Yes / BACKGROUND: For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT). DESIGN: The INSPIRE study will be conducted within the Medical Research Council (MRC) Framework for the Evaluation of Complex Interventions (Phases 0-2) and includes an exploratory two-arm delayed intervention randomised controlled trial. Eighty patients and/or their carers will be randomly allocated to one of two groups: (I) Intervention: GNP in addition to standard care or (II) Control: Standard Care. Recipients of the GNP will be asked for their views on participating in both the study and the intervention. Quantitative and qualitative data will be gathered from both groups over eight weeks through face-to-face interviews which will be conducted before, during and after the intervention. The primary outcome is the effect of the intervention on social and practical need. Secondary outcomes are quality of life, loneliness, social support, social capital, unscheduled health service utilisation, caregiver burden, adverse impacts, and satisfaction with intervention. Volunteers engaged in the GNP will also be assessed in terms of their death anxiety, death self efficacy, self-reported knowledge and confidence with eleven skills considered necessary to be effective GNP volunteers. DISCUSSION: The INSPIRE study addresses an important knowledge gap, providing evidence on the efficacy, utility and acceptability of a unique model of social and practical support for people living at home, with advanced life-limiting illness. The findings will be important in informing the development (and evaluation) of similar service models and policy elsewhere both nationally and internationally. TRIAL REGISTRATION: ISRCTN18400594 18(th) February 2015.

Abstract: Background: In Parkinson’s disease, postural instability and falls are of particular socioeconomic relevance. Although effective fall prevention and the prophylaxis of fall-related injuries depend on low-threshold symptom monitoring, validated instruments are lacking. Objectives: To develop a self-report questionnaire for the assessment of falls, near falls, fear of falling, fallrelated injuries, and causes of falls for patients with Parkinson’s disease (PwPD). - Methods: A pool of potential items was generated from a literature review and by discussion in an expert panel. The first version of the Dresden Fall Questionnaire (DREFAQ) was tested in a group of German-speaking movement disorder specialists as well as PwPD. The resulting 5-item questionnaire was assessed in a validation cohort of 36 PwPD who documented fall events and near-fall events in a calendar for 3 months and completed the DREFAQ at the end of the study. The questionnaire was subsequently used in a separate cohort of 46 PwPD to determine test–retest reliability and confirm the factor structure. - Results: The DREFAQ showed good internal consistency (Cronbach’s α = 0.84) and good test–retest reliability (intraclass correlation coefficient, 0.76; 95% confidence interval, 0.60–0.86). The total DREFAQ score showed good concurrent validity with fall events (Spearman’s ρ = 0.82) and near-fall events (Spearman’s ρ = 0.78) as determined by fall and near-fall diaries. Factor analysis revealed a 2-factor structure composed of near falls with fear of falling and severe falls with injuries. - Conclusions: The DREFAQ is a reliable and valid 5-item questionnaire for determining the incidence of falls, near falls, fear of falling, fall-related injuries, and causes of falls in PwPD.

<p>Uvod - Etiologija sindroma gornjeg otvora grudnog ko&scaron;a (thoracic outlet syndrome- TOS) je udruženost vi&scaron;e faktora koji su posledica naru&scaron;avanja anatomsko-topografskih odnosa u nivou gornjeg otvora grudnog ko&scaron;a: kostoklavikularnog prostora, prednjeg skalenskog otvora, kao i same mehanike rebarnih zglobova i hrskavica, koji dovode do suženja prostora kroz koje prolaze neurovaskularne strukture, njihove kompresije, a samim tim i iritacije neurovaskularnih struktura. Sindrom gornjeg otvora grudnog ko&scaron;a je kompleks simptoma uzrokovanih kompresijom brahijalnog spleta, vene subklavije, arterije subklavije i simpatičkih vlakana, koji karakteri&scaron;u bol, parestezije, mi&scaron;ićna slabost i osećaj nelagodnosti u ruci/rukama koji se pojačava podizanjem ruke/ruku ili prekomernim pokretima glave i vrata, te dovode do smanjenja funkcionalne sposobnosti ruke/ruku i pote&scaron;koća u obavljanju svakodnevnih aktivnosti. Pored toga imaju često izraženu tahikardiju, osećaj stezanja u grudima, glavobolju, vrtoglavicu, zujanje u u&scaron;ima. Navedene tegobe su izraženije ponekad noću i dovode do poremećaja spavanja (problemi usnivanja, hrkanje, ka&scaron;ljanje, osećaj toplo/hladno, apnea, poremećaj dnevno/noćnog ritma- hronotipizacija, itd). Kao posledica lo&scaron;eg spavanja moguća je pojava depresivnih simptoma. U raspoloživoj literaturi, spavanje i kvalitet spavanja se uglavnom posmatraju kroz prizmu drugih bolesti i stanja. Materijal i metode - Istraživanjem je obuhvaćeno ukupno 181 (sto osam deset jedna) osoba. Od tog broja 53 mu&scaron;karca i 128 žena. Test grupu sačinjavalo je 82 ispitanika sa dijagnostikovanim TOS, a 99 zdravih osoba/osoba oba pola koji nemaju simptomatologiju TOS, je predstavljalo kontrolnu grupu. Grupe su bile ujednačene po polu i starosti (od 18 do 65). Tokom studije ispitanici su podvrgnuti kliničkom pregledu &ndash; fizikalnom i neurolo&scaron;kom pregledu. Pregled je podrazumevao pregled posture obolelog (posmatranje mi&scaron;ića regije vrata, ramena i ruku- trofika, tonus, konzistencija, mobilnost i kontraktilnost), posmatranje promena na koži (sa posebnim osvrtom na promene boje kože, trofičkih promena kože i noktiju i temperature kože ruku - &scaron;aka), testiranje refleksa, ispitivanje senzibiliteta u regijama inervacije odgovarajućih spinalnih korenova brahijalnog spleta. Takođe vr&scaron;ena je analiza stanja uhranjenosti (telesna visina, telesna masa, indeks telesne mase) i izvođenje provokativnih testova (Adson manevar, Rus test, Halsted test, Elvi test i Kostoklavikularni test). Kao deo ispitivanja obavljeno je i radiolo&scaron;ko snimanje vratne kičme kao i pregled oscilografom. Ispitanici su imali za zadatak da ispune sledeće upitnike: Upitnik o nesposobnosti ruke, ramena i &scaron;ake (DASH), Pitsbur&scaron;ki indeks kvaliteta spavanja (PSQI), Upitnik o hronotipizaciji (MEQ), Bekov upitnik o depresiji (BDI II). Na kraju ispitanici su davali odgovore na pitanja iz vodiča za istraživača sastavljenog sa ciljem evaluacije različitih aspekata spavanja. Rezultati - Rezultati su pokazali da su upotrebljene skale dale zadovoljavajuću pouzdanost. Pokazalo se da osobe sa dijagnozom TOS pored bogate simptomatologije imaju jo&scaron; i probleme sa spavanjem. Analizom rezultata do&scaron;lo se do zaključka da osobe sa dijagnozom TOS su starije, imaju vi&scaron;e problema sa spavanjem i veću nesposobnost ruke, ramena i &scaron;ake. Nije se pokazala razlika u hronotipizaciji kod osoba sa TOS u odnosu na kontrolnu grupu. Takođe može se zaključiti da osobe koje imaju izraženu nesposobnost ruku, ramena i &scaron;ake imaju značajno veću &scaron;ansu da imaju sindrom gornjeg otvora grudnog ko&scaron;a. Ove osobe pri tom imaju i veću &scaron;ansu da razviju depresiju i poremećaj spavanja, te se zaključuje da ova dva parametra svoj uticaj na TOS ostvaruju preko problema sa funkcionisanjem ruke, ramena i &scaron;ake. Dobar prediktor za postavljanje dijagnoze TOS može biti testiranje osoba DASH skalom. Zaključak - Rezultati studije mogu biti putokaz daljim istraživanjima, koja bi otvorila vrata formiranju protokola i opservaciji kvaliteta života osoba sa sindroma gornjeg otvora grudnog ko&scaron;a, sa posebnim osvrtom na poremećaje spavanja.