Shift Work, Quality of Life and Work Ability among Croatian Hospital Nurses

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007–2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses’ work ability and quality of life

WORK STRESS: RECOGNITION, PREVENTION AND SOLUTION

Budući da je stres na radnom mjestu postao jedan od vodećih problema u radnoj zajednici i da je rizik obolijevanja od kardiovaskularnih bolesti veći kod ljudi izloženih raznim stresorima, bitno je ukazati na mogućnosti njegovog prepoznavanja, rješavanja i prevencije. Stres na radnom mjestu je rezultat niza okolnosti koje uzrokuju pojavu štetnih fizioloških, psiholoških i bihevioralnih reakcija radnika, pri čemu njegove sposobnosti nisu u skladu s njegovim potrebama. Mjerama prepoznavanja stresa pripada i prepoznavanje štetnih učinaka kako na samog radnika, tako i na cijelu tvrtku. Štetni učinci su ponekad lako prepoznatljivi, a katkad je potrebno upotrebljavati posebne upitnike o stresnim uvjetima na radu kako bi se dobila cjelovita slika o zaposlenima. Potrebno je redovito organizirati zdravstvene preglede zaposlenih, ukazati im na mogućnost obraćanja stručnoj osobi, kao i osigurati interdisciplinarni pristup koji uključuje psihologe, doktore medicine rada i stručnjake za zaštitu na radu. Različiti su načini kojima se stres na radu može smanjiti, a uključuju primarnu, sekundarnu i tercijarnu prevenciju. U današnjem svijetu sve se više ističe važnost tercijarne prevencije čiji je jedan od ciljeva smanjiti razvoj daljnjih štetnih posljedica za pojedinca ili skupinu ljudi izloženih stresorima. Pojam prevencija uključuje dva pristupa: mijenjanje pojedinca s pomoću treninga za upravljanje stresom i smanjenje stresa promjenom organizacije posla. Faze programa za prevenciju stresa su sljedeće: faza pripreme, identificiranje problema, oblikovanje i primjena intervencija i evaluacija primijenjenih metoda intervencije. Rješavanje stresa na radnom mjestu je složen interdisciplinarni postupak kojim se u budućnosti smanjuju negativne posljedice za zajednicu i samog radnika.SUMMARY: Since the work stress has become a major problem in work organization and the risk of morbidity of cardiovascular diseases is greater among the ones exposed to variety of stressors, it is important to point out the methods for its recognition, solution and prevention. Work stress presents a series of circumstances that lead to harmful physiological, psychological and behavioural reactions in employees whose capacities do not match work demands. Assessing the risk at work includes identification of harmful effects both on employees and on the entire organization. Stress is not always easily detectable, and sometimes it is necessary to use special work stress related questionnaires in order to get a full view of the employees’ stress level. It is necessary to schedule regular check-ups, interview employees about their health and tell them whom to address about the problems, and to ensure interdisciplinary approach that includes psychologists, occupational medicine specialists and experts on protection at work. There are a number of methods by which the risk of work stress can be reduced. These include primary, secondary and tertiary prevention. Contemporary work stress management should cover tertiary prevention that includes reduction of further harmful effects on individual or on people who are exposed to stressors. The term prevention comprises two approaches: changing individuals through work stress related training, and reduction of work stress through changing work organization. Steps toward prevention include: preparation phase, identification of the problem, designing and implementing interventions and evaluation of the interventions. Solving work stress problems is a complex, interdisciplinary task which reduces future negative consequences on the organization and on the employee

Shift Work, Quality of Life and Work Ability among Croatian Hospital Nurses

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007–2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses’ work ability and quality of life

