<p>Uvod: Antimikrobna rezistencija bakterija predstavlja globalni problem. Najvažniji faktor za njen nastanak je neadekvatna primena antibiotika, koja podrazumeva: Upotrebu antibiotika bez odgovarajuće dijagnoze, neadekvatan izbor leka, dužinu<br />primene i doziranje. Zbog specifičnosti populacije vitalno ugroženih bolesnika u jedinicama intenzivne terapije (JIT) i bolničkih infekcija uzrokovanih multirezistentnim bakterijama, primena antibiotika je na ovim odeljenjima učestala. Pokazana je povezanost između razvoja antimikrobne rezistencije i veličine potro&scaron;nje antibiotika u JIT. Cilj: Analiza primene antibiotika prema indikacijama na Klinici za anesteziju i intenzivnu terapiju, KC Vojvodine, zatim analiza stanja antimikrobne rezistencije<br />najče&scaron;ćih uzročnika bolničkih infekcija i analiza korelacije između navedenih uzročnika bolničkih infekcija i empirijski primenjivane antibiotske terapije na Klinici za anesteziju i intenzivnu terapiju. Materijal i metode: Prospektivna, opservaciona studija, sprovedena u jednogodi&scaron;njem period, u JIT, Klinike za anesteziju i intenzivnu terapiju, uključila je 856 ispitanika, oba pola, starijih od 18 godina kod kojih je tokom hospitalizacije u JIT bio primenjen antibiotik. Ispitanici su, radi prikupljanja podataka, bili podeljeni u dve grupe u zavisnosti od toga da li su imali bolničku infekciju ili ne. Adekvatnost primene antibiotika je analizirana prema indikacijama (hirur&scaron;ka profilaksa, bolničke infekcije, vanbolničke infekcije i drugo), a u odnosu na izbor antibiotika, dužinu primene, režim doziranja, veličinu pojedinačne doze i način promene terapije (prema preporukama farmakoterapijskog vodiča The Sanford guide to antimicrobial therapy i antimikrobnoj osetljivosti bakterijskih uzročnika bolničkih infekcija u JIT. Za izračunavanje potro&scaron;nje antibiotika u JIT kori&scaron;ćena je ATC/DDD metodologija. Podaci o antimikrobnoj osetljivosti dobijeni su iz rezultata mikrobiolo&scaron;ke obrade uzorkovanog materijala. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 21 Statistics. Podaci su predstavljeni tabelarno i grafički, obrađeni su standardnim statističkim testovima, a statistička značajnost određivanja je bila na nivou p&lt; 0,05. Ispitivanje povezanosti između potro&scaron;nje anibiotika i antimikrobne rezistencije urađeno je primenom Pirsonovog koeficijenta korelacije. Rezultati: Izbor antibiotika kod bolesnika u JIT nije bio adekvatan u 52,19% preskripcija. Izbor empirijski indikovanih antibiotika za lečenje bolničkih infekcija nije bio u skladu antimikrobnom osetljivo&scaron;ću izolovanog uzročnika u 78,44% preskripcija. Izbor antibiotika za hirur&scaron;ku profilaksu nije bio adekvatan u 55,6% preskripcija. Antimikrobna rezistencija Acinetobacter spp.na karbapeneme, fluorohinolone i cefalosporine bila je preko 90%, na aminoglikozide preko 70%. Klebsiella pneumoniae bila je rezistentna na fluorohinolone i cefalosporine 80%, dok je na grupu karbapenema bila 18%. Pseudomonas aeruginosa je bio rezistentan na karbapeneme i aminoglikozide preko 50%, na antipseudomonasne cefalosporine preko 40%. Na kolistin nije zabeležena rezistencija ni jedne izolovane bakterijske vrste. Značajna pozitivna korelacija zabeležena je između potro&scaron;nje empirijski indikovanog meropenema i rezistencije Acinetobacter spp. Zaključak: U vise od 50% slučajeva primena antibiotika u JIT nije bila u skladu sa stanjem antimikrobne rezistencije bakterijskih uzročnika bolničkih infekcija i savremenim farmakoterapijskim protokolima. Antimikrobna rezistencija Acinetobacter spp, Klebsiellae pneumoniae и Pseudomonas aeruginosae je iznosila preko 20% na antibiotike preporučene savremenim farmakoterapijskim smernicama, osim u slučaju rezistencije Klebsiellaе pneumoniae na grupu karbapenema. Između pojave rezistencije Acinetobacter spp. i potro&scaron;nje empirijski indikovanog meropenema utvrđena je statistički značajna pozitivna povezanost, dok za druge dve navedene bakterijske vrste ova povezanost nije bila statistički značajna. Na osnovu podataka o najče&scaron;ćim bakterijskim uzročnicima i njihovoj antimikrobnoj osetljivosti za empirijsku<br />terapiju pneumonija mogao bi biti preporučen jedino kolistin, dok bi za lečenje urinarnih infekcija mogao biti preporučen imipenem ili meropenem. Potrebno je promeniti farmakoterapijski pristup u primeni antibiotika u JIT.</p> / <p>Uvod: Antimikrobna rezistencija bakterija predstavlja globalni problem. Najvažniji faktor za njen nastanak je neadekvatna primena antibiotika, koja podrazumeva: Upotrebu antibiotika bez odgovarajuće dijagnoze, neadekvatan izbor leka, dužinu<br />primene i doziranje. Zbog specifičnosti populacije vitalno ugroženih bolesnika u jedinicama intenzivne terapije (JIT) i bolničkih infekcija uzrokovanih multirezistentnim bakterijama, primena antibiotika je na ovim odeljenjima učestala. Pokazana je povezanost između razvoja antimikrobne rezistencije i veličine potro&scaron;nje antibiotika u JIT. Cilj: Analiza primene antibiotika prema indikacijama na Klinici za anesteziju i intenzivnu terapiju, KC Vojvodine, zatim analiza stanja antimikrobne rezistencije<br />najče&scaron;ćih uzročnika bolničkih infekcija i analiza korelacije između navedenih uzročnika bolničkih infekcija i empirijski primenjivane antibiotske terapije na Klinici za anesteziju i intenzivnu terapiju. Materijal i metode: Prospektivna, opservaciona studija, sprovedena u jednogodi&scaron;njem period, u JIT, Klinike za anesteziju i intenzivnu terapiju, uključila je 856 ispitanika, oba pola, starijih od 18 godina kod kojih je tokom hospitalizacije u JIT bio primenjen antibiotik. Ispitanici su, radi prikupljanja podataka, bili podeljeni u dve grupe u zavisnosti od toga da li su imali bolničku infekciju ili ne. Adekvatnost primene antibiotika je analizirana prema indikacijama (hirur&scaron;ka profilaksa, bolničke infekcije, vanbolničke infekcije i drugo), a u odnosu na izbor antibiotika, dužinu primene, režim doziranja, veličinu pojedinačne doze i način promene terapije (prema preporukama farmakoterapijskog vodiča The Sanford guide to antimicrobial therapy i antimikrobnoj osetljivosti bakterijskih uzročnika bolničkih infekcija u JIT. Za izračunavanje potro&scaron;nje antibiotika u JIT kori&scaron;ćena je ATC/DDD metodologija. Podaci o antimikrobnoj osetljivosti dobijeni su iz rezultata mikrobiolo&scaron;ke obrade uzorkovanog materijala. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 21 Statistics. Podaci su predstavljeni tabelarno i grafički, obrađeni su standardnim statističkim testovima, a statistička značajnost određivanja je bila na nivou p&lt; 0,05. Ispitivanje povezanosti između potro&scaron;nje anibiotika i antimikrobne rezistencije urađeno je primenom Pirsonovog koeficijenta korelacije. Rezultati: Izbor antibiotika kod bolesnika u JIT nije bio adekvatan u 52,19% preskripcija. Izbor empirijski indikovanih antibiotika za lečenje bolničkih infekcija nije bio u skladu antimikrobnom osetljivo&scaron;ću izolovanog uzročnika u 78,44% preskripcija. Izbor antibiotika za hirur&scaron;ku profilaksu nije bio adekvatan u 55,6% preskripcija. Antimikrobna rezistencija Acinetobacter spp.na karbapeneme, fluorohinolone i cefalosporine bila je preko 90%, na aminoglikozide preko 70%. Klebsiella pneumoniae bila je rezistentna na fluorohinolone i cefalosporine 80%, dok je na grupu karbapenema bila 18%. Pseudomonas aeruginosa je bio rezistentan na karbapeneme i aminoglikozide preko 50%, na antipseudomonasne cefalosporine preko 40%. Na kolistin nije zabeležena rezistencija ni jedne izolovane bakterijske vrste. Značajna pozitivna korelacija zabeležena je između potro&scaron;nje empirijski indikovanog meropenema i rezistencije Acinetobacter spp. Zaključak: U vise od 50% slučajeva primena antibiotika u JIT nije bila u skladu sa stanjem antimikrobne rezistencije bakterijskih uzročnika bolničkih infekcija i savremenim farmakoterapijskim protokolima. Antimikrobna rezistencija Acinetobacter spp, Klebsiellae pneumoniae i Pseudomonas aeruginosae je iznosila preko 20% na antibiotike preporučene savremenim farmakoterapijskim smernicama, osim u slučaju rezistencije Klebsiellae pneumoniae na grupu karbapenema. Između pojave rezistencije Acinetobacter spp. i potro&scaron;nje empirijski indikovanog meropenema utvrđena je statistički značajna pozitivna povezanost, dok za druge dve navedene bakterijske vrste ova povezanost nije bila statistički značajna. Na osnovu podataka o najče&scaron;ćim bakterijskim uzročnicima i njihovoj antimikrobnoj osetljivosti za empirijsku<br />terapiju pneumonija mogao bi biti preporučen jedino kolistin, dok bi za lečenje urinarnih infekcija mogao biti preporučen imipenem ili meropenem. Potrebno je promeniti farmakoterapijski pristup u primeni antibiotika u JIT.