destruction of cartilage and bones is followed, in further course, by damage to various tissues, including tendons, ligaments and blood vessels. Rheumatoid arthritis can be accompanied by extra-articular manifestations, which are poor prognostic factors. An incidence of approximately 3 cases per 10,000 inhabitants was recorded, and the prevalence rate was 0.46% - 1%. Many of the immune system responses which occur in RA, are associated with depressive symptoms that are much more common in these patients than in the general population. The relationship between depression and RA was multifactorial, on the one hand that depression is mediated by socioeconomic factors related to RA and could be a consequence of pain, functional limitations, or is associated with the action of proinflammatory cytokines. This chronic autoimmune disease, which is characterized by a gradual deterioration of joint function, can lead to a decrease in the adaptive abilities of persons, thus reducing the quality of life, whereby the loss of functionality reduces their working abilities. The main goal of RA treatment is to stop inflammation, alleviate symptoms, prevent damage to joints and organs, improve physical functioning and prevent or reduce long-term complications. The optimal treatment of patients with RA consists of an integrated approach that includes non-pharmacological and pharmacological therapy. The use of non-biological and biological DMARDs, whether as monotherapy or in combination therapy, is the most important action in the successful treatment of RA. Depression is said to reduce the response to biologic therapy in RA and may either increase pain or disease activity itself or reduce the likelihood of RA remission. The goal: Objective 1. To examine the frequency and degree of depressive symptoms in patients with RA. Objective 2. To investigate the association of serum levels of TNF-α and IL-6 with the occurrence and degree of depressive symptoms in patients with RA. Objective 3. To investigate the association of serum levels of TNF-α and IL-6 with functional status, degree of disease activity, degree of fatigue and quality in patients with RA. Objective 4. To compare the impact of different therapeutic approaches (conventional synthetic drugs that modify the course of the disease and biological drugs that modify the course of the disease) used in the treatment of patients with RA on disease activity, functional status, chronic fatigue, sleep quality and depressive symptoms. Objective 5. Compare the influence of different biological drugs (TNF-α inhibitors and IL-6 receptor antagonists) on the functional status of patients and frequency of depressive symptoms. Materials and methods: The study was conducted as a cross-sectional study, prospective in nature and included 84 patients who were hospitalized or monitored on an outpatient basis at the Clinic of Nephrology and Clinical Immunology, University Clinical Center of Vojvodina. Of the total number of respondents, 95.2% were female, while the remaining 4.8% were male. The age ranged from 19-75 years, with the average age of the entire sample being M = 53.19 years (SD = 13.09). All patients were previously diagnosed with RA according to the criteria of the American College of Rheumatology and the European League Against Rheumatism. All patients were examined for the presence and degree of depressive symptomatology using the standardized Beck Depression Inventory (BDI), functional status using the Health Assessment Questionnaire (HAQ-QI), chronic fatigue rate using the Assessment Questionnaire. fatigue in chronic diseases (FACIT-F-Functional Assessment of Chronic Illness Therapy-Fatigue), sleep quality through the Pittsburgh Sleep Quality Index (PSQI) and the degree of disease activity through the Index of Disease Activity Incorporating Sedimentation Eng. Disease Activity Score-28 for Rheumatoid Arthritis with ESR-DAS28-ESR), the Index of Disease Activity Incorporating CRP - DAS28-CRP Index, and the Clinical Disease Activity Index (CDAI). The serum IL-6 and TNF-α concentrations were also determined singlehanded in all patients who were at least 6 months from the time of enrollment on stable doses of current therapy (exclusively conventional disease-modifying synthetic drugs or a combination of these drugs with a biologics). Results: Of the total sample, 82% of RA patients were seropositive, and of the associated diseases, the most common comorbidity was hypertension, which is present in about 31% of subjects. About 30% of the sample was free of comorbidities. The average duration of the disease was M = 12.74 years (SD = 7.38). When it comes to conventional synthetic drugs which modify the course of the disease, the largest percentage of respondents use methotrexate (about 47%), while a very similar percentage take sulfasalazine and antimalarials. About 18% of them do not take conventional therapy. The most frequent therapy from the biological group according to the obtained data is TNF-α inhibitors, which was received by about 48% of the subjects, compared to 33% who receive IL-6 receptor antagonists. From the group of respondents who are treated with biological drugs, about 84% of the respondents take one medication, while the remaining 16% take two. When it comes to the duration of current biological therapy, it averages M = (5.37 years), while the range of use is from 0.5 to 12 years. About 40% of respondents do not have morning stiffness as a symptom. In relation to the categories of the total score on the Disease Activity Index, it can be noticed that about 40% of the examined sample is in remission, while, when the disease is active, the largest percentage of respondents has a moderate degree of disease activity 42%. According to the second indicator of disease activity, the Clinical Index of Disease Activity - CDAI, about 18% of the examined sample is in remission, and the largest number of respondents is in the categories of moderate and low degree of disease activity (36% and 40%, respectively). According to the Questionnaire on Health Assessment, the largest percentage of respondents belongs to the category that functions without restrictions (about 60%), followed by the category of moderately limited functioning (about 34%). Estimates of disease activity based on CRP and SE differ statistically significantly, and the value of DAS28 is almost always higher in the case when SE is used in the assessment compared to the assessment in which the CRP parameter is used. The largest percentage of respondents do not have symptoms of depression (75%) as assessed by the Beck Depression Scale. On the other hand, among those who show symptoms of depression, a relatively uniform number of respondents show signs of mild depression and depression, which is classified as moderate in severity (13% and 11%). In relation to the categories of the total score on the Beck anxiety scale, it can be noticed that the largest percentage of respondents, about 82%, belong to the category of low anxiety, while about 2% of respondents report a high degree of anxiety. The largest percentage of respondents (47%) belong to the category of moderate fatigue or extreme fatigue (34%). The highest percentage of respondents (70%) cite symptoms that place them in the category of poor sleep quality. There were statistically significant correlations of positive direction and high intensity (r = 0.842 and r = 0.634) between serum interleukin 6 levels and the degree of depression and anxiety. There are statistically significant correlations that are high in intensity (0.535 to 0.732) while in direction both positive and negative between the level of serum interleukin 6 and various parameters concerning the degree of disease activity, fatigue and sleep quality. Subjects who have moderate and high levels of disease activity, moderate and severe limitation of functioning, poor sleep quality, have higher values of tumor necrosis factor alpha. On the other hand, subjects who have mild fatigue assessed by the FACIT questionnaire have higher values of tumor necrosis factor alpha. There are statistically significant differences between subjects taking conventional therapy with the addition of TNF-α inhibitors compared to subjects taking conventional therapy with the addition of IL-6 receptor antagonists. People who have symptoms of depression have a higher level of disease activity, a higher level of disability, as well as a higher number of painful joints, a higher degree of pain assessed by both the patient and the doctor. All the differences suggest that people who have symptoms of depression have a higher level of anxiety activity, poorer quality of sleep and a higher degree of chronic fatigue compared to patients who do not have depression within the clinical picture. DAS28-CRP (p=0,009) and disease duration (p=0,025) have been identified as significant predictors of depression outcome. Conclusion: The results of this study show that the largest number of patients with RA (75%) do not have symptoms of depression assessed using the BDI questionnaire, while the remaining subjects have equally mild depression and depression of moderate intensity. Almost half of the respondents have chronic fatigue of a moderate degree. As many as two thirds of respondents have poor sleep quality, and one third of respondents have a moderate degree of disability. Most respondents report low levels of anxiety. Patients who have a proven presence of depressive symptoms have a higher degree of disease activity, a higher degree of anxiety, poorer quality of sleep and a higher degree of chronic fatigue and disability. The presence of depressive symptoms in patients with RA is associated with a greater number of painful joints, a higher degree of pain expressed on a visually analogoue scale by both the patient and the physician. The duration of the disease and the degree of disease activity expressed through DAS-28 CRP are possible predictors of the development of depressive symptoms in patients with RA. There is an association between serum IL-6 and TNF-α values with the degree of depressive symptomatology. Elevated serum levels of IL-6 and TNF-α are also associated with higher disease activity, the presence of anxiety, more pronounced fatigue, decreased functionality, and poorer sleep quality. Therapy with conventional synthetic drugs that modify the course of the disease has proven to be equally effective in relation to biological in terms of controlling the degree of disease activity, functional status, fatigue and the occurrence of depressive symptoms, better functional status, reduction of chronic fatigue, better quality of sleep, lower degree of both depressive symptoms and anxiety, and reduced activity of the underlying disease. Compared to the type of biological therapy, IL-6 receptor antagonists have been shown to be more effective in controlling the underlying disease, achieving better functional status, lower chronic fatigue, better sleep quality and less frequent depressive symptoms compared to TNF-α inhibitors.

