Background: Mental health is integrated into PHC as a strategy of WHO to fill the gap in mental health treatment. Part of this strategy needs a level of task shifting so that mental health care is ...provided by different level of PHC workers and not only specialists such as psychiatrists and psychologists.
Objectives: To assess the knowledge and attitudes of family doctors regarding the provision of psychological health in PHCC and if there is an association between the certificates of these family doctors and their Knowledge and attitudes to psychological health.
Subjects and Methods: A cross-sectional descriptive study with analytic elements was conducted in 8 family health care centers in Baghdad city/Al-Karkh. Data was collected via questionnaire form which consists of three domains: Domain one includes sociodemographic data, domain two was about knowledge and consists of (7) questions and domain three consisted of (12) questions about the attitude of physicians regarding mental health. A convenient sample of (83) family health care physicians were included in the current study.
Results: The mean age of participants was 42 years (range: 27 – 53). The results revealed that 22.9% of participants were male, 77.1% were female. The percentage of mental illness seen by the physicians daily in the health care center was (15.7%). Physicians with higher degree certificates obtained higher knowledge scores in comparison to residents or practitioners as well as the females reported a significantly higher score of knowledge in comparison to males. Moreover, higher scores of positive attitudes were found.
Conclusion: Physicians with higher certificates had more knowledge and attitude than other certificates; therefore, raising the awareness among family physicians about mental health services through making workshops, symposiums, more training courses is recommended.
Iako najčešće zahvaća gornji respratorni sustav sa simptomima vrućice, kašlja i umora, novi virus SARS-CoV-2 može dovesti do pneumonije i težih komplikacija poput multiorganskog zatajenja. Kako ...pandemija napreduje i pogađa sve veći broj osoba, pojavljuju se sve više simptomi koji nisu usko povezani s gornjim dišnjim sustavom. Javljaju se gastrointestinalni simptomi, neurološki i kardiološki simptomi, kožne promjene te simptomi unutrašnjeg i srednjeg uha poput gubitka sluha, tinitusa, otalgije i vrtoglavica. Moguća patogeneza virusno-induciranog gubitka sluha jest u direktnom oštećenju struktura unutrašnjeg uha ili u imunološki posredovanom odgovoru. Cilj rada je analizirati i prikazati bolesnike s gubitkom sluha, tinitusom i vrtoglavicom kao kliničkim manifestacijama infekcije SARS-CoV-2. Analizirirali smo 25 bolesnika u dobi između 33 i 70 godina koji se se javili u audiološku ambulantu u vremenu od 1. prosinca 2020. godine do 6. veljače 2021. godine sa simptomima gubitka sluha, tinitusom i vrtoglavicom. Rezultati studije pokazuju da je došlo do akutnoga jednostranog gubitka sluha u dvojice bolesnika, a do akutnoga obostranog u jednog bolesnika tijekom infekcije SARS-CoV-2. U jednog bolesnika je došlo do potpunog oporavka sluha nakon kortikosteroidne terapije, a u dvojice do djelomičnog oporavka. Do gubitka sluha samo u visokim frekvencijama na 4000 i 6000 Hz obostrano došlo je u 13 bolesnika. Radi se ujedno o najkarakterističnijem i najčešćem nalazu sluha. Također vidimo da je došlo do egzacerbacije tinitusa u 4 bolesnika, a do novonastalnog tinitusa u 11 bolesnika. Vrtoglavica se javila u trojice pacijenata i radi se o novonastalim vrtoglavicama. Iako smo otkrili vezu između koronavirusa i gubitka sluha, tinitusa i vrtoglavice, još uvijek ne znamo prevalenciju audioloških manifestacija bolesti jer je i dalje fokus na težim i životno ugrožavajućim stanjima pa se smetnje sluha i ravnoteže često zanemaruju ili se čeka na mogući spontani oporavak i time gubi dragocjeno vrijeme za liječenje i mogući brži oporavak.
