Risk factors for severe dental anxiety among medical students

Background/Aim. Severe dental anxiety (SDA) is the most severe form of dental anxiety, thus the aim of this study was to determine the factors associated with SDA in students of health-related disciplines. Methods. In this case-control study the cases were students with severe dental anxiety. The study was conducted at the Faculty of Medical Sciences, University of Kragujevac, Serbia. The participants were undergraduate students attending lectures during spring semester 2010/2011 (n = 1,812). A random sample of 800 students was assessed for the association between various risk factors and the severe dental anxiety. The main outcome measures were the data on demographics, dental anxiety, habits concerning oral hygiene, nutrition, general anxiety and (co)morbidity which were collected from the study participants by semi-structured questionnaire. Results. Less frequent visits to the dentist (OR adjusted = 7.02 [2.65; 18.60]) and visiting the dentist only when there is a dental problem (OR adjusted = 8.08 [1.28; 50.93]) were associated with severe dental anxiety. The same was true for improper oral hygiene (OR adjusted = 4.25 [1.16; 15.60]). Factors as changing toothbrush more frequently (OR adjusted = 0.33 [0.14; 0.76]) and having chronic disease (OR adjusted = 0.01 [0.00; 0.09]) were inversely associated with severe dental anxiety. The level of education of students was not associated with severe dental anxiety. Conclusion. Inappropriate oral hygiene, less frequent changes of a toothbrush and less frequent visits to the dentist are important risk factors for severe dental anxiety. [Projekat Ministarstva nauke Republike Srbije, br. 175007

Education of genaral surgions as a method to improve antibiotic prescribing

U ovoj prospektivnoj interventnoj studiji detaljno je analizirana upotreba antibiotika u opštoj hirurgiji. Studijska populacija je zbog prirode dizajna, imala dve osnove grupe: bolesnike i lekare. Edukativna intervencija je bila usmerena prema lekarima, hirurzima klinike, a posledice intervencije uslovljene izmenom terapijskih stavova, praćene su na bolesnicima, koji se smatraju ispitanicima studije u užem smislu. Studija je obuhvatila sledeće faze: početnu analizu, usmerenu na prikupljanje bazalnih vrednosti praćenih ishoda, faza edukativne intervencije u trajanju od 3 meseca i naknadnu fazu analize podataka o vrednostima praćenih ishoda i to posle sprovedene edukativne intervencije. Ovim istraživanjem su predstavljeni i detaljno analizirani uzroci prekomerne i neracionalne upotrebe antibiotika u opštoj hirurgiji. U tom smislu, primenom edukativne interventne studije se ciljano ukazivalo lekarima na neracionalnosti u profilaktičkoj i terapijskoj primeni antibiotika u hirurgiji. Ova edukativna intervencija se pokazala uspešnom u smislu značajnog smanjenja ukupne potrošnje antibiotika, ali i racionalnije upotrebe ovih lekova u opštoj hirurgiji. U konačnom ishodu, ova studija ima veliki značaj u kliničkoj praksi, jer se redukcijom i racionalizacijom upotrebe antibiotika, smanjuju štetne posledice prekomerne primene ovih lekova, smanjuju troškovi lečenja i, što je najvažnije, poboljšava ishod lečenja hirurških bolesnika.We have analyzed the use of antibiotics in general surgery in prospective intervention clinical study. The study population consist of two groups: patients and doctors. Educational intervention was focused on surgeons, and the effects of educational intervention caused by changing of attitudes, were observed in treatment of patients who are considered as the study subjects. The study included the following phases: initial, which analyzed baseline values of observed outcomes, phase of 3 months of educational intervention and at last phase aimed to estimate the effect of education on utilization and appropriate use of antibiotics. This research presents a detailed analysis of the causes of excessive and inappropriate use of antibiotics in general surgery. Furthermore, the aim of educational intervention was also to increase rationality in prophylactic and therapeutic use of antibiotics in surgery. In conclusion, this educational intervention has been successful in terms of a significant reduction in the total consumption of antibiotics, as well as increased rational use of these drugs in general surgery. In the final outcome, this study has great benefits in clinical practice to improve appropriate use of antimicrobial therapy and reduce of cost of antibiotics treatment in surgery. This intervention also reduces the harmful effects of excessive use of these drugs and, most importantly, improves the treatment outcome of surgical patients

