Stress may affect patients with atopic dermatitis (AD). The aim of this study was to examine the impact of the COVID-19 pandemic and the earthquake in Zagreb, Croatia (March 2020), on AD patients and ...their disease severity, symptoms/itch, and perceived stress.
Our observational cross-sectional study included three groups of AD patients diagnosed by a physician: group 1 (n = 50), who experienced both the pandemic (quarantine) and the earthquake; group 2 (n = 50), who experienced only the pandemic; and group 3 (n = 50), the comparison group, who experienced neither disaster (patients examined 2018-2019). Groups 1 and 2 were examined May-June 2020, immediately after the national lockdown/quarantine. Disease severity (SCORAD), data from the Perceived Stress Scale (PSS), and information on patients' confirmed allergies were recorded for all groups, while groups 1 and 2 additionally completed a questionnaire concerning their disease, hand hygiene, and experience during the pandemic and/or earthquake.
The patients exposed to both disasters reported more pronounced AD worsening (p < 0.001; r = 0.388) and more frequent itching (p < 0.001; r = 0.350) than those exposed to the pandemic only. Notably, we found certain differences by gender: during the pandemic, women significantly more frequently washed their hands (81% of women washed "very frequently," while 52% of men washed "quite often") and had significantly higher PSS levels than men (p < 0.05). Concerning allergies, present or absent, during the pandemic, there was no significant difference in SCORAD between groups 1 and 2, neither when analyzed separately for indoor nor for outdoor allergens. The most commonly reported psychological disturbances during the pandemic were concern (46%), anger (18%), anxiety (16%), depression (9%), and increased alcohol, cigarette, and opioid agent use (6%).
The COVID-19 pandemic together with the earthquake significantly increased disease severity and influenced AD worsening, itching, and psychological disturbances. This indicates that stressful events meaningfully affect the course of AD.
Naša ratna medicinska doktrina rađala se zajedno s hrvatskom državom i vojskom. U uvjetima nametnutog rata i nedostatka ratnog saniteta nametnula se potreba stvaranja ratne doktrine. Organizacijski ...možemo definirati tri osnovne sastavnice ratnog zdravstva u Karlovcu. Prva sastavnica je Opća bolnica Karlovac, druga vojni sanitet, a treća je hitna, preventivna i opća medicinska skrb. Bolnica je provodila prihvat i obradu svih ozlijeđenih duž crte bojišta našeg područja. Medicinskim centrom je rukovodio Krizni stožer koji je provodio sve zapovijedi Glavnog stožera saniteta Republike Hrvatske, Ministarstava zdravstva i Ministarstva obrane. Tijekom cijelog Domovinskog rata Opća bolnica Karlovac je bila udaljena od prvih redova bojišnice nekoliko tisuća metara zračne linije. Takav položaj uvjetovao je značajne organizacijske i kadrovske promjene. Iziskivalo je to veliki napor svih
djelatnika tijekom svih godine rata. Od prvih ranjenika za vrijeme “krvavog Uskrsa” na Plitvicama 31. 3. 1991. u Općoj bolnici Karlovac zbrinuto je 1475 ranjenika. Tijekom hospitalizacije od zadobivenih ozljeda umrlo je 39 osoba. Smrtno stradalih, doveženih na odjel patologije, bilo je 229. Druga komponenta je bio vojni sanitet, na čijoj se razini zbog specifičnosti blizine bojišta provodila samo obrada na razini prvog i eventualno drugog ešalona pružanja zdravstvene skrbi te svi postupci iz djelokruga primarne zdravstvene zaštite na razini bojne i brigade. Suradnja svih segmenata ratnog zdravstva u Karlovcu je bila primjerena i može se sa sigurnošću reći kako je zdravstvo imalo značajnu ulogu u obrani i oslobađanju naše domovine, te kako se integralni koncept zdravstva u prilikama rata i neposredne ratne opasnosti pokazao efikasan.
Because the results of studies investigating the relation between human papilloma virus (HPV) infection and the effects of psychological stress are inconsistent, this study was conducted to expand on ...previous research by analyzing patient stress levels, serum immune parameters, and cortisol levels in patients with clinical HPV manifestations. It also looked for differences in clinical manifestations of HPV depending on patient level of experienced stress.
