TRUDNOĆA – NEISKORIŠTENE PRILIKE ZA PREVENCIJU I INTERVENCIJU U PATRONAŽNOJ SLUŽBI

Attachment is a term used to describe a deep and lasting emotional relationship with another individual. It primarily designates emotion between a mother and her baby, but it is also inherent to life-long human behavior. It is characterized by a tendency to seek and maintain closeness with caring people in stressful situations. The feeling of safety that is generated through the mother-child relationship is the foundation for basic trust or distrust in relationships, and also affects children’s expectations concerning how the environment will respond to their needs. Development of attachment is to a large extent determined by the mother’s responsiveness to the child’s needs, compatibility of the mother and her child, the child’s temperament, the mother’s recollections of her childhood, and the supporting community. Good functioning of families is of great importance to all family members, especially pregnant women. The health care system supports pregnant women through the visiting nurse service that is in charge of preventive measures. Of all health professionals, the community health nurse is the only one who, visiting the home and family environment of a pregnant woman, has complete insight into the possible occurrence of risk factors for the development of maternal and child disorders. With this intervention, we can act preventively in order to preserve physical, mental and social well-being. The aim of this study was to determine discrepancy in the number of anticipated and performed preventive nursing visits to pregnant women in Croatia. The situation was analyzed at county (regional) and national level. The authors used the information on the health care of pregnant women, puerperal women and infants up to 12 months of age published in the Croatian Health Statistics Yearbooks and in reports on the natural change in the population by the Croatian Bureau of Statistics between 1995 and 2018. Study results showed the rate of nursing visits to pregnant women and to infants up to 12 months of age, as well as the difference in the number of nursing visits in the Republic of Croatia over a period of 23 years. During the observed period, there was a signifi cant drop in the total number of childbirths, as well as in the number of nursing visits to pregnant women, and the trend has continued. During the observed period, a mean of 42.1% of women went through their pregnancy without a single nursing visit, which means that an opportunity to provide such a vulnerable group with an important segment of social and professional support was lost. The potential opened by drop in the number of pregnant women to increase the scope of nursing visits to at least once per pregnancy, after the 16th week of pregnancy, remained unused. The number of visits to newborns and women in the puerperal period was on the rise, while visits to infants were oscillating with a slight downward trend. In conclusion, the opportunity created by drop in the number of pregnancies was not utilized to improve the scope of community nurse visits to at least once in pregnancy after week 16. Community health nursing for pregnant women failed to reach the desired health care standard.Privrženošću opisujemo duboku i trajnu emocionalnu vezu s drugom osobom. Privrženošću se primarno opisuje emocionalna veza između dojenčeta i majke, iako je privrženost svojstvena cjeloživotnom ljudskom ponašanju. Obilježava ju tendencija traženja i održavanja bliskosti privrženim ljudima za vrijeme stresnih situacija. Osjećaj sigurnosti nastao iz odnosa majke i djeteta stvara osnovno povjerenje ili nepovjerenje u odnosima te određuje vjerovanje djeteta o tome kako će okolina reagirati na njegove potrebe. U razvoju privrženosti važnu ulogu ima osjetljivost majke za potrebe djeteta, usklađenost majke i djeteta, temperament djeteta, majčina sjećanja iz njezina djetinjstva kao i podržavajuća okolina. Zdravo obiteljsko funkcioniranje vrlo je važno svim članovima obitelji, osobito trudnicama. Zdravstveni sustav trudnicama pruža potporu kroz sustav preventivnih posjeta patronažne službe. Od svih zdravstvenih djelatnika patronažna sestra je jedina koja ulaskom u dom i obiteljsku sredinu trudnice ima cjelokupan uvid u moguću pojavu rizičnih čimbenika za razvoj poremećaja povezanosti majke i djeteta. Ovom intervencijom možemo preventivno djelovati u cilju očuvanja fi zičkog, psihičkog i socijalnog blagostanja. Cilj je bio utvrditi razlike u broju predviđenih i ostvarenih preventivnih posjeta patronažne sestre trudnicama u Hrvatskoj. Analiza je napravljena po županijama Republike Hrvatske i na razini cijele Hrvatske. Korišteni su podatci o zdravstvenoj zaštiti trudnica, babinjača i djece do godinu dana života objavljeni u hrvatskim zdravstveno-statističkim ljetopisima i izvješću o prirodnom kretanju stanovništva Državnog zavoda za statistiku u razdoblju od 1995. do 2018. godine. Prikazan je broj posjeta patronažne sestre trudnicama i djeci do godine dana života te razlika broja posjeta u Republici Hrvatskoj u razdoblju od 23 godine. Očevidan je značajan pad broja živorođenih, ali isto tako i pad broja posjeta trudnicama, a tendencija pada se nastavlja. U promatranom razdoblju prosječan broj trudnica (nakon 16. tjedna trudnoće) bez ijednog patronažnog posjeta je 42,5 %, a posljednjih godina taj postotak raste. Tako se propušta prilika da se toj osjetljivoj skupini pruži makar taj segment socijalne i stručne potpore i pomoći. Nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći. Broj posjeta babinjačama i novorođenčadi raste, dok broj posjeta trudnicama pada, pa je 2018. godine bez ijednog patronažnog posjeta bilo 62,1 % trudnica u Hrvatskoj. Zaključuje se kako nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći, a nakon 16. tjedna trudnoće. Patronažna zaštita trudnica nije dostigla predviđeni standard zdravstvene zaštite

