OCD and somatostatin


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(Updated 8/9/04)

Altemus M, Pigott T, L'Heureux F, Davis CL, Rubinow DR, Murphy DL, Gold PW.
CSF somatostatin in obsessive-compulsive disorder.
Am J Psychiatry. 1993 Mar;150(3):460-4.
"OBJECTIVE: Because the central administration of somatostatin to experimental animals produces behaviors with some similarities to the compulsions of patients with obsessive-compulsive disorder and because serotonin reuptake inhibitors have been reported to reduce brain content of somatostatin, the authors examined central somatostatin activity in patients with obsessive-compulsive disorder. METHOD: CSF for measurement of somatostatin was obtained from 15 drug-free outpatients with obsessive-compulsive disorder and 27 normal volunteers. RESULTS: The mean CSF somatostatin level was significantly higher in the patients with obsessive-compulsive disorder than in the normal subjects. CONCLUSIONS: Although the functional significance of this finding is unknown, these data are consistent with a role for somatostatin in the clinical symptomatology of obsessive-compulsive disorder and its response to neuropharmacological agents. The high levels of CSF somatostatin reported here in a patient subgroup whose predominant symptoms consisted of overly focused, perseverative thought processes are in contrast to the consistently low levels of CSF somatostatin seen in patients with a spectrum of disorders characterized by substantial cognitive deficits." [Abstract]

Schettini G.
Brain somatostatin: receptor-coupled transducing mechanisms and role in cognitive functions.
Pharmacol Res. 1991 Apr;23(3):203-15.
" Biological studies on the effects of increased brain somatostatin showed a facilitation in learning behavioural tasks, while brain somatostatin depletion by cysteamine caused memory loss. These observations, along with the severe somatostatinergic neurotransmission impairment demonstrated in Alzheimer's patients, strongly suggest a fundamental role for somatostatin in the modulation of cognitive functions." [Abstract]

Roy BF, Benkelfat C, Hill JL, Pierce PF, Dauphin MM, Kelly TM, Sunderland T, Weinberger DR, Breslin N.
Serum antibody for somatostatin-14 and prodynorphin 209-240 in patients with obsessive-compulsive disorder, schizophrenia, Alzheimer's disease, multiple sclerosis, and advanced HIV infection.
Biol Psychiatry. 1994 Mar 1;35(5):335-44.
"Patients with obsessive-compulsive disorder (OCD) demonstrated significant levels of antibody for somatostatin-28, its C-terminal fragment somatostatin-14, and prodynorphin. In contrast there were lower levels of reactivity for somatostatin-28(1-14) (the N-terminal fragment of somatostatin-28) and negligible reactivity for several other peptides including beta-endorphin and corticotropin. Healthy volunteers and disease controls [schizophrenia, Alzheimer's disease, multiple sclerosis, and subjects with advanced human immunodeficiency virus (HIV) infection] exhibited negligible reactivity. These data raise the consideration of an autoimmune mechanism for some OCD." [Abstract]

Allen JP, Hathway GJ, Clarke NJ, Jowett MI, Topps S, Kendrick KM, Humphrey PP, Wilkinson LS, Emson PC.
Somatostatin receptor 2 knockout/lacZ knockin mice show impaired motor coordination and reveal sites of somatostatin action within the striatum.
Eur J Neurosci. 2003 May;17(9):1881-95.
"The peptide somatostatin can modulate the functional output of the basal ganglia. The exact sites and mechanisms of this action, however, are poorly understood, and the physiological context in which somatostatin acts is unknown. Somatostatin acts as a neuromodulator via a family of five 7-transmembrane G protein-coupled receptors, SSTR1-5, one of which, SSTR2, is known to be functional in the striatum. We have investigated the role of SSTR2 in basal ganglia function using mice in which Sstr2 has been inactivated and replaced by the lacZ reporter gene. Analysis of Sstr2lacZ expression in the brain by beta-galactosidase histochemistry demonstrated a widespread pattern of expression. By comparison to previously published in situ hybridization and immunohistochemical data, Sstr2lacZ expression was shown to accurately recapitulate that of Sstr2 and thus provided a highly sensitive model to investigate cell-type-specific expression of Sstr2. In the striatum, Sstr2 expression was identified in medium spiny projection neurons restricted to the matrix compartment and in cholinergic interneurons. Sstr2 expression was not detected in any other nuclei of the basal ganglia except for a sparse number of nondopaminergic neurons in the substantia nigra. Microdialysis in the striatum showed Sstr2-null mice were selectively refractory to somatostatin-induced dopamine and glutamate release. In behavioural tests, Sstr2-null mice showed normal levels of locomotor activity and normal coordination in undemanding tasks. However, in beam-walking, a test of fine motor control, Sstr2-null mice were severely impaired. Together these data implicate an important neuromodulatory role for SSTR2 in the striatum." [Abstract]

