OVERCOMING FEAR AVOIDANCE BEHAVIORS AND KINESIOPHOBIA IN PATIENTS WITH CHRONIC LOW BACK PAIN

Chronic low back pain (CLBP) is a very complex medical, social and economic problem. Long duration and variability of symptoms can be frustrating for patients and lead to various psychological and behavioral changes, which can be expressed as an over-powering fear of movement and lead to avoidance behavior. The aim of this study was to highlight  the importance of individually designed exercises (IDE) and cognitive-behavioral treatment (CBT) in the treatment of patients with CLBP who have signs of fear-avoidance behavior and kinesiophobia. One hundred and thirty patients were included in a prospective randomized study. Group 1 (G1; n = 35) had a combined IDE and CBT program. Group 2 (G2; n = 35) had IDE, without CBT. Group 3 (G3; n = 30) had standard group exercises for CLBP. Group 4 (G4; n = 30) was a control, patients did not have IDE or CBT. Waddel's Fear Avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK), were used for monitoring and evaluation. Patients completed them at the beginning, at the end of the therapy, and also after 3 months. After therapy and three months later, a statistically significant reduction in symptoms in G1 and G2 was recorded, with better results in G1: FABQph = 4.77±3.83/5.51±4.02; FABQw = 2.31±3.69/2.94±4.19; TSK = 5.63±4.56/5.69 ± 4.55. (p <0.001). The combination of IDE and CBT is an effective therapy for CLBP patients with fear avoidance behaviour and kinesiophobia

EVIDENCE-BASED STROKE REHABILITATION

Stroke can have different clinical characteristics and consequences, with unequal disability and outcome, thus demanding individual approach, specific skills and general knowledge. Treatment of stroke has significantly improved during the last twenty years, mainly because of clinical and experimental studies, adequate medicamentous therapy, and the use of new technologies as well. Use-dependent rehabilitation strategy includes repetitive training with proper adjustment of the program. Other rehabilitation practices should also be incorporated, such as self-care, recreation, and home-based activities. Motivation of the patients, improving quality of life, functional independence, activities of daily life are crucial. Holistic approach means that the patient as a whole should be considered and treated. Scientific evidence is sufficient to confirm the necessity of physical rehabilitation of patients after stroke in order to achieve the optimal results. Current evidence on the effect of physical therapy in stroke rehabilitation is presented

Opažena stigmatizacija, samopoštovanje i socijalno poređenje osoba sa intelektualnom ometenošću