The importance of headaches in multiple sclerosis is largely neglected as focal neurological symptoms such as optic neuritis, paresthesia or weakness of organs has become the main focus of conce rn. ...Studies indicate a prevalence of 43% for migraine in patients with MS, which is higher than general population. Therefore, this study emphasizes on the importance of headache in MS patients and its precise workup, as well as timely management of headaches in MS. In the current study, we examined a 49-year-old patient with sudden throbbing headache that worsened with movement, photophobia and phonophobia, concomitant with non-pulsating tinnitus and true vertigo. In the physical examinations, we found a preceding decrease in the force of the right upper limb and the left lower limb since a long time before. CT scan and MRI of the brain was performed. CT scan showed evidence of periventricular and centrum semiovale lucency, and MRI findings along with clinical observations were consistent with RRMS. Periventricular and pericerebellar plaques with Gad Enhancement were evident. During the admission for headache, the patient was hypertensive and received amlodipine, metoral and valsartan. His headache was treated with acetaminophen and vitamin B. The headache was successfully controlled, and the blood pressure decreased. Furthermore, due to a recent evidence of tinnitus and true vertigo, pulse corticosteroid therapy and dimethyl fumarate were administered for MS attack.
Audiovježbe Andrijašević, Andrea; Čulina, Mirta
Zbornik Veleučilišta u Rijeci,
2023, Letnik:
11, Številka:
1
Journal Article, Paper
Recenzirano
Odprti dostop
Gubitak sluha i tinitus svakodnevno u znatnoj mjeri otežavaju govornu komunikaciju pogođenim osobama. Teškoće slušanja uzrokovane njima mogu se ublažiti različitim terapijskim pristupima, međutim ...rehabilitacijski postupci usmjereni na poboljšanje slušanja kod odrasle populacije slabo su zastupljeni u zdravstvenom sektoru. U novije vrijeme, računalni programi za tretiranje različitih zdravstvenih teškoća sve više pokazuju potencijal, no često uz naknadu za korištenje. U ovom radu, spoznaje iz područja audiologije i audiorehabilitacije primijenjene su pri izradi besplatnog računalnog programa na hrvatskom jeziku namijenjenog odrasloj populaciji s teškoćama razumijevanja govora zbog stečenog oštećenja sluha ili izazvanih pojavom tonskog tinitusa. Izbor vježbi i način prezentacije zadataka u izrađenom programu vođeni su suvremenim terapijskim pristupima, a oslanjaju se i na primjere modernih računalnih programa za rehabilitaciju slušanja. Program sadrži dvanaest slušnih vježbi različitog stupnja zahtjevnosti za testiranje slušne razabirljivosti prilikom čijeg dizajniranja su se slijedili osnovni verbotonalni principi, stoga se pristupa prepoznavanju poznatih pojmova prije nepoznatih i optimalnim uvjetima slušanja prije neoptimalnih. Osim vježbi slušanja, program omogućava korisniku identifikaciju frekvencije tonskog tinitusa te terapiju Tailor-made notched music training (TMNMT) terapijom glazbom, koja za cilj ima smanjenje njegovog intenziteta. Izrađeni program može poslužiti kao dodatak standardnim udiorehabilitacijskim postupcima kod osoba sa stečenim oštećenjem sluha, a, osim terapijske funkcije, može pomoći i pripadnicima opće populacije u objektivnijoj samoprocjeni njihovog slušnog funkcioniranja.
Hearing loss and tinnitus represent a significant challenge for affected individuals in everyday spokencommunication. Hearing difficulties caused by them can be alleviated through different therapeuticapproaches, however hearing therapy approaches aimed at hearing improvement in the adultpopulation are not very common in the health sector. In recent years, desktop and mobile applicationsfor the treatment of a variety of health difficulties have shown potential, but unfortunately they arestill rarely available at no charge. In this paper, the knowledge in the area of audiology and hearingtherapy has been applied in designing a computer program for the Croatian speaking adult populationwith speech intelligibility difficulties caused by acquired hearing impairment and tonal tinnitus. Thetypes of exercises and their representation have been modelled based on the conventional hearingtherapy methods as well as on currently available web, mobile and desktop apps. The programcontains twelve listening exercises that differ in their degree of complexity, whose design was guidedby the fundamental principles of the verbotonal method. Accordingly, the exercises start with familiarterms before advancing to the unfamiliar ones and with optimal hearing conditions before movingon to the nonoptimal ones. In addition to these exercises, the program offers tonal tinnitus frequencyidentification and sound therapy for its loudness reduction based on the Tailor-made notched musictraining (TMNMT) principles. The program can serve as an addition to the conventional hearingtherapy for individuals in the later stages of adaptation to hearing aids or cochlear implants, as wellas help the non-diagnosed individuals to assess their hearing more objectively and, if necessary, seekprofessional help.