</p> / <p>Etiology of thoracic outlet syndrome (TOS) is an association of several factors which are the result of disruption in the anatomical-topographical relations, in the level of superior thoracic aperture: costoclavicular space, anterior scalene aperture, as well as the mechanics of rib joints and cartilage, causing narrowing of space through which the neurovascular structures pass, their compression, and thus the irritation of neurovascular structures. Thoracic outlet syndrome is a complex of symptoms caused by the compression of the brachial plexus, subclavian vein, subclavian artery and sympathetic fibres, which is characterized by pain, parasthesias, muscle weakness and a feeling of discomfort in the arm / arms, which increases with raising the arm/arms or by excessive head and neck movements leading to a reduction of functional capabilities of the hands / arms and difficulties in everyday activities. In addition, patients often have expressed tachycardia, feeling of tightness in the chest, headache, dizziness, tinnitus. These problems are more pronounced at night and sometimes lead to sleep disorders (difficulty in falling asleep, snoring, coughing, feeling hot/cold, apnea, day/night rhythm disorder - Morningness/Eveningness disorder, etc.). As a result of poor sleeping depressive symptoms may occur. In the available bibliography, sleep and quality of sleep are mainly viewed through other diseases and conditions. The study included a total number of 181 (one hundred eighty one) people. Out of that 53 men and 128 women. The test group consisted of 82 patients diagnosed with TOS, and 99 healthy persons of both genders who had no symptoms of TOS, and constitute the control group. Groups were equalled by gender and age (18 to 65). Throughout the study subjects underwent clinical examination - both physical and neurological. This included an assessment of posture of the patient (observation of muscles in region of the neck, shoulders and arms - trophic, muscle tone, consistency, mobility and contractility), observation of changes on the skin (with a special emphasis on skin colour changes, trophic changes of the skin, nails and skin temperature of arms - hands), reflex testing, sensitivity testing in regions of innervations which correspond to spinal roots of the brachial plexus. Moreover, an analysis was conducted on the body composition analysis (body height, body weight, body mass index) as well as provocative tests (Adson manoeuvre, the Roos test, Halstead test, Elvy test and Costoclavicular test). Radiology scan of the cervical spine as well as oscillograph testing was conducted as a part of the test. The subjects were asked to fulfil the following questionnaires: Questionnaire on Disabilities of the Arm, Shoulder and Hand (DASH), Pittsburgh Sleep Quality Index (PSQI), The Morningness / Eveningness Questionnaire (MEQ), Beck Questionnaire on Depression (BDI II). Finally the subjects answered questions that researcher had drawn up in order to evaluate different aspects of sleep. The results showed that the scales used were reliable. It proved that persons diagnosed with TOS in addition to numerous symptoms also had problems with sleep. By analyzing the results it was concluded that people diagnosed with TOS are older, have more problems with sleep and greater disability of arms, shoulders and hands. There was no difference in Morningness/Eveningness type in patients with TOS in comparison to the control group. It can also be concluded that people who have pronounced disability of arms, shoulders and hands have a significantly greater chance of having thoracic outlet syndrome. These persons are more likely to develop depression and sleep disorders therefore those two entities impact TOS through the problems with the functioning of the arms, shoulders and hands. A good predictor in diagnosis of TOS may be testing people with DASH scale. The study findings can serve as a guideline for further research, opening the door into forming protocols and observation of the quality of life of people with the thoracic outlet syndrome, with special emphasis on sleep disorders.</p>

<p>Cilj: Utvrditi funkcionalni i mentalni status pacijenata pre i posle medicinske rehabilitacije, a nakon operacije kuka kod osoba starije životne dobi primenom standardizovanih upitnika (SF36, Harris hip score, MMS, TUG, FES-I) . Materijal i metod:Istraživanje je bilo prospektivno i uzorak je činilo 96 pacijenata sa prethodnom operacijom kuka koji su u toku 18 meseci, od januara 2014., bili u rehabilitacionom programu na Klinici za medicinsku rehabilitaciju KCV. Kod svih pacijenata je registrovan: pol i starosna dob, kao i uzrok odnosno vrsta operativnog zahvata. Pacijenti su pregledani i anketirani sa svih 5 upitnika u tri vremenska trenutka: pre samog početka rehabilitacionog tretmana i na 3 i 6 meseci posle. SF-36 je generički merni obrazac koji se koristi za procenu kvaliteta života. Harris Hip Score (HHS) predstavlja merni instrument za procenu funkcionalnih parametara. Mini Mental State (MMS) se koristi kod procene mentalnog statusa. Timed Up and Go Test (TUG) je efikasan metod procene pokretljivosti i funkcije lokomotornog sistema kod starijih pacijenata. Falls Efficacy Scale- International (FES-I) je test kojim se meri stepen zabrinutosti od pada. Metodom ponovljenih merenja analizirana su stanja pacijenata pre i posle medicinske rehabilitacije. Izvr&scaron;ena je i korelaciona analiza kori&scaron;ćenih upitnika, kao i univarijantna analiza u odnosu na vrstu operacije. Rezultati:Nakon medicinske rehabilitacije posle operacije kuka kod osoba starije životne dobi je značajno bolji ukupni fizički skor SF36: 29,0 / 38,7 / 46,3; kao i vrednost HHS skora 50,2 / 63,4 / 76,3; i TUG testa 31,3s / 19,6s / 13,6s; (pre rehabilitacije, 3m i 6m respektivno). Postoje statistički značajne korelacije ukupnog fizičkog domena SF36 i vrednosti Harris Hip, TUG i FES-I, kao i ukupnog mentalnog domena SF36 i MMS skora. Zadovoljstvo pacijenata rehablitacionim tretmanom je u korelaciji sa vrednostima funkcionalnih testova (Harris Hip Score), testom ustani kreni (TUG) i ukupnim fizičkim domenom upitnika SF36, kao i sa skorom FES-I. Zaključci: Kvalitet života i funkcionalna sposobnost operisanih pacijenata nakon medicinske rehabilitacije je značajno bolja kako u komparaciji stanja na tri meseca i na početku rehabilitacije tako i u komparaciji stanja na 6 meseci u odnosu na stanje na 3 meseca.</p> / <p>Objective: To determine the functional and mental status of patients before and after medical rehabilitation after hip surgery in elderly by using standardized questionnaires (SF36, Harris hip score, MMS, TUG, FES-I). Materials and methods:The study was prospective and the sample consisted of 96 patients with previous hip surgery that during the 18 months from January 2014, was in a rehabilitation program at the Department of medical rehabilitation KCV. For all patients registered sex and age, as well as the cause and type of surgery.Patients are screened and interviewed with all 5 of the questionnaire in three time points: before the start of the rehabilitation treatment and at 3 and 6 months after. SF-36 is a generic form that measurement is used to assess the quality of life. Harris Hip Score (HHS) is a measuring instrument for the assessment of functional parameters. Mini Mental State (MMS) used in the assessment of mental status. Timed Up and Go Test (TUG) is an effective method of evaluating the mobility and function of the musculoskeletal system in older patients.Falls Efficacy Scale- International (FES-I) is a test that measures