Überzeugungen und kenntnisse einer gelegenheitsprobe von medizinstudenten über körperstrafe bei kindern

Suvremena istraživanja ukazuju kako tjelesno kažnjavanje slabi mentalno zdravlje, kvalitetu odnosa roditelj-dijete, samokontrolu i moralne standarde, a poja-čava agresivnost, delinkvenciju i antisocijalno ponašanje. U Hrvatskoj je zakonom zabranjeno od 1998. godine. Ipak, u svakodnevnoj kliničkoj praksi psiholog se su-sreće s djecom koju roditelji tjelesno kažnjavaju,ali i s pitanjima zdravstvenih djelat-nika o djelotvornosti tjelesne kazne. Stručnjaci u zdravstvu koji rade s djecom imaju mogućnosti razgovarati s roditeljima o odgoju djeteta, a znanjem i stavovima utje-cati na roditeljska uvjerenja o načinima discipliniranja. S obzirom na to kako liječ-nici mogu biti izvor informacija i podrške roditeljstvu, cilj ovoga istraživanja bio je ispitati mišljenja i znanja o tjelesnom kažnjavanju budućih liječnika. U istraživanju su sudjelovala 62 studenta pete godine medicine. Primijenjeni su Skala uvjerenja o opravdanosti i djelotvornosti tjelesnog kažnjavanja, pitanja za procjenu uvjerenja o posljedicama verbalnog i tjelesnog kažnjavanja i Skala stavova okoline prema tjele-snom kažnjavanju (sve Pećnik i Tokić, 2011). Glavni rezultati pokazali su kako se trećina studenata slaže s tvrdnjom da dijete treba nekad dobiti batine. Ukupno 43% studenata zna da je u Hrvatskoj tjelesno kažnjavanje zakonom zabranjeno, 25,8% odgovorilo je da nije sigurno treba li se treća osoba umiješati ako roditelj udari dije-te, a 34% ih misli da se vjerojatno ne treba miješati. Stavove liječnika prema tjeles-nom kažnjavanju studenti medicine u prosjeku percipiraju kao „ni za ni protiv“, a stavove pedagoga, psihologa i socijalnih radnika percipiraju kao stavove stručnjaka koji su protiv tjelesnog kažnjavanja. Rezultati pokazuju kako stavovi i znanja dijela studenata medicine nisu usklađeni s važećim zakonima i spoznajama o tjelesnom kažnjavanju. Odgovori su poticajni za opsežnija ispitivanja, ali i edukacije u medici-ni o podržavajućem roditeljstvu koje unapređuje zdravlje djeteta i kvalitetu života obitelji, dok se primijenjene skale mogu koristiti za senzibilizaciju i razgovore o ponašanjima roditelja koja nose potencijalnu štetu djetetovu razvoju i dostojanstvu.Modern research has shown that corporal punishment affects and weakens mental health, the quality of the parent–child relationship, self-control and moral standards, while it enhances aggression, delinquency and antisocial behavior. It has been prohibited by law in Croatia since 1998. Nevertheless, in everyday clinical practice, psychologists deal with children who have been corporally punished by their parents, as well as with questions raised by health professionals on the effectiveness of corporal punishments. Health professionals who work with children, have the possibility to talk to parents about the child\u27s upbringing, thus, their knowledge and standpoints can influence the parents\u27 views on keeping children disciplined. Since physicians can be a source of information and support to parents, the aim of this research is to question beliefs and knowledge of prospective physicians on corporal punishment. There were 62 fifth-year medical students participating in the research. The following questionnaires were applied: Beliefs on justifiability and efficacy of corporal punishment, Beliefs on consequences of verbal and corporal punishment and Standpoints of community regarding corporal punishment (Pećnik and Tokić, 2011). The main results have shown that one third of the students approve of an assumption that a child should sometimes get spanked. In total, 43.5% of students are familiar with the fact that corporal punishment is prohibited by law in Croatia, about 