Perception of communication between doctors and patients - On-line research among doctors in Croatia.

BACKGROUND: Different studies clearly show that doctor-patient relationship and communication are extremely important. They have a big influence on the outcome of medical treatment, but also on the cooperability, quality of life, safety of patients, teamwork, cultural sensitivity and fewer complaints to the doctor+s work. In this paper, we present results of our original research about attitudes of doctors and their perception related to the importance of communication between doctors and patients and person-centered approach. SUBJECTS AND METHODS: This cross-sectional study used a 28 items on-line survey to collect data from doctors in the period from 29 September 2015 till 23 November 2015 by using the Google forms. Total of 939 doctors from the entire Croatia responded. RESULTS: Main results of the study suggest that doctors are aware of the importance of communication between doctors and patients and that education about communication skills was not appropriate during their study. Doctors have undoubtedly expressed their desire for further development and learning about a better communication between doctors and patients and they have showed in this research that they love their job. CONCLUSION: The research unambiguously speaks in favor of the need of the significant strengthening of this segment within the program of the School of Medicine and support the current changes in the medical curriculum at the School of medicine University of Zagreb.

The Role of PTSD in Perception of Health-Related Quality of Life and Social Support among Croatian War Veterans.

BACKGROUND: Different studies clearly show that posttraumatic stress disorder (PTSD) is important factor in a reduction of the overall quality of life. PTSD remains a substantial problem in Croatia, nearly three decades after the beginning of the Croatian Homeland war. In this paper, we present results of our original research about impact of PTSD on the self-perceived health-related quality of life and social support in Croatian Homeland war veterans. SUBJECTS AND METHODS: A total of 277 war veterans were included from all Croatian counties. 158 (57.03%) veterans has PTSD and 119 (42.47%) are without PTSD. Strucured questionnaire was designed for socio-demographic data and information about combat experience and health problems. SF-36 was used in the estimation of health-related quality of life and Multidimesional Scale for Perceived Social Support for estimation of social support. Research was performed from June 2017 till November 2017. RESULTS: Main results of the study suggest that Croatian veterans with PTSD have lower health-related quality of life in almost all doimains, and that they perceive less social support from family, friends and significant others in comparison to veterans without PTSD. CONCLUSION: The results of this study reiterate strong impact of PTSD on quality of life and perception of social support. The research speaks in favor of the need to develop person-centered interdisciplinry health-care programs for this population, with special emphasis on their overall quality of life.

Factor structure and cut-off scores of the Hospital Anxiety and Depression scale (HADS) in a Croatian sample of adult patients suffering from advanced cancer.

BACKGROUND: Patients with cancer should be systematically screened for psychological problems at key points in their pathway. Usage of self-report scales for measuring anxiety and depression (such as Hospital Anxiety and Depression scale (HADS)) is a very practical methodfor detecting anxiety and depression. The aim of this research was to determine latent structure, reliability and cut-off scores of HADSin a Croatian sample of adult patients suffering from advanced metastatic cancer. SUBJECTS AND METHODS: According to inclusion and exclusion criteria, participant were recruited at University Hospital Centre Zagreb (N=46; January 2015) and Clinical Hospital Centre 'Sisters of Mercy' (N=29; April 2015). All participants underwent short structured psychodiagnostic interview, cognitive evaluation (usingMontreal Cognitive Assessment (MoCA) test) and were given HADS. RESULTS: When using PCA separately for the items of each original scale of HADS, only four items for the component Depression satisfactorily saturate principal component and when using PCA for all the items, only seven items from the original scale satisfactorily saturate unique principal component. Maximum Likelihood extraction method showed that only four items from the original scale satisfactorily saturated the theoretical scales. CONCLUSIONS: The results show that the best solution to use HADS, in defined Croatian population, is as one-dimensional screening instrument (Cronbach's alpha coefficient of internal consistency=0.774) with cut-off score 11/12.

Is experimentally induced pain associated with socioeconomic status? Do poor people hurt more?