the level of concern of falling. Method of repeated measurements were used to analyse condition of patients before and after medical rehabilitation. There was also a correlation analysis of used questionnaires, as well as the univariate analysis in relation to the type of surgery. Results: After medical rehabilitation after surgery of the hip in the elderly is significantly better overall physical SF36 score: 29.0 / 38.7 / 46.3; as well as the value of the HHS score of 50.2 / 63.4 / 76.3; and the TUG test 31,3s / 19,6s / 13,6s; (before rehabilitation, 3m and 6m respectively). There are statistically significant correlations of total physical domain SF36 and values Harris Hip, TUG and the FES-I, and the overall mental domain of SF36 and MMS score. Patient satisfaction with rehabilitation treatment is correlated with the values of functional tests (Harris Hip Score) test Up and go (TUG) and total physical domain SF36 questionnaires, as well as the FES-I. Conclusion: Quality of life and functional capacity of treated patients after medical rehabilitation significantly improved both in comparison to the situation in three months and at the beginning of rehabilitation as well as in comparison at 6 months compared to 3 months.</p>

<p>Увод: Астма као хронично оболење представља велики здравствени, социјални и економски проблем широм света Ово оболење једно је од најчешћих хроничних оболења код деце и најчешћи узрок повећаног броја хоспитализација код деце млађе од 15 година. Резултати досадашњих студија говоре у прилог пораста преваленције астме и алергијских болести код деце у последњих десетак година. Епидемиолошка испитивања су значајна за разумевање природе астме, као и откривања могућих фактора за тренд пораста учесталости астме код деце. Разлика у географској дистрибуцији учесталости симптома астме унутар исте земље сугерише да фактори средине, више него можда генетски фактори, утичу на дистрибуцију преваленције симптома астме. У литератури се као најзначајнији фактори средине истичу загађење животне средине и климатски фактора. Доступне студије показују да постоји узрочна повезаност између повећане изложености загађењу животне средине и акутних респираторних симптома. Процењено је да је у Европи током 2000. године дошло до губитка 3,6 милиона година живота услед повећања концентрације респирабилних честица. И новије препоруке Светске здравствене организације одлучно предлажу смањење изложености деце загађујућим материјама. Резултати доступних студија сугеришу да ефекти загрејавања и топлотних таласа, као и ниских темепратура, утичу на морбидитет и учесталост хоспитализација деце са астмом. Циљеви истраживања били су одредити преваленцију симптома астме код деце узраста од 6 до 15 година на територији Републике Српске, затим одредити утицај загађујућих материја животне средине и климатских фактора на преваленцију симптома астме код деце узраста од 6 до 15 година на територији Републике Српске. Материјал и методе: Истраживање је проведено у облику студије пресека и обухватало је 3000 деце узраста од 6 до 15 година из 13 основних школа на територији Републике Српске. Преваленција симптома астме код деце узраста од 6 до 15 година одређивала се путем упитника Интернационалне студије за астму и алергије код деце (The International Study of Asthma and Allergies in Childhood &ndash; ISAAC). Овај упитник дизајниран је за потребе мултицентричне студије о преваленцији астме, алергијског ринитиса и екцема код деце. Мерење квалитета ваздуха обухватало је следеће параметре: сумпoр диoксид SO2 (&mu;g/m3), угљен мoнoксид CO (mg/m3), азот диоксид NO2 (&mu;g/m3), oзoн O3 (&mu;g/m3) и респирабилне честице PM10 (&mu;g/m3). Континуирана мерења компоненти загађености ваздуха вршила су се на метеоролошком опсерваторију гдје су се континуирано мерили имисионе концентрације стационарним еколошким лабораторијем. Мерења климатских фактора на станицама Републичког хидрометеоролошког завода Републике Српске вршила су се према стандардима Светске метеоролошке организације (WMO). Мерења су се вршила у оквиру метеорoлошког круга који се налази на отвореном простору да би се избегао вештачки утицај околине и у одређеним терминима у зависности од ранга станице. Подаци су анализирани уз помоћ статистичког софтвера IBM SPSS Statistics 21. Резултати: Визинг у последњих 12 месеци имало је 7,9% деце укључене у студију. Дијагнозу астме икада имало је постављено 3,5% испитаника. Статистички значајну учесталост недијагностиковане астме имала су деца са блажим симптомима астме у последњих 12 месеци. Сув кашаљ ноћу био регистрован је код 14,8% испитаника. Код дечака је била значајно виша преваленција визинга у последњих 12 месеци и сувог кашља него код девојчица. Код превремено рођене деце статистички значајно је виша преваленција свих симптома астме. Регистрована је и значајна релација између пушења међу укућанима и појаве визинга у последњих 12 месеци (&chi;2 (1, N=1956) = 5,13, p=0,02). Код испитаника чији укућани су пушачи била је виша преваленција овог симптома (9,6%) у односу на децу чији укућани не пуше (6,7%). Пушење мајки у трудноћи статистички значајно је утицало на преваленцију свих симптома астме код деце. Концентрација азот оксида и PM10 је статистички значајно повезана са преваленцијом визинга и сувог кашља у последњих 12 месеци, док је повезаност са преваленцијом дијагнозе астме код деце на маргини статистичке значајности. Концентрација сумпор диоксида и озона је статистички значајно повезана са преваленцијом визинга у последњих 12 месеци. Преваленција астме у планинској регији је 7,3%, у умерено-континенталној регији је 8,0% и медитеранској регији 8,4%. Просечна годишња температура даје статистички значајан допринос предвиђању појаве визинга у последњих 12 месеци међу децом која су икада имали визинг у току живота. Са порастом просечне годишње температуре за 1 степен вероватноћа појаве визинга у последњих 12 месеци је 1,98 пута већа међу децом која су икада имала визинг. Пораст максималне просечне дневне температуре статистички значајно утиче на појаву визинга у току живота и сувог кашља у последњих 12 месеци. Постоји статистички значајна повезаност између минималне просечне дневне температуре и појаве визинга толико тешког да дете није у могућности изговорити неколико речи између два удаха. Закључак: Мушки пол, рођење пре термина, изложеност дуванском диму и пушење мајке током трудноће представљају статистички значајане ризике за развој астме код детета. Дечаци, деца млађег узраста, превремено рођена деца и деца храњена млечним формулама у првих 6 месеци живота имају статистичи значајан ризик за развој сувог кашља. Статистички значајну повезаност са преваленцијом астме код деце имају следеће мерене загађујуће материје: SO2, O3, азот оксиди и PM10. Статистички значајну повезаност са преваленцијом астме код деце има пораст просечне годишње температуре и више вредности максималне просечне дневне температуре.