Chronicity and sensory-clinical phenotyping of musculoskeletal pain syndromes

The dissertation investigated the differentiation of subsyndromes in a spectrum from regional to widespread chronic musculoskeletal pain on the basis of mechanism-related somatosensory and clinical phenotypes within the framework of the multidimensional model of chronic pain. The first study analyzed the dimensional structure of the chronicity construct and its necessary and sufficient components. The second study identified discriminable pain-related phenotypes in two exemplary syndromes of chronic musculoskeletal pain by a stepwise cluster-analytic approach and related these to secondary comorbidity and psychosocial factors. In the first study, diagnostic entrance data of 185 patients with chronic regional vs. widespread musculoskeletal pain (unspecific back pain, fibromyalgia syndrome) from regional pain clinics and of 170 active employees in a nationwide prevention program were included in a retrospective cross-sectional analysis to reanalyze the construct of chronicity. The marker sets of three established chronicity indices (IASP Pain Taxonomy Axis IV, Chronic Pain Grade, Mainz Pain Staging System) were reanalyzed by correlations and frequency distributions of successive duration classes. Factor and latent class analyses were applied to assess the dimensional structure of pain and chronicity. Pain intensity distributions showed inhomogeneous courses from short to long durations differing between groups. Both dimensions, pain intensity and duration, related unsystematically to CPG and MPSS. Different dimensions and clusters of chronicity markers were discovered, that differed between the groups (three dimensions and clusters in patients, two dimensions and clusters in employees). In fact, there was evidence for at least three weakly coupled core domains of chronicity, i.e., the primary clinical pain characteristics, the direct consequences of current interference with activities and aspects of the patient history (duration and health care utilization). In the second study, the sensory and clinical characteristics of the patient sample were reanalyzed to identify necessary and sufficient markers differentiating subsyndromes with different sensory-clinical phenotypes along the continuum from regionally confined to extensively widespread pain. For this purpose, 107 chronic unspecific back pain patients and 78 patients with fibromyalgia syndrome were taken as exemplary instantiations with circumscribed diagnoses. Four clusters of differential sensory-clinical phenotypes covering a spectrum from regional to widespread pain were discovered on the basis of four pressure pain sensitivity markers (number of sensitive ACR tender and control points, test pain intensity and pressure pain threshold) and two clinical pain markers (number of pain regions, present pain intensity). A consecutive discriminant analysis showed that the pressure sensitivity markers alone sufficed already to discriminate between the clusters with a high correct rate. The sensory-clinical phenotypes differed also in other somatic symptoms and impairment but not in psychopathology nor in psychosocial co-factors. The project showed that differential diagnostics of chronic musculoskeletal pain requires at least a multifactorial determination of its chronicity with respect to the necessary components of duration, severity and impairment and the identification of the individual pain phenotype by comprehensive sensory and clinical assessment. This is considered as the prerequisite of differential indication of specific modules in multimodal pain therapy to avoid unselective polypragmasia

Dentoalveloar Compensatory Mechanism in Skeletal Open Bite

Svrha istraživanja bila je utvrditi morfološke značajke u ispitanika sa skeletnim otvorenim zagrizom, odnosno povećanim mandibularnim kutom povezanost dubine prijeklopa s vrijednostima veličine kuta mandibularne baze, kuta maksilarne baze i međučeljusnoga kuta povezanost dubine prijeklopa s vrijednostima prednje i stražnje visine lica, te dentoalveolarne kompenzatorne mehanizme kod okomitoga tipa rasta. Uzorak se sastojao od 77 laterolateralnih rentgenkefalograma ispitanika sa skeletnim otvorenim zagrizom, obaju spolova, dobi od 13 do 18 godina. Utvrđeno je da 49,4% ispitanika ima otvoreni zagriz a 50,6% ispitanika je kompenzirano, tj. da 41,5% ima normalni prijeklop, a 9,1% duboki zagriz. Ne postoji povezanost dubine prijeklopa s vrijednostima veličine kutova koje čine maksilarna i kranijalna baza, mandibularna i kranijalna baza, te međučeljusnoga kuta. Prednja donja visina (spa-gn) i ukupna prednja visina lica (n-gn) statistički su znatno manje u skupini ispitanika s dubokim prijeklopom. U skupini ispitanika s dubokim zagrizom prona|eno je statistički znatno smanjena udaljenost vrha kvržice gornjega prvog molara i apeksa od baze maksile.The object of the study was to determine morphologic characteristics in subjects with skeletal open bite and increased mandibular angle; correlation between the depth of the over bite and values of the size of the angle of the mandibular base, maxillary base and intermaxillary angle; correlation between the depth of the over bite with values of anterior and posterior facial height and dentoalveolar compensatory mechanism in vertical type growth. The sample consisted of 77 laterolateral cephalograms of subjects with skeletal open bite of both genders, aged from 13 to 18 years. It was determined that 49.4% of the subjects had open bite, while 50.6% of the subjects were compensated, i.e. 41.5% had normal over bite and 9.1% deep bite

