Materia socio-medica最新文献_第9页

Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women 希腊版爱荷华孕妇婴儿喂养态度量表的信度和效度

Materia socio-medica

Pub Date : 2019-09-01 DOI: 10.5455/msm.2019.31.160-165

M. Iliadou, K. Lykeridou, P. Prezerakos, C. Tzavara, S. Tziaferi

Introduction: A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes. Aim: to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women. Materials and Methods: Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach’s alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score. Results: The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach’s alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment. Conclusion: The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women’s infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS.

与母乳喂养有关的一个可改变的因素是母乳喂养态度。爱荷华州婴儿喂养态度量表(IIFAS)用于评估这一因素。虽然希腊的母乳喂养率有所下降，但没有任何有效的工具来评估婴儿喂养态度。目的:确定孕妇样本中希腊语适应IIFAS的心理测量特性。材料与方法:203名来自希腊雅典某大学医院的孕妇在住院期间使用希腊版IIFAS，并在产后6个月通过电话记录其婴儿喂养模式。量表的可靠性通过使用校正的项目-总量相关性和Cronbach’s alpha来评估。量表的建构效度采用验证性因子分析，预测效度采用t检验。采用逐步方法进行多元线性回归分析(去除p设为0.1，进入p设为0.05)，以找到与IIFAS总分独立相关的变量。结果:平均IIFAS评分为70.0 (SD=7.6)。修正后的项目-总相关系数在0.22 - 0.51之间。Cronbach 's alpha = 0.71。验证性因子分析表明单因素模型拟合良好。关于IIFAS的预测有效性，6个月母乳喂养显著。在六个月时进行纯母乳喂养的妇女(平均(SD): 68.4(6.6))的平均IIFAS评分显著高于未进行纯母乳喂养的妇女(平均(SD): 64.0(7.5)) (p=0.001)。在年龄较大、受教育程度较高以及在社会环境中母乳喂养儿童的妇女中，IIFAS得分较高。结论:希腊版本的IIFAS显示了令人满意的信度和效度来测量希腊背景下妇女喂养婴儿的态度。此外，本研究的结果进一步证明了国际财务会计准则的国际适用性。

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引用次数: 10

Neuralgic Amyotrophy in a 66-year-old Hiker: a Case Report 66岁徒步旅行者神经能性肌萎缩1例报告

Materia socio-medica

Pub Date : 2019-09-01 DOI: 10.5455/msm.2019.31.224-226

Dženan Jahić, B. Marjanovic, J. Merkac, N. Mirnik, N. Babic

Introduction: Neuralgic amyotrophy (NA) or Parsonage Turner syndrome is a clinical syndrome characterized by sudden attack of neuropathic pain, motor weakness and sensory loss that could be more or less clinically present. Different interpretations regarding the differential diagnosis, symptoms, cause and treatment were given till now. Aim: We report our experience with a 66-year-old male who had a sudden pain attack and palsy in shoulder region, without sensory loss, and associated calcific tendinitis of rotator cuff and degenerative changes in cervical spine. Case report: Patient came to our hospital with strong pain in shoulder area and signs of frozen shoulder. Active abduction and anteflexion was only to 30 degrees. He experienced the intense pain with visual analogue scale (VAS) 10/10 a night before, during his sleep. No trauma. Neurontin (gabapentin) was given to the patient. After 4 days, he felt better with abduction and anteflexion to 90 degrees. After 2 weeks VAS was 3/10, abduction and anteflection to 100 degrees. Conclusion: Neuralgic amyotrophy (NA) is a self-limiting inflammatory disorder usually with idiopathic etiology. The condition can be challenging to treat since many associated symptoms and diagnostic tests and procedures may mimic NA. In that case, accurate differential diagnosis is essential.