</p> / <p>Uvod: Astma kao hronično obolenje predstavlja veliki zdravstveni, socijalni i ekonomski problem širom sveta Ovo obolenje jedno je od najčešćih hroničnih obolenja kod dece i najčešći uzrok povećanog broja hospitalizacija kod dece mlađe od 15 godina. Rezultati dosadašnjih studija govore u prilog porasta prevalencije astme i alergijskih bolesti kod dece u poslednjih desetak godina. Epidemiološka ispitivanja su značajna za razumevanje prirode astme, kao i otkrivanja mogućih faktora za trend porasta učestalosti astme kod dece. Razlika u geografskoj distribuciji učestalosti simptoma astme unutar iste zemlje sugeriše da faktori sredine, više nego možda genetski faktori, utiču na distribuciju prevalencije simptoma astme. U literaturi se kao najznačajniji faktori sredine ističu zagađenje životne sredine i klimatski faktora. Dostupne studije pokazuju da postoji uzročna povezanost između povećane izloženosti zagađenju životne sredine i akutnih respiratornih simptoma. Procenjeno je da je u Evropi tokom 2000. godine došlo do gubitka 3,6 miliona godina života usled povećanja koncentracije respirabilnih čestica. I novije preporuke Svetske zdravstvene organizacije odlučno predlažu smanjenje izloženosti dece zagađujućim materijama. Rezultati dostupnih studija sugerišu da efekti zagrejavanja i toplotnih talasa, kao i niskih temepratura, utiču na morbiditet i učestalost hospitalizacija dece sa astmom. Ciljevi istraživanja bili su odrediti prevalenciju simptoma astme kod dece uzrasta od 6 do 15 godina na teritoriji Republike Srpske, zatim odrediti uticaj zagađujućih materija životne sredine i klimatskih faktora na prevalenciju simptoma astme kod dece uzrasta od 6 do 15 godina na teritoriji Republike Srpske. Materijal i metode: Istraživanje je provedeno u obliku studije preseka i obuhvatalo je 3000 dece uzrasta od 6 do 15 godina iz 13 osnovnih škola na teritoriji Republike Srpske. Prevalencija simptoma astme kod dece uzrasta od 6 do 15 godina određivala se putem upitnika Internacionalne studije za astmu i alergije kod dece (The International Study of Asthma and Allergies in Childhood &ndash; ISAAC). Ovaj upitnik dizajniran je za potrebe multicentrične studije o prevalenciji astme, alergijskog rinitisa i ekcema kod dece. Merenje kvaliteta vazduha obuhvatalo je sledeće parametre: sumpor dioksid SO2 (&mu;g/m3), ugljen monoksid CO (mg/m3), azot dioksid NO2 (&mu;g/m3), ozon O3 (&mu;g/m3) i respirabilne čestice PM10 (&mu;g/m3). Kontinuirana merenja komponenti zagađenosti vazduha vršila su se na meteorološkom opservatoriju gdje su se kontinuirano merili imisione koncentracije stacionarnim ekološkim laboratorijem. Merenja klimatskih faktora na stanicama Republičkog hidrometeorološkog zavoda Republike Srpske vršila su se prema standardima Svetske meteorološke organizacije (WMO). Merenja su se vršila u okviru meteorološkog kruga koji se nalazi na otvorenom prostoru da bi se izbegao veštački uticaj okoline i u određenim terminima u zavisnosti od ranga stanice. Podaci su analizirani uz pomoć statističkog softvera IBM SPSS Statistics 21. Rezultati: Vizing u poslednjih 12 meseci imalo je 7,9% dece uključene u studiju. Dijagnozu astme ikada imalo je postavljeno 3,5% ispitanika. Statistički značajnu učestalost nedijagnostikovane astme imala su deca sa blažim simptomima astme u poslednjih 12 meseci. Suv kašalj noću bio registrovan je kod 14,8% ispitanika. Kod dečaka je bila značajno viša prevalencija vizinga u poslednjih 12 meseci i suvog kašlja nego kod devojčica. Kod prevremeno rođene dece statistički značajno je viša prevalencija svih simptoma astme. Registrovana je i značajna relacija između pušenja među ukućanima i pojave vizinga u poslednjih 12 meseci (&chi;2 (1, N=1956) = 5,13, p=0,02). Kod ispitanika čiji ukućani su pušači bila je viša prevalencija ovog simptoma (9,6%) u odnosu na decu čiji ukućani ne puše (6,7%). Pušenje majki u trudnoći statistički značajno je uticalo na prevalenciju svih simptoma astme kod dece. Koncentracija azot oksida i PM10 je statistički značajno povezana sa prevalencijom vizinga i suvog kašlja u poslednjih 12 meseci, dok je povezanost sa prevalencijom dijagnoze astme kod dece na margini statističke značajnosti. Koncentracija sumpor dioksida i ozona je statistički značajno povezana sa prevalencijom vizinga u poslednjih 12 meseci. Prevalencija astme u planinskoj regiji je 7,3%, u umereno-kontinentalnoj regiji je 8,0% i mediteranskoj regiji 8,4%. Prosečna godišnja temperatura daje statistički značajan doprinos predviđanju pojave vizinga u poslednjih 12 meseci među decom koja su ikada imali vizing u toku života. Sa porastom prosečne godišnje temperature za 1 stepen verovatnoća pojave vizinga u poslednjih 12 meseci je 1,98 puta veća među decom koja su ikada imala vizing. Porast maksimalne prosečne dnevne temperature statistički značajno utiče na pojavu vizinga u toku života i suvog kašlja u poslednjih 12 meseci. Postoji statistički značajna povezanost između minimalne prosečne dnevne temperature i pojave vizinga toliko teškog da dete nije u mogućnosti izgovoriti nekoliko reči između dva udaha. Zaključak: Muški pol, rođenje pre termina, izloženost duvanskom dimu i pušenje majke tokom trudnoće predstavljaju statistički značajane rizike za razvoj astme kod deteta. Dečaci, deca mlađeg uzrasta, prevremeno rođena deca i deca hranjena mlečnim formulama u prvih 6 meseci života imaju statističi značajan rizik za razvoj suvog kašlja. Statistički značajnu povezanost sa prevalencijom astme kod dece imaju sledeće merene zagađujuće materije: SO2, O3, azot oksidi i PM10. Statistički značajnu povezanost sa prevalencijom astme kod dece ima porast prosečne godišnje temperature i više vrednosti maksimalne prosečne dnevne temperature.</p> / <p>Introduction: Asthma аs a chronic diseases is a major health, social and economic problem worldwide. It is one of the most common chronic diseases in children and the most common cause of an increased number of hospitalizations in children under the age of 15 years. The results of previous studies show an increase in the prevalence of asthma and allergic diseases in children in the last ten years. Epidemiological studies are important for understanding the nature of asthma, as well as for discovering of possible factors for the increasing trend of the prevalence of asthma in children. The difference in the geographical distribution of the prevalence of asthma symptoms within the same country suggests that environmental factors, rather than genetic factors may influence the distribution of the prevalence of asthma symptoms. Air pollution and climatic factors highlight as the most important environmental factors in the literature. Available studies indicate that there is a causal link between increased exposure to air pollution and acute respiratory symptoms. It is estimated that was a loss of 3.6 million years of life due to increased concentrations of respirable particles in Europe during 2000. year. Also, the recent recommendations of the World Health Organization strongly suggest reducing children&#39;s exposure to air pollutants. The results of the available studies suggest that the effects of warming and heat waves, as well as low temperatures, influence on the incidence of morbidity and hospitalization in children with asthma. The aims of this research were to determine the prevalence of asthma symptoms in children aged 6 to 15 years on the territory of Republic of Srpska, to determine the impact of air pollutants and climatic factors on the prevalence of asthma symptoms in children aged 6 to 15 years on the territory of Republic of Srpska. Materials and Methods: The study was conducted in the form of cross-sectional study and included 3,000 children aged 6 to 15 years from 13 primary schools in Republic of Srpska. The prevalence of asthma symptoms in children aged 6 to 15 years is determined through a questionnaire of the International Study of Asthma and Allergies in Children (ISAAC). This questionnaire has been designed for the needs of a multi-center study of the prevalence of asthma, allergic rhinitis and eczema in children. Measuring air quality included the following parameters: sulfur dioxide SO2 (mg/m3), carbon monoxide CO (mg/m3), nitrogen dioxide NO2 (mg/m3), ozone O3 (g/m3) and respirable particles PM10 (mg/m3). Air quality monitoring is performed using the meteorological observatory, where we continuously measured the emission concentration by a stationary ecological laboratory. Measurements of climate