Sedentary behavior as a public health issue: Ergonomics as a useful tool

Background: Sedentary behavior carries the risk of musculoskeletal problems, especially in the lumbosacral region of the spinal column.  According to modern lifestyle, this has begun to be a public health issue. Objective: To point to the health risks of working at the computer and present an ergonomic analysis of the typical and improved position of workers in front of the computer, thereby reducing the chances of emergence occupational diseases. Results:  Changing the position of the subjects led to a change in lumbar pressure from 2,818 N/m2 to 351 N/m2. Software analysis of the changed position indicates that this position is acceptable, both for the lumbosacral region of the spine and for the abdominal muscles. Conclusions:  A change in body position will decrease lumbar moment and the load on the lumbosacral region of the spine. Work chair with lumbar support, the right desk height, setting the appropriate position of the monitor, selecting the optimal keyboard and mouse, dividing the workspace into appropriate zones, as well as changing lifestyle and habits should be part of the management of people who spend most of their working time in a sitting position

Lafora Disease during a Seven-Year Period, Bosnian and Herzegovinian experience

Abstract:Lafora progressive myoclonus epilepsy (Lafora disease, LD) is a fatal autosomal recessive neurodegenerative disorder (with an onset in teenage years in previously normal adolescents). This paper represents a view of a patient diagnosed with Lafora progressive myoclonus epilepsy, over a course of seven years. A description of the initial manifestation of symptoms, doctors' attempts to combat the symptoms with drug treatment, further attempts towards reaching the correct diagnosis, the final confirmation of the Lafora diagnosis (mutation in the NHLRC1 gene), and the current state of the patient is presented. The absence of a positive family history, the lack of staff specialized in dealing with this or similar pathology, and the diagnostic inability to characterize this type of disorder in Bosnia and Herzegovina have led to a fair delay in diagnosing and beginning of an adequate pharmacological treatment. Overall, recent identification of LD cases in Bosnia and Herzegovina warrants an establishment of a Centre for Genetic Testing in order to ensure more humane counseling of an entire family whose family member(s) might be diagnosed with this devastating and currently an incurable disorder.Keywords: Progressive myoclonus epilepsy; Lafora disease; NHLRC1 mutatio

Office wall color influence on subjective response in patients with chronic heart failure

Heart failure is defined as a clinical state, which occurs as a result of structural or functional damage of ventricle with consequential blood hypo perfusion of organs (reduced stroke volume of heart muscle and/or increased intracardial pressure in rest or during work activity). Therapeutical monitoring of patient is imperative, and it includes assessment of objective and subjective state of patient, which is often guide for optimizing of pharmacological treatment. The aim of paper is assessment of the room wall color influence as one of the factor for optimizing the therapeutic modality of patients with diagnosis of heart failure. Findings suggest that the influence of color in environment can be neutral, enabling or disabling, and this is the aspect of treatment that needs to be investigated further in future.&nbsp

Increased of the carotid intima media thickness in preeclampsia

Objectives: The aim of the study was to determine carotid intima-media thickness (CIMT) values in patients who developed and did not develop preeclampsia (PE), and to determine whether CIMT values could be predictors of PE development. Methods: The study included pregnant women who were examined by regular ultrasound examination at the Materno-Infantil Presidente Vargas Hospital (HMIPV) in Porto Alegre, Brazil, from April 2016 to September 2017. The examinations were performed every three months. Patients were divided into two groups. The first group included patients diagnosed with PE (n=21) and second group included patients who did not have PE (n=199). A high frequency ultrasound device (12 MHz) with a semiautomatic method was used to estimate CIMT. Results: CIMT was significantly higher in pregnant women with PE than in women without PE (55±0.11 vs. 0.44±0.06, respectively; p0.42 mm, the probability was only 4.2%. Conclusions: An increase in CIMT was associated with the onset of PE. CIMT values were significantly higher in patients who develop PE

