Clinical practice of diabetologists and diabetes nurses regarding sexual dysfunction (SD) in Croatian patients with diabetes

U ovom se istraživanju ispitivala klinička praksa liječnika dijabetologa i dijabetoloških medicinskih sestara u vezi sa seksualnom disfunkcijom (SD) u hrvatskih bolesnika sa šećernom bolešću. Uključeno je 39 liječnika i 33 medicinske sestre, koji su anonimnim upitnikom dali podatke o svojim osobnim karakteristikama, učestalosti pitanja bolesnika sa šećernom bolešću o SD-u, vjerojatnosti da o tim smetnjama pitaju bolesnike s različitim medicinskim i nemedicinskim karakteristikama te o svojoj procjeni prepreka uključivanju SD-a u redovitu dijabetološku praksu. Dvije trećine liječnika (n = 26) i najveći dio medicinskih sestara (n = 28) o SD-u pita manje od polovine muškaraca s dijabetesom; 7,7 % dijabetologa o SD-a pita gotovo svakog bolesnika, a 15,4 % o tome ne pita gotovo nijednog bolesnika. Više od polovice medicinskih sestara (n = 17) o seksualnoj disfunkciji ne pita gotovo nijednog bolesnika. Dijabetolozi o SD-u najvjerojatnije pitaju bolesnike s trajanjem dijabetesa dužim od 10 godina te sa simptomatskim (ali ne krajnjim) komplikacijama šećerne bolesti. Također, o SD-u vjerojatnije pitaju bolesnike koje doživljavaju ugodnima u komunikaciji, kao i bolesnike koji su mlađi, urbani, oženjeni i za koje pretpostavljaju da su boljih imovinskih prilika. Glavne prepreke uključivanju SD-a u dijabetološku obradu uključuju brigu da bi to bolesnicima bilo nelagodno te nedostatak znanja i vremena za liječenje te smetnje.This paper researched the clinical practice of diabetologists and diabetes nurses regarding sexual dysfunction (SD) in Croatian patients with diabetes. It included 39 physicians and 33 nurses, who filled out an anonymous questionnaire concerning their personal characteristics, the frequency of patients inquiring about SD, the likelihood that they will ask patients with particular medical and non-medical characteristics about SD, and the barriers to including SD in regular diabetology practice. Two-thirds of physicians (n = 26) and the majority of nurses (n = 28) inquire about SD in less than half of men with diabetes; 7,7% diabetologists ask almost every patient about SD, and 15,4% of doctors and 54,8% of nurses ask almost none of the patients. Diabetologists are more likely to inquire about SD in patients who had diabetes longer than 10 years, and in those who have symptomatic (but not end-stage) chronic diabetes complications. They are more likely to ask about SD patients whom they perceive to be pleasant in communication, and patients who are younger, urban, married, and in a better material situation. The chief barriers include concern that patients may be uncomfortable with questions about sexuality, and a lack of knowledge and time to treat the SD

NURSING EVALUATION OF DIABETES SELF-MANAGEMENT IN TERTIARY HEALTHCARE SETTINGS IN CROATIA

Background: Systematic and efficient education on patient self-management behaviour represents one of the key approaches to diabetes treatment. The aim of this paper was to evaluate the current process and content of nursing assessment of illness selfmanagement behaviour in persons with diabetes treated at a tertiary healthcare facility. Subjects and methods: Electronic patient records of N=15,116 persons with type 2 diabetes (51.3% men) who took part in nursing evaluation and education throughout 2011 were collected. The patients’ mean age was 65.0±11.1 years, with mean diabetes duration of 12.6±8.3 years; they were mostly treated with oral anti-diabetic drugs (38.4%) or insulin therapy (38.5%). The likelihood of non-participation in the nursing evaluation was predicted based on a number of patient characteristics using a multivariate logistic regression. Results: The nurses mostly rated the patients’ self-management knowledge and real-life application of that knowledge as appropriate; however, in a large number of patients, the nursing evaluation was not evidenced in the electronic patient record. Multivariate logistic regression revealed that longer diabetes duration, insulin treatment and better glyceamic control as measured by glycated haemoglobin were associated with a higher likelihood of participating in a nursing evaluation and diabetes re-education. Conclusion: Diabetes specialist nurses may use informal criteria when deciding which type 2 diabetes patients to interview about diabetes knowledge and self-care. Participative research on the processes of nurses’ decision-making may be needed