Despite manual therapy has been used as an effective treatment but there is limited of literature emphasizing its role to improve quality of life and pain pressure threshold in patients with somatic ...tinnitus. In this Meta analysis we compared the effects of manual therapy on quality of life and pain pressure threshold in the patients with somatic tinnitus associated with cervicogenic and temporomandibular dysfunction domain. We systematically searched different databases such as Pubmed, Google Scholar and Scopus to find out the relevant studies compairing the effects of manual therapy with quality of life and pain pressure threshold. Two independent reviewers performed quality check and data extraction. We analyzed the data using RevMan ver. 5.4 software. Total three randomised controlled trials were included in this study. Manual Therapy proven to be effective in improving quality of life as well pain pressure threshold in somatic tinnitus patients. {ORs 0.80; 95% Confidence Interval (95%CI),
P
= 0.97}. Further clinical trials are needed to explore manual therapy as an effective intervention.
To provide physicians and patients with the tools needed to evaluate patients' problems and health-related quality of life by cross-culturally adapting and validating the Chronic Otitis Media ...Questionnaire 12 (COMQ-12), the Dizziness Handicap Inventory (DHI), the Neuropsychological Vertigo Inventory (NVI) and the Tinnitus Handicap Inventory (THI).
COMQ-12, DHI, NVI and THI were translated into the Slovenian language and completed by patients treated at our department for chronic otitis media, vertigo or tinnitus. The control group for each questionnaire consisted of healthy volunteers. Internal consistency, test-retest reliability, discriminant validity, diagnostic accuracy and cut-off value were determined for each questionnaire.
Test-retest reliability was excellent for DHI (ICC A=0.946) and NVI (p=0.315, ICC A=0.975), good to excellent for COMQ-12 (p=0.680, ICC A=0.858) and satisfactory for THI (p=0.120). Discriminant validity was confirmed for each questionnaire (p>0.05) using the Mann-Whitney U test (COMQ-12, DHI, THI) or the Welch t-test (NVI). COMQ-12 had acceptable (α=0.796) and DHI (α=0.910), NVI (α=0.950) and THI (α=0.924) perfect internal consistency. COMQ-12 and DHI had excellent, NVI acceptable and THI perfect diagnostic accuracy (AUC=0.987, AUC=0.999, AUC=0.781 and AUC=1.000 respectively). Cut-off values determined by Youden's index were 7, 7, 9 and 56 for COMQ-12, THI, DHI and NVI, respectively.
Slovenian COMQ-12, DHI, NVI and THI are a valid and accurate tool for the diagnosis and measurement of health-related quality of life in patients with chronic otitis media, vertigo and tinnitus. They could aid general practitioners, occupational health specialists, neurologists and otorhinolaryngologists.
En psiquiatría de enlace se logra obtener una visión integral del tratamiento y de las necesidades de cada paciente prestando especial atención a las interacciones medicamentosas y a las ...contraindicaciones. Algunos casos particulares motivaron la descripción, reporte y revisión bibliográfica acerca de otras posibles aplicaciones de fármacos antagonistas de los recetores 5HT2A y 3, particularmente mirtazapina y olanzapina, en síndrome de hiperalgesia, tinitus y leucoencefalopatía multifocal progresiva por virus JC.
reporte de casos.
Se describen los casos de tres pacientes en los cuales fue necesario usar mirtazapina y olanzapina no solo para el control de los síntomas psiquiátricos (afectivos, comportamentales y trastorno del sueño), sino también como coadyuvantes en las patologías de base de cada paciente. El uso de cualquier medicamento en psiquiatría de enlace debe tener en cuenta el contexto del paciente, la comorbilidad, las contraindicaciones y las interacciones farmacológicas para garantizar un desenlace positivo, además de promover el trabajo multidisciplinario entre especialistas.