Molecular profiles and urinary biomarkers of upper tract urothelial carcinomas associated with aristolochic acid exposure

Recurrent upper tract urothelial carcinomas (UTUCs) arise in the context of nephropathy linked to exposure to the herbal carcinogen aristolochic acid (AA). Here we delineated the molecular programs underlying UTUC tumorigenesis in patients from endemic aristolochic acid nephropathy (AAN) regions in Southern Europe. We applied an integrative multiomics analysis of UTUCs, corresponding unaffected tissues and of patient urines. Quantitative microRNA (miRNA) and messenger ribonucleic acid (mRNA) expression profiling, immunohistochemical analysis by tissue microarrays and exome and transcriptome sequencing were performed in UTUC and nontumor tissues. Urinary miRNAs of cases undergoing surgery were profiled before and after tumor resection. Ribonucleic acid (RNA) and protein levels were analyzed using appropriate statistical tests and trend assessment. Dedicated bioinformatic tools were used for analysis of pathways, mutational signatures and result visualization. The results delineate UTUC-specific miRNA:mRNA networks comprising 89 miRNAs associated with 1,862 target mRNAs, involving deregulation of cell cycle, deoxyribonucleic acid (DNA) damage response, DNA repair, bladder cancer, oncogenes, tumor suppressors, chromatin structure regulators and developmental signaling pathways. Key UTUC-specific transcripts were confirmed at the protein level. Exome and transcriptome sequencing of UTUCs revealed AA-specific mutational signature SBS22, with 68% to 76% AA-specific, deleterious mutations propagated at the transcript level, a possible basis for neoantigen formation and immunotherapy targeting. We next identified a signature of UTUC-specific miRNAs consistently more abundant in the patients' urine prior to tumor resection, thereby defining biomarkers of tumor presence. The complex gene regulation programs of AAN-associated UTUC tumors involve regulatory miRNAs prospectively applicable to noninvasive urine-based screening of AAN patients for cancer presence and recurrence

The Impact of Family Support during the Postpartum Period on the Incidence of Postpartum Depression in Maternal Acceptance of the Newborn