Umor je jedan od najčešćih i najviše otežavajućih simptoma multiple skleroze, a česta je pojava anksioznih i depresivnih poremećaja. Za evaluaciju i praćenje navedenih simptoma kod pacijenata oboljelih od multiple skleroze, najkorisnije su skale samoprocjene poput Skale zamora (FSS) i Skale bolničke anksioznosti i depresije (HADS). Cilj ovog istraživanja bio je ispitati psihometrijske karakteristike FSS-a i HADS-a na uzorku oboljelih od multiple skleroze u Hrvatskoj. Ispitala se faktorska struktura, pouzdanost unutarnje konzistencije, konkurentna i konvergentna valjanost. Također se ispitao doprinos umora, anksioznosti i depresije u objašnjenju varijance fizičkog i psihološkog utjecaja multiple skleroze na svakodnevni život. Istraživanje je provedeno online, a u analizu je uključeno 175 ispitanika oboljelih od multiple skleroze i 758 zdravih ispitanika. Osim već spomenutih skala, primijenjena je i Skala utjecaja multiple skleroze na svakodnevni život (MSIS-29), kao i opći upitnik sociodemografskih podataka i podataka o samoj bolesti. Rezultati su potvrdili jednodimenzionalnu strukturu FSS-a i dvofaktorsku strukturu HADS-a, kao i visoku pouzdanost tipa unutarnje konzistencije obje skale. Ispitanici oboljeli od MS-a u prosjeku imaju viši rezultat na FSS-u i subskalama Anksioznost i Depresija (HADS) u odnosu na zdrave ispitanike, što ukazuje na zadovoljavajuću konkurentnu valjanost ovih skala. Nadalje, rezultati na FSS-u su umjereno pozitivno povezani sa rezultatima na MSIS-29. Pronađena je pozitivno niska povezanost rezultata na subskali Anksioznost (HADS) sa rezultatima na subskali Fizički utjecaj (MSIS-29), a umjereno pozitivna povezanost sa rezultatima na subskali Psihološki utjecaj (MSIS-29). Rezultati na subskali Depresija (HADS) su umjereno pozitivno povezani sa rezultatima obje subskale MSIS-29. Dakle, može se reći da obje skale imaju zadovoljavajuću konvergentnu valjanost. Na kraju, utvrđeno je da su dužina trajanja multiple skleroze, umor, anksioznost i depresija značajni pozitivni prediktori fizičkog utjecaja multiple skleroze na svakodnevni život. Također, umor, anksioznost i depresija su značajni pozitivni prediktori psihološkog utjecaja multiple skleroze na svakodnevni život, dok je dob značajan negativan prediktor psihološkog utjecaja multiple skleroze na svakodnevni život. Fatigue is one of the most common and most debilitating symptoms of multiple sclerosis, and anxiety and depression disorders are common to. Self-report scales such as the Fatigue Severity Scale (FSS) and the Hospital Anxiety and Depression Scale (HADS) are the most useful for evaluating and monitoring these symptoms in multiple sclerosis patients. The aim of this study was to examine the psychometric properties of the FSS and HADS on a sample of patients with multiple sclerosis in Croatia. Factor structure, internal consistency reliability, concurrent and convergent validity were examined. The contribution of fatigue, anxiety, and depression in explaining the variance of the physical and psychological impact of multiple sclerosis on daily life was also examined. The research was conducted as online survey. 175 subjects with multiple sclerosis and 758 healthy subjects were included in the analysis. In addition to the already mentioned scales, the Multiple Sclerosis Impact Scale (MSIS-29) was also applied, as well as questionnaire of sociodemographic data and disease-related data. The results confirmed the unidimensional structure of the FSS and the two-factor structure of the HADS, as well as the excellent internal consistency of both scales. In relation to healthy subjects, subjects with MS had on average a higher score on the FSS and the Anxiety and Depression subscales (HADS), which indicates a satisfactory concurrent validity of these scales. Furthermore, scores on the FSS are moderately positively related to scores on the MSIS-29. A positive low correlation of the results on the Anxiety subscale (HADS) with the results of the Physical Impact subscale (MSIS-29) was found, and a moderately positive correlation with the results of the Psychological Impact subscale (MSIS-29). Results on the Depression subscale (HADS) are moderately positively correlated with results on both MSIS-29 subscales. Thus, it can be said that both scales have satisfactory convergent validity. Finally, it was determined that the duration of multiple sclerosis, fatigue, anxiety, and depression are significant positive predictors of the physical impact of multiple sclerosis on daily life. Also, fatigue, anxiety and depression are significant positive predictors of the psychological impact of multiple sclerosis on daily life, while age is a significant negative predictor of the psychological impact of multiple sclerosis on daily life.

