Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients.

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

A Conceptual Model of Nurses' Turnover Intention.

The World Health Organisation predicts a lack of 15 million health professionals by 2030. The lack of licenced professionals is a problem that keeps emerging and is carefully studied on a global level. Strategic objectives aimed at stimulating employment, improving working conditions, and keeping the nurses on board greatly depends on identifying factors that contribute to their turnover. The aim of this study was to present a conceptual model based on predictors of nurses' turnover intention. Methods: A quantitative, non-experimental research design was used. A total of 308 registered nurses (RNs) took part in the study. The Multidimensional Work Motivation Scale (MWMS) and Practice Environment Scale of the Nursing Work Index (PES-NWI) were used. Results: The conceptual model, based on the binary regression models, relies on two direct significant predictors and four indirect significant predictors of turnover intention. The direct predictors are job satisfaction (OR = 0.23) and absenteeism (OR = 2.5). Indirect predictors that affect turnover intention via job satisfaction are: amotivation (OR = 0.59), identified regulation (OR = 0.54), intrinsic motivation (OR = 1.67), and nurse manager ability, leadership and support of nurses (OR = 1.51). Conclusions: The results of the study indicate strategic issues that need to be addressed to retain the nursing workforce. There is a need to ensure positive perceptions and support from managers, maintain intrinsic motivation, and promote even higher levels of motivation to achieve satisfactory levels of job satisfaction.

Association between Health Literacy and Prevalence of Obesity, Arterial Hypertension, and Diabetes Mellitus.

Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional, single-center study included 500 patients (42.2% male and 57.8% females; median age, 63 years (interquartile range, 42−73)) hospitalized at General County Hospital in Pozega, Croatia, between July and October 2020. The Short Assessment of Health Literacy for Croatian Adults (SAHLCA-50) questionnaire was used. Descriptive statistics (median with interquartile range (IQR), frequency, and percentages) and binary logistic regression were utilized. Results: Patients with AH had an inadequate level of health literacy as compared to those without AH (32 vs. 40 points; Mann−Whitney U test, p < 0.001). Patients with T2DM scored 31 points versus 39 points in patients without T2DM (Mann−Whitney U test, p < 0.001). Patients suffering from both AH and T2DM scored 31 points versus 33 points in those with either AH or T2DM and 41 points in patients without AH and T2DM (Kruskal−Wallis test, p < 0.001). There were no statistically significant differences in SAHLCA-50 scores according to the patient body mass index. Conclusions: An inadequate level of health literacy is significantly associated with AH and T2DM but not with obesity. Male gender, low level of education, rural place of residence, retirement, and older age are significant predictors of inadequate health literacy.

Croatian Version of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50): Cross-Cultural Adaptation and Psychometric Evaluation.

(1) Background: Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was originally designed for Spanish-speaking regions, and translations validated for several languages. The aim of the study was to adapt and verify the psychometric characteristics of SAHLSA-50 in the Croatian context; (2) Methods: The cross-sectional study included 590 respondents from the general population older than 18 years of age. Health literacy was measured by two scales: SAHLCA-50 and the Croatian version of the Newest Vital Sign screening test (NVS-HR), which was used as a measure of concurrent validity. Subjective Health Complaints (SHC) and Satisfaction with Life Scale (SWLS) questionnaires were also used to assess convergent validity; (3) Results: Internal consistency reliability of SAHLCA-50 was high and corresponds to the findings of the authors of the original research. The Cronbach alpha coefficient for SAHLCA-50 version was 0.91. The correlation of SAHLCA-50 with the NVS-HR test speaks in favor of concurrent validity. Correlation between health literacy and SHC speaks for convergent validity, just as was expected, while correlation with life satisfaction was not observed; (4) Conclusions: The SAHLCA-50 test can be a good and quick tool to assess health literacy of the adult population in the Croatian language. HL can affect the health and quality of life of the individual and the wider community.

The Impact of Education, COVID-19 and Risk Factors on the Quality of Life in Patients with Type 2 Diabetes.

BACKGROUND: The aim of this study was to examine the impact of education, coronavirus disease 2019 (COVID-19), and risk factors on the quality of life in patients with type 2 diabetes. METHODS: A prospective study was conducted in three phases: before education, after education, and in the period of pandemic coronavirus disease 2019 (COVID-19). The subjects were diabetics on oral therapy. To determine the quality of life index, a standardized Ferrans and Powers survey questionnaire was used. RESULTS: A total of 205 participants took part in the study, of which 111 (54.1%) were men and 94 (46%) women. Participants were enrolled in the study between January 2019 and September 2020. Glycated hemoglobin values were significantly higher before education compared to post-education and at the time of COVID-19 (Friedman test, p = 0.002), and body mass index was significantly lower after education compared to values before education (Friedman test, p = 0.008). The quality of life was significantly lower in all domains in the COVID-19 period (Friedman test, p < 0.001). CONCLUSIONS: A significant predictor of worse assessment of overall quality of life was male gender and rural place of residence. Disease duration of up to 5 years was a significant predictor of worse assessment in the psychological/spiritual domain, while being married was a predictor of better assessment of the quality of life in the family domain. The education of diabetics brought an increase in the health and quality of life while the coronavirus disease pandemic had negative consequences on the same parameters. We consider it necessary to systematically educate diabetics about the comorbidity of COVID-19.

