Assessment of the Frequency, Causes, Degree and Consequences of Violence against Health Workers in Psychiatric Institutions.

(1) Background: The prevalence of workplace violence within the health sector varies between 50 and 88%. Depending on the health care environment, the percentages mentioned can be much higher. (2) The aim of this study was to determine the prevalence, characteristics, factors, and consequences of violence against healthcare workers (physicians, nurses, and technicians) in psychiatric institutions in the Republic of Serbia. Additionally, this study should validate the Serbian version of the aggression questionnaire, which could be a significant tool in recognizing and assessing any type of violence against health care workers in psychiatric institutions. (3) Methods: This study was designed as an observational questionnaire study that included 191 health workers (physicians, medical technicians, workers in kitchens or maintenance, and others) from three psychiatric institutions. As an instrument, this study validated and used the Serbian version of the aggression standardized questionnaire. We observed the primary and secondary outcomes of potential violence in psychiatric institutions against healthcare workers using different parameters. (4) Results: The internal consistency of each item as well as the instrument was very good (the mean Cronbach alfa = 0.91). A total of 104 of the participants never experienced physical violence, while more than five times that had 20 health workers (10.5%). We observed the statistical significance of gender, age, working status (permanent/limited) and professional status (physician/medical technician/worker etc.) on physical attack incidence. (5) Conclusions: The incidence of violence against healthcare workers is very high, especially in terms of physical assault and threats in the workplace. The majority of the victims were women who work as medical technicians, attacked by male patients with unknown motivation. A number of changes in the structure and organizational culture of the hospital are required. All hospital employees, employers, patients, and their families share responsibility for the creation of a safe workplace.

Potential role of d-chiro-inositol in reducing oxidative stress in the blood of nonobese women with polycystic ovary syndrome.

d-chiro-Inositol (DCI), an isomer of inositol, possesses antioxidative and endothelial protective properties. Possibly due to a deficiency of insulin mediators, polycystic ovary syndrome (PCOS) is often associated with insulin resistance (IR) and hyperinsulinemia, likely responsible for an elevated production of reactive oxygen species. We investigated oxidative-related alterations of inositol in the blood of women with PCOS before and after treatment with DCI. A total of 38 normal-weight PCOS women were investigated before and after DCI administration (500 mg/day for 12 weeks; n = 38) by evaluating serum testosterone, serum androstenedione, fasting serum insulin, fasting serum glucose, and parameters of IR. From the blood, we determined biomarkers of oxidative stress: superoxide anion radicals, hydrogen peroxide, nitric oxide, and the index of lipid peroxidation. The activity of catalase and superoxide dismutase and the reduced glutathione (GSH) content in the hemolysate were also assessed. Data showed that PCOS patients' plasma underwent oxidative stress, as indicated by the higher level of prooxidants and reduced cytosolic GSH content. DCI treatment significantly improved the metabolic parameters. Also, serum values of testosterone were reduced. In conclusion, PCOS patients suffer from a systemic oxidative stress that induces endothelial dysfunction. Treatment with DCI is effective in reducing hormonal, metabolic, and oxidative abnormalities in PCOS patients by improving IR.

The acute effects of different spironolactone doses on cardiac function in streptozotocin-induced diabetic rats.

Currently, cardiovascular diseases are the leading cause of global mortality, while diabetes mellitus remains an important cause of cardiovascular morbidity. A recent study showed that patients with diabetes mellitus treated with mineralocorticoid receptor antagonists have improved coronary microvascular function, leading to improved diastolic dysfunction. In this study, we evaluated the influence of acute administration of spironolactone on myocardial function in rats with streptozotocin-induced diabetes mellitus, with special emphasis on cardiodynamic parameters in diabetic rat hearts. The present study was carried out on 40 adult male Wistar albino rats (8 weeks old). Rats were randomly divided into 4 groups (10 animals per group): healthy rats treated with 0.1 µmol/L of spironolactone, diabetic rats treated with 0.1 µmol/L of spironolactone, healthy rats treated with 3 µmol/L of spironolactone, and diabetic rats treated with 3 µmol/L of spironolactone. Different, dose-dependent, acute responses of spironolactone treatment on isolated, working diabetic and healthy rat heart were observed in our study. In healthy rats, better systolic function was achieved with higher spironolactone dose, while in diabetic rats, similar effects of low and high spironolactone dose were observed.