Mnogi proizvođači automobila u svoja vozila ugrađuju razne sustave za nadzor vozača kako bi povećali sigurnost u prometu. Budući da stariji automobili nemaju takve sustave za nadzor vozača, ugrožena je sigurnost sudionika u prometu. U radu je predstavljeno nekoliko komercijalnih sustava za nadzor vozača. Zatim su opisani zahtjevi sustava za nadzor vozača i implementacija takvog sustava na osobno računalo i na pametni telefon. Na kraju je predstavljen rezultat evaluacije sustava za nadzor vozača. Many car manufacturers install various driver monitoring systems in their vehicles to increase traffic safety. Since older cars do not have such driver monitoring systems, the safety of road users is at risk. Several commercial driver monitoring systems are presented in the paper. Then the requirements of the driver monitoring system and the implementation of such a system on a personal computer and on a smartphone are described. At the end, the result of the evaluation of the driver monitoring system was presented.

Ovaj rad će promatrati razlike između kontinuiranog i diskontinuiranog načina plivanja, pokušat će dokučiti razloge i način kretanja fizioloških pokazatelja indikatora umora i razraditi problematiku održavanja brzine strategijom tempa. Tempo i njegovo održavanje predstavlja vrlo bitnu stavku trenažnog procesa vrhunskih plivača te je neophodno razumjeti što više faktora koji na njega utječu. Razlike će se ispitivati metodom studentovog t-testa. U testiranju i u zaključku će doći do nekih novih spoznaja vezanih uz ovo polje istraživanja i uz uređaje za davanje tempa. Također će se pratiti brzina plivanja po dionicama u oba načina plivanja te će se usporediti promjene brzine uslijed umora ili mogućnost sportaša da svoju brzinu održava. Rad će predstaviti koristi nekih instrumenata i tehničkih pomagala u trenažnom procesu i navesti će njihove nedostatke i smjer u kojem bi se trebali razvijati radi uspješnije i preciznije uporabe. This paper is going to observe differences between continuous and discontinuous swimming, it will try to figure out why and how do physiological parameters that indicate fatigue alter during activity and it will work on the issue of pacing strategies. Pacing and maintaining speed take up a major role during the training process of elite swimmers and it’s necessary to understand as many factors that influence them as possible. The differences will be tested using student t-test. Within testing and in conclusion there will be some newfound data related with this field of research and pacing training devices. Also, speed parameters will be kept track of in both tests and the change in speed will be compared between them whether the swimmers start to slow down due to fatigue or they manage to maintain their speed. This paper will present useful functions of some instruments and technical tools in training and it will mention some of their flaws and which direction should be taken to improve them so their use is more efficient and more precise.

Profesionalni sportaši izloženi su napornim treninzima kao dio njihova načina života. Svakodnevni treninzi, koji ih pripremaju za natjecanja i natjecanja sama po sebi, pomiču granice psihičkog i fizičkog napora. Ta je granica često iznad razine sposobnosti tijela da se odgovarajuće oporavi i pripremi za idući napor. Mnogi će sportaši postati kronično umorni zbog ovakvog ponavljajućeg napora. Zbog toga postaju podložni fizičkim ozljedama, psihičkim bolestima, hormonalnim promjenama itd. To može uzrokovati, uobičajeno u duljem razdoblju, nesklad između napornog fizičkog i psihičkog rada te očekivanih rezultata. Budući da karijera sportaša i njihov opći osjećaj zadovoljstva ovise o rezultatima koje ostvaruju, iznimno je bitna prevencija i odgovarajuća dijagnoza ovoga stanja. Glavni je cilj ovog stručnog rada pronaći nove spoznaje povezane s umornim sportašem (moguće uzroke, načine otkrivanja i praćenja te moguće prevencije) odabrati članke povezane s temom te povezati njihove rezultate ako je moguće. To je napravljeno koristeći PRISMA protokol. Pretraženi članci bili su isključivo meta- analize i sustavni pregledi. Korištenjem ovog protokola, odabrano je i obrađeno 6 sustavnih pregleda povezanih s temom. Glavne teme odabranih istraživanja su: utjecaj stresa uzrokovanim sportom na os mikrobiom-mozak, objektivne metode (koje se trenutno najčešće koriste) u usporedbi sa subjektivnim metodama, sindrom pretreniranosti sa stajališta hormona, pretreniranost kod vježbi s otporom, sindrom pretreniranosti kod vojnika i zamor srca uzrokovan vježbanjem. Metodološka kvaliteta svih odabranih sustavnih pregleda ocijenjena je AMSTAR-R instrumentom. Zbog ograničene kvalitete istraživanja, nije moguće dati čvrste preporuke. Međutim, postoje pronalasci čiju primjenu bi trebalo razmotriti. Primjerice, korištenje probiotika prilikom prevencije SP, korištenje subjektivnih mjera (POMS, RESTQ-s i DALDA upitnici) te korištenje objektivnih mjera (kortizola, KK, NA, omjera T/K, koncentracije laktata, AKTH, HR i prolaktina), ali sve uz određene uvjete. Procjena srčanog umora uzrokovanim vježbanjem napreduje evolucijom ehokardiografije, ali su nalazi još uvijek varijabilni., Professional athletes are exposed to strenuous exercises as a part of their lifestyle. Everyday trainings, which prepare them for competitions and even competitions themselves, push the limits of mental and physical effort. This limit is often above body’s ability to appropriately heal and prepare for the upcoming effort. Many of athletes will become chronically tired due to this repeating exhaustion. Because of that, they are susceptible to physical injuries, mental illnesses, hormonal changes, etc. This can cause, usually in the long run, impairment between hard work and expected results. As careers of athletes and their wellbeing depend on the results they perform, it is extremely important to prevent and appropriately diagnose this condition. The main goal of this paper is to explore available literature using PRISMA protocol and to select articles connected to tiredness of athletes (possible causes, methods of detection and prevention if possible). Searched articles were only systematic reviews and meta-analyzes. Using this protocol, 6 relevant systematic reviews were selected and analyzed. The main topics of selected reviews are: influence of stress caused by sport on microbiota- brain axis, objective measures (which are currently mostly used) vs. self-reported measures, hormonal aspect of overtraining syndrome, overtraining in resistance exercise, overtraining syndrome in soldiers and exercise-induced cardiac fatigue. Methodological quality of all selected systematic-reviews was scored using AMSTAR-R instrument. Due to limited quality of researches, it is not possible to make firm recommendations. However, there are findings whose application should be considered. For example, the use of probiotics in the prevention of overtraining syndrome, the use of subjective measures (POMS, RESTQ-s and DALDA questionnaires) and the use of objective measures (cortisol, creatine kinase, noradrenaline, estosterone/cortisol ratio, lactate concentration, adrenocorticotropic hormone, growth hormone and prolactin), but all within certain conditions. Assessment of exerciseinduced cardiac fatigue is advancing with the evolution of echocardiography, but the findings are still variable.

