Povezanost depresije i anksioznosti kod bolesnika s kroničnom nemalignom boli

Introduction. Two-thirds of primary care patients with depression also have somatic symptoms present, making detection of depression more difficult. Primary health care is the first level of screening for depression, and early detection is key to treatment success. Anxiety also has a high comorbidity rate with chronic pain conditions. Generalized anxiety disorder (GAD) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic musculoskeletal pain after trauma. Belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depressive symptoms. Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research dealing with the processes involved in the examination of depression, anxiety, and chronic non malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malignant pain according to ethnicity. Methods. Methods for identifying the study were derived from the Medline database (via PubMed). The analysis included all scientific papers in English, regardless of methodology, published since 2011. The papers dealt with the correlation between depression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic nonmalignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review. Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. Depression and anxiety are significantly associated with the intensity and duration of pain. Chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression. Conclusion. Depression is the most common mental health disorder associated with chronic pain. It is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. Cultural differences and ethnicity, which can significantly reduce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.Uvod. Dvije trećine pacijenata primarne zdravstvene zaštite s depresijom ima prisutne i somatske simptome, čineći otkrivanje depresije težom. Primarna zdravstvena zaštita prva je razina probira za depresiju, a rano otkrivanje ključno je za uspjeh liječenja. Anksioznost također ima visoku stopu komorbiditeta s kroničnim bolnim stanjima. Generalizirani anksiozni poremećaj (GAD) čest je među pacijentima s „medicinski neobjašnjivom” kroničnom boli i kroničnim fizičkim bolestima te je i prediktor kronične mišićno-koštane boli nakon traume. Pripadnost različitim etničkim skupinama i činjenica da liječnici primarne zdravstvene zaštite ne poznaju te razlike mogu biti prepreka u dobroj zdravstvenoj skrbi, prije svega ranom prepoznavanju simptoma depresije. Cilj. Cilj ovog predloženog, sistematičnog rada bio je izvući zaključke iz empirijskog istraživanja koje se bavi procesima uključenima u ispitivanje depresije, anksioznosti i kronične nemaligne boli. Istraživačko pitanje za ovaj pregledni rad bilo je ispitati povezanost depresije i anksioznosti s kroničnom nemalignom boli. Cilj je bio ispitati ulogu primarne zdravstvene zaštite u prepoznavanju, prevenciji i liječenju depresije i anksioznosti kod bolesnika s kroničnom nemalignom boli te postoji li razlika u povezanosti depresije, anksioznosti i kronične nemaligne boli s obzirom na etničku pripadnost. Metode. Metode za identifikaciju studije izvedene su iz baze podataka Medline (via PubMed). U analizu su uključeni svi znanstveni radovi na engleskom jeziku, bez obzira na metodologiju, objavljeni od 2011. koji se odnose na povezanost depresije, anksioznosti i kronične nemaligne boli, koji obuhvaćaju populaciju pacijenata iz primarne zdravstvene zaštite starijih od 18 godina koji boluju od kronične nemaligne boli i istodobno imaju prisutne simptome depresije i anksioznosti ili su pripadnici etničkih skupina. Pronađeno je 403 članka, originalnih i preglednih radova, od kojih je nakon detaljnog čitanja odabrano 10 koji zadovoljavaju uključujuće kriterije za potrebe ovog pregleda. Rezultati. Depresija i anksioznost značajno su prisutnije kod osoba s kroničnom boli (23%) u odnosu na one koji ih nemaju (12%). Najčešća je mišićno-koštana kronična bol, pri čemu trećina pacijenata ima depresiju. Depresija i anksioznost značajno su povezane s intenzitetom i trajanjem boli. Kronična bol i depresija razlikuju se i s obzirom na etničke skupine, pri čemu kulturalne razlike i jezična barijera mogu biti prepreka u ranom otkrivanju depresije. Zaključak. Depresija je najčešća smetnja mentalnog zdravlja koja je povezana s kroničnom boli. Od iznimne je važnosti liječenje i depresije i boli, kako bi se u ranoj fazi spriječio razvoj teže depresije i kronične boli. Od integriranog programa na razini primarne zdravstvene zaštite očekuju se pozitivni učinci i na fizičko i na psihičko stanje pacijenata. Svakako treba uzeti u obzir kulturološke razlike i etničku pripadnost, koje na razini primarne zdravstvene zaštite mogu značajno smanjiti otkrivanje simptoma depresije

Healthy Settings / Health Promoting Settings

In addition to genetic factors, human health is influ¬enced by many other exogenous factors: environ¬mental set-up, housing conditions, education, public services, social security, protection of people, etc. Health improvement and the creation of potentials for good health before health problems and vulner¬ability appear are the fundamental determinants of health promotion. The World Health Organization advocates health promotion and providing healthy surroundings that would allow the maximal expression of all human potentials (mental, physical, social, spiritual). The aim of this article was to examine the association of environmental factors that affect mental and physical health. By a series of public health pro¬grams, there is an attempt to preserve health from the earliest beginning of life – from its conceivement. Negative environmental factors present in the early phases of childhood may produce far-reaching consequences for the entire life. Critical groups include elderly people, homeless, migrants, persons with special needs and those living on the margin of poverty. The reorientation of the health system is necessary, so that its focus is moved toward the individual and community, and to strengthen the culture oriented to health and prevention, not to disease. The coop¬eration and linking inside the sector and with other sectors by the creation of partnerships and networks is unavoidable. There are many examples of the Healthy Cities project that contributed to the wellbeing of citizens on the level of city administration

Hrvatska prilagodba i validacija upitnika percipirano implicitno racioniranje sestrinske skrbi (PIRNCA) - presječna studija