25.8% of them answered that they are uncertain if a third person should interfere when it comes to child punishment, and if a parent should hit a child, but 34% of the students think that no one should interfere. They consider physicians\u27 standpoint towards corporal punishment on average to be \u27\u27neither pro nor con\u27\u27, and consider pedagogues, psychologists and social workers as experts who are against corporal punishment. The results have shown that standpoints and views of part of the medical students are not in conformity with applicable laws and the knowledge of corporal punishment. The responses can serve as an incentive for more extensive medical research, as well as education on supportive parenting which improves children\u27s health and family life quality, and the questionnaires can be applied raise awareness and discuss parental behavior bearing a potential harm to child development and dignity.Aktuelle Forschungsprojekte belegen, dass körperliche Züchtigung die psychische Gesundheit schwächt, die Beziehung zwischen Eltern und Kind, die Selbstkontrolle und moralische Normen beeinträchtigt sowie Aggressivität, Delinquenz und antisoziales Verhalten verstärkt. In Kroatien ist Körperstrafe seit 1998 gesetzlich verboten. Dennoch treffen Psychologen in ihrem Berufsalltag ständig auf Kinder, die von ihren Eltern körperlich gezüchtigt werden, oder sie werden von Mitarbeitern über die Effizienz körperlicher Züchtigung befragt. Fachleute aus dem Gesundheitssektor, die mit Kindern arbeiten, haben die Möglichkeit, mit Eltern über Kindererziehung zu sprechen. Mithilfe ihrer Kenntnisse und Einstellungen können sie auf die Überzeugungen der Eltern bezüglich Fragen von Disziplinierung Einfluss nehmen. Da Ärzte eine wichtige Informationsquelle und Unterstützung für Eltern sein können, war das Ziel dieser Studie, zukünftige Ärzte über ihre Meinung und ihre Kenntnisse über Körperstrafe zu befragen. An der Studie nahmen 62 Studenten des 5. Studienjahrs Medizin teil. Angewandt wurden folgende Fragebögen: die Skala über die Überzeugung von der Rechtfertigung und Effizienz von Körperstrafe, Fragen zur Bewertung der Einstellung gegenüber den Folgen verbaler und körperlicher Züchtigung, die Skala über die Einstellung der Umgebung gegenüber körperlicher Züchtigung (alle nach Pećnik und Tokić, 2011). Die Umfragen haben ergeben, dass ein Drittel der Studenten mit der Behauptung überstimmt, dass Kinder manchmal körperlich bestraft werden sollten. 43% der Studenten weiß, dass in Kroatien Körperstrafe gesetzlich verboten ist. 25,8% Studenten antworteten, dass sie nicht sicher wären, ob sich Außenstehende einmischen sollten, wenn ein Elternteil sein Kind schlägt, während 34% glauben, dass man sich wahrscheinlich nicht einmischen sollte. Die Einstellung von Ärzten gegenüber körperlicher Züchtigung perzipieren die Medizinstudenten eher als „weder dafür, noch dagegen“, die Einstellung von Pädagogen, Psychologen und Sozialarbeitern perzipieren sie allerdings als Überzeugungen von Fachleuten, die gegen Körperstrafe sind. Die Ergebnisse belegen, dass die Überzeugungen und Kenntnisse eines Teils der Medizinstudenten nicht im Einklang stehen mit dem gängigen Gesetz und den aktuellen Erkenntnissen über Körperstrafe. Die Antworten der Probanden motivieren zu umfangreicheren Forschungsarbeiten, aber auch zur Edukation im Laufe des Medizinstudiums in Richtung autoritativer Elternschaft, die die Gesundheit des Kindes und die Lebensqualität der Familie verbessert. Die in den Fragebögen angewandten Skalen können hilfreich sein bei der Sensibilisierung der Eltern und bei Gesprächen über das nachteilige Verhalten der Eltern gegenüber ihren Kindern, das der Entwicklung des Kindes und seiner Würde nur schaden kann