Protective role of carbon dioxide (CO2) in generation of reactive oxygen species.

The results testify to the fact that CO2 is a powerful inhibitor of reactive oxygen species (ROS) generation by cells (blood phagocytes and alveolar macrophages of 96 people and cells of inner organs and tissue phagocytes (of liver, brain, myocardium, lungs, kidneys, stomach, and skeleton muscles), as well as by mitochondria of the liver of 186 white mice and human tissues. Generation of ROS was determined using various methods with CO2 directly acting on the cells and bioptates and indirectly on the organism as a whole. CO2 in the concentration of 5.1% (P = 37.5 mmHg), 8.2% (P = 60.0 mmHg), and 20% (P = 146.0 mmHg) in a mixture with air (total pressure = 730 mmHg) inhibits the basal ROS generation by phagocytes on the average by 3.52, 5.69, and 10.03 times, respectively (p < 0.05), and the stimulated by corpuscular particles: (a) zymosan by 3.24, 4.43, and 7.95 times; (b)SiO2: by 2.99, 3.24, and 5.76 times (p < 0.05). This is confirmed by the feet that CO2, along with inhibiting the O2 (-) generation by cells of the various organs, including the liver, as a rule, by 2.19-4.7 times, p < 0.01 or <0.001 induces simultaneously a decrease in the O2 (-) generation by mitochondria isolated from the liver (by 1.91-3.2 times, p < 0.001). The mechanism of CO2 influence is realized, in part, by inhibition of NADPH-oxidase activity. Taken into consideration proven role of CO2 in different pathophysiological conditions, (such as endoarteritis, bronchial asthma, and infectious diseases), present findings may be of clinical interest in terms of potential implementation of CO2 donors as adjuvant therapeutics in these diseases.

The effects of chronic administration of nandrolone decanoate on redox status in exercised rats.

For the past 40 years, anabolic-androgenic steroids have been used by a wide variety of athletes with the hope of improving their training, endurance, and performance. The aim of this study was to examine the chronic effects of nandrolone decanoate (20 mg/kg, s.c, Deca-Durabolin DECA(®)) on oxidative stress biomarkers in the hearts of sedentary and exercised rats. The male Wistar albino rats (n = 180, four groups with three subgroups, 15 per subgroup, age 10 weeks, body mass 200-220 g) were sacrificed, and in the collected samples of blood, the following markers of oxidative stress were measured spectrophotometrically: (1) index of lipid peroxidation (measured as TBARS-thiobarbituric acid reactive substances); (2) nitrites (NO2 (-)); (3) hydrogen peroxide (H2O2); (4) superoxide anion radical (O2 (-)), and superoxide dismutase, catalase, and glutathione reductase. The results clearly show that the impact of ND alone, or in combination with physical training in general, is mildly pro-oxidative. The chronic physical training probably induces the protective antioxidant enzyme system , which may be of clinical interest when faced with overdosage of this drug.

Occupational exposure to blood and body fluids among health-care workers in Serbia.

OBJECTIVES: The aim of this study was to examine the epidemiology of occupational accidents and self-reported attitude of health-care workers (HCWs) in Serbia. SUBJECTS AND METHODS: A cross-sectional study was conducted among HCWs in selected departments of five tertiary care hospitals and in one secondary care hospital in February 2012. A previously developed self-administered questionnaire was provided to HCWs who had direct daily contact with patients. χ(2) test and Student's t test were used for statistical analysis of the data. RESULTS: Of the 1,441 potential participants, 983 (68.2%) completed the questionnaire: 655 (66.7%) were nurses/medical technicians, 243 (24.7%) were physicians and 85 (8.6%) were other personnel. Of the 983 participants, 291 (29.6%) HCWs had had at least one accident during the previous year and 106 (40.2%) of them reported it to the responsible person. The highest prevalence (68.6%) of accidents was among nurses/technicians (p = 0.001). Accidents occurred more often in large clinical centers (81.1%; p < 0.001) and in the clinical ward, intensive care unit and operating theater (p = 0.003) than in other departments. Seventy-six (13.1%) nurses/medical technicians had an accident during needle recapping (p < 0.001). Of all the HCWs, 550 (55.9%) were fully vaccinated, including significantly more doctors (154, 63.4%) than participants from other job categories (p < 0.001). CONCLUSION: There was a relatively high rate of accidents among HCWs in our hospitals, most commonly amongst nurses and staff working in clinical wards, intensive care units and operating theaters. The most common types of accidents were needlestick injuries and accidents due to improper handling of contaminated sharp devices or occuring while cleaning instruments or by coming into contact with blood through damaged skin or through the conjunctiva/mucous membranes.