The aim of this study was to determine the relationship between self-esteem, perceived stigma and social comparison of persons with intellectual disabilities. The sample consisted of 100 persons with mild and moderate intellectual disability, aged 18 years and older, of different sexes, with or without stigmatized characteristics, who lived in an institution or in a family. We used questionnaires of Perceived stigma, Adapted Scale of Social Comparison and Adapted Rosenberg Self-Esteem Scale. The results showed relatively low level of perceived stigma in people with ID (AS=5.15). Respondents showed a moderately positive level of general self-esteem, moderately high positive self- esteem and less pronounced negative self- esteem. When compared with people with ID respondents evaluate themselves more positively then when compared with persons of general population. Marginally significant, low negative correlation between general selfesteem and perceived stigma was established. It was observed that negative self-esteem correlates with perceived stigmatization while between positive self-esteem and perceived stigma correlation was not established. Self- esteem was not linked to any type of social comparisons except the subscale Achivement when compared to persons with ID. The perceived stigma also did not correlate with any type of social comparison. Perception of stigma is predicative of self-esteem and indicates its importance in the lives of people with ID. Although most persons with ID managed to maintain a high level of self-esteem despite the negative experiences of stigmatization, concerns remain regarding the quality of life and mental health problems in people with ID who have low self-esteem.Cilj ovog istraživanja je utvrđivanje odnosa između samopoštovanja, opažene stigmatizacije i socijalnog poređenja kod osoba sa intelektualnom ometenošću. Uzorak se sastojao od 100 osoba sa lakom i umerenom IO, uzrasta iznad 18 godina, različitog pola, koje su bile sa i bez stigmatizujućeg obeležja i koje su stanovale u instituciji ili u roditeljskom domu. Od instrumenata su korišćeni Upitnik opažene stigmatizacije, Adaptirana skala socijalnog poređenja i Adaptirana Rozenbergova skala samopoštovanja. Rezultati su pokazali relativno nizak nivo opažene stigmatizacije (AS=5.15), iako su svi ispitanici, osim jednog, imali navedeno iskustvo. Ispitanici su pokazali umereno pozitivan nivo opšteg samopoštovanja, umereno visoko pozitivno i manje izraženo negativno samopoštovanje. Prilikom obe vrste socijalnog poređenja (sa osobama sa IO i osobama opšte populacije) ispitanici se procenjuju umereno pozitivno, procene su pozitivnije prilikom poređenja sa vršnjacima sa IO nego sa osobama opšte populacije. Utvrđena je marginalno značajna, niska, negativna korelacija između opšteg samopoštovanja i opažene stigmatizacije. Uočava se da negativno samopoštovanje korelira sa opaženom stigmatizacijom dok između pozitivnog samopoštovanja i opažene stigmatizacije nema povezanosti. Samopoštovanje nije povezano ni sa jednim tipom socijalnog poređenja osim sa subskalom Postignuće, u okviru skale Poređenje sa osobama sa IO. Opažena stigmatizacija takođe ne korelira ni sa jednim tipom socijalnog poređenja. Percepcija stigme je prediktivna za samopoštovanje što ukazuje na njen značaj u životu osoba sa IO. Iako većina osoba sa IO uspeva da održi visok nivo samopoštovanja uprkos negativnim iskustvima stigmatizacije, ostaje zabrinutost u pogledu kvaliteta života i problema mentalnog zdravlja kod osoba sa IO koje imaju nizak nivo samopoštovanja

The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children

Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF) of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children), and group B in which rehabilitation started after 15 days and more (15 children). The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest) and after the rehabilitation. Pearson's coefficient of liner correlation was applied. Results. Statistically significant negative correlation of DASH score and extension was verified in all three measurements. The values for the first test and for the final test were highly significant (p &lt; 0.001), as well as negative correlation of DASH score and flexion on the first test and retest (p &lt; 0.01), and at the end of rehabilitation (p &lt; 0.001) in the group B. For all three tests in the group A negative correlation without significant differences for DASH score and flexion was found. Conclusion. A modified DASH questionnaire correlates with objective parameters of final status of elbow after SCF in children and it is applicable to small series of patients. A positive effect of early rehabilitation of children with SCF was found

Influence of socio-demographic and clinical variables on perceived stigmatization and self-esteem of adult persons with intellectual

