Caries risk assesment

Karijes je kronična bolest koja zahvaća 60-90 % djece i većinu odrasle populacije. Etiologija karijesa je višečimbenična, a čimbenici koju uzrokuju karijes su dentobakterijski plak, prehrana bogata rafiniranim ugljikohidratima, smanjena salivacija, nedostatni puferski kapaciteti sline, nedostatna oralna higijena, genski čimbenici i socioekonomski čimbenici. Kako bi prevenirali nastanak karijesa, važno je kod svakog pacijenta odrediti čimbenike rizika. Čimbenike rizika određujemo pomoću anamneze, koja uključuje pćemedicinsku i stomatološku anamnezu, kliničkog pregleda i kliničkih testova pomoću kojih određujemo količinu plaka, broj i vrstu bakterija, protok sline i puferske kapacitete sline. Na temelju pronađenih čimbenika rizika, svakog pacijenta određujemo kao nisko, srednje ili visoko rizičnog pacijenta. Neki od alata koji nam pomažu u određivanju karijes rizika su Cariogram i CAMBRA model. Ovisno o skupini rizika u koju spada, određuje se odgovarajuća terapija za svakog pacijenta individualno.Dental caries is a chronic disease that affects 60-90 % of children and majority of adult world population. Caries has a multifactorial etiology and factors that cause caries are dentobacterial plaque, food rich in refined carbohydrates, decreased saliva flow rate, insufficient saliva buffer capacities, sufficient oral hygiene, gene factors and socioeconomic factors. To achieve caries prevention, it is very important to assess those risk factors for every patient. To assess risk factors we need to take medical history, both general and dental, make clinical examine and clinical tests to evaluate oral hygiene, quantity and quality of bacteria, saliva flow rate and buffer capacities. Based on assessed risk factors, patients can be sorted into low, medium or high risk groups. Some of the tools used in risk assessment are Cariogram and CAMBRA model. Depending on which group the patient belongs to, the right therapy can be chosen for every patient individualy

Persons with latent autoimmune diabetes in adults express higher dipeptidyl peptidase-4 activity compared to persons with type 2 and type 1 diabetes

AIMS: We aimed to determine serum dipeptidyl peptidase-4 (DPP-4) activity in a group of persons with latent autoimmune diabetes in adults (LADA) and to compare it with persons with type 1, type 2 diabetes and healthy controls. ----- METHODS: DPP-4 activity measurement was performed in 67 persons (21 with type 1, 26 type 2 and 19 with LADA) and 13 healthy age and gender matched controls. ----- RESULTS: Persons with LADA showed highest DPP-4 activity among the study groups (32.71±3.55 vs 25.37±2.84 vs 18.57±2.54 vs 18.57±2.61U/L p<0.001). Mean glutamic acid autoantibody in persons with LADA was 164.32±86.28IU/mL. It correlated with DPP-4 activity (r=0.484, p=0.013). Furthermore, DPP-4 activity correlated with waist circumference (r=0.279, p=0.034) and glycated haemoglobin A1c (r=0.483, p<0.001), as well as with LDL cholesterol (r=0.854, p<0.001) and total daily insulin dose (r=0.397, p=0.001). In the multinomial regression analysis DPP-4 activity remained associated with both LADA (prevalence ratio 1.058 (1.012-1.287), p=0.001) and type 1 diabetes (prevalence ratio 1.506 (1.335-1.765), p<0.001) while it did not show an association with type 2 diabetes (prevalence ratio 0.942 (0.713-1.988), p=0.564). ----- CONCLUSIONS: Persons with LADA express higher DPP-4 activity compared to persons with both type 1 and type 2 diabetes. The possible pathophysiological role of DPP-4 in the LADA pathogenesis needs to be further evaluated

Dipeptidyl peptidase-4 activity might be a link between tumour necrosis factor alpha and insulin resistance in type 1 diabetes

Tumour necrosis factor alpha (TNF α) leads to β cell damage in type 1 diabetes (T1DM) but also causes insulin resistance (IR). It modulates dipeptidyl peptidase-4 (DPP-4) activity, adipokine linked with both IR and T1DM. We were interested if there is an association of TNF α in conjunction with DPP-4 and IR in T1DM. DPP-4 activity, TNF α concentration measurements, and insulin sensitivity calculation using estimated glucose disposal rate (eGDR) equation were performed in 70 T1DM patients. They were divided into two groups according to eGDR median. The group with higher IR had higher value of DPP-4 activity (27.57 ± 1.77 vs. 18.33 ± 1.14, p < 0.001) and TNF α concentration (12.91 ± 0.83 vs. 6.72 ± 0.36, p < 0.001). TNF α concentration and DPP-4 activity negatively correlated with eGDR (r = -0.616, p < 0.001 and r = -0.643, p < 0.001) while correlating positively with each other (r = 0.422; p = 0.001). The linear regression showed that eGDR decreases for 0.166 mg kg(-1) min(-1) by TNF α concentration increase of 1 pg/mL (p < 0.001) and for 0.090 mg kg(-1) min(-1) by DPP-4 activity increase of 1 U/L (p = 0.001) when adjusted for age, gender disease duration, glycated haemoglobin, body mass index and waist-to-hip ratio. eGDR decreased by additional 0.60 mg kg(-1) min(-1) (B = -0.150, p < 0.001) when DPP-4 activity was additionally adjusted for TNF α. TNF α concentration is associated with IR, correlates with its severity and increases the drop in insulin sensitivity modulated by DPP-4 activity. Whether TNF α involvement in the insulin signalling pathway is mediated by DPP-4 activity needs to be further evaluated