CILJ ovog istraživanja bio je utvrditi utjecaj obiteljske podrške tijekom postporođajnog razdoblja na pojavnost postporođajne tuge u rodilja i spremnost rodilja na prihvaćanje novorođenčeta. ISPITANICI: Istraživanje je provedeno u „Klinici za ženske bolesti i porođaje“ KBC-Split i Patronažnoj službi Doma zdravlja Splitsko dalmatinske Županije u razdoblju od 1. lipnja do 15. kolovoza 2014. godine. U istraživanju su u tri mjerenja sudjelovale 282 rodilje. 395 rodilja sudjelovalo je u prvom mjerenju dok ih je 328 sudjelovalo u prvom i drugom mjerenju. Osipanje uzorka je 113 rodilja. Rodilja starosne dobi od 18 do 22 godine je 6,40%, od 23 do 28 godina je 32,93%, od 29 do 36 godina je 47,56%, a iznad 36 godina je 13,10% rodilja. Najviše je rodilja s srednjom stručnom spremom 55,79%, 42,98% rodilja sa višom i 1,21% rodilja s visokom stručnom spremom te sa osnovnom školom. U bračnoj zajednici živi 89,32% rodilja, u nevjenčanoj 10,36%, a samohrana majka je jedna (0,30%). Prvorotkinja je 46,04%, a višerotkinja 53,96%. U gradu živi 53,92% rodilja, 46,08% rodilja živi u ruralnom naselju. Nezaposlenih je 37,19% rodilja, a u radnom odnosu je 59,75%. METODE: U provedenoj prospektivnoj studiji sva tri mjerenja sudjelovale su 282 rodilje. One su popunjavale upitnike dan pred otpust iz rodilišta, 10. i 30. dan poslije otpusta iz rodilišta. Uz sociodemografski upitnik primijenjeni su validirani upitnici: Blues Questionnaire: Kennerley 1989.(40); Postpartum Bonding Questionnaire (73) i Family Functioning Questionnaire (74). REZULTATI: U ispitivanom uzorku 282 rodilje njih 30,13% treći dan po porodu iskazuje smetnje odnosa majka dijete bilo da se radi o graničnom odnosu ili patološkom. Taj je udio u drugom mjerenju 23,02% rodilja, dok su smetnje prisutne u 22,68% rodilja mjesec dana poslije (Tablica 5.b.). Nemogućnost organiziranja osnovne skrbi o novorođenčetu, nespremnost rodilje za odgoj djeteta i loš odnos s partnerom mjere su obiteljskog funkcioniranja koje doprinose oblikovanju patoloških obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. Ograničen opseg i kvaliteta socijalnih kontakata i loša iskustva rodilje iz primarne obitelji mjere su obiteljskog funkcioniranja koje doprinose oblikovanju granično poremećenih obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. 37,19% rodilja je nezaposleno što je za približno 12% više od hrvatskog prosjeka. Značajne poteškoće u svim mjerama obiteljskog funkcioniranja imaju rodilje s nezadovoljavajućim financijskim stanjem, rodilje s neriješenim stambenim pitanjem i rodilje koje žive u nuklearnoj obitelji. Rodilje s jednim djetetom imaju značajnije poteškoće od rodilja s dvoje, troje i više djece. Poteškoće se očituju u njihovoj pripremljenost za odgojne zadatke, u opsegu i kvaliteti socijalnih kontakata i iskustvima koja su imale u svojoj primarnoj obitelji. Gornja vršna procjena (cut-off point) simptoma postporođajne tuge treći dan nakon poroda u našem uzorku rodilja iznosi >5,03. 33,67% rodilja imalo je izražen teški poremećaj postporođajne tuge treći dan nakon poroda. Gornja vršna procjena simptoma postporođajne tuge 13 dana nakon poroda >3,32, a 33 dana nakon poroda je >3.12. To upućuje na opadanje teških simptoma postporođajne tuge u rodilje koji su naglašeni treći dan. 13 dana nakon poroda simptomi postporođajne tuge bili su manje izraženi. Slijed opadanja izraženosti simptoma procijenjen je i na kraju mjeseca (33 dana nakon poroda) (42, 44). Postoje značajne razlike u izraženosti simptoma postporođajne tuge između procjena rodilje 3 i 33 dana nakon poroda (Tablica 12.c.). Simptomi postporođajne tuge značajno su najnaglašeniji treći dan nakon poroda u rodilja koje su imale komplikacije u porodu, u onih u kojih je napravljena epiziotomija, u rodilja u kojih je napravljen carski rez i u onih žena čija su novorođenčad imala Apgar procjenu od 5-8. Emocionalna tupost bila je naglašenija u rodilja 33 dana nakon porodna i to u onih čija su djeca nakon rođenja imala Apgar procjenu od 5-9. Simptomi postporođajne tuge primarna tuga i smanjeno samopouzdanje značajno otežavaju uspostavu veze majka novorođenče treći dan života novorođenčeta. Ova dva simptoma postporođajne tuge doprinose 21% objašnjenju varijabiliteta uspostavljene veze majka novorođenče.Trinaesti dan nakon poroda simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje rodilje značajno otežavaju uspostavu veze majka novorođenče. Ova dva simptoma postporođajne tuge doprinose 23% objašnjenju varijabiliteta uspostavljene veze majka novorođenče. 33 dana nakon poroda iste varijable značajno otežavaju uspostavu veze majka novorođenče (Tablica 19. a-c.). Simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje doprinose 20% objašnjenju varijabiliteta uspostavljene veze majka novorođenče. Smanjeno samopouzdanje majke je konstantna mjera postporođajne tuge koja rodilji 33 dana nakon poroda otežava uspostavljanje veze majka novorođenče. ZAKLJUČAK: Emocionalno stanje rodilje doprinosi uspostavi veze majka dijete u značajnom, ali znatno manjem omjeru nego što se mislilo. Simptomi postporođajne tuge primarna tuga, preosjetljivost i smanjeno samopouzdanje doprinose 21% (3 dana nakon poroda), 23% (13 dana nakon poroda) i 20% (33 dana nakon poroda) objašnjenju varijabiliteta uspostavljenog odnosa majka novorođenče. Okolinski i situacijski čimbenici kao obiteljsko funkcioniranje, socijalni status, osobne karakteristike rodilje i osobitosti poroda objašnjavaju veći dio tog odnosa. To upućuje da se pažnja s majčinog ponašanja naspram djeteta usmjeri na emocionalne potencijale koje nudi proširena obitelj rodilje i na međugeneracijski dodir u brizi za novorođenče.AIM: The goal of this study was to examine the influence of family support during the postpartum period on the incidence of postpartum blues among young mothers and their readiness to accept their newborn child STUDY POPULATION: This study took place at the „Hospital for women's health and labors“ at the Clinical Hospital Center Split and at „Home care service“ of Splitsko-Dalmatinska County Health Center. Study was conducted during the period of June 1st until August 15th of 2014. In this study, all three measurements were completed by 282 parturient women. At the beginning