Iako su osobe sa intelektualnom ometenošću (IO) jedna od najstigmatizovanijih društvenih grupa, istraživanja o iskustvu stigmatizacije kod ovih osoba nisu brojna Cilj istraživanja je da se ispita uticaj socio-demografskih i kliničkih varijabli na socijalno poređenje, nivo opažene stigmatizacije i samocenjenje kod odraslih osoba sa IO. Uzorak je činilo 63 punoletnih osoba sa lakom IO i 37 sa umerenom IO oba pola, od kojih 38 živi u instituciji, a ostali u porodici. Sve ispitane osobe sa umerenom IO imaju stigmatizirajuće obeležje i 36 sa lakom IO. Od instrumenata su korišćeni Upitnik doživljene stigmatizacije, Prilagođena Rosenbergova skala samopoštovanja i Adaptirana skala socijalnog poređenja. Utvrđeno je da se muškarci i žene ne razlikuju u nivou opšteg samocenjenja, kao ni u stepenu opažene stigmatizacije. Ispitanici sa stigmatizujućim obeležjem pokazuju viši nivo opažene stigmatizacije i niže samocenjenje. Ove osobe se pozitivnije procenjuju u obe vrste socijalnog poređenja (sa osobama tipične populacije i sa osobama sa IO). Ispitanici sa lakom IO procenjuju sebe negativnije u poređenju sa osobama sa umerenom IO. Osobe koje žive u porodici se pozitivnije procenjuju u poređenju sa osobama koje žive u instituciji. Potrebno je usmeriti pažnju na osobe sa IO i stigmatizujućim obeležjem koje su predisponirane da višim opažanjem stigmatizacije i nižim samocenjenjem ispoljavaju veći rizik za probleme mentalnog zdravlja.Although people with intellectual disabilities (ID) is one of the most stigmatized social groups, research on the experience of stigma in these persons are rare. The aim of the study was to examine the influence of socio-demographic and clinical variables on social comparison, level of perceived stigma and self-esteem in adult persons with intellectual disability (ID). The sample encompassed 63 adults with mild and 37 with moderate ID of both sexes. A total of 62 subjects were in the institutions, while 38 lives with their families. All the persons with moderate ID have stigmatizing characteristics and 36 with mild ID. Questionnaire of Perceived Stigma, Adapted Rosenberg Self-Esteem Scale and Adapted Scale of Social Comparison were applied. It was found that men and women do not differ in the level of general self-esteem as well as in the degree of perceived stigma. It was found that people with stigmatizing characteristics have higher levels of perceived stigma and lower self-esteem. They positively evaluated themselves in both types of social comparisons. Individuals with mild ID evaluated themselves more negatively in both types of social comparisons. Persons who live in the family positively evaluated themselves in both types of social comparisons, when compared to people living in institution. It is necessary to focus attention on those persons with ID and stigmatizing characteristics as they experience higher level of perceived stigmatization and low self-esteem which puts them at greater risk for mental health problems

Influence of socio-demographic and clinical variables on perceived stigmatization and self-esteem of adult persons with intellectual

Iako su osobe sa intelektualnom ometenošću (IO) jedna od najstigmatizovanijih društvenih grupa, istraživanja o iskustvu stigmatizacije kod ovih osoba nisu brojna Cilj istraživanja je da se ispita uticaj socio-demografskih i kliničkih varijabli na socijalno poređenje, nivo opažene stigmatizacije i samocenjenje kod odraslih osoba sa IO. Uzorak je činilo 63 punoletnih osoba sa lakom IO i 37 sa umerenom IO oba pola, od kojih 38 živi u instituciji, a ostali u porodici. Sve ispitane osobe sa umerenom IO imaju stigmatizirajuće obeležje i 36 sa lakom IO. Od instrumenata su korišćeni Upitnik doživljene stigmatizacije, Prilagođena Rosenbergova skala samopoštovanja i Adaptirana skala socijalnog poređenja. Utvrđeno je da se muškarci i žene ne razlikuju u nivou opšteg samocenjenja, kao ni u stepenu opažene stigmatizacije. Ispitanici sa stigmatizujućim obeležjem pokazuju viši nivo opažene stigmatizacije i niže samocenjenje. Ove osobe se pozitivnije procenjuju u obe vrste socijalnog poređenja (sa osobama tipične populacije i sa osobama sa IO). Ispitanici sa lakom IO procenjuju sebe negativnije u poređenju sa osobama sa umerenom IO. Osobe koje žive u porodici se pozitivnije procenjuju u poređenju sa osobama koje žive u instituciji. Potrebno je usmeriti pažnju na osobe sa IO i stigmatizujućim obeležjem koje su predisponirane da višim opažanjem stigmatizacije i nižim samocenjenjem ispoljavaju veći rizik za probleme mentalnog zdravlja.Although people with intellectual disabilities (ID) is one of the most stigmatized social groups, research on the experience of stigma in these persons are rare. The aim of the study was to examine the influence of socio-demographic and clinical variables on social comparison, level of perceived stigma and self-esteem in adult persons with intellectual disability (ID). The sample encompassed 63 adults with mild and 37 with moderate ID of both sexes. A total of 62 subjects were in the institutions, while 38 lives with their families. All the persons with moderate ID have stigmatizing characteristics and 36 with mild ID. Questionnaire of Perceived Stigma, Adapted Rosenberg Self-Esteem Scale and Adapted Scale of Social Comparison were applied. It was found that men and women do not differ in the level of general self-esteem as well as in the degree of perceived stigma. It was found that people with stigmatizing characteristics have higher levels of perceived stigma and lower self-esteem. They positively evaluated themselves in both types of social comparisons. Individuals with mild ID evaluated themselves more negatively in both types of social comparisons. Persons who live in the family positively evaluated themselves in both types of social comparisons, when compared to people living in institution. It is necessary to focus attention on those persons with ID and stigmatizing characteristics as they experience higher level of perceived stigmatization and low self-esteem which puts them at greater risk for mental health problems