FROM HEART MURMUR TO ECHOCARDIOGRAPHY CONGENITAL HEART DEFECTS DIAGNOSTICS USING MACHINELEARNING ALGORITHMS

The most common clinical sign in pediatric cardiology is heart murmur, which can often be uncharacteristic. The aim of this research was to present the results of development of a classifier based on machine learning algorithms whose purpose is to classify organic murmur that occur in congenital heart defect (CHD). The study is based on the data collected at Pediatric Clinic, Clinical Center University of Sarajevo during three-year period. Totally, 116 children aged from 1 to 15 years were enrolled in the study. Input parameters for classification are parameters obtained during basic physical examination and assessment of patient. First, analysis of relevance of the feature for classification was done using InfoGain, GainRatio, Relief and Correlation method. In the second step, classifiers based on Naive Bayes, Logistic Regression, Decision Tree, Random Forest and Support Vector Machine were developed and compared by performance. The results of this research suggest that high accuracy (>90%) classifier for detection of CHD based on 16 parameters can be developed. Such classifier with appropriate user interface would be valuable diagnostic aid to doctors and pediatricians at primary healthcare level for diagnostic of heart murmurs

FROM HEART MURMUR TO ECHOCARDIOGRAPHY CONGENITAL HEART DEFECTS DIAGNOSTICS USING MACHINELEARNING ALGORITHMS

The most common clinical sign in pediatric cardiology is heart murmur, which can often be uncharacteristic. The aim of this research was to present the results of development of a classifier based on machine learning algorithms whose purpose is to classify organic murmur that occur in congenital heart defect (CHD). The study is based on the data collected at Pediatric Clinic, Clinical Center University of Sarajevo during three-year period. Totally, 116 children aged from 1 to 15 years were enrolled in the study. Input parameters for classification are parameters obtained during basic physical examination and assessment of patient. First, analysis of relevance of the feature for classification was done using InfoGain, GainRatio, Relief and Correlation method. In the second step, classifiers based on Naive Bayes, Logistic Regression, Decision Tree, Random Forest and Support Vector Machine were developed and compared by performance. The results of this research suggest that high accuracy (>90%) classifier for detection of CHD based on 16 parameters can be developed. Such classifier with appropriate user interface would be valuable diagnostic aid to doctors and pediatricians at primary healthcare level for diagnostic of heart murmurs

MEDICAL HODEGETICS - ALMOST FORGOTTEN ART AND SCIENCE OF UPBRINGING MEDICAL DOCTORS

Introduction: Education in medicine faces a number of challenges and dilemmas and the onus is on Medical hodegetics, an important but almost forgotten discipline, to address them effectively. The task and final goal of education in medicine is to coach students into professionals, effective and ethical practitioners of medicine, giving them the best available knowledge, skills and attitudes and providing them with a professional identity so that they are able to think, speak, act and feel like medical doctors. During the life course human beings organize their experiences into a meaningful narrative that involves their personal, private, public and professional selves. The self can be defined as a distinct principle of identity, as a narrative construction and as an experiential dimension. Aim: The aim of this paper is to address the actuality and vitality of the hodegetic approach in medical education and professionalism. Methods: By cross-sectional study authors of the paper searched on-line scientific data-bases and analyzed references about Medical hodegetics subject. Results: Drawing on the literature on psychology of self, identity formation and personality styles as well as on own experience in medical education, the authors stress the increasing importance of medical hodegetics, very useful, but almost completely forgotten discipline. Medical hodegetics which involves all evidence-based medicine, values-based medicine, narrative medicine and person-centered medicine can significantly improve the quality of medical education. The identity of any person in any moment reflects its three domains: individual identity, relational identity, and collective identity, all relevant to medical education. The concept of professional identity formation has recently emerged and attracted great attention in literature on medical education and professionalism. Hodegetics, as a discipline that trains it, seems to us that the essential part of life and what every person should follow. Concluson: Medical hodegetics is an important pillar of the triad of medical deontology as well as it could be an important discipline in medical education and professional identity formation