In liaison psychiatry it is possible to get an integral view of patient's treatment and needs, paying special attention to pharmacological interactions and contraindications. Some particular cases motivated the description, report and review about other possible applications of 5HT2A and 5HT3 antagonist, particularly Mirtazapine and Olanzapine, in hyperalgesia syndrome, tinnitus and Progressive Multifocal Leukoencephalopathy by JC virus.
Cases report.
We describe 3 cases of patients in which Mirtazapine and Olanzapine were necessary not only to control psychiatric symptoms (affective / behavioral symptoms and insomnia) but to act as adjuvant therapy in axis III diseases. The use of any drug in psychiatry must take in to account the context of the patient, the presence of comorbidity, contraindications and pharmacological interactions so as to grant a positive outcome also promoting the multidisciplinary work between specialists.
UVOD: Šum u uhu (tinitus) predstavlja percepciju zvuka u
uhu ili glavi koja se pojavljuje bez očitog vanjskog zvučnog
podražaja, odnosno fantomski slušni podražaj. Pojavu
tinitusa može uzrokovati ...npr. oštećenja ili promjene u
otološkom sustavu, tumor, multipla skleroza, kardiovaskularna
oboljenja, lijekovi, psihička oboljenja ili mišićnokoštani
sustav. Tinitus nije bolest već simptom, tako da
ne postoji jedinstvena terapija u njegovom liječenju. M.
sternocleidomastoideus se često u literaturi spominje kao
uzročnik tinitusa.
MATERIJALI I METODE: U istraživanju je sudjelovalo
30 ispitanika, s prisutnošću tinitusa, kao faktorom uključenja.
Jačina tinitusa određena je pomoću skale i klasifi -
kacije po Fischeru DIMDI (Deutsches Institut für Medizinische
Dokumentation und Information) prije i poslije
tretmana. Učinkovitost tretmana te usporedba učinkovitost
između Triggerpoint- terapije i konvencionalne terapije
određena je pomoću efekta interakcije (F- Test).
REZULTATI: Kod 20% ispitanika u eksperimentalnoj skupini
te 13% u kontrolnoj dolazi do nestanka tinitusa te je
kod 20% ispitanika, u kontrolnoj skupini, došlo do smanjenja
jačine tinitusa. Nije dokazana statistički značajna
razlika u učinkovitosti primjenjenih metoda p>0,05
ZAKLJUČAK: Tinitus doprinosi narušavanju kvalitete
života, utječući na psihosocijalne, ekonomske i tjelesne
aspekte, stoga je važno pronaći adekvatne metode njegovog
liječenja. Provedeno istraživanje ukazuje da manualna
triggerpoint terapija primjenjena na m. sternocleidomastoideus,
kod nekih bolesnika, može ublažiti i/ili ukloniti
tinitus. Triggerpoint terapija je primjereniji izbor terapije
kod mlađih osoba jer imaju manje terapijskih kontraindikacija
i drugih komorbiditeta. Radi lakšeg dijagnosticiranja
uzroka tinitusa te pronalaska moguće terapije i dalje
je nužno interdisciplinarno uspostaviti nove evaluacijske
protokole, algoritme diferencijacije uzroka, kao i specifi čne
tretmane. Pravilno postavljenom dijagnozom, osobe s prisutnošću
tinitusa bi brže dobile adekvatnu terapiju i na taj
način znatno poboljšala kvaliteta života.