引言：神经性肌萎缩（NA）或Parsonage-Turner综合征是一种临床综合征，其特征是神经性疼痛、运动无力和感觉丧失的突然发作，临床上可能或多或少存在。迄今为止，对其鉴别诊断、症状、病因和治疗方法有不同的解释。目的：我们报告了一名66岁男性的经历，他突发肩部疼痛发作和麻痹，没有感觉丧失，并伴有肩袖钙化肌腱炎和颈椎退行性变化。病例报告：患者来我院就诊时肩部剧烈疼痛，并有肩部冻结迹象。主动外展和前屈仅为30度。前一天晚上，他在睡觉时用视觉模拟量表（VAS）10/10感受到剧烈疼痛。没有创伤。给病人服用了神经元素（加巴喷丁）。4天后，他感觉好多了，外展和前屈达到90度。2周后VAS评分为3/10，外展和前弯达到100度。结论：神经能性肌萎缩是一种自限性炎症性疾病，病因多为特发性。这种情况可能很难治疗，因为许多相关症状、诊断测试和程序可能会模拟NA。在这种情况下，准确的鉴别诊断至关重要。

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引用次数: 1

The Importance and Role of Proprioception in the Elderly: a Short Review 本体感觉在老年人中的重要性和作用:综述

Materia socio-medica

Pub Date : 2019-09-01 DOI: 10.5455/msm.2019.31.219-221

Ana Ferlinc, Ester Fabiani, T. Velnar, L. Gradišnik

Introduction: Aging causes alterations in various body functions, such as motor, sensory, cognitive and psychosocial. One of the factors associated with aging is also the decline in proprioceptive function. Aim: This paper provides an overview from the literature about the definition and importance of proprioception and the correlation with the elderly population. Material and Methods: The scientific literature was reviewed through PubMed, Medline and Science Direct. The articles were chosen in correlation with the study objective and their scientific relevance. Results: Proprioceptive training is fundamental in the rehabilitation and prevention of sports injuries. With the loss of proprioception during aging, the biomechanics of joints and the neuromuscular control of the limbs may change, resulting in impaired balance and a higher possibility of falls. Appropriate and proper physical activity can slow the age-related decline in proprioception. Conclusion: An appropriate proprioceptive training is important for maintaining the best possible physical fitness. It encompasses exercises for stability and coordination, stimulates motor learning, helps in maintaining proper body posture and balance, and improves body control.

导读:衰老导致各种身体功能的改变，如运动、感觉、认知和社会心理。与衰老相关的因素之一也是本体感觉功能的下降。目的:本文综述了本体感觉的定义、重要性及其与老年人群的关系。材料和方法:通过PubMed、Medline和Science Direct对科学文献进行综述。文章的选择与研究目的和它们的科学相关性相关。结果:本体感觉训练是运动损伤康复和预防的基础。随着年龄的增长，本体感觉的丧失，关节的生物力学和四肢的神经肌肉控制可能会发生变化，导致平衡能力受损，摔倒的可能性更高。适当和适当的体育活动可以减缓与年龄相关的本体感觉下降。结论:适当的本体感觉训练对保持最佳的身体素质非常重要。它包括稳定和协调的练习，刺激运动学习，帮助保持适当的身体姿势和平衡，并提高身体控制。

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引用次数: 44

Annual Incidence of Thyroid Disease in Patients Who First Time Visit Department for Thyroid Diseases in Tuzla Canton. 图兹拉州首次就诊甲状腺疾病科的患者甲状腺疾病的年发病率。

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.130-134

Maja Sulejmanovic, Amra Jakubovic Cickusic, Sabina Salkic, Fatima Mujaric Bousbija

Aim: The aim of this paper was to evaluate the incidence of thyroid gland diseases in relation to age, sex, existing associated symptoms and thyroxine and thyroid-stimulating hormone levels, in correlation with morphological characteristics and corresponding clinical diagnosis for thyroid gland.

Methods: Retrospective research was conducted in the period 1-Dec-2017 to 31-Dec-2017 and included a total of 500 subjects of both sexes aged 1 to 80 years. All subjects had clinical examination, which included anamnestic data, palpatory examination of thyroid gland, as well as functional status of thyroid gland.

Results: The results of the research have shown that majority of subjects were females (78.6% vs. 21.4%). The largest number of subjects was in the age group 41 to 60 years. The average age of females was 43.22 years and 42.86 for males. The most common associated symptom for both sexes was related to cardiovascular system disorder (61.2%). Subclinical hypothyroidism was the most prevalent thyroid gland disease (12.8%), while diffuse enlargement of thyroid gland (4.60 %) was the most common in morphological classification. The mean value for free thyroxine for the overall sample was 14.39 pmol/L and 3,4 mlU/L for thyroid-stimulating hormone. Thyroid-stimulating hormone levels were highest in the age group 41-60 years (p=0.043).

