Uvod u verifikaciju instrumenta GOHAI za merenje oralnozdravstvenog kvaliteta života osoba sa zubnim nadoknadama primenom preliminarne srpske verzije - pilot studija

Background/Aim. Quality of life related to health should be seen as a multidimensional concept that, in addition to the physical symptoms associated with a disease and treatment, should include physical, psychological and social functioning of a person. The primary objective of this study was to use the Serbian preliminary version of the Geriatric Oral Health Assessment Index (GOHAI) questionnaire in order to examine the consistency, reliability and stability, as well as an introduction to the verification tool. Methods. The GOHAI questionnaire with 6-level Likert scale, translated into Serbian, including the relevant oral health characteristics (oral hygiene, required dentures, number of teeth extracted), was filled by five specialists in prosthodontics for 30 randomly selected respondents, before and after the dental prosthetic treatment. Subsequently, in order to measure the reliability of the questionnaire, 27 patients were reinterviewed. Results. The value of Cronbach's Alpha Coefficient (Crα) before the treatment was 0.878, and after the treatment it was 0.788 confirming the internal consistency and stability of the questionnaire. The validity of discriminatory properties of the GOHAI was confirmed by the Spearman's correlation coefficient (r), which was highly significantly associated with oral health characteristics, confirming the high reliability of the measurement. The results of test-retest analysis measured by the individual Pearson's correlation coefficient (r) were in the range of 0.34-0.97, and for the total score r was 0.927, while the Kappa coefficient was 0.63. The correlation analysis of the GOHAI score before the treatment showed that for 10 questions there was a statistically significant correlation of the score with the answers to the questions, and for 6 questions Spearman's r was ≥ 0.7. After the treatment a highly significant correlation of the GOHAI was shown with the answers to 10 questions, while for 5 questions the Spearman's r was > 0.6. The GOHAI average score before the treatment was 19.44 ± 11.12, and after the treatment 2.77 ± 3.83, where the lower value indicates better quality of life. Conclusion. The results of this pilot study confirm internal consistency and stability of the Serbian preliminary version of the GOHAI questionnaire and the causal relation between the quality of life and the characteristics of oral health of the patients with dentures. Accordingly, instrument verification is recommended.Uvod/Cilj. Kvalitet života u vezi sa zdravljem treba posmatrati kao multidimenzioni koncept koji, pored fizičkih simptoma vezanih za bolest i lečenje, treba da obuhvati i fizičko, psihičko i društveno funkcionisanje osobe. Primarni cilj studije bio je da se korišćenjem preliminarne srpske verzije upitnika Geriatric Oral Health Assessment Index (GOHAI) ispita konzistentnost, pouzdanost i stabilnost, kao uvod u verifikaciju instrumenta. Metode. GOHAI upitnik sa 6- stepenom Likertovom skalom, preveden na srpski jezik, koji je uključivao i oralnozdravstvene karakteristike (oralna higijena, potrebne zubne nadoknade, broj izvađenih zuba), popunjavan je od strane petoro specijalista stomatološke protetike za 30 slučajno izabranih ispitanika, pre i posle stomatoprotetskog lečenja. Naknadno, radi merenja pouzdanosti upitnika, ponovo je intervjuisano 27 ispitanika. Rezultati. Vrednost Cronbach's Alpha Coefficient (Crα pre lečenja bila je 0,878, a posle lečenja 0,788, čime su potvrđene interna konzistentnost i stabilnost upitnika. Valjanost diskriminatornog svojstva GOHAI potvrđena je vrednostima Spearmanovog koeficijenta korelacije (r), koji je značajan kada su u pitanju oralnozdravstvene karakteristike, čime je potvrđena valjanost merenja. Rezultati test-retest analize merene pojedinačnim Pearsonovim koeficijentom korelacije (r) bili su u rasponu 0,34-0,97, a za ukupan skor r je bio 0,927, dok je Kappa koeficijent bio 0,63. Korelaciona analiza GOHAI pre lečenja ukazala je da je za 10 pitanja postojala značajna povezanost skora sa odgovorima na pitanja, a za 6 Spearmanov r bio je ≥ 0,7. Posle lečenja utvrđena je značajna veza GOHAI sa odgovorima na 10 pitanja, a za 5 Spearmanov r bio je > 0.6. Prosek GOHAI skora pre lečenja bio je 19,44 ± 11,12, a posle lečenja 2,77 ± 3,83, gde manja vrednost ukazuje na bolji kvalitet života. Zaključak. Rezultati ovog pilot istraživanja potvrdili su internu konzistentnost i stabilnost preliminarne srpske verzije GOHAI upitnika, kao i kauzalnu vezu kvaliteta života sa karakteristikama oralnog zdravlja ispitanika sa zubnim nadoknadama, te se može preporučiti sprovođenje verifikacije instrumenta