</p> / <p>Introduction: Antimicrobial resistance is a global health problem.The most important factor in the development of antimicrobial resistance is inadequate use of antibiotics, which means: inadequate diagnosis of bacterial infection, inadequate antibiotic choice, dosage and duration of therapy. Specificities of critically ill patients and nosocomial infections caused by multidrug-resistant pathogens are important reasons for large antibiotic consumption in ICU settings. Many studies have confirmed a positive correlation between antibiotic use and antimicrobial resistance. Aims: The aims of this study were: to analyze the use of antibiotics at the ICU of the Clinic for anesthesia and intensive care at the Clinical Centre of Vojvodina, according to indications for antibiotic treatment; to analyze the pattern of antimicrobial resistance ofthe most common bacteria causing hospital acquired infections in our participants and to analyze the correlation between the consumption of empirically indicated antibiotics and antimicrobial resistance pattern. Methodology: Prospective observational study was conducted during a one-year period at the Clinic for anesthesia and intensive care, Clinical Centre of Vojvodina. The study included 856 participatns, aged over 18 years and of both genders. The participants were divided into two cohorts, depending on whether they showed symptoms of hospital-acquired infection or not. Adequacy of antibiotic use was analyzed with regard to indication for antibiotic treatment (surgical prophylaxis, treatment of hospital acquired infection, outpatient infection or other) and with regard to antibiotic choice, dosage and duration of treatment. An adequate antibiotic choice was compared to the resistance pattern of positive bacterial isolates as outlined by The Sanford guide to antimicrobial therapy). To calculate the consumption of antibiotics in ICU we used ATC/DDD methodology. Data on antibacterial sensitivity was obtained from the results of microbiological analysis of sample materials. IBM SPSS version 21 was used for statistical analysis, standard statistical tests were applied. The results were presented in tables and graphs. Statistically significant correlation was set at the value of p˂0.05. Pearson correlation coefficient was used to measure the strength between variables. Results: Antibiotic choice was inadequate in 52,19% of all antibiotic prescriptions for all indications. Antibiotic choice in surgical prophylaxis was inadequate in 55,59% of prescriptions for this indication. Inadequate choice of empirically indicated antibiotics (for treatment of hospital-acquired infections) according to antimicrobial resistance pattern occurred in 78,44% of all prescription for this indication. The three the most important bacterial causative agents of hospital acquired infections in ICU were: Acinetobacter spp, Klebsiella pneumonia and Pseudomonas aeruginosa. The resistance of Acinetobacter spp. to antibiotic groups was as follows: to carbapenems, fluoroquinolones and cephalosporins over 90% and to aminoglycosides over 70%. The antimicrobial resistance of Klebsiella pneumoniae was: to fluoroquinolones and cephalosporins over 80% and to carbapenems up to 20%. The resistance pattern of Pseudomonas aeruginosa was as follows: to carbapenems and aminoglykozides over 50%, and to antipseudomonal cephalosporins over 40%. Statistically significant correlation was found between the consumption of empirically prescribed meropenem and antimicrobial resistance of Acinetobacter spp. Conclusion:In more than 50% of antibiotic prescriptions at ICU, regardless of indication, the choice of prescribed antibiotics was inadequate. Antimicrobial resistance pattern of Acinetobacter spp, Klebsiella pneumoniae and Pseudomonas aeruginosa to antibiotics recomennded by contemporary guidelines for antimicrobial therapy was over 20%, except in the case of the resistance of Klebsiellae peneumoniae to carbapenems. Statistically significant correlation was found between the consumption of empirically prescribed meropenem and antimicrobial resistance of Acinetobacter spp. No statistically significant correlation was observed in the other two bacterial strains. Initial, empiric therapy for nosocomial pneumonia in our ICU, should be colistin, and for urinary tract infection imipenem or meropenem. It is important to change antibiotic prescribing praxis in ICU.</p>

<p>Rod Salix pripada porodici Salicaceae i obuhvata oko 450 vrsta &scaron;irom sveta, od kojih u Republici Srbiji raste oko 18. Kora vrbe ispoljava antiinflamatorno, antireumatsko, analgetičko i antipiretičko delovanje sinergističkim efektom njenih glavnih aktivnih supstanci &ndash; glikozida salicina, fenolnih i flavonoidnih jedinjenja. Ciljevi ovog rada bili su ispitivanje uticaja klasične i savremenih metoda ekstrakcije na hemijski sastav i biolo&scaron;ke aktivnosti ekstrakata različitih vrsta vrba, utvrđivanje razlika u sadržaju aktivnih komponenti i biolo&scaron;kom potencijalu između ekstrakata kore i ekstrakata lista iste vrste vrbe, kao i utvrđivanje razlika u sadržaju sekundarnih metabolita i antioksidantnoj aktivnosti kod ekstrakata različitih vrsta vrba. Ispitivanja su uključivala analizu 92 ekstrakta kore i lista osam predstavnika roda Salix, dobijenih različitim metodama (maceracija, ultrazvučna i mikrotalasna ekstrakcija) i pri različitim uslovima ekstrakcije (rastvarač, vreme, veličina čestica). Sadržaj ukupnih fenola i flavonoida, kao i antioksidativna aktivnost određeni su spektrofotometrijski. Hemijska karakterizacija ekstrakata vr&scaron;ena je primenom visokoefikasne tečne hromatografije (HPLC). Metodom in silico molekularnog dokinga ispitan je inhibitorni potencijal sastojaka ekstrakata prema enzimima ciklooksigenaze (COX-1 i COX-2) i acetilholinesterazi (AChE). Savremenim metodama ekstrakcije izolovan je veći broj pojedinačnih komponenata u najvećoj koncentraciji i dobijeni su ekstrakti sa jačim potencijalom neutralizacije hidroksilnih radikala. Klasična metoda maceracije 70% etanolom (v/v) bila je pogodnija za dobijanje ekstrakata sa jačim antioksidativnim potencijalom prema DPPH radikalu kod gotovo svih ispitivanih Salix vrsta. Kod većine Salix vrsta jači antioksidantni potencijal prema DPPH radikalu ispoljili su ekstrakti kore. Kod polovine ispitivanih vrsta ekstrakti lista su inhibisali hidroksilne radikale u većoj meri. Veći sadržaj pojedinačnih jedinjenja u ekstraktima kore ili lista zavisio je od same vrste vrbe. Najjaču antioksidantu aktivnost ispoljila je vrsta S. alba, dok je u pogledu hemijskog sastava najraznovrsnija vrsta bila S. fragilis. In silico analizom metodom molekularnog dokinga utvrđen je jak inhibitorni potencijal flavonoidnih jedinjenja kvercetina, naringenina i epikatehina, kao i hlorogenske kiseline među fenolnim kiselinama prema enzimima COX-1 i COX-2. Epikatehin, salicin i hlorogenska kiselina ispoljili su značajno inhibitorno delovanje na enzim AChE u doking studijama. Dobijeni rezultati ukazuju da pored kore i list vrbe ima veliki potencijal primene kao izvor značajnih fitokomponenata, kao i na mogućnost eksploatacije vrsta vrba koje nisu u komercijalnoj upotrebi kao lekovitih sirovina za izolovanje antioksidanasa i farmakolo&scaron;ki aktivnih supstanci.