Family quality of life: adult school children with intellectual disabilities in Bosnia and Herzegovina.

AIMS: This study endeavours to provide initial data on quality of life for families with adult children who have intellectual disabilities (ID) in the Canton of Sarajevo. METHODS: The principal measure used was the Family Quality of life Survey 2006 - main caregivers of people with intellectual or developmental disabilities. The sample consisted of the main caregivers of 35 families with adult school children with ID who attended classes in a specially adapted programme in the Center of Vladimir Nazor and in the Vocational Secondary School in Sarajevo. Of the 35 participants, 21 were male and 14 female. Students with disabilities ranged from 19 to 32 years old (mean 21.45). RESULTS: Consistent with previous research, the nine domains measured by the scale were all rated high for Importance. Opportunities were considered to be particularly low for Financial Well-Being and Support from Others. These domains were also rated lowest for Attainment and Satisfaction. Initiative was relatively high across all domains, and Stability (the degree to which things were seen as likely to improve or decline) varied slightly across domains but the means indicated that things are expected to stay almost the same or improve slightly. CONCLUSIONS: This research provides initial data for family quality of life in Bosnia and Herzegovina. It also provides suggestions for improving quality of life for families that have one or more members with ID. The results should also contribute to rejecting stereotypes and promoting inclusion of children with ID as well as the rights of their families.

[Reconstruction of mental health services in Bosnia and Herzegovina]. / Rekonstrukcija sluzbe za zastitu mentalnog zdravlja u Federaciji Bosne i Hercegovine.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

[Reconstruction of mental health services in the Federation of Bosnia-Herzegovina]. / Rekonstrukcija sluzbe za mentalno zdravlje na teritoriji Federacije Bosne i Hercegovine.

The war in Bosnia and Herzegovina has caused severe suffering of the population, and left behind destruction and misery. Hundreds of thousands were killed, ten thousands were severely injured, and almost the whole population has endured severe psychological traumas. The consequences today are numerous stress related psychical disorders, and especially PTSD. The war has almost destroyed the system of psychiatric services, and lead to lack of professional staff. Because of this, after the war, Federal Ministry of Health of Bosnia and Herzegovina has decided to carry out a complete reconstruction of psychiatric services based on new principles. Comprehensive care for improvement of mental health; prevention of mental illness, treatment and rehabilitation of mentally ill, should be transferred from institutions into the community. Consequently Ministry of Health have designed 38 Community Mental Health Centers in the Federation of Bosnia and Herzegovina in connection with already existing Primary Health Care centers (Dom zdravljas). Each of these centers is responsible for mental health in general within a catchment area of 50,000-80,000 inhabitants. A network of Community Mental Health Centers has started to operate. An efficient and useful training of the staff going to work in these centers have been carried out. Nevertheless, there is still significant resistance towards this new approach to mental health services and treatment of people with mental illness in the community. However, many problems related to this new program of community psychiatry have been identified and are under consideration.

[Psychosocial research during the war in Sarajevo]. / Psihosocijalna istrazivanja u toku rata u Sarajevu.

War in Bosnia and Herzegovina has caused many psychic and social breakdowns. The consequences on mental health of the war which caused stress are of importance, as well as influences on psychic functioning of individuals are caused by changes in social structure of population and economic potential of the society. Project "Psycho-social aspects of war in BiH" carried out within the frame of the Academy of Sciences and Arts of Bosnia and Herzegovina and the Department of Psychiatry of Clinical Center of Sarajevo University. In this article are given the results of the Project, but only partially. The investigations showed that the number of patients visiting hospitals during the war was greatly increased in the field of stress reactions and reactive psychoses. But incidence and prevalence of alcohol psychoses decreased. Findings are the same for out patient clinics. The field investigation on the free territories of Sarajevo s communities shows enormous increase of mental disorders among the citizens: neurotic over 40%, psychotic about 20% and that is, together, more than 60% of the population of the town Sarajevo were disturbed at that time. Among the children and adolescents there was an increase of neurotic and psychotic disorders in the very beginning of the first year of the war, and decrease of the same diagnoses during the second year. This might be explained by particular adaptation of the youngsters to war conditions. When we are talking about invalidity of neurological and psychiatric disorders, the investigations showed that illness is the mostly caused by invalidity (85.1%) among the global invalidity during the war in Sarajevo. Injuries before the war were at 3%, during the war are 11% of cases. But, all those shows temporary, because war caused invalidity more and we are expecting to registration later. Our investigation among the refugee camps and population in Sarajevo shows that "life equipment" among the displaced persons was lower than domestic people. That shows that after the phase of surviving this part of the population was at risk of many psycho-social problems. Also, our investigation shows that very low socio-economical level of inhabitants of Sarajevo leads to the potential of absolutely poverty. The indicators of this trend are: low level of education, very low life standard, unemployment, bad health conditions etc. Among refugees all those indicators are worse. Criminality in Sarajevo during the war has been increased, particularly among adolescents. One fifth of contents of daily newspaper "Oslobodenje" has been during the war oriented to the health system problems.

Genetics of mood disorders--an overview. Part two.

The present article reviews the recent molecular findings in mood disorders. Results of linkage and association studies are discussed in regard to the main limitations of these approaches in psychiatric disorders. On the whole linkage and association studies contributed to the localisation od some potential vulnerability genes for Bipolar disorder (BP) on chromosomes 11, 4, 21 and X. The hypothesis of anticipation in mood disorders is also considered in light of interesting results with trinucleotide repeat expansions.