Effect of Preoperative Hormonal Therapy in Hypospadias Surgery: Evaluation of the current practice at the Pediatric surgery Clinic, Clinical Center University of Sarajevo

Introduction:The most common congenital abnormality of the penis is hypospadias. Although the main treatment is surgical; hormone therapy with dihydrotestosterone is also used.Materials and Methods: This randomized clinical trial was carried out between January 2012 and December 2017 on 79 children with hypospadias (in the Clinic of Pediatric Surgery, Clinical Centre University of Sarajevo). Their mean age was 38.2±2.8 months. GroupI included 36 children whom were treated with 2.5% dihydrotestosterone gel which was applied twice a day to the penile shaft and glans for one month prior to surgery. GroupII included 43 children whom did not receive any treatment preoperatively.Results: Mean age of patients in group I was 37.3±6.3 months and in groupII it was 39.1±5.9 months which were comparable. Complications occurring postoperatively were: urethrocutaneous fistula in 6 patients (13.9%) in group II, versus 1 patient (2.7%) in group I. There were 2 patients with meatalstenosis in group II (4.7%), and 3 (8.3%) in group I. Finally, there was a significant difference (p<0.05) between the overall reoperation rates between groups (p<0.05).Conclusion: Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates

Analysis of improving business processes by implementing the lean concept at the level of tertiary healthcare

Introduction. The success of healthcare organizations depends on the quality and speed of providing services to patients. Synonym for the term success of health care organization is the implementation of modern concepts Synonymous with the success of healthcare organizations is the implementation of modern concepts. In this paper, the emphasis is on the lean concept, affects the quality and speed of providing health services. Subject of research. The subject being researched in this paper is a lean concept which essence is determined by the implementation of methods that affect the speed and quality of providing health services. The aim of the work is to point out the actuality of the lean concept and its application at the tertiary level of health care. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). Aim of this paper is to indicate the actuality of the lean concept and its application at the tertiary level of health care system. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). More precise possibilities of imple- menting the lean methodology, which can be used to improve clinical processes. Materials and methods. The research was conducted by designing and using research questionnaires. Questionnaire structured by the author for the purposes of research in this paper. The questionnaire was sent to 472 employees’ mail addresses and was filled out by 91 employees. One of the reasons for the lower questionnaire return rate is the lack of familiarity of employees with the lean concept and its effects on the provision of health services. The return rate of referrals indicates the need for prior presentation and familiarization with the concept itself and its impact on business processes. A Likert scale was used to assess the opinions of healthcare services workers about the effects that would be achieved by applying the lean concept at the tertiary level. Medical wastes are shown in the oncology department (case analysis). We statistically processed the data obtained from the questionnaire using the SPSS 20.0 software package. The results are presented tabularly and graphically. The following methods are used in the paper: analysis method, inductive - deductive method, synthesis method, description method and proof method. Results. The results of the research showed that (analysis of health organizations that apply the lean concept) and the opinion of health workers about the possibility of applying the lean concept at the tertiary level of health care has a positive impact on improving the efficiency of the provision of health services. The interpretation of the correlation coefficient from the previous table indicates the exist- ence of a positive relationship between the effectiveness and efficiency of business processes (r=0.846; p<0,05). Based on the literature review and the obtained results, it was determined that there is no formalized concept with instructions on the implementation of clinical process improvement methods. There was a positive impact on improving the efficiency of the provision of health services, through the imple- mentation of modern methods. The review of the literature and the obtained results revealed that there is no formalized concept with instructions on the implementation of clinical process improvement methods. Conclusion The expected positive effects of the implementation of the lean concept at the tertiary lev- el of the health care of are manifested through: faster service delivery to patients, reduction of service waiting time and general improvement of business processes. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services