BACKGROUND: The association of pain and socioeconomic status is widely reported, yet much less clearly understood. The aim of this study was to investigate the association of experimentally induced pain threshold and tolerance with socioeconomic status. MATERIAL/METHODS: The study sample consisted of 319 adult subjects from the population of the island of Vis, Croatia, which was previously shown to have a high level of social homogeneity. A manual dolorimeter was used to measure mechanical pressure pain threshold (least stimulus intensity) and pain tolerance (maximum tolerance stimulus intensity) on both hands. Pain tolerance interval was defined as the difference between pain tolerance and threshold. Years of schooling and material status were used as socioeconomic estimates. RESULTS: Both of the socioeconomic estimates were significantly correlated with pain threshold, tolerance, and tolerance interval (P<0.001). The mixed modeling analysis, controlled for the effects of age, gender, and 4 psychological variables, indicated that education was not a significant predictor in any of the 3 models. However, lower material status was significantly associated with lower pain tolerance (P=0.038) and narrower pain tolerance interval (P=0.032), but not with pain threshold (P=0.506). The overall percentages of explained variance were lower in the tolerance interval model (20.2%) than in pain tolerance (23.1%) and threshold (33.1%), suggesting the increasing share of other confounding variables in pain tolerance and even more so in tolerance interval model. CONCLUSIONS: These results suggest a significant association between experimentally induced pain tolerance and tolerance interval with material status, suggesting that poor people indeed do hurt more.

Person-centered pain management - science and art.

We are witnessing an unprecedented development of the medical science, which promises to revolutionize health care and improve patients' health outcomes. However, the core of the medical profession has always been and will be the relationship between the doctor and the patient, and communication is the most widely used clinical skill in medical practice. When we talk about different forms of communication in medicine, we must never forget the importance of communication through art. Although one of the simplest, art is the most effective way to approach the patient and produce the effect that no other means of communication can achieve. Person-centered pain management takes into account psychological, physical, social, and spiritual aspects of health and disease. Art should be used as a therapeutic technique for people who suffer from pain, as well as a means of raising public awareness of this problem. Art can also be one of the best forms of educating medical professionals and others involved in treatment and decision-making on pain.

Person-centered medical interview.

We are witnessing an unprecedented development of medical science and personalized medicine. However, technological superiority must not make us lose sight of the physical, psychological, social, and spiritual totality of the patient. The core of the medical profession has always been and will be the relationship between the health professional and the person seeking assistance. However, the traditional relationship between the physician and the patient has changed and is greatly impacted by huge social, philosophical, economic, and scientific developments. It is important to develop and promote the culture of health instead of the culture of illness through a patient-doctor collaborative partnership, as well as partnership among professionals. Person-centered medical interview is an important bridge between personalized and person-centered medicine.

Psychiatrists' empathy, beliefs and attitudes towards veterans suffering from combat-related posttraumatic stress disorder.

BACKGROUND: Empathy is a powerful and necessary skill for understanding another person's subjective experience. In this study we wanted to explore psychiatrists' attitudes towards PTSD, general empathy, possible differences related to age, sex and regional location in Croatia. SUBJECTS AND METHODS: 205 psychiatrists from different Croatian regions participated in this study. To define psychiatrists' attitudes towards PTSD patients a questionnaire was devised. It contained 14 items related to psychiatrists' ability to live through emotional and social conditions of PTSD patients. BarOn Emotional Quotient-Inventory Empathy Subscale was used to measure the empathy among the subjects. RESULTS: This study has found statistically significant differences regarding gender in measured variables of the designed questionnaire. Male participants believed they were able to understand war veterans' feeling's and relate to traumatic experience while female participants stated that they had the ability to understand the trivial triggers for suicidal intentions. Regional differences were found in the understanding of war traumatic experience and social deviations occurring in PTSD. Older psychiatrists stated their incomprehension of the social difficulties the PTSD patients were facing. The years of experience in the psychiatric field were associated with inability to understand the patients' feelings'. Differences in empathy among the subjects were not found. CONCLUSION: The understanding of the empathic process in the therapeutic approach towards PTSD explored in this study was associated with basic variables such as gender and age but the construct of empathy itself is more complex and related with variables not assessed in this study, so our findings are preliminary and further research is needed.

Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain.

BACKGROUND: The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP). METHODS: A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering. RESULTS: The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator. CONCLUSIONS: The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.

Anxiety and depression in pregnant women with previous history of spontaneous abortion.