</p> / <p>The genus Salix belongs to the family Salicaceae and comprises about 450 species worldwide, out of which 18 grow in the Republic of Serbia. Willow bark exhibits anti-inflammatory, anti-rheumatic, analgesic and antipyretic effects through synergistic action of its main ingredients -glycosidesalicin, phenolic and flavonoid compounds. Aims of this paper were to analyse the impact of classical and modern extraction methods on chemical composition and biological activities of extracts of different willow species, determine the differences in the amount of active compounds and biological potential between bark and leaf extracts within the same willow species, as well as between extracts of various species. The analysis included 92 bark and leaf extracts of eight species from the genus Salix, obtained by different extraction methods (maceration, ulrasound and microwave assisted extraction) and conditions (solvent, time, particle size). Total phenolics and flavonoids content, as well as antioxidant activity were determined spectrophotometrically. Chemical characterization was carried out by high performance liquid chromatography (HPLC). Cyclooxygenase (COX-1 and COX-2) and acetylcholine esterase (AChE) inhibitory potential of compounds isolated from the extracts was examined by in silico method of molecular docking. Greater number of individual components in highest concentration, as well as exracts with stronger hydroxyl radical scavenging potential were obtained by modern extraction methods. Classical method of maceration with 70% ethanol (v/v) was more suitable for obtaining extracts with higher DPPH radical scavenging activity in the vast majority of tested species. In half of the analysed species leaf extracts inhibited hydroxyl radicals more than bark. Higher amount of individual compounds in bark or leaf extracts depended on the species itself. S. alba exhibited the strongest antioxidant activity, whereas S. fragilis had the most diverse chemical composition. Strong COX-1 and COX-2 inhibitory potential of flavonoids quercetin, naringenin and epicatechin, as well as chlorogenic acid among phenolic acids was determined by in silico molecular docking analysis. Molecular docking studies also demonstrated the inhibitory activity of epicatechin, salicin and chlorogenic acid toward AChE. The obtained results indicate that not only bark, but willow leaf as well could be used as source of significant phytochemicals and also the possibility of exploitation of willow species that are not commercially used as medicinal raw material for isolation of antioxidants and pharmacologycally active substances.</p>

Background: The goal of social integration is part of the ideological motivation behind the transition from institutionalised to decentralised psychiatric care. Modern community mental health care considers social integration vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated.Aim: The overall aim of the study was to achieve a deeper understanding of the phenomenon of social integration of people with mental health problems in the community. An additional aim was to develop the healthcare professionals’ insight into this phenomenon by means of co-operative inquiry. The specific research questions were: How have people with mental health problems affected their neighbourhood after re-establishing in the community? How do people with mental health problems experience social integration in the community? How does knowledge of social integration promote practical changes in mental health professionals’ practice?Methods: This study, which comprises four papers, has a hermeneutic design. The data collection methods took the form of interviews with 19 neighbours of group homes for people with mental health problems (Paper I) and focus groups in two separate studies of people with mental health problems, one of which comprised 12 participants in three groups (Paper II) and the other 17 participants in three different multistage focus groups (Paper III), i.e. a total of 14 focus groups. Paper IV utilises findings from Papers I-III by means of a co-operative approach. There were two areas of knowledge development in the research process: dialogue-based teaching and focus groups. The main emphasis of the dialogue-based teaching was to facilitate the articulation of practical and tacit knowledge. Twenty-two healthcare professionals and social workers participated in two different multistage focus groups, a total of 6 focus groups (Paper IV). Data-analysis methods included both the constant comparative process and qualitative content analysis.Findings: The first paper begins with the experiences of neighbours of people who suffer from mental health problems. The neighbours reported frightening behaviours as well as complications in their contact with people who had long-term mental health problems, which led to increased insecurity and fear. The reaction of the neighbourhood was exclusion and segregation in the form of distancing or watching. The next two papers employed a user perspective and revealed that, when meeting people, the participants experienced shame and fear of exclusion due to lack of acceptance and loss of autonomy. Integrity proved a necessary quality for the possibility to be treated as an equal. Lack of work or a meaningful occupation and a low income contributed to a sense of worthlessness and loneliness. Those who had a job or took part in club activities seemed to achieve social companionship, which gave them a sense of being more socially integrated. The co-operative research project enabled co-researchers to gain increased professional knowledge and awareness, as well as providing potential for improvements in clinical practice. Systematic reflection on practice leads to an increased awareness of one’s own attitudes and intervention methods, societal conditions and the community’s attitude to the increased social integration of people with mental health problems. The experiential knowledge gained may contribute to health-promotion strategies such as social integration.Conclusions: Integration difficulties are experienced by both individuals with mental health problems and their neighbouring community. In order to achieve social integration, a person with long-term mental health problems needs to develop adequate social competence. Those working in community mental health care must ensure that people suffering from mental health problems experience a sense of belonging in the community, which can enable them to develop a network and achieve social integration in the planning and development of day-time activities and work, thus promoting social integration. The neighbourhood requires, at the very least, general information when a group home is established. Co-operative inquiry can be beneficial in the public sector, although in order to achieve the best possible result, the whole team must be involved and play an active role in all areas of the research project. If the groups are too large, the participants’ level of engagement may suffer. Multistage focus groups proved to be a powerful method for knowledge acquisition and should be further developed as a means of expanding new knowledg / Bakgrunn: En viktig ideologisk motivasjon for overgang fra institusjonalisert til desentralisert psykisk helsearbeid er målet om sosial integrering. Moderne lokalbasert psykisk helsearbeid anser sosial integrering som avgjørende for å bedre menneskers psykisk helse. Men rapporter viser at mennesker med psykiske