Oral administration of antineoplastic agents: the challenges for healthcare professionals

Recent progress in cancer treatmen

Pathways to care for people for dementia: an international multi-centre study

Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO “Encounter Form”, a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the ‘pathways diagram’ revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally

Interplay of Brain-Derived Neurotrophic Factor and Cytokines in Schizophrenia

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family and plays an important role in neuroplasticity, differentiation and survival of neurons, as well as their function. Neuroinflammation has been explored in the pathophysiology of many mental disorders, such as schizophrenia. Cytokines representing different types of immune responses have an impact on neurogenesis and BDNF expression. Cross-regulation of BDNF and cytokines is accomplished through several signalling pathways. Also, typical and atypical antipsychotic drugs variously modulate the expression of BDNF and serum levels of cytokines, which can possibly be used in evaluation of therapy effectiveness. Comorbidity of metabolic syndrome and atopic diseases has been considered in the context of BDNF and cytokines interplay in schizophrenia

Cigarette smoking and heavy coffee drinking affect therapeutic response to olanzapine

© 2018, Serbia Medical Society. All rights reserved. Introduction/Objective Considering relatively complex pharmacokinetic profile of olanzapine, it is expected that certain medications and some compounds, found in food and drink, can induce or inhibit its metabolism. The aim of our study was to investigate the influence of cigarette smoking and heavy coffee consumption on the clinical response to olanzapine. Methods The phase IV, open-labeled, four-week-long prospective clinical trial included 108 adult patients diagnosed with schizophrenia. According to cigarette smoking (n = 52) and coffee drinking (n = 55), four subgroups were defined: non-smokers, non-heavy coffee consumers (group 1), non-smokers, heavy coffee consumers (group 2), smokers, non-heavy coffee consumers (group 3) and smokers and heavy coffee consumers (group 4). Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scales were used for therapeutic response evaluation. Results Baseline and final GAF scores were 33.3 ± 5.0 and 61.5 ± 9.6, respectively, and PANSS scores were 100.7 ± 3.9 and 85.5 ± 5.4, respectively. The changes of GAF and PANSS scores from the baseline to the study end were 115.1 ± 35.7 and -19.6 ± 3.1, respectively (group 1), 91.1 ± 30.8 and -15.3 ± 2.9, respectively (group 2), 76.1 ± 29.8 and -13.4 ± 4.4, respectively (group 3), and 64.7 ± 29.3 and -11.3 ± 3.22, respectively (group 4), making significant subgroup differences for both scale scores (p < 0.001). Cigarette smoking and heavy coffee drinking significantly and independently diminished improvement in both GAF and PANSS total score (p < 0.001). Changes of body mass index from the baseline significantly influenced the change of PANSS total score only (p = n.s.), in a negative direction (r = -0.454, p < 0.001). Conclusion Smoking and heavy coffee drinking influenced effects of olanzapine in patients with schizophrenia treated in routine practice

Cannabis as a Possible Treatment for Spasticity in Multiple Sclerosis / Kanabis Kao Moguci Tretman U Lecenju Spasticnosti Kod Multiple Skleroze

The therapeutic potential of cannabis has been known for centuries. Cannabinoids express their effects through two types of receptors, cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). Present studies indicate that cannabis-based drugs can make a positive impact in the treatment of different diseases. For many years, multiple sclerosis patients have self-medicated with illegal street cannabis to alleviate spasticity, a common and debilitating symptom that impairs quality of life

Quality of Life in Primary Insomnia: Three-week Treatment With Zolpidem Vs. Lorazepam

Insomnia is a condition of inadequate quality or quantity of sleep that has extremely adverse effects on daytime activities. Th e aim of this study was to compare the quality of life in patients with primary insomnia before and after a 3-week treatment with lorazepam (n=20) and zolpidem (n=21) and to compare the potential differences in dysfunctional beliefs and attitudes regarding patients’ sleep between the two groups. Th e diagnosis of primary insomnia was established using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and patients had to complete a specially designed sleep log every day; on scheduled visits, we also administered a Visual Analogue Scale for quality of life and a self-evaluation questionnaire about Dysfunctional Beliefs and Attitudes related to Sleep at the beginning and end of this study. In summary, the examinees in our study had significantly decreased parameters of quality of life, quite lower than expected based on previous findings in this area. However, by the end of the study, quality of life significantly improved with treatment: it improved by approximately 2/3 in the Lorazepam group and more than twice in the Zolpidem group, with a significant difference in favour of Zolpidem (p=0.047). Th is finding is most likely a consequence of its better safety profile and in part its better efficiency in terms of influence on certain domains of sleep itself, as previously discussed. Further specialized studies in this area with larger samples and a more detailed methodology are clearly warranted