NURSING EVALUATION OF DIABETES SELF-MANAGEMENT IN TERTIARY HEALTHCARE SETTINGS IN CROATIA

Background: Systematic and efficient education on patient self-management behaviour represents one of the key approaches to diabetes treatment. The aim of this paper was to evaluate the current process and content of nursing assessment of illness selfmanagement behaviour in persons with diabetes treated at a tertiary healthcare facility. Subjects and methods: Electronic patient records of N=15,116 persons with type 2 diabetes (51.3% men) who took part in nursing evaluation and education throughout 2011 were collected. The patients’ mean age was 65.0±11.1 years, with mean diabetes duration of 12.6±8.3 years; they were mostly treated with oral anti-diabetic drugs (38.4%) or insulin therapy (38.5%). The likelihood of non-participation in the nursing evaluation was predicted based on a number of patient characteristics using a multivariate logistic regression. Results: The nurses mostly rated the patients’ self-management knowledge and real-life application of that knowledge as appropriate; however, in a large number of patients, the nursing evaluation was not evidenced in the electronic patient record. Multivariate logistic regression revealed that longer diabetes duration, insulin treatment and better glyceamic control as measured by glycated haemoglobin were associated with a higher likelihood of participating in a nursing evaluation and diabetes re-education. Conclusion: Diabetes specialist nurses may use informal criteria when deciding which type 2 diabetes patients to interview about diabetes knowledge and self-care. Participative research on the processes of nurses’ decision-making may be needed

Lifestyle habits of Croatian diabetic population: observations from the Croatian Adult Health Survey [Životne navike osoba sa šećernom bolepću u Republici Hrvatskoj: zapažanja iz Hrvatske zdravstvene ankete]

The aim of this study was to assess the behavioural risk factors in Croatian diabetic population and to compare them with the lifestyle habits of individuals with no known history of diabetes. The study was a part of the Croatian Adult Health Survey (CAHS), a cross-sectional survey that provided comprehensive health assessment of the Croatian adult population. Risk factors were defined as an unhealthy nutritional regimen, excessive alcohol consumption, smoking and lack of physical activity. Physical inactivity was the most prevalent risk factor observed in a significant number of both diabetic and non-diabetic subjects (44.8% and 29.1%). It was also the only behavioural risk factor that was more prevalent in the diabetic individuals as compared to those without diabetes. Alcohol consumption did not vary significantly between the two groups (5.8% vs. 6.3%), while unhealthy dietary pattern and smoking were less frequent in respondents with diabetes (10.0% vs. 16.5% and 14.3% vs. 23.2%, respectively). Among diabetic patients, a significantly larger proportion of men than women reported smoking (19.2% vs. 10.0%), whereas no such sex-related differences were observed in other behavioural risk factors. Although the most prominent risk factor in diabetic patients was physical inactivity, a significant proportion of respondents with diabetes also reported the presence of other risk factors investigated in this survey. Since the majority of diabetic patients do not reach their treatment goals, there is a substantial need for curative and preventive interventions. Given the importance of physical activity in the treatment and prevention of diabetes and the high proportion of inactive diabetic patients, any future preventive programme in Croatia should address that risk as well

Änderung von Einstellungen und Erkenntnisbedürfnis bei Debattanten und Nichtdebattanten