To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS., Sukladno našim saznanjima nema studije koja je istraživala nastaju li umor i depresija kao najučestaliji simptomi kod bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili iz sekundarnih povezanih stanja kao što je OSA kod bolesnika s MS. Cilj naše anketne studije bio je utvrditi jesu li depresija i umor u bolesnika s MS povezani s kliničkim obilježjima OSA ili MS. Proveli smo anketu pomoću četiri validirana upitnika (STOP-BANG, Epworthova ljestvica pospanosti, ljestvica težine umora i revidirana ljestvica depresije Centra za epidemiološke studije) u 28 uzastopnih ambulantnih bolesnika s klinički i paraklinički dokazanom MS. Učestalost bolesnika s MS s povećanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna od kliničkih značajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuća terapija, drugi lijekovi) nije bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilježje OSA bila je značajno i pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). Također, depresija je značajno i pozitivno korelirala s povećanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). Konačno, utvrđena je značajna pozitivna korelacija između težine umora i simptoma depresije (p=0,003). OSA je čest poremećaj kod bolesnika s MS. Kliničke značajke i čimbenici rizika za OSA u bolesnika s MS povezani su s dva najčešće prijavljivana simptoma depresije i umora, podupirući tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS.

Olimpijsko dizanje utega ili dizanje utega klasičnim načinom je dinamički sport snage i jakosti koji je već dugi niz godina dio modernih Olimpijskih igara i sve se više ljudi odlučuje baviti ovim sportom diljem svijeta. Ono se dijeli na dvije discipline: trzaj te nabačaj i izbačaj. Tijekom izvedbe ovih disciplina zabilježeni su jedne od najvećih izmjerenih vrijednosti relativne i apsolutne jakosti zabilježene u literaturi. Upravo zbog generiranja maksimalne moguće mišićne sile lako možemo zaključiti da obje discipline djeluju zahtjevno na ljudski organizam, a ponajviše na lokomotorni sustav. Zato se uz ovaj sport vežu i određene ozljede, od kojih su najčešće akutne, kronične te strukturne ili funkcionalne promjene mišićno koštanog sustava. Najčešći uzroci ovih ozljeda su neadekvatna priprema, loša tehnika izvedbe, nedostatak određenih motoričkih sposobnosti, neprimjeren izbor vanjskog opterećenja, nedovoljno zagrijavanje i istezanje, gubitak ravnoteže i umor. Olympic weightlifting or classic weightlifting is a dynamic sport that features strength and endurance. It has been a part of modern Olympic games for years and increasing numbers of people are taking up this sport worldwide. The sport can be separated into two disciplines: the snatch and the clean and jerk. Some of the most drastic values of both relative and absolute strength were recorded precisely in this sport. It is because of the generation of maximum muscle force that both disciplines put a heavy strain on the human organism, especially the locomotor system. That is why certain injuries are easily recognizable as connected to this sport, some of which are acute, chronic and structural or functional changes in the muscoskeletal system. The most common causes of the injuries are inadequate equipment, bad technique, lack of motor skills, inadequate choice of external load, loss of balance and fatigue.

V diplomski nalogi sta predstavljena dva kruta umora, ki sta se zgodila v okraju Škofja Loka v 30. letih 20. stoletja. Leta 1932 sta bili v Dražgošah umorjeni mati in hči, ki sta se preživljali s trgovino, leta 1939 pa je morilec vzel življenje zakoncema iz Sv. Barbare. V diplomski nalogi sta orisana oba umora in potek njune preiskave, opisana sta kraja zločina in navedena so odkri-tja orožnikov. Poleg preiskav so opisane tudi možne teorije o tem, kdo bi lahko bili morilci, saj sta umora ostala nerazrešena. Metodološko raziskava temelji na kvalitativni metodi – opisovanju, primerjavi, pojasnjevanju itd. Velik poudarek je na kritični analizi virov, saj se raziskava naslanja predvsem na časopisne vire, podkrepljena pa je tudi s podatki iz arhivskega gradiva, ki ga predstavljajo zapuščinski spisi in kazenski spis. The thesis aims to present two cruel murders that took place in the Škofja Loka region in the 1930's. In 1932 a mother and daughter from Dražgoše were murdered in their home, and in 1939 a murderer took the lives of a husband and wife from St. Barbara. The thesis focuses on the murders and their investigation – it describes the crime scenes and the evidence gathered by the police forces. Since the murders have stayed unsolved, the description of the investigation is followed by the theories concerning potential murderers. The thesis is based on the qualitative research method, which consists of descriptions, comparisons, and explanations. The emphasis is also on the critical analysis of the sources, because the research paper is based mainly on the newspaper articles, but it is also backed up by official inheritance documents and a police file.

The aim of the study was to investigate serum vitamin D level in undergraduate students of health studies and its relationship with the frequency of vitamin D rich food consumption, sun exposure, study-related fatigue, headache and psychopathological status, and the relationship of the latter three parameters with the type of physical activity. A blood level of 25-hydroxyvitamin D (25(OH)D), Migraine Disability Assessment (MIDAS), Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), nutrition and physical activity were surveyed in randomly chosen students. Study results showed that 49% of students had 25(OH)D insufficiency/deficiency. The MIDAS values were higher in the insufficient/ deficient group (p=0.035) and were associated with hours of weekly cardio exercises (r=-0.48, p=0.031). CORE-OM and total fatigue correlated with 25(OH)D (r=-0.59, p=0.024; r=0.51, p=0.023). Students with sufficient 25(OH)D had a significantly higher vitamin D intake by consuming sardines in their monthly nutrition (p=0.048). 25(OH)D correlated with the amount of monthly consumed sardines (r=0.59, p=0.006) in general. Our results provide initial evidence that an appropriate lifestyle along with proper physical activity, especially cardio exercise, and vitamin D rich nutrition is important to reduce fatigue, headaches and psychological distress., Cilj ove studije bio je ispitati vitamin D u serumu kod studenata prijediplomskog zdravstvenog studija i njegovu povezanost s učestalošću konzumacije hrane bogate vitaminom D, izlaganjem suncu, umorom vezanim za studiranje, glavoboljom i psihopatološkim statusom, te posljednja tri s vrstom tjelesne aktivnosti. Razina 25-hidroksivitamina D (25-OHD-a) u krvi, procjena nesposobnosti vezane za migrenu (Migraine Disability Assessment (MIDAS)), kakvoće života vezane za umor (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale), psihopatološkog statusa (Clinical Outcomes in Routine Evaluation – Outcome Measure (COREOM)), načina prehrane i tjelesne aktivnosti ispitani su kod nasumice izabranih studenata. Rezultati studije su pokazali da je 49% studenata imalo nedostatak/manjak 25-OHD-a . Vrijednosti MIDAS-a bile su veće u skupini s nedostatkom/manjkom (p =0.035) i bile su povezane su sa satima tjednih kardio-vježbi (r = -0,48, p =0,031). CORE-OM i ukupni umor korelirali su s 25-OHD-a (r = -0,59, p =0,024; r =0,51, p =0,023). Studenti s dovoljno 25- OHD-a imali su značajno veći unos vitamina D konzumirajući srdele u svojoj mjesečnoj prehrani (p =0,048); 25-OHD je korelirao s količinom mjesečno pojedenih srdela (r =0,59, p =0,006). Naši rezultati pružaju početne dokaze o tome kako je pravilan način života ispunjen pravilnom tjelesnom aktivnošću, posebno kardio-vježbanjem, i prehranom bogatom vitaminom D važan za smanjenje umora, glavobolje i psiholoških tegoba.