Bezbednost zdravlja - multidisciplinarni pristup proučavanju oralno-zdravstvenog kvaliteta života

The aim of this paper is to promote the necessity of a multidisciplinary approach to the study of oral health and oral health quality of life. When it comes to oral health, multidisciplinary approach requires the study of oral health from a medical and dental point of view, but also from a social and socio-medical aspects, with full appreciation of the importance of psycho-social problems caused by oral diseases. It is obvious that there is a professional need to define a multidimensional model for monitoring of dental patients, which will enable the provision of relevant indicators for the assessment of oral health problems, and hence for planning and programming of measures in the field of dentistry, from the aspect of public health, and socio-medical standpoint.Cilj ovog rada je da promoviše neophodnost multidisciplinarnog pristupa proučavanju oralnog zdravlja, odnosno oralno-zdravstvenog kvaliteta života. Kada je u pitanju oralno zdravlje, multidisciplinarni pristup zahteva proučavanje oralnog zdravlja sa medicinskog, odnosno stomatološkog stanovišta, ali i sa društvenog, socio-medicinskog aspekta, uz puno uvažavanje značaja psiho-socijalnih problema, koje oralne bolesti uzrokuju. Očigledno je da postoji stručna potreba da se definiše multidimenzionalni model za praćenje (monitoring) stomatoloških pacijenata, koji će omogućiti obezbeđivanje relevantnih indikatora za sagledavanje oralno-zdravstvenih problema, a samim tim i za planiranje i programiranje mera u oblasti stomatologije, sa aspekta javnog zdravlja, odnosno socijalno-medicinskog stanovišta