of the study, 395 mothers were enrolled during the first measurement while 328 completed second measurement. However, the final stage and third measurement was reached and completed by 282 women, establishing a dropout rate of 28%. In terms of age distribution among the women who gave birth, most of them fit the range between 29 to 36 years of age (47.6%), while third of them (32.9%) were in between 23 to 28 years of age. Youngest age group (18 to 22 years of age) was represented by 6.4% while there were 13.1% of women who were older than 36 years. Majority of mothers (55.8%) had a high school diploma, 43% had a higher education while 1.21% had high education diploma or had only elementary school diploma. Dominant majority of mothers were married (89.3%), 10.4% were not married while one mother (0.3%) identified herself as a single parent. More than half of women were multiparous (54%) while 46% gave birth for the first time. Likewise, 54% lived in the urban, city setting while 46% lived in the rural areas. Most of the women were employed (59.8%) while 37.2% were unemployed. METHODS: In this prospective study, all three designated instruments were completed by 282 mothers. They were asked to complete a first questionnaire the day before they were discharged from hospital and then on the 10th (second questionnaire) and 30th day (third questionnaire) after being discharged. Along with the sociodemographic questionnaire, following validated questionnaires were used: Blues Questionnaire (Kennerley 1989) (40), Postpartum Bonding Questionnaire (73) and Family Functioning Questionnaire(74). RESULTS: In our sample pool (N=282), almost a third (30.1%) of mothers exhibited disturbances in terms of mother-newborn relationship at the 3rd day postpartum. This relationship was either borderline or pathological. This proportion changed to 23% at the second measurement while disturbances were still reported in 22.7% of women, 30 days after their discharge from hospital. The inabilities to organize a basic care about a newborn, unpreparedness of a mother to raise a child and a bad relationship with their partner are established measures of family functioning that contribute to the possible development of pathological patterns in terms of mother’s behavior towards the child - 33 days postpartum. The limited magnitude and quality of social contacts and bad previous experiences of a mother, originating from their primary family, are measures that contribute to borderline pathological patterns of behavior of a mother towards her child. In our study, 37.2% mothers were unemployed which is 12% above the Croatian national unemployment rate. Significant difficulties were identified in all measures of family functioning among those women who had insufficient financial resources, who did not have adequate housing or lived in a nuclear family. Women with only one child had significantly more difficulties than those women who had more children. These problems among first-time mothers arise due to their level of preparedness for upcoming challenges and the range and quality of social contacts and experiences that they had in their primary family. The upper cut-off point for postpartum blues symptoms at the 3rd day after labor in our sample was > 5.03, meaning that 33.7% of mothers had a substantial postpartum blues, three days after labor. The upper cut-off point for postpartum blues symptoms, thirteen days after labor was > 3.32 and more than 3.12 on a 33rd day. This trend suggests that the severe symptoms of a postpartum blues were declining after the day three when they were expressed the most. This trend was observed at the day 13 and continued towards the end of the month (33rd day postpartum). Certain statistical differences were identified in terms of the expression of the postpartum blues symptoms among the mothers, based on first (day 3) and last measurement (33 days postpartum). Symptoms of postpartum blues on a day three were significantly worse among those mothers who had the episiotomy, who gave birth via caesarean section and whose newborns had Apgar score ranging from 5 to 8. Emotional dullness was the most highlighted symptom among mothers whose newborns had Apgar score ranging from 5 to 9. This was recorded at the third measurement (day 33 postpartum). Symptoms of postpartum blues – primary depression and decreased self-confidence are factors that significantly complicate the normal relationship between a mother and a child, three days after labor. These two symptoms contributed 21% to the explanation of the variability of a mother-child formed connection. Thirteen days after labor, dominant symptoms of postpartum blues were emotional hypersensibility and decreased self-confidence. These symptoms complicate mother-child relationship as well and contribute by 23% to variability of the mother-child established relationship. These mentioned variables also significantly complicate the mother-child relationship 33 days postpartum and contribute by 20% to the variability of the mother-child bond formation. Data clearly showed that the decreased self-confidence of a mother was a constant measure (factor) of postpartum blues that has been persistent at all stages of measurement during the 33 day postpartum period. This variable burdened the mother-child bond formation. CONCLUSION: The emotional state of the mother contributes to a successful formation of mother-child relationship, however, to a significantly lesser extent than previously thought. Symptoms of postpartum blues: primary depression, hypersensitivity and decreased self-confidence contribute 21 % (3 days postpartum), 23% (13 days postpartum) and 20% (33 days postpartum) to variability of formed mother-child relationship. Environmental and situational determinants such as family functioning, social status, individual characteristics of a mother along with the circumstances of the laboring process explain the most part of mother-child relationship formation. This suggests that the attention should be diverted towards the emotional potentials that are offered through the expanded family of the women and towards the intergenerational paradigm in the care for the newborn

