• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 4
  • 4
  • Tagged with
  • 8
  • 5
  • 5
  • 3
  • 3
  • 3
  • 3
  • 3
  • 3
  • 1
  • 1
  • 1
  • 1
  • 1
  • 1
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Följsamhet till rekommenderade nutritionsbehov hos patienter på en intensivvårdsavdelning

Méstamandy, Alexander, Blomgren, Per-Ola January 2016 (has links)
SAMMANFATTNING Bakgrund: Undernäring leder till förlängd vårdtid och andra komplikationer. En nutritionsmätning på ett Universitetssjukhus i Mellansverige visade att 44 % av alla inneliggande patienter led av undernäring vid mätningstillfället. Syfte: Att undersöka hur stor andel av patienterna på en intensivvårdsavdelning (IVA) i ett universitetssjukhus i Mellansverige som erhöll det av Socialstyrelsen rekommenderade kravet på 25 Kcal/kg/dygn under behandlingsdag 1 till 7. Ett annat syfte var att undersöka hur korrelationen mellan energiintaget och energibehovet påverkar den totala sjukhusvistelsen på IVA samt hur energiintaget påverkas av confounding variabler såsom kön och diagnosgrupp. Metod: En kvantitativ, retrospektiv studie där 63 journaler, granskades. En systematisk urval användes från 2013 till 2015. Data analyserades med icke-parametriska test, med hjälp av korrelationer och signifikanstester vid jämförelser mellan grupper. Resultat: Inga patienter erhöll det rekommenderade energibehov från dag 1-7. Korrelationer fanns med energiintag efter behov. Män och kvinnor behandlas ej likvärdigt utifrån energiintag efter energibehov. Majoriteten av de patienter som drabbats av någon av de diagnosgrupper med högst prevalens hade sämre följsamhet till sitt energibehov jämfört med patienter som inte led av diagnosgruppen. Slutsats: Studien visar stora brister i att tillgodose energibehovet hos patienter på IVA. Detta resultat kommer förhoppningsvis att leda till förbättrade rutiner och lägga en grund för förbättrade lokala riktlinjer om följsamhet till näringsintag på IVA. Kvinnor och män behandlas inte likvärdigt och att drabbas av någon av de sjukdomsgrupper som har den högsta prevalensen ledde till att patienten behandlades sämre i fråga om näring.
2

Faktorer av betydelse vid depression och låg plasma albumin i samband med hemodialys samt omvårdnadsåtgärder

Drybcak, Vladimir January 2011 (has links)
Bakgrund : Patient i hemodialys (HD) behandling är utsatt olika stressfaktorer, som till exempel den strikta diet, begränsat vattenintag, bundenhet till dialysenhet eller känsla av trötthet även på dialysfria dagar. Cirka 20 procent patienter i HD behandling utvecklar depression som i sin tur leder till låg plasma albumin. Syftet: Att belysa samband mellan stressfaktorer, depression, låg plasma albumin och mortalitet/morbiditet samt omvårdnadens betydelse för patienter i hemodialysbehandling. Metod: Studie genomfördes som en litteraturöversikt och granskning av vetenskapliga artiklar. Resultat: Resultat baserar på 15 artiklar, varav 1 kvalitativ, 14 kvantitativ . Resultatet delades i fem kategorier: stressfaktorer och deras koppling till depression, depression, låg plasma albumin, omvårdnadsåtgärder vid låg plasma albumin, omvårdnadsåtgärder vid depression. Diskussion: I diskussion lyfts upp samband mellan högre morbiditet/mortalitet och depression samt låg plasma albumin hos patienter i HD behandling. Det tas upp även vikten av omvårdnadsinsatser vid depression och låg plasma albumin hos patient i HD behandling. Slutsats: Mer forsknings behövs för att sjuksköterska kan erbjuda patienten effektiva strategier som hjälper denne att hantera de stressfaktorerna och livsstilförändringar som HD innebär.
3

Effekt av vitamin A-tillskott på mortalitet och morbiditet hos barn mellan 6 månader och 6 års ålder : En litteraturstudie med fokus på effekter av vitaminA-tillskott på dödlighet och sjuklighet i diarré och luftvägsinfektioner hos barn i utvecklingsländer

Al-Obaidi, Mays January 2017 (has links)
No description available.
4

Kardijalni biomarkeri kao prediktori težine i ishoda egzacerbacije hronične opstruktivne bolesti pluća / Cardiac biomarkers as predictors of severity and mortality in patients with exacerbation of chronic obstructive pulmonary disease

