Increasing longevity raised the prospect of a workplace for ageing workers. Previous studies reveal that work ability decreases with age, even among the healthy, and decreased significantly with age ...among women. The aim of the study is to examine the perception of work ability of public sector employees aged 55 years and older and gender differences in three European countries.
A prospective longitudinal study design and standardized "Work Ability Index" (WAI) were used. This study analysed the relationship between ageing, gender, and perceived work ability among 1653 employees aged 45.06±10.90 years (562 men and 1091 women) from Spain, Bosnia and Herzegovina and Monte Negro. The research was conducted in 2018.
Older employees had a better WAI than their younger colleagues (P<0.001). The lowest prevalence rate 20% of excellent WAI was between 35 and 44 years of age. The reduction of WAI in Bosnia and Herzegovina was huge 68%, compared with 30% in Monte Negro (more than 2 times) and 14% in Spain (almost 5 times more).
Gender and age was not protector and predictor of excellent or reduced work ability. Work ability did not decrease with age among women and men, public sector employees. Work ability depends of health and safety, promotion and preventive activities at the workplace.
One of the aims of health care reform in Montenegro is to strengthen primary care. An important step forward is the implementation of specialty training in family medicine (FM). The aim of this ...article is to evaluate the implementation of specialty training in family medicine in Montenegro, regarding the content, structure and methods, by the first generation of trainees and the coordinator of the training.
A questionnaire was sent by mail in July and August 2017 to all 26 eligible trainees who started specialty training in 2013. Twenty-two of the 26 trainees (84.6%) responded. The questionnaire consisted of closed and open-ended questions related to the evaluation of the training. A descriptive quantitative and qualitative analysis with predefined themes and a semi-structured interview with the coordinator were carried out.
The process of training in FM was assessed positively by both trainees and the coordinator. The positive assessment included that the specialisation course offered modern design through modules and practice, and trainees both improved their existing knowledge and skills and acquired new ones necessary for everyday work. The coordinator emphasised the importance of the introduction of new teaching methods and formative assessment, the important role of mentors, and the involvement of Slovenian colleagues in the teaching process and supervision of the programme.
The implementation of speciality training in FM in Montenegro was successful. Several assessment methods were used that can be further developed in individual structured feedback, which could stimulate the continual improvement of trainees' knowledge and competencies.
Primary Care Reform in Montenegro Cvejanov Kezunović, Ljiljana; Drecun, Mara; Švab, Igor
Zdravstveno varstvo,
12/2013, Letnik:
52, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract
Background: Montenegro is a newly independent state. As with many countries of that region, the country was faced with the need to reform its health care system. The overall aims of the ...reform were to improve the quality of services. This paper describes the process of implementation of the reform and its first achievements in patient satisfaction and quality of services since it has been introduced.
Methods: The ministry of health introduced a series of steps that included changes to legislation, financing and manpower structure. Investments in primary care have been made and informatics support was developed. Educational interventions at the undergraduate and postgraduate levels were also introduced.
Results: The initial results show that the changes have improved the quality of care provided: the composition of professionals in primary care has improved; preventive activities have remained high. Primary care is more accessible and organization of services is better, which can be seen in reduced waiting times for consultation in primary care and improved satisfaction with health care.
Conclusions: The initial results show some progress since the reform was put into place. New measures aimed at raising the level of health care to reach European Union standards are still to be introduced.
Subclinical hypothyroidism represents a state with increased values of thyroid stimulating hormone (TSH) and normal values of thyroxine (T4) and triiodothyronine (T3). The disorder is asymptomatic, ...and the diagnosis is made based on the results of laboratory findings when the level of TSH reaches values above 4.0 mU/l. It is still subject to debate whether patients with subclinical hypothyroidism are at increased risk of cardiovascular disease, neuropsychiatric and neuromuscular disorders. Studies have shown that the appearance of general symptoms and complications are more common in patients whose values of TSH are above 10 mU/l. Therefore, the initiation of therapy with levothyroxine, which is the foundation of substitution therapy, is advised in patients whose TSH is >10 mU/l. As for patients whose values of TSH are from 4.0 to 10.0 mU/l and who make up 90% of the patients with subclinical hypothyroidism, further research is needed to determine the effects of the disorder and levothyroxine therapy on the health. Until then, the introduction of the substitution therapy in patients with TSH which is <10 mU/l should be considered in the case of the presence of general symptoms, anti-thyroid antibodies, increased lipids and other risk factors, goitre, pregnancy, ovarian dysfunction and infertility.