The Impact of Family Support during the Postpartum Period on the Incidence of Postpartum Depression in Maternal Acceptance of the Newborn

CILJ ovog istraživanja bio je utvrditi utjecaj obiteljske podrške tijekom postporođajnog razdoblja na pojavnost postporođajne tuge u rodilja i spremnost rodilja na prihvaćanje novorođenčeta. ISPITANICI: Istraživanje je provedeno u „Klinici za ženske bolesti i porođaje“ KBC-Split i Patronažnoj službi Doma zdravlja Splitsko dalmatinske Županije u razdoblju od 1. lipnja do 15. kolovoza 2014. godine. U istraživanju su u tri mjerenja sudjelovale 282 rodilje. 395 rodilja sudjelovalo je u prvom mjerenju dok ih je 328 sudjelovalo u prvom i drugom mjerenju. Osipanje uzorka je 113 rodilja. Rodilja starosne dobi od 18 do 22 godine je 6,40%, od 23 do 28 godina je 32,93%, od 29 do 36 godina je 47,56%, a iznad 36 godina je 13,10% rodilja. Najviše je rodilja s srednjom stručnom spremom 55,79%, 42,98% rodilja sa višom i 1,21% rodilja s visokom stručnom spremom te sa osnovnom školom. U bračnoj zajednici živi 89,32% rodilja, u nevjenčanoj 10,36%, a samohrana majka je jedna (0,30%). Prvorotkinja je 46,04%, a višerotkinja 53,96%. U gradu živi 53,92% rodilja, 46,08% rodilja živi u ruralnom naselju. Nezaposlenih je 37,19% rodilja, a u radnom odnosu je 59,75%. METODE: U provedenoj prospektivnoj studiji sva tri mjerenja sudjelovale su 282 rodilje. One su popunjavale upitnike dan pred otpust iz rodilišta, 10. i 30. dan poslije otpusta iz rodilišta. Uz sociodemografski upitnik primijenjeni su validirani upitnici: Blues Questionnaire: Kennerley 1989.(40); Postpartum Bonding Questionnaire (73) i Family Functioning Questionnaire (74). REZULTATI: U ispitivanom uzorku 282 rodilje njih 30,13% treći dan po porodu iskazuje smetnje odnosa majka dijete bilo da se radi o graničnom odnosu ili patološkom. Taj je udio u drugom mjerenju 23,02% rodilja, dok su smetnje prisutne u 22,68% rodilja mjesec dana poslije (Tablica 5.b.). Nemogućnost organiziranja osnovne skrbi o novorođenčetu, nespremnost rodilje za odgoj djeteta i loš odnos s partnerom mjere su obiteljskog funkcioniranja koje doprinose oblikovanju patoloških obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. Ograničen opseg i kvaliteta socijalnih kontakata i loša iskustva rodilje iz primarne obitelji mjere su obiteljskog funkcioniranja koje doprinose oblikovanju granično poremećenih obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. 37,19% rodilja je nezaposleno što je za približno 12% više od hrvatskog prosjeka. Značajne poteškoće u svim mjerama obiteljskog funkcioniranja imaju rodilje s nezadovoljavajućim financijskim stanjem, rodilje s neriješenim stambenim pitanjem i rodilje koje žive u nuklearnoj obitelji. Rodilje s jednim djetetom imaju značajnije poteškoće od rodilja s dvoje, troje i više djece. Poteškoće se očituju u njihovoj pripremljenost za odgojne zadatke, u opsegu i kvaliteti socijalnih kontakata i iskustvima koja su imale u svojoj primarnoj obitelji. Gornja vršna procjena (cut-off point) simptoma postporođajne tuge treći dan nakon poroda u našem uzorku rodilja iznosi >5,03. 33,67% rodilja imalo je izražen teški poremećaj postporođajne tuge treći dan nakon poroda. Gornja vršna procjena simptoma postporođajne tuge 13 dana nakon poroda >3,32, a 33 dana nakon poroda je >3.12. To upućuje na opadanje teških simptoma postporođajne tuge u rodilje koji su naglašeni treći dan. 13 dana nakon poroda simptomi postporođajne tuge bili su manje izraženi. Slijed opadanja izraženosti simptoma procijenjen je i na kraju mjeseca (33 dana nakon poroda) (42, 44). Postoje značajne razlike u izraženosti simptoma postporođajne tuge između procjena rodilje 3 i 33 dana nakon poroda (Tablica 12.c.). Simptomi postporođajne tuge značajno su najnaglašeniji treći dan nakon poroda u rodilja koje su imale komplikacije u porodu, u onih u kojih je napravljena epiziotomija, u rodilja u kojih je napravljen carski rez i u onih žena čija su novorođenčad imala Apgar procjenu od 5-8. Emocionalna tupost bila je naglašenija u rodilja 33 dana nakon porodna i to u onih čija su djeca nakon rođenja imala Apgar procjenu od 5-9. Simptomi postporođajne tuge primarna tuga i smanjeno samopouzdanje značajno otežavaju uspostavu veze majka novorođenče treći dan života novorođenčeta. Ova dva simptoma postporođajne tuge doprinose 21% objašnjenju varijabiliteta uspostavljene veze majka novorođenče.Trinaesti dan nakon poroda simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje rodilje značajno otežavaju uspostavu veze majka novorođenče. Ova dva simptoma postporođajne tuge doprinose 23% objašnjenju varijabiliteta uspostavljene veze majka novorođenče. 33 dana nakon poroda iste varijable značajno otežavaju uspostavu veze majka novorođenče (Tablica 19. a-c.). Simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje doprinose 20% objašnjenju varijabiliteta uspostavljene veze majka novorođenče. Smanjeno samopouzdanje majke je konstantna mjera postporođajne tuge koja rodilji 33 dana nakon poroda otežava uspostavljanje veze majka novorođenče. ZAKLJUČAK: Emocionalno stanje rodilje doprinosi uspostavi veze majka dijete u značajnom, ali znatno manjem omjeru nego što se mislilo. Simptomi postporođajne tuge primarna tuga, preosjetljivost i smanjeno samopouzdanje doprinose 21% (3 dana nakon poroda), 23% (13 dana nakon poroda) i 20% (33 dana nakon poroda) objašnjenju varijabiliteta uspostavljenog odnosa majka novorođenče. Okolinski i situacijski čimbenici kao obiteljsko funkcioniranje, socijalni status, osobne karakteristike rodilje i osobitosti poroda objašnjavaju veći dio tog odnosa. To upućuje da se pažnja s majčinog ponašanja naspram djeteta usmjeri na emocionalne potencijale koje nudi proširena obitelj rodilje i na međugeneracijski dodir u brizi za novorođenče.AIM: The goal of this study was to examine the influence of family support during the postpartum period on the incidence of postpartum blues among young mothers and their readiness to accept their newborn child STUDY POPULATION: This study took place at the „Hospital for women's health and labors“ at the Clinical Hospital Center Split and at „Home care service“ of Splitsko-Dalmatinska County Health Center. Study was conducted during the period of June 1st until August 15th of 2014. In this study, all three