Milutinov Senka 03 December 2015 (has links)
<p>Hronična opstruktivna bolest pluća (HOBP) spada u bolesti sa rastućom stopom morbiditeta i mortaliteta uprkos svim preventivnim strategijama koje se aktivno sprovode. S obzirom na to da se radi o bolesti hroničnog, progresivnog toka, periodi remisije i egzacerbacija, deo su njenog &bdquo;prirodnog&ldquo; toka. Epizode egzacerbacija (pogor&scaron;anja) bolesti mogu zahtevati ambulantno ili pak hospitalno lečenje i značajno utiču na kvalitet života ali i smrtnost u ovoj populaciji bolesnika. Težina egzacerbacije odredjena je izmedju ostalog i uticajem pridruženih bolesti (komorbiditeta). U nekim slučajevima nije lako razgraničiti uticaj komorbiditeta na tok i ishod osnovne HOBP bolesti, naročito kada se simptomi i znaci pogor&scaron;anja preklapaju kao &scaron;to je to slučaj sa pridruženim kardiovaskularnim bolestima. U većini ovakvih slučajeva potrebno je brzo i adekvatno zbrinjavanje pacijenata. Stoga su nam potrebne precizne metode dijagnostike kojima bi se na relativno brz način mogla izvr&scaron;iti diferencijacija ovih pacijenata a samim tim i sprovodjenje odgovarajućeg nivoa lečenja. Kardijalni biomarkeri kao &scaron;to su NT-proBNP i troponin I, pokazali su u dosada&scaron;njim istraživanjima dobru korelaciju sa stepenom srčane insuficijencije i ishemije miokarda. S obzirom da egzacerbacija HOBP-a u nekom smislu predstavlja i kardiovaskularan dogadjaj s obzirom na hipoksemiju i povećan srčani napor, moguće je da se isti biomarkeri mogu koristiti i u predikciji stepena težine pogor&scaron;anja, odnosno mortaliteta. Primarni ciljevi ovog istraživanja su bili da se odredi uticaj kardijalnih biomarkera, NT-proBNP i troponin I markera, u odnosu na stepen pogor&scaron;anja (srednje te&scaron;ko ili te&scaron;ko) i ishod akutne egzacerbacije HOBP-a. Sekundarni cilj bilo je odredjivanje granične (cut-off) vrednosti NT-proBNP markera koja bi poredjeno sa ehokardiografskim nalazom ukazivala na disfunkciju isključivo &bdquo;desnog srca&ldquo;. U istraživanje je bilo uključeno 209 pacijenata koji su zbog akutne egzacerbacije HOBP-a bili hospitalizovani u Institutu za plućne bolesti Vojvodine, u periodu od juna 2013. do oktobra 2014.godine. U odnosu na stepen težine pogor&scaron;anja HOBP-a, 44% pacijenata je imalo srednje te&scaron;ko, a 55% pacijenata te&scaron;ko pogor&scaron;anje osnovne bolesti. Vrednosti NT-proBNP markera pokazale su pozitivnu korelaciju u odnosu na ove procente. Prosečna vrednost NT-proBNP markera iznosila je 1589 pg/ml. Vrednosti NT-proBNP markera takodje su bile statistički značajne i u odnosu na ishod hospitalizacije (pozitivan ili negativan). Vi&scaron;e vrednosti zabeležene su kod pacijenata sa negativnim odnosno smrtnim ishodom. Prema ehokardiografskim kriterijumima 60% pacijenata je imalo znake hroničnog plućnog srca. Vrednosti NT-proBNP markera bile su statistički značajno vi&scaron;e kod pacijenata sa smanjenom sistolnom funkcijom leve komore. Odredjena granična, tzv &bdquo;cut off&ldquo; vrednost NT proBNP markera u diferencijaciji pacijenata sa HOBP-om i pridruženom insuficijencijom &bdquo;levog srca&ldquo; je iznosila 1505 pg/l. Senzitivnost i specifičnost ovog testa su iznosile: 76,6% I 83,3%. Pozitivna (PPV) i negativna prediktivna (NPV) vrednost ovog testa su iznosile 57,14% i 92,4%. Istraživanje predstavlja detaljnu analizu slučajeva pacijenata u akutnoj egzacerbaciji HOBP-a na na&scaron;oj teritoriji i moglo bi biti od koristi u boljem razumevanju difierencijalnodijagnostičkih problema vezano za navedenu populaciju pacijenata, naročito sa pridruženim kardiovaskularnim bolestima.</p> / <p>Chronic Obstructive Pulmonary Disease (COPD) is still among diseases with an increasing rate of morbidity and mortality despite all preventive and actively involved treatment strategies. Considering that this is a disease with a chronic and progressive course, periods of reemission and exacerbation are inevitable part. Episodes of exacerbation of the disease may be treated ambulatory or in hospital which has significant influence on quality of life as and survival rate for this group of patience. Severity of exacerbation is defined, among other, by concomitant diseases. In some cases, it is hard to distinguish between symptoms and signs of basic disease and comorbidity. That is especially in the case of concomitant cardiovascular diseases. Most of these patients require adequate treatment as soon as possible due to severity of disease. There is a need for rapid and precise diagnostic approach to this problem. Cardiac biomarkers, NT/proBNP and troponin I, are well known biomarkers of cardiac insufficiency and ischemia. As the COPD exacerbation represents also a cardiovascular event due to increased cardiac stress and effort these biomarkers may be also used as markers of severity and mortality prediction. Primary goal of this research was to investigate the influenze of cardiac biomarkers on sverety and intrahospital mortality in pacients admitted to the hospital due to acute exacerbation of COPD. Secondary goal was to determined cut off value of NT/proBNP marker which will be significant in differentiation of patients with left heart failure at COPD exacerbation. We include 209 consecutive patients hospitalized at the Institute of Pulmonary Diseases of Vojvodine due to acute exacerbation of COPD. There were 44% of patients with moderate and</p>
5

Maternella komplikationer vid flerbörd : Hur skiljer sig graviditetskomplikationer och förlossningssättvid flerbörd jämfört med enkelbörd? - en populationsbaserad registerstudie av förstföderskor i Sverige

Sahlsten, Marita, Hammerling, Sofia January 2022 (has links)
Background: In Sweden, annually, approximately 1,5% out of 115 000 newborns are twins. Itis widely documented that multiple gestation pregnancy contributes to an increased risk of maternal morbidity. Nevertheless, the direct impact of multiple gestation on some maternal complications remains debated. The expected difference in maternal characteristics between populations may also contribute to divergent conclusions. Objective: The aim of this study is to assess the risk of maternal complications and the occurrence of different mode of delivery during pregnancy and childbirth in nulliparous women with multiple gestation. Study design: A population-based cohort study based on data from the Swedish Medical Birth Register between 1999 and 2017.Results: In total 13 014 nulliparous women with multiple gestation and 850 021 nulliparous women with single gestation were included in the study. Women with multiple gestation were slightly older and more often gave birth prematurely than single gestation counterparts. Pregnancy through IVF were almost five times as common in the multiple gestation group. These women suffered a four times increased risk of both preeclampsia and severe forms of preeclampsia. Multiple gestation in nulliparous women was, in this cohort, associated with nearly six times elevated risk of developing ICP, relative to single gestation counterparts. Intrapartal bleeding and post-partum hemorrhage were also more common in women with multiple gestation. The majority of the nulliparous women with multiple gestation had a caesarean section, elective or acute, while nulliparous women with single gestation more often delivered vaginally. An increased risk for placenta previa and GDM, as a consequence of multiple gestation, could, however, not be observed in this study. Conclusion: Multiple gestation is associated with increased risk of several obstetric complications. It is important that healthcare professionals become fully aware of these risks in the encounter with the woman in order to be able convey appropriate information and take appropriate preventive measures. Continued work to reduce multiple gestation caused by IVF is also recommended. / Bakgrund: I Sverige föds ca 115 000 barn årligen och av dessa är knappt 1,5% tvillingar. Flerbördsgraviditet innebär ökad risk för maternell morbiditet, men forskningen går isär gällande flerbörds inverkan på somliga komplikationer. Dessutom kan variationer i maternella karakteristika skilja sig åt mellan populationer. Syfte: Syftet med denna uppsats är att studera risken för maternella komplikationer samt förekomst av olika förlossningssätt under graviditet och förlossning vid flerbörd hos förstföderskor. Metod: En populationsbaserad kohortstudie utifrån data från Medicinska födelseregistret mellan åren 1999–2017.Resultat: Totalt ingick 13 014 förstföderskor gravida med flerbörd i studien och 850 021enkelbörd. Flerbördsgruppen var något äldre än de i enkelbördsgruppen och de födde oftare prematurt. Graviditet genom IVF var nästan fem gånger så vanligt i flerbördsgruppen. Preeklampsi och svår preeklampsi var fyra gånger så stor i flerbördsgruppen och risken för ICP var nästan sex gånger så stor. Även intrapartal blödning och PPH var betydligt vanligare hos kvinnorna i flerbördsgruppen. Majoriteten av personerna i flerbördsgruppen förlöstes medkejsarsnitt, planerat eller akut, medan förstföderskorna i enkelbördsgruppen i större utsträckning födde vaginalt. Ökad risk för placenta praevia och GDM kunde ej observeras. Slutsats: Att vänta flerbörd är förenat med en ökad risk för flera obstetriska komplikationer. Denna risk är viktigt att vårdpersonal är medvetna om i mötet med kvinnan för att kunna informera, förebygga och behandla. Även ett fortsatt arbete att minska flerbörd som uppkommit genom IVF rekommenderas.
6

Morbiditet, telesni i rani psihomotorni razvoj prevremeno rođene dece začete vantelesnom oplodnjom / Morbidity, physical and early psychomotor development of prematurely born children conceived by assisted reproductive technologies