Conclusion: The overall incidence of thyroid gland diseases was 18.57% for females and 13.08% for males. Free thyroxine levels were highest in thyroid gland with nodular changes and subclinical hypothyroidism (p=0.0001). Thyroid-stimulating hormone levels had the highest value in a thyroid gland with diffuse changes and subclinical hypothyroidism (p=0.0001).

目的：本文旨在评估甲状腺疾病的发病率与年龄、性别、现有的相关症状以及甲状腺素和促甲状腺激素水平的关系，并与甲状腺的形态学特征和相应的临床诊断相关联。方法：回顾性研究于2017年12月1日至2019年12月31日期间进行，共纳入500名1至80岁的男女受试者。所有受试者都进行了临床检查，包括记忆数据、甲状腺触诊检查以及甲状腺功能状态。结果：研究结果显示，大多数受试者是女性（78.6%对21.4%）。受试者人数最多的是41至60岁的年龄组。女性平均年龄为43.22岁，男性平均年龄为42.86岁。男女最常见的相关症状与心血管系统疾病有关（61.2%）。亚临床甲状腺功能减退症是最常见的甲状腺疾病（12.8%），而甲状腺弥漫性肿大（4.60%）在形态学分类中最常见。总样本的游离甲状腺素平均值为14.39 pmol/L，促甲状腺激素平均值为3,4 mlU/L。促甲状腺激素水平在41-60岁年龄组最高（p=0.043）。结论：甲状腺疾病的总发病率女性为18.57%，男性为13.08%。甲状腺结节性变化和亚临床甲状腺功能减退症患者的游离甲状腺素水平最高（p=0.0001）。甲状腺弥漫性变化和亚临床甲状腺功能低下症患者的促甲状腺激素水平最高（p=0.0001）。

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引用次数: 10

Redesign of Work Space in Order to Reduce Noise Health Effects 重新设计工作空间以减少噪音对健康的影响

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.135-140

Fikret Veljović, Senad Burak, E. Begić, I. Masic

Introduction: Noise represent an unwanted sound that endangers human health in multiple manners and in work setting causes reduction of productivity on one side, and increased waste on the other. Noise pollution occurs when the ear is exposed to the volume of sound that is disturbing, stressful or directly damaging hearing, but also acting on the organism as a whole. Aim: The aim of the article is to examine the vulnerability of workers working on the „press“ machine, and to carry out an analysis and examine the press operator workplace, then perform the noise spread measurement in the press operator work area and compare the current measurements with the permissible levels and analyze the time period of worker exposure, as well as presentation of the effects of noise on productivity and workers health. The aim of the article also includes the proposal for decrease of noise pollution. Methods: A noise analysis at the workplace of workers working on a „press“ machine was performed, which is exposed to a high impulse noise due to which the quality and quantity of production are reduced. For the purpose of calculating the noise level for one working day at the press operator site 1, 2 and 3, it is necessary to analyze the noise level in time. Operators spend most of their working hours at stations 1 and 3 where the measured noise level is Lm1 = 94.7 dB is taken, or at position 3, Lm3 = 97.2 dB. The measured noise level at these locations without the operation of the press is Lm1 = 80.1 dB, or at station 3 is Lm3 = 80.1 dB. Results: It was found that these operators working on the machine in question were exposed to a noise over the limit for more than three years. Their health problems that arise as a result of noise exposure are documented in their health charts. In order to achieve uninterrupted work at the press machine, during the eight hours shift, a noise correction is required to allow the equivalent sound level to fall within one day to the permissible 85 dB. In this regard, we consider the fact that we have known that the press produces a sound level of 110 dB, and that there is a reverberation (reflecting) sound. Given the technical characteristics of the plant, the reduction of the sound intensity of the source itself is not possible, so the suggestions of the technical solution will be based on reduced reflected sounds and to prevent the spread of direct sound to the operator. Conclusion: Workers are exposed to permanent noise during a working day, which produces a number of consequences for the health of the worker, but also the employer and the community. The imperative of the employer is to reduce the number of rejects, increase profitability and to have a positive impact on the health of the individual.

