Davorina Petek, Ambrož Pušnik, Polona Selič, Eva Cedilnik-Gorup, Žan Trontelj, Marine Riou and Jean Yves Le Reste
Therapeutic alliance is a term most commonly associated with psychotherapeutic treatment, but recently its use has become increasingly significant in the other fields of medicine. An increasing amount of evidence implies that the quality of the therapeutic alliance between the doctor and patient substantially affects treatment outcomes. A European consensus chose the Working Alliance Inventory – Short Revised (WAI-SR) scale as the most efficient for European primary care. This paper presents the process of establishing the semantic and cultural equivalence of the two WAI-SR scales in Slovene.
As a part of a larger international project, a group of four experts translated the two WAI SR scales (physician and patient versions) from English into Slovene. Twenty-six Slovenian family medicine doctors participated in the process of obtaining semantic, idiomatic, experiential and conceptual equivalence in translation using a Delphi consensus procedure. Afterward, a cultural equivalence was made to adapt the translations within the national context.
Agreement on translation was achieved after two Delphi rounds. The back-translation and cultural equivalence were accomplished without major problems, with some minor additional linguistic corrections.
A Slovene version of the WAI-SR scale was successfully adapted and is available for further scale validation and research on therapeutic alliance.
Andrijana Milošević Georgiev, Jelena Kotur-Stevuljević and Dušanka Krajnović
Smoking rates in Serbian adults are among the highest in Europe. The objective of this study is to assess the prevalence of smoking and smoking-related behaviours of Belgrade University students depending on their sociodemographic characteristics and faculty group.
A cross-sectional study was carried out among 2,608 Belgrade University students (59.6% female) in 2015. A self-administered questionnaire was applied to the opportunity sample to collect the data describing students’ smoking habits and attitudes across all 30 faculties of the university.
30.5% of students reported smoking: 26.4% of medical, and 31.1% of non-medical ones. Smoking rate among female students was 31.2% vs. 29.5% among males. Age (p=0.001), relationship (<0.001) and employment status (p=0.002) had statistically significant influence on smoking status, while the differences in smoking status between genders (p=0.141) and medical and non-medical group of students (p=0.066) were not statistically significant. The highest percentage of students started smoking during high school (66.2%). As the most common reason to start smoking, respondents cited peer influence (36.5%). 44.3% of students who smoked unsuccessfully tried to quit smoking.
To combat high smoking prevalence among a younger population, the formal education of students about the adverse impacts of smoking should be integrated in all active anti-smoking programs. Medical students, as future healthcare professionals, can play an important role in smoking rates reduction among both younger and general populations, if properly trained and educated about smoking prevention and cessation techniques.
Biljana Stern, Gregor Socan, Ksenija Rener-Sitar, Andreja Kukec and Lijana Zaletel-Kragelj
To validate the Slovenian version (SOC-13-SVN) of Sense of Coherence 13-item instrument (SOC-13) in Slovenian multiple sclerosis (MS) patients.
A consecutive 134 Slovenian MS patients were enrolled in a cross-sectional study in 2013. The reliability of the SOC-13-SVN was assessed for internal consistency by Cronbach’s alpha coefficient (α), dimensionality by the confirmatory factor analysis (CFA), and criterion validity by Pearson correlation coefficient (r) between SOC-13-SVN global score and MSQOL-54 composite scores – Mental Health Composite score (MHC) and Physical Health Composite score (PHC).
For the SOC-13-SVN instrument as a whole, internal consistency was high (αtotal=0.88) while it was low for three subscales (αcomprehensibility=0.79; αmanageability=0.66; αmeaningfulness=0.69). The results of the CFA confirmed a three-factor structure with good fit (RMSEA=0.059, CFI=0.953, SRMR=0.065), however, the correlations between the factors were very high (rcomprehensibility/manageability=0.938; rcomprehensibility/meaningfulness=0.811; rmanageability/meaningfulness=0.930). The criterion validity analysis showed a moderate positive strength of relationship between SOC-13-SVN global score and both MSQOL-54 composite scores (MHC: r=0.597, p<0.001; PHC: r=0.437, p<0.001).
Analysis of some psychometric properties confirmed that this instrument is a reliable and valid tool for use in Slovenian MS patients. Despite the three-dimensional structure of the instrument, the use of the global summary score is encouraged due to the low reliability of the subscale scores and high correlations between them.
Objective. This study aimed to provide the true picture of a ten-year absenteeism survey with regard to work-related illnesses and injuries in medical-social workers, and to develop an analytical model for the occupational health practitioner to facilitate record linkage between health outcomes and occupational data.
Methods. Severity indicator and specific weight indicator were calculated on the basis of sick leaves evidence from seven care facilities, as well as the average lost days per year within the period 2008-2017. Four types of work-related illnesses, non-reported accidents and five occupational groups accounted for statistic modeling of data.
Results. According to the specific weight indicator for occupations, nurses ranked the first place for musculoskeletal disorders, respiratory and cardiovascular diseases, and traumatic injuries, followed by medical-social-educational staff. Severity indicator for musculoskeletal disorders was high correlated with the number of employees (r=0.66).
Conclusions: This analytical method is reliable to be applied in risk assessment procedures and occupational health expertise.
Case-report of Mycosis fungoides in a patient with occupational asbestos exposure
Alexandra Maria Rașcu, Maria-Gabriela Neicu, Agripina Rașcu and Marina Ruxandra Oțelea
Mycosis fungoides is one of the most common forms of cutaneous T-cell lymphoma. Its diagnosis is sometimes challenging and quite difficult for the physician, because its onset clinical appearance is similar to other skin diseases. Although there are a few hypotheses about mycosis fungoides’ etiology, they aren’t fully understood and still need confirmation. We report the case of a 68 years old patient diagnosed with mycosis fungoides, who has been exposed to asbestos fibers. This case is one of the few reported cases of association between asbestos and mycosis fungoides. There is no data exploring the causal relation between asbestos exposure and mycosis fungoides but common biological mechanisms could represent an argument. If occupational exposure to asbestos will be confirmed in larger studies, a new research-field of asbestos-related diseases needs to be opened.