factors in stations of the Republic Hydrometeorological Service of Republic of Srpska were done according to the standards of the World Meteorological Organization (WMO). Measurements were made in certain periods depending on the station rank in the space of the meteorological circle which was located in the open space in order to avoid artificially influence the environment. Data were analyzed using statistical software IBM SPSS Statistics 21. Results: The prevalence of wheezing in the past 12 months was 7.9%, while the prevalence of diagnosed asthma ever was 3.5%. Children with symptoms of mild asthma in the past 12 months had statistically significant prevalence of undiagnosed asthma. A dry cough at night was registered in 14.8% of participants. Boys have significantly higher prevalence of wheezing in the past 12 months and a dry cough than girls. Premature infants have significantly higher prevalence of all asthma symptoms. It was registered significant relationship between smoking among family members and the occurrence of wheezing in the past 12 months (&chi;2 (1, N = 1956) = 5.13, p = 0.02). Prevalence of these symptoms was higher for participants who lived with smokers (9.6%) compared to children whose family members do not smoke (6.7%). Maternal smoking during pregnancy significantly influenced the prevalence of asthma symptoms in children. The concentration of nitrogen oxides and PM10 was significantly associated with the prevalence of wheezing and dry cough in the past 12 months. The concentration of sulfur dioxide and ozone was significantly associated with the prevalence of wheezing in the past 12 months. The prevalence of asthma in the highland climate regions was 7.3%, in the continental regions was 8.0% and 8.4% in the mediterranean regions. The average annual temperature gives a statistically significant contribution to predicting the occurrence of wheezing in the past 12 months among children who have ever had wheezing during their lifetime. The likelihood of wheezing in the past 12 months was 1.98 times higher for each degree of average annual temperature rise among children who ever had wheezing. The increase of average daily maximum temperature significantly affects the occurrence of wheezing ever and dry cough in the past 12 months. There is a statistically significant correlation between the average daily minimum temperature and the occurrence of severe wheezing that the child is not able to say a few words between breaths. Conclusion: Male gender, preterm birth, exposure to environmental tobacco smoke and maternal smoking during pregnancy are a statistically significant risk for the development of asthma in children. Boys, younger children, premature babies and children formulas fed during first 6 months of life have a statistically significant risk for the development of a dry cough. Statistically significant association with the prevalence of asthma in children showed following air pollutants: SO2, O3, nitrogen oxides and PM10. Statistically significant association with the prevalence of asthma in children has rise of the average annual temperature and higher value of the maximum average daily temperature.</p>

<p>Uvod: Hronična HCV infekcija je povezana sa nizom ekstrahepatičnih manifestacija, uključujući pojavu depresivnih i anksioznih simptoma, zamora, bolova u mi&scaron;ićima i zglobovima koji su povezani sa smanjenjem kvaliteta života u vezi sa zdravljem (HRQOL). Ciljevi istraživanja: Proceniti različite aspekte kvaliteta života bolesnika sa hroničnim hepatitisom C koji nisu na terapijskom tretmanu interferonom; Sagledati učestalost određenih psihosocijalnih obeležja (depresivnost, anksioznost, radni status, stepen obrazovanja) i njihovu povezanost sa kvalitetom života bolesnika sa hroničnim hepatitisom C koji nisu na terapijskom tretmanu, kao i ispitati povezanost osnovnih demografskih obeležja (starost, pol, bračno stanje) i kvaliteta života bolesnika sa hroničnim hepatitisom C; Ispitati povezanost osnovnih medicinskih obeležja vezanih za oboljenje (način prenosa infekcije, dužna infekcije, prisustvo ciroze) i kvaliteta života bolesnika sa hroničnim hepatitisom C. Materijal i metode: Istraživanje je sprovedeno kao prospektivna studija u periodu od aprila 2013. do aprila 2015. godine na Klinici za infektivne bolesti Kliničkog centra Vojvodine u Novom Sadu, Infektivnom odeljenju i u Službi za transfuziju krvi Op&scaron;te bolnice ,,Dr Radivoj Simonović&rdquo; u Somboru. Ispitano je 150 osoba, oba pola, obolelih od hroničnog hepatitisa C koji su činili studijsku grupu obolelih. U kontrolnoj grupi ispitano je ukupno 150 zdravih osoba, oba pola, uzrasta iznad 18 sličnih socio-demografskih karakteristika. Kvalitet života ispitan je pomoću upitnika: SF-36, CLDQ i HADS. Putem op&scaron;teg upitnika prikupljni su socio-demografski podaci o ispitanicima, kao i odeđena obeležja vezana za oboljenje. Rezultati: Sagledavanjem skorova upitnika SF-36 razlika u kvalitetu života između obolelih od hroničnog hepatitis C i kontrolne grupe je statistički značajna na svakom od pojedinačnih domena, ukupnom skoru SF-36 upitnika, Fizičkom kompozitnom skoru i Mentalnom kompozitnom skoru (p&lt; 0,000). Oboleli od hroničnog hepatitisa C pokazuju statistički značajno izraženiju depresivnost (t=3,37; p&lt;0,01) i anksioznost (t=2,35; p&lt;0,05) u odnosu na kontrolnu grupu. Multiplom regresionom analizom utvrđeno je da se visok procenat depresivnosti (72%) može objasniti sa skupom prediktora koji su činili domeni kvaliteta života sa upitnika SF-36. Najveći parcijalni doprinos pojavi depresivnosti imaju tri domena kvaliteta života: Fizičko funkcionisanje, Vitalnost i Mentalno zdravlje. Univarijantnom analizom utvrđen je nezavisan efekat bračnog statusa na promene u kvalitetu života kod obolelih od HHC. Lo&scaron;iji kvalitet života kod osoba koje boluju od hroničnog hepatitisa C če&scaron;će je prisutan kod onih koji žive u braku ili vanbračnoj zajednici i onih starosti 30-50 godina, dok oni koji su zaposleni imaju bolji kvalitet. Zaključak: S obzirom na lo&scaron;iji kvalitet života osoba obolelih od hroničnog hepatitisa C i če&scaron;će prisustvo depresivnih i anksioznih obeležja potrebno je proceniti kvalitet života obolelih nakon postavljanja dijagnoze, kao i tokom kliničkog praćenja i lečenja.</p> / <p>Background: Chronic HCV infection is associated with a variety of extrahepatic manifestations, including the occurrence of depressive and anxiety symptoms, fatigue, muscle pain and joint pain associated with a reduction in quality of life related to health (HRQOL). Objectives: Assess the different aspects of quality of life in patients with chronic hepatitis C who are not on interferon therapy treatment; Consider the frequency of certain psychosocial characteristics (depression, anxiety, employment status, education level) and their association with the quality of life of patients with chronic hepatitis C who have not on therapeutic treatment, as well as examine the relationship between basic demographic characteristics (age, sex, marital status) and quality of life in patients with chronic hepatitis C; To analyze the association of basic medical characteristics related to disease (mode of transmission of infection, responsible for the infection, the presence of cirrhosis) and quality of life of patients with chronic hepatitis C. Materials and Methods: The study was conducted as a prospective study from April 2013 to April 2015 at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina in Novi Sad, Department of Infectious Diseases and the Blood Transfusion General Hospital ,,Dr Radivoj Simonovic&ldquo; Sombor . The study has included 150 patients with