The aim was to perform adaptation and validation of the Perceived Implicit Rationing of Nursing Care. Implicit delaying of nursing care is an intermediate step, linking nurses with the quality of outcomes for patients and nurses, and it is the result of prioritization of health care measures within the assigned group of patients cared for by nurses. The Perceived Implicit Rationing of Nursing Care instrument is a tool used to assess the rationing of care in nursing practice. Study participants were nurses working at hospital wards in 4 university hospitals in the Republic of Croatia. The questionnaire was filled-in by 438 nurses. Data were collected between April and November 2018. After principal axis factoring, a single factor solution based on the correlation matrix was adopted. The measured construct is one-dimensional, and the extracted factor explains 47.2% of its variance. Additionally, the reliability of the whole questionnaire was determined by using the internal consistency coefficient Cronbach alpha on the Perceived Implicit Rationing of Nursing Care with 31 of 0.96 particles, which is extremely high internal consistency reliability. In conclusion, the study found a high level of reliability and validity of the translated Perceived Implicit Rationing of Nursing Care questionnaire, fully comparable to that of the original. The questionnaire can be used to assess the phenomenon of implicit care rationing in Croatian hospitals.Cilj ove studije bio je provesti prilagodbu i validaciju upitnika Percipirano implicitno racioniranje sestrinske skrbi. Implicitno odlaganje prvi je korak koji povezuje medicinske sestre s kvalitetom ishoda liječenja bolesnika i rezultira određivanjem prioriteta zdravstvene skrbi u određenoj skupini bolesnika za koju medicinska sestra skrbi. Percipirano implicitno racioniranje sestrinske skrbi je instrument koji se rabi u procjeni racioniranja skrbi u sestrinskoj praksi. Sudionici studije bili su medicinske sestre i tehničari koji rade na bolničkim odjelima u 4 kliničke bolnice u Republici Hrvatskoj. Upitnik je ispunilo 438 sudionika. Podatci su prikupljani od travnja do studenog 2018. godine. Nakon faktoriranja glavne osi usvojeno je jednofaktorsko rješenje na temelju korelacijske matrice. Izmjereni konstrukt je jednodimenzionalan, a ekstrahirani faktor objašnjava 47,2% varijance. Nadalje, pouzdanost cijelog upitnika utvrđena je korištenjem koeficijenta unutarnje konzistentnosti Cronbach alpha za Percipirano implicitno racioniranje sestrinske skrbi na 31 česticu, koji je bio 0,96, što je iznimno visoka pouzdanost unutarnje konzistencije. Zaključno, studija je otkrila visoku razinu pouzdanosti i valjanosti prevedenog upitnika Pericipirano implicitno racioniranje sestrinske skrbi, potpuno usporedivog s izvornikom. Upitnik se može primjenjivati za procjenu fenomena implicitnog racioniranja sestrinske skrbi u hrvatskim bolnicama

Instrumenti koji se primjenjuju u procjeni kvalitete života povezane sa zdravljem

Introduction. Health-related quality of life (HRQoL) and well-being are used in clinical practice to measure the effects of chronic illness, treatments, and short- and long-term disabilities on the quality of life. Currently, more than 1000 instruments are designed specifically for measuring the quality of life. While some are designed for assessing any disease, others are created for specific conditions. Aim. To establish characteristics of instruments for assessing health-related quality of life. Methods. A review of scientific papers was made to establish characteristics of most commonly used tools for assessing health-related quality of life. Results. Questionnaires shown in this review paper have strong reliability; they use the Likert scale; they consist of approximately 30 items and most of them are holistic; and they evaluate the physical, psychological, social, and environmental domains through numerous questions. The criteria for selecting tools and judging the appropriateness of measures include the following: appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility. Conclusion. Even though many different instruments for measuring HRQoL are available, none is perfect as they are only tools best suited to a particular condition. The choice of instrument depends on the reason for measurement, the primary concepts of interest and the purpose of the study.Uvod. Kvaliteta života povezana sa zdravljem i dobrobit primjenjuju se u kliničkoj praksi za mjerenje učinka kroničnih bolesti, liječenja te kratkoročnih i dugotrajnih invaliditeta na kvalitetu života. Trenutačno postoji više od 1000 instrumenata dizajniranih posebno za mjerenje kvalitete života. Dok su neki dizajnirani za procjenu bilo koje bolesti, drugi su dizajnirani za određene medicinske dijagnoze. Cilj. Utvrditi karakteristike instrumenata koji se primjenjuju za procjenu kvalitete života povezane sa zdravljem. Metode. Učinjen je pregled znanstvenih radova kako bi se utvrdile karakteristike najčešće korištenih alata za procjenu kvalitete života povezane sa zdravljem. Rezultati. Upitnici prikazani u preglednom radu imaju veliku pouzdanost, upotrebljavaju skalu za odgovore Likertova tipa, sastoje se od otprilike 30 čestica i većina holistički pristupa ciljanoj skupini procjenjujući fizičku domenu, psihološku domenu, društvenu domenu i okolišnu domenu kroz brojna pitanja. Kriteriji za odabir alata i prosuđivanje prikladnosti mjera uključuju sljedeće: prikladnost, pouzdanost, valjanost, prilagodljivost, preciznost, mogućnost interpretacije, prihvatljivost te izvedivost. Zaključak. Iako je dostupno mnogo različitih instrumenata za procjenu kvalitete života povezane sa zdravljem, nijedan od njih nije savršen jer su to samo alati koji najbolje odgovaraju određenom stanju. Izbor instrumenta ovisi o razlogu mjerenja, primarnom interesu i svrsi istraživanja