引言：噪音是一种有害的声音，它以多种方式危害人类健康，在工作环境中，一方面会导致生产力下降，另一方面会增加浪费。当耳朵暴露在干扰、压力或直接损害听力的音量中时，就会发生噪音污染，但也会对整个生物体产生影响。目的：这篇文章的目的是研究新闻工作者的脆弱性“机器，并对压力机操作员工作场所进行分析和检查，然后在压力机操作员工作区进行噪声传播测量，将当前测量值与允许水平进行比较，分析工人暴露的时间段，以及噪声对生产力和工人健康的影响降低噪声污染的可能性。方法：对压力机工人工作场所的噪音进行分析“这台机器暴露在高脉冲噪声中，从而降低了生产的质量和数量。为了计算压机操作员现场1、2和3一个工作日的噪声水平，有必要及时分析噪声水平。操作员的大部分工作时间都在1号和3号站，测得的噪声水平为Lm1=94.7取dB，或者在位置3处，Lm3=97.2 dB。在没有压机操作的情况下，在这些位置测得的噪声水平为Lm1=80.1dB，或在3号站测得的噪音水平为Lm3=80.1dB。结果：发现这些在相关机器上工作的操作员暴露在超过限值的噪音中超过三年。他们因接触噪音而出现的健康问题记录在他们的健康图表中。为了在压力机上实现不间断的工作，在八小时轮班期间，需要进行噪音校正，以使等效声级在一天内降至允许的85 dB。在这方面，我们考虑了这样一个事实，即我们已经知道印刷机产生的声级为110 dB，并且存在混响（反射）声音。鉴于工厂的技术特点，降低声源本身的声音强度是不可能的，因此技术解决方案的建议将基于减少的反射声，并防止直接声音传播给操作员。结论：工人在工作日暴露在永久性噪音中，这对工人的健康产生了许多影响，也对雇主和社区产生了一些影响。雇主的当务之急是减少拒收数量，提高盈利能力，并对个人健康产生积极影响。

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引用次数: 2

Talking Genes in Breast and Pancreatic Malignancies 乳腺和胰腺恶性肿瘤中的谈话基因

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.146-149

M. Barbara, Adrianne Tsen, L. Tenner, L. Rosenkranz

Introduction: Both breast and pancreatic cancers have high mortality rates. Breast cancer is the second leading cause of cancer death in females, while pancreatic ductal adenocarcinoma (PDAC) is the fourth most common cause of cancer death. Almost 4-16 % of individuals with pancreatic cancer have a family history of the disease. Intra-ductal papillary mucinous neoplasms (IPMNs) are cystic lesions that received more attention lately due to their associations with PDAC and other solid organ tumors, such as breast cancer. Aim: The purpose of this article is to discuss the association of the familiar pancreatic cancer (FPC), sporadic pancreatic cancer, and IPMNs with the breast cancer. Results: Mutations in BRCA2, BRCA1, p16 and PALB2 play a major role in the genetic etiologies of familial pancreatic cancer. In familial and sporadic pancreatic cancers, mutations in BRCA2 are associated with a high incidence of PDAC, while mutations in BRCA1have shown inconsistent results. Data is insufficient to prove an association between IPMNs and breast cancer. Conclusion: The familial clustering of PDAC is not well understood. Further studies are required for greater comprehension of the genetic basis of PDAC and the association between IPMNs and breast cancer.

乳腺癌和胰腺癌的死亡率都很高。乳腺癌是女性癌症死亡的第二大原因，而胰腺导管腺癌(PDAC)是癌症死亡的第四大常见原因。几乎4- 16%的胰腺癌患者有家族病史。导管内乳头状粘液瘤(IPMNs)是一种囊性病变，近年来由于其与PDAC和其他实体器官肿瘤(如乳腺癌)的关联而受到越来越多的关注。目的:探讨常见胰腺癌(FPC)、散发性胰腺癌和IPMNs与乳腺癌的关系。结果:BRCA2、BRCA1、p16和PALB2基因突变在家族性胰腺癌的遗传病因中起重要作用。在家族性和散发性胰腺癌中，BRCA2突变与PDAC的高发病率相关，而brca1突变的结果不一致。数据不足以证明IPMNs与乳腺癌之间存在关联。结论:PDAC的家族聚类尚不清楚。为了更好地了解PDAC的遗传基础以及IPMNs与乳腺癌之间的关系，还需要进一步的研究。

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引用次数: 3

Perception and Knowledge of Facial Plastic Surgery Among Health Care Professionals at Tertiary Care Center, Jeddah, Saudi Arabia: Cross Sectional Study 沙特阿拉伯吉达三级保健中心卫生保健专业人员对面部整形手术的认知和知识:横断面研究