The goal of this study was to examine the prevalence of chronic respiratory symptoms in potroom workers and to compare these results with changes in spirometric parameters. A modified questionnaire ...on respiratory symptoms from the British Medical Research Council was used to take the medical history data about respiratory symptoms. Spirometric parameters were determined on the same day (as a part of regular checkups) using the Jaeger spirometer. The study included 215 potroom workers from the aluminium factory in Podgorica, Montenegro. All subjects were men, but they differed in age and duration of work. The group used for comparison consisted of 81 unemployed male applicants for jobs in the factory who had never been exposed to this kind of air pollution before. Potroom workers mostly complained of breathlessness associated with the workplace (56.7 %) or weather changes (rain, cold wind, and humidity) (41.9%) and of dyspnoea when climbing stairs (51.2 %), but only 22.3 % reported using medication to treat these episodes. Most workers reported to have been smoking at the time of the study (62.4 %). Spirometric data showed only insignificant variations compared to the expected values (CECA standards). Chronic obstructive pulmonary disease (COPD), characterised by FEV1/VC % <88 % was found in only 17 (7.9 %) potroom workers, while asthma was identified in 9 (4.2 %). Although the prevalence of chronic respiratory symptoms reported by the examined potroom workers was quite high at the group level, they were not associated with ventilatory impairments.
The performed study focused on determining the effect of vitamin D supplementation on enzymes involved in both inflammation and reactive oxygen species (ROS) production and ROS degradation in ...patients with type 2 diabetes mellitus (T2DM).
The 6-month follow-up, randomized, controlled study included 140 patients with T2DM, ≥ 30 years old, with good metabolic control, treated with metformin and lifestyle advice only. All patients were randomly assigned to two groups (70 each). Patients from the first group (Intervention group) were assigned to receive vitamin D3 50 000 IU or 14 000 IU regarding their vitamin D baseline levels. Patients from the second (Metformin) group continued to receive only metformin during the 6-month study period.
After 6 months, the myeloperoxidase activity was significantly lower and gradually decreased in the Intervention group by about 40%, compared to the baseline measurement (
= 0.015) and compared to the Metformin group (
= 0.001). After 6 months, the xanthine oxidase (XO) activity decreased significantly in the Intervention group compared to the baseline and 3
month levels (
< 0.001). In the Metformin group there was also a significant decrease in XO after 6 months compared to baseline (
< 0.001) and the 3
month (
= 0.003). The catalase activity significantly increased within the Intervention group only when comparing the 3
and 6
month (
= 0.027).
Our study showed that vitamin D may improve endothelial dysfunction in patients with T2DM on metformin therapy by influencing two important factors implicated in the pathogenesis of diabetic complications - ROS production and inflammation, which can additionally contribute to a stable metabolic control during metformin therapy.
Education means: learning, teaching or the process of acquiring skills or behavior modification through various exercises. Traditionally, medical education meant the oral, practical and more passive ...transferring of knowledge and skills from the educators to students and health professionals. Today the importance of focus on educational quality, particularly in the professions operating in the services required by people is agreed by all involved. The higher educational system shoulders some critical responsibilities in the economic, social, cultural and educational development and growth in the communities. In countries that are in transition it is in charge of educating professional human workforce in every field and if the education is optimal in terms of quality, it is capable of carrying out its responsibilities. It is reason why there is the necessity behind discovering some strategies to uplift the quality of education, especially at university level.. By increasing the courses and establishing universities and higher education centers, the countries around the world have generated more opportunities for learning, especially using modern information technologies. Regarding to evaluating different educational services quality, one of the most important measures should be the way to develop programs to promote quality and also due to the shortage of resources, evaluating the services quality enables the management to allocate the limited financial resources for realization whole educational process. Advances in medicine in recent decades are in significant correlation with the advances in the new models and concepts of medical education supported by information technologies. Modern information technologies have enabled faster, more reliable and comprehensive data collection. These technologies have started to create a large number of irrelevant information, which represents a limiting factor and a real growing gap, between the medical knowledge on one hand, and the ability of students and physicians to follow its growth on the other. Furthermore, in our environment, the term technology is generally reserved for its technical component. This terminology essentially means not only the purchase of the computer and related equipment, but also the technological foresight and technological progress, which are defined as specific combination of fundamental scientific, research and development work that gives a concrete result. The quality of the teaching-learning process at the universities in former Yugoslav countries and abroad, depends mainly of infrastructure that includes an optimal teaching space, personnel and equipment, in accordance with existing standards and norms at the cantonal or entity level, which are required to implement adequately the educational curriculum for students from first to sixth year by Bologna studying concept. For all of this it is necessary to ensure adequate funding. Technologies (medical and information, including communications) have a special role and value in ensuring the quality of medical education at universities and their organizational units (faculties). "Splitska inicijativa" project, which started 6 years ago as simple intention to exchange experiences of application new model of education, based on: Bologna studying concept, and other types of under and postgraduate education, was good idea to improve also theory and practice of it within Family medicine as academic and scientific discipline. This year scope of our scientific meeting held in Sarajevo on 24th and 25th March 2017, was quality assessment of theoretical and practical education and, also, evaluation of knowledge by students exams (a-y).