chronic hepatitis C who have done a study group, both sexes. In the control group, has included 150 healthy subjects of both sexes, aged over 18 years, similar socio-demographic characteristics. Quality of life was tested using a questionnaire SF-36, HADS and CLDQ. Through a general questionnaire have collected the socio-demographic data on the respondents, as well as the diseases characteristics. Results: By reviewing the scores of SF-36 difference in quality of life between patients with chronic hepatitis C and control group was statistically significant in each of the individual domains, the total score of the SF-36 questionnaire, Physical and Mental composite score (p &lt;0.000). Patients with chronic hepatitis C show significantly more pronounced depression (t = 3.37; p &lt;0.01) and anxiety (t = 2.35; p &lt;0.05) compared to the control group. Multiple regression analysis showed that a high percentage of depression (72%) can be explained by a set of predictors consisted of the domain of quality of life questionnaire SF-36. The greatest partial contribution occurs depression have three domains of quality of life: Physical functioning, Vitality and Mental health. Univariate analysis identified the independent effect of marital status on changes in the quality of life in patients with HHC. Worse quality of life in patients suffering from chronic hepatitis C often present in those living in married or common-law marriage and those aged 30-50 years, while those who are employed have better quality. Conclusion: Due to the inferior quality of life of patients suffering from chronic hepatitis C and frequent presence of depressive and anxiety traits it is necessary to assess the quality of life of patients after diagnosis and during clinical follow-up and treatment.</p>

<p>Uvod: Lumbalni bolni sindrom (LBS) podrazumeva tegobe u vidu bolova, u lumbalnom ili lumbosakralnom segmentu kičmenog stuba, sa ili bez iradijacije u donje ekstremitete, uz poremećaj funkcije umbosakralnog dela kičmenog stuba, za&scaron;titnu mi&scaron;ićnu reakciju na bol (spazam) uz moguće znake senzitivnog poremećaja. Laser male snage (LMS) ima &scaron;iroku primenu u fizikalnoj medicini i rehabilitaciji zbog analgetskog, antiinflamatornog, antiedematoznog i biostimulativnog dejstva. Cilj rada: Glavni ciljevi su bili da se utvrdi da li fizikalna terapija primenom LMS utiče na smanjenje bola, povećanje pokretljivost lumbalne kičme, smanjenje spazma pravertebralne muskulature, kao i na smanjenje funkcionalne osnesposobljenosti u subakutnom LBS. Materijal i metode: Sprovedena je prospektivna studija na 123 pacijenata (50 mu&scaron;karaca i 73 žene), različitih profesija, izabranih metodom slučajnog izbora, prosečne životne dobi 32.59&plusmn;5.67 godina (ispitivana grupa 31.87&plusmn;5.84, kontrolna grupa 33.31&plusmn;5.45, raspon od 19-45). U studiju su uključeni ispitanici koji su prvi put doživeli lumbalni bolni sindrom koji su pregledani u Odeljenju za fizikalnu medicinu i rehabilitaciju Doma zdravlja Novi Sad. Ispitivanu grupu je činio 61 ispitanik koji su uključeni u fizikalni tretman, primenom laseroterapije i kineziterapije uz medikamentoznu terapiju. Kontrolnu grupu je činilo 62 ispitanika koji koji su uključeni u fizikalni tretman primenom kineziterapije uz medikamentoznu terapiju. Svim ispitanicima je uzeta anamneza, obavljen klinički pregled, izvr&scaron;ena samoprocena bola i popunjavali su upitnike. Navedeno ispitivanje je sprovedeno na početku tretmana, nakon 6 nedelje i nakon sprovedenog tretmana. Kori&scaron;ćeni su sledeći upitnici: vizuelna analogna skala (VAS), standardizovani upitnici za merenje funkcionalnog ishoda - The Oswestry Disability Index (ODI), The Rolland&amp;Morris Disability Questionnaire (RMDQ) i SF-36 upitnik. Rezultati: Rezultati ukazuju da se intenzitet bola meren VAS skalom u obe ispitivane grupe značajno smanjivao tokom svih posmatranih perioda ispitivanja, pri čemu dobijena razlika između dve grupe nije statistički značajna (p=0.904). Pokretljivost lumbalne kičme u obe ispitivane grupe tokom posmatranog perioda se značajno povećala tokom svih posmatranih perioda ispitivanja, pri čemu dobijena razlika između dve grupe nije statistički značajna (p=0.798). U obe ispitivane grupe spazam paravertebralne muskulature se značajno smanjivao tokom svih posmatranih perioda ispitivanja, dok dobijena razlika između grupa nije statistički značajna (p=0.453). Funkcionalna onesposobljenost pacijenata (procenjivana smanjenjem funkcionalne onesposobljenosti ODI i RMDQ) se značajno smanjivala u obe ispitivane grupe pacijenata tokom svih posmatranih perioda ispitivanja. Dobijena razlika u skorovima procenjivana RMDQ između ispitivanih grupa pacijenata nije statistički značajna (p=0.648), kao i putem ODI skora između ispitivanih grupa (p=0.311). Procena funkcionalne onesposobljenosti putem procene kvaliteta života (SF-36), ukazuje da se kvalitet života značajno povećavao u svim ispitivanim skorovima u obe ispitivane grupe tokom svih posmatranih perioda ispitivanja. Nema razlika u funkcionalnoj onesposobljenost (SF-36), odnosno nema razlike u kvalitetu života u skorovima fizičko funkcionisanje, ograničenje zbog emocionalnih problema, socijalno funkcionisanje, mentalno zdravlje, telesni bol, energija i vitalnost, sumarni skor fizičkog i sumarni skor mentalnog zdravlja između ispitivanih grupa. Dimenzije kvaliteta života u skorovima ograničenje zbog fizičkog zdravlja je značajno bolje u kontrolnoj grupi ispitanika (p=0.028). Dimenzija kvaliteta života u skoru op&scaron;te zdravlje je značajno bolje u ispitivanoj grupi pacijenata (p=0.041). Zaključci. Primenom LMS u subakutnom LBS do&scaron;lo je statistički značajnog smanjenja intenziteta bola, povećanja pokretljivosti lumbalne kičme, smanjenja spazma paravertebralne muskulature, kao i smanjenja funkcionalne onesposobljenosti. S obzirom da ne postoji koncenzus oko primene LMS, kao ni drugih metoda fizikalne terapije u subakutnom stadijumu LBS, navedeni rezultati bi mogli doprineti usvajanju kliničkih smernica, odnosno dijagnostičkih i terapijskih protokola za subakutni LBS.</p> / <p>Introduction: Low back pain syndrome (LBP) implies pain in the lumbar or lumbosacral segment of the spine, with or without irradiation into the lower extremities, with a disorder to the function of the lumbosacral part of the spine, a protective muscular reaction to pain (spasm) and possible signs of a sensory processing disorder. Low-Level Laser Therapy (LLLT) has broad application in physical medicine and rehabilitation due to analgesic, antiinflammatory, anti-edematous and biostimulative effects. Objective: The main objective of this study was to determine whether physical therapy with a LLLT has an effect on reducing pain, increasing mobility in the lumbar spine, reducing spasms of the paravertebral muscle, as well as in reducing functional incapacity in subacute LBP. Material and methods: A prospective study was conducted on 123 patients (50 men and 73 women), of different professions, chosen through random selection, with a mean age of 32.59 &plusmn; 5.67 years (examined group 31.87 &plusmn; 5.84, control group 33.31 &plusmn; 5.45, range 19-45). The study included respondents who had experienced lumbar pain syndrome for the first time and who had been examined in the Department of Physical Medicine and Rehabilitation of the Novi Sad Health Center. The examined group consisted of 61 respondents undergoing physical treatment with the application of LLLT and kinesiotherapy with medication therapy. The control group consisted of 62 respondents undergoing physical treatment with the application of kinesiotherapy with medication therapy. All patients