problemer ikke har oppnådd tilfredsstillende sosial integrering.Mål: Det overordnede målet for studien var å oppnå en dypere forståelse av fenomenet sosial integrering for mennesker med psykiske problemer i lokalsamfunnet. Et tilleggsmål var å utvikle helse- og sosialarbeideres innsikt i fenomenet med bruk av handlingsorientert forskningssamarbeid. De spesifikke forskningsspørsmålene var: Hvordan har mennesker med psykiske problemer påvirket deres nabolag etter reetablering i lokalsamfunnet? Hvordan erfarte mennesker med psykiske problemer sosial integrering i lokalsamfunnet? Hvordan kan kunnskap om sosial integrering fremme praksisforandringer for psykisk helsearbeidere?Metode: Denne studien, som omfatter fire artikler, har et hermenautisk design. Metodene for datainnsamling var kvalitative intervjuer med 19 naboer til fellesboliger for mennesker med psykiske problemer (Art. I), og fokusgruppeintervjuer, i to separate studier, med mennesker med psykiske problemer. En studie med 12 informanter i 3 fokusgrupper (Art. II) og en studie med 17 informanter i 3 flersteg-fokusgrupper (Art. III), totalt 14 fokusgruppeintervjuer. Art. IV brukte funnene fra Art. I-III i et handlingsorientert forskningssamarbeid. Det var to former for kunnskapsutvikling i forskningsprosessen: Dialogbasert undervisning, som skulle fremme praktisk og taus kunnskap, samt fokusgruppeintervjuer. 22 helse- og sosialarbeidere deltok i 2 flersteg-fokusgrupper, totalt 6 fokusgruppeintervjuer (Art. IV). Datamateriale ble analysert med Grounded Theory og kvalitativ innholdsanalyse.Funn: Naboer til fellesbolig for mennesker med psykiske problemer beskriver i den første studien opplevelser som gav usikkerhet, skremmende adferd og problemer med å få kontakt med menneskene som hadde alvorlige psykiske problemer. Dette ledet til økt usikkerhet og frykt. Nabolaget reagerte med eksklusjon og segregering. De to neste studiene hadde et brukerperspektiv, og viste at informantene opplevde skam og frykt for eksklusjon som en følge av manglende akseptasjon og tap av autonomi i møte med mennesker. Integritet var en nødvendig forutsetning for å bli møtt som likverdig. Mangel på arbeid eller annen meningsfull dagaktivitet, samt lav inntekt, bidro til en følelse av verdiløshet og ensomhet. De som hadde et arbeid eller var aktiv deltager i klubbvirksomhet fikk et sosialt felleskap som gjorde at de kjente seg sosialt integrerte. I siste studie gav handlingsorientert forskningssamarbeid medforskerne økt profesjonell kunnskap og bevissthet, samt potensiale for å forbedre praksis. Systematisk refleksjon på praksis leder til en økt bevissthet for egne holdninger og interveneringsmetoder, sosiale betingelser og lokalsamfunnets holdninger til økt sosial integrasjon for mennesker med psykiske problemer. Økt kunnskapsdannelse i praksis kan bidra til forebyggende helsearbeid som sosial integrering.Konklusjon: Både mennesker med psykiske problemer og deres nabolag erfarte vanskeligheter med integrering. For at mennesker med alvorlige psykiske problemer skal erfare sosial integrering må de ha tilstrekkelig sosial kompetanse. Det må arbeides for at mennesker med psykiske problemer opplever tilhørighet i lokalsamfunnet, noe som kan sette dem i stand til å utvikle nettverk, og få til sosial integrering i planlegging og utvikling av dagaktiviteter og arbeid, og på den måten fremme sosial integrering. Nabolag bør i hvert fall ha generell informasjon når det etableres fellesboliger. Handlings- orientert forskningssamarbeid kan være gunstig i kommunehelsetjenesten. En forutsetning for et best mulig resultat er at hele team blir involvert og deltar i kunnskapsskapningen i praksis. Blir enhetene som deltar for store, blir det ikke noe eierforhold til forskningssamarbeidet. Flersteg-fokusgruppeintervju viste seg å være en god metode for kunnskapsutvikling, og metoden burde utvikles videre.Nøkkelord: Psykisk helsearbeid i kommunehelsetjenesten, sosial integrering, sosialt nettverk, handlingsorientert forskningssamarbeid, kvalitativ metode

Older people often experience loneliness and depression, especially those dependent on institutional care. The loneliness can be attributed to multiple losses such as the loss of physical and cognitive abilities, the loss of relationships with familiar environments, the loss of significant others, as well as changing contact with family members and friends. The strategy commonly used by older people to deal with such feelings of loss, is to reminisce on such losses as well as on the lost or altered relationships. This strategy might result in a situation where the focus older people have on the past prevents them from recognizing the potential of relationships in their immediate environment. In order to make older people more aware of meaningful relationships in their immediate environment, the method of appreciative inquiry was used. Appreciative inquiry uses questioning as an intervention. Questions were formulated in such a way that the positive aspects of possible relationships in interpersonal environments were emphasised. The aim of the appreciative inquiry was to determine what relationship qualities older people experience as meaningful or effective. A qualitative and investigative research method was used in an attempt to investigate older people's subjective experiences of the relationships they have in the residential care facility. Participants to the study were volunteers who permanently reside in a residential care facility for older people in Gauteng, South Africa. Textual- and visual data was collected through the use of the World Café method, where the participants were divided into three separate groups of approximately six members each. Group discussions were facilitated as group leaders alternated with various activities between the groups. Sheets of A2 paper served as tablecloths allowing participants to conveniently jot down notes from the group discussion, and also to draw symbolic representations of their subjective experiences of the relationships they enjoy in their immediate environment. Data gathered in the various groups was then visually displayed so that a focus group discussion could occur. Crystallization confirmed the trustworthiness of the findings. Crystallization is an approach where data is combined using two or more genres of representation of socially constructed meanings as well as different methods of data analysis. In this study, several different data collection methods were used, including the use of symbols, group discussions and a focus group. The data analysis comprised of a combination of several methods of analysis, being thematic analysis, interactive pattern analysis and the visual analysis of posters. Approval pertaining to the ethical aspects of the research project was obtained from the North-West University. From the findings it became apparent that essential relationship qualities such as confirmation, empathy, unconditional acceptance and clarity of self-presentation between the residents spontaneously developed out of the safe and enabling interpersonal environment created by the management. This safe and enabling interpersonal environment is characterized by predictability, interpersonal flexibility, confirmation, congruence and empathy. According to this research, it can be argued that residents in this specific care facility were still able to identify and describe relationships that could effectively satisfy their needs – despite having experienced multiple losses associated with the aging process and/or losses in their particular lives. This study hence holds important implications for the creation of an interpersonal context by management in order to promote wellbeing among older people that reside in residential care facilities. / Thesis (MA (Clinical Psychology))--North-West University, Potchefstroom Campus, 2013.