The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study.

The aim of this study is to examine the influence of nurses' self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses' self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses' CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession.

Core self-evaluation (CSE) is a theory that includes four personality dimensions: self-esteem, self-efficacy, locus of control and emotional stability. CSE proved to be a significant predictor of the research on cognitive, emotional and behavioral responses across various situations in the workplace. The aim of this study was to examine the relationship between personality traits of the core self-evaluation and clinical decision-making in nurses' profession. A cross-sectional design was applied. Data was collected with standardized instruments: Core Self-Evaluation Scale and Clinical Decision-Making Nurses Scale, 584 nurses have participated in the study. Correlation and hierarchical regression analysis were used to test the relations and prediction of variables. The findings of the study revealed that there is a significant positive relationship between overall core self-evaluation and nurses' clinical decision-making, and there is a significant contribution of self-esteem, self-efficacy and locus of control on all dimensions of clinical decision, especially in the area of canvassing of objectives and values. Nurses with high CSE have positive self-views and tend to be confident in their ability and they also feel in control while performing nursing interventions, whereas those with low CSE tend to have fewer accessible positive resources and are more prone to risk aversion.

Parental Perception of Changes in Basic Life Needs of Children with Disabilities after Six Months of Therapeutic Horseback Riding: A Qualitative Study.

Therapeutic horseback riding (THR) has a positive effect on the physical, cognitive, and psychosocial functioning of children with disabilities. Parents' reports of the effects of THR on their children support professionals in individualizing the THR program. With this qualitative study, we aimed to explore parents' perceptions of changes in the basic life needs of their children with disabilities after six months of THR lessons and to survey parents' explanations for the causes of these changes. The study involved parents of 13 children with disabilities who were enrolled in a six-month THR program. Parents continuously monitored their children and wrote a report on possible changes in their child's needs according to Virginia Henderson's need theory. Qualitative content analysis of parents' reports indicated only positive changes in 11 children. Most codes were identified in categories "relationships and communication with other people" and "movement and posturing". Other categories identified codes such as easier breathing, a better quality of sleep, better appetite, better elimination of stool and urine, more independence in clothing and maintaining personal hygiene, and greater interest in play and learning. Parents' reports are further supported by the assessments of professionals. Most parents think THR is responsible for the noticeable improvements in their children's quality of life.

Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study.

The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38-0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.

Diet Education as a Success Factor of Glycemia Regulation in Diabetes Patients: A Prospective Study.

BACKGROUND: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. METHODS: A two-year prospective study was conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Nasice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education. RESULTS: A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann-Whitney U test, p = 0.035). Significant differences were observed in fasted blood glucose (Friedman's test, p = 0.001), diastolic pressure (Friedman's test, P = 0.018), and glycated hemoglobin (Wilcoxon test, p < 0.001) between Phase 1 and Phase 3. CONCLUSIONS: Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia.

The quality of life of Croatian women after mastectomy: a cross-sectional single-center study.

BACKGROUND: Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy. METHODS: This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher's exact test, Kolmogorov-Smirnov test, Student's t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.). RESULTS: Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 [95% CI 33.3-61.6]) and sexual functioning (16.67 [95% CI 0-33.3]) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 [95% CI 33.3-100]) and fatigue 33.33 [95% CI 24-44]) 1 month and 1 year after mastectomy, respectively. CONCLUSION: In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients.

The mediating role of nurses' professional commitment in the relationship between core self-evaluation and job satisfaction.

OBJECTIVES: The aim of this study has been to examine the degree to which it is possible to predict job satisfaction in hospital nurses based on core self-evaluation and the nurses' professional commitment. Psychological constructs of nurses' professional commitment could predict a level of job satisfaction. MATERIAL AND METHODS: A cross-sectional design was applied. Data was collected from 584 nurses of the University Hospital Osijek between April and November 2016. Core Self-Evaluation Scale (CSES), Job Satisfaction Survey (JSS) and Nurses' Professional Commitment Scale (NPCS) were administrated to the study participants. Confirmatory factor analyses were conducted to test the validity of each questionnaire. Structural equation modeling was used for testing the prediction of nurses' professional commitment and core self-evaluation of job satisfaction. Nurses' professional commitment is variable, which functions as a mediator between predictor (core selfevaluation - CSE) and criterion variable (job satisfaction - JS). As a mediator, it explains what the effect is, provided that correlations among all variables are significant. RESULTS: The correlation analyses reveal significant positive correlations between job satisfaction and core self-evaluation (r = 0.441, p > 0.001) as well as between job satisfaction and nurses' professional commitment (r = 0.464, p > 0.001). Furthermore, core self-evaluation significantly and positively correlates with nurses' professional commitment (r = 0.402, p > 0.001). The results have shown that nurses' professional commitment mediates the relationship between core self-evaluation and job satisfaction. The bootstrap analysis showed that core self-evaluation partially mediated the relationship between nurses' professional commitment and job satisfaction (ß = 0.78, p < 0.001**). The indirect effects of core self-evaluation on job satisfaction through nurses' professional commitment was also significant (ß = 0.17, p < 0.001**). CONCLUSIONS: Nurses who are more committed to their work, regardless of the structure of personality, have greater satisfaction in their work. Int J Occup Med Environ Health 2018;31(5):649-658.

Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign.

AIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment. PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain. RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally. CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.