Molekulska osnova delovanja glikokortikoida

Glucocorticoid hormones are involved in regulation of cell processes and coordinate physiological response to diverse signals. These hormones, through interaction with specific intracellular receptors, coordinate components of physiological repertoires by activating the expression of gene networks. Thus hormone-receptor complexes may function as key constituent in regulation of specific cell functions as well as in provoking differentiation in already determined cells. Analysis of steroid receptors are important for understanding of molecular details of transcriptional control as well as providing the insight as to how an individual transcriptional factor such as glucocorticoid receptor, contributes to cell identity and function. The purpose of this review is to establish the general molecular mechanism of glucocorticoid action and mechanism associated hormone-receptor complexes with the control of differential patterns (i.e. "positive" and "negative") of gene expression. One of the examples of two signal pathways regulating opposite gene expression are NF-kB and GR-mediated signal pathways. These pathways have important and opposite roles in the immune function. NF-kB is transcription factor which induces the expression of many genes that participate in immune and inflamatory response, while GR is transcription factor that serves as antiinflammatory agent and immune suppressor. Their interactions within the cell, although not yet completely understood, appear to be an important, possibly even the primary mechanism of immune homeostasis. It has not been established that glucocorticoid sensitivity can be caused by mechanisms other than changes of GR number and properties, although recent studies have indicated that receptor isoforms and transcriptional factors may modulate glucocorticoid responsiveness by interacting with receptor protein or directly at the site of DNA binding. The aim of this review is also to describe the role of glucocorticoid receptors in mechanism of glucocorticoid action on cell functions, including immune responses, as well as to present emerging issues on clinical aspects of molecular mechanisms of glucocorticoid action.Glikokortikoidni hormoni su uključeni u regulaciju ćelijskih procesa koji koordiniraju fiziološke odgovore na različite signale. Ovi hormoni u kompleksu sa specifičnim ćelijskim receptorima preko aktivacije ekspresije mreže različitih gena učestvuju u koordinaciji komponenti koje su u osnovi fizioloških odgovora. Na taj način kompleksi hormona i receptora funkcionišu kao ključni faktor u regulaciji specifičnih ćelijskih funkcija, a takođe podstiču i procese diferencijacije u već determinisanim ćelijama. Analize glikokortikoidnih receptora (GR) su značajne, kako za bolje upoznavanje transkripcione kontrole, tako i za objašnjenje kako pojedini transkripcioni faktori, kao što su GR, doprinose identitetu ćelije i njenom funkcionisanju. U ovom radu su prikazani opšti principi molekulskog mehanizma delovanja glikokortikoida, kao i mehanizmi koji povezuju komplekse hormona i receptora sa kontrolom različitog tipa („pozitivnom” ili „negativnom”) genske ekspresije. Jedan od primera za signalne puteve koji suprotno regulišu aktivnost gena su nukleusni faktor kapaB (NFκB) i signalni putevi posredovani sa GR. Ovi putevi imaju suprotne uloge u regulaciji funkcionisanja imunskog sistema. NFκB je transkripcioni faktor koji indukuje ekspresiju gena uključenih u imunske i zapaljenjske procese. GR je takođe transkripcioni faktor, ali deluje kao antiinflamacioni i imunosupresivni agens. Njihove interakcije su značajne u ćelijama imunskog sistema, iako još nisu potpuno objašnjene; one su možda čak i primarne u mehanizmu imunske homeostaze. Do sada nije dokazano da ćelijska senzitivnost na delovanje glikokortikoida zavisi od mehanizama koji ne uključuju promene količine i funkcionalnih osobina GR. Međutim, novija istraživanja pokazuju da izoforme receptora i transkripcioni faktori mogu da menjaju ćelijski odgovor na glikokortikoide preko interakcije sa receptornim proteinom ili direktno sa mestima vezivanja na DNK. U ovom radu su takođe prikazani podaci iz literature o ključnoj ulozi glikokortikoidnih receptora u mehanizmu delovanja glikokortikoida u regulaciji ćelijskih funkcija, uključujući i ćelije imunskog sistema, kao i podaci o kliničkim aspektima molekulskog delovanja glikokortikoida

Health-related quality of life in elderly patients hospitalized with chronic heart failure

Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods: The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P lt 0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Conclusion: Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL

Biochemical and molecular biological aspects of glucose intolerance in elderly persons

Changes in carbohydrate metabolism in elderly persons have drawn considerable attention but the findings from different studies are in contrast and are even controversial. The insulin receptors in erythrocytes were studied in elderly euglycaemic patients and in a middle-aged control group. The examined persons were also subjected to measurements of blood glucose, insulin and C-peptide concentrations, before and 3 hours after a dietetic meal. In the present study it was found that in spite of the maintained insulin level and C-peptide secretion, some structural and corresponding changes in membrane insulin receptors and the binding site caused differences in postreceptor responses in elderly persons. The examined groups, consisted of 29 males, average age of 66 years (65-70), with normal serum glucose level and 19 middle-aged males, average age of 42 years (32-48), with normal glycoregulation. In basal condition, elderly persons have both normal morning serum insulin (19.68 ± 4.00 mU/L) and C-peptide (2.04 ± 0.78 nmol/L) level. In elderly persons, the number of high affinity insulin receptors in erythrocytes membrane is 22.80 ± 6.18 but the formed insulin-high affinity receptors were not stable. Dissociation constant (Kd1) indicates its elevated dissociation (0.11 ± 0.04). At the same time the number of insulin low affinity binding sites is increased (13 273 ± 5 572) with a fast dissociation of the hormone (13.99 ± 3.37). Food intake raised the number of high affinity receptors compared to the basal value. Alteration in insulin binding affinity suggests the structural and corresponding changes in membrane receptors that may cause differences in postreceptors responses in elderly persons