Education of genaral surgions as a method to improve antibiotic prescribing

U ovoj prospektivnoj interventnoj studiji detaljno je analizirana upotreba antibiotika u opštoj hirurgiji. Studijska populacija je zbog prirode dizajna, imala dve osnove grupe: bolesnike i lekare. Edukativna intervencija je bila usmerena prema lekarima, hirurzima klinike, a posledice intervencije uslovljene izmenom terapijskih stavova, praćene su na bolesnicima, koji se smatraju ispitanicima studije u užem smislu. Studija je obuhvatila sledeće faze: početnu analizu, usmerenu na prikupljanje bazalnih vrednosti praćenih ishoda, faza edukativne intervencije u trajanju od 3 meseca i naknadnu fazu analize podataka o vrednostima praćenih ishoda i to posle sprovedene edukativne intervencije. Ovim istraživanjem su predstavljeni i detaljno analizirani uzroci prekomerne i neracionalne upotrebe antibiotika u opštoj hirurgiji. U tom smislu, primenom edukativne interventne studije se ciljano ukazivalo lekarima na neracionalnosti u profilaktičkoj i terapijskoj primeni antibiotika u hirurgiji. Ova edukativna intervencija se pokazala uspešnom u smislu značajnog smanjenja ukupne potrošnje antibiotika, ali i racionalnije upotrebe ovih lekova u opštoj hirurgiji. U konačnom ishodu, ova studija ima veliki značaj u kliničkoj praksi, jer se redukcijom i racionalizacijom upotrebe antibiotika, smanjuju štetne posledice prekomerne primene ovih lekova, smanjuju troškovi lečenja i, što je najvažnije, poboljšava ishod lečenja hirurških bolesnika.We have analyzed the use of antibiotics in general surgery in prospective intervention clinical study. The study population consist of two groups: patients and doctors. Educational intervention was focused on surgeons, and the effects of educational intervention caused by changing of attitudes, were observed in treatment of patients who are considered as the study subjects. The study included the following phases: initial, which analyzed baseline values of observed outcomes, phase of 3 months of educational intervention and at last phase aimed to estimate the effect of education on utilization and appropriate use of antibiotics. This research presents a detailed analysis of the causes of excessive and inappropriate use of antibiotics in general surgery. Furthermore, the aim of educational intervention was also to increase rationality in prophylactic and therapeutic use of antibiotics in surgery. In conclusion, this educational intervention has been successful in terms of a significant reduction in the total consumption of antibiotics, as well as increased rational use of these drugs in general surgery. In the final outcome, this study has great benefits in clinical practice to improve appropriate use of antimicrobial therapy and reduce of cost of antibiotics treatment in surgery. This intervention also reduces the harmful effects of excessive use of these drugs and, most importantly, improves the treatment outcome of surgical patients

Education of genaral surgions as a method to improve antibiotic prescribing

U ovoj prospektivnoj interventnoj studiji detaljno je analizirana upotreba antibiotika u opštoj hirurgiji. Studijska populacija je zbog prirode dizajna, imala dve osnove grupe: bolesnike i lekare. Edukativna intervencija je bila usmerena prema lekarima, hirurzima klinike, a posledice intervencije uslovljene izmenom terapijskih stavova, praćene su na bolesnicima, koji se smatraju ispitanicima studije u užem smislu. Studija je obuhvatila sledeće faze: početnu analizu, usmerenu na prikupljanje bazalnih vrednosti praćenih ishoda, faza edukativne intervencije u trajanju od 3 meseca i naknadnu fazu analize podataka o vrednostima praćenih ishoda i to posle sprovedene edukativne intervencije. Ovim istraživanjem su predstavljeni i detaljno analizirani uzroci prekomerne i neracionalne upotrebe antibiotika u opštoj hirurgiji. U tom smislu, primenom edukativne interventne studije se ciljano ukazivalo lekarima na neracionalnosti u profilaktičkoj i terapijskoj primeni antibiotika u hirurgiji. Ova edukativna intervencija se pokazala uspešnom u smislu značajnog smanjenja ukupne potrošnje antibiotika, ali i racionalnije upotrebe ovih lekova u opštoj hirurgiji. U konačnom ishodu, ova studija ima veliki značaj u kliničkoj praksi, jer se redukcijom i racionalizacijom upotrebe antibiotika, smanjuju štetne posledice prekomerne primene ovih lekova, smanjuju troškovi lečenja i, što je najvažnije, poboljšava ishod lečenja hirurških bolesnika.We have analyzed the use of antibiotics in general surgery in prospective intervention clinical study. The study population consist of two groups: patients and doctors. Educational intervention was focused on surgeons, and the effects of educational intervention caused by changing of attitudes, were observed in treatment of patients who are considered as the study subjects. The study included the following phases: initial, which analyzed baseline values of observed outcomes, phase of 3 months of educational intervention and at last phase aimed to estimate the effect of education on utilization and appropriate use of antibiotics. This research presents a detailed analysis of the causes of excessive and inappropriate use of antibiotics in general surgery. Furthermore, the aim of educational intervention was also to increase rationality in prophylactic and therapeutic use of antibiotics in surgery. In conclusion, this educational intervention has been successful in terms of a significant reduction in the total consumption of antibiotics, as well as increased rational use of these drugs in general surgery. In the final outcome, this study has great benefits in clinical practice to improve appropriate use of antimicrobial therapy and reduce of cost of antibiotics treatment in surgery. This intervention also reduces the harmful effects of excessive use of these drugs and, most importantly, improves the treatment outcome of surgical patients