VALIDATION OF THE QUESTIONNAIRE ON WORKPLACE STRESSORS FOR HOSPITAL WORKERS

Rad prikazuje faktorsku strukturu i pouzdanost upitnika o stresorima na radnom mjestu bolničkih zdravstvenih djelatnika i time pridonosi daljnjoj validaciji i standardizaciji mjernog instrumenta stresa u zdravstvenih djelatnika, čime bi se direktno utjecalo na sigurnost pacijenata i zdravstvenih djelatnika u radnoj okolini bolnica. U istraživanje je uključeno 1.900 ispitanika između 18 i 65 godina starosti koji rade na radnom mjestu zdravstvenih djelatnika (medicinske sestre i tehničari srednje i više stručne spreme, te liječnici) u KB Dubrava, KBC Zagreb, KB Sestre milosrdnice, OB „Sveti Duh“ i koji su dobrovoljno pristali na istraživanje. Stopa odgovora bila je 78% te je na kraju dobiven uzorak od 1.481 ispitanika (1.086 medicinskih sestara/tehničara i 395 liječnika). U upitniku je pored osnovnih sociodemografskih pitanja ponuđeno 37 stresora na radu koji se odnose na organizaciju rada, smjenski rad, napredovanje u struci, edukaciju, profesionalne zahtjeve, međuljudsku komunikaciju, komunikaciju zdravstvenih djelatnika s pacijentima te na strah od opasnosti i štetnosti u zdravstvu. Ispitanici su svoj doživljaj ispravnosti odgovora ocijenili na Likertovoj ljestvici ocjenama od 1 = “nije uopće stresno” do 5 = “izrazito stresno”. Faktorska analiza je izlučila šest faktora relativno visoke pouzdanosti tipa unutarnje konzistencije (sve vrijednosti Crombach α su bile veće od 0,7): Organizacija radnog mjesta i financijska pitanja, Javna kritika, Opasnosti i štetnosti na poslu, Sukobi i komunikacija na poslu, Smjenski rad, Profesionalni i intelektualni zahtjevi. Pojedine čestice logično objašnjavaju strukturu odgovarajućih faktora te daju dobar oslonac daljnjoj izradi mjernog instrumenta stresa na radnom mjestu bolničkih zdravstvenih djelatnika. Ovim istraživanjem pridonijelo se daljnjem razvoju odgovarajućeg mjernog instrumenta, njegovoj praktičnoj primjeni, a time boljem prepoznavanju, rješavanju te prevenciji stresa i očuvanju sigurnosti u radnoj okolini bolnica u sklopu cjelokupnog očuvanja zdravlja na radnom mjestu zdravstvenih djelatnika.The paper presents factor structure and reliability of the workplace stressor questionnaire for hospital healthcare workers and hopes to further validate and standardise the stress measuring instrument for healthcare workers and thus directly affect the safety of patients and healthcare workers in hospital environments. The study was based on a sample of 1,900 participants aged between 18 and 65, employed in healthcare (nurses, lab technicians and physicians) in the hospitals Dubrava, Zagreb, Sestre milosrdnice and Sveti Duh. All participants voluntarily joined the study. Rate of response was 78%, from the actual sample of 1,481 participants (1,086 nurses and technicians and 395 physicians). In addition to general socio-demographic questions, the questionnaire included 37 workplace stressors referring to work organisation, shift work, opportunities for promotion, education, professional demands, interpersonal communication, communication between the healthcare workers and patients, and fear of dangers and potential harms in healthcare. The participants assessed their experience on the Likert scale (1-5) from 1 = \u27\u27no stress\u27\u27 to 5 = \u27\u27great stress\u27\u27. Factor analysis yielded six factors of relatively high reliability of inner consistency (all values of Crombach α exceeded 0.7): Workplace Organisation and Financial Issues, Public Criticism, Dangers and Harms at Workplace, Conflicts and Communication at Work, Shift Work, Professional and Intellectual Demands. Individual particles logically explain the structure of the corresponding factors and provide good foundation for further development of the stress measuring instrument at the workplace for hospital healthcare workers. The study contributes to the improvement of a suitable measuring instrument and its implementation in practice, and assists in better recognition and better solutions in the prevention of stress and preservation of safety in hospitals which should help to protect the health of healthcare workers

Ramipril and Risk of Hyperkalemia in Chronic Hemodialysis Patients

Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory

VITAMIN B12 DEFICIENCY IN CHILDREN – UNDERESTIMATED DANGER IN THE LIGHT OF NEW KNOWLEDGE

Vitamin B12 (kobalamin) ima dva aktivna oblika, adenozilkobalamin i metilkobalamin, koji imaju ključnu ulogu u dvama važnim metaboličkim putovima u ljudi i njihov je manjak odgovoran za kliničke teškoće u bolesnika. Kobalamin je nuždan tijekom cijelog života, no njegova dovoljna količina posebno je bitna u fetalno i dojenačko doba, kada je iznimno važan za normalan rast i razvoj djeteta, kao i za normalan razvoj središnjega živčanog sustava. Zbog vrlo složenog prometa i metabolizma njegov se manjak može očitovati pri raznim prirođenim i stečenim poremećajima. Klinička slika kojom se očituje manjak vitamina B12 obično je nespecifična, nosi velik rizik od trajnih posljedica za bolesnika, a najčešće se vrlo jednostavno liječi ako se na vrijeme prepozna. U Republici Hrvatskoj poremećaji metabolizma kobalamina u djece prerijetko se otkrivaju. Zato je cilj ovog rada skrenuti pozornost na nove spoznaje o metabolizmu kobalamina, prikazati bolesnike s tipičnim kliničkim tijekom i laboratorijskim nalazima te dati smjernice za brzo dijagnosticiranje i liječenje poremećaja vitamina B12 u djece.Vitamin B12 (cobalamin) has two active forms, adenosylcobalamin and methylcobalamin which have a key role in two important metabolic pathways in humans and their deficiency is responsible for clinical problems. Cobalamin is essential during whole life, but its sufficient amount is extra important in fetal and neonatal period, when it is essential for normal child growth and development as well as for normal development of the central nervous system. Because of very complex transport and metabolism, its deficiency can be manifested in numerous congenital and acquired disorders. Vitamin B12 deficiency mostly has non-specific clinical features, it carries a great risk of permanent consequences, but most frequently it is easily curable if diagnosed on time. In Croatia cobalamin deficiency in children has been diagnosed too rarely. Accordingly, the aim of this paper is to point to the recently gained knowledge on cobalamin metabolism, present typical case reports and to provide guidelines for rapid and proper diagnostic and therapeutic approach