Articles on elderly in Serbian medical journals

Introduction Population aging is a feature of all countries in the world. According to statistics, the Republic of Serbia is one of the countries with the majority of the elderly. Taking this into account, are articles on the elderly well represented in domestic medical journals? Objective The aim of the paper was to determine whether there was a sufficient number of articles on the elderly in domestic medical journals. Methods The articles on the elderly were searched using search engines in domestic and foreign medical journals for the last 5 years compared with the number of articles on children in the same publications for the same period. Results In the Serbian Citation Index, 11 articles on the topic of the elderly, and 487 on children were registered. In Srpski arhiv za celokupno lekarstvo, there was registered only one article on the topic of the elderly, and 30 on children. In Vojnosanitetski pregled, 2 articles on the elderly and 13 on children were registered (p<0001). For the last five years, in the New England Journal of Medicine, there were 593 articles on the elderly and 759 articles on children; in the JAMA, there were 63 articles on the elderly and 303 articles on children; and in The Lancet, in the last five years, 46 articles on the elderly and 148 articles on children were published. Conclusion The themes of the elderly were rarely represented in Serbian medical journals. This has reduced the interest of physicians in medical problems of this growing population of patients and further sent them away from making standards in the diagnosis and treatment of the elderly

Introduction to verification of the GOHAI instrument for measuring the oral health-related quality of life in patients with dentures using the Serbian preliminary version: A pilot study

Background/Aim. Quality of life related to health should be seen as a multidimensional concept that, in addition to the physical symptoms associated with a disease and treatment, should include physical, psychological and social functioning of a person. The primary objective of this study was to use the Serbian preliminary version of the Geriatric Oral Health Assessment Index (GOHAI) questionnaire in oder to examine the consistency, reliability and stability, as well as an introduction to the verification tool. Methods. The GOHAI questionnaire with 6-level Likert scale, translated into Serbian, including the relevant oral health characteristics (oral hygiene, required dentures, number of teeth extracted), was filled by five specialists in prosthodontics for 30 randomly selected respondents, before and after the dental prosthetic treatment. Subsequently, in order to measure the reliability of the questionnaire, 27 patients were reinterviewed. Results. The value of Cronbach's Alpha Coefficient (Crα) before the treatment was 0.878, and after the treatment it was 0.788 confirming the internal consistency and stability of the questionnaire. The validity of discriminatory properties of the GOHAI was confirmed by the Spearman's correlation coefficient (r), which was highly significantly associated with oral health characteristics, confirming the high reliability of the measurement. The results of test-retest analysis measured by the individual Pearson's correlation coefficient (r) were in the range of 0.34-0.97, and for the total score r was 0.927, while the Kappa coefficient was 0.63. The correlation analysis of the GOHAI score before the treatment showed that for 10 questions there was a statistically significant correlation of the score with the answers to the questions, and for 6 questions Spearman’s r was ≥ 0.7. After the treatment a highly significant correlation of the GOHAI was shown with the answers to 10 questions, while for 5 questions the Spearman’s r was > 0.6. The GOHAI average score before the treatment was 19.44 ± 11.12, and after the treatment 2.77 ± 3.83, where the lower value indicates better quality of life. Conclusion. The results of this pilot study confirm internal consistency and stability of the Serbian preliminary version of the GOHAI questionnaire and the causal relation between the quality of life and the characteristics of oral health of the patients with dentures. Accordingly, instrument verification is recommended