HEARING LOSS IN RHEUMATOID ARHRITIS

The incidence of hearing loss in patients with rheumatoid arthritis (RA) and the treatment have been differently reported. The aims of this study were to establish the presence and to differentiate the type of hearing loss in patients with RA, and to investigate the results of corticosteroid and methotrexate treatment on hearing loss in RA. Longitudinal, prospective study included 87 patients aged between 18 and 70 years diagnosed with RA. Disease Activity Score (DAS 28 Se) and Health Assessment Questionnaire (HAQ) were measured. 38 Patients were treated with prednisone; intratympanic appliction was used in 11 persons, and in case of weak or absent improvement after steroids methotrexate was applied for further treatment. Predominantly sensorineural hearing loss was present in 56.3% of the patients, without correlation with the duration of disease and clinical activity of RA. Corticosteroid therapy, both peroral or intratympanic contributed to hearing improvement in 60.0%. Audiometric tests are recommended in patients who suffer from RA in order to control hearing in rheumatoid arthritis and analyze the effect of proposed therapeutic procedures

Influential Factors, Complications and Survival Rate of Primary and Salvage Total Laryngectomy for Advanced Laryngeal Cancer

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60–70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy whan compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor

Influence of Point Defects Concentration on Densification Process and Optical Properties of Sintered ZnO Ceramics

Zinc oxide is one of the most studied materials due to its potential applications in electronics, optoelectronics and spintronics. In the forms of single crystal and thin-film ZnO could be used as UV and blue light emitter, while sintered ZnO-based ceramics are important as varistors, thermistors or wide-band gap semiconductors. Intrinsic defects, such as vacancies, interstitials and antisites, in the crystal structure of a ZnO strongly influenced its electrical and optical properties. Thus, understanding the behavior of intrinsic defects during densification of ZnO ceramics as well as correlation of the defects with band gap energy of final product is important to its application in opto-electronic devices. In this study, the influence of point defects concentration on the densification process and optical properties of ZnO sintered ceramics was investigated. To obtain ZnO sintered ceramics with variety of point defects concentration we employed two starting powders with a different crystal structure ordering, as well different morphology and specific surface area. Sinterability of the powders was investigated by thermo mechanical analyzer; shrinkage data, collected in axial (h) direction during non-isothermal sintering with heating rates of 5, 10 and 20 °/min, were used to calculate activation energy of sintering process. Sintering of uniaxially pressed (P = 100 MPa) cylindrical compacts (ø 6 mm and h ≈ 3 mm) were done in air atmosphere by heating rate of 10 °/min up to 1100 and 1200 °C, and dwell time of 2 h. To study a crystal structure of the sintered samples XRD and Raman spectroscopy were used, for microstructural investigation field emission scanning electron micrographs were recorded while optical properties were determined by UV-Vis diffuse reflectance and photoluminescence spectroscopy. A detailed study shows that point defect strongly influenced densification process as well optical properties. Sintered ZnO ceramic with a high crystal defect concentration and nanosized grains shows band gap energy of about 2 eV while band gap energy increased with a decrease of defect concentration

Uticaj socio-demografskih i kliničkih varijabli na nivo opažene stigmatizacije i samo-cenjenja odraslih osoba sa intelektualnom ometenošću

IX međunardna naučna konferencija: Specijalna edukacija i rehabilitacija dana