Homozygous form of hereditary hemochromatosis in a patient with beta-thalassemia minor: case report

Uvod: Dijagnostički pristup bolesniku koji istodobno boluje od nasljedne hemokromatoze i beta-talasemije može biti dosta složen zbog činjenice da teži oblici beta-talasemije sami po sebi mogu imati za posljedicu hemokromatozu. S druge strane, i najlakši oblik beta-talasemije može dovesti do ozbiljnih manifestacija hemokromatoze u bolesnika s heterozigotnim oblikom HFE polimorfizama. Ova stanja, kao i HFE polimorfizmi naslijeđeni u homozigotnom obliku kao rizični čimbenici za razvoj hemokromatoze mogu imati za posljedicu cirozu jetre i hepatocelularni karcinom pa pravodobno prepoznavanje navedenih stanja ima presudno značenje za dužinu i kvalitetu bolesnikova života. Metode: Za prikaz slučaja izabran je bolesnik primljen na Kliniku za zarazne bolesti Kliničke bolnice Osijek s febrilitetom, hepatosplenomegalijom i neurološkim simptomima. Kod prijma su učinjene osnovne laboratorijske pretrage te ultrazvučni pregled abdomena i snimanje glave magnetskom rezonancijom. Naknadno je provedena biopsija jetre, elektroforeza hemoglobina te određivanje koncentracije haptoglobina i utvrđivanje Cys282Tyr polimorfizma HFE gena. Rezultati: Anamnestički podaci i rezultati rutinske laboratorijske obrade su ukazali na mogućnost da bolesnik boluje od beta-talasemije. Proširenom laboratorijskom obradom je dijagnosticirana pigmentna ciroza-hemokromatoza, a potvrđena je dijagnoza beta-talasemije minor. Odgovarajući moleularno-dijagnostički postupak je dokazao prisutnost homozigotnog oblika nasljedne hemokromatoze. Zaključak: Određivanje koncentracije feritina i zasićenje transferina željezom, elektroforeza hemoglobina i utvrđivanje polimorfizma Cys282Tyr HFE gena pokazali su se ključnim čimbenicima za relativno brzo postavljanje ispravne dijagnoze u prikazanom slučaju istodobnog nasljeđivanja beta-talasemije minor i homozigotnog oblika nasljedne hemokromatoze. Homozigotni oblik nasljedne hemokromatoze uz beta-talasemiju minor objašnjava težinu simptoma prisutnih kod bolesnika u vrijeme hospitalizacije.Background: Diagnostic approach to the simultaneous inheritance of beta-thalassemia and hereditary hemochromatosis might be quite complex due to the fact that severe beta-thalassemia itself may lead to hemochromatosis. On the other hand, beta-thalassemia minor accompanied by some heterozygous form of HFE polymorphism may also lead to the disease manifestation. These conditions as well as the homozygous forms of HFE polymorphisms are hemochromatosis risk factors that may lead to liver cirrhosis and hepatocellular carcinoma. Therefore, early diagnosis is crucial for patient quality of life and life expectancy. Methods: A febrile patient admitted to Department of Infectious Diseases, Osijek University Hospital, with hepatosplenomegaly and some neurological symptoms has been chosen for this case report. Basic laboratory tests as well as ultrasound examination of the abdomen and magnetic resonance imaging of the head were performed shortly upon admission. Liver biopsy, hemoglobin electrophoresis, haptoglobin concentration and Cys282Tyr polymorphism determination were subsequently obtained. Results: History data and laboratory findings suggested the diagnosis of beta-thalassemia. Extended laboratory work-up pointed to the diagnosis of pigment cirrhosis-hemochromatosis, and verified the diagnosis of beta-thalassemia minor. Appropriate molecular diagnostic procedure indicated the homozygous form of hereditary hemochromatosis. Conclusions: In this case of homozygous hereditary hemochromatosis and beta-thalassemia minor coinheritance, serum ferritin concentration, tran-sferrin saturation, hemoglobin electrophoresis and HFE gene Cys282Tyr polymorphism analysis proved to be crucial for the relatively fast establishment of accurate diagnosis. Recognition of the homozygous form of hemochromatosis in association with beta-thalassemia minor explained the complexity and severity of the disease presentation

ANXIETY AND DEPRESSION IN PAEDIATRIC PATIENTS WITH PAINFUL SOMATIC COMPLAINTS

Cilj istraživanja je bio procijeniti razinu i strukturu anksioznosti i depresivnosti djece i mladih s ponavljanim bolnim tjelesnim tegobama (1) i usporediti ih s vrijednostima normativnog uzorka (2), usporediti bolesnike s pojedinačnim i one s višestrukim tjelesnim tegobama te (3) ispitati proporciju klinički značajno anksioznih i depresivnih bolesnika. Skalom strahova i anksioznosti (SKAD-62) i skalom depresivnosti (SDD) ispitano je 160-ero djece u dobi od 10 do 17 godina, koju su pedijatri uputili psihologu u okviru bolničkog ili ambulantnog liječenja: 57-ero djece s glavoboljama, 24-ero s bolovima u trbuhu, 40-ero s bolovima u prsištu i njih 39-ero s višestrukim tegobama. Rezultati su pokazali kako svi bolesnici imaju sličnu ukupnu razinu anksioznosti i depresivnosti kao i djeca iz normativnog uzorka. Klinički značajna anksioznost registrirana je u 22%, a klinički značajna depresivnost u 4% bolesnika. Najviše je visoko anksiozne djece s bolovima u prsištu (35%), a najmanje s glavoboljama (8,6%). Djeca s višestrukim tjelesnim tegobama ne iskazuju veću anksioznost i depresivnost od one s pojedinačnim tegobama. Između kliničkih skupina iskazana je razlika u dominantnim oblicima anksioznosti: djeca s glavoboljama većinom su separacijski anksiozna, ona s bolovima u trbuhu i u prsištu većinom su anksiozno osjetljiva, a djeca s više tjelesnih tegoba zabrinuta.The aim of this study was to examine the level and different aspects of anxiety and depression in children and youth with recurrent painful somatic complaints and (1) compare them to the norm values of a general population sample, (2) compare the patients with single complaints to patients with multiform somatic complaints and (3) to examine the proportion of clinically significant anxiety and depressive patients. The Fear and Anxiety Scale SKAD-62 and The Depression Scale SDD were applied to 160 children, ages 10 to 17, who were referred by paediatric specialists for psychology assessment under hospital or ambulatory treatment: 56 with headaches, 24 stomach pain sufferers, 40 chest pain sufferer and 39 children with multiple somatic complaints. The results showed that all patients had similar global levels of anxiety and depression as compared to the norm values. Clinically significant anxiety was observed in 22% patients and clinically significant depression in 4% patients. Most anxiety in patients was found in the chest pain group (35%) and less in those with headache (8.6%). Children with multiform complaints are as anxious as single complaint sufferers. A difference was found between clinical samples in different aspects of anxiety symptoms: those with headache were separation anxious, abdominal and chest pain sufferers were more anxiety sensitive, multiform complainers were more worried