Pavlović Vesna 01 March 2018 (has links)
<p>Uvod: Infertilitet se defini&scaron;e kao bezuspe&scaron;na koncepcija nakon jedne godine seksualnih odnosa bez upotrebe kontracepcije u fertilnoj fazi menstrualnog ciklusa. Metode asistirane reprodukcije predstavljaju efektivan način lečenja infertiliteta. Ispitivanje i identifikacija kratkoročnih i dugoročnih efekata arteficijalnih reproduktivnih tehnologija je veoma izazovan zadatak. Prvenstveni razlog tome je velika heterogenost u načinu sakupljanja, obrade, klasifikacije i tumačenja, sada već, obilja informacija koje su prikupljene u različitim istraživanjima. Individualni pristup lečenju neplodnosti, brz napredak i stalne promene u metodologiji arteficijalnih reproduktivnih tehnologija, uz ranije navedene pote&scaron;koće u vezi sa prikupljanjem i analizom podataka, značajno otežavaju precizno sagledavanje svih mogućih rizika i posledica arteficijanog začeća. Uprkos brojnim istraživanjima, naučnim publikacijama i akumuliranim dokazima, ostale su mnoge dileme u vezi odgovora na pitanja - da li su arteficijalno začete trudnoće u većoj meri praćene rizicima za neadekvatan razvoj ploda, lo&scaron;ijim perinatalnim ishodom i kakve su dugoročne posledice po decu, kao i da li su ovi rizici podjednako zastupljeni u jednoplodnim i vi&scaron;eplodnim trudnoćama.<br />Cilj rada: Ciljevi rada su bili da se utvrdi struktura morbiditeta kod prevremeno rođene dece začete vantelesnom oplodnjom (iz jednoplodnih i vi&scaron;eplodnih trudnoća) u prve dve godine života, te da se identifikuju perinatalni faktori koji su povezani sa pojavom akutnih i hroničnih komplikacija i oboljenja kod prevremeno rođene dece začete vantelesnom oplodnjom. Takođe, cilj rada je bio da se utvrde karakteristike psihomotornog razvoja kod prevremeno rođene dece začete vantelesnom oplodnjom na kraju dvanestog, osamnaestog i dvadesetčetvrtog meseca života, kao i da se identifikuju specifični faktori rizika za nepovoljan telesni, neurolo&scaron;ki i psiholo&scaron;ki ishod lečenja kod prevremeno rođene dece začete vantelesnom oplodnjom.<br />Materijal i metode: U studiju su uključena prevremeno rođena deca koja su bila hospitalizovana u Službi za neonatologiju i intenzivnu i poluintenzivnu negu i terapiju, i koja su nakon toga, tokom prve dve godine života redovno praćena u neonatolo&scaron;koj ambulanti Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine u Novom Sadu. Retrospektivnim delom studije su obuhvaćena deca koja su lečena u Službi i praćena u neonatolo&scaron;koj ambulanti, a koja su rođena počev od 01. 01. 2011. do 31.12.2012. godine i praćena do navr&scaron;ena puna 24 meseca života. Podaci o pacijentima koji su uključeni u retrospektivni deo istraživanja prikupljani su pregledom medicinske dokumentacije. U prospektivni deo studije su uključena deca koja su lečena u Službi i koja su praćena u neonatolo&scaron;koj ambulanti, a koja su rođena između 01.01. 2013.godine i 31.12.2014. godine i potom praćena do navr&scaron;enih 24 meseca života. Iz navedene kohorte, formirane se dve grupe: Ispitivana grupa (Grupa 1) je obuhavatila svu prevremeno rođenu decu začetu vantelesnom oplodnjom koja su bila hospitalizovana i praćena na Institutu u navedenom periodu. Kontrolna grupa (Grupa 2) obuhvatila je prevremeno rođenu decu začetu prirodnim putem. Deca iz kontrolne grupe izabrana su iz kohorte tako da njihov broj bude jednak broju dece iz ispitivane grupe. Ispitanici iz ove grupe su ujednačeni (&#39;&#39;mečovani&#39;&#39;) sa decom iz ispitivane grupe prema gestacijskoj starosti i datumu rođenja. Gestacijska starost ispitanika iz kontrolne grupe se ne razlikuje za vi&scaron;e od &plusmn; 4 dana u odnosu na decu iz ispitivane grupe. Datum rođenja ispitanika koji su uključeni u kontrolnu grupu se ne razlikuje za vi&scaron;e od &plusmn; 3 meseca u odnosu na decu iz ispitivane grupe.<br />U momentu uključivanja u studiju uzimani su sledeći anamezni podaci:<br />Podaci u vezi sa majkom, trudnoći i porođaju: starost majke u momentu koncepcije, broj prethodnih poku&scaron;aja asistirane koncepcije, stručna sprema, mesto stanovanja, hronične bolesti dijagnostikovane pre trudnoće, akutne i hronične bolesti dijagnostikovane tokom trudoće (hipertenzija, pre-eklampsija, eklampsija, o&scaron;tećenje jetre), prevremena ruptura plodovih ovojaka, primena lekova tokom trudnoće, jednoplodna ili vi&scaron;eplodna trudnoća. Podaci o poremećajima posteljice i ovojaka: ablacija, placenta previja, horioamnionitis. Podaci u vezi sa detetom: intrauterina infekcija, intrauterina restrikcija rasta, način porođaja, Apgar skor. Antropometrijski parametri (telesna masa, telesna dužina, obim glave) na rođenju i tokom perioda ambulantnog praćenja deteta. Dužina inicijalne hospitalizacije deteta. Dužina invazivne i/ili neinvazivne respiratorne potpore i oksigenoterapije. Dijagnoze na otpustu iz bolnice: prisustvo te&scaron;kih posledica prematuriteta, &scaron;to podrazumeva: intrakranijalnu hemoragiju 3. i 4. stepena (definisanu u međunarodnoj klasifikaciji bolesti &ndash; deseta revizija (MKB10) pod &scaron;ifrom P52.2), cističnu periventrikularnu leukomalaciju, retinopatiju prematuriteta, bronhopulmonalnu displaziju, nekrotizirajući enterokolitis, sepsu i/ili meningitis (mikrobiolo&scaron;ki ili klinički dijagnostikovanu). Prisustvo urođenih anomalija ili genetskih sindroma i bolesti (definisanih u MKB10 pod &scaron;iframa Q00 do Q99), kao i prisustvo urođenih bolesti metabolizma (definisanih u MKB10 pod &scaron;iframa E00 do E90).<br />U retrospektivnom delu studije, pregledani su specijalistički izve&scaron;taji iz neonatolo&scaron;ke ambulante pri posetama deteta u uzrastu deteta od 12, 18 i 24 meseca, i beleženi su sledeći podaci: sve prethodno postavljene dijagnoze koje su navedene na specijalističkim izve&scaron;tajima iz neonatolo&scaron;ke ambulante, antropometrijski prametri u momentu pregleda (telesna dužina, telesna masa i obim glave), neurolo&scaron;ki nalaz (tonus, trofika, kožni i tetivni refleksi, prisustvo lateralizacije u neurolo&scaron;kom nalazu), nalaz oftalmologa (uredan nalaz/patalo&scaron;ki nalaz), procena fine i grube motorike, govora, kognitivne funkcije i socijalnog kontakta i zbirna procena psihomotornog razvoja. U prospektivnom delu studije, pri kontrolnim pregledima u neonatolo&scaron;koj ambulanti, u uzrastu deteta od 12, 18 i 24 meseca, određivano je i beleženo sledeće: ranije postavljene dijagnoze koje su navedene u medicinskoj dokumentaciji, antropometrijski prametri u momentu pregleda (telesna dužina, telesna masa i obim glave), neurolo&scaron;ki nalaz (tonus, trofika, kožni i tetivni refleksi, prisustvo lateralizacije u neurolo&scaron;kom nalazu), nalaz oftalmologa (uredan nalaz/patalo&scaron;ki nalaz), procena fine i grube motorike, govora, kognitivne funkcije i socijalnog kontakta i zbirna procena psihomotornog razvoja.<br />Rezultati: Prosečna vednost TM ispitanika iz Grupe 1, u uzrastu od 12 meseci, bila je statistički značajno manja u odnosu na ispitanike iz Grupe 2 (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 12 meseci, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 12 meseci, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Fi&scaron;erov test tačne verovatnoće). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti globalnog koeficijenta razvoja (RQ), kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali, nisu se statistički značajno razlikovale između grupa (Studentov t test). U Grupi 1 bilo je 92 (59,740%) deteta čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 61 (39,610%) dete čiji je nekorigovani RQ bio ispod 90. Ova razlika u broju dece sa RQ koji je ispod proseka za kalendarski uzrast je statistički značajna (Hi kvadrat test, p=0,0004). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,495; 95% CI 1,181 &ndash; 1,892). U Grupi 1, bilo je 87 (56,494%) dece koja su postigla ispodprosečne korigovane vrednosti skora na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90). U Grupi 2 bilo je 69 (44,805%) dece koja su postigla ispodprosečne korigovane vrednosti skora na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90). Ova razlika je statistički značajna (Hi kvadrat test, p =0,040). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,261; 95%CI 1,008 &ndash; 1,577). U kategoriji dece, koja su i pored korekcije u odnosu na GS imala ispodprosečno postignuće na testu za procenu psihomotornog razvoja, u Grupi 1 čak 81/87 (93,310%) dece je imalo vrednost korigovanog RQ &ge; 85, a u Grupi 2 ovu vrednost korigovanog RQ imalo je 60/69 (86,956%) dece.<br />Prosečne vednosti TM ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički načajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti RQ, kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali su se statistički značajno razlikovale između grupa u uzrastu od 18 meseci (Studentov t test). U Grupi 1 bilo je 57 (37,013%) dece čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 31 (20,130%) dete čiji je nekorigovani RQ bio ispod 90. Udeo dece sa RQ koji je ispod proseka za kalendarski uzrast je statistički značajno različit između grupa (Hi kvadrat test, p = 0,010). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (nekorigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,288; 95%CI 1,181 &ndash; 2,730). Statistički značajna razlika postojala je i kada je upoređen broj dece sa vrednostima korigovanog RQ ispod 90 u Grupi 1 i Grupi 2 (36 naspram 19 po redosledu navođenja; Hi kvardat test, p = 0,011). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,895; 95%CI 1,139 &ndash; 3,152).<br />Prosečne vednosti TM ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti RQ, kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali, nisu se statistički značajno razlikovale između grupa, u uzrastu od 24 meseca (Studentov t test). U Grupi 1 bilo je 21 dete (13,636%) čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 17 (11,049%) dece čiji je nekorigovani RQ bio ispod 90. Razlika u broju dece sa RQ koji je ispod proseka za kalendarski uzrast nije statistički značajna (Hi kvadrat test, p= 0,488). Statistički značajna razlika nije postojala ni kada je upoređen broj dece sa vrednostima korigovanog RQ ispod 90 u Grupi 1 i Grupi 2 (12 naspram 9 po redosledu navođenja; Hi kvardat test, p = 0,497).<br />Logističkom regresionom analizom pokazano je da su ve&scaron;tačko začeće, vi&scaron;eplodnost trudnoće i IUGR nezavisni faktori rizika za manju TM u kalendarskom uzrastu od 12 meseci. Logističkom regresionom analizom dobijena je statistički značajna korelacija između vrednosti RQ u uzrastu od 18 meseci i sledećih nezavisnih varijabli: arteficijalno začeta trudnoća i vi&scaron;eplodna trudnoća. Isptanici iz Grupe 1 i Grupe 2 nisu se statistički značajno razlikovali ni po jednom od posmatranih pokazatelja telesnog i psihomotornog razvoja u uzrastu od 24 meseca.<br />Struktura morbiditeta kod dece, tokom dvogodi&scaron;njeg perioda praćenja, nije se značajno razlikovala između grupa. Jedina razlika između grupa, konstatovana je u uzrastu od 12 i 18 meseci, bila je u učestalosti akutnih respiratornih infekcija, čija je pojava, pak, bila direktno povezana sa vi&scaron;eplodnim trudnoćama, odnosno brojem siblinga u domaćinstvu.<br />Zaključak: Prosečna starost majki dece koja su začeta IVF-om je veća od prosečne starosti majki dece koja su spontano začeta. Struktura morbiditeta majki dece koja su začeta IVF-om i majki dece koja su začeta spontanom koncepcijom je ista, ali je stopa morbiditeta veća kod majki dece koja su začeta IVF-om. Vi&scaron;eplodne trudnoće su veoma zastupljene kod začeća IVF-om. Trudnoće začete IVF-om se dominantno i skoro ekskluzivno okončavaju carskim rezom. Prevremena ruptura ovojaka ploda je česta komplikacija trudnoća koje su začete IVF-om. Stopa morbiditeta prevremeno rođene dece začete vantelesnom oplodnjom nije veća u odnosu na prevremeno rođenu decu začetu prirodnim putem. U strukturi morbiditeta kod dece koja su začeta vantelesnom opodnjom, zastupljena su ista oboljenja i komplikacije kao kod prevremeno rođene dece začete prirodnim putem. Incidencija pojedinih oboljenja je ista, sa izuzetkom bronhopulmonalne displazije koja se javlja če&scaron;če kod dece začete vantelesnom oplodnjom i retinopatije prematuriteta koja se javlja če&scaron;če kod dece začete prirodnim putem. Porođajna telesna masa, intrauterina restrikcija rasta, starost majke, stručna sprema majke, prethodna hronična oboljenja majke, bolesti majke dijagnostikovane tokom trudnoće, jednoplodna i vi&scaron;eplodna trudnoća, način porođaja i PROM su potencijalni faktori rizika za lo&scaron;iji postnatalni ishod kod dece iz arteficijalno začetih trudnoća. U uzrastu od 12 meseci, prevremeno rođena deca začeta tehnikama in vitro fetrilizacije, sem po dostignutoj telesnoj masi, ne razlikuju se značajno po drugim telesnim karakteristikama, od prevremeno rođene dece koja su začeta prirodnim putem. Faktori rizika za manju telesnu masu kod prevremeno rođene dece, u uzrastu od 12 meseci su: arteficijalno začeće, vi&scaron;eplodne trudnoće i intrauterina restrikcija rasta. U uzrastu od 12 meseci, prevremeno rođena deca začeta in vitro fertilizacijom, imaju blago lo&scaron;ije (ali ne i značajno niže) postignuće na testovima za procenu psihomotornog razvoja, odnosno imaju vi&scaron;i rizik da postignu ispodprosečne vrednosti skora na testu za procenu psihomotornog razvoja. U uzrastu od 18 meseci, nema razlike u pokazateljima telesnog razvoja između prevremeno rođene dece koja su arteficijalno začeta i dece koja su rođena iz spontano začetih trudnoća. U uzrastu od 18 meseci, prevremeno rođena deca iz arteficijalno začetih trudnoća imaju niže postignuće na testovima za procenu psihomotornog razvoja u odnosu na prevremeno rođenu decu iz spontano začetih trudnoća. Faktori rizika koji su povezani sa lo&scaron;ijim postignućem na testu za procenu psihomotornog razvoja kod prevremeno rođene dece su arteficijalno začeće trudnoće i vi&scaron;eplodnost trudnoće. U uzrastu od 24 meseca nema razlike u telesnim parametrima između prevremeno rođene dece koja su arteficijalno začeta i prevremeno rođene dece koja su začeta prirodnim putem. U uzrastu od 24 meseca nema razlike u postignuću na testu za procenu psihomotornog razvoja kod prevremeno rođene dece su arteficijalno začeće trudnoće i vi&scaron;eplodnost trudnoće. U uzrastu od 24 meseca, prevremeno rođena deca, i iz arteficijalno, i iz spontano začetih trudnoća, na testu za procenu psihomotornog razvoja postižu rezultate koji su u skladu sa njihovim kalendarskim uzrastom.