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.181-185

Abdullah Alamri, Reham Aljehani, Majed Alnefaie, Sabah S. Moshref, Abdulkareem Fida

Introduction: Plastic surgery is a medical specialty involving the restoration, reconstruction, or alteration of the body. Knowledge about facial plastic surgery among doctors is limited according to some literatures and enriched according to others, depending on the country and study population. Aim: Aim of the study was to evaluate level of knowledge of health care professionals regarding facial plastic surgery. Material and Methods: A cross-sectional study included total of 261 health care professionals (consultants, specialists and residents in training) at King Abdul-Aziz University Hospital (KAUH) from all subspecialties during July 2018. The data collected using pre-designed questionnaire and analyzed using professional statistics software. Results: Among 261 participants, sex distribution shows a male-female ratio of 2.78:1. The majority (62.8%) of participants were residents. Mean age (± SD) of participants was 32.28 ± 8.43. Pediatrics, internal medicine, and general surgery were the most common specialties. Among participants, 75.5% agreed that taking training in plastic surgery program is a requirement to be a facial plastic surgeon whether it should be accompanied with at least one other surgery training (23%) or more than one other training (22.2%). The majority (97.7%) have never undergone a facial plastic surgery operation and 78.2% were not willing to undergo one. Conclusion: The study concludes that the knowledge and perception among healthcare professionals in KAUH regarding facial plastic surgeries is on relatively good basis but needs more updates and trainings.

简介:整形外科是一门涉及身体修复、重建或改变的医学专业。根据国家和研究人群的不同，医生对面部整形手术的了解在一些文献中是有限的，在另一些文献中则是丰富的。目的:本研究的目的是评估卫生保健专业人员对面部整形手术的知识水平。材料和方法:一项横断面研究包括2018年7月在阿卜杜勒-阿齐兹国王大学医院(KAUH)来自所有亚专科的261名卫生保健专业人员(顾问、专家和住院医师)。使用预先设计的问卷收集数据，并使用专业统计软件进行分析。结果:在261名参与者中，性别分布为男女比例为2.78:1。大多数参与者(62.8%)是居民。参与者平均年龄(±SD)为32.28±8.43岁。儿科、内科和普通外科是最常见的专科。调查对象中，75.5%的人认为，要成为一名面部整形外科医生，必须接受至少一项其他手术培训(23%)或不止一项其他手术培训(22.2%)。大多数人(97.7%)从未做过面部整形手术，78.2%的人不愿意做面部整形手术。结论:我院医护人员对面部整形手术的知识和认知基础较好，但仍需加强更新和培训。

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引用次数: 2

Outcomes and Complications After Repeat Cesarean Sections Among King Abdulaziz University Hospital Patients. 阿卜杜勒阿齐兹国王大学医院患者重复剖宫产术后的结果和并发症。

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.119-124

Khalid A Alshehri, Ahmed A Ammar, Meshal A Aldhubabian, Mohammed S Al-Zanbaqi, Ahyad A Felimban, Motaz K Alshuaibi, Ayman Oraif

Introduction: Cesarean section (CS) is a surgical procedure that often saves the lives of both the mother and the baby, while a previous CS is one of the main indications for cesarean delivery in current pregnancy.

Aim: Our aim was to determine the surgical and obstetrical outcomes and complication for the mother and the neonate after 4 or more CSs and compare it with mothers who had less than 4 previous CSs.

Methods: This case-control study was conducted by reviewing the records of all women who underwent multiple CSs from 2013 to 2018. Our study group comprised of 394 women who had 4 or more CSs, and our control group comprised of similar number of women who had previous history of two or three CSs.

Results: A total of 788 patients were enrolled in our study. We found that adhesions were the most common complications in our study group with a considerable increase in number of both moderate and severe adhesions in the study group compared to the controls with p-value of <0.001.

Conclusion: Increasing number of CSs leads to an increase of the complications risk. Among the complications, adhesions were the most common in our study group, followed by intraoperative bleeding.