Plasma leptin in obesity related hypertension

Background and Purpose: It is well known that obesity is related to hypertension through several mechanisms, such as sympathetic overactivity and excess renal sodium reabsorption. Obesity and hypertensionmay also be linked by leptin, a peptide that is elevated in obese individuals. Leptin is an adipocyte derived hormone that acts in hypothalamus to regulate appetite, energy expenditure and sympathetic nervous system outflow, as well as in peripheral tissues, such as blood vessels and kidneys. The aim of our research was to determine plasma leptin in hypertensive and normotensive obese patients with the same body mass index (BMI) and show a possible difference between leptin levels in these two groups of patients. Materials and Methods: The research was carried out on 21 hypertensive and 19 normotensive patients (20 men and 20 women) with BMI in range 30–35 kg/m2, normal values of fasting plasma glucose, urea and creatinine. Leptin was determined using Elisa method. Results and Conclusion: The results showed that men had significantly higher waist to hip ratio (W/H). Plasma leptin was significantly higher in hypertensive women as well as in hypertensive men (p=0.03) in relation to normotensive patients. There was also significant difference in serum craetinine and creatinine clearance between normotensive and hypertensive women, although creatinine was within normal range. There was a significant difference in serum tryglicerides between men and women in general, where men had higher values (p=0.016). This confirmed that leptin correlates with hypertension in both men and women

ANXIETY AND DEPRESSION IN PAEDIATRIC PATIENTS WITH PAINFUL SOMATIC COMPLAINTS

Cilj istraživanja je bio procijeniti razinu i strukturu anksioznosti i depresivnosti djece i mladih s ponavljanim bolnim tjelesnim tegobama (1) i usporediti ih s vrijednostima normativnog uzorka (2), usporediti bolesnike s pojedinačnim i one s višestrukim tjelesnim tegobama te (3) ispitati proporciju klinički značajno anksioznih i depresivnih bolesnika. Skalom strahova i anksioznosti (SKAD-62) i skalom depresivnosti (SDD) ispitano je 160-ero djece u dobi od 10 do 17 godina, koju su pedijatri uputili psihologu u okviru bolničkog ili ambulantnog liječenja: 57-ero djece s glavoboljama, 24-ero s bolovima u trbuhu, 40-ero s bolovima u prsištu i njih 39-ero s višestrukim tegobama. Rezultati su pokazali kako svi bolesnici imaju sličnu ukupnu razinu anksioznosti i depresivnosti kao i djeca iz normativnog uzorka. Klinički značajna anksioznost registrirana je u 22%, a klinički značajna depresivnost u 4% bolesnika. Najviše je visoko anksiozne djece s bolovima u prsištu (35%), a najmanje s glavoboljama (8,6%). Djeca s višestrukim tjelesnim tegobama ne iskazuju veću anksioznost i depresivnost od one s pojedinačnim tegobama. Između kliničkih skupina iskazana je razlika u dominantnim oblicima anksioznosti: djeca s glavoboljama većinom su separacijski anksiozna, ona s bolovima u trbuhu i u prsištu većinom su anksiozno osjetljiva, a djeca s više tjelesnih tegoba zabrinuta.The aim of this study was to examine the level and different aspects of anxiety and depression in children and youth with recurrent painful somatic complaints and (1) compare them to the norm values of a general population sample, (2) compare the patients with single complaints to patients with multiform somatic complaints and (3) to examine the proportion of clinically significant anxiety and depressive patients. The Fear and Anxiety Scale SKAD-62 and The Depression Scale SDD were applied to 160 children, ages 10 to 17, who were referred by paediatric specialists for psychology assessment under hospital or ambulatory treatment: 56 with headaches, 24 stomach pain sufferers, 40 chest pain sufferer and 39 children with multiple somatic complaints. The results showed that all patients had similar global levels of anxiety and depression as compared to the norm values. Clinically significant anxiety was observed in 22% patients and clinically significant depression in 4% patients. Most anxiety in patients was found in the chest pain group (35%) and less in those with headache (8.6%). Children with multiform complaints are as anxious as single complaint sufferers. A difference was found between clinical samples in different aspects of anxiety symptoms: those with headache were separation anxious, abdominal and chest pain sufferers were more anxiety sensitive, multiform complainers were more worried