Odnos med duševnimi motnjami in kriminaliteto predstavlja področje, ki je bilo v strokovni literaturi doslej pogosto obravnavano. Tuje študije ob tem navajajo številne dejavnike tveganja, ki prispevajo k razvoju antisocialnega in odklonskega vedenja, med katere spadajo tudi duševne motnje. V večini obstoječih raziskav je bila prisotnost duševne motnje pri posamezniku povezana z večjim tveganjem za izvršitev kaznivega dejanja umora, ki je opredeljen kot kaznivo dejanje zoper življenje in telo posameznika. V magistrski raziskavi sem analiziral značilnosti kaznivega dejanja umora pri storilcih z duševnimi motnjami v Sloveniji. Poleg tega sem preučeval, ali se storilci glede na prisotnost duševne motnje razlikujejo v osebnih, situacijskih in kliničnih dejavnikih. V študijo je bilo vključenih 461 oseb, ki so izvršile kaznivo dejanje umora med leti 1991 in 2015. Storilci kaznivega dejanja umora z diagnozo duševne motnje so bili višje izobraženi, prihajali so iz ekonomsko in socialno ugodnejšega okolja, bili večkrat samski in pogosteje brez otrok. Za predhodno kaznivo dejanje so bili obsojeni v manjšem deležu in bili v času umora redkeje pod vplivom alkohola. Največkrat so z nožem ali drugim ostrim predmetom umorili prijatelja ali znanca, najpogostejši motiv umora pa so predstavljali predhodni spori. Največji delež storilcev glede na diagnozo duševne motnje so predstavljali posamezniki z motnjo osebnosti. Ti so bili v povprečju najmlajši, prihajali so iz socialno in ekonomsko najbolj neugodnega okolja in bili največkrat obsojeni za preteklo kaznivo dejanje. Ugotovitve raziskave lahko prispevajo k pripravi preventivnih programov za prepoznavanje posameznikov z visoko stopnjo tveganja in so v pomoč strokovnjakom, ki se ukvarjajo s področjem kazenskega pregona, hkrati pa predstavljajo tudi osnovo za nadaljnje raziskovanje na tem področju. The relationship between mental disorders and crime represents a thoroughly studied area of academic research. Existing studies indicate that multiple risk factors contribute to the development of antisocial and deviant behavior, including mental disorders. Furthermore, the diagnosis of a mental disorder was associated with a higher risk of homicide, which is defined as a crime against life and body of an individual. The aim of my research was to analyze the characteristics of homicidal acts, commited by perpetrators with mental disorders in Slovenia. In addition, I examined whether perpetrators differ in personal, situational and clinical factors, depending on the presence of mental disorder. The study included 461 subjects, who commited homicide between 1991 and 2015. Mentally disordered homicide offenders attained a higher level of education and came from a better social and economic background, but they were also more often single and childless. They were less frequently convicted of a previous crime and rarely intoxicated during the crime. Most often, a knife or other sharp object was used to kill a friend or acquaintance and previous conflicts were the most common motive. Offenders diagnosed with personality disorders represented the largest group. They were also the youngest, they came from socially and economically most disadvantaged background and were most often convicted of a previous crime. Findings of my master's thesis can contribute to the development of prevention programs for identifying high-risk individuals and to assist law enforcement professionals, as well as providing a basis for further research in this area.

Rak dojke je najčešće dijagnosticirani karcinom kod žena i drugi najčešći uzrok smrti od raka kod žena u Hrvatskoj prema podatcima Registra za rak Republike Hrvatske iz 2018. godine. Hormonski receptor (HR) pozitivan, receptor ljudskog epidermalnog faktora rasta 2 (HER-2) negativan rak dojke je imunofenotipski podtip s trenutno najviše dostupnih terapijskih opcija. Unatrag nekoliko godina, zlatni standard u liječenju ovog podtipa raka dojke u uznapredovalom stadiju bolesti, je primjena inhibitora selektivnih ciklin ovisnih kinaza 4/6 (CDK 4/6), kao dodatak antihormonskoj terapiji. Umor, kao jedan od najučestalijih simptoma kod oboljelih od karcinoma, ima značajan negativan utjecaj na funkcioniranje pacijenata jednako kao i na njihovu kvalitetu života, a u isto vrijeme, umor je često zanemaren i nedovoljno se procjenjuje kao nuspojava. Ovom analizom iz stvarne kliničke prakse prikazali smo kako je umor u našoj, promatranoj populaciji, česta nuspojava. Također smo ukazali na potrebu za podrobnijem osvrtanju i razumijevanju simptoma na koje se referiraju bolesnici tijekom sustavnog liječenja. Umor ima značajan potencijal uzrokovanja akutnog stresa kod onkoloških pacijenata te, iako nije nuspojava koja izravno ugrožava život bolesnika, uistinu je jedan od zahtjevnijih simptoma kako za oboljele tako i za njihove ordinarijuse.

In this paper fatigue for professional soldier caused by active physical activity and endurance limits is investigated. The resulting workload is one of indicators of how training, preparedness and other acquired work skills can contribute to the human body being a large working "machine". Ergometry test was conducted and field test for soldier fitness condition and energy expenditure was measured regarding the level of body's metabolism. Field test consisted of three runs on a polygon of 10 km and different workloads, the energy consumption was monitored. Work load was compared with Occupational Safety and Health law acts. The results showed difference in workload conditions and hart rate which allowed to determine rest spots and safety in training conditions., U ovom radu istražuje se umor profesionalnog vojnika uzrokovan aktivnom fizičkom aktivnošću i ograničenjima izdržljivosti. Rezultat radnog opterećenja jedan je od pokazatelja kako obuka, pripremljenost i druge stečene radne vještine mogu pridonijeti ljudskom tijelu kao velikom radnom „stroju“. Provedeno je ergometrijsko ispitivanje i terenski test za kondicijsko stanje vojnika i potrošnja energije mjereno je s obzirom na razinu metabolizma u tijelu. Terensko ispitivanje sastojalo se od staza na poligonu od 10 km i različitih opterećenja, a praćena je i potrošnja energije. Radno opterećenje uspoređeno je sa zakonima o zaštiti na radu. Rezultati su pokazali razliku u uvjetima radnog opterećenja i brzini vrtnje, što je omogućilo određivanje mjesta odmora i sigurnosti u uvjetima treninga.