Hearing sense is very important for enabling speech and establishing communication. Disabling it’s function alters the ones personality, limits expression of it’s capabilities and significantly ...affects it’s psychological, emotional and social aspect of it’s life. Hearing handicap is a big problem because of disability, comorbidity with mental disorders (depression and anxiety ) and significant decrease of quality of life, as important factor in overview of health state. The level of hearing handicap (hearing threshold) is not of crucial relevance as individual perception of damage, which is why it is necessary to determine audiology parameters in function of communication, social contacts and mental health. Usage of tests for self evaluate of hearing and tinnitus disability, psychological-psychiatric scales for evaluating presence and magnitude depressive and anxiety symptoms, enables adequate overviewing of relevant advantages limitations for certain options therapeutic treatments or hearing rehabilitation, prevention and in time observation of mental disorders. Goal. Goal of research was to examine influence of hearing disability on developing depression, anxiety and life quality of respondents with tinnitus. Method. Research Is by the type of clinical, prospective cross-sectional study. During a period of six months a presence of mental disorders was examined at respondents with or without hearing handicap and tinnitus. Research covered 92 respondents both sexes, age 40 to 65 years of life, with normal cochlear, sensorineural damage of hearing and tinnitus in a period of 3 months to 5 years. Leading parameters where results of respondents for self-assessment the level of disability because hearing handicap and tinnitus and their correlations with levels for assessment of presence and severity of depression, anxiety and quality of life. Results. According to the questionnaire for self-assessment of level of disability 69.2% of respondents with hearing handicap have significant disability due to hearing handicap. Estimate of subjective experience of tinnitus is significantly changed with responders with hearing handicap, 45.7% have expressed, and 15.2% hard disability, while 34.8% respondents with normal hearing demonstrate moderate and 39.1% pronounced disablement due to tinnitus. Borderline and moderate depression dominates with respondents with hearing handicap 41.3%, while serious depression is present with 15.2%. Severe and moderate anxiety is more represented at respondents with hearing handicap and tinnitus 34.7%. Respondents of both group show significant drop of life quality in almost every segment, while the significant drop of life quality is in the segment of social functionality, role of emotions, mental health and basic dimension of mental health, at respondents with hearing handicap and tinnitus. We notices that lose of hearing function, followed by tinnitus to some extent represents loss of autonomy, loneliness, endangers self-esteem and independence, leads to withdrawal from social and emotional life and in time leads into anxiety and depression. Conclusion. Reviewing psychological, social and emotional consequences from loss of hearing function in our research, we tried to objectify influence of disrupted hearing sensation on entire life of a man expressing mental disorders and suggest a way for early detection and prevention. It is necessary, on all levels of health care, to overview cause and effect relations between hearing disorder and mental disorders, which will lead to more efficient treatment and higher level of mental health for an individual and whole community in general.
Uvod. Čulo sluha je veoma značajno za omogućavanje govora i ostvarivanje komunikacije a poremećaj njegove funkcije menja čovekovu ličnost, ograničava ispoljavanje sposobnosti i značajno utiče na psihičke, emocionalne i socijalne aspekte života. Poremećaj slušne funkcije predstavlja veliki problem zbog onesposobljenosti, komorbiditeta sa mentalnim poremećajima (depresija i anksioznost) i značajnog smanjenja kvaliteta života, kao značajanog faktora u sagledavanju stanja zdravlja. Stepen oštećenja sluha (prag sluha) nije od suštinskog značaja kao individualna percepcija oštećenja zbog čega je neophodno utvrditi audiološke parametre u funkciji komunikacije, socijalnih kontakata i mentalnog zdravlja. Primena testova za samoprocenu slušne i tinitus onesposobljenosti, psihološko-psihijatrijskih skala za