Shift work, quality of life and work ability among Croatian hospital nurses [Smjenski rad, kvaliteta života i radna sposobnost kod medicinskih sestara u Hrvatskim bolnicama]

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007-2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses' work ability and quality of life

Smjenski rad, kvaliteta života i radna sposobnost kod medicinskih sestara u Hrvatskim bolnicama

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007-2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses' work ability and quality of life.U ovom radu prikazani su rezultati analize o povezanosti smjenskog rada sa radnom sposobnošću i kvalitetom života među kliničkim medicinskim sestrama. Presječno istraživanje provedeno je 2007–2008 godine na 1124 medicinske sestre pomoću Upitnika Indeksa radne sposobnosti i Upitnika o kvaliteti života (WHOQOL-BREF). Niže obrazovanje je prediktor za nisku radnu sposobnost i nisku domenu fizičkog zdravlja kvalitete života. Starija dobi i status bez partnera bile su statistički značajno povezani s nižom domenom socijalne interakcije. Prediktori koji su statistički značajno povezani sa niskom domenom okoliša kvalitete života su nizak stupanj obrazovanja i smjenski rad. Smjenski radnici imali su veću radnu sposobnost, ali klinički beznačajno. Studija ne daje dokaz o povezanosti između smjenskog rada i radne sposobnost ili kvalitete života. Obrazovanje ima pozitivan utjecaj nas radnu sposobnost i kvalitetu života medicinskih sestara

Smjenski rad, kvaliteta života i radna sposobnost kod medicinskih sestara u Hrvatskim bolnicama

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007-2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses' work ability and quality of life.U ovom radu prikazani su rezultati analize o povezanosti smjenskog rada sa radnom sposobnošću i kvalitetom života među kliničkim medicinskim sestrama. Presječno istraživanje provedeno je 2007–2008 godine na 1124 medicinske sestre pomoću Upitnika Indeksa radne sposobnosti i Upitnika o kvaliteti života (WHOQOL-BREF). Niže obrazovanje je prediktor za nisku radnu sposobnost i nisku domenu fizičkog zdravlja kvalitete života. Starija dobi i status bez partnera bile su statistički značajno povezani s nižom domenom socijalne interakcije. Prediktori koji su statistički značajno povezani sa niskom domenom okoliša kvalitete života su nizak stupanj obrazovanja i smjenski rad. Smjenski radnici imali su veću radnu sposobnost, ali klinički beznačajno. Studija ne daje dokaz o povezanosti između smjenskog rada i radne sposobnost ili kvalitete života. Obrazovanje ima pozitivan utjecaj nas radnu sposobnost i kvalitetu života medicinskih sestara

Vitamin B12 Deficiency in Children – Underestimated Danger in the Light of new Knowledge

Vitamin B12 (kobalamin) ima dva aktivna oblika, adenozilkobalamin i metilkobalamin, koji imaju ključnu ulogu u dvama važnim metaboličkim putovima u ljudi i njihov je manjak odgovoran za kliničke teškoće u bolesnika. Kobalamin je nuždan tijekom cijelog života, no njegova dovoljna količina posebno je bitna u fetalno i dojenačko doba, kada je iznimno važan za normalan rast i razvoj djeteta, kao i za normalan razvoj središnjega živčanog sustava. Zbog vrlo sločenog prometa i metabolizma njegov se manjak može ožitovati pri raznim priro|enim i stečenim poremećajima. Klinička slika kojom se očituje manjak vitamina B12 obično je nespecifična, nosi velik rizik od trajnih posljedica za bolesnika, a najčešće se vrlo jednostavno liječi ako se na vrijeme prepozna. U Republici Hrvatskoj poremećaji metabolizma kobalamina u djece prerijetko se otkrivaju. Zato je cilj ovog rada skrenuti pozornost na nove spoznaje o metabolizmu kobalamina, prikazati bolesnike s tipičnim kliničkim tijekom i laboratorijskim nalazima te dati smjernice za brzo dijagnosticiranje i liječenje poremećaja vitamina B12 u djece.Vitamin B12 (cobalamin) has two active forms, adenosylcobalamin and methylcobalamin which have a key role in two important metabolic pathways in humans and their deficiency is responsible for clinical problems. Cobalamin is essential during whole life, but its sufficient amount is extra important in fetal and neonatal period, when it is essential for normal child growth and development as well as for normal development of the central nervous system. Because of very complex transport and metabolism, its deficiency can be manifested in numerous congenital and acquired disorders. Vitamin B12 deficiency mostly has non-specific clinical features, it carries a great risk of permanent consequences, but most frequently it is easily curable if diagnosed on time. In Croatia cobalamin deficiency in children has been diagnosed too rarely. Accordingly, the aim of this paper is to point to the recently gained knowledge on cobalamin metabolism, present typical case reports and to provide guidelines for rapid and proper diagnostic and therapeutic approach