Cilj ove studije bio je ispitati vitamin D u serumu kod studenata prijediplomskog zdravstvenog studija i njegovu povezanost s učestalošću konzumacije hrane bogate vitaminom D, izlaganjem suncu, umorom vezanim za studiranje, glavoboljom i psihopatološkim statusom, te posljednja tri s vrstom tjelesne aktivnosti. Razina 25-hidroksivitamina D (25-OHD-a) u krvi, procjena nesposobnosti vezane za migrenu (Migraine Disability Assessment (MIDAS)), kakvoće života vezane za umor (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale), psihopatološkog statusa (Clinical Outcomes in Routine Evaluation – Outcome Measure (COREOM)), načina prehrane i tjelesne aktivnosti ispitani su kod nasumice izabranih studenata. Rezultati studije su pokazali da je 49% studenata imalo nedostatak/manjak 25-OHD-a . Vrijednosti MIDAS-a bile su veće u skupini s nedostatkom/manjkom (p =0.035) i bile su povezane su sa satima tjednih kardio-vježbi (r = -0,48, p =0,031). CORE-OM i ukupni umor korelirali su s 25-OHD-a (r = -0,59, p =0,024; r =0,51, p =0,023). Studenti s dovoljno 25- OHD-a imali su značajno veći unos vitamina D konzumirajući srdele u svojoj mjesečnoj prehrani (p =0,048); 25-OHD je korelirao s količinom mjesečno pojedenih srdela (r =0,59, p =0,006). Naši rezultati pružaju početne dokaze o tome kako je pravilan način života ispunjen pravilnom tjelesnom aktivnošću, posebno kardio-vježbanjem, i prehranom bogatom vitaminom D važan za smanjenje umora, glavobolje i psiholoških tegoba., The aim of the study was to investigate serum vitamin D level in undergraduate students of health studies and its relationship with the frequency of vitamin D rich food consumption, sun exposure, study-related fatigue, headache and psychopathological status, and the relationship of the latter three parameters with the type of physical activity. A blood level of 25-hydroxyvitamin D (25(OH)D), Migraine Disability Assessment (MIDAS), Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), nutrition and physical activity were surveyed in randomly chosen students. Study results showed that 49% of students had 25(OH)D insufficiency/deficiency. The MIDAS values were higher in the insufficient/ deficient group (p=0.035) and were associated with hours of weekly cardio exercises (r=-0.48, p=0.031). CORE-OM and total fatigue correlated with 25(OH)D (r=-0.59, p=0.024; r=0.51, p=0.023). Students with sufficient 25(OH)D had a significantly higher vitamin D intake by consuming sardines in their monthly nutrition (p=0.048). 25(OH)D correlated with the amount of monthly consumed sardines (r=0.59, p=0.006) in general. Our results provide initial evidence that an appropriate lifestyle along with proper physical activity, especially cardio exercise, and vitamin D rich nutrition is important to reduce fatigue, headaches and psychological distress.

Primarni cilj ovog rada bio je kroz sustavni pregled literature utvrditi utjecaj Kinesiotapinga (KT) na jakost i posturalnu kontrolu zdravih odraslih ispitanika, sa ili bez prethodnog protokola umaranja. Uzorci su pripadali skupini neaktivne ili rekreativno aktivne opće populacije, sportaša amaterskog ili profesionalnog ranga i zdravih starijih osoba. Ovom kvalitativnom analizom obuhvaćen je ukupno 2241 ispitanik, od čega gotovo podjednak udio ženskih (N=1094) i muških ispitanika (N=1147). Dob ispitanika se nalazi u rasponu od 18-75, uz napomenu da su samo 3 studije sadržavale uzorak ispitanika starijih od 60 godina. Nekoliko je potencijalnih izvora heterogenosti analiziranih studija poput različitih razina treniranosti ispitanika, različite količine natega i tehnika primjene KT-a, različitih načina mjerenja jakosti, korištenja različitih uređaja za mjerenje jakosti i različitih kutnih brzina prilikom testiranja na izokinetičkim uređajima. Nadalje, velike su razlike prisutne u mišićima na koje se primjenivao KT, testovima i promatranim varijablama posturalne kontrole kao i protokolima umaranja. Utvrđen je neznatan učinak KT-a na maksimalnu i eksplozivnu jakost, ali treba napomenuti da zaključivanje u velikoj mjeri otežavaju navedeni izvori heterogenosti. Značajniji pozitivni učinci KT-a utvrđeni su na posturalnu kontrolu u statičkim i dinamičkim uvjetima, premda je teško zaključivati o posturalnoj kontroli/ravnoteži uspoređujući testove statičkog i dinamičkog karaktera. Najveći učinci utvrđeni su na oporavak maksimalne i eksplozivne jakosti te posturalne kontrole u uvjetima umora, i čini se da je KT najdjelotvojirniji kad su te sposobnosti narušene. Nekoliko je pravaca u kojima bi buduća istraživanja trebala ići. Homogenizacija uzoraka je ključna, s obzirom na to da se u okviru istih uzoraka učinak KT-a različito odrazio na ispitanike sa slabije i bolje razvijenim sposobnostima. Također, primjena KT-a na veći broj mišićnih skupina donjih ekstremiteta bi trebala biti u fokusu budućih istraživanja. Konačno, standardizacija razina natega i tehnika primjene je ključna za usporedbu i generalizaciju rezultata. This systematic review aims to analyze the effects of Kinesiotaping (KT) on strength, power and postural control, in rested or previously fatigued healthy adult individuals. Samples included were either amateur or high-level athletes, healthy inactive or recreationally active adults or healthy elderly individuals. A total of 2241 participants were included, with nearly equal number of female (N=1094) and male participants (N=1147). Age range of the subjects was rather wide, going from 18 to 75 years, with only 3 studies containing subjects over the age of 60. There are a few potential sources of heterogeneity in the included studies, such as varying activity levels, varied tension levels of KT applied, different ways of measuring strength, usage of different strength measuring devices and varying angular velocities during isokinetic testing. Furthermore, substantial differences were observed in the muscles being taped, tests and observed variables of postural control and fatiguing protocols. Insignificant effects were observed for the use of KT in improving muscle strength and power, with sources of heterogeneity having a significant impact on the lack of positive effects. In regards to static and dynamic postural control, it seems that KT is more effective, however, it has proven difficult to compare and draw inferences about static and dynamic postural control interchangeably. KT has proven most effective in mediating or attenuating the effects of fatigue on muscle strength, power and postural control. It seems that the effects of KT are more pronounced when the motor abilities observed are diminished for some reason, thus indicating the need to elucidate the underlying mechanisms. Also, application of KT on more lower extremity muscles seems to be a prudent strategy. Future research should strive for homogenisation of the included samples, since the effects of KT are better in individuals who demonstrate initially lower ability levels. Finally, future studies should aim at standardising the levels of tension and techniques of KT application.