CLOTHING BUYING MOTIVES AND STORE SELECTION CRITERIA – THE CASE OF CROATIAN ADOLESCENTS

The aim of this paper is to analyse Croatian adolescents’ clothing buying motives and their retail store selection criteria. The paper examined their preferences, attitudes and behaviours when buying clothes - whether adolescents with different primary clothing motives would have similar or different store selection criteria. Also, the paper determined how today’s adolescents spend money on clothes and whether they are more inclined to purchase branded clothes or not. Finally, the paper explained whether Croatian adolescents prefer purchasing in small or large specialized apparel stores, or whether they are more prone to online purchasing or even buying clothes in second-hand shops. Also, the society influences in forming adolescents’ attitudes and decisions towards store selection and purchasing preferences of clothes were examined. The research findings showed that shopping centres are the preferred retail format. In addition, adolescents do not have a fully developed attitude on fashion and clothing. Therefore, they strongly refer to opinions of family and friends when choosing clothes. Moreover, the Internet and TV are evaluated as influential channels of consumer communication within this particular group of consumers. Based on the findings, suggestions for service management and marketing strategies are provided for apparel retail companies that target adolescents

Radioactivity Measurements of Ceramic Tiles Produced in Serbia

This paper presents the results of gamma spectrometry measurements of natural radionuclides ( 226Ra, 232Th, and 40K) in some floor and wall ceramic tiles produced in Serbia and used in homes and workplaces. The level of radioactivity of some ceramic tiles produced in Serbia by two major manufacturers–Zorka Keramika and Toza Markovic was examined. The measured mean value of the activity concentration of 226Ra, 232Th, and 40K exceeds the average values in the world for building materials with values of 67.2±6.9 Bq kg-1 for 226Ra, 57.4±4.7 Bq kg-1 for 232Th and 808±48 Bq kg-1 for 40K. Based on these calculated values, the representative level index gamma index, associated with gamma radiation, whose average value is 0.78±0.06, and annual effective dose, whose average value is 0.117±0.009 mSv y-1 for home was obtained. Estimated values fulfill all the recommendations of the European Union for building materials, thus analyzed materials are considered not to be a health hazard for the public.BPU11 : 11th International Conference of the Balkan Physical Union : Proceedings book; Aug 11 - Sep 1, 2022S01-NPNE Nuclear Physics and Nuclear Energ

