Motivation of health professionals and associates to perform daily job activities

Introduction: Motivation is one of the most complex elements of human behavior, it is the subject of debates by which we answer to the question of why someone behaves in a certain way. The aim of this study wasto examine the factors of motivation for health workers and staff in working with diffi cult patients in intensive care units and to evaluate implementation of motivation factors by managers in their daily work with a team of health professionals.Methods: The study was designed as prospective. It was conducted on 27 employees who work in intensive care units in Clinical Center of Sarajevo University. The survey questionnaire was used with a clear andconcise questions , aimed at testing the factors of motivation for daily work with diffi cult patients, as well as implementation of motivational factors by managers in the organizational unit (OU).Results: Respondents indicated that motivates them, good organization of work - 10 of them (37%), while 26% of respondents indicated that they are motivated by fi nancial gain. In our study 21 (77%) of respondentssaid that their managers infuenced the motivation for a better job. Mobbing at the workplace did not had 80% of respondents, while 8% of respondents stated that they had some form of mobbing, and 12% of respondents give partial response.Conclusions: The survey showed that most respondents have a good motivation factors for the performance of daily activities to work with diffi cult patients. As the main motivating factors respondents reportedgood organization of work, as well as positive examples of their managers

Balneogynaecology in the 21st century: increasingly recommended primary and complementary treatment of chronic gynaecological diseases

Balneo-gynaecological treatment methods include external bath hydrotherapy, sedentary baths and topical dressings/cataplasm, and internal (intravaginal or intrarectal use of peloids and mineral water). Hyperosmolar thermal spas have been very popular in the treatment of infertility due to the improvement of symptoms of chronic pelvic pain, endometriosis, chronic vascular and inflammatory pelvic diseases. Acute pelvic inflammatory syndrome is a contraindication for balneo-hydrotherapy while hyperthermal hydrotherapy is contraindicated in endometriosis and neurovegetative dystonia due to the stimulation of hyperemia, which worsens the clinical picture. Balneo-hydrotherapy is not recommended in metrorrhagia and malignancies. Balneogynaecological treatment certainly has its own primary but also complementary role in the treatment of chronic gynaecological diseases and is increasingly recommended today

ETIOLOŠKI RIZIČNI ČIMBENICI ZA KLJENUT BRAHIJALNOG PLEKSUSA

During a period of nine years, from 01. 01. 1996 to 31. 12. 2004, 45 544 live-born children were analyzed. The analysis is retrospective and is based on medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Rehabilitation and Physiatrics of University Clinical Center Tuzla. The 86 newborns with brachial plexus palsy have been recorded, the prevalence is 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the delivery pattern itself, it has been found that the highest risk-factors for brachial plexus injury are birth weight over 4000 grams, precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted delivery of newborns. Brachial plexus palsy was more frequent when the newborns\u27 mothers were overweight, with a body mass index 29 kg/m2 or more. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had a ¬narrowed pelvis. Newborns, who were delivered vaginally, were not diagnosed to have a higher frequency of brachial plexus palsy compared to newborns who were delivered by Caesarean section, but newborns with vaginal breech delivery have had a higher incidence of brachial plexus palsy. Newborns, whose mothers were older than 35, had have brachial plexus palsy more frequently; statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed to have a fracture of clavicle, which was the most frequently combined damage with brachial plexus injury. The 42 newborns (48.8%) had an Apgar score of<8 in the first minute after delivery, which indicates intrapartal distress of fetus and points to traumatic nature of these deliveries. Average birth weight of newborns with plexus brachialis damage was 3858±grames, which, for an average gestation age of 38.8±1,8 weeks of gestation, corresponds to eutrophic newborns. Both male and female newborns were diagnosed to have plexus brachialis equally and almost all deliveries (97.7%) started spontaneously. The majority of newborns were born early in the morning between 2–3 hours or afternoon between 14–15 hours.U devetgodišnjem vremenskom razdoblju od 01. 01. 1996. do 31. 12. 2004. godine analizirano je 45 564 živorođene novorođenčadi. Analiza je retrospektivna, bazirana na medicinskoj dokumentaciji Klinike za ginekologiju i akušerstvo, Klinike za neurologiju i Klinike za rehabilitaciju i fizijatriju Univerzitetsko-kliničkog centra Tuzla. Registrirano je 86 novorođenčadi s paralizom pleksusa brahijalisa, incidencija je 1,89 na 1000 živorođene novorođenčadi. Analizom maternalnih i neonatalnih faktora, te samog tijeka poroda utvrđeno je da su najveći rizični faktori za nastanak povrede pleksusa brahijalisa porodna težina novorođenčeta preko 4000 grama, skraćeno drugo porodno doba (<15 minuta) te rađanje novorođenčeta uz pomoć vakuum ekstraktora. Povreda pleksusa brahijalisa češće nastaje kod novorođenčadi gojaznih majki, kod kojih je indeks tjelesne mase 29 kg/m2 i više. Ni jedna rodilja nije imala suženu zdjelicu. Nije nađena veća učestalost povrede pleksusa brahijalisa novorođenčadi rođene vaginalno u odnosu na novorođenčad rođenu carskim rezom, a češće nastaje povreda pleksusa brahijalisa kod novorođenčadi rođene u stavu zatkom. U novorođenčadi majki starijih od 35 godina nađena je veća učestalost povreda brahijalnog pleksusa, a nije nađena statistički značajna razlika povreda pleksusa brahijalisa između prvorotkinja i višerotkinja. Najčešća združena povreda s paralizom pleksusa brahijalisa je fraktura klavikule koja je dijagnosticirana u 39 novorođenčadi (45,2%). 42 novorođenčadi (48,8%) imalo je Apgar zbroj u 1. minuti <8, što govori o intrapartalnoj patnji ploda i ukazuje na traumatsku prirodu ovih poroda. Prosječna ¬porodna težina novorođenčadi s povredom pleksusa brahijalisa je 3858±587,7 grama, što za prosječnu gestacijsku dob od 38,8±1,8 nedjelja gestacije odgovara eutrofičnoj novorođenčadi. Povreda pleksusa brahijalisa nastaje podjednako često kod muške i ženske novorođenčadi, a gotovo svi porodi (97,7%) su započeti spontano. Najviše novorođenčadi je rođeno noću između 2–3 sata i poslije podne između 14–15 sati