Sindrom pretreniranosti javlja se kao posljedica pretjeranog opterećenja organizma, te nedostatka odmora i prilagodbe na tjelesni stres. To znači da tijelu i ogranizmu nismo dali dovoljno vremena da se adaptira i oporavi od treninga, ili smo jednostavno pretjerali i opteretili organizam. Najčešće se događa u periodu kada sportaš ili rekreativac stekne određenu formu, pa ima ambicije i želje napredovati još više, što prije to bolje. Umor definiramo kao nemogućnost održavanja potrebne mišične snage za nastavak muskulaturnog rada u zadanom intenzitetu. Izraz umor obično koristimo za opisivanje opadanja u mišićnoj izvedbi u suradnji s naporom popraćenim općim senzacijama umora. Za napredovanje u trenažnom procesu, odgovarajući odmor neizostavna je komponenta. Napredak se događa kada damo organizmu dovoljno vremena da se mehanizmom tendencije povratka u homeostazu, nakon trenažnog stresa, inicijalne sposobnosti ili morfološke karakteristike pomaknu u pozitivu. Taj fenomen nazivamo superkompenzacijom. Pretreniranost je stanje umora , iscrpljenosti i nemogućnosti obavljanja treninga na onoj razini na kojoj je sportaš bio prije nego se pretrenirao. Do pretreniranosti dolazi zbog nesrazmjera intenziteta treninga i vremena potrebnog da se organizam od njega oporavi. Ovo je stanje praćeno psihološkim smetnjama poput depresije, anksioznosi, apatije, naglih promijena raspoloženja i slično. Ozljede kroničnog tipa u obliku mikrotrauma javljaju se kao posljedica ponavljanja krivih obrazaca pokreta ili pretjerane uporabe određene mišićnotetivne jedinice.Za oporavak od sindroma pretreniranosti ili ozljeda kroničnog tipa, pojedinac se mora držati strogih uputa i dati organizmu dovoljno vremena za oporavak. Overtraining syndrome occurs as a result of excessive burden on the body, as well as lack of rest and adjustment to physical stress. This means that we have not given the body and branch enough time to adapt and recover from training, or we have simply overdone and burdened the organism. Most often it happens in a period when an athlete or recreational athlete acquires a certain form, so he has ambitions and desires to progress even more, the sooner the better. We define fatigue as an inability to maintain the necessary muscle power to continue musculature in a given intensity. The term fatigue is usually used to describe decline in muscle performance in conjunction with exertion accompanied by general sensations of fatigue. For advancing in the training process, a proper rest is an indispensable component. Progress occurs when we give the body sufficient time to move the mechanism of the tendency to return to homeostasis, after training stress, initial abilities or morphological characteristics to the positive. We call this phenomenon supercompensation. Retraining is a state of fatigue , exhaustion and inability to perform training at the level the athlete was at before he retrained. Overtraining occurs due to the discrepancy in the intensity of the training and the time it takes for the organism to recover from it. This condition is accompanied by psychological disorders such as depression, anxiety, apathy, sudden mood swings and the like. Injuries of chronic type in the form of microtrauma occur as a result of repeated misconceives of movement or excessive use of a certain musculoskelete unit. In return for recovery from over-trained syndrome or injuries of a chronic type, the individual must follow strict instructions and give the body sufficient time to recover.

Moderni sport postavlja pred sportaše i sportske stručnjake velike zahtjeve i svakodnevne izazove. Vrhunski sportaši postaju svjesni koliko je potrebno ulagati u vlastiti razvoj kako bi zadržali sportsku izvedbu na vrhunskoj razini. To posebno dolazi do izražaja u profesionalnom ekipnom sportu gdje je kalendar natjecanja zgusnut i natjecanja se događaju svaka 3-4 dana. Treneri i sportaši u tim natjecanjima svjesni su važnosti oporavka te čine sve što je moguće da ubrzaju proces oporavka i vrate organizam u ravnotežno stanje. Za kontrolu procesa oporavka u praksi se koriste brojni markeri oporavka od kojih su neki jeftini i jednostavni za primjenu, a neki skupi i nepraktični. Nadalje, u literaturi se može pronaći, a i u praksi se koristi širok spektar različitih metoda koje se koriste kako bi se pospješio oporavak sportaša i kako bi sportaši bili na optimalnoj razini sposobnosti u što kraćem periodu nakon napora treninga ili natjecanja. Kombinacijom tih metoda znanstvenici i stručnjaci predlažu različite modele oporavka nakon natjecanja za koje vjeruju da ubrzavaju proces oporavka. Cilj ovog rada je pregledom znanstvene i stručne literature opisati markere oporavka te utvrditi da li i u kojoj mjeri određene metode oporavka sportaša u sportskim igrama imaju pozitivan učinak na organizam u vidu bržeg i učinkovitijeg oporavka sportaša te predstaviti modele oporavka nakon natjecanja. Modern day sport places big demands and daily challenges on athletes and professionals within sports. As a result of growing popularity, athletes are becoming more aware of how much time and energy they need to invest in themselves and work hard every day to stay at top level. This kind of mentality is especially evident in professional team sports where congested schedules demand athletes to play matches every 3-4 days. Coaches and athletes are aware of importance of recovery in those kind of professional setups and hence they do everything in their ability to speed up recovery process and return athletes organism to homeostatis. To monitor recovery process coaches in practice use many recovery markers, some of them are cheap and easy to apply, while others are expensive and impractical. Furthermore, in modern literature we will find that in practice coaches are using a wide spectrum of different methods that are used to accelerate recovery process. Scientists and experts are combining those methods and suggest different models for which they believe that are speeding up the recovery process. The aim of this paper is to describe recovery markers and to determine if certain recovery methods have positive effects on organism in form of faster and more efficient recovery, and also to present after-competition recovery models.