[Analysis of regulatory-ethical framework of clinical trials].

INTRODUCTION: Every clinical trial has to meet all ethical criteria in addition to the scientific ones. The basic ethical principles in the clinical trials are the following: nonmaleficence, beneficence, respect for autonomy and the principle of justice. OBJECTIVE: The aim of the study was to analyse clinical cases with the outcomes leading to the changes in regulatory-ethical framework related to the clinical trials, as well as the outcomes of key clinical trials that influenced the introduction of the ethical principles into clinical trials. METHODS: This was a descriptive research (methods of analysis and documentation; desk analysis of the secondary data). RESULTS: By analysing the cases from the secondary sources as well as clinical and ethical outcomes, it may be noticed that the codes, declarations and regulations have been often preceded by certain events that caused their adoption. Moral concern and public awareness of the ethical issues have initiated not only the development of numerous guidelines, codes, and declarations, but also their incorporation into the legislative acts. CONCLUSION: It is desirable that ethical instruments become legally binding documents, because only in this way will be possible to control all phases of the clinical trials and prevent abuse of the respondents.

Serbian translation of the 20-item Toronto Alexithymia Scale: psychometric properties and the new methodological approach in translating scales.

INTRODUCTION: Since inception of the alexithymia construct in 1970's, there has been a continuous effort to improve both its theoretical postulates and the clinical utility through development, standardization and validation of assessment scales. OBJECTIVE: The aim of this study was to validate the Serbian translation of the 20-item Toronto Alexithymia Scale (TAS-20) and to propose a new method of translation of scales with a property of temporal stability. METHODS: The scale was expertly translated by bilingual medical professionals and a linguist, and given to a sample of bilingual participants from the general population who completed both the English and the Serbian version of the scale one week apart. RESULTS: The findings showed that the Serbian version of the TAS-20 had a good internal consistency reliability regarding total scale (alpha=0.86), and acceptable reliability of the three factors (alpha=0.71-0.79). CONCLUSION: The analysis confirmed the validity and consistency of the Serbian translation of the scale, with observed weakness of the factorial structure consistent with studies in other languages. The results also showed that the method of utilizing a self-control bilingual subject is a useful alternative to the back-translation method, particularly in cases of linguistically and structurally sensitive scales, or in cases where a larger sample is not available. This method, dubbed as 'forth-translation' could be used to translate psychometric scales measuring properties which have temporal stability over the period of at least several weeks.

[Importance of early detection of lung cancers with initial paraneoplastic manifestations].