</p> / <p>Introduction: Infertility is defined as an unsuccessful conception after one year of sexual intercourse without the use of contraception in the fertilizing phase of the menstrual cycle. Assisted reproduction methods represent an effective way of treating infertility. Examination and identification of short-term and long-term effects of artificial reproductive technologies is a very challenging task. The primary reason for this is the great heterogeneity in the way of collecting, processing, classifying and interpreting, now, the abundance of information that has been gathered in various studies. Individual approach to the treatment of infertility, rapid progress and constant changes in the methodology of the artificial reproductive technologies, in addition to the aforementioned difficulties associated with the collection and analysis of data, significantly hamper accurate assessment of all possible risks and consequences artificial conception. Despite numerous studies, scientific publications and the accumulated evidence, many doubts about the question whether artificially conceived pregnancies are accompanied by the higher risks or inadequate fetal development, poor perinatal and long-term outcomes still remained.<br />The Aim: The objectives of this work were to determine the structure of morbidity in prematurely born children conceived by artificial reproductive technologies (from single and multiple pregnancies) in the first two years of life, and to identify perinatal factors that are associated with the occurrence of acute and chronic complications and diseases in prematurely born children from this pregnancies. In addition, the aim of the study was to determine the characteristics of psychomotor development in prematurely born children conceived by artificial reproductive technologies at the end of the twelfth, eighteenth and twenty-fourth month of life, as well as to identify specific risk factors for the unfavorable physical, neurological and psychological outcome of those children.<br />Materials and Methods: The study included premature born newborns who were hospitalized in the Department for neonatology and intensive and semi-intensive care unit, and are thereafter, during the first two years of life. The retrospective part of the study included children who were hospitalized at the Institute, and who were born from January 1st 2011. to December 31st 2012. and were followed up to 2 years of life. Data on patients included in the retrospective part of the survey were collected through a review of medical records. The prospective part of the study included children who were treated and followed up at the Institute, and who were born between January 1st 2013 and December 31st 2014. and then followed up to 2 years of life. From this cohort two groups were formed: The tested group (Group 1) included all preterm infants who were conceived by ART. The control group (Group 2) included naturally conceived prematurely born children. The children in the control group were selected from the cohort so that their number was equal to the number of children in the study group. The gestational age of the examinees from the control group does not differ for more than &plusmn; 4 days from the children from the study group. The date of birth of subjects included in the control group does not differ for more than &plusmn; 3 months from the children in the study group.<br />At the moment of inclusion in the study, the following individual data were taken:<br />Maternal data, pregnancy and childbirth: the age of the mother at the moment of conception, the number of previous attempts at assisted conception, professional care, place of residence, chronic diseases diagnosed before pregnancy, acute and chronic diseases diagnosed during pregnancy (hypertension, pre-eclampsia, eclampsia, liver damage), premature rupture of the fetuses, the use of medication during pregnancy, single or multiple pregnancy. Data on placental disorders and abnormalities: ablation, placenta overdose, horioamnionitis. Child-related data: intrauterine infection, intrauterine growth restriction, delivery method, Apgar score. Anthropometric parameters (body weight, body length, head circumference) at birth and during the period of outpatient monitoring of the child. Length of initial hospitalization of the child. Length of invasive and / or non-invasive respiratory support and oxygen therapy. Diagnosis on discharge from the hospital: the presence of severe consequences of prematurity, which implies intracranial hemorrhage of 3rd and 4th degree (defined in International Classification of Disease - Tenth Revision (MKB10) under code P52.2), cystic periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia , necrotizing enterocolitis, sepsis and / or meningitis (microbiologically or clinically diagnosed). Presence of congenital anomalies or genetic syndromes and diseases (defined in MKB10 under codes Q00 to Q99), as well as the presence of congenital metabolic diseases (defined in MKB10 under codes E00 to E90).<br />In the retrospective part of the study, specialist reports from a neonatological clinic were examined for child visits at the age of 12, 18 and 24 months, and the following data were ecorded: all pre-diagnosis reported on specialist reports from a neonatological clinic, anthropometric arms at the moment examination (body length, body weight and head circumference), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings (neat / patial findings), assessment of fine and coarse motoring, speech, cognitive functions and social contact and a collective assessment of psychomotor development. In the prospective part of the study, during control examinations in a neonatological clinic, at the age of 12, 18 and 24 months, the following were determined and recorded: previously set out in the current medical documentation, anthropometric parameters at the moment of examination (body length, body weight and the volume of the head), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings, assessment of fine and grose motor functions, speech, cognitive functions, social contact and psychomotor development.<br />Results: The average BW of subjects in Group 1 at the age of 12 months, was statistically significantly lower in relation to respondents from Group 2 (Student&#39;s T test). The average length of subjects from both groups at the age of 12 months did not statistically differ (Student&#39;s T test). The average head circumference between children from both groups, at the age of 12 months, did not statistically differ (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Fischer&#39;s exact probability test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average values of the global development coefficient (RQ), as well as the average score values for individual elements of development evaluation test - Brunet-L&eacute;zine scale (motor function, coordination, speech and sociability) did not differ significantly between groups (Student t test). In Group 1 there were 92 (59.740%) of children whose uncorrected RQ was under 90, while in Group 2 there were 61 (39.610%) children whose uncorrected RQ was below 90. This difference in the number of children with RQ below the average for calendar age is statistically significant (Hi square test, p = 0.0004). The relative risk of under-achievement in the psychomotor evaluation test (RQ &lt;90) for children from Group 1 was higher than in children from Group 2 (RR = 1.495; 95% CI 1.181 - 1.922). In Group 1, there were 87 (56.494%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ &lt;90). In Group 2, there were 69 (44.805%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ &lt;90). This difference is statistically significant (Hi square test, p = 0.040). The relative risk for the suboptimal achievement in the psychomotor evaluation test (corrected RQ &lt;90) for children from Group 1 was higher than in Group 2 (RR = 1.261; 95% CI 1.008 - 1.577). In Group 1, as many as 81/87 (93.310%) of children had a corrected RQ value of &ge; 85, while in Group 2 this value of the corrected RQ there were 60/69 (86.956%) children.