procenu prisustva i izraženosti depresivnih i anksioznih simptoma, omogućuju pravilno sagledavanje relativnih prednosti i ograničenja za određene opcije terapijskih tretmana ili slušne rehabilitacije, prevenciju i rano sagledavanje mentalnih poremećaja. Cilj. Cilj istraživanja je bio da se ispita uticaj oštećenja sluha na pojavu depresije, anksioznosti i kvalitet života kod ispitanika sa tinitusom. Metod. Istraživanje je po tipu kliničke, prospektivne studije preseka. U trajanju od šest meseci istraženo je prisustvo mentalnih poremećaja kod ispitanika sa i bez oštećenja sluha i tinitusom. Istraživanjem je obuhvaćeno 92 ispitanika oba pola, starosti od 40 – 65 godina, sa normalnim i kohlearnim, senzorineuralnim oštećenjem sluha i tinitusom u trajanju od 3 meseca do 5 godina. Vodeći parametar su bili rezultati upitnika za samoprocenu težine onesposobljenosti zbog oštećenja sluha i tinitusa i njihova korelacija sa skalama za procenu prisustva i težine depresije, anksioznosti i kvaliteta života. Rezultati. Prema upitniku samoprocene težine onesposobljenosti 69. 9% ispitanika oštećenog sluha ima značajnu onesposobljenost zbog poremećaja sluha. Procena subjektivnog doživljaja tinitusa je značajnije promenjena kod ispitanika oštećenog sluha, 45. 7% ima izraženu, a 15. 2% tešku onesposobljenost, dok 34. 8% ispitanika sa urednim sluhom pokazuje umerenu i 39. 1% izraženu onesposobljenost zbog tinitusa. Granična i umerena depresija dominira kod ispitanika sa oštećenim sluhom 41. 3% , dok je ozbiljna depresija prisutna kod 15. 2%. Teška i umerena anksioznost zastupljenija je kod ispitanika sa oštećnim sluhom i tinitusom 34. 7%. Ispitanici obe grupe pokazuju značajan pad kvaliteta života u skoro svim dimenzijama, dok je značajan pad kvaliteta života zabeležen u dimenziji socijalno funkcionisanje, uloga emocija, mentalno zdravlje i osnovnoj dimenziji mentalno zdravlje, kod ispitanika sa oštećenim sluhom i tinitusom. Zapazili smo da gubitak slušne funkcije praćen tinitusom u izvesnoj meri predstavlja gubitak autonomije, samostalnosti, ugrožava samopoštovanje inezavisnost, dovodi do povlačenja iz društvenog i emocionalnog života i vremenom vodi u anksioznost i depresiju. Zaključak. Sagledavajući psihološke, socijalne i emotivne posledice gubitka sluha u našem istraživanju pokušali smo da objektiviziramo uticaj poremećene slušne senzacije na celokupni život čoveka, ispoljavanje mentalnih poremećaja i sugerišemo način za njihovo rano otkrivanje i prevenciju. Neophodno je na svim nivoima zdravstvene zaštite sagledavanje uzročno-posledičnih veza između poremećaja slušne senzacije i mentalnih poremećaja, čime će se postići efikasnije lečenje i viši nivo mentalnog zdravlja pojedinca i cele zajednice.
Tinitus je percepcija zvuka u odsutnosti vanjskog izvora zvuka. U većini slučajeva tinitus je prisutan uz istovremeno oštećenje sluha. Cilj istraživanja bio je utvrditi učestalost, vrstu i stupanj ...oštećenja sluha u pacijenata sa subjektivnim tinitusom te analizirati karakteristike tinitusa u odnosu na oštećenje sluha. Analizirali smo audiometrijske, otoskopske nalaze i medicinske izvještaje 1046 pacijenata, 573 muškaraca (54.8%) i 473 žena (45.2%), u dobi od 19 do 89 godina. Pacijenti su pregledani na Odjelu za otorinolaringologiju Gradske opće bolnice “8-mi Septemvri”, Skoplje, Republika Makedonija, u razdoblju od siječnja 2014. do listopada 2015. Statistička analiza podataka provedena je hi-kvadrat testom uz razinu značajnosti p<0.05. Većina pacijenata bili su muškarci u dobi od 60 do 69 godina (13.4%), ali nije bilo značajne razlike u distribuciji po dobi i spolu (p=0.156). Prevalencija gubitka sluha kod pacijenata s tinitusom bila je 91.9%. Većina pacijenata imala je bilateralni zamjedbeni gubitak sluha (58.2%), uglavnom na visokim frekvencijama (p<0.00001), te su opisivali svoj tinitus kao piskavi zvuk. Bilateralni tinitus bio je najčešće prisutan (59.4%), nakon čega slijedi lijevi jednostrani tinitus (22.8%). Akustična trauma i gubitak sluha izazvan bukom bili su prisutni u 27.8% svih otoloških stanja. Kod većine pacijenata sa subjektivnim tinitusom bio je prisutan neki stupanj gubitka sluha. Bilateralni, visoko frekventni tinitus i bilateralni zamjedbeni gubitak sluha, uglavnom na visokim frekvencijama, bili si najčešći nalazi. Akustična trauma i gubitak sluha izazvan bukom bili su najčešća otološka stanja, a tinitus izazvan bukom bio je najčešći tip tinitusa.
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