Ciljevi ovog istraživanja bili su utvrditi utječe li bavljenje debatom na otpornost stavova srednjoškolaca, te postoje li razlike između debatanata i nedebatanata na dimenziji potrebe za spoznajom (PS). Sudionici istraživanja bili su srednjoškolci, članovi debatnih klubova (N=30) i srednjoškolci koji nisu članovi debatnih klubova (N=58). U prvoj fazi istraživanja izmjeren je inicijalni stav sudionika prema zadanom objektu stava (prijedlog spuštanja dobne granice za konzumaciju alkohola s 18 godina na 16). Tri tjedna nakon toga, sudionici su dobili zadatak da zapišu sve argumente kojih se mogu domisliti protiv tog prijedloga, izmjerena im je PS i ponovno izmjeren stav prema zadanom objektu. Prema razultatima, stavovi debatanata jednako (ne)otporni na promjenu kao i stavovi nedebatanata, navodeći na zaključak da bavljenje debatom ne utječe na otpornost stavova. Sukladno drugoj hipotezi, debatanti su pokazali izraženiji PS, vjerojatno zato što mladi više PS odabiru debatu kao izbornu aktivnost. U ovom se istraživanju nije pokazala povezanost potrebe za spoznajom i otpornosti stavova. Relevantnom varijablom za veličinu promjene stava se pokazala dob sudionika. Mlađi sudionici imali su restriktivniji početni stav koji je bio otporniji na promjenu od starijih sudionika, vjerojatno jer je odabrani objekt stava bio važniji mlađim nego starijim sudionicimaThe aims of this research were to establish whether participating in competitive debate clubs affects the resistance of attitudes of high school students, and whether there were differences between debaters and non-debaters on the dimension of the need for cognition (NFC). Participants were high-school students, members of debate clubs (N=30) and high-school students who were not members of debate clubs (N=58). In the first stage of the research, their initial attitude towards a given object (the proposal of lowering the legal age for the consumption of alcohol from 18 years to 16 years) was measured. Three weeks afterwards, the participants were given the assignment to list all the arguments they could think of against that proposal. During the same session, NFC was measured and student attitude towards the given object was measured once again. The results show that attitudes of debaters are equally (non)resistant to change as attitudes of non-debaters, pointing to the conclusion that participating in debate clubs does not influence resistance of attitudes. Debaters showed a higher NFC, probably because young people with a higher NFC were more likely to choose debate as an activity. In this research, the correlation of NFC and attitude resistance was not demonstrated. Age of participants was a relevant variable for the magnitude of attitude change. Younger participants had a more restrictive initial attitude that was more resistant to change than attitudes of older participants, probably because the chosen object was more important to younger than to older participants.Diese Forschung hatte zum Ziel festzustellen, ob das Debattieren bei den Mittelschülern die Resistenz ihrer Einstellungen beeinflusst, sowie ob es Unterschiede zwischen Debattanten und Nichtdebattanten im Hinblick auf die Dimension Erkenntnisbedürfnis gibt. Beteiligt an der Forschung waren Mittelschüler, Mitglieder von Debattenklubs (N =30) und Mittelschüler, die keinem Debattenklub angehörten (N=58). In der ersten Forschungsphase wurde die initiale Einstellung der Beteiligten zu dem vorgegebenen Einstellungsobjekt (Vorschlag einer Verringerung der Altersgrenze für den Alkoholkonsum von 18 Jahren auf 16 Jahre). Drei Wochen später erhielten die Beteiligten den Auftrag, alle Argumente, die ihnen gegen diesen Vorschlag einfallen, niederzuschreiben, es wurde ihr Erkenntnisbedürfnis gemessen sowie erneut ihre Einstellung zum vorgegebenen Objekt. Die Ergebnisse zeigen auf, dass die Einstellungen von Debattanten gleichermassen Änderungen unterworfen sind wie die Einstellunngen von Nichtdebattanten, woraus geschlossen werden kann, dass Debattieren die Resistenz von Einstellungen nicht beeinflusst. Im Einklang mit der zweiten Hypothese zeigten die Debattanten ein ausgeprägteres Erkenntnisbedürfnis, wahrscheinlich deswegen, weil die Jugendlichen mit höherem Erkenntnisbedürfnis das Debattieren als Wahlfach auswählen. In dieser Forschung wurden keine Zusammenhänge zwischen dem Erkenntnisbedürfnis und der Resistenz von Einstellungen festgestellt. Als relevante Variable für die Größe der Einstellungsänderung zeigte sich das Alter der Beteiligten. Jüngere Teilnehmer hatten eine restriktivere Anfangseinstellung, die resistenter auf Änderungen war als die Einstellung von älteren Teilnehmern, wahrscheinlich weil das ausgewählte Einstellungsobjekt für die jüngeren Teilnehmer wichtiger war als für die älteren

Procjena i praćenje psihosocijalnih potreba u liječenju osoba sa šećernom bolešću