Ageing populations and the unique challenges they pose are characteristic of the accelerating demographic transition evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). The influx of the baby boomer generation will inevitably lead to an exponential increase in the numbers of white older people within the next two decades. Regardless of integration policies in post-apartheid South Africa, 90% of all residential care facilities are still occupied solely by white older people. Such facilities are described as buildings or other structures used primarily for the purposes of providing accommodation and of providing a 24-hour service to older persons. The increasingly larger segment of white older people holds considerable implications for the future of these facilities since more individuals will turn to this living arrangement. The Older Persons Act of South Africa was inaugurated by the government in 2006 and its key objectives are aligned with the recommendations of the Madrid International Plan of Action on Ageing (2002). Amongst many other objectives, the Older Persons Act emphasises practices that enhance the wellbeing and quality of life (QoL) of all older persons. However, the reigning circumstances in most residential care facilities have been described as challenging. A national audit of residential care facilities in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undefined and unspecific. The purpose of the study was to explore the construction of QoL, from the perspective of the older people living in residential care facilities. A purposive sample of 54 participants (male, n=10; female, n=44) with ages ranging between 62 and 95 years was drawn. The participants were able to communicate congruently and understood the research purpose. Participants resided in four similar facilities situated in urban areas in two South African provinces. A multiple-context inquiry was conducted to gather rich data and collateral information. The study made use of interviews, focus groups, journals, and the Mmogo-method® to collect qualitative data. Interpretative Phenomenological Analysis (IPA) and visual analysis methods were used to analyse the data. Interactive Qualitative Analysis (IQA) was conducted with 19 participants, resulting in a conceptual model of QoL. Member-checking was performed by the participants. Ethical approval was granted by the Ethics Committee of the North-West University (Potchefstroom Campus), as part of a larger project, namely “An exploration of enabling contexts (05K14)”. The findings revealed that the nature of QoL is informed by spiritual worldviews, interpersonal contexts and the maintained ability of older people to regulate aspects of their own lives. The nature of QoL was also revealed as transitional throughout the ageing process and that the dimensions of QoL may be found on a continuum. Six domains were elicited in the construction of QoL, namely spirituality, health, relationships, meaningfulness, autonomy and sense of place. Each domain presented with certain contributors and inhibitors influencing the older person’s ability to experience QoL. Findings revealed the strengths of older people to deal with adversities associated with later life. The inhibitors of QoL are emphasised for the attention of policy makers, the managers of residential care facilities, care givers and family members. The study provided insight into the causal influences between the domains of QoL. A conceptual model with systemic properties is proposed. The theoretical implications of this systems model are that QoL domains are mutually informing and exercise a particular influence on the relational states of older people. It is hoped that new knowledge in the area of QoL might direct future research efforts and put resources channeled to residential care facilities to better use. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013.

Older people often experience loneliness and depression, especially those dependent on institutional care. The loneliness can be attributed to multiple losses such as the loss of physical and cognitive abilities, the loss of relationships with familiar environments, the loss of significant others, as well as changing contact with family members and friends. The strategy commonly used by older people to deal with such feelings of loss, is to reminisce on such losses as well as on the lost or altered relationships. This strategy might result in a situation where the focus older people have on the past prevents them from recognizing the potential of relationships in their immediate environment. In order to make older people more aware of meaningful relationships in their immediate environment, the method of appreciative inquiry was used. Appreciative inquiry uses questioning as an intervention. Questions were formulated in such a way that the positive aspects of possible relationships in interpersonal environments were emphasised. The aim of the appreciative inquiry was to determine what relationship qualities older people experience as meaningful or effective. A qualitative and investigative research method was used in an attempt to investigate older people's subjective experiences of the relationships they have in the residential care facility. Participants to the study were volunteers who permanently reside in a residential care facility for older people in Gauteng, South Africa. Textual- and visual data was collected through the use of the World Café method, where the participants were divided into three separate groups of approximately six members each. Group discussions were facilitated as group leaders alternated with various activities between the groups. Sheets of A2 paper served as tablecloths allowing participants to conveniently jot down notes from the group discussion, and also to draw symbolic representations of their subjective experiences of the relationships they enjoy in their immediate environment. Data gathered in the various groups was then visually displayed so that a focus group discussion could occur. Crystallization confirmed the trustworthiness of the findings. Crystallization is an approach where data is combined using two or more genres of representation of socially constructed meanings as well as different methods of data analysis. In this study, several different data collection methods were used, including the use of symbols, group discussions and a focus group. The data analysis comprised of a combination of several methods of analysis, being thematic analysis, interactive pattern analysis and the visual analysis of posters. Approval pertaining to the ethical aspects of the research project was obtained from the North-West University. From the findings it became apparent that essential relationship qualities such as confirmation, empathy, unconditional acceptance and clarity of self-presentation between the residents spontaneously developed out of the safe and enabling interpersonal environment created by the management. This safe and enabling interpersonal environment is characterized by predictability, interpersonal flexibility, confirmation, congruence and empathy. According to this research, it can be argued that residents in this specific care facility were still able to identify and describe relationships that could effectively satisfy their needs – despite having experienced multiple losses associated with the aging process and/or losses in their particular lives. This study hence holds important implications for the creation of an interpersonal context by management in order to promote wellbeing among older people that reside in residential care facilities. / Thesis (MA (Clinical Psychology))--North-West University, Potchefstroom Campus, 2013.