Spontaneous abortion is the most common adverse pregnancy outcome, and stress has been suggested to be important factor. We hypothesized that those female pregnant women with previous spontaneous abortion will have higher anxiety and depression than female pregnant women without previous spontaneous abortion and controls (healthy non-pregnant women). Age and socio-demographic parameters did not differ significantly between the three groups of participants. Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no significant differences in the scores on Beck Depression Inventory between three groups of participants at the week 10 of gestation-1st assessment and week 20 of gestation-2nd assessment. Contrary of these results, pregnant women with history of spontaneous abortion have had statistically significant higher anxiety score than pregnant women without history of spontaneous abortion and control group-non-pregnant women, on both assessment of anxiety. Negative correlations between months passed form the last spontaneous abortion and anxiety on both assessment, emphasize the role of psychological support for the women who have experienced spontaneous abortion.

Correlation of cognitive functions with some aspects of illness, treatment and social functioning in recurrently hospitalized schizophrenic patients.

Cognitive deficits are found to be contributors to poorer psychosocial functioning, rehabilitation outcome and lack of treatment success in schizophrenia. Aim of the study was to examine correlation of cognitive functions with some aspects of illness, treatment and social functioning in a group of recurrently hospitalized schizophrenic patients (N=60). Deficient results on psychomotor processing speed, verbal fluency and verbal learning correlated with the longer duration of illness, higher number of hospitalizations and shorter duration of regular antipsychotic treatment. Deficient results on verbal fluency correlated with the younger age of onset, poor functional autonomy and organizational skills, whereas deficient results on psychomotor processing and verbal learning correlated with poor organizational skills alone. Score on verbal fluency was predictive of social skills impairment, whereas score on psychomotor processing was predictive of functional autonomy and organizational skills impairment. Functioning of different cognitive domains could be predictive of functioning in different social domains. Interplay of specific cognitive deficit and social functioning could be responsible for recurrent hospitalizations and unfavorable treatment choices.

Life satisfaction in persons of the third age after retirement.

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.

Person-centered medicine versus personalized medicine: is it just a sophism? A view from chronic pain management.

The main aim of this brief overview is to explore the concepts of person-centered medicine and personalized medicine in the areas of chronic pain research and management. Through several definitions and paradigms of pain, the authors introduce the complexity of pain phenomenology in order to establish the challenge of person-centered and personalized medicine in everyday practice. By providing deeper insight into fibromyalgia, its presentation, biology and treatment, several questions are addressed, ranging from person-centered diagnosis to personalizing the various processes of the fibromyalgia spectrum complex. By reviewing current treatment options and evaluating treatment pitfalls derived from methodological flaws in current research, the authors discuss various possibilities of personalizing treatment and, therefore, propose how the use of these two paradigms could enhance outcomes in chronic pain management. If we wish to make comments about enhanced outcomes we need to talk about outcomes of pain treatments, we need to discuss what successful treatment is from the patient's point of view as well as in the reviewed models.

Neurobiological and clinical relationship between psychiatric disorders and chronic pain.

Pain is one of the most ubiquitous problems of today's world, its impact being far-reaching. Current conceptualizations of pain medicine adopt a bio-psycho-social perspective. In this model, pain is best described as an interactive, psycho-physiological behavioral pattern that cannot be divided into independent psycho-social and physical components. Neurophysiologic substrates of the pain experience can be broken down into the pain transmission elements emanating from peripheral, spinal, and supra-spinal processes. There are many complex mechanisms involved in pain processing within the central nervous system, being influenced by genetics, interaction of neurotransmitters and their receptors, and pain- augmenting and pain-inhibiting neural circuits. The patient's emotional experiences, beliefs and expectations may determine the outcome of treatment, and are fully emphasized in the focus of treatment interventions. There are several common psychiatric disorders accompanying and complicating the experience of pain that warrant clinical attention and that can be the focus of psychiatric treatment. These include depression, anxiety, sleep disorders, somatoform disorders, substance-related disorders and personality disorders. Complex and disabling pain conditions often require comprehensive pain treatment programs, involving interdisciplinary and multimodal treatment approaches. There are many roles that the psychiatrist can perform in the assessment and treatment of the patients with pain, individually tailored to meet the specific needs of the patient. Rational poly-pharmacy is of a high importance in the treatment of patients with chronic pain, with antidepressants and anticonvulsants contributing as the important adjuvant analgesic agents.