This cross-sectional study included 213 subjects (94 women and 119 men aged ≥18 years; average age, 41 years) with clinical manifestations of HPV infection (165 subjects with extragenital manifestations and 48 with genital manifestations) who were treated at the Department of Dermatovenerology, Karlovac General Hospital, from January 1, 2012, to December 31, 2015. Psychological, neurohormonal and immune parameters (serum values of leukocytes, alpha2-globulins, beta-globulins, albumins, and proteins), and serum cortisol levels were analyzed. Questionnaires were used to determine patients' perception of stress: the Recent Life Changes Questionnaire, the Perceived Stress Scale, and the Brief Cope Test. One group of subjects had confirmed stressful experiences, defined by the Recent Life Changes Questionnaire as a period of 1 year with at least 500 life change units; the control group included patients with no significant stressful experiences.
Patients with confirmed significant stress experience had a statistically significant higher degree of perception of stress. There were no statistically significant differences in terms of the impact of stress on clinical HPV manifestations (genital and extragenital), sex, lesional duration, or recurrence. In patients with significant stress experience, significantly higher values of leukocytes (6.68 × 109/L), alpha2-globulins (6.85 g/L), and beta-globulins (7.33 g/L) were observed. Adaptive coping and a lower perception of stress significantly reduced the chances of having extragenital manifestations by 2.63 times. A higher perception of stress significantly increased the likelihood of genital manifestations.
Although this study found that stress increased the values of leukocytes, alpha2-globulins, and beta-globulins, no evidence was found that it affected clinical manifestations of HPV infection. The redundancy of the immune system could account for this finding. This study is among the first to investigate the correlation between psychological, neurohormonal, and immune indicators of stress.
•The interaction of psychological, neurohormonal and immune factors affects the development and manifestation of disease, therapy and outcomes.•Adaptive coping and a lower perception of stress can significantly reduce the chances of belonging to a group that have extragenital manifestations.•A significant level of stressful events does not influence the clinical incidence of HPV infection.•Significantly higher values of leukocytes, alpha-2 and beta globulins, albumins and proteins and serum cortisol were observed in patients with significant stressful experience.
Chronic wounds on lower extremities most commonly result from chronic venous insufficiency. Chronic leg ulcer impacts the quality of life in a number of ways such as reduced mobility, pain, ...unpleasant odor, sleep disturbances, social isolation, etc. This study included 100 patients with chronic wounds/lower leg ulcer (59% of women and 41% of men, aged 31 to 89) treated locally with special wound dressings for moist wound healing. Study results showed no age and sex correlation with the quality of life, and all participants evaluated their quality of life and health satisfaction as neither good nor bad, but it was found that the disease mostly affected social relationships and to a lesser extent patient satisfaction with their physical and mental health, and the environment. Results on the disease perception showed that the participants considered their disease to have a significant effect on their life and would last for a relatively long time, but they also believed they had good control of their disease. Also, they considered the disease to have many symptoms affecting them; they were worried about their disease which they understood relatively well; they were aware that treatment could be very helpful; and that the disease had moderate effect on their emotional health. According to sex, the disease was found to have greater effect on women (especially on their emotional condition) and women had more faith in successful treatment, while correlation with age was nonsignificant. This study confirmed the importance of the patient psychological condition and the need of due care of their psychological reactions to and facing with the disease.
There are a limited number of studies that have addressed coping strategies in patients with psoriasis, so the aim of this study was to examine how patients with psoriasis cope with their illness. We ...included 122 participants in the study: 56 patients with psoriasis vulgaris and 66 healthy subjects. They filled out the Recent Life Changes Questionnaire (RLCQ), blinded to their stress and clinical status, and the Brief COPE questionnaire with 28 questions measuring 14 coping strategies that are either adaptive or maladaptive. We statistically analyzed the self-reported magnitude of each stressful event in the participants' lives. Our results show patients with psoriasis most commonly used active coping, seeking emotional support, positive reframing, and acceptance, while their least used strategies were denial and substance use. Since patients with psoriasis often experience psychologically related problems/consequences, it is necessary to take into account their psychological state and try to provide appropriate help and support.