measurements were completed by 282 parturient women. At the beginning of the study, 395 mothers were enrolled during the first measurement while 328 completed second measurement. However, the final stage and third measurement was reached and completed by 282 women, establishing a dropout rate of 28%. In terms of age distribution among the women who gave birth, most of them fit the range between 29 to 36 years of age (47.6%), while third of them (32.9%) were in between 23 to 28 years of age. Youngest age group (18 to 22 years of age) was represented by 6.4% while there were 13.1% of women who were older than 36 years. Majority of mothers (55.8%) had a high school diploma, 43% had a higher education while 1.21% had high education diploma or had only elementary school diploma. Dominant majority of mothers were married (89.3%), 10.4% were not married while one mother (0.3%) identified herself as a single parent. More than half of women were multiparous (54%) while 46% gave birth for the first time. Likewise, 54% lived in the urban, city setting while 46% lived in the rural areas. Most of the women were employed (59.8%) while 37.2% were unemployed. METHODS: In this prospective study, all three designated instruments were completed by 282 mothers. They were asked to complete a first questionnaire the day before they were discharged from hospital and then on the 10th (second questionnaire) and 30th day (third questionnaire) after being discharged. Along with the sociodemographic questionnaire, following validated questionnaires were used: Blues Questionnaire (Kennerley 1989) (40), Postpartum Bonding Questionnaire (73) and Family Functioning Questionnaire(74). RESULTS: In our sample pool (N=282), almost a third (30.1%) of mothers exhibited disturbances in terms of mother-newborn relationship at the 3rd day postpartum. This relationship was either borderline or pathological. This proportion changed to 23% at the second measurement while disturbances were still reported in 22.7% of women, 30 days after their discharge from hospital. The inabilities to organize a basic care about a newborn, unpreparedness of a mother to raise a child and a bad relationship with their partner are established measures of family functioning that contribute to the possible development of pathological patterns in terms of mother’s behavior towards the child - 33 days postpartum. The limited magnitude and quality of social contacts and bad previous experiences of a mother, originating from their primary family, are measures that contribute to borderline pathological patterns of behavior of a mother towards her child. In our study, 37.2% mothers were unemployed which is 12% above the Croatian national unemployment rate. Significant difficulties were identified in all measures of family functioning among those women who had insufficient financial resources, who did not have adequate housing or lived in a nuclear family. Women with only one child had significantly more difficulties than those women who had more children. These problems among first-time mothers arise due to their level of preparedness for upcoming challenges and the range and quality of social contacts and experiences that they had in their primary family. The upper cut-off point for postpartum blues symptoms at the 3rd day after labor in our sample was > 5.03, meaning that 33.7% of mothers had a substantial postpartum blues, three days after labor. The upper cut-off point for postpartum blues symptoms, thirteen days after labor was > 3.32 and more than 3.12 on a 33rd day. This trend suggests that the severe symptoms of a postpartum blues were declining after the day three when they were expressed the most. This trend was observed at the day 13 and continued towards the end of the month (33rd day postpartum). Certain statistical differences were identified in terms of the expression of the postpartum blues symptoms among the mothers, based on first (day 3) and last measurement (33 days postpartum). Symptoms of postpartum blues on a day three were significantly worse among those mothers who had the episiotomy, who gave birth via caesarean section and whose newborns had Apgar score ranging from 5 to 8. Emotional dullness was the most highlighted symptom among mothers whose newborns had Apgar score ranging from 5 to 9. This was recorded at the third measurement (day 33 postpartum). Symptoms of postpartum blues – primary depression and decreased self-confidence are factors that significantly complicate the normal relationship between a mother and a child, three days after labor. These two symptoms contributed 21% to the explanation of the variability of a mother-child formed connection. Thirteen days after labor, dominant symptoms of postpartum blues were emotional hypersensibility and decreased self-confidence. These symptoms complicate mother-child relationship as well and contribute by 23% to variability of the mother-child established relationship. These mentioned variables also significantly complicate the mother-child relationship 33 days postpartum and contribute by 20% to the variability of the mother-child bond formation. Data clearly showed that the decreased self-confidence of a mother was a constant measure (factor) of postpartum blues that has been persistent at all stages of measurement during the 33 day postpartum period. This variable burdened the mother-child bond formation. CONCLUSION: The emotional state of the mother contributes to a successful formation of mother-child relationship, however, to a significantly lesser extent than previously thought. Symptoms of postpartum blues: primary depression, hypersensitivity and decreased self-confidence contribute 21 % (3 days postpartum), 23% (13 days postpartum) and 20% (33 days postpartum) to variability of formed mother-child relationship. Environmental and situational determinants such as family functioning, social status, individual characteristics of a mother along with the circumstances of the laboring process explain the most part of mother-child relationship formation. This suggests that the attention should be diverted towards the emotional potentials that are offered through the expanded family of the women and towards the intergenerational paradigm in the care for the newborn