Possible Role of TGF – B Pathways in Schizophrenia / Moguća Uloga TTGF - B Signalnih Puteva U Shizofreniji

The phenomenological uniqueness of each patient with schizophrenia is determined by complex symptomatology, particularly the overlapping of symptoms and their prominence in certain phases of this mental disorder. Establishing biological markers is an important step in the further objectivisation and quantification of schizophrenia. Identifying the cytokine profiles that precede a psychotic episode could direct the strategies for relapse prevention and be useful in predicting disease progression and treatment response. In the context of infl ammation, TGF-β exerts potent anti-inflammatory and immunosuppressive functions by inhibiting pro-inflammatory cytokine synthesis, but it can also have pro-inflammatory functions through its stimulatory effects on inflammatory Th17 cells. It has been shown that the T helper cell type-1 and type-17 responses are reduced and type-2 response is increased in patients with schizophrenia. Both data from the literature and our results also indicate the presence of an anti-inflammatory response through production of the TGF-β regulatory cytokine. A meta-analysis of plasma cytokine alterations suggested that TGF-β is the state marker for acute exacerbation of schizophrenia, and we showed that TGF-β can also be a valuable marker for psychosis. Hyperactivity of TGF-β signalling pathways in schizophrenia may be both a neuroprotective mechanism and a possible therapeutic target

Burnout, Depression and Proactive Coping in Underground Coal Miners in Serbia - Pilot Project

Mining is unsurprisingly considered a high-risk occupation because it involves continuous hard labour under highly demanding and stressful conditions. Many of these work stressors can impair individuals’ well-being in both a physiological and psychological sense. The aims of this study were to assess the prevalence of burnout and depressive symptoms and to evaluate aspects of proactive coping among underground coal miners in Serbia. The study involved 46 male underground coal miners. Burnout was measured with the Copenhagen Burnout Inventory, depression was assessed with the Patient Health Questionnaire-9, and level of proactive coping was measured with the Proactive Coping Inventory. The results showed a low level of burnout syndrome among the underground coal miners (12.46±4.879). Depression was slightly above the minimum (1.2±2.094), and the majority of the participants had no symptoms of depression (93.5%). Overall, the underground coal miners’ ability to proactively cope with work stress was very good (42.17±6.567). This is in contrast to the findings of the few previous international studies and is a good basis for further research using a larger sample in Serbia

The Prevalence of Physical and Psychological Abuse and its Correlation with Depressive and Anxiety Symptoms among Students

Abuse in younger populations has been an issue of growing concern globally since youth already face various life situations that can heighten the occurrence of depression and anxiety disorders. The aim of this study was to determine the prevalence of physical and psychological abuse and its correlation with depressive and anxiety symptoms among students

Characteristics of reproductive health of women in their generative age

Introduction Any research of reproductive health has to encompass the relevant connotations of this complex term. In order to establish relevant multidimensional characteristics, it is necessary to assess intercorrelations of the characteristics most commonly used to describe it. Objective Our aim was to describe the characteristics of reproductive health and to establish their significance in describing this term. Methods Within the study of health of adult inhabitants of Serbia, on the sample of 2,817 women aged 20-49 years, the data on different reproductive health characteristics were collected by way of a structured questionnaire. By way of factorial analysis (principal components method, Kaisser Varimax criterion), representative characteristics (factors) were selected out of a large number of characteristics, describing reproductive health of women in a multidimensional way, interrelationships of the factors were explained, and carriers - the most important individual characteristics - were selected for further analysis. Results The characteristics of female reproductive health in Serbia are poor, both from the health policy standpoint and in comparison with other countries. Reproductive health describes 7 relevant factors and their carriers (characteristics which best reflect the variability of characteristics involved in a factor). These involve sexual behaviour (self-assessed HIV infection risk), contraception (use of contraceptive devices on one's own initiative), adequate protection of reproductive health (usage of gynaecological services even when healthy), abortions (pregnancy outcome), HIV control (HIV testing usage), postpartal protection (visits of field nurses after being discharged from maternity ward) and reproductive period (doctor visits after being discharged from maternity ward). Conclusion All the characteristics of reproductive health used in various studies are not equally important in the description of this complex phenomenon. Factorial analysis can explain intercorrelations of the studied characteristics and make possible the selection of those most representative