Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental ...health, particularly anxiety.
This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia.
Cross-sectional study among elective surgery patients at different departments of a single hospital.
University Hospital Sveti Duh, a tertiary health care facility in Croatia.
Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses.
178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R2 = 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear.
The study was single-center and cross-sectional and did not assess patients' specific religious identity.
This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.
The Surgical Fear Questionnaire (SFQ) is an instrument for self-assessment of surgical fear and consists of two subscales, one assessing the fear of short-term consequences (SFQ-s) and another one of ...long-term consequences (SFQ-l) of surgery. The aim of this study was to test the Croatian version of the SFQ with regard to its psychometric properties. This prospective cohort study included patients who presented to the Department of Surgery for elective surgery in the inpatient setting at a tertiary health care facility in Croatia between April 1 and May 31, 2019. Data on 144 patients were suitable for data analysis. Data collection was performed in the afternoon before surgery using the Personal Information Form, Numerical Rating Scale self-report instruments (NRS), SFQ and Hospital Anxiety and Depression Scale (HADS) assessing sociodemographic factors, surgical fear via NRS and SFQ, expected pain and emotional state. The Cronbach alpha value as a statistical measure for reliability of psychometric tests for the SFQ-s subscale was 0.79, for SFQ-L subscale 0.84, and for total SFQ 0.81. The exploratory factor analysis (EFA) showed a two-factor structure. Significant correlations of the SFQ with the NRS and HADS-anxiety subscale were demonstrated. Our study demonstrated the Croatian version of the SFQ to have a high level of reliability and hence can be used as a self-report instrument for surgical fear with two subscales. Convergent validity of the SFQ with other self-report instruments is shown.
Abstract
Background
The important role that the immune system plays in malignant diseases is well known. The action of interleukin-7 (IL-7) as a cytokine has been observed in many cellular processes, ...both in normal cells of the immune system and in some cancer cells. The aim of this study has been to explore whether there is any elevation of interleukin-7 serum levels in early invasive breast cancer (EIBC) patients in comparison with healthy controls. In addition, the correlation between the IL-7 serum level and the histopathological characteristics of the tumor has been evaluated.
Methods
This cross-sectional, observational, and analytical study included 213 consecutive patients with EIBC (113 from Croatia and 100 from Kosovo) and 62 healthy participants as the control group (30 from Croatia and 32 from Kosovo). Blood samples have been taken from patients confirmed with breast cancer (BC) by biopsy, prior to surgical intervention and other oncological treatments, as well as from healthy participants. A serum IL-7 level has been measured, using the “Sandwich” ELISA Immunoenzyme test. In addition, after the surgical intervention, histopathological specimen examinations and immunohistochemistry have been performed and analyzed. The differences in the distribution of the numerical variables have been analyzed with the Mann–Whitney
U
test and Kruskal–Wallis ANOVA test. Correlations have been tested with Pearson coefficients. A
P
-value < 0.05 has been accepted as statistically significant.
Results
The serum level of IL-7 in EIBC patients was significantly higher than in control cases (
P
0.001). Patients with invasive lobular carcinoma (ILC) seem to have a lower IL-7 serum level compared to other histological subtypes, and the difference has been significant (
P
= 0.043). There has been no correlation between IL-7 serum level and histopathological characteristics of the tumor, with neither age nor menopausal status of the patients.
Conclusions
Noting the significant increase in the IL-7 serum level in the EIBC patients as compared to the healthy control group, the use of IL-7 as a potential diagnostic indicator for BC, as well as in the follow-up of the patients after treatment, can be assumed. The lack of correlation with tumor size, lymph node metastasis, and all other histopathological characteristics of the tumor questions its use as a prognostic indicator.
To assess the health status among dentists in Croatia regarding the symptoms of musculoskeletal, dermatological, sight, hearing and neurological disorders.
The anonymous online survey was conducted ...among 506 Croatian dentists.
It was found that over 78.18% of the surveyed dentists experienced work related pain in upper back, 76.97% of them in lower back. Work-related skin problems were reported by 29.29% of dentists. Vision problems were reported by 46.87% and hearing problems by 19.03% of participants. Neurological disorders were reported by 15.76% of dentists.