Ageing populations and the unique challenges they pose are characteristic of the accelerating demographic transition evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). The influx of the baby boomer generation will inevitably lead to an exponential increase in the numbers of white older people within the next two decades. Regardless of integration policies in post-apartheid South Africa, 90% of all residential care facilities are still occupied solely by white older people. Such facilities are described as buildings or other structures used primarily for the purposes of providing accommodation and of providing a 24-hour service to older persons. The increasingly larger segment of white older people holds considerable implications for the future of these facilities since more individuals will turn to this living arrangement. The Older Persons Act of South Africa was inaugurated by the government in 2006 and its key objectives are aligned with the recommendations of the Madrid International Plan of Action on Ageing (2002). Amongst many other objectives, the Older Persons Act emphasises practices that enhance the wellbeing and quality of life (QoL) of all older persons. However, the reigning circumstances in most residential care facilities have been described as challenging. A national audit of residential care facilities in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undefined and unspecific. The purpose of the study was to explore the construction of QoL, from the perspective of the older people living in residential care facilities. A purposive sample of 54 participants (male, n=10; female, n=44) with ages ranging between 62 and 95 years was drawn. The participants were able to communicate congruently and understood the research purpose. Participants resided in four similar facilities situated in urban areas in two South African provinces. A multiple-context inquiry was conducted to gather rich data and collateral information. The study made use of interviews, focus groups, journals, and the Mmogo-method® to collect qualitative data. Interpretative Phenomenological Analysis (IPA) and visual analysis methods were used to analyse the data. Interactive Qualitative Analysis (IQA) was conducted with 19 participants, resulting in a conceptual model of QoL. Member-checking was performed by the participants. Ethical approval was granted by the Ethics Committee of the North-West University (Potchefstroom Campus), as part of a larger project, namely “An exploration of enabling contexts (05K14)”. The findings revealed that the nature of QoL is informed by spiritual worldviews, interpersonal contexts and the maintained ability of older people to regulate aspects of their own lives. The nature of QoL was also revealed as transitional throughout the ageing process and that the dimensions of QoL may be found on a continuum. Six domains were elicited in the construction of QoL, namely spirituality, health, relationships, meaningfulness, autonomy and sense of place. Each domain presented with certain contributors and inhibitors influencing the older person’s ability to experience QoL. Findings revealed the strengths of older people to deal with adversities associated with later life. The inhibitors of QoL are emphasised for the attention of policy makers, the managers of residential care facilities, care givers and family members. The study provided insight into the causal influences between the domains of QoL. A conceptual model with systemic properties is proposed. The theoretical implications of this systems model are that QoL domains are mutually informing and exercise a particular influence on the relational states of older people. It is hoped that new knowledge in the area of QoL might direct future research efforts and put resources channeled to residential care facilities to better use. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013.

The purpose of this study was to make a contribution towards decision–making in complex environmental problems, especially where data is limited and associated with a high degree of uncertainty. As a young scientist, I understood the value of science as a measuring and quantification tool and used to intuitively believe that science was exact and could provide undisputable answers. It was in 1997, during the Safety Assessments done at the Vaalputs National Radioactive Waste Repository that my belief system was challenged. This occurred after there were numerous scientific studies done on the site that was started since the early 1980’s, yet with no conclusion as to how safe the site is in terms of radioactive waste disposal. The Safety Assessment process was developed by the International Atomic Energy Agency (IAEA) to transform the scientific investigations and data into decision–making information for the purposes of radioactive waste management. It was also during the Vaalputs investigations when I learned the value of lateral thinking. There were numerous scientists with doctorate and master’s degrees that worked on the site of which I was one. One of the important requirements was to measure evaporation at the local weather station close to the repository. It was specifically important to measure evaporation as a controlling parameter in the unsaturated zone models. Evaporation was measured with an Apan that is filled with water so that the losses can be measured. Vaalputs is a very dry place and water is scarce. The local weather station site was fenced off, but there was a problem in that the aardvark dug below the fence and drank the water in the A–pan, so that no measurements were possible. The solution from the scientists was to put the fence deeper into the ground. The aardvark did not find it hard to dig even deeper. The next solution was to put a second fence around the weather station and again the aardvark dug below it to drink the water. It was then that Mr Robbie Schoeman, a technician became aware of the problem and put a drinking water container outside the weather station fence for the aardvark and – the problem was solved at a fraction of the cost of the previous complex solutions. I get in contact with the same thinking patterns that intuitively expect that the act of scientific investigations will provide decision–making information or even solve the problem. If the investigation provides more questions than answers, the quest is for more and more data on more detailed scales. There is a difference between problem characterization and solution viidentification. Problem characterization requires scientific and critical thinking, which is an important component but that has to be incorporated with the solution identification process of creative thinking towards decision–making. I am a scientist by heart, but it was necessary to realise that apart from research, practical science must feed into a higher process, such as decision–making to be able to make a practical difference. The process of compilation of this thesis meant a lot to me as I initially thought of doing a PhD and then it changed me, especially in the way I think. This was a life changing process, which is good. As Jesus said in Mathew 3:2 And saying, Repent (think differently; change your mind, regretting your sins and changing your conduct), for the kingdom of heaven is at hand. / Thesis (Ph.D. (Geography and Environmental Studies))--North-West University, Potchefstroom Campus, 2011.

The purpose of this study was to make a contribution towards decision–making in complex environmental problems, especially where data is limited and associated with a high degree of uncertainty. As a young scientist, I understood the value of science as a measuring and quantification tool and used to intuitively believe that science was exact and could provide undisputable answers. It was in 1997, during the Safety Assessments done at the Vaalputs National Radioactive Waste Repository that my belief system was challenged. This occurred after there were numerous scientific studies done on the site that was started since the early 1980’s, yet with no conclusion as to how safe the site is in terms of radioactive waste disposal. The Safety Assessment process was developed by the International Atomic Energy Agency (IAEA) to transform the scientific investigations and data into decision–making information for the purposes of radioactive waste management. It was also during the Vaalputs investigations when I learned the value of lateral thinking. There were numerous scientists with doctorate and master’s degrees that worked on the site of which I was one. One of the important requirements was to measure evaporation at the local weather station close to the repository. It was specifically important to measure evaporation as a controlling parameter in the unsaturated zone models. Evaporation was measured with an Apan that is filled with water so that the losses can be measured. Vaalputs is a very dry place and water is scarce. The local weather station site was fenced off, but there was a problem in that the aardvark dug below the fence and drank the water in the A–pan, so that no measurements were possible. The solution from the scientists was to put the fence deeper into the ground. The aardvark did not find it hard to dig even deeper. The next solution was to put a second fence around the weather station and again the aardvark dug below it to drink the water. It was then that Mr Robbie Schoeman, a technician became aware of the problem and put a drinking water container outside the weather station fence for the aardvark and – the problem was solved at a fraction of the cost of the previous complex solutions. I get in contact with the same thinking patterns that intuitively expect that the act of scientific investigations will provide decision–making information or even solve the problem. If the investigation provides more questions than answers, the quest is for more and more data on more detailed scales. There is a difference between problem characterization and solution viidentification. Problem characterization requires scientific and critical thinking, which is an important component but that has to be incorporated with the solution identification process of creative thinking towards decision–making. I am a scientist by heart, but it was necessary to realise that apart from research, practical science must feed into a higher process, such as decision–making to be able to make a practical difference. The process of compilation of this thesis meant a lot to me as I initially thought of doing a PhD and then it changed me, especially in the way I think. This was a life changing process, which is good. As Jesus said in Mathew 3:2 And saying, Repent (think differently; change your mind, regretting your sins and changing your conduct), for the kingdom of heaven is at hand. / Thesis (Ph.D. (Geography and Environmental Studies))--North-West University, Potchefstroom Campus, 2011.