Effects of Athamanta turbith Fruit Essential Oils on CCl4-induced Hepatic Failure in Mice and Their Antioxidant Properties

The effects of essential oils isolated from mature fruits of Athamanta turbith ssp. hungarica (Borbás) Tutin and A. turbith ssp. haynaldii (Borbás & Uechtr.) Tutin (Umbelliferae) on some liver biochemical parameters in mice intoxicated with carbon tetrachloride were investigated. Pretreatment with both essential oils extenuated the effects caused by carbon tetrachloride. In order to investigate in vitro antioxidant properties of the oils, three methods were applied: scavenging of both 2,2-diphenyl-1-picrylhydrazyl (DPPH) and OH radicals, as well as a test of inhibition of Fe2+/ascorbic-induced lipid peroxidation. Investigated essential oils exhibited modest antioxidant capacity. Therefore, their infl uence on biochemical parameters in intoxicated animals might be linked to the inhibition of enzymes (cytochrome P450 2E1) involved in metabolic activation of halomethanes

Drina Transboundary Biosphere Reserve—Opportunities and Challenges of Sustainable Conservation

This study aims to explore the opportunities and challenges of sustainable conservation in the Drina Transboundary Biosphere Reserve (TBR Drina). Two countries in 2004 launched activities on the designation of TBR Drina, which would make a unique territorial system of Tara National Park (NP Tara) in the Republic of Serbia and Drina National Park (NP Drina) in the Republic of Srpska/Bosnia and Herzegovina. Through the analysis of institutional and legal jurisdiction, the authors presented the management system of protected areas in both countries, with detailed insight into the specific mechanisms of government functioning and management in Bosnia and Herzegovina. Its complex state apparatus represents the biggest limiting factor for the formation of TBR Drina. Through qualitative research, the researched area’s natural, cultural-historical, and socio-economic potentials were identified and recommendations were made for their optimal valorization and utilization. Research has shown that the natural, cultural-historical conditions of TBR Drina represent the potential for development, in contrast to the socio-economic conditions that make up its limiting factor. By planning through the cooperation between the border regions of both countries through support at the state level, TBR Drina can be recovered gradually, with the relative coexistence of ecological, social, and economic components of space, in the forthcoming period

Drina Transboundary Biosphere Reserve—Opportunities and Challenges of Sustainable Conservation