FACTORS ASSOCIATED WITH ESTIMATE OF HIGH TERATOGENIC RISK IN FEMALES EXPOSED TO ANTI-INFECTIVE AND ANTI-INFLAMMATORY DRUGS DURING PREGNANCY

ABSTRACT Introduction. Considering that small number of drugs are completely safe for use during pregnancy, right choice and adequate risk assessment is extremely important. Objective. The aim of this study was to analyze factors associated with estimate of high teratogenic risk (as judged by clinical pharmacologist) in pregnant females who were prescribed anti-infective drugs or mild analgesics. Methods. A cross-sectional study included 284 pregnant women who came for an advice about teratogenic risk to clinical pharmacologist in Clinical Centre Kragujevac, Serbia during the period from 1997 to 2012. All of included pregnant women were prescribed mild analgesics and/or anti-infective drugs during the first 3 months of pregnancy. The data were collected from patient files and by phone interviews. Results. Clinical pharmacologists estimated the risk of teratogenicity as “high” in pregnant females who were using tetracyclines or propionic acid derivatives. Disorders of development reported by mothers during phone interviews were associated with cephalosporin use during first 3 months of pregnancy, while miscarriages or abortions happened more often in women who used a tetracycline. Conclusions. Estimate of risk from congenital anomalies after use of drugs during pregnancy, which make clinical pharmacologists as part of their routine healthcare services, depends on amount of published data about previous experiences with specific drugs during the first 3 months of pregnancy. Key Words: pregnancy; drugs; risk of teratogenicity; risk estimat

Effects of antidepressants on serum concentrations of bone metabolism markers and major electrolytes in patients from routine psychiatric practice

Background/Aim. Data about effects of antidepressant on calcium, phosphorous and magnesium metabolisms are very scorce. The aim of this study was to investigate effects of antidepressants on serum concentration of bone metabolism markers and main electrolytes in patients from routine psychiatric practice. Methods. A prospective, before-and-after, time-series research included 9 males and 24 females, with average 53.3 ± 11.5 years-of-age, suffering from depression (n = 26) and neurotic disorders (n = 7), mostly taking selective serotonin reuptake inhibitors. We measured analytes at baseline, and 4th, 6th and 12th weeks during the treatment and tested the parameter changes from baseline and the trends with appropriate statistics at p ≤ 0.05 significance level. Results. The age above 60 years was a significant factor for appearance of negative cumulative changes (in percent) of 25-hydroxyvitamin D – 25(OH)D concentrations from the base-line (OR = 11.4, 95% CI 1.2–113.1, p = 0.037). Serum concentrations of calcium significantly correlated with sodium (rs = 0.531, p < 0.001), with chloride (r = 0.496, p < 0.001), with magnesium (rs = 0.402, p < 0.001) and with osteocalcin (r = 0.240, p = 0.019). Significant correlations were among phosphorous with chloride (r = -0.218, p = 0.035); magnesium with sodium (r = 0.295, p = 0.004) and with potassium, (r = 0.273, p = 0.009); osteocalcin with C-telopeptide (r = 0.760, p < 0.001) with sodium (r = 0.215, p = 0.039) and with chloride (r = 0.209, p = 0.041); sodium with chloride (r = 0.722, p < 0.001). There were no statistically significant changes between antidepressant treatment and changes of absolute serum concentration of calcium, magnesium, phosphorous, 25(OH)D, osteocalcin, C-telopeptide, sodium, potassium and chloride. There were no statistically significant changes in frequency of disturbances in values of laboratory analytes (below/above lower/upper normal limits), too. Conclusion. Antidepressant treatment was not significantly associated with the changes in study analytes but some of them positively correlated with each other, suggesting the need for individual patient approach and further research in the field of bone metabolism in patients with mental disorders