<p>Hronična bolest bubrega (HBB) je zdravstveni problem koji se javlja &scaron;irom sveta i povezana je sa visokim kardiovaskularnim komorbiditetom i smrtno&scaron;ću. Veliki porast broja bolesnika koji imaju terminalnu bubrežnu slabo&scaron;ću (TBS) nastaje kao posledica eksponencijalnog porasta broja bolesnika čija je slabost bubrega posledica hipertenzije i dijabetesa, kao i porasta broja starih sa TBS. Zbog toga vi&scaron;e od 50% bolesnika sa HBB umire zbog kardiovaskularnih bolesti i pre započinjanja lečenja metodama za zamenu funkcije bubrega. Utvrditi kliničke karakteristike bolesnika sa i bez kontrastom indukovane nefropatije (pre svega varijable bubrežne funkcije definasane pomoću AKIN i RIFLE kriterijuma) podvrgnutih kardiohirur&scaron;kim operacijama, potom utvrditi postojanje razlike u mortalitetu i postoperativnom morbiditetu između bolesnika sa i bez kontrastom indukovane nefropatije, a koji se podvrgavaju kardiohirur&scaron;koj operaciji i takođe utvrditi prediktore mortaliteta i morbiditeta kod bolesnika sa prethodnom kontrastom indukovanom nefropatijom koji se podvrgavaju kardiohirur&scaron;koj operaciji. Studija je koncipirana kao retroprospektivna opservaciona studija u ukupnom trajanju od pet godina retrospektivnog perioda i pola godine prospektivnog perioda kojim su obuhvaćene dve grupe bolesnika: I grupa - pacijenti sa kontrastom indukovanom nefropatijom (CIN) i II grupa - pacijenti bez CIN; koji su podvrgnuti kardiohirur&scaron;kim operacijama (koronarna, valvularna, kombinovana hirurgija i ostale) na Institutu za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici. Od ukupnog broja operisanih pacijenata u ovom perioda (oko 5000 bolesnika) u ovu studiju je uključeno 1269 bolesnika. U na&scaron;oj studiji ukupno je analizirano 1269 bolesnika koji su svrstani u dve grupe. Prvu grupu je činilo 59 (4,6%) pacijenata koji su koronarografisani (dijagnostička, terapijska) i razvili CIN te su upućeni u istoj hospitalizaciji po indikaciji konzilijuma na koronarnu, valvularnu i kombinovanu hirurgiju. Drugu grupu je činilo 1210 (95,4%) bolesnika kod kojih nakon koronarografije nije razvijena kontrastom indukovana nefropatija, a takođe su tokom iste hospitalizacije operisani. Kriterijumi za uključivanje pacijenata u studiju su svi punoletni bolesnici koji su upućeni na kardiohirur&scaron;ke operacije (koronarna, valvularna, kombinovana i ostale). CIN je definisan kao porast vrednosti kreatinina unutar pet dana nakon koronarografije za 25% u odnosu na vrednost kreatina pre koronarografije. Praćene su preoperativne, operativne i postoperativne karakteristike bolesnika sa CIN i bolesnika bez CIN. U disertaciji su kori&scaron;ćene mere deskriptivne statistike: aritmetička sredina, standardna devijacija, medijana, kvartili, frekvence i procenti. Za poređenje srednjih vrednosti varijabli dve populacije primenjen je test za nezavisne uzorke i Man-Vitnijev test. Povezanost kategorijskih varijabli ispitana je pomoću Hi-kvadrat testa za tabele kontigencije ili pomoću Fi&scaron;erovog testa. Određivanje uticaja promenljivih na ishod lečenja izvr&scaron;en je primenom univarijantne i multivarijantne binarne logističke regresije, koja je poslužila i za pravljenje nove varijable (modela) za procenu ishoda lečenja. Prediktivni kvalitet varijabli na ishod ocenjen je pomoću ROC krivih. Za određivanje dužine preživljavanja primenjena je Kaplan-Meier analiza preživljavanja. Uticaj varijabli na preživljavanje izvr&scaron;en je na osnovu Coxove regresione analize. Za statistički značajnu testa uzeta je vrednost p&lt;0,05. Statistička obrada podataka izvedena je primenom statističkog paketa SPSS 17. Dokazana je statistička značajnost u ispitivanim grupama u pogledu akutizacije bubrežne insuficijencije (p=0,007). Broj bolesnika sa akutizacijom bubrežne insuficijencije u grupi CIN je bio 3 (5,1%), a u grupi bez CIN je 6 (0,5%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu perikardnog izliva (p=0,046). Statističku značajnost treba uslovno prihvatiti jer je broj bolesnika sa perikardnim izlivom u grupi sa CIN bio samo 1 (1,7%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu mortaliteta (p&lt;0,0005). Broj umrlih u grupi pacijenata sa CIN je 8 (13,6%), a u grupi pacijenata bez CIN je 23 (1,9%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu AKIN kriterijuma (p&lt;0,0005). Broj bolesnika bez AKIN kriterijuma u grupi sa CIN bio je 29 (49,2%), a u grupi pacijenata bez CIN je 1210 (100,0%). U Stadijumu 1 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 26 (44,1%), a u grupi bolesnika bez CIN je 0 (0,0%). U Stadijumu 2 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 1 (1,7%), a u grupi bolesnika bez CIN bio je 0 (0,0%). U Stadijumu 3 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 3 (5,1%), a u grupi bolesnika bez CIN bio je 0 (0,0%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu RIFLE kriterijuma (p&lt;0,0005). Broj bolesnika bez RIFLE kriterijuma u grupi sa CIN bio je 0 (0,0%), a u grupi pacijenata bez CIN bio je 1169 (96,6%). U riziku (Risc) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 51 (86,4%), a u grupi bolesnika bez CIN bio je 41 (3,4%). U o&scaron;tećenju (Injury) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 5 (8,5%), a u grupi bolesnika bez CIN bio je 0 (0,0%). U stabost (Failure) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 3 (5,1%), a u grupi bolesnika bez CIN bio je 0 (0,0%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu broja komplikacija (p&lt;0,0005). Broj bolesnika bez komplijacija u grupi sa CIN bio je 39 (66,1%), a u grupi pacijenata bez CIN bio je 1027 (84,9%). Broj bolesnika sa 1 komplijacijom u grupi sa CIN bio je 12 (20,3%), a u grupi pacijenata bez CIN bio je 146 (12,1%). Broj bolesnika sa 2 komplijacije u grupi sa CIN bio je 6 (10,2%), a u grupi pacijenata bez CIN bio je 20 (1,7%). Broj bolesnika sa 3 komplijacije u grupi sa CIN bio je 1 (1,7%), a u grupi pacijenata bez CIN bio je 11 (0,9%). Broj bolesnika sa 4 komplijacije u grupi sa CIN bio je 1 (1,7%), a u grupi pacijenata bez kontrastom indukovane nefropatije bio je 6 (0,5%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu MACE komplikacija (p&lt;0,0005). Broj bolesnika sa MACE komplikacijama u grupi sa CIN bio je 20 (33,9%), a u grupi pacijenata bez CIN bio je 183 (15,1%). Akutna bubrežna slabost je relativno česta komplikacija kardiohirur&scaron;kih operacija. Posebno su ugroženi bolesnici sa visokim preoperativnim rizikom, u na&scaron;oj studiji pacijenti sa prethodnim CIN-om, kod kojih je akutizacija bubrežne slabosti znatno učestalija. Kardiohirur&scaron;ki bolesnici kod kojih nastane akutna bubrežna slabost imaju, kao i u na&scaron;oj studiji, vi&scaron;e postoperativnih komplikacija, produžen boravak u jednici intenzivne nege, kao i rizik za nastanak hronične bubrežne bolesti.