INTRODUCTION: Lung cancers are mostly detected in the developed clinical stages, with clearly manifested pulmonary, extrapulmonary or metastatic manifestations. In the early disease stages, radiographic and clinical manifestations may be absent or mimicked. OBJECTIVE: The aim of this study was the timely detection of early pulmonary, extrapulmonary and paraneoplastic manifestations of lung cancers in order to apply the most appropriate treatment protocols. METHODS: We examined 230 patients with lung cancer, among them 125 of the working study group with minimal pulmonary and/or initial paraneoplastic symptoms, and 105 patients in the control group with clear tumour manifestations. RESULTS: The symptom analysis revealed a statistically significantly lesser presence of the respiratory symptoms in the working study group (68%) in comparison with the control group of patients (97%) (chi2 = 29.996; p < 0.001). The analysis of radiographic presentations of lung cancer showed that there were significantly more patients with normal findings in the working group (6.4%) than in the control group--1.9% (p > 0.05), and a positive bronchoscopic finding of the centrally localized tumour (mainly right upper lobe) was confirmed in patients of both groups with normal radiographic findings. The number of diagnosed patients in earlier clinical disease stages (I, II, IIIa) with better prognosis in non-small cell lung cancer was significantly higher (chi2 = 19.149; p < 0.001) in the working group (71.1%) in comparison with the control group (38.1%). Small cell lung cancer was more frequently diagnosed in the stage of limited disease in the working (80%) than in the control group (38.1%) (chi2 = 10.039; p < 0.05). With regard to treatment administration, there is a statistically significant difference (chi2 = 4.013; p = 0.0452) in the frequency between the use of chemotherapy and highly significant difference (chi2 = 22.044; p < 0.001) in the frequency of use of surgical treatment in the working group in comparison with the control group--both chemotherapy and surgery treatment were more frequent in the patients of the working group. CONCLUSION: Recognizing the initial pulmonary, extrapulmonary or paraneoplastic manifestations as well as performing diagnostic procedures in due time represent the most important guidelines in early detection and the most efficacious therapeutic choice in lung cancer.

Monitoring of drug-associated electrolyte disturbances in a hospital.

PURPOSE: The aim of our study was to find drug-associated changes in serum levels of major electrolytes using clinical-event monitoring method. METHODS: During 1-year period, electrolyte disturbances in serum samples from patients of Clinical Center Kragujevac, Serbia, were monitored in central biochemical facility. A sample of 982 patients was randomly selected from total population of 43,120 patients whose electrolyte serum levels were measured in the facility during the study period. RESULTS: Clinically important drug-associated electrolyte disturbances were detected in 181 patient. There were 25 significant associations between the drugs and electrolyte values outside the reference range. However, only four causal connections were established: use of normal saline infusion with hypernatremia (OR 6.97, 95%CI 2.24-21.67), theophylline with acid-base disturbances (7.75, 1.46-41.02), polygeline infusion with decrease in bicarbonate levels (4.08, 1.42-11.73), and association of risperidone and hypocalcemia (4.10, 1.42-11.81). CONCLUSION: Although clinical-event monitoring method is far from optimal, it could quantify the known risks and provide evidence for credible hypothesis of drug adverse reactions, based on both relevant biological pathways and reasonable clinical thinking, as it was the case in our study.

Trends in consumption of psychiatric drugs in Serbia and Montenegro 2000-2004.

PURPOSE: To investigate the trends in psychiatric drugs utilization in Serbia and Montenegro over the 5-years period (2000-2004). MATERIALS AND METHODS: The wholesale data issued by the manufacturers or distributors were used. Also, the lists of drugs used from the Institute of Mental Health (institution which provides primary, secondary and tertiary psychiatric care) were used to corroborate the wholesale data. The utilization of drugs in general population was calculated using ATC/DDD methodology, and was expressed in Defined Daily Doses (DDD) per 1000 inhabitants per day. The utilization of drugs in the Institute of Mental Health was calculated from the hospital pharmacy records and was expressed as the number of DDDs per 100 bed-days. The statistics was performed using standard statistical methods. RESULTS: The general consumption of psychiatric drugs in Serbia and Montenegro significantly increased during the 2000-2004 period (from 45.1 DDD/1000 inhabitants/day in 2000 to 69.1 DDD/1000 inhour/day in 2004). The general utilization of anxiolytic/hypnotic drugs surged significantly, but the inhospital use remained rather stable. The most prominent changes were noted in the utilization of antidepressants, which doubled in that period, both in general and inhospital settings. Among antipsychotics in general population, there is a significant increase in the utilization of clozapine. In inhospital setting, there is a significant increase of total utilization of antipsychotic drugs, but this is also mainly on the account of atypicals. CONCLUSIONS: The total consumption of psychiatric drugs significantly increased. The utilization of anxiolytic/hypnotic drugs in 2004 reached 60 DDDs/1000 inhabitants/day, which is in collision with the trend in developed countries. It is necessary to form national guidelines for prescribing anxiolytic/hypnotic drugs, in order to rationalize their use. More favourable is the antidepressant (SSRIs in particular) and atypical antipsychotic drugs utilization increase.