POTENTIAL OF CONGRESS TOURISM IN THE REPUBLIC OF CROATIA IN COMPARISON TO NEIGHBORING DESTINATIONS

The phenomenon of globalization has led to the development of various selective forms of tourism. One of them is MICE tourism known in Croatia as a business form of tourism. Business tourism is still a relatively new concept and covers all aspects of business travel. The development of business travel has led to the development of congress tourism as a separate form of business tourism which is the focus of this paper. Congress tourism is a lucrative segment of the tourist offer that often takes place out of the tourist season. It requires quality congress facilities which can meet the needs of the participants and organizers of the congress. The main role of congress tourism is to gather participants from different countries and promote different products, services, training, education and many other fields of business while at the same time it promotes the hosting destination and its tourism attractions. The aim of this paper is to research and determine the current situation, supply and demand of the Croatian meetings and congress industry in comparison with the neighbouring destinations, the Republic of Slovenia and the Republic of Serbia. The study and comparison between three destinations imply changes that need to take place to improve the congress offer, to detect what the competitive position of the Republic of Croatia is, which marketing activities to improve so that the Republic of Croatia can become a competitive destination in the region and Europe. Congress tourism as a form of business tourism in Croatia is growing. The most prominent cities in this form of tourism are Zagreb, Dubrovnik and Opatija. The objectives pursued in Croatian congress offer are: the number of participants in congresses, strengthening the quality of congress offer and infrastructure, ensuring coordinated actions of stakeholders and increasing the recognition and awareness of Croatia as a congress destination. Since joining the EU, Slovenia has become an interesting destination for other members of the EU. Congress activity in Slovenia is booming, with a growing number of modern equipped convention venues with modern facilities for implementation of convention events. Slovenia has three major congress destinations; Ljubljana, Portorož and Bled that meet the conditions fororganizing congresses. The Republic of Serbia with its tourism development strategy, presented business tourism as a potential selective form of tourism that can contribute to increasing tourist traffic of local and foreign tourists. Congress destinations that represent an ideal destination for congresses are: Belgrade, Novi Sad and Zlatibor. The application of sustainable development in the area of congress tourism plays an important role in form of preservation of resources and environmental protection. Therefore, congress tourism should be managed in a way to meet economic, social, ecological and aesthetic needs of a destination. Methodology used in this research paper consists of desk research, descriptive method, historical method, method of analysis, synthesis and comparative method. Beside secondary data analysis through literature review data are induced from Central Bureau of Statistics, the Institute for Tourism, Zagreb Tourist Board, Tourist Board of Opatija, The Dubrovnik Tourist Board, Serbian Convention Bureau and Research as well as from available published articles, books and internet data related to Slovenian business tourism. This research paper contributes to further scientific research and improvements needed in order to continuously develop and increase the size and quality of business tourism

CHALLENGES OF ONLINE TEACHING DURING THE COVID-19 PANDEMIC

The teaching profession has always been complex and dynamic, but now the challenges are posed to a society as a whole by the COVID-19 pandemic. The purpose of the research was to determine teachers' perceptions of the challenges of conducting online teaching during the COVID-19 pandemic. 413 teachers from Croatia participated in the research. Respondents were distributed according to the level of education at which they work in three groups (primary school teachers - grades 1st to 4th, subject teachers – grades 5th to 8th of primary school, subject teachers - secondary school). According to the results of the research, teachers estimated that difficulties in online teaching generally occur occasionally. There were statistically significant differences in some of the items in the perception of the challenges in online teaching among teachers depending on the level of education at which they work. Still, in general, teachers at all three levels of education experienced approximately the same amount of challenges. More challenges in online teaching have been related to a higher level of burnout and correlated positively with higher numbers of students to teach. Age has been unrelated to challenges in online teaching. Since difficulties in conducting online teaching hinder the educational process, this research could serve as an indicator of problems and an initial step to solving them.