<br />At the age of 18 months, the average BW of subjects from both groups did not differ significantly (Student&#39;s T test). The average length of subjects from both groups, at the age of 18 months, did not statistically differ (Student&#39;s T test). The average head circumference of children from both groups, at the age of 18 months, did not statistically differ (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average scores for individual elements of psychomotor development (motor function, coordination, speech and sociability) according to the Brunet-L&eacute;zine scale, have been statistically significantly different between groups, at the age of 18 months (Student&#39;s T test). In Group 1 there were 57 (37.013%) children whose uncorrected RQ was below 90, while in Group 2 there were 31 (20,130%) children whose uncorrected RQ was below 90. The share of children with RQ below the average value for the calendar age is statistically significantly different between groups (Hi square test, p = 0.010). The relative risk for the suboptimal achievement in the Psychomotor Development Assessment (uncorrected RQ &lt;90) for Group 1 children was higher than in Group 2 (RR = 1.288; 95% CI 1.181 - 2.730). A statistically significant difference between Group 1 and Group 2 existed when the number of children with corrected RQ below 90 was compared (36 naspram 19 respectively, Hi quadrate test, p = 0.011). The relative risk for the suboptimal achievement on the Psychomotor Evaluation Test (corrected RQ &lt;90) for the children from Group 1 was higher when compared to children in Group 2 (RR = 1.895; 95% CI 1.139 &ndash; 3.152).<br />At the age of 24 months the average BW, body length and head circumference of subjects in both groups were not significantly different (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average score values for individual elements for development evaluation (motor function, coordination, speech and sociability) according Brunet-L&eacute;zine scale, did not significantly differ between groups at the age of 24 months (Student&#39;s T test). In Group 1, there were 21 children (13.636%) whose uncorrected RQ was under 90, while in Group 2 there were 17 (11.049%) of children whose uncorrected RQ was below 90. The difference in the number of children with RQ below the average for the calendar age was not statistically significant (Hi square test, p = 0.488). A statistically significant difference did not exist even when the number of children with values of the corrected RQ below 90 in Group 1 and Group 2 (12 naspram 9 respectively, Hi quadrate test, p = 0.497) was compared.<br />Logistic regression analysis has shown that artificial conception, multiple pregnancy and IUGR are independent risk factors for lesser BW in a calendar age of 12 months. By logistic regression analysis, a statistically significant correlation between RQ values at 18 months of age and the following independent variables was obtained: artificially started pregnancy and multiple pregnancy. Group 1 and Group 2 patients did not significantly differ by any of the indicators of physical and psychomotor development at the age of 24 months.<br />The structure of morbidity in children, during the two-year follow-up period, did not differ significantly between groups. The only difference between the groups was found in the rates of acute respiratory infections at the age of 12 and 18 months (rate of infections was higher in Group 1), whose occurrence, however, was directly related to multiple pregnancies, or the number of sibling in the household.<br />Conclusion: The average age of mothers of children conceived by the IVF is higher than the average age of mothers of children who were conceived spontaneously. The structure of the morbidity of mothers of children who were artificially conceived and mothers of children born after spontaneous conception is the same, but the morbidity rate is higher in the mothers of children who were conceived by IVF. Pregnancies concieved by IVF almost exclusively ended by cesarean section. Premature rupture of the membranes is a common complication of IVF pregnancies. The rate of morbidity of prematurely born children conceived by ART is not higher than that of prematurely born children conceived naturally. The structure of morbidity in children from ART pregnancies was the same as in naturally conceived prematurely born children. The incidence of specific illnesses is the same, with the exception of bronchopulmonary dysplasia that occurs more frequently in children born from ART pregnancies, and retinopathy of prematurity that occurs more frequently in spontaneously conceived children. Maternal birth weight, intrauterine growth restriction, mother&#39;s age, maternal care, previous mother&#39;s chronic illness, mother&#39;s disease diagnosed during pregnancy, single and multiple pregnancies and PROM are potential risk factors for worse postnatal outcome in children from artificially initiated pregnancies. Risk factors for lower body weight in premature babies, at the age of 12 months, are: artificial conception, multiple pregnancy and intrauterine growth restriction. At the age of 12 months, prematurely born children from IVF pregnancies, have slightly worse (but not significantly lower) psychomotor achievements. At the age of 18 months, there is no difference in the indicators of physical development between prematurely born children who are artificially conceived and children born from spontaneous pregnancies. At the age of 18 months, prematurely born children from ART pregnancies have lower achievement on tests for assessing psychomotor development compared to prematurely born children from spontaneously initiated pregnancies. Risk factors associated with a poor performance on the psychomotor development assessment tests, in preterm infants, are an artificial conception of pregnancy and a multi fertile pregnancy. At the age of 24 months, there is no difference in the physical parameters between prematurely born children from ART and naturally conceived pregnancies. At the age of 24 months, there is no difference in the achievement on the test for the assessment of psychomotor development between children from ART and spontaneous pregnancies. At the age of 24 months, on the psychomotor development assessment, prematurely born children achieve the results consistent with their calendar age.</p>
7