We have registered that with growing interest of the middle-aged in sport activities in our country the incidence of Achilles tendon ruptures has increased. It was usually preceded by its ...degenerative changes. Our aim was to examine the results of Achiles tendon rupture treatment in the group treated with our modified percutaneous technique with double - crossed suture.We compared these results with those obtained by the treatment with the nonsurgical method.Our study included 139 patients who gained injuries during their sports activities. They were active professionals or ex-active who continued training sports for recreation, and finally, amateurs who trained sports for the sake of recreation. We also analyzed differences in the results of those three groups after the treatment and checked them statistically.The results have showed superiority of this percutaneous operative treatment because of its simple operative technique, possibility of doing it in the local anaesthesia, continuous ultrasonographic following of the rupture during the process of healing up and shorter immobilisation time, practically without hospitalization and rare complications.
Cilj rada bio je da se kod radnika u pogonu elektrolize aluminija ispita učestalost respiratornih simptoma koji imaju kroničan karakter i da se usporedi s učestalošću promjena spirometrijskih ...parametara kod istih osoba. Anamnestički podaci o respiratornim simptomima uzimani su s pomoću modificiranog upitnika o respiratornim simptomima Britanskog savjeta za medicinska istraživanja. Spirometrijski parametri određivani su ispitanicima istoga dana (u sklopu njihova periodičnog pregleda) s pomoću spirometra marke Jaeger. Skupinu ispitanika činilo je 215 radnika pogona elektrolize Kombinata aluminijuma u Podgorici. Svi ispitanici bili su muškog spola, a različite dobi i dužine ekspozicije u elektrolizi. Istodobno je na jednak način ispitana skupina od 81 radnika također muškog spola, svi kandidati za radno mjesto u istoj tvornici, koji do tada nisu bili izloženi toj vrsti aeroonečišćenja. Najčešći respiratorni simptomi kod radnika u elektrolizi bili su napadaji gušenja na radnome mjestu (56,7 %), dispneja pri usponu (51,2 %) i utjecaj vremenskih prilika (kiša, hladan vjetar, povišena vlažnost zraka) na disanje (41,9 %). Međutim, tek je četvrtina (22,3 %) navela da pri napadu gušenja uzima neki od medikamenata. Među pregledanim radnicima bilo je najviše aktivnih pušača (62,3 %). Istodobno, vrijednosti ventilacijskih volumena pokazale su samo neznatna odstupanja od očekivanih (po standardima CECA), a prevalencija kronične opstruktivne plućne bolesti (KOPB) definirana kriterijem FEV1/VC % < 88 % nađena je samo kod 17 (7,9 %) radnika. Na osnovi ovog istraživanja zaključili smo da je učestalost respiratornih simptoma koje prijavljuju radnici elektrolize aluminija visoka, ali da nju ne prate adekvatni pomaci objektivnih pokazatelja kakvi su spirometrijski.
Kako bi se procijenila profesionalna izloženost krvi bolničkih radnika u Crnoj Gori tijekom 2010. godine, provedeno je presječno istraživanje prilagođenim Hrvatskim upitnikom samoprocjene izloženosti ...infekcijama koje se prenose krvlju u devet bolnica. Od 1043 ispitanika, njih 517 (49,6 %) prijavilo je izloženost krvi. Nije bilo značajnih razlika između bolnica, osim bolnice u Kotoru koja se izdvaja visokim udjelom izloženih bolničkih radnika (p<0,05). Više od 77 % izloženosti nije prijavljeno u vrijeme nastanka incidenta putem standardnog bolničkog protokola. Najizloženija skupina bile su medicinske sestre (357 od 517; 69,1 %), ali udio izloženih sestara unutar skupine nije se značajno razlikovao u usporedbi s liječnicima (50,57 % prema 57,49 %). Broj bolničkih radnika koji imaju odgovarajući HBV cjepni status bio je iznenađujuće nizak (35,70 %) i značajno ispod preporučene dobre prakse (najmanje dvije uzastopne doze HBV cjepiva koje su dokumentirane u 100 % zaposlenih; p<0,001). Unatoč svojim ograničenjima, rezultati istraživanja popunjavaju raskorak u spoznajama o stvarnom broju ozljeda oštrim predmetima, ostalim profesionalnim izloženostima krvi i o vrlo uobičajenoj praksi bolničkih radnika u Crnoj Gori da ne prijavljuju te incidente. Također potvrđuju potrebu hitnog djelovanja u aktivnom uvođenju specifičnih i sveobuhvatnih mjera za prevenciju ubodnih incidenata i ozljeda oštrim predmetima. Preporučuje se kontinuirana obuka osoblja, cjeloživotno učenje i standardiziranje postekspozicijskih postupaka.
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