Umori z zastrupitvami so kazniva dejanja, ki so v primerjavi z drugimi načini umorov redka. Njihovo odkrivanje ni enostavno. Umor z zastrupitvijo ne vzbuja sumov o storjenem kaznivem dejanju. Tudi kraj dejanja in izbor načina umora nista tipična in zahtevata od preiskovalcev drugačne pristope preiskovanja. Umori z zastrupitvijo so se pojavljali že od nekdaj in še danes veljajo za misteriozna kazniva dejanja, ki odpirajo veliko vprašanj. Storilci namesto po klasičnem orožju posežejo po različnih toksičnih snoveh, ki s svojim delovanjem v odvisnosti od njihovega odmerka lahko povzročijo znake, ki sprva spominjajo na začetek neke bolezni, nato pa se simptomi stopnjujejo in na koncu sledi smrt. Vsaka snov, katere odmerek je dovolj velik, je potencialen strup, ki lahko povzroči znake in simptome bolezni ali smrt. To so bodisi farmacevtski izdelki, čistila, pesticidi, kemikalije, strupene rastline ali živali, droge, kemično orožje, težke kovine itd. Storilec strup izbere glede na to, kako težko ga je odkriti v telesu žrtve, oziroma se ga pri obdukciji in s toksikološkimi preiskavami težko zazna in ki v odvisnosti od odmerka povzroči relativno hitro in gotovo smrt. Poleg izbora primernega strupa je za storilca ključen dober načrt in priprava na dejanje. Pri preiskovanju takšnih kaznivih dejanj morajo preiskovalci tesno sodelovati z zdravstveno stroko, ki pri tem igra ključno vlogo. Ugotovitve zdravnikov, ki so bili v stiku z žrtvijo, lahko razjasnijo marsikatero dilemo. Obdukcija in toksikološke preiskave so v primerih umorov z zastrupitvijo ključne in lahko v najbolj idealnem primeru (če ne gre za izjemno težko izsledljiv strup) podajo odgovore na vsa vprašanja o morebitni zastrupitvi. V primerih, ko gre za zastrupitev z redkim strupom, je potrebno sodelovanje z različnimi institucijami in laboratoriji, ki razpolagajo s primerno opremo za odkrivanje in dokazovanje določenega strupa. V Sloveniji so to med drugim Inštitut za sodno medicino, Institut »Jožefa Stefana«, Inštitut za mikrobiologijo in imunologijo, Fakulteta za kemijo in kemijsko tehnologijo itd. Če se sumi o storjenem kaznivem dejanju pojavijo, ko je truplo že pokopano, sledi izkop trupla (ekshumacija) in ponovna obdukcija ter toksikološke preiskave, da bi se ugotovilo pravi vzrok smrti. Criminal poisonings are criminal actions which do not occur frequently in comparison to other types of murder. Detection of such crimes is difficult since criminal poisoning does not raise suspicion of a crime. Crime scene and the choice of a murder weapon are not typical and require different approaches in the investigation process. Murderers have been choosing poison for a long period of time and such murders are still considered mysterious crimes which raise many questions for criminal investigators. Instead of using conventional weapons, perpetrators resort to a variety of toxic substances which by their action, depending on their dose, can produce signs that initially resemble the onset of a disease. The symptoms then escalate and eventually cause death. Any substance with a high enough dose is a potential poison that can cause signs and symptoms of an illness or death (for example pharmaceuticals, pesticides, chemicals, toxic plants or animals, drugs, chemical weapons, heavy metals, among others). The perpetrator chooses the poison according to how difficult it is to detect the said poison in the body of the victim, or how difficult it is to detect it during an autopsy and toxicological tests and which, depending on the dose, causes relatively fast and certain death. In addition to choosing the right poison, a good plan and preparation are crucial for the perpetrator. When it comes to the investigation, investigators must work closely with medical professionals. The findings of physicians who have been in contact with the victim can clarify many dilemmas. Autopsy findings and toxicological tests are crucial in the investigation and can provide answers to many difficult questions about the potential poisoning (unless the poison is extremely difficult to detect). In cases where rare poisons are involved, cooperation with various institutions and laboratories that have the appropriate equipment to detect and prove a particular poison is required. Such institutions in Slovenia are for example The Institute of Forensic Medicine, The Jožef Stefan Institute, The Institute of Microbiology and Immunology, and The Faculty of Chemistry and Chemical Technology. If a suspicion of criminal offense occurs when the corpse is already buried, an exhumation of the corpse is carried out. After the exhumation an autopsy and toxicological tests are carried out to determine the true cause of death.

This bachelor thesis deals with the area of mortgage loans. These are one of the possibilities how to obtain your own housing nowadays. Based on the available sources, the basic knowledge concerning the issue of mortgage loans, including the development of mortgage banking in our territory, is described. The thesis also includes an analysis of the current situation in the mortgage market. The aim of the thesis is to describe the currently offered variants of mortgage loans for selected banking houses. Based on the market share, the five largest banks in the mortgage market were chosen. Specifically, it concerns Hypoteční banka, Česká spořitelna, Komerční banka, Raiffeisenbank and UniCredit Bank. The main goal of the thesis is to choose the most advantageous solution in the form of a mortgage loan according to the specific requirements of fictitious applicants based on the comparison of individual offers of the mentioned banks. In the final part, recommendations for model situations are processed.

Tumori vrata jedni su od najzastupljenijih tumora. Obično se na vratu pojavljuju metastaze nekih primarnih tumora. Njihove funkcije i mogući deformiteti pridonose njihovoj važnosti. Tumori vrata najčešće nastaju zbog prekomjernog uživanja u alkoholnim pićima i cigaretama. Njihova se pojavnost razlikuje u različitim zemljopisnim područjima. Najčešće se liječe kirurškim zahvatom, kemoterapijom i radioterapijom. Kirurški zahvat je najčešći oblik liječenja. Kako je riječ o osjetljivom području, često sa sobom donosi i određene posljedice. Onkološka rehabilitacija bolesnika bitna je i prije i nakon same operacije vrata. Prije operacije bitno je da fizioterapeut ostvari kontakt s bolesnikom, uspostavi kvalitetnu komunikaciju, prvenstveno kako bi bolesnik bio educiran o tome što ga čeka nakon operacije. Uloga fizioterapeuta je vrlo bitna i nakon operacije. Naime, on bolesniku mora pomoći kako bi nadomjestio potencijalno izgubljenu funkciju te poboljšao kvalitetu svog života.

Kod zavarenih konstrukcija, oštećenja umorom najčešće nastaju na mjestima zavara, koji predstavljaju geometrijske i materijalne diskontinuitete. Zbog toga su razvijene metode obrade zavara nakon zavarivanja. Jedna od relativno novih metoda obrade je metoda mehaničkog udara visokom frekvencijom. Ta metoda utječe na promjenu geometrije zavara, lokalno povećanje tvrdoće te uklanjanje nepovoljnih zaostalih naprezanja nastalih procesom zavarivanja. U radu se daje pregled navedene metode te se ističu područja koja zahtijevaju dodatna razmatranja., In welded structures, fatigue damage often occurs in welds, which are the points of geometrical and material discontinuity. Accordingly, post-weld treatment methods have been developed. One of the relatively new methods is the high-frequency mechanical impact treatment. The method is characterised by the change in weld geometry, local increase in hardness, and elimination of residual stresses generated by the welding process. An overview of this method is provided, and areas requiring further consideration are highlighted.