The newly established Department of neuropsychiatry of the Medical Center of Karlovac opened on November 3rd, 1969, thus enabling a comprehensive and modern approach to people with mental disorders. ...Prior to its opening, the first stage of the hospital in Švarča was completed. Up until that point, psychiatric care had been inadequate despite the enthusiasm of individuals, such as Dr. Andrija Štampar who worked in Karlovac in 1912 and 1913. The first decade of the Department's work marked the overload of "mixing" psychiatric and neurological cases, as well as the leadership of the scholar, Prim. Dr. Dražen Neimarević. The establishment of separate departments in 1980 showed improvement in the working conditions, and further steps were made with the formation of day hospitals for alcoholism and psychotherapy. Better access to patients was achieved due to the independence of psychiatric care in 1994. The start of the 21st century saw innovative breakthroughs with the opening of the first unit for treating sexual disorders in Croatia and the establishment of one of the first mobile psychiatric teams within the national implementation of Community-based psychiatry model. In honor of the 50th anniversary of the establishment of the Department of neuropsychiatry in the General Hospital Karlovac, it is important to give thanks to everyone who contributed to the development of psychiatric care. Following the foundations that were laid, it is necessary to adapt and improve the approaches to those with mental disorders, with the aim to provide recovery and destigmatization. Finally, following the development in Croatian psychiatry and parallel activities in similar institutions, the overview of "psychiatry in Karlovac" can be used as a representative sample of the development in other institutions and similar county/regional centers.
The aim of this study was to provide an overview of the central nervous system (CNS) tumours epidemiology in Karlovac region, over the 1995-2010 period. We analyzed data on 359 patients (194 men and ...165 women), diagnosed with CNS tumours according to the World Health Organization's diagnostic criteria, in period 1995-2010. The data were obtained from the Neurology and Neurosurgery Department, including other medical records. The data were analysed with t-test and chi-square test. A total of 359 cases of tumours in CNS were recorded for the period of 1995-2010, with slight predominance of men (194;54.0%) over women (165;46.0%). Under the assumption of gender equality, we did not detect a significant gender difference in tumour diagnosis (p = 0.279). Mean age at the diagnosis was 64.1 +/- 12.6 years, with significant gender difference: mean age at diagnosis for men was 62.8 +/- 11.6 years, while for women it was 65.7 +/- 13.5 (p = 0.029). The commonest type of all tumours was metastases (144;40.1%). When only primary tumours were analysed, the commonest type was glioblastoma (125;58.15%), followed by meningeoma (44;20.5%). The remaining types were much less frequent, with i.e. 5 recorded cases of the following three types: astrocytoma, ependimoma and oligodendroglyoma (2.3%). These results suggest a commonly encountered epidemiological profile in the region, with commonest metastases, and glioblastoma as the most common primary tumour. Due to difficulties related to patient gravitating hospitals admittance and overall small sample size for more detailed analyses, it remains for future studies to determine potential association of the Homeland war (1991-1995) and the occurrence of CNS tumours.
Stressful life events in response to a psychosocial trigger have been reported to negatively affect the course of infections. This study was based on patients with clinical manifestations of human ...papillomavirus (HPV) infection and a control group of patients with psoriasis who were admitted over a period of one year to the Dermatology Department of Karlovac General Hospital. A total of 122 patients participated in the study, either with a confirmed diagnosis of clinical manifestations of HPV infection (n=66) or in a psoriasis control group (n=56). The aim of this study was to determine which coping strategies are used in patients with clinical manifestations of HPV infection. We used the Recent Life Changes Questionnaire and Brief COPE test for stress evaluation. There were no statically significant differences between adaptive and maladaptive coping strategies comparing patients with HPV and a control group. The difference in specific coping strategies between HPV and control groups showed that self-blame and planning strategies were statistically significantly more common in the HPV group. Patients with HPV with genital warts used maladaptive coping statistically significantly more than patients with non-genital localization of HPV. Patients with HPV who had a higher score of life stress events used maladaptive coping statistically significantly more than patients with a lower life stress events score. The results point to the need for patients with HPV with genital localization and high numbers of stress events to learn how to cope with stress, enabling them to take action and change their ways of coping. There is also a need to integrate psychological intervention into standard care protocols of dermatologic diseases.
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