This study is the first to report on the overall health status of Croatian dentists and, unfortunately, it showed undesirable results. Numerous health hazards, increased professional requirements and limited ergonomics in the work environment of Croatian dental practitioners cause various health disorders, and the prevalence of occupational diseases is very high.
Aims and objectives
This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator.
Background
Integrated care is a global imperative in all ...healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators.
Methods
The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist.
Results
Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long‐term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration.
Conclusions
Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination.
Relevance to clinical practice
Palliative care provides a range of individualised, coordinated services that meet the medical and non‐medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role.
•Integrated care is a key principle in Croatia's model of palliative care.•Numerous national and local determinants influence the implementation of integrated palliative care.•New organizational ...structures, stakeholders’ empowerment, and service provision are crucial.•A bottom-up approach and the mapping of business processes can foster integration.
In Croatia, palliative care has been developing as an integral part of the health care system since 2014. This development is in line with the integrated care concept emerging in many countries. However, there are a number of implementation problems. The aim of this article was to identify positive and negative determinants for the integration of palliative care in Croatia. We identified policy processes or organizational changes within three key domains: the development of new organizational structures, stakeholders’ empowerment, and removing barriers to the provision of integrated palliative care. The progress visible in these domains shows the sustainability of the palliative care model used in Croatia. However, there are also barriers hindering the integration of palliative care. We conclude that patient-centred and process-based change in health care can have a positive effect on the integration of care. Staff education and regulation of business processes are key for the sustainability of reforms. Lastly, it seems easier to achieve the integration of care when it develops as a bottom-up model and reflects the need for new processes, than when it is imposed from above as a single regional or national model.
Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and ...limited resources in health and social care, volunteers are becoming an important resource in meeting these needs. In Croatia, palliative care has been developing as an integrated care model since 2014. To assess the position and the role of volunteers, we analyzed legislative documents from healthcare and social care and conducted a focus group with volunteers in palliative care. We found that volunteers provide support from the social aspect of care, for the patient and the family. The formal palliative care system involves them as partners in the provision of care, even though this cooperation is informal. The main determinants of their activities are an individualized approach, flexibility, a community presence, and project funding. In conclusion, these determinants allow them to react quickly to identified needs, but with them come some uncertainties of their sustainability. Their activities could indicate what needs to be integrated between health and social care and in what areas. Volunteers both fill in gaps in the system and are ahead of the system, and by doing this they develop new processes around identified unmet needs.
•A substantial drop of pediatric burns in the major paediatric burn centre in Croatia.•Improvement in the standard of living is most likely to be related to this drop.•Housing standard, employment ...rate and level of education were crucial.
In the “Children’s Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)” we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade.
In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children’s Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models.
Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably.
Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.
Svrha: Istražiti zdravstveni status među stomatolozima u Hrvatskoj s obzirom na simptome mišićno-koštanih, kožnih, vidnih, slušnih i neuroloških poremećaja. Metode: Među 506 hrvatskih stomatologa ...provedena je anonimna internetska anketa. Rezultati: Ustanovljeno je da je 78,18 % ispitanih stomatologa iskusilo bolove u gornjem dijelu leđa koje povezuju sa svojim poslom, a njih 76,97 % istaknulo je bolove u donjem dijelu leđa. Profesionalno izazvani problemi s kožom utvrđeni su kod 29,29 % stomatologa. Probleme s vidom navelo je njih 46,87 %, a tegobe sa sluhom 19,03 %. O neurološkim problemima izvijestilo je 15,76 % stomatologa. Zaključak: Ovo istraživanje prvo je koje objavljuje podatke o zdravstvenom stanju hrvatskih stomatologa i, nažalost, to stanje nije dobro. Mnogobrojni zdravstveni rizici, povećani profesionalni zahtjevi i ograničeni ergonomski uvjeti u radnom okruženju uzrokuju hrvatskim stomatolozima različite i vrlo česte zdravstvene poteškoće.
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