PERCEPTION OF COMMUNICATION BETWEEN DOCTORS AND PATIENTS - ON-LINE RESEARCH AMONG DOCTORS IN CROATIA

Background: Different studies clearly show that doctor-patient relationship and communication are extremely important. They have a big influence on the outcome of medical treatment, but also on the cooperability, quality of life, safety of patients, teamwork, cultural sensitivity and fewer complaints to the doctor’s work. In this paper, we present results of our original research about attitudes of doctors and their perception related to the importance of communication between doctors and patients and personcentered approach. Subjects and methods: This cross-sectional study used a 28 items on-line survey to collect data from doctors in the period from 29 September 2015 till 23 November 2015 by using the Google forms. Total of 939 doctors from the entire Croatia responded. Results: Main results of the study suggest that doctors are aware of the importance of communication between doctors and patients and that education about communication skills was not appropriate during their study. Doctors have undoubtedly expressed their desire for further development and learning about a better communication between doctors and patients and they have showed in this research that they love their job. Conclusion: The research unambiguously speaks in favor of the need of the significant strengthening of this segment within the program of the School of Medicine and support the current changes in the medical curriculum at the School of medicine University of Zagre

Učinkovitost škole zdravog mršavljenja u liječenju pretilosti

Obesity is a condition characterized by storage of excessive amounts of fat in the body. According to the World Health Organization, obesity has reached epidemic proportions and has become a leading public health issue. The increase in body weight causes numerous clinical complications and affects the quality of life, ability to work, and longevity of the patient. The treatment costs, direct and indirect, have become a substantial burden of healthcare systems. The etiology of obesity is complex and includes genetic factors, lifestyle, psychological factors, and, of course, high-fat diet. Fats are significant sources of calories, which are stored in the body in the form of fatty tissue. Typical human diet contains over 40% of fat, although the recommended maximum is 30%. Insufficient physical activity fosters the accumulation of adipose tissue. A sensible approach to the treatment should include moderate diets rich in carbohydrates, regular exercise, and pharmacological aid, if necessary. Weight loss programs offer a new multidisciplinary approach with a long-term goal to change the patient’s lifestyle and to treat the illness and its complications. The aim of this pilot study was to assess to what extent intensive healthy diet education, psychotherapist’s counseling, and exercise contribute to successful pharmacological treatment of obesity. Besides the psychotherapeutic and nutritional counseling, the Healthy Weight Loss Program relied on the treatment with orlistat, a representative of the new therapeutic group of lipase inhibitors, which selectively binds to the lipase enzyme in the gastrointestinal tract, thus preventing the fat digestion into simpler forms and reducing their absorption in the body by up to 30%. The analysis of the six-month program, which included 111 subjects, showed the comprehensive approach to therapy of obesity to have a statistically significant effect on weight control. The average weight loss was 12.5% of the baseline weight. Besides the weight reduction, the glucose metabolism improved, and blood pressure levels dropped by 5%. The subjects expressed satisfaction with the program and the results achieved. The analysis of the achievements confirmed the weight loss program based on education, psychotherapeutic counseling, and therapy with orlistat to be an efficient and reliable mode of obesity management.Pretilost je stanje prekomjernog nakupljanja masnog tkiva u organizmu. Prema mišljenju Svjetske zdravstvene organizacije, pretilost je poprimila epidemijske razmjere i postala vodeći problem javnog zdravstva. Zbog povećane tjelesne težine nastaju brojne kliničke komplikacije koje smanjuju kvalitetu života, radnu sposobnost i životni vijek oboljelih. Izravni i neizravni troškovi liječenja pretilosti predstavljaju velik teret za proračune zdravstvenih sustava. Etiologija pretilosti je složena i uključuje genetske čimbenike, životne navike, psihološke čimbenike, ali nedvojbeno je da jednu od ključnih uloga ima masna prehrana. Masti čine značajan izvor kalorija koje se uskladištavaju u organizmu u obliku masnog tkiva, a tipičan sastav ljudske hrane sadrži više od 40% masti, iako se preporuča da udio masti iznosi najviše 30%. Istodobno premala tjelesna aktivnost pomaže gomilanju masnog tkiva. Razborito liječenje pretilosti temelji se stoga na umjerenoj dijeti bogatoj ugljikohidratima, redovitoj tjelesnoj aktivnosti, uz farmakološku potporu kada je to potrebno. Škole zdravog mršavljenja predstavljaju potpuno nov multidisciplinarni pristup koji ima za cilj promjenom životnih navika dugoročno riješiti problem pretilosti i njenih komplikacija. Cilj ovoga probnog istraživanja bio je utvrditi u kojoj mjeri intenzivna izobrazba o prehrani, psihoterapijska potpora i redovita tjelesna aktivnost pojačavaju učinak farmakoterapije. Kao sastavni dio škole se, uz psihoterapijske i nutricionističke savjete, primjenjivao orlistat, predstavnik nove terapijske skupine inhibitora lipaze, koji djeluje u gastrointestinalnom sustavu selektivno se vezujući za enzim lipazu, čime sprječava razgradnju masti do jednostavnih oblika i na taj način smanjuje apsorpciju masti unesenih hranom za 30%. Analiza šestomjesečnih rezultata škole, u koju je bilo uključeno 111 ispitanika, pokazuje da ovakav cjelovit pristup u terapiji pretilosti statistički značajno poboljšava kontrolu tjelesne težine. Prosječni gubitak tjelesne težine iznosio je 12,5% početne tjelesne težine. Uza smanjenje tjelesne težine statistički je značajno učinkovito regulirana lipidemija, poboljšan je metabolizam glukoze, te su snižene vrijednosti krvnog tlaka za 5%. Ispitanici su iskazali veliko zadovoljstvo programom škole, kao i postignutim rezultatima. Navedena analiza i dobiveni rezultati potvrđuju da škola zdravog mršavljenja utemeljena na izobrazbi, psihoterapijskoj potpori, u kombinaciji s orlistatom predstavlja učinkovitu i sigurnu terapiju pretilosti