</p> / <p>Chronic kidney disease (CKD) is a healthcare problem that occurs worldwide and is associated with high cardiovascular comorbidity and mortality. A large increase in the number of patients with terminal renal failure (TRF) occurs as a result of an exponential increase in the number of patients whose renal failure is due to hypertension and diabetes, as well as an increase in the number of elderly with TRF. As a result, more than 50% of patients with CKD die from cardiovascular disease even before starting treatment with kidney replacement therapy. To determine the clinical characteristics of patients with and without contrast-induced nephropathy (CIN) (renal function parameters defined by AKIN and RIFLE criteria) undergoing cardiac surgery, to determine the difference in mortality and postoperative morbidity between patients with and without CIN who are submitted to cardiac surgery and also to determine predictors of mortality and morbidity in patients with CIN undergoing cardiac surgery. The study was conceived as a retroprospective observational study with a total duration of five years of retrospective period and half a year of prospective period which included two groups of patients: Group I - patients with contrast-induced nephropathy (CIN) and Group II - patients without CIN; who underwent cardiac surgery (coronary, valvular, combined surgery and other) at the Institute for Cardiovascular Diseases of Vojvodina in Sremska Kamenica. Out of the total number of operated patients in this period (about 5000 patients), 1269 patients were included in this study. In our study, a total of 1269 patients were analyzed, which were classified into two groups. The first group consisted of 59 (4.6%) patients who underwent coronary angiography (diagnostic, therapeutic) and developed CIN and were submitted to surgery in the same hospitalization as indicated by heart team. The second group consisted of 1210 (95.4%) patients who did not develop CIN after coronary angiography but were also operated on during the same hospitalization. Criteria for inclusion of patients in the study are: all adult patients who are referred for cardiac surgery (coronary, valvular, combined and other). CIN was defined as a at least 25% increase in creatinine value within five days after coronary angiography compared to creatine value before coronary angiography. Preoperative, operative and postoperative characteristics of patients with CIN and patients without CIN were analyzed. Statistical analyses included measures of descriptive statistics: arithmetic mean, standard deviation, median, quartiles, frequencies and percentages. To compare the mean values of the variables of the two populations, t-test for independent samples and the Mann-Whitney test were applied. The correlation of categorical variables was examined using the Chi-square test for contingency tables or using the Fisher test. The influence of variables on the treatment outcome was determined by applying univariate and multivariate binary logistic regression, which also served to create a new variable (model) for assessing the treatment outcome. The predictive quality of outcome variables was assessed using ROC curves. Kaplan-Meier survival analysis was used to determine survival length. The influence of variables on survival was performed based on Cox regression analysis. For a statistically significant test, the value of p &lt;0.05 was taken. Statistical data processing was performed using the statistical package SPSS 17. Statistical significance was observed in the examined groups regarding the acutization of renal failure (p = 0.007). The number of patients with acute renal failure in the CIN group was 3 (5.1%), and in the group without CIN it was 6 (0.5%). Statistical significance was observed between the examined groups based on pericardial effusion (p = 0.046). Statistical significance should be conditionally accepted because the number of patients with pericardial effusion in the group with CIN was only 1 (1.7%). Statistical significance was demonstrated in the examined groups based on mortality (p &lt;0.0005). The number of deaths in the group of patients with CIN was 8 (13.6%), and in the group of patients without CIN it was 23 (1.9%). Statistical significance was demonstrated in the examined groups based on the AKIN criteria (p &lt;0.0005). The number of patients without AKIN criteria in the group with CIN was 29 (49.2%), and in the group of patients without CIN it was 1210 (100.0%). In Stage 1 of the AKIN criterion, the number of patients in the group with CIN was 26 (44.1%), and in the group of patients without CIN it was 0 (0.0%). In Stage 2 of the AKIN criterion, the number of patients in the group with CIN was 1 (1.7%), and in the group of patients without CIN it was 0 (0.0%). In Stage 3 of the AKIN criterion, the number of patients in the group with CIN was 3 (5.1%), and in the group of patients without CIN it was 0 (0.0%). Statistical significance was demonstrated between the examined groups based on the RIFLE criteria (p &lt;0.0005). The number of patients without RIFLE criteria in the group with CIN was 0 (0.0%), and in the group of patients without CIN it was 1169 (96.6%). In the Risk of the RIFLE criterion, the number of patients in the group with CIN was 51 (86.4%), and in the group of patients without CIN it was 41 (3.4%). In the Injury of the RIFLE criterion, the number of patients in the group with CIN was 5 (8.5%), and in the group of patients without CIN it was 0 (0.0%). In the Failure of the RIFLE criterion, the number of patients in the group with CIN was 3 (5.1%), and in the group of patients without CIN it was 0 (0.0%). Statistical significance was demonstrated in the examined groups based on the number of complications (p &lt;0.0005). The number of patients without complications in the group with CIN was 39 (66.1%), and in the group of patients without CIN it was 1027 (84.9%). The number of patients with 1 complication in the group with CIN was 12 (20.3%), and in the group of patients without CIN it was 146 (12.1%). The number of patients with 2 complications in the group with CIN was 6 (10.2%), and in the group of patients without CIN it was 20 (1.7%). The number of patients with 3 complications in the group with CIN was 1 (1.7%), and in the group of patients without CIN it was 11 (0.9%). The number of patients with 4 complications in the group with CIN was 1 (1.7%), and in the group of patients without contrast-induced nephropathy it was 6 (0.5%). Statistical significance was demonstrated between the examined groups based on MACE complications (p &lt;0.0005). The number of patients with MACE complications in the group with CIN was 20 (33.9%), and in the group of patients without CIN it was 183 (15.1%). Acute renal failure is a relatively common complication of cardiac surgery. Vulnerable patients are particularly at risk, in our study patients with previous CIN, in whom the acutazation of renal failure is significantly more frequent. Cardiac surgery patients who develop acute renal failure have, as demonstrated in our study, more postoperative complications, prolonged stay in the intensive care unit, as well as the risk of developing chronic kidney disease.</p>