INTEGRIRANA SKRB U MOSTARU: PRIORITET ZA ZDRAVSTVENI SUSTAV

Introduction: Integrated care could be defi ned differently and that is why the following terms can be found in the literature: integrated health, coordinated care, comprehensive care, seamless care, or trans-mural care. It has become a worldwide trend in health care reforms and new organizational arrangements focusing on more coordination between professionals and institutions and integrated forms of care or service provision. The Agency for Quality and Accreditation in Health Care in the Federation of Bosnia and Herzegovina (AKAZ) is using accreditation standards as a tool for quality improvement process aiming to increase the capacity of health care institutions in the Federation of Bosnia and Herzegovina in order to provide safe and quality care for the citizens. In the Agency, it is fi rmly believed that a wisely set and well-organized integrated care can help health professionals deliver health care in accordance with patient needs and even expectations. Aim: The aim of the study was to fi nd out how to implement measures for integration of health care, to fi nd out whether there are any gaps in the health care system, and how to bridge to the application of the best solutions of integrated care in the city of Mostar and Herzegovina-Neretva Canton (HNC). Methods: In this paper, we used feedback and results from the workshop held at the Federal Public Health Institute in Mostar as part of lectures for participants of the course within the Integrated Health Care module held in June 2019. The Integrated Health Care module is part of the Continuous Professional Education for Health Managers in the Federation of Bosnia and Herzegovina. Participants were experienced experts in different fi elds of medicine and pharmacists divided into two groups. Results: Participants identifi ed the most common problems for both primary and hospital physicians, such as unclear referral system to specialist examination, inappropriate patient expectations from primary care, lack of communication between primary care and hospital care, and inadequate use of clinical practice guidelines. To solve these problems, both groups stressed the importance of common strategy documents and guidelines, which should provide clear framework for cooperation and integration including levels of competence and service prices. Furthermore, effi cient information system is crucial for the integration or digitalization of, in strategy documents, agreed mechanisms of coordination and integration. Third, the growing proportion of elderly population should be taken in consideration, including the need of hospice and development of geriatric medicine in the Canton. Participants discussed and compared the results with feedback and results from three workshops held several years before. Discussion: The results of our study stressed the importance of better communication among different sectors, institutions and levels of health care involved in the treatment of patients, pointed to some measures for integration including standardized models of communication, training and education and highlighted priorities for integration. Analysis indicated the necessity for the following: regular analysis of unnecessary or inappropriate referrals and evaluation of such practices, as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities regarding screening programs and patient path analysis. Conclusions: Strong commitment of health care authorities and vision of integrated care and collaborative networks, as well as good communication and leadership were highlighted as key integrated care facilitators. Health care institutions at all levels of care have to organize multidisciplinary teams to work more on better and effective communication and to exchange information among key stakeholders in the system.Uvod: Integrirana skrb može se različito defi nirati i to je razlog zbog kojeg se u literaturi mogu naći sljedeći pojmovi: integrirano zdravlje, koordinirana njega, sveobuhvatna njega, besprijekorna njega ili transmuralna njega. Postala je svjetski trend u reformama zdravstva i novim organizacijskim aranžmanima koji su usredotočeni na veću koordinaciju između stručnjaka, institucija i pružatelja usluga. Agencija za kvalitet i akreditaciju u zdravstvu u Federaciji Bosne i Hercegovine koristi akreditacijske standarde kao alat za poboljšanje kvalitete s ciljem povećanja kapaciteta zdravstvenih ustanova u Federaciji Bosne i Hercegovine za pružanje sigurne i kvalitetne skrbi za građane. U Agenciji čvrsto vjeruju da mudro postavljena i dobro organizirana integrirana skrb može pomoći zdravstvenim radnicima da pruže zdravstvenu skrb u skladu s potrebama, pa čak i očekivanjima pacijenta. Cilj: Otkriti i analizirati kako se provode mjere za integraciju zdravstvene zaštite, postoje li nedostatci u zdravstvenom sustavu i kako ih premostiti za primjenu najboljih rješenja integrirane skrbi u gradu Mostaru i Hercegovačko-neretvanskoj županiji. Metode: U ovom smo radu koristili povratne informacije i rezultate radionice Federalnog zavoda za javno zdravstvo u Mostaru u sklopu predavanja za polaznike tečaja u okviru modula Integrirana zdravstvena zaštita održanog u lipnju 2019. Integrirani modul zdravstvene zaštite je dio kontinuiranog stručnog usavršavanja za zdravstvene menadžere u Federaciji Bosne i Hercegovine. Sudionici radionice bili su iskusni liječnici specijalisti različitih specijalnosti i farmaceuti podijeljeni u dvije skupine. Rezultati: Sudionici su odredili najčešće poteškoće za uspostavljanje integrirane zdravstvene zaštite kako za primarne, tako i za bolničke liječnike, a to su: nejasan sustav upućivanja na specijalistički pregled, neprimjereno očekivanje pacijenta od liječnika primarne zdravstvene zaštite, nedostatak komunikacijskog kanala između primarne i tercijarne bolničke skrbi i nedosljedna uporaba smjernica za kliničku praksu. Za rješavanje ovih problema obje skupine ističu važnost zajedničkih strateških dokumenata i smjernica koje bi trebale dati jasan okvir za suradnju i integraciju uključujući razinu stručnosti i cijene usluga. Nadalje, učinkovit informacijski sustav ključan je za integraciju ili digitalizaciju, u strateškim dokumentima, dogovorenih mehanizama koordinacije i integracije. Treće, potrebno je uzeti u obzir starenje populacije, nužne potrebe za hospicijima i razvoj gerijatrijske medicine u Županiji. Sudionici su raspravljali i uspoređivali svoje rezultate s povratnim informacijama i rezultatima ostalih triju istovjetnih radionica održanih ranijih godina. Rasprava: Rezultati naše studije istaknuli su važnost bolje komunikacije između različitih sektora, institucija i razina zdravstvene zaštite uključenih u liječenje pacijenata te istaknuli određene mjere integracije uključujući standardizirane modele komunikacije, obuke i obrazovanja te istaknute prioritete integracije. Analiza je ukazala na potrebu za sljedećim: redovitim analizama nepotrebnih ili neprikladnih uputnica i procjenom takve prakse, kao i podvostručenja testova i recepata (propust u kontroli troškova); zajedničko planiranje preventivnih tretmana i jasne odgovornosti u vezi s programima probira i analizom puta pacijenta. Zaključci: Snažna predanost zdravstvenih vlasti, vizija integrirane skrbi i suradničke mreže, kao i dobra komunikacija i vodstvo istaknuti su kao ključni pokretači integrirane skrbi. Zdravstvene ustanove sa svih razina skrbi moraju organizirati multidisciplinske timove koji će raditi na boljoj i učinkovitijoj komunikaciji i razmjeni informacija između ključnih dionika u sustavu