Hathway GJ, Humphrey PP, Kendrick KM.
Somatostatin induces striatal dopamine release and contralateral turning behaviour in the mouse.
Neurosci Lett. 2004 Mar 25;358(2):127-31.
"Application of somatostatin to the striatum of the anaesthetized rat has previously been shown to elicit large increases in extracellular levels of dopamine and GABA via a glutamate-dependent mechanism. These actions have been ascribed to the SSTR2 receptor. Here we describe experiments designed to investigate whether these effects occur in C57Bl6 mice and if they elicit rotational behaviours associated with increased dopamine in the striatum. Application of somatostatin resulted in increased concentrations of dopamine in striatum, hippocampus and amygdala of anaesthetized mice. Unilateral striatal infusions of the peptide by retrodialysis increased locomotion. Application of N-methyl-D-aspartate and AMPA to the freely-moving mouse striatum resulted in increased dopamine release; however, only AMPA caused increased locomotion. These results further confirm that somatostatin can play a role in the control of locomotor function by modulating striatal dopamine release." [Abstract]

Magalie Rocheville, Daniela C. Lange, Ujendra Kumar, Shutish C. Patel, Ramesh C. Patel, and Yogesh C. Patel
Receptors for Dopamine and Somatostatin: Formation of Hetero-Oligomers with Enhanced Functional Activity
Science 2000; 288 (5463) : 154-157. (in Reports)
"Somatostatin and dopamine are two major neurotransmitter systems that share a number of structural and functional characteristics. Somatostatin receptors and dopamine receptors are colocalized in neuronal subgroups, and somatostatin is involved in modulating dopamine-mediated control of motor activity. However, the molecular basis for such interaction between the two systems is unclear. Here, we show that dopamine receptor D2R and somatostatin receptor SSTR5 interact physically through hetero-oligomerization to create a novel receptor with enhanced functional activity. Our results provide evidence that receptors from different G protein (heterotrimeric guanine nucleotide binding protein)-coupled receptor families interact through oligomerization. Such direct intramembrane association defines a new level of molecular crosstalk between related G protein-coupled receptor subfamilies." [Full Text]

Bendotti C, Tarizzo G, Fumagalli F, Baldessari S, Samanin R.
Increased expression of preproneuropeptide Y and preprosomatostatin mRNA in striatum after selective serotoninergic lesions in rats.
Neurosci Lett. 1993 Oct 1;160(2):197-200.
"The levels of neuropeptide Y and somatostatin may change when serotoninergic neurotransmission is altered in different brain regions. To assess whether serotonin regulates the synthesis of these peptides, we measured the levels of preproneuropeptide Y (ppNPY) and preprosomatostatin (ppSOM) mRNA in different brain regions after intracerebroventricular injection of 5,7-dihydroxytryptamine (5,7-DHT), a selective serotonin neurotoxin. The mRNA of these peptides significantly increased in the striatum but not in hippocampus and frontal cortex. It thus appears that serotonin has an inhibitory effect on the biosynthesis of neuropeptide Y and somatostatin in striatum whereas it probably acts by stimulating the release of these peptides in hippocampus and frontal cortex." [Abstract]