Health safety multidisciplinary approach to the study of oral health quality of life

The aim of this paper is to promote the necessity of a multidisciplinary approach to the study of oral health and oral health quality of life. When it comes to oral health, multidisciplinary approach requires the study of oral health from a medical and dental point of view, but also from a social and socio-medical aspects, with full appreciation of the importance of psycho-social problems caused by oral diseases. It is obvious that there is a professional need to define a multidimensional model for monitoring of dental patients, which will enable the provision of relevant indicators for the assessment of oral health problems, and hence for planning and programming of measures in the field of dentistry, from the aspect of public health, and socio-medical standpoint

Introduction to verification of the GOHAI instrument for measuring the oral health-related quality of life in patients with dentures using the Serbian preliminary version: A pilot study

Background/Aim. Quality of life related to health should be seen as a multidimensional concept that, in addition to the physical symptoms associated with a disease and treatment, should include physical, psychological and social functioning of a person. The primary objective of this study was to use the Serbian preliminary version of the Geriatric Oral Health Assessment Index (GOHAI) questionnaire in order to examine the consistency, reliability and stability, as well as an introduction to the verification tool. Methods. The GOHAI questionnaire with 6-level Likert scale, translated into Serbian, including the relevant oral health characteristics (oral hygiene, required dentures, number of teeth extracted), was filled by five specialists in prosthodontics for 30 randomly selected respondents, before and after the dental prosthetic treatment. Subsequently, in order to measure the reliability of the questionnaire, 27 patients were reinterviewed. Results. The value of Cronbach's Alpha Coefficient (Crα) before the treatment was 0.878, and after the treatment it was 0.788 confirming the internal consistency and stability of the questionnaire. The validity of discriminatory properties of the GOHAI was confirmed by the Spearman's correlation coefficient (r), which was highly significantly associated with oral health characteristics, confirming the high reliability of the measurement. The results of test-retest analysis measured by the individual Pearson's correlation coefficient (r) were in the range of 0.34-0.97, and for the total score r was 0.927, while the Kappa coefficient was 0.63. The correlation analysis of the GOHAI score before the treatment showed that for 10 questions there was a statistically significant correlation of the score with the answers to the questions, and for 6 questions Spearman's r was ≥ 0.7. After the treatment a highly significant correlation of the GOHAI was shown with the answers to 10 questions, while for 5 questions the Spearman's r was > 0.6. The GOHAI average score before the treatment was 19.44 ± 11.12, and after the treatment 2.77 ± 3.83, where the lower value indicates better quality of life. Conclusion. The results of this pilot study confirm internal consistency and stability of the Serbian preliminary version of the GOHAI questionnaire and the causal relation between the quality of life and the characteristics of oral health of the patients with dentures. Accordingly, instrument verification is recommended.Uvod/Cilj. Kvalitet života u vezi sa zdravljem treba posmatrati kao multidimenzioni koncept koji, pored fizičkih simptoma vezanih za bolest i lečenje, treba da obuhvati i fizičko, psihičko i društveno funkcionisanje osobe. Primarni cilj studije bio je da se korišćenjem preliminarne srpske verzije upitnika Geriatric Oral Health Assessment Index (GOHAI) ispita konzistentnost, pouzdanost i stabilnost, kao uvod u verifikaciju instrumenta. Metode. GOHAI upitnik sa 6- stepenom Likertovom skalom, preveden na srpski jezik, koji je uključivao i oralnozdravstvene karakteristike (oralna higijena, potrebne zubne nadoknade, broj izvađenih zuba), popunjavan je od strane petoro specijalista stomatološke protetike za 30 slučajno izabranih ispitanika, pre i posle stomatoprotetskog lečenja. Naknadno, radi merenja pouzdanosti upitnika, ponovo je intervjuisano 27 ispitanika. Rezultati. Vrednost Cronbach's Alpha Coefficient (Crα pre lečenja bila je 0,878, a posle lečenja 0,788, čime su potvrđene interna konzistentnost i stabilnost upitnika. Valjanost diskriminatornog svojstva GOHAI potvrđena je vrednostima Spearmanovog koeficijenta korelacije (r), koji je značajan kada su u pitanju oralnozdravstvene karakteristike, čime je potvrđena valjanost merenja. Rezultati test-retest analize merene pojedinačnim Pearsonovim koeficijentom korelacije (r) bili su u rasponu 0,34-0,97, a za ukupan skor r je bio 0,927, dok je Kappa koeficijent bio 0,63. Korelaciona analiza GOHAI pre lečenja ukazala je da je za 10 pitanja postojala značajna povezanost skora sa odgovorima na pitanja, a za 6 Spearmanov r bio je ≥ 0,7. Posle lečenja utvrđena je značajna veza GOHAI sa odgovorima na 10 pitanja, a za 5 Spearmanov r bio je > 0.6. Prosek GOHAI skora pre lečenja bio je 19,44 ± 11,12, a posle lečenja 2,77 ± 3,83, gde manja vrednost ukazuje na bolji kvalitet života. Zaključak. Rezultati ovog pilot istraživanja potvrdili su internu konzistentnost i stabilnost preliminarne srpske verzije GOHAI upitnika, kao i kauzalnu vezu kvaliteta života sa karakteristikama oralnog zdravlja ispitanika sa zubnim nadoknadama, te se može preporučiti sprovođenje verifikacije instrumenta