ANOMALIES OF CENTRAL NERVOUS SYSTEM AS PERINATAL PROBLEM IN TUZLA

Anomalije CNS-a predstavljaju veliki problem perinatalne medicine. Cilj rada je prikazati učestalost ¬anomalija CNS-a na uzorku Klinike za ginekologiju i akušerstvo u Tuzli u razdoblju od 1. 1. 1996. do 31. 12. 2003. ¬godine. Metode. Retrospektivnom studijom ispitana je učestalost anomalija CNS-a i vrste pojedinih anomalija te kvaliteta antenatalne zaštite i životna dob majki koje su rodile novorođenčad s anomalijama CNS-a. Dobiveni rezultati obrađeni su standardnim metodama deskriptivne statistike. Rezultati. U analiziranom razdoblju od 1. 1. 1996. do 31. 12. 2003. godine rođeno je 647 novorođenčadi s nekom od kongenitalnih anomalija, od toga 76 s anomalijama CNS-a. Incidencija ovih anomalija je 1:544, a prevalencija 1,83/1000 živorođenih. Meningomijelokelu smo registrirali najčešće, u 55,26% novorođenčadi, mikrocefaliju u 26,62%, a hidrocefalus u 18,42% od ukupnog broja novorođenčadi s anomalijama CNS-a. Prosječna životna dob majki koje su rodile novorođenčad s anomalijama CNS-a iznosi 30,4±7,15 godina i ¬približna je životnoj dobi majki u kontrolnoj skupini. Antenatalna zaštita je nedovoljna, više od 20% majki koje su rodile novorođenčad s anomalijama CNS-a nema ni jednu kontrolu tijekom trudnoće, a optimalan broj pregleda u analiziranoj skupini ima samo njih 8%. Zaključak. Učestalost anomalija CNS-a, u ukupnom broju svih poroda i ukupnom broju poroda s anomalijama još uvijek je znatno veća u odnosu na razvijene zemlje Europe, što povezujemo s nedovoljnim brojem kontrola u trudnoći.CNS anomalies currently represent a big challenge in the perniatal medicine. Objective. To present the incidence of CNS anomalies in newborns at the Clinic for Gynaecology and Obstetrics in Tuzla in the period from 1. 1. 1996. to 31. 12. 2003. Methods. By retrospective study during the eight-year period, incidence of CNS anomalies has been ¬assessed, as well as the types of certain anomalies, quality of antenatal care and age of mothers who delivered newborns with CSN anomalies. The obtained results have been evaluated by using standard descriptive statistic methods. Results. During the observed period 647 newborns were delivered with congenital anomaly. The 76 of them had CNS anomalies, so that the incidence of anomalies is 1:544, and prevalence 1,83/1000. The distribution of CNS anomalies was: spina bifida 55,26%, microcephalus 26,62%, and hydrocephalus 18,42%. Average mothers’ age who delivered babies with CNS anomalies is 30,4±7,15 and is similar to the age of mothers in all investigated women. Antenatal care is insufficient: over 20% of mothers who delivered babies with CNS anomalies did not have a single medical control during ¬pregnancy, optimal number of controls in observed group was performed in only 8% of them. Conclusion. The incidence of CNS anomalies in the total number of all the deliveries and total number of newborns with anomalies is still much higher in comparison with the developed European countries, that may be related to insufficiently developed antenatal care

Doppler measurements of feto-placental blood stream in pregnant smokers

Introduction: Doppler analysis of the feto-placental and fetal circulation give dynamic information on the condition of the bloodstream during pregnancy, and early detection of fetal hypoxia. The objectives of the study were: testing whether there is influence of smoking on feto-placental circulation; determining whether there is a link to a number of smoked cigarettes during the day; assessing the benefits of Doppler ultrasonographic screening in detection of fetal hypoxia in pregnant women who smoke during pregnancy.Methods: 300 pregnancies were included in the prospective research. With regard to a number of smoked cigarettes the pregnant women were divided into three groups: I. the first group (moderate smokers) consisted of 100 pregnant women who smoked up to 15 cigarettes a day during pregnancy; II. the second group (heavy smokers) 100 pregnant women who smoked more than 15 cigarettes a day during pregnancy and III. the third group (control group) 100 pregnant women who did not smoke during pregnancy. All pregnant women underwent Doppler measurements of blood circulation (determination of resistance index – RI) in the umbilical artery, fetal aorta and middle cerebral artery.Results: The intensity of smoking has influence to circulation because RI in the umbilical artery and fetal aorta is increased and RI is decreased in the middle cerebral artery in pregnant women heavy smokers in comparison to pregnant women moderate smokers.Conclusion: Doppler sonography of the blood vessels could have an important role in detection of hypoxia and monitoring of the condition of the fetus of pregnant women who smoked during pregnancy