Suvremena istraživanja i intervencije vezane uz psihološke i psihosocijalne činitelje u šećernoj bolesti usmjerila su se u dva područja [1]. Prvi smjer istraživanja i djelovanja tiče se povezanosti psihosocijalnih čimbenika sa zdravstvenim ishodima liječenja šećerne bolesti. S druge strane, psihosocijalnu dobrobit se promatra kao vrijedan ishod liječenja sam po sebi. Psihosocijalni čimbenici utječu na zdravstvene ishode bolesti, jer djeluju na uspješnost pojedinca u svim aspektima samozbrinjavanja šećerne bolesti. Pritom valja imati na umu da je veza između psihosocijalnih činitelja i zdravstvenih ishoda bolesti dinamička. S jedne strane, psihosocijalni resursi kojima raspolaže osoba oboljela od šećerne bolesti će pozitivno ili negativno djelovati na njezinu dobrobit. Oni će time posredno dovoditi i do boljeg ili slabijeg samozbrinjavanja, što će uvjetovati poželjne ili štetne zdravstvene ishode. S druge strane, poželjni zdravstveni ishodi će povećavati psihosocijalnu dobrobit, čime će doprinositi održavanju poželjnih obrazaca ponašanja samozbrinjavanja i očuvanju dobrog zdravstvenog stanja. Nepoželjni zdravstveni ishodi će otežavati daljnje pokušaje samozbrinjavanja i negativno djelovati na dobrobit pojedinca, čime će postizanje boljih zdravstvenih ishoda biti teže. Ovo je perspektiva koja je često od primarne važnosti medicinskom osoblju koje se bavi liječenjem osoba sa šećernom bolešću. Psihosocijalna dobrobit kao važan samostalni ishod skrbi za oboljele veže se uz činjenicu da šećerna bolest pogoduje razvoju različith psiholoških i psihosocijalnih smetnji i tegoba. Prevalencija depresije među osobama sa šećernom bolešću iznosi oko 20%, što je oko tri puta učestalije nego u općoj populaciji [2], a procjenjuje se da oko 40% osoba sa šećernom bolešću doživljava smetnje raspoloženja različitog intenziteta. Pritom oko dvije trećine depresivnih poremećaja kod dijabetičara ostaje neprepoznato i neliječeno. S druge strane, život sa šećernom bolešću u sličnoj mjeri povećava i vjerojatnost razvoja anksioznih poremećaja i klinički značajno povišene anksioznosti [3]. Konačno, osobe sa šećernom bolešću, a osobito mlađe ženske osobe, sklonije su razvoju poremećaja prehrane, kao i poremećenim obrascima hranjenja koji ne zadovoljavaju pune dijagnostičke kriterije [4]

Multidisciplinarni pristup kod seksualne disfunkcije žena u sportu

Sexual dysfunction is registered as an ever increasing problem that occurs equally in men and women. In women who are actively involved in sports sexual dysfunction has so far not been sufficiently studied. In most cases, the problem of sexual dysfunction is more likely as age increases. Lack of interest in sexual relations and the inability to achieve orgasm in women, as well as premature ejaculation in men, are the most common sexual problems. Etiology of sexual dysfunction is complex and related to changes in the vascular, neurological, endocrine and muscular system. Types of sexual dysfunction in women include reduced sex drive, orgasmic disorders and painful intercourse. Female athletes can have all types of sexual dysfunctions, and alongside complex medical treatment, kinesiology-anthropological analyses and physiotherapy process should also be implemented, which would define the need, type and extent of therapeutic exercises as part of a multidisciplinary treatment.Seksualna disfunkcija registrira se kao sve češći problem koji se podjednako javlja kod žena i muškaraca. U žena koje se aktivno bave sportom seksualna disfunkcija do sada je nedovoljno proučavana. U većini slučajeva, problem seksualne disfunkcije izraženiji je porastom životne dobi. Nedostatak interesa za seksualne odnose i nemogućnost postizanja orgazma u žena, te prerana ejakulacija u muškaraca, najčešći su seksualni problemi. Etiologija seksualne disfunkcije je kompleksna i povezana s promjenama na vaskularnom, neurološkom, endokrinom i mišićnom sustavu. Tipovi seksualne disfunkcije kod žena uključuju smanjenu seksualnu želju, poremećaje orgazma i bolne spolne odnose. Žene u sportu mogu imati sve tipove seksualne disfunkcije, a uz složenu liječničku obradu u toj je skupini potrebno provesti i kinantropološke analize uz fizioterapijski proces čime bi se definirala potreba, tip i opseg terapijskih vježbi kao dijela multidisciplinarnog liječenja