The prevalence of hypertension and microalbuminuria in diabetes mellitus type 1 and type 2

INTRODUCTION. The prevalence of hypertension is two times higher in diabetics than in non-diabetics. In type 1 diabetes mellitus (T1DM), the incidence of hypertension is similar to the incidence of nephropathy. In obese patients with type 2 DM (T2DM) there can be associated complications of hyperinsulinaemia, dyslipidaemia, and hypertension, which can lead to coronary artery disease and stroke. These associated complications are the result of a genetic defect that produces insulin resistance - Syndrome X. Increased microalbuminuria correlates with increased levels of blood pressure (BP) and increased LDL cholesterol, and this is why microalbuminuria is associated with an increase in cardiovascular deaths in diabetics, even in the absence of renal failure. AIM. The aim of this study was to research the influence of a patient's age, diabetes duration, and obesity on the frequency of hypertension and its association with microalbuminuria inT1DM and T2DM. METHOD. 168 hospitalized patients with DM (79T1DM, 89T2DM) were analyzed. The main outcome measures were: 24-hour urinary albumin excretion rate by radioimmunoassay (MA=30-30O mg/24h), arterial hypertension (systolic BP>140 mm Hg and/or diastolic BP>90 mm Hg), and body mass index (BMI). RESULTS. Microalbuminuria was detected in 42% of patients with T1DM and 47% of patients with T2DM. 34% of T1DM patients and 78% of T2DM patients were hypertensive. Patients were divided into four groups, according to the presence of hypertension and microalbuminuria; Group I - patients with hypertension and MA, Group II - patients with hypertension but without MA, Group III - patients without hypertension and MA, Group IV - patients without hypertension but with MA. 44% of T1DM patients were without hypertension and microalbuminuria, while the most frequent T2DM patients were those with hypertension (37% with and 41% without microalbuminuria). A significant correlation between BMI and diastolic BP in both types of DM (p<0.01 for T1 DM, and p<0.05 for T2DM) was discovered. T2DM hypertensive patients were obese and there was a significant correlation between a patient's systolic BP and his or her age (p<0.05). CONCLUSION. These results suggest that hypertension can be prevented in patients with T2DM with weight reduction. There was a significant association between hypertension and microalbuminuria, especially in T1DM patients. Tight control of blood pressure is essential for the reduction of microalbuminuria as well as further micro- and macro-vascular diabetic complications