Uticaj suspendovanih čestica " PM2,5" iz vazduha životne sredine na mortalitet, kardiovaskularni i respiratorni morbiditet odraslog stanovništva Grada Novog Sada / Impact of ambient suspended particles “PM2,5” on mortality, cardiovascular and respiratory morbidity of adults in the city of Novi Sad

Dragić Nataša 27 February 2020 (has links)
<p>Kvalitet vazduha u urbanim sredinama predstavlja jedan od glavnih uzroka zdravstvenih problema. Prema podacima SZO u svetu se godi&scaron;nje usled zagađenja vazduha u urbanim sredinama dogodi preko 2,7 miliona smrtnih slučajeva. Procenjuje se da najbolji indikator za procenu veličine zdravstvenog rizika od zagađenja vazduha jeste koncentracija suspendovanih čestica PM2,5 u vazduhu životne sredine. Cilj: Proceniti uticaj suspendovanih čestica PM2,5 iz vazduha životne sredine na ukupan mortalitet, kardiovaskularni i respiratorni bolnički morbiditet odraslog stanovni&scaron;tva Grada Novog Sada. Takođe, cilj istraživanja je bio da se i utvrdi koncentracija i hemijski sastav suspendovanih čestica PM2,5 u vazduhu životne sredine na teritoriji Grada Novog Sada, na dnevnom i godi&scaron;njem nivou, uzimajući u obzir i uticaj meteorolo&scaron;kih parametara. Metod: Istraživanje je sprovedeno kao prospektivna studija vremenske serije podataka o kvalitetu vazduha, meteorolo&scaron;kim parametrima i zdravstvenim ishodima, u intervalima od najmanje 30 dana tokom sva četiri godi&scaron;nja doba 2017. godine. Uzorkovanje i određivanje koncentracije i hemijskog sastava čestica PM2,5 u skladu sa propisanim standardnim metodama, je obavljeno na mernim mestima u životnoj sredini Grada Novog Sada, koja reprezentuju uticaj saobraćaja i urbanog pozadinskog područja na zagađenje vazduha životne sredine. Primenjen je Lenschow pristup za kvantifikaciju veličine doprinosa saobraćaja porastu koncentracije suspendovanih čestica PM2,5 u vazduhu životne sredine. Podaci o meteorolo&scaron;kim parametrima (temperatura vazduha, relativna vlažnost vazduha i brzina vetra), su preuzeti od Republičkog hidrometeorolo&scaron;kog zavoda Srbije. Podaci o zdravstvenim ishodima (dnevni broj umrlih i hospitalizovanih zbog kardiovaskularnih i respiratornih bolesti), za stanovni&scaron;tvo starije od 18 godina, čije mesto stanovanja pripada teritoriji Grada Novog Sada, obezbeđeni su od strane Centra za informatiku i biostatistiku u zdravstvu Instituta za javno zdravlje Vojvodine. Za procenu uticaja nezavisnih promenljivih na zavisne (ukupan mortalitet / bolnički morbiditet) primenjen je generalizovani linearni model regresione analize za vremenske serije podataka (Poason). Rezultati: Prosečna godi&scaron;nja koncentracija suspendovanih čestica PM2,5 iz vazduha životne sredine na teritoriji Grada Novog Sada je iznosila 30,27 &mu;g/m3, a srednje dnevne koncentracije 8-79&nbsp; g/m3. Približno 30% varijabilnosti srednjih dnevnih koncentracije suspendovanih čestica PM2,5 se može objasniti lokalnim meteorolo&scaron;kim uslovima. Hemijski sastav čestica na području Grada Novog Sada u najvećem procentu čini ekvivalent karbonatne frakcije čestica, zatim sekundarni neorganski aerosol i rastvorljiva organska frakcija, dok su joni rastvorljivi u vodi (kalcijum, hloridi, natrijum, kalijum i magnezijum) zastupljeni u najmanjem procentu. Prisutni izvori zagađenja vazduha životne sredine na području Grada Novog Sada su procesi sagorevanja fosilnih goriva i biomase, saobraćaj, mineralna (zemlji&scaron;na) pra&scaron;ina i sekundarno zagađenje regionalnog porekla. Doprinos saobraćaja porastu prosečne godi&scaron;nje koncentracije suspendovanih čestica PM2,5 je iznosio 40%. Masena koncentracija čestica PM2,5, kao i hemijski sastav čestica (ekvivalent karbonatne frakcije, rastvorljiva organska frakcija, joni kalijuma i kalcijuma) doprinose umiranju i oboljevanju odraslog stanovni&scaron;tva Grada Novog Sada. Na uticaj masene koncentracije i hemijskog sastava čestica PM2,5 najosetljivije su žene i stanovni&scaron;tvo starosti &ge; 65 godina, kao i mu&scaron;karci u pogledu uticaja ekvivalenta karbonatne frakcije čestica PM2,5. Zaključak: Dobijeni rezultati po prvi put opisuju zdravstveni uticaj masene koncentracije i hemijskog sastava čestica PM2,5 na području Grada Novog Sada, odnosno kvantifikuju rizik za ukupan mortalilteta i kardiovaskualrni i respiratorni morbiditet. Razumevanje uticaja suspendovanih čestica PM2,5 na oboljevanje i umiranje stanovni&scaron;tva, stratifikovanih prema starosnoj i polnoj strukturi, uz identifikaciju mogućih izvora zađenja vazduha na području Grada Novog Sada, predstavlja osnovu za razvoj javnozdravstvene politike u cilju unapređenja zdravlja stanovni&scaron;tva Grada Novog Sada.</p> / <p>Urban ambient air pollution is one of the leading causes of health problems. According to WHO data, over 2.7 million deaths occur in urban areas annually due to urban air pollution. Particulate matter PM2.5 is estimated to be the best indicator for assessing the magnitude of the health risk induces by ambient air pollution. Aim: To assess the impact of PM2.5 on total mortality, cardiovascular and respiratory hospital morbidity of the adult population of the City of Novi Sad. Also, the aim of the study was to determine the concentration and chemical composition of ambient PM 2.5 particles in the territory of the City of Novi Sad, on daily and annual bases, taking into account the impact of meteorological parameters. Method: The study was conducted as a prospective, a time series study of of data on air quality, meteorological parameters and health outcomes, at intervals of at least 30 days during all four seasons of 2017. Sampling and determination of the mass concentration and chemical composition of PM2.5 particles in accordance with the prescribed standard methods, it was performed at sampling stations in the City of Novi Sad, representing the impact of traffic and urban background impact on environmental air pollution. A Lenschow approach was used to quantify the magnitude of traffic contribution to the increase of ambient PM2.5 mass concentration. Meteorological data (air temperature, relative humidity and wind velocity) were taken from the Republic Hydrometeorological Institute of Serbia. Data on health outcomes (daily number of deaths and hospitalizations due to cardiovascular and respiratory diseases) for the population older than 18, residing within the territory of the City of Novi Sad, have been provided by the Centre for Informatics and Biostatistics, Institute of Public Health of Vojvodina. To evaluate the impact of independent variables on dependent (total mortality/hospital morbidity), a generalized linear regression model for time series data (Poisson) was applied. Results: The average annual mass concentration of PM2.5 in the territory of the City of Novi Sad was 30.27&mu;g/m3, while mean daily concentrations were 8- 79&mu;g/m3. Approximately 30% of the variability in mean daily concentrations of PM2.5 particles can be explained with local meteorological conditions. The chemical composition of PM2.5 in the area of Novi Sad is to the a great extent the equivalent of the carbonate fraction of the particles, then the secondary inorganic aerosol and the soluble organic fraction, while the water-soluble ions (calcium, chlorides, sodium, potassium and magnesium) are present in the lowest percentage. The sources of ambient air pollution in the area of the City of Novi Sad were the combustion of fossil fuels and biomass, traffic, mineral (soil dust) and secondary pollution of regional origin. Contribution of traffic to the increase of the average annual mass concentrations of PM2.5 particles was 40%. PM2.5 particle mass concentration, as well as the chemical composition of the particles (carbonate fraction equivalent, soluble organic fraction, potassium and calcium ions) contribute to the deaths and diseases of the adult population of the City of Novi Sad. Women and the population aged &ge;65, were more susceptible to mass concentration and chemical composition of PM2.5 related deaths and diseases, as well as men according to the impact of the equivalents of carbonate fractions of PM2.5. Conclusion: The results obtained show for the first time the health effects of mass concentration and chemical composition of PM2.5 particles in the City of Novi Sad, i.e. they quantify the risk for total mortality and cardiovascular and respiratory morbidity. Understanding the impact of suspended particles PM2.5 on population mortality and morbidity, stratified by age and sex structure, along with identifying of possible air pollution sources is the basis for the development of public health policies aimed at improving the population health in the City of Novi Sad.</p>
8