GENERAL PRACTICE MEETING THE NEEDS FOR PSYCHIATRIC CARE IN CROATIA

Background: In recent decades, general practitioners (GPs) have become critical components of mental health services. However, in Croatia the role of GPs in mental health services is still mostly perceived as “gate keeping”, whereas seeking help for serious mental illnesses is mostly restricted to psychiatrists. The aim of this study is to investigate the practices and attitudes of family doctors in providing care for psychiatric patients. Subjects and methods: The study included 111 GPs, working in 38 different locations in four major towns in Croatia. Data were collected using a questionnaire, specifically designed for the purpose of this study. Results: By their own estimation, GPs prescribed antidepressants without a psychiatrist’s recommendation in about 37% of patients who use them. Also, GPs prescribed sedatives without a psychiatrist’s recommendation in about 60% of patients who use them. Although certain categories of psychiatric patients (elderly, patients with PTSD) were almost always referred to a psychiatrist, it was GPs\u27 attitudes toward psychiatric casualties and their proneness to prescribe antidepressants and sedatives without a psychiatrist’s recommendation that predicted whether a patient will be treated by himself of referred to a psychiatrist. "Interest/Competency" and "Knowledge" of the GPs positively correlated with the number of courses attended as a part of continuous medical education (CME). Conclusion: Overall, the role of GPs in mental health services in Croatia is changing into a more active one, as a significant portion of patients with depression and anxiety are being treated by GPs. Personal interest and self confidence in proper knowledge and skills, in part acquired also from current CME programs, are determinants of higher autonomy of GPs in treating psychiatric patients. Psychiatrists, as active promoters of community mental health should more actively encourage their alliance with GPs, especially through offering higher quality CME courses

Heritage value attribution

This work aims at retrieving the historical trajectory of Sítio Alagadiço Novo – Fortaleza, Ceará – birthplace of the romantic writer, José de Alencar. Having never before been considered under the yoke of a scientific investigation, Sítio Alagadiço is currently suffering from the lack of attention and use by the surrounding community. By assuming that the relation between cultural heritage and community is a matter of value attribution, it is essential to understand the paths which led to this conflicting situation. Therefore, we seek to retrieve the property’s history since the arrival of the Alencar family up to the time it was heritage-listed by the National Historic and Artistic Heritage Institute (IPHAN). Some of the questions raised throughout the process include: is the importance of the place due to the figure of José de Alencar and his literary heritage? What are the values assigned to it? Has the idea of upgrading the property as a historical asset come from the community? These questions guide the content of this paper. We intend to pursue the valuation process within its historical context and therefore reflect upon the inconsistency perceived between such valuation and the treatment currently given to the property

Is the chemotherapy era in advanced non-small cell lung cancer really over? Maybe not yet

Lung cancer is one of the most frequently diagnosed tumors in both the male and female population. In Italy it is the leading cause of cancer deaths in men and the third in women. Although the 5-year survival rate has moderately increased in the last years, the diagnosis remains associated with a very poor prognosis. However, in the last decade significant progress has been made, also in the treatment of advanced-stage non-small cell lung cancer. The advent of targeted therapies and the recent explosion of immunotherapy seem to have limited the role of chemotherapy. But is this completely true? The aim of this editorial is to discuss some of the most controversial aspects of the therapeutic scenario in non-small cell lung cancer, with particular attention to the role that chemotherapy still play

Dual effect of Thymosin α 1 on human monocyte-derived dendritic cellin vitrostimulated with viral and bacterial toll-like receptor agonists

OBJECTIVES: Thymosin α 1 (Tα1) recently gained interest as immune adjuvant for vaccines because of its ability to modulate the T-cell/dendritic cell (DC) axis and to improve antibody production. The objective of this study was to determine whether Tα1 would address in vitro the response of human primary monocyte-derived DC, crucial regulators of vaccine-induced immunity, upon exposure to different toll-like receptor (TLR) agonists or infection with viruses or bacteria. METHODS: DC maturation and production of pro-inflammatory cytokines were analyzed. RESULTS: Our data revealed a dual effect of Tα1 on DC biology upon viral or bacterial stimulation. Interestingly, Tα1 enhanced human leukocyte antigen (HLA)-I and II surface expression and secretion of IL-6, TNF-α and IL-8 when DCs were treated with viral TLR3 and TLR7/8 agonists. Similarly, in pandemic H1N1 influenza A-infected DCs, Tα1 raised the expression of maturation markers and type I and III Interferon (IFN). In contrast, following bacterial TLR2 and 4 stimulation, as well as upon Bacillus Calmette-Guerin infection, the presence of Tα1 in DC cultures drastically lowered the analyzed cellular parameters. CONCLUSION: The knowledge that Tα1 pleiotropic effect might ameliorate anti-viral immune responses and, at the same time, dampen inflammation caused by bacterial infections could lay the groundwork for a more appropriate therapeutic application of this molecule

Enabling technologies and green processes in cyclodextrin chemistry

The design of efficient synthetic green strategies for the selective modification of cyclodextrins (CDs) is still a challenging task. Outstanding results have been achieved in recent years by means of so-called enabling technologies, such as microwaves, ultrasound and ball mills, that have become irreplaceable tools in the synthesis of CD derivatives. Several examples of sonochemical selective modification of native α-, β- and γ-CDs have been reported including heterogeneous phase Pd- and Cu-catalysed hydrogenations and couplings. Microwave irradiation has emerged as the technique of choice for the production of highly substituted CD derivatives, CD grafted materials and polymers. Mechanochemical methods have successfully furnished greener, solvent-free syntheses and efficient complexation, while flow microreactors may well improve the repeatability and optimization of critical synthetic protocols