Genetics of mood disorders--an overview. Part one.

Mood disorders are severe and common psychiatric diseases with two main clinical forms: Bipolar disorder, type 1 (BP1), and Unipolar disorder (UP). This paper provides an overview of the Literature on genetics of BP1 and UP disorders. We described the problems of diagnostic definitions, and statistical methods for studying the genetic etiology of these disorders. Epidemiological and quantitative genetic studies are reviewed. Interactions of susceptibility genes and environmental factors in this disorders are also fundamental and has to be properly investigated. The understanding of genetic aspects of BP1 and UP disorders has benefited from recent findings with DNA markers. Therefore we also provide an overview of linkage and association studies that reveal several chromosomal regions, candidate genes and dynamic mutations which may play role in BP1 and UP disorders.

A rabbit lung model for testing reaction to inhaled dental restorative particles.

A study was designed to test the outcome of the deposition of particles of plastic composite dental restorative material in rabbit lungs. Grinding and polishing these restorations in situ produces some particles in the 0.5- to 10-microns size range that easily enter and remain in human lungs and are associated with industrial lung disease. Dental restorative plastic material was ground in the laboratory, suspended in saline solution, and injected transtracheally into four New Zealand white rabbits. Two control rabbits were similarly injected with saline solution transtracheally. Twenty-four hours later, the rabbits were injected with 1 mCi of 67Ga citrate intravenously and subsequently reanesthetized for scanning. Baseline scans were obtained in the six animals prior to the injection of the test particles. Positive gallium scans were obtained 72 h after the administration of particulate material in the four test rabbits. The gallium scans of the control rabbits remained no different from baseline. The study was repeated one month later. The animals were killed seven days after the last gallium scan. Light microscopy and transmission electron microscopy of the lungs of the test animals showed foci of chronic inflammation around particles of the restorative material. Particles were in vacuoles within alveolar macrophages and also free in interstitium. Control animals had normal histologic conditions. Silver amalgam and gold dental restorations have years of clinical use but the new plastic composite restorative materials are rapidly being introduced into human clinical dental practice. Normal use involves polymerization, grinding, and polishing of the material within the mouth. The chronic inflammation in the lungs of rabbits indicates a need to test dental restorative material for lung biocompatibility before further, extensive clinical use.

Interaction of chlorpromazine and nortriptyline in patients with schizophrenia.

Seven male inpatients suffering from acute schizophrenia were treated with chlorpromazine elixir 100mg 8-hourly for 9 weeks. Nortriptyline 50mg 8-hourly was added during weeks 4, 5 and 6. Plasma chlorpromazine concentrations, antipyrine plasma half-life, blood pressure, pulse rate, pupil size, salivation, handwriting and clinical state were measured at weekly intervals. Plasma chlorpromazine concentrations rose when nortriptyline was added, and the antipyrine plasma half-life was prolonged. Blood pressure dropped on institution of chlorpromazine and dropped further with the addition of nortriptyline. The pulse rate rose in a parallel fashion. Pupil size, salivation and handwriting were diminished by chlorpromazine, but hardly affected further by nortriptyline. The addition of nortriptyline dramatically reversed the therapeutic actions of chlorpromazine, mainly through pharmacodynamic interaction. It is concluded that this combination is potentially deleterious, and must be used with care.

Rupture of base pairing in double-stranded poly(riboadenylic acid)-poly(ribouridylic acid) by formaldehyde: medium chain lenghts.

By assuming that the opening of hydrogen bonds due to thermal fluctuations is a very fast step and that the reaction of formaldehyde with the imino or amino group is a slow step, we have constructed a model for the unwinding process of poly(A-U) induced by formaldehyde. The denaturation equation derived from the model is essentially the same as that of the zipper model for moderately long chain lengths. The model predicts the following phenomena which are in agreement with our experimental findings. The rate of unwinding is approximately first order for unfractionated polynucleotides and zero order for fractionated samples. This means that formaldehyde ruptures helical residues sequentially starting from the ends and working toward the center. Our model further predicts that the denaturation rate is linearly dependent on -log[Na+] and pH at low ionic strength and is almost independent of [Na+] and pH at high ionic strength. Spectrophotometric measurements on poly(A-U) were done to confirm our theoretical findings.

Interactions of orphenadrine and phenobarbitone with chlorpromazine: plasma concentrations and effects in man.

1 Two studies were carried out on acutely psychotic patients receiving chlorpromazine (100 mg) 8-hourly. 2 In the pilot study on five patients, plasma chlorpromazine concentrations fell over the course of 3 weeks of treatment and parallel changes were noted in the plasma half-life of antipyrine, salivation rate and handwriting length. 3 In the main study involving twelve patients treated for 15 weeks, the above findings were confirmed and were interpreted as indicating that chlorpromazine accelerated its own metabolism by inducing liver microsomal oxidising enzymes. No metabolites of chlorpromazine were detected in plasma. 4 The addition of phenobarbitone (50 mg) 8-hourly for 3 weeks, or orphenadrine (100 mg) 8-hourly for 3 weeks, resulted in a lowering of plasma chlorpromazine concentrations together with a further shortening of plasma antipyrine half-life. 5 Physiological effects of the additional treatments suggested that phenobarbitone lessens the effects of chlorpromazine by lowering body concentrations. However, orphenadrine acts more by virtue of its anticholinergic effects. 6 It was concluded that phenobarbitone and orphenadrine should not be prescribed routinely in patients receiving major tranquillisers. The need for the addition of orphenadrine should be assessed in each individual case.