引言：剖宫产（CS）是一种通常可以挽救母亲和婴儿生命的外科手术，而之前的CS是当前妊娠期剖宫产的主要适应症之一。目的：我们的目的是确定4次或4次以上CSs后母亲和新生儿的手术和产科结果及并发症，并将其与之前CSs少于4次的母亲进行比较。方法：本病例对照研究通过回顾2013年至2018年接受多次CS的所有女性的记录进行。我们的研究组由394名患有4种或4种以上CSs的女性组成，而我们的对照组由同样数量的既往有两种或三种CSs病史的女性组成。结果：共有788名患者参与了我们的研究。我们发现，在我们的研究组中，粘连是最常见的并发症，与p值为的对照组相比，研究组中中度和重度粘连的数量都显著增加。结论：CS数量的增加导致并发症风险的增加。在并发症中，我们研究组最常见的是粘连，其次是术中出血。

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引用次数: 8

Workplace Violence and Sanctioning of Family Medicine Physicians Due to the Rules of Health Insurance Funds in the Western Balkan. 西巴尔干地区因健康保险基金规定而发生的工作场所暴力和对家庭医生的制裁。

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.99-104

Tanja Pekez-Pavlisko, Maja Racic, Larisa Gavran, Danica Rotar Pavlic, Ljubin Sukriev, Slavoljub R Zivanovic, Dinka Jurisic

Introduction: After family medicine's famous beginnings in the early 60's through introduction of the world's first family medicine specialization, with transitional changes and war also come changes in former Yugoslavia's healthcare systems.

Aim: The primary aim of this article is to analyze frequency and causes of sanctioning of family physicians by Health insurance funds in the countries of former Yugoslavia. The secondary aim is to evaluate frequency and types of workplace violence family physicians experienced due to insurance boundaries for patients.

Methods: The comparative, cross-sectional survey was carried out from October 2017 to February 2018. Study participants were general practitioners' (GPs), family physicians (FPs) and those without a specialty designation but providing family medicine services in one of the five Western Balkans countries: Croatia, Slovenia, Serbia, Macedonia and Bosnia and Herzegovina (B&H). The questionnaire was designed for the purpose of the study.

Results: Forty-nine percent of participating physicians have been sanctioned by Health Insurance Fund and 77. 5% has been exposed to workplace violence. The most common type of violence was verbal (76.6%). Financial penalties according to the scale had the highest rates in Macedonia (73.9%) and Slovenia (43.9%).

Conclusion: It is necessary to educate creators of healthcare policies, doctors and patients for the purpose of establishing partner relations which would lead to strengthening of primary healthcare, but also to a more efficient healthcare system.

引言：在60年代初家庭医学的著名开端之后，通过引入世界上第一个家庭医学专业，随着过渡时期的变化和战争，前南斯拉夫的医疗体系也发生了变化。目的：本文的主要目的是分析前南斯拉夫国家医疗保险基金制裁家庭医生的频率和原因。第二个目的是评估家庭医生因患者保险边界而经历的工作场所暴力的频率和类型。方法：2017年10月至2018年2月进行横断面比较调查。研究参与者包括全科医生（GP）、家庭医生（FP）以及那些没有专业名称但在西巴尔干五个国家之一提供家庭医学服务的人：克罗地亚、斯洛文尼亚、塞尔维亚、马其顿和波斯尼亚和黑塞哥维那（B&H）。调查问卷是为研究目的而设计的。结果：49%的参与医生得到了健康保险基金的批准，77名。5%的人曾遭受过工作场所的暴力。最常见的暴力类型是言语暴力（76.6%）。马其顿（73.9%）和斯洛文尼亚（43.9%）的经济处罚率最高。结论：有必要教育医疗政策的制定者、医生和患者，以建立伙伴关系，从而加强初级医疗保健，而且还涉及更高效的医疗保健系统。

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引用次数: 3

Venous Thromboembolism During Ten-year Follow up on Clinical Center University of Sarajevo 萨拉热窝大学临床中心对静脉血栓栓塞的10年随访