This study aims to explore the opportunities and challenges of sustainable conservation in the Drina Transboundary Biosphere Reserve (TBR Drina). Two countries in 2004 launched activities on the designation of TBR Drina, which would make a unique territorial system of Tara National Park (NP Tara) in the Republic of Serbia and Drina National Park (NP Drina) in the Republic of Srpska/Bosnia and Herzegovina. Through the analysis of institutional and legal jurisdiction, the authors presented the management system of protected areas in both countries, with detailed insight into the specific mechanisms of government functioning and management in Bosnia and Herzegovina. Its complex state apparatus represents the biggest limiting factor for the formation of TBR Drina. Through qualitative research, the researched area’s natural, cultural-historical, and socio-economic potentials were identified and recommendations were made for their optimal valorization and utilization. Research has shown that the natural, cultural-historical conditions of TBR Drina represent the potential for development, in contrast to the socio-economic conditions that make up its limiting factor. By planning through the cooperation between the border regions of both countries through support at the state level, TBR Drina can be recovered gradually, with the relative coexistence of ecological, social, and economic components of space, in the forthcoming period

Antimikrobni hidrogelovi na bazi 2-hidroksietil metakrilata i itakonske kiseline koji sadrže srebro(I) jon

The objective of our study was to develop new antimicrobial hydrogels silver/poly(2-hydroxyethyl methacrylate/ itaconic acid) (Ag/P(HEMA/IA)). The P(HEMA/IA) samples, with different HEMA/IA ratio, were prepared by free radical crosslinking copolymerization. Ag ion were introduced in hydrogels by immersing dried P(HEMA/IA) disks in silver(I) salt solution, which was confirmed by FTIR spectroscopy. The in vitro controlled release of silver(I) ion from (Ag/P(HEMA/IA)) gels, and antimicrobial activity during the release period were also studied. The release profiles have shown a two-phase exponential profile, with fast initial phase, followed by a much slower release rate. Kinetic parameters determined, have indicated Fickian transport of Ag(I) ion in the initial phase. It is perceived that the antimicrobial activity of the Ag/P(HEMA/IA) depends on IA content. Excellent antimicrobial potential was maintained during the entire release time.Cilj našeg istraživanja je bio da se razviju novi antimikrobni hidrogelovi. Srebro/poli(2-hidroksietil metakrilat/itakonska kiselina) (Ag/P(HEMA/IK)) hidrogelovi su sintetisani, i proučavano je kontrolisano otpuštanje srebro(I) jona iz Ag/P(HEMA/IK) hidrogelova, kao i njihov antimikrobni potencijal. P(HEMA/IK) uzorci, sa različitim odnosima monomera HEMA/IK, dobijeni su radikalnom kopolimerizacijom/ umrežavanjem. Ag/P(HEMA/IK) hidrogelovi su formirani potapanjem suvih diskova gelova u srebro(I) so, što je i potvrđeno FTIR spektroskopijom. Ispitani su kontrolisano otpuštanje srebro(I) jona iz Ag/P(HEMA/IA) gelova in vitro, kao i antimikrobna aktivnost tokom perioda otpuštanja. Profili otpuštanja su pokazali dve faze (eksponencijalni rast), sa brzom početnom fazom, a zatim sporijom brzinom otpuštanja. Antimikrobna aktivnost u toku otpuštanja u maloj meri zavisi od sadržaja IA i vremena otpuštanja. Odličan antimikrobni potencijal se održava tokom celog vremena otpuštanja. Na osnovu dobijenih rezultata proizilazi da se Ag/P(HEMA/IK) hidrogelovi mogu koristiti u širokom spektru biomedicinskih primena

Aristolactam-DNA adducts are a biomarker of environmental exposure to aristolochic acid

Endemic (Balkan) nephropathy is a chronic tubulointerstitial disease frequently accompanied by urothelial cell carcinomas of the upper urinary tract. This disorder has recently been linked to exposure to aristolochic acid, a powerful nephrotoxin and human carcinogen. Following metabolic activation, aristolochic acid reacts with genomic DNA to form aristolactam-DNA adducts that generate a unique TP53 mutational spectrum in the urothelium. The aristolactam-DNA adducts are concentrated in the renal cortex, thus serving as biomarkers of internal exposure to aristolochic acid. Here, we present molecular epidemiologic evidence relating carcinomas of the upper urinary tract to dietary exposure to aristolochic acid. DNA was extracted from the renal cortex and urothelial tumor tissue of 67 patients that underwent nephroureterectomy for carcinomas of the upper urinary tract and resided in regions of known endemic nephropathy. Ten patients from nonendemic regions with carcinomas of the upper urinary tract served as controls. Aristolactam-DNA adducts were quantified by 32P-postlabeling, the adduct was confirmed by mass spectrometry, and TP53 mutations in tumor tissues were identified by chip sequencing. Adducts were present in 70% of the endemic cohort and in 94% of patients with specific A:T to T:A mutations in TP53. In contrast, neither aristolactam-DNA adducts nor specific mutations were detected in tissues of patients residing in nonendemic regions. Thus, in genetically susceptible individuals, dietary exposure to aristolochic acid is causally related to endemic nephropathy and carcinomas of the upper urinary tract