Ionizing radiation are classified as Class I carcinogens. The exposure to this factor increases the risk of developing cancer, and researchers aim to establish the relationship between the exposure and the risk levels, as well as guidelines which would limit exposure to it. The risks were assessed through studies related to the atomic bomb survivors, to the populations exposed to radiation for the purpose of diagnosis or therapy and to the professionally exposed populations – radiologists, radiotherapists, workers in uranium mines, operatives in the nuclear industry. The population of Japanese survivors of the atomic bombs is the largest population exposed and studied with an extremely wide age range (from the irradiation in utero to old people). This population, made up of 93.000 people, represents a major source of information used to determine the potential risk of low dose radiation exposure. Health professionals working with ionizing radiation have been studied ever since the 1890’s. After the implementation of a radiation protection system, the doses received decreased only to increase again with the technical development and its use in a wide variety of specialties. Two recent studies on large cohorts and during long periods of time brought information about the cancer risk due to occupational exposure to ionizing radiation and shed light on the need to monitor exposed staff and re-evaluate radiological safety standards. This review is focused on recent literature concerning the radiation exposure of medical professionals.
Context. It has been decades since the circadian variation of the secretion of the thyroid stimulating hormone (TSH) was proven in humans. Even so, there are few studies on human beings that explored the relationship existing between night shift circadian rhythm deregulation and thyroid disorders.
Methods. We have revised the occupational medicine files of all employees in a single speciality hospital to conduct an observational study on the prevalence of thyroid disorders in night shift compared to day shift workers. Age, gender, occupational history, body mass index and specialist diagnosed thyroid disorders were recorded. Numerical variables were compared with ANOVA test, and categorical ones with chi test (StatPlus for Mac version v6).
Results. Obesity was slightly more prevalent in night shift workers, but not statistically significant. Instead, we found a significant increase in the prevalence of thyroid disorders in night shift workers (X= 7.424, p = 0.006). As this is a mere observational study, our results only contribute to the pool of data concerning the relationship between thyroid dysfunction and night shifts.
Conclusions: These results should raise awareness, particularly among occupational physicians and endocrinologists, about the influence of sleep and circadian rhythm deregulation on the raising incidence of thyroid disorders.
Case presentation and literature review of the TB diagnosis in silicosis
Patricia Petculescu, Andrei Năstase, Ana-Maria Mănescu and Marina Ruxandra Oțelea
Romania is recognized as the European country with the highest tuberculosis rate in Europe. The association of tuberculosis with silicosis determines synergistic immunosuppression of the alveolar macrophages resulting in a higher grade of pulmonary parenchymal destruction and consequently respiratory failure. The case report approaches a patient with third stage of silicosis and associated active secondary pulmonary tuberculosis disease with positive smears. The impact of the Mycobacterium tuberculosis (MTB) infection’s activation is known to be severe, worsening the prognosis of silicosis and reducing the patient’s quality of life. Regarding the high morbidity rate of tuberculosis, an early diagnosis of tuberculosis in patients with silicosis is paramount, and sometimes cannot be achieved by usual bacteriological tests. Therefore, a better strategy is to be considered in silicotuberculosis, namely to prevent the progression of the latent tuberculosis foci by testing the positive predictive value of up-to-date tests such as IFN-γ inducible protein 10 biomarker, which may allow early detection and treatment.
Iulia-Rahela Marcu, Ion Toma and Adrian Costin Bighea
Quality of life studies in patients with knee osteoarthritis (OA) attest to the significant impact of the disease on day-to-day activities and social interactions. The aim of this study was to assess the efficacy of a physical exercise program on functional status and quality of life in patients with work-related knee osteoarthritis. The present study included 144 participants with knee osteoarthritis, 72% women, mean age (SD) 47.2 (11.1) years. The patients were randomly assigned in two lots based on the type of kinetic treatment: lot A-with knee OA and medication (72 patients) and lot B- with knee OA, medication and exercise program (72 patients). They followed for 12 days ambulatory exercise programs based on increasing knee flexion, muscular strength and endurance, improving balance, coordination, and respiratory exercises. The patients in the control group continued their daily living activities. The evaluation was made at the beginning of the study (T0), after 2 weeks (T1) and 8 weeks after the 12 days of exercise program (T2) and was based on the following parameters: knee mobility (knee flexion), muscular strength, pain assessment on a Visual Analogue Scale (VAS), functional status (Western Ontario &McMaster Universities Osteoarthritis Index - WOMAC) and quality of life evaluation using SF-36 Questionnaire (36-Item Short Form Survey). Out of 144 participants who completed the initial evaluation, 138 also completed the 2 weeks and the 8 weeks follow-up assessments: 70 patients from the control lot and 68 patients from the exercise lot. The benefits of the kinetic programs were shown by a significant improvement in knee mobility and muscular strength for knee extensors (quadriceps muscle) and knee flexor muscles. Testing the linear correlations between the SF-36 score and the VAS (r=0.71, p<0.05) and WOMAC (r=0.83, p<0.05) indicators demonstrates a highly positive relationship between the quality of life expression, the pain assessment score and the functional status score in patients with knee OA. The physical exercise program improves both functional status and quality of life in patients with work-related knee osteoarthritis by increasing the range of motion and muscular strength and by reducing pain.