were subject to an anamnesis, a clinical examination, a selfassessment of pain and were required to complete questionnaires. The above study was carried out at the beginning of treatment, after 6 weeks, and after treatment was completed. The following questionnaires were used: Visual Analogue Scale (VAS), standardized questionnaires for assessing functional outcomes &ndash; The Oswestry Disability Index (ODI), The Rolland &amp; Morris Disability Questionnaire (RMDQ) and the SF-36 questionnaire. Results: Results indicate that pain intensity assessed using the VAS scale was significantly decreased, in both examined groups, during all observed study periods, where the difference between the two groups was not statistically significant (p = 0.904). Mobility of the lumbar spine was significantly increased, in both examined groups, during all observed study periods, where the obtained difference between the two groups was not statistically significant (p = 0.798). In both examined groups, spasm of the paravertebral musculature significantly decreased during all observed study periods, while the difference between the groups was not statistically significant (p = 0.453). Functional disability of patients (assessed by a reduction of functional disabilities of ODI and RMDQ) significantly decreased in both examined groups of patients during all observed examination periods. The obtained difference in scores assessed via the RMDQ, between the studied patient groups, was not statistically significant (p = 0.648), as well as via the ODI score between the researched groups (p = 0.311). Assessment of functional disability through the assessment of quality of life (SF-36) indicates that the quality of life increased significantly, for all examined scores in both examined groups, during all observed testing periods. There is no difference in functional disability (SF-36), that is, there is no difference in quality of life in score physical functioning, restrictions due to emotional problems, social functioning, emotional wellbeing, bodily pain, energy/vitality, physical and mental health, between the examined groups. The dimensions of quality of life in score role limitations due to physical health problems are significantly better in the control group (p = 0.028). The quality of life dimension in the general health perceptions is significantly better in the examination group (p = 0.041). Conclusions: The application of LLLT in subacute LBP resulted in a statistically significant reduction in pain intensity, increased lumbar spine mobility, decreased spasms of paravertebral musculature, and decreased functional disability. Given that there is no consensus on the use of LLLT, nor any other methods of physical therapy, during the subacute LBP, these results could contribute to the adoption of clinical guidelines, that is, diagnostic and therapeutic protocols for subacute LBP.</p>

Diets which emphasize intakes of plant-based foods are recommended to reduce disease risk and for promoting healthy weight. The aim of this study was to examine the association between fruit, vegetables, pulses and nut intake and body mass index (BMI) across countries in adolescents (13-14 years) and children (6-7 years). Data from the International Study of Asthma and Allergies in Childhood; 77,243 children's parents and 201,871 adolescents was used to examine the association between dietary intake (Food Frequency Questionnaire) and BMI using general linear models, adjusting for country gross national index. Adolescents who consumed fruit, vegetables, pulses and nuts three or more times a week had a lower BMI than the never or occasional group; eating nuts three or more times a week, was associated with a BMI value of 0.274 kg/m² lower than the never group (p < 0.001). Compared to children who never or occasionally reported eating vegetables, those reporting that they ate vegetables three or more times per week had a lower BMI of -0.079 kg/m². In this large global study, an inverse association was observed between BMI and the reported increasing intake of vegetables in 6-7 years old and fruit, vegetables, pulses and nuts in adolescents. This study supports current dietary recommendations which emphasize the consumption of vegetables, nut and pulses, although the effect sizes were small. / Acknowledgments: This work was supported by Cure Kids New Zealand through a grant to E.A. Mitchell and I. Braithwaite. Cure Kids New Zealand had no role or influence in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. / Revisión por pares

A toxicidade vestibular pode ser definida como danos que uma substância química causa sobre a estrutura e a função vestibular. Entre as drogas que podem causar a vestibulotoxicidade estão os agentes antineoplásicos como os derivados da platina. OBJETIVO: Identificar a frequência de ocorrência de alteração vestibular em pacientes oncológicos tratados com derivados da platina, os sinais e sintomas vestibulares nestes pacientes, e se a alteração vestibular pré-existente exacerba os sintomas eméticos durante a quimioterapia com derivados da platina. METODOLOGIA: Amostra foi composta por pacientes adultos com câncer que realizaram tratamento com drogas derivadas da platina. O protocolo para o monitoramento vestibular foi composto pelo questionário Dizziness Handicap Inventory (DHI) Brasileiro, Testes da Função Vestibular (manobra de Dix-Hallpike e vecto-eletronistagmografia) e pela descrição de sintomas eméticos e tontura durante a quimioterapia e avaliação vestibular. RESULTADOS: Quarenta e oito pacientes realizaram a avaliação vestibular pré-quimioterapia, sendo que 23 (48%) apresentaram avaliação vestibular dentro da normalidade. Dezesseis pacientes submeteram-se ao monitoramento vestibular com avaliação antes e após tratamento, sendo que após o tratamento dois pacientes (12,5%) apresentaram avaliação vestibular dentro da normalidade e 14 (87,5%) apresentaram algum tipo de alteração vestibular, evidenciada somente pela prova calórica. Nenhum paciente referiu queixas vestibulares ao DHI na avaliação pré-tratamento, assim como quase todos os pacientes, exceto um, na avaliação pós tratamento. Apenas um (6,3%) com avaliação vestibular alterada pós-tratamento apresentou grau leve no DHI. A dose de cisplatina entre os pacientes que mostraram piora do quadro vestibular variou entre 160 e 400 mg/m² e dois pacientes foram tratados com carboplatina com dose de 2306 mg/m² e 1801 mg/m². Não houve diferença de manifestação dos sintomas eméticos/tontura durante a avaliação vestibular ou após quimioterapia entre os pacientes com e sem alteração vestibular prévia. Entretanto, os pacientes que referiram sintomas eméticos durante os ciclos de quimioterapia foram aqueles que manifestaram maior desconforto na PC, independente da dose de quimioterapia ou da alteração vestibular. CONCLUSÃO: Alteração vestibular ou a modificação do quadro vestibular ocorreu em 50% dos pacientes com câncer tratados com derivados da platina. O sinal mais frequente de alteração nos testes vestibulares foi a hiporreflexia à prova calórica, sem sintomas vestibulares relatados na vida diária destes pacientes. As alterações vestibulares pré-existentes não exacerbaram os sintomas eméticos durante a quimioterapia / Vestibular toxicity may be defined as a damage that chemical substances cause on the structure and the function of the vestibular system. Among the drugs that may cause vestibulotoxicity there are antineoplastic agents, such as those derived from platinum. OBJECTIVE: To identify the frequency of occurrence of vestibular alterations in cancer patients treated with platinum-based chemotherapy; the vestibular signs and