Since vaccination coverage in Serbia has been decreasing and health professionals have been identified as the most important factor in making decisions about immunization, vaccination knowledge and attitudes of students, especially medical students, are of particular interest. A cross-sectional survey was carried out on three groups of 509 Belgrade University students (medical, law and engineering students). The data were collected using an on-line questionnaire posted to student groups and included the Vaccine Knowledge Questionnaire and Attitudes Toward Vaccination Scale. This survey also included questions about demographic characteristics and perceived negative experiences. Multiple linear regression analysis was performed. There was a significant difference in the Vaccine Knowledge score (F=40.48, p<0.01) among the three groups of students. Medical students (N=251, Mean=4.47, SD=1.71) had significantly higher mean knowledge scores than did law (N=128, Mean=2.80, SD=1.56) or engineering students (N=130, Mean=3.98, SD=1.81). Compared with the law (Mean=49.77, SD=10.23) and engineering students (Mean=57.62, SD=12.21), medical students (Mean=59.52, SD=9.62) also had significantly higher attitude scores (F=37.56, p<0.01). These findings demonstrate general positive attitudes of Serbian students toward immunization. However, some knowledge gaps were identified. Multivariate analysis showed that those who had better vaccine knowledge, those who studies medicine, those who attended at university for more years, and those who do not know someone who had a negative experience with vaccines were more likely to have positive attitudes toward vaccination. Considering the growing vaccination hesitance in the general population, this is an important result that indicates that medical students are possible important participants in future public health campaigns. A strong association between vaccine knowledge and attitudes implies recommendations to introduce a specialized vaccination curriculum at both the undergraduate and graduate levels of medical study.
This study reminds clinicians that syphilis presents in many guises. Wars, migration and sexual promiscuity prepare the ground for its return as an important cause of neurological and psychiatric syndromes. Our patient's diagnosis was not suspected at earlier admission. Stage III spirochaetosis was improved by high dose penicillin.
Background: Sarcopenia is an age-related progressive, generalized skeletal muscle disorder involving the accelerated loss of muscle function and muscle mass. The aim of this study was to assess the complex relationship between sarcopenia, malnutrition, cognitive impairment, physical activity, and depression in the elderly, with the potential role of quality of life as a mediator in these associations. Methods: A cross-sectional study was conducted on a sample (n = 298) of elderly patients admitted to Special Hospital for Rehabilitation “Termal”, Vrdnik, Serbia. Sarcopenia, the risk for malnutrition, cognitive impairment, physical activity, quality of life, and depressive symptoms were measured by standardized instruments. Additional data included sociodemographic characteristics. Simultaneous assessment of the direct and indirect relationships of all determinants was performed by path analysis. Results: A total of 40% (n = 120) of the elderly were diagnosed with sarcopenia, and 42.6% had depression symptoms. The risk of malnutrition was present in 23.5%, cognitive impairment in 5.4%, and a low level of physical activity was reported in 26.2% of elderly participants. The mean reported quality of life measured by Sarcopenia and Quality of Life Questionnaire was 60 (on the scale ranging from 0 to 100; where a higher score reflects a higher quality of life). The best-fitted model (χ2/DF = 1.885, NFI = 0.987, CFI = 0.993, GFI = 0.997, RMSEA = 0.055) highlighted the mediating effect of quality of life between sarcopenia, malnutrition, cognitive impairment, lower level of physical activities and depression. According to the model, quality of life was a direct negative predictor of depressive symptoms in the elderly, while malnutrition positively affected depression. Conclusions: The presented path model may assist rehabilitation centers in developing strategies to screen for sarcopenia and risk of malnutrition, and promote physical activity in elderly, aiming to prevent their negative effects on mental health. For the elderly currently affected by sarcopenia, we consider regenerative medicine and stem cell therapy, which, in view of their etiology, could be a potential therapeutic strategy for sarcopenia.
This paper deals with euthanasia and assisted suicide in people with mental health problems, based on the fundamental principles of contemporary medical ethics. In some situations, psychiatric patients are incapable of realizing they are ill and they need to be treated due to the compromise of cognitive functions. It is difficult to establish the relationship of negotiation and joint decision-making with such patients, so it is necessary that the psychiatrist takes responsibility in order to protect both their patient and the environment from any potentially harmful activity.
Introduction. Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform dual-energy X-ray absorptiometry (DXA) analysis in the diagnostic process of musculoskeletal disorders, such as cerebral palsy (CP). This study aimed to evaluate the bone mineral density (BMD) in children with CP and the ethical justification of applying DXA analysis in these children. Material and Methods. In this monocentric retrospective analysis, data were collected from children and adolescents with CP who were treated for a primary illness for three years. A clinical examination, which included a DXA analysis, recommended by the multidisciplinary team, was performed. After applying inclusion and exclusion criteria, 60 scans remained for statistical analysis. BMD and Z-scores for the lumbar spine (LS), and hip right and left femoral neck (RFN and LFN, respectively), and total hip (TH) were recorded. Results. The average age of children with CP when DXA analysis was first performed was about 7 years. The BMD (mean±SD) at LS (LS-BMD) of all patients was 0.612±0.12, at RFN 0.555±0.11, at LFN 0.572±0.1, and at TH (TH-BMD) 0.581±0.13. The values of the Z-score (mean±SD) at LS of all patients were −2.5±0.22, at RFN −2.2±0.21, at LFN -2.25 (SD=0.2), and at TH -2.3 (SD=0.23). There was no statistical significance between age and gender; however, BMI, walking ability, fracture history, and pattern of CP had a significant impact on BMD and Z-score values of these children. Conclusion. The results of our study clearly indicate that children with CP have a higher risk of low BMD, osteoporosis, and bone fractures, which makes it ethically justifiable to perform the DXA analysis in these children.
Introduction. Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifestation of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clinically known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report. We are presenting a case of acute gastric outlet obstruction caused by giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she didn't think her behavior was unusual and she has not been treated before. Followed initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively patient had a psychiatric consult exam. She recovered well and discharged without complications. She was referred for further psychiatric follow-up. Conclusion. Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences.
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