Rana karotidna endarterektomija nakon akutnog neurološkog deficita / Early carotid endarterectomy after acute neurological deficit

Koprivica Radenko 02 September 2016 (has links)
<p>Ciljevi: Cilj ove studije je da ispita bezbednost rane karotidne endarterektomije (CEA) u odnosu na odložene CEA nakon akutnog ishemijskog neurolo&scaron;kog deficita (TIA/CVI). Drugi cilj je da istražimo da li postoji razlika u brzini neurolo&scaron;kog oporavka između navedenih grupa. Metode: Ukupno 157 ispitanika u prospektivnoj studiji je praćeno 30 dana postoperativno. Grupa I ili rana CEA, je imala 50 ispitanika operisanih od 3. do 14. dana po TIA/CVI događaju. Grupa II ili odložena CEA, je imala 107 ispitanika operisanih od 15. do 180. dana nakon TIA/CVI. Praćen je proceduralni op&scaron;ti i specifični morbiditet i mortalitet u 30-dnevnom postoperativnom periodu. Rankin skor (mRS) smo koristili za procenu neurolo&scaron;kog invaliditeta. U odnosu na vrednost mRS skora smo formirali dve podgrupe mRS&lt;3 i mRS3. U statističkoj analizi koristili smo Pirsonov hi test, Studentov test, ANOVU analizu varijanse, Boniferonijev test i multiplu analizu varijanse za ponovljena merenja (GLM- general line model), kao i parametarsku i neparametarsku korelaciju i regresiju. Nivo značajnosti je bio 0,05. Rezultati: Prosečna starost ispitanika je bila 66,72 godine uz 66,2% osoba mu&scaron;kog pola. U grupi I je prosečno vreme do intervencije bilo 9,5 dana, a u grupi II 72,22 dana. Grupe su homogene u odnosu na faktore rizika i komorbiditet. Grupa I je imala 54% nestabilnih aterosklerotskih plakova u poređenju sa grupom II gde ih je bilo 31,8% (&chi;2 = 7.084; p &lt; 0.01). U grupi I TIA je imalo 50% ispitanika, a u grupi II CVI nalaza je bilo 68,2% (&chi;2 =4.825; p &lt;0.05). CVI do 1 cm veličine je statistički značajno vi&scaron;e zastupljen u grupi I , a CVI do 2 cm u grupi II (&chi;2 = 6.913; p &lt;0.05). Stopa CVI je u grupi I bila 2.0% a u grupi II je 2.8% (F = 0.083; p &gt; 0.05). Stopa postoperativnog infarkta miokarda (IM) je u grupi I je 2.0% a u grupi II je 1.9%. Stopa specifičnog hirur&scaron;kog morbiditeta je u grupi I 4.0% a u grupi II 3.7%. U grupi I ukupni morbiditet bio 6.0% a u grupi II 7.5%, razlika nije bila statistički značajna (F =0.921; p &gt; 0.05). Mortaliteta u obe grupe nije bilo. CVI/IM/smrt stopa je u grupi I bio 4.0% a u grupi II je bio 4.7% (F = 0.122; p &gt;0.05). Hiperlipidemija je signifikantan faktor rizika za CVI/IM/smrt (&chi;2 = 4.083; p &lt; 0.05). Pobolj&scaron;anje mRS je u grupi I imalo 52%, a u grupi II 31,8% pacijenata (&chi;2 = 5.903; p &lt;0.01). Relativni rizik je 2,4 odnosno toliko puta je veća &scaron;ansa da kod bolesnika dođe do promene mRS ako je bolesnik u grupi I. Pad mRS koji nastupa između trećeg i desetog dana nakon CEA je statistički visoko značajno izraženiji u grupi ranih CEA ( F 3,701 df 1 p=0,029). Kod bolesnika sa TIA u preko 60% slučajeva do&scaron;lo je do pada mRS, a kod onih koji su imali CVI u oko 25.5% (&chi;2 = 18.050; p &lt; 0.01). Kod Rankin skora podgrupe mRS&lt;3 i mRS3 je pad bio značajan i po vremenu (F 18,774; df 6; p=0,000) i po podgrupi ali je daleko brži pad zapažen u podgrupi mRS&lt;3(F 6,010; df 1; p=0,003). Zaključak: Rana CEA je jednako bezbedna kao i odložena CEA u pogledu incidence perioperativnog morbiditeta i mortaliteta. Ranom CEA se postiže znatno brži neurolo&scaron;ki oporavak pacijenata, naročito onih sa TIA i mRS&lt;3 skorom.</p> / <p>Objectives: The aim of this study was to investigate the safety of early carotid endarterectomy (CEA) in relation to the delayed CEA after acute ischemic neurological events (TIA / CVI). The second objective was to investigate whether there is a difference in speed of neurological recovery between these groups. Methods: A total of 157 patients in the prospective study followed 30 days postoperatively. Group I or early CEA, had 50 patients operated from 3 to 14 days after TIA / CVI event. Group II or delayed CEA, had 107 patients operated from 15 to 180 days after the TIA / CVI. Accompanied by the general and specific procedural morbidity and mortality in 30-day postoperative folow up. Rankin score (mRS) were used for evaluation of neurologic disability. In relation to the value of mRS score we formed two subgroups mRS &lt;3 i mRS3. In the statistical analysis we used the Pearson chi test, Student&#39;s test, ANOVA analysis of variance, Boniferony test and multiple analysis of variance for repeated measures (GLM- general line model), as well parametric and nonparametric correlation and regression. The significance level was 0.05. Results: The mean age was 66.72 years with 66.2% of males. In Group I is the average time to intervention was 9.5 days, and in group II 72.22 days. The groups were homogeneous in relation to risk factors and comorbidities. Group I had 54% of unstable atherosclerotic plaques compared with group II, where it was 31.8% (&chi;2 = 7.084; p &lt;0.01). In the group I TIA had 50% of respondents, while in group II CVI was 68.2% (&chi;2 = 4.825; p &lt;0.05). CVI to 1 cm in size were significantly more frequent in the group I, a CVI to 2 cm in group II (&chi;2 = 6.913; p &lt;0.05). CVI rate in the group I was 2.0%, and in group II was 2.8% (F = 0.083, p&gt; 0.05). Postoperative myocardial infarction (MI) in the group I is 2.0%, and in group II was 1.9%. Specific surgical morbidity rate in the group I and 4.0% in the group II 3.7%. In group I total morbidity was 6.0% in group II 7.5%, the difference was not statistically significant (F = 0.921; p&gt; 0.05). Mortality in both groups was not. CVI/IM/death rate in group I was 4.0% in group II was 4.7% (F = 0.122; p&gt; 0.05). Hyperlipidemia is a significant risk factor for CVI/IM/death (&chi;2 = 4.083; p&lt;0.05). Improving mRS in the group I had 52% and in group II 31.8% of patients (&chi;2 = 5.903; p &lt;0.01). The relative risk was 2.4 times as much and is more likely to occur in patients mRS changes if the patient in group I. Improving mRS that occurs between the third and tenth days after CEA was highly statistically significantly greater in the group of early CEA (F 3,701 df 1 p = 0.029). In patients with TIA in 60% of cases there was a decline mRS, and those had CVI in about 25.5% (&chi;2 = 18.050; p &lt;0.01). In Rankin score subgroups mRS &lt;3 i mRS 3 the decline was significant and time (F 18,774; df 6; p =0.000) and in the subgroup but it is far more rapid decline observed in the subgroup mRS &lt;3 (F 6.010; df 1; p = 0.003). Conclusions: Early CEA is as safe as the delayed CEA in respect incidence of perioperative morbidity and mortality. Early CEA is achieved significantly faster recovery of neurological patients, especially those with TIA and mRS &lt;3 compared with delayed CEA.</p>

Page generated in 0.0826 seconds