PEER EDUCATION AS AN INNOVATIVE APPROACH IN IMPROVEMENT OF YOUTH MENTAL HEALTH CARE

Uvod: Vršnjačka edukacija postaje sve važnija u praksi kao snažan alat za promociju zdravlja. Promocijom mentalnog zdravlja adolescentima se pomaže u izgradnji otpornosti kako bi se mogli dobro snalaziti u teškim situacijama i nepovoljnim okolnostima u životu. Kako bi preuzeli aktivniju ulogu u poboljšanju zaštite mentalnog zdravlja među mladima, Međunarodna udruga studenata medicine Hrvatska u suradnji s Gradskim uredom za zdravstvo Grada Zagreba i Domom zdravlja Zagreb-Zapad pokrenuli su projekt o mentalnom zdravlju mladih. Projekt je baziran na vršnjačkoj edukaciji na način da prethodno educirani studenti medicine provode radionice u srednjim školama s ciljem promocije mentalnog zdravlja i rane prevencije. Cilj ove studije je procijeniti učinkovitost vršnjačke edukacije kao dobrog modela za promociju mentalnog zdravlja među mladima. Metode: Provedeno je 7 radionica u 17 razreda, s ukupnim obuhvatom od 390 srednjoškolaca. Svaka radionica je evaluirana s Evaluacijskim obrascem propitujući mišljenje srednjoškolaca o korisnosti, zadovoljstvu, sadržaju, itd. Srednjoškolci su također ispunjavali Skalu svijesti o sebi (Fenigstein, Scheier, Buss, 1975) i Privatnu skalu svijesti o sebi (Huić, 2009) prije i nakon provođenja projekta kako bi objektivno procijenili učinak provedenih radionica na svijest o sebi. Rezultati: Preliminarni rezultati su pokazali statistički značajnu promjenu u svim aspektima skale Svijesti o sebi na kraju projektu u usporedbi s upitnicima prije početka projekta. Najveći napredak se vidi na varijabli privatne svijesti o sebi (t = -3,474; p<.01), ali također se vidi napredak na varijablama koji procjenjuju svijest o svojim emocijama (t= -3,320; p<.01), svijest o svojoj kogniciji (t= -2,336; p<.05) i svijesti o svojem tijelu (t= -2,580; p<.01). Izvješća srednjoškolaca su pokazala i subjektivni napredak na njihovom mentalnom zdravlju i veliko zadovoljstvo projektom. Zaključak: Vršnjačka edukacija bi se češće trebala uzeti u obzir kao snažan alat za aktivniji rad na poboljšanju mentalnog zdravlja među mladima, u suradnji sa službama za zaštitu mentalnog zdravlja te aktivnim angažmanom učitelja i roditelja.Introduction: Peer education is growing in popularity and practice as a powerful tool for health promotion. Promotion of mental health helps adolescents in building resilience so that they can cope well in difficult situations or adversities. In order to take a more active role in improvement of youth mental health care Croatian Medical Students\u27 Association in collaboration with City Office for Health in Zagreb and Regional Health Center Zagreb - West started a project on mental health promotion. Project is based on peer education, with previously educated medical students conducting workshops in high schools, in order to emphasize the importance of early prevention and mental health promotion. The aim of this study was to evaluate whether peer education is a good framework for mental health promotion among youth, with physicians actively involved as educators and supervisors. Methods: There were 7 workshops conducted in 17 classes, with 390 high school students participating. Every workshop was evaluated with Evaluation form, questioning students\u27 opinion on usefulness, satisfaction, content etc. High school students were also given Self-Consciousness Scale (Fenigstein, Scheier, Buss, 1975) and Private Self-Consciousness Scale (Huić, 2009) before and after the project to objectively evaluate benefits on their self-consciousness. Results: Preliminary results showed a statistically relevant change in all aspects of the Self-Consciousness Scale in the post, compared to prequestionnaires. The biggest improvement is seen in the private self-consciousness part (t = -3,474; p<.01), but there were also improvements in the parts evaluating emotions (t= -3,320; p<.01), cognition (t= -2,336; p<.05), and body image (t= -2,580; p<.01). Students reported subjective improvement of their mental health and high satisfaction with project. Conclusion: Peer education should be considered as a powerful framework for active involvement in improvement of youth mental health care, in collaboration with mental health services and efforts from teachers and parents