Materia socio-medica

Pub Date : 2019-06-01 DOI: 10.5455/msm.2019.31.84-87

A. Mlačo, N. Mlačo, Demir Bejtović, A. Džubur, M. Spužić

Introduction: Venous thromboembolism (VTE) consists of two entities, deep venous thrombosis (DVT), and its complication, pulmonary embolism (PE). The main therapeutic goal is the prevention of this complication. Aim: The aim of the study was to present epidemiological data of patients with the diagnosis of deep venous thrombosis, with regard to the location of thrombosis, the value of fibrinogen and D-dimer in relation to the sex of the patients, the presentation of therapeutic modality, with the presentation of PE and treatment outcomes. Methods: The study has a retrospective and observational feature, covering the period from 2008 to 2017, and included 1154 patients with the diagnosis of deep venous thrombosis as a basic criterion for inclusion. Data on sex, age, diagnosis with thrombosis localization, hospitalization duration, administered therapy, D-dimer and fibrinogen values, pulmonary thromboembolism and mortality were collected. Results: The deep venous thrombosis was mostly located at the lower limbs - in 1079 respondents (93.5%), then at the upper limbs in 65 (5.63%) cases. The left side is more represented (58.9%) than the right (40.3%), which is statistically significant (χ2=40.03, p<0.005), while 0.9% of patients had DVT bilaterally. At the lower limbs is the most common iliac thrombosis, represented in 47% of thrombosis cases at the lower limbs. Subclavian axillary thrombosis has been reported in ¾ cases at the upper limbs. The mean fibrinogen concentration in all respondents is 5.2 mg/L, for men 5.0 mg/L and for women 5.3 mg/L, above the reference values (1.8-3.8 g/L). The mean value of D-dimer was 7.33 mg/L for all respondents, 8.46 mg/L for women and 6.5 mg/L for men, which was high above the reference limit (0.55 mg/L). From baseline, 88 (7.6%) of respondents had proven/high-grade pulmonary thromboembolism as a DVT complication in the observed period. Pearson correlation established a positive correlation between lethal outcome and patient age, r=0.13, p<0.005, followed by a higher incidence of lethal outcome after DVT in older patients. Conclusion: The incidence of venous thromboembolism is approximately equal among the genders, and increases with the age of the patients, especially in men. Fibrinogen and D-dimer values in hospitalized patients are higher than the reference, in both cases more among women. Multidisciplinary approach to patients, in cooperation with angiologists, pulmonologists, cardiologists and nuclear medicine specialists is an imperative. The development of a state-level registry that would follow the incidence of deep venous thrombosis, with reference to risk factors, is imperative and necessary in planning of community health system.

静脉血栓栓塞(VTE)由深静脉血栓形成(DVT)和其并发症肺栓塞(PE)两部分组成。主要的治疗目标是预防这种并发症。目的:本研究的目的是提供深静脉血栓患者的流行病学资料，包括血栓形成的部位，纤维蛋白原和d -二聚体的值与患者性别的关系，治疗方式的表现，PE的表现和治疗结果。方法:本研究具有回顾性和观察性特点，研究时间为2008 - 2017年，纳入1154例患者，诊断为深静脉血栓形成作为纳入的基本标准。收集性别、年龄、血栓定位诊断、住院时间、给予治疗、d -二聚体和纤维蛋白原值、肺血栓栓塞和死亡率的数据。结果:1079例(93.5%)患者下肢深静脉血栓多，65例(5.63%)患者上肢深静脉血栓多。左侧DVT占58.9%，高于右侧(40.3%)，差异有统计学意义(χ2=40.03, p<0.005)，双侧DVT占0.9%。下肢是最常见的髂血栓形成，占下肢血栓形成病例的47%。据报道，锁骨下腋窝血栓在上肢有3 / 4的病例。所有应答者的平均纤维蛋白原浓度为5.2 mg/L，男性为5.0 mg/L，女性为5.3 mg/L，高于参考值(1.8-3.8 g/L)。d -二聚体的平均值为7.33 mg/L，女性为8.46 mg/L，男性为6.5 mg/L，均高于参考值(0.55 mg/L)。从基线开始，在观察期间，88例(7.6%)的应答者被证实/高度肺血栓栓塞为DVT并发症。Pearson相关性显示，死亡结局与患者年龄呈正相关，r=0.13, p<0.005，老年患者DVT后死亡结局发生率较高。结论:静脉血栓栓塞的发生率在男女之间大致相等，且随患者年龄的增长而增加，尤其是男性。住院患者的纤维蛋白原和d -二聚体值高于参考值，在这两种情况下，女性更高。与血管专家、肺科专家、心脏病专家和核医学专家合作，对患者采取多学科方法势在必行。在社区卫生系统规划中，建立一个国家级的深静脉血栓发生率登记系统，并参考危险因素，是当务之急和必要的。

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引用次数: 3