symptoms in these patients, and whether the pre-existing vestibular alterations exacerbate emetic symptoms during chemotherapy with platinum-based drugs. METHODS: The sample was composed of adults who were treated of the cancer with platinum-based chemotherapy. The vestibular monitoring protocol involved the Brazilian Dizziness Handicap Inventory (DHI), Vestibular Function Tests (positioning nystagmus with Dix-Hallpike maneuver and vectoelectronystagmography) and the description of emetic symptoms and dizziness during chemotherapy and vestibular evaluation. RESULTS: Forty-eight subjects performed the pre-treatment vestibular evaluation, and 23 of them (48%) presented vestibular assessment within the normal range. Sixteen patients underwent the vestibular monitoring evaluation before and after treatment: after the treatment two patients (12.5%) showed normal vestibular assessment while 14 (87.5%) showed a vestibular disorder, basically in the caloric tests, but the alteration was considered a modification in their baseline stage in eight patients (50%). None of the patients reported complaints in the pre-treatment assessment, with a DHI scores within the normal range, as well as all the patients, except one, in the post treatment assessment (81,3%). Only one patient (6.3%) had a score above normal (mild complaint) with altered vestibular evaluation in the post treatment assessment. The dose of cisplatin among these patients who had a modification in the vestibular function varied from 160 to 400 mg/m² and two patients were treated with carboplatin with do of 2306 mg/m² and 1801 mg/m². There was no difference of emetic symptoms/dizziness during the chemotherapy or the vestibular evaluation among patients with or without previous vestibular alterations. However, patients who reported more emetic symptoms during chemotherapy cycles were those who showed greater discomfort in the caloric test, regardless of the dosage of chemotherapy or vestibular alteration. CONCLUSION: Vestibular alterations or modification of the baseline alteration were found in 50% of cancer patients treated with platinum-based chemotherapy. The most common sign of vestibular alteration in the vestibular tests was the hiporeflexia at the caloric test with no reported symptoms in their daily life. The preexisting vestibular alterations did not exacerbate emetic symptoms during chemotherapy

OBJETIVOS: Validar o uso de questionários multidimensionais, como o Inventário Resumido da Dor (BPI) e o Questionário de Dor de McGill (MPQ) no pós-operatório da ceratectomia fotorefrativa (PRK). Comparar o perfil da dor no pós-operatório da PRK entre os dois olhos operados sob as mesmas condições e verificar preditores de dor como sexo, estado de ansiedade, conhecimento prévio da cirurgia e equivalente esférico do erro refrativo (EEER). MÉTODOS: Oitenta e seis olhos de 43 pacientes submeteram-se à PRK com intervalo de 14 dias entre cada olho. Uma hora antes da cirurgia, os pacientes responderam ao Inventário de Estado de Ansiedade (IDEA). No pós-operatório os pacientes receberam tratamento usual para dor e responderam aos questionários Escala Visual Analógica (EVA), BPI e MPQ após uma, 24, 48, 72 e 96 horas. Estudaram-se a consistência interna e as correlações de cada questionário. Compararam-se as pontuações de dor e a ansiedade entre primeiros e segundos olhos operados usando o teste de Wald, pareados através do teste t de Student. Utilizou-se o teste de Wald para comparar o comportamento da dor de acordo com sexo e EEER. RESULTADOS: Os questionários MPQ e BPI demonstraram alta consistência interna. Os questionários apresentaram pontuações mais elevadas na primeira mensuração da EVA (4.93 ± 2.38), MPQ - Índice de Estimativa de Dor (PRI) (26.95 ± 10.58), BPI - Índice de Intensidade de Dor (IID) (14.53 ± 7.36) e o BPI - índice de Interferência Funcional de Dor (IIFD) (22.30 ± 15.13), reduzindo-se gradativamente a cada momento subseqüente de avaliação. O MPQ-PRI na subescala subjetiva, apresentou curva de dor com redução lentificada. Todas as escalas apresentaram redução média estatisticamente significativa de um momento para o outro (p < 0.05) no pósoperatório, exceto no MPQ-PRI Subjetivo. Observaram-se correlações positivas entre as subescalas BPI e MPQ com a EVA (p < 0.05). Não houve diferença estatisticamente significativa nas pontuações de dor da EVA, BPI e MPQ-PRI entre ambos os olhos para todos os momentos avaliados. Os pacientes estavam menos ansiosos antes da PRK do segundo olho (p < 0.001), mas isto não apresentou correlação com níveis de dor após a cirurgia. O sexo e o conhecimento prévio do procedimento cirúrgico não influenciou significativamente em qualquer das escalas de dor. O EEER entre -3D to -5D correlacionou-se (p=0.035) com o BPI. CONCLUSÃO: O BPI e o MPQ apresentaram boas propriedades psicométricas em relação a confiabilidade e validade. Questionários multidimensionais fornecem uma avaliação mais abrangente sobre o perfil de dor após a PRK, se comparados à EVA, principalmente nos aspectos afetivos e cognitivos. O perfil da dor pósoperatória da PRK apresentou-se similar em ambos os olhos sob as mesmas condições. O EEER entre -3D to -5D foi o único fator preditor deste estudo para elevado nível de dor pós-operatória / PURPOSE: to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ) in the postoperative photorefractive keratectomy (PRK). To compare the profiles of postoperative PRK pain between both eyes operated under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). METHODS: eighty-six eyes of 43 patients with myopia underwent PRK in both eyes at an interval of 14 days between the procedures. One hour before surgery, subjects answered the State Anxiety Inventory (SAI). After surgery, usual PRK pain treatment was given and subjects answered to the Visual Analogue Scale (VAS), BPI and MPQ pain questionnaires at one, 24, 48, 72 and 96 hours intervals. The internal consistency was evaluated and convergent validity of each questionnaire was assessed using correlation testing. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test. Wald test was also used to test gender and SERE for each eye separately. RESULTS: both BPI and MPQ questionnaires showed internal consistency higher than 0.70. Subjects reported higher postoperative pain scores at the first measurement of the VAS (4.93 ± 2.38), MPQ - Pain Rating Index (26.95 6 10.58), BPI - Pain Severity Index (14.53 ± 7.36), and BPI- Pain Interference Index (22.30 ± 15.13) with decreasing scores at each subsequent observation period in all scales. All scales showed statistically significant (p < 0.05) pain reduction from one measurement to the next postoperatively, except the MPQ-PRI Evaluative. The majority of the scales and subscales showed a statistically significant (p < 0.05) direct correlation with the VAS at all of the evaluation periods. There were no statistically significant differences between the two eyes at all examination intervals regarding the VAS, BPI, and MPQ scores. Subjects were less anxious on average before the second surgery compared to the first surgery (p < 0.001), but this finding was not related to pain ratings after surgery. Gender and knowledge of the procedure did not significantly interfere with any scale of pain. The SERE between -3 D (diopters) and -5 D (p=0.035) revealed interference on the BPI. CONCLUSION: the BPI and the MPQ showed good psychometric properties regarding reliability and validity. The multidimensional questionnaires expanded the assessment of the PRK postoperative pain profile, compared to VAS, mainly in cognitive and affective aspects. The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK