Management accounting change in BSH Group Slovenia- BSH Hišni aparati d.o.o.

In order for an organization to be successful in the current complex and fast changing environment, organizations need to develop performance measurement systems (PMS) that helps them to measure and monitor performance. PMS should be complete, integrated and at the same time, simple and easy to understand. As new strategies were developed alongside, measurement of success evolved too. The purpose of this Work Project is to describe and analyse PMS change of the BSH Group Slovenia - BSH Hišni aparati d.o.o. In this change, BSH Group Slovenia has replaced the Performance Pyramid (PP) by the Balanced Scorecard (BSC). Findings revealed that the company created a new framework, Reversed Performance Pyramid (RPP) in order to facilitate complex change to BS

Neurobiološke osnove ovisnosti o alkoholu

Alcohol addiction is a heterogeneous psychiatric disorder according to both phenotype and etiology. Difference in phenotype characteristics manifests in the manner the addiction arises, history of the alcoholic and history of drinking, comorbid disorders, and the phenomenon of abstinence difficulties. Concerning the etiology of alcoholism, the disease itself is considered to be a consequence of an interactive influence of the environment and genetic factors. Numerous researches conducted in the last decades discovered many aspects of the biochemical, cell and molecular bases of alcohol addiction, leading to a conclusion that alcoholism is, like many other addictions, a brain disease. By recognizing alcoholism as a disease which basically implies changes of the neurobiological mechanisms, as well as a clear genetic basis, it was supposed that the disease, having its basis solely in the symptomatology, is essentially heterogeneous. By trying to solve the problem of a clinically heterogeneous nature of the disease during the last fifty years, various sub-classifications of such patients have been suggested. According to Cloninger, subtypes of alcoholism differ also according to changes in the brain neurotransmission systems, i.e. it is supposed that patients suffering from alcoholism type 1 have a more pronounced dopaminergic transmission deficit, while dopaminergic transmission is not disturbed significantly in patients diagnosed with alcoholism type 2, who, however, have a significant lack of serotonergic transmission. In such a way, Cloninger actually presented the basis of the so-called neurobiological alcoholism model. Since he has connected differences in neurotransmission with differences in personality characteristics, this model is also known as the psychobiological model of alcoholism. The characteristic of alcoholism type 1 is avoiding damage (Harm Avoidance, HA) decreased dopamine transmission and increased serotonin transmission, while the significant characteristic of alcoholism type 2 is seeking for excitement (Novelty Seeking, NS), unchanged dopamine transmission and decreased serotonin transmission. These neurochemical differences among alcoholism subtypes represent the basis for a different therapy approach. Intake of alcohol changes different gene expression in the human brain. The inheritance model of alcoholism is not fully explained, however, it is considered that the disease is connected to a larger gene number included in neurotransmission, cell mechanisms and general metabolic function, with a simultaneous influence of the environment. The contribution of genetic factors is stronger in certain types of alcoholism and thus we have been confronted in the last years of alcoholism research with studies researching the connections of some alcoholism subtypes with the polymorphism phenomenon in the genes coding the synaptic proteins included in the alcoholism etiology. The primary role of monoamine oxidase (MAO) in the brain is catalysis of deamination of the oxidative neurotransmitter amines, i.e. serotonin, adrenaline, noradrenaline and dopamine. Thus, this enzyme is the key factor for maintaining cytoplasmic concentration of various neurotransmitters and for regulation of the neurotransmitting synaptic activity. Taken this MAO function into consideration, MAO is the enzyme included in the etiology and pathogenesis of various neuropsychiatric and neurological disorders. The finding of the decreased platelet MAO activity in various psychiatric disorders has brought us to the assumption that this enzyme may be a constitutional/genetic indicator (trait marker) or an indicator of disease condition (state marker) in biologic psychiatry. There are only a few studies of alcohol addiction researching the connections of the MAO coding gene polymorphism and alcoholism; however, these studies are primarily related to the variable number of tandem repeats (VTNR) polymorphism in the regulatory gene region for MAO-A, considered to influence the transcription activity/functionality of the enzyme.Ovisnost o alkoholu predstavlja heterogeni psihijatrijski poremećaj po svojoj etiologiji i fenotipu. Razlike u fenotipskim karakteristikama se ogledaju u dobi nastanka ovisnosti, alkohološkoj anamnezi, odnosno povijesti pijenja, komorbidnim poremećajima i nastanku apstinencijskih smetnji. Što se tiče etiologije alkoholizma, smatra se kako bolest nastaje kao posljedica međusobnog djelovanja okruženja i genetskih čimbenika. Brojnim istraživanjima tijekom posljednjih nekoliko desetljeća upoznati su mnogi aspekti biokemijske, stanične i molekularne podloge ovisnosti o alkoholu, što je dovelo do toga da se alkoholizam kao i druge ovisnosti danas smatra moždanom bolesti. Prepoznavanjem alkoholizma kao bolesti koja u svojoj osnovi ima promjene neurobioloških mehanizama, kao i jasnu genetsku podlogu, pretpostavljeno je i da je dijagnoza bazirana samo na simptomatologiji, u osnovi heterogena. Kako bi se pokušao riješiti problem klinički heterogene prirode ovisnosti tijekom proteklih pedesetak godina predložene su različite subklasifikacije bolesnika. Prema Cloningeru podtipovi alkoholizma razlikuju se i s obzirom na promjene u moždanim neurotransmiterskim sustavima pa tako pretpostavlja da bolesnici tipa 1 alkoholizma imaju jače deficitarnu dopaminergičnu transmisiju, dok kod bolesnika tipa 2 alkoholizma dopaminergična transmisija nije znatnije poremećena, ali je prisutan značajan nedostatak serotonergične transmisije. Time je utemeljio tzv. neurobiološki model alkoholizma. Kako razlike u neurotransmisiji povezuje i s razlikama u osobnosti/crtama ličnosti taj model naziva se i psihobiološki model alkoholizma. Kod tipa 1 alkoholizma prisutna je izražena osobina izbjegavanja štete (HA), smanjena transmisija dopamina i povišena serotoninska transmisija, dok tip 2 alkoholizma ima izraženu osobinu traženja uzbuđenja (NS), nepromijenjenu dopaminsku (DA) transmisiju i smanjenu serotoninsku (5HT) transmisiju. Navedene neurokemijske razlike među podtipovima alkoholizma čine osnovu za drugačiji terapijski pristup bolesnicima. Pijenje alkohola mijenja ekspresiju različitih gena u mozgu čovjeka. Model nasljeđivanja alkoholizma nije jasan, no smatra se da je bolest povezana s većim brojem gena (poligenska) uključenih u neurotransmisiju, stanične mehanizme i opće metaboličke funkcije uz istodobni utjecaj okoliša. Doprinos genetičkih čimbenika jači kod određenih tipova alkoholizma te se posljednjih godina u istraživanjima alkoholizma susreću studije koje istražuju povezanost pojedinog podtipa alkoholizma s pojavom polimorfizama u genima koji kodiraju sinaptičke proteine uključene u nastanak alkoholizma. Primarna uloga monoaminoksidaze (MAO) u mozgu je katalizacija oksidativne deaminacije neurotransmiterskih amina – serotonina, adrenalina, noradrenalina, dopamina, i stoga taj enzim predstavlja ključni čimbenik u održavanju citoplazmatske koncentracije različitih neurotransmitera, odnosno u regulaciji neurotransmiterske sinaptičke aktivnosti. Obzirom na svoju funkciju, MAO je enzim koji je uključen u etiologiju i patogenezu različitih neuropsihijatrijskih i neuroloških bolesti. Nalaz snižene aktivnosti trombocitne MAO-B u različitim psihijatrijskim bolestima doveo je do pretpostavke da taj enzim može biti konstitucijski/genetički pokazatelj (trait marker) ili pokazatelj stanja bolesti (state marker) u biološkoj psihijatriji. Vezano uz ovisnost o alkoholu, postoji više studija koje su istraživale povezanost polimorfizama u genima koji kodiraju MAO i alkoholizma, no one se prvenstveno odnose na VNTR polimorfizam u regulatornoj regiji gena za MAO-A za koji se smatra da utječe na transkripcijsku aktivnost/funkcionalnost enzima

Pregled psihoneuroimunoloških spoznaja o etiologiji depresivnih poremećaja

The brain is no longer considered an immunoprivileged organ which is completely separated from the circulating immune cells by the blood-brain barrier and which shows a lowered or changed immunoreactivity. It has become clear that there are numerous interactions between the neurological, immune and neuroendocrinologic systems. The psychiatric disorder which is supposed to be connected to changes in the functioning of the immune system is depression. One of the hypotheses suggesting the pathophysiology of depression is the cytokine hypothesis of depression. According to it, the behavior changes in depressed patients are a consequence of changes in cytokines. Physiological and psychological effects of the immune activation during an infection, primarily mediated by central activity of peripherally excreted proinflammatory cytokines, are called“sickness behavior”. Depression is connected with the activation of the inflammatory response system. When it comes to the immune characteristics of depressive disorders, it should be stressed that depression is a heterogeneous disorder, so different types of depression can differ not only psychopathologically but also at the immune level. Depression is characterized by disorders in noradrenergic and serotonergic neurotransmission. Proinflammatory cytokines are included in the noradrenergic and serotonergic neurotransmission in the brain areas that are thought to be involved in the pathogenesis of depression. According to this model, depression can be considered a psychoneuroimmune disease in which the peripheral immune activation is responsible (by excreting the inflammatory mediator) for various behavioral, neuroendocrinologic and neurochemical changes connected to the psychiatric condition.Mozak se više ne smatra imunoprivilegiranim organom koji je potpuno odvojen od cirkulirajućih imunih stanica krvno moždanom barijerom i koji pokazuje smanjenu ili promijenjenu imunoreaktivnost. Jasno je da postoje brojne interakcije između neurološkog, imunog i neuroendokrinog sustava. Psihijatrijski poremećaj za koji se pretpostavlja da je povezan s promjenama u funkcioniranju imunog sustava je depresija. Jedna od hipoteza koja objašnjava patofiziologiju depresije je citokina hipoteza; prema tom shvaćanju promjene ponašanja u depresivnih bolesnika posljedica su promjena u citokinima. Fiziološki i psihološki učinci imune aktivacije tijekom infekcije, koji su primarno posredovani središnjim djelovanjem periferno izlučenih proupalnih citokina, jednim imenom nazivaju se “bolesnim osjećanjem”. Depresija je povezana s aktiviranjem sustava upalnog odgovora. U svezi s imunološkim značajkama depresije treba napomenuti da je depresija heterogeni poremećaj, što znači da različiti tipovi depresije mogu biti ne samo psihopatološki različiti, nego se jedni od drugih mogu razlikovati i na imunološkoj razini. Depresija je obilježena poremećajima u noradrenergičnoj i serotoninergičnoj neurotransmisiji. Proupalni citokini uključeni su u promjene u noradrenergičnoj i serotoninergičnoj neurotransmisiji u moždanim regijama za koje se misli da su uključene u patogenezu depresije. Prema tom modelu ona se može smatrati psihoneuroimunom bolešću u kojoj je periferna imuna aktivacija potaknuta lučenjem medijatora upale odgovorna za brojne ponašajne, neuroendokrine i neurokemijske promjene koje su povezane s psihijatrijskim stanjem

Electroconvulsive Therapy During the COVID-19 Pandemic

U ožujku 2020., tri mjeseca nakon prvih zabilježenih slučajeva u kineskom gradu Wuhan, WHO je proglasio globalnu pandemiju novootkrivenog koronavirusa koji je do tada već zahvatio veliki broj država širom svijeta. U svrhu zaštite zdravlja zdravstvenih radnika i pacijenata, poduzete su aktivnosti i mjere za sprječavanje širenja bolesti COVID-19 u zdravstvenom sustavu, pri čemu se u psihijatriji kao jedan od izazova nametnulo osiguravanje kontinuiteta elektrokonvulzivne terapije (EKT-a) kod osoba s teškim i rezistentnim psihijatrijskim poremećajima. Takvi pacijenti su prioritetni i zahtijevaju neodgodivo liječenje u bolničkim uvjetima prilagođenim epidemiološkim okolnostima. Proučivši upute i preporuke nadležnih tijela te pregledom dostupne literature, u ovom radu se predstavljaju najvažnije mjere za neometano izvođenje EKT-a u uvjetima povezanima s bolesti COVID-19.In March 2020, three months after the first cases surfaced in the Chinese city of Wuhan, WHO declared a global pandemic of the novel coronavirus, which by than had already spread through a great number of countries all over the world. In order to protect the health of healthcare workers and patients, activities and measures of disease prevention have been taken; in such circumstances, psychiatry found itself faced with various challenges, one of them being the preservation of the continuity of electroconvulsive therapy (ECT) in patients with severe or refractory psychiatric disorders. Such patients are a priority and demand immediate treatment in hospital settings adapted to epidemiological circumstances. Having studied the instructions and recommendations of the competent authorities, as well as reviewing available literature, this paper presents the most important measures for the smooth performance of ECT in conditions associated with the COVID-19 disease

Metabolic side-effects of novel antipsychotic drugs

Prvi opisani slučajevi metaboličkih nuspojava antipsihotika potječu još od vremena kada se ti lijekovi uvode u kliničku upotrebu, tj. sredinom pedesetih godina prošlog stoljeća. Pokazalo se, međutim, da se metaboličke nuspojave ne javljaju samo kod primjene konvencionalnih antipsihotika, poput klorpromazina. Danas smo suočeni sa sličnim problemima kod primjene novijih, takozvanih atipičnih antipsihotika. Uvođenje atipičnih antipsihotika u terapiju bitno je unaprijedilo liječenje bolesnika sa shizofrenijom i ostalim psihotičnim poremećajima. Glavna prednost ovih lijekova u odnosu na konvencionalne antipsihotike je manja učestalost ekstrapiramidnih nuspojava, kao i hiperprolaktinemije, te sveukupno bolja podnošljivost. Ipak, neki od atipičnih antipsihotika povezuju se s porastom tjelesne težine, pojavom šećerne bolesti i porastom vrijednosti kolesterola i triglicerida. Ovaj se pregled bavi razlikama u djelovanju pojedinih atipičnih antipsihotika na homeostazu glukoze i inzulina te metabolizam lipida, kao i pitanjem na koji način racionalno primjenjivati antipsihotike kod kojih se javljaju metaboličke nuspojave. Odnosno, daju se preporuke, po prvi put u Hrvatskoj, za svakodnevni klinički rad o tome kako nadzirati metabolički status bolesnika liječenih novijim antipsihoticima.First descriptions of metabolic side-effects of antipsychotic drugs date back to the 1950s when these drugs were introduced. In the meantime, metabolic side-effects have been shown to occur not only during therapy including conventional antipsychotics like chlorpromazine. Presently, similar problems are encountered with application of the novel, so-called atypical antipsychotics. Introduction of atypical antipsychotics in therapy has substantially promoted the treatment of patients with schizophrenia and other psychotic disorders. Major advantage of these drugs in comparison to conventional antipsychotics is lower frequency of extra pyramidal side-effects and hyperprolactinemia, and generally better tolerance. Still, some atipical antipsychotics are associated to body weight gain, occurrence of diabetes, and elevated cholesterol and triglyceride concentrations. This review addresses differences in effect of certain atypical antipsychotics on glucose and insulin homeostasis and lipid metabolism, as well as the question of the rational method of applying antipsychotics that are accompanied by metabolic side-effects. For the first time in Croatia, this article provides recommendations for routine clinical practice, i.e. on the monitoring of metabolic status of patients treated by novel antipsychotics

Osamdeset godina elektrokonvulzivne terapije u Hrvatskoj i u Kliničkom bolničkom centru Sestre milosrdnice

In 1937, Ugo Cerletti and Lucio Bini performed electroconvulsive treatment (ECT) in Rome for the first time. That was the time when different types of ‘shock therapy’ were performed; beside ECT, insulin therapies, cardiazol shock therapy, etc. were also performed. In 1938, Cerletti and Bini reported the results of ECT. Since then, this method has spread rapidly to a large number of countries. As early as 1940, just two years after the results of the ECT had been published, it was also introduced in Croatia, at Sestre milosrdnice Hospital, for the first time in our hospital and in the then state of Yugoslavia. Since 1960, again the first in Croatia and the state, we performed ECT in general anesthesia and continued it down to the present, with a single time brake.Ugo Cerletti i Lucio Bini prvi put su izveli elektrokonvulzivnu terapiju (EKT) 1937. godine u Rimu. To je bilo doba kada su se provodile različite vrste “šok terapija”; uz EKT bile su to još inzulinske terapije, kardiazolski šokovi itd. O rezultatima EKT Cerletti i Bini izvijestili su 1938. godine i od tada se ta metoda vrlo brzo proširila u velik broj zemalja. Već 1940., samo dvije godine nakon objave rezultata o EKT, uvodi se i u Hrvatskoj u Bolnici Sestara milosrdnica, prvi puta u nas i u ondašnjoj državi Kraljevini Jugoslaviji. Od 1960. godine, opet prvi u Hrvatskoj i ondašnjoj državi, u našoj bolnici radimo EKT u općoj anesteziji sve do današnjih dana samo s jednim prekidom

Management of Radioactive Waste in Slovenia

Izboljšanje kakovosti in udobja našega bivanja, ki ga dosegamo z uporabo virov ionizirajočega sevanja, bi z napačnim pristopom reševanja neizogibnih in neželenih produktov, ki nastajajo pri tem in zahtevajo posebno skrb, lahko za človeka in njegovo okolje pomenilo katastrofalne radiološke obremenitve. Govorimo o ravnanju z radioaktivnimi odpadki, ki so v resnici nevarni, a imamo po mnenju strokovnjakov znane in preizkušene rešitve. Če bi bil problem reševanja z radioaktivnimi odpadki (krajše RAO) le stvar stroke, ne bi bil tako težaven. Ob tem se namreč poraja tudi občutljivo družbeno in politično vprašanje. Za uresničevanje varnega ravnanja z radioaktivnimi odpadki v Sloveniji je potreben učinkovit in sistematičen pristop že v pravni ureditvi. Znano je, da smo z RAO sposobni ravnati tako, da danes in tudi v prihodnosti ne bo škodljivih posledic v okolju. V Sloveniji je za radioaktivne odpadke in izrabljeno gorivo dobro poskrbljeno. Trenutno so varno shranjeni v začasnih skladiščih, poleg tega pa smo v fazi načrtovanja izgradnje odlagališča za nizko- in srednjeradioaktivne odpadke. Na lokaciji Vrbina v občini Krško bomo v naslednjih nekaj letih, za danes začasno skladiščene NSRAO, zagotovili trajno in varno rešitev, na povsem pasiven način. Tako bodo nekoč trajno odloženi odpadki postali nenevarni, njihova radioaktivnost bo upadla, naša generacija (uživalka koristi od jedrske energije) pa ne bo po nepotrebnem preložila bremena na kasnejše generacije. Veliko težje se bomo v prihodnosti spoprijemali z visokoradioaktivnimi odpadki (gre predvsem za izrabljeno gorivo), ki kljub majhni količini, zaradi svoje visoke aktivnosti in dolge življenjske dobe, predstavljajo nevarnost več tisočletij. Končna rešitev zanje pa ni le slovenski, temveč globalni problem.By using ionizing radiation sources, we are improving the quality and comfort of our lives, but the wrong approach to solving the problem of the inevitable and unwanted waste that is created in the process and that requires special care could have catastrophic radiological consequences for the people and the environment. The thesis discusses the management of radioactive waste, which is in fact dangerous, but, according to experts, we have adopted known and tested solutions. If the problem of dealing with radioactive waste would lie only in the hands of the profession, it would not be that difficult to solve. However, sensitive social and political issues have been arising lately in connection with this problem. In order to achieve a safe management of radioactive waste in Slovenia, an effective and systematic approach should be incorporated into the legal system. As is known, radioactive waste can be managed in such a way that there are no harmful consequences for the environment, either today or in the future. In Slovenia, radioactive waste and spent nuclear fuel are well taken care of. Currently, they are safely kept in temporary storagesmoreover, the construction of a landfill for low and intermediate-level radioactive waste is in the planning phase. In a few years, this landfill will provide a permanent and safe solution for storing low and intermediate-level radioactive waste at Vrbina in the Municipality of Krško, in a completely passive way. Thus, this permanently stored waste will become non-hazardous, as its radioactivity will decrease, and our generation (that is reaping the benefits of nuclear energy) will not unnecessarily leave this burden to future generations. In the future, it will be much harder to deal with high-level radioactive waste (predominantly spent nuclear fuel) which, despite its small quantity, represents a real danger for millennia to come, due to its high activity and long life. The struggle to find an ultimate solution for such waste is not only a Slovenian but a global problem

Depression and Suicide in Regards to Sex

Psychiatric disorders represent one of the leading problems of the public health community in the modern world today, especially because their incidence is steadily increasing and they are one of the main reasons for the overall disease burden in Europe. One of the most frequently diagnosed, yet under recognized diseases, is depression. Depression, whether a symptom, part of a syndrome or an independent diagnosis, is characterized by feelings of sadness, loss of interest and pleasure in activities that normally bring joy to a person, and can affect how a person feels, thinks and behaves. It affects all age and social groups, as well as both sexes, it is often comorbid with other physical diseases, and increases the risk of developing other physical diseases. There are certain differences between the sexes in the prevalence, the way a certain sex group deals with problems caused by depression, and the possible causes of these differences, which we present in more detail in this paper. Differences are observed in all cultures, environments and across different age groups. Patients suffering from depression have a particularly high risk of committing suicide. Suicide is a psychopathological phenomenon of multifactorial aetiology that is most often associated with psychiatry and mental disorders and is not a diagnosis in itself, but a complication of many psychiatric disorders. here are many differences in the rate of suicide by age and sex, as well as in the method of suicide, which we also present in more detail in this paper

Metabolic side-effects of novel antipsychotic drugs

Prvi opisani slučajevi metaboličkih nuspojava antipsihotika potječu još od vremena kada se ti lijekovi uvode u kliničku upotrebu, tj. sredinom pedesetih godina prošlog stoljeća. Pokazalo se, međutim, da se metaboličke nuspojave ne javljaju samo kod primjene konvencionalnih antipsihotika, poput klorpromazina. Danas smo suočeni sa sličnim problemima kod primjene novijih, takozvanih atipičnih antipsihotika. Uvođenje atipičnih antipsihotika u terapiju bitno je unaprijedilo liječenje bolesnika sa shizofrenijom i ostalim psihotičnim poremećajima. Glavna prednost ovih lijekova u odnosu na konvencionalne antipsihotike je manja učestalost ekstrapiramidnih nuspojava, kao i hiperprolaktinemije, te sveukupno bolja podnošljivost. Ipak, neki od atipičnih antipsihotika povezuju se s porastom tjelesne težine, pojavom šećerne bolesti i porastom vrijednosti kolesterola i triglicerida. Ovaj se pregled bavi razlikama u djelovanju pojedinih atipičnih antipsihotika na homeostazu glukoze i inzulina te metabolizam lipida, kao i pitanjem na koji način racionalno primjenjivati antipsihotike kod kojih se javljaju metaboličke nuspojave. Odnosno, daju se preporuke, po prvi put u Hrvatskoj, za svakodnevni klinički rad o tome kako nadzirati metabolički status bolesnika liječenih novijim antipsihoticima.First descriptions of metabolic side-effects of antipsychotic drugs date back to the 1950s when these drugs were introduced. In the meantime, metabolic side-effects have been shown to occur not only during therapy including conventional antipsychotics like chlorpromazine. Presently, similar problems are encountered with application of the novel, so-called atypical antipsychotics. Introduction of atypical antipsychotics in therapy has substantially promoted the treatment of patients with schizophrenia and other psychotic disorders. Major advantage of these drugs in comparison to conventional antipsychotics is lower frequency of extra pyramidal side-effects and hyperprolactinemia, and generally better tolerance. Still, some atipical antipsychotics are associated to body weight gain, occurrence of diabetes, and elevated cholesterol and triglyceride concentrations. This review addresses differences in effect of certain atypical antipsychotics on glucose and insulin homeostasis and lipid metabolism, as well as the question of the rational method of applying antipsychotics that are accompanied by metabolic side-effects. For the first time in Croatia, this article provides recommendations for routine clinical practice, i.e. on the monitoring of metabolic status of patients treated by novel antipsychotics