PERCEPTION OF COMMUNICATION BETWEEN DOCTORS AND PATIENTS - ON-LINE RESEARCH AMONG DOCTORS IN CROATIA

Background: Different studies clearly show that doctor-patient relationship and communication are extremely important. They have a big influence on the outcome of medical treatment, but also on the cooperability, quality of life, safety of patients, teamwork, cultural sensitivity and fewer complaints to the doctor’s work. In this paper, we present results of our original research about attitudes of doctors and their perception related to the importance of communication between doctors and patients and personcentered approach. Subjects and methods: This cross-sectional study used a 28 items on-line survey to collect data from doctors in the period from 29 September 2015 till 23 November 2015 by using the Google forms. Total of 939 doctors from the entire Croatia responded. Results: Main results of the study suggest that doctors are aware of the importance of communication between doctors and patients and that education about communication skills was not appropriate during their study. Doctors have undoubtedly expressed their desire for further development and learning about a better communication between doctors and patients and they have showed in this research that they love their job. Conclusion: The research unambiguously speaks in favor of the need of the significant strengthening of this segment within the program of the School of Medicine and support the current changes in the medical curriculum at the School of medicine University of Zagre

THE ROLE OF PTSD IN PERCEPTION OF HEALTH-RELATED QUALITY OF LIFE AND SOCIAL SUPPORT AMONG CROATIAN WAR VETERANS

Background: Different studies clearly show that posttraumatic stress disorder (PTSD) is important factor in a reduction of the overall quality of life. PTSD remains a substantial problem in Croatia, nearly three decades after the beginning of the Croatia n Homeland war. In this paper, we present results of our original research about impact of PTSD on the self-perceived health-rela ted quality of life and social support in Croatian Homeland war veterans. Subjects and methods: A total of 277 war veterans were included from all Croatian counties. 158 (57.03%) veterans has PTSD and 119 (42.47%) are without PTSD. Strucured questionnaire was designed for socio-demographic data and information about combat experience and health problems. SF-36 was used in the estimation of health-related quality of life and Multidimesional S cale for Perceived Social Support for estimation of social support. Research was performed from June 2017 till November 2017. Results: Main results of the study suggest that Croatian veterans with PTSD have lower health-related quality of life in almost all doimains, and that they perceive less social support from family, friends and significant others in comparison to veterans without PTSD. Conclusion: The results of this study reiterate strong impact of PTSD on quality of life and perception of social support. The research speaks in favor of the need to develop person-centered interdisciplinry health-care programs for this population, with special emphasis on their overall quality of life

Art terapija kao suportivno-ekspresivna terapija u liječenju karcinoma dojke

Art terapija dobiva sve veće značenje u psihoonkologiji. Cilj ovog rada je opisati iskustvo pacijentice na kojoj se provodila art terapija te napraviti pregled literature o učinkovitosti art terapije u pacijentica s karcinomom dojke. Metode: Pacijentica koja se liječila od raka dojke liječena je i kod psihijatra u Klinici za psihološku medicine Kliničkog bolničkog centra Zagreb. Analizirani su prikupljeni podatci o pacijentici prije, tijekom i nakon terapije. Napravljen je pregled literature u području psihoonkologije s posebnim naglaskom na primjenu art terapije kod onkoloških bolesnika. Rezultati: Istraživanja su pokazala kako rak dojke značajno utječe na emocionalno, kognitivno i socijalno funkcioniranje žena. Također rezultati pokazuju kako je važno poticati mehanizme obrane kod pacijentica koje boluju od karcinoma kako bi uspjele pokazati osjećaje koji su potisnuti. Glavni ciljevi ove suportivno-ekspresivne terapije su proraditi žalovanje za gubitcima koje donosi teška bolest kao i prilagodba na promijenjenu sliku tijela. Ekspresija u umjetnosti daje simptomima formu I boju te se oni više ne moraju konvertirati u fizičke ili psihološke tegobe. Zaključak: Literaturni podatci i analiza slučaja pokazali su kako art terapija ima dugodjelujući učinak na veliki spektar simptoma vezanima uz rak dojke i njegove posljedice. Također, uočen je pozitivan utjecaj na samospoznaju i samoaktualizaciju pacijenata. Zbog toga se art terapiju može koristiti kao visoko učinkovit pristup u pružanju psihološke pomoći pacijenticama oboljelima od raka dojke, koji omogućava ekspresiju emocija i bolju kvalitetu života.Aims: Art therapy as supportive-expressive therapy is gaining increasing importance in psycho-oncology. The aim of this paper is to describe the experience of participating in art therapy of a patient with breast cancer and to review the literature regarding the effectiveness of art therapy during breast cancer treatment. Methods: The participant undergoing medical treatment for breast cancer was treated at the Clinical Hospital Centre Zagreb, at the Department of Psychological Medicine. A therapeutic approach was used to analyze the patient’s data. Review of the literature in the field of art therapy in psycho-oncology was done, with a particular focus on the approach to patients with breast cancer. Results: Studies have found that breast cancer diagnosis has a large impact on the emotional, cognitive and social functioning of women. It is important to develop strategies to strengthen coping mechanisms in women with breast cancer and help them express often-repressed emotions. The main point of supportive-expressive therapy includes mourning the losses that cancer brings and adapting to a changed body image. Expression in art gives emotions a form and a color instead of just the physical or psychological symptoms. Conclusion: The literature and this case show that art therapy has a lasting effect on a large spectrum of symptoms related to breast cancer and its consequences as well as on self-knowledge and self-realization of the patient. Therefore, art therapy can be used as a highly effective approach to provide breast cancer patients with better quality of life and psychological support while giving them freedom to express themselves and add meaning to their days