Mota A, Bento A, Penalva A, Pombo M, Dieguez C.
Role of the serotonin receptor subtype 5-HT1D on basal and stimulated growth hormone secretion.
J Clin Endocrinol Metab. 1995 Jun;80(6):1973-7.
"Our results indicate that 5-HT1D receptors have a stimulatory effect on GH secretion, possibly by inhibiting hypothalamic somatostatin release." [Abstract]

Mundo E, Richter MA, Zai G, Sam F, McBride J, Macciardi F, Kennedy JL.
5HT1Dbeta Receptor gene implicated in the pathogenesis of Obsessive-Compulsive Disorder: further evidence from a family-based association study.
Mol Psychiatry 2002;7(7):805-9
"Obsessive-Compulsive Disorder (OCD) is a psychiatric condition with strong evidence for a genetic component and for the involvement of genes of the serotonin system. In a recent family-based association study we reported an association between the G allele of the G861C polymorphism of the 5HT1Dbeta receptor gene and OCD. The aim of the present study was to further investigate for the presence of linkage disequilibrium between each of two polymorphisms of the 5HT1Dbeta receptor gene and OCD in a larger sample of OCD families. In a total of 121 families the G861C and the T371G polymorphisms of the 5HT1Dbeta receptor gene were genotyped using standard protocols. The genotyping data were analyzed with a new extension of the Transmission Disequilibrium Test (FBAT). The phenotypes considered in the analyses were the diagnosis of OCD and two quantitative phenotypes related to the diagnosis and clinically relevant, ie, the age at onset and the severity of OCD symptoms. We confirmed the previously found preferential transmission of the G861 allele to the affected subjects (z = 2.262, P = 0.02). No significant association was found between the polymorphism and the quantitative phenotypes considered. These results represent a confirmation of our previous published study and thus, could have important implications for the role of the 5HT1Dbeta receptor gene in the pathogenesis and treatment of OCD. Further genetic investigations on this marker considering additional polymorphisms and other quantitative phenotypes related to OCD are warranted." [Abstract]

Prosperini E, Rizzi M, Fumagalli F, Tarizzo G, Samanin R, Bendotti C.
Acute and chronic treatments with citalopram lower somatostatin levels in rat brain striatum through different mechanisms.
J Neurochem. 1997 Jul;69(1):206-13.
"The suggestion that somatostatin is involved in the pathophysiology of obsessive-compulsive disorder and the evidence that selective serotonin reuptake inhibitors show significant antiobsessional effect prompted us to examine the effect of citalopram, a selective and potent serotonin reuptake inhibitor, on the somatostatinergic system in different brain regions of the rat. A single intraperitoneal injection of 10 mg/kg citalopram significantly reduced somatostatin levels in the striatum and nucleus accumbens after 4 but not 1, 8, or 24 h. No changes were found in hippocampus. In addition, we found that the K+-evoked overflow of somatostatin-like immunoreactivity from striatal slices was significantly increased 1 h after a single injection of citalopram and was still higher, although not significantly, 4 h after the drug injection. Levels of preprosomatostatin mRNA were unchanged in striatum and accumbens 1 and 4 h after a single drug administration. In rats treated with citalopram (10 mg/kg i.p.) twice daily for 14 days, the levels of somatostatin and its mRNA were significantly decreased in the striatum but not in other brain regions 24 h after the last dose. No change was found in the basal or K+-evoked overflow of somatostatin-like immunoreactivity at 1, 4, and 24 h after the last drug injection. These results suggest that acute and chronic treatment with citalopram reduces somatostatin levels in striatum by different mechanisms. Whereas a single dose of the drug reduces somatostatin levels by increasing the release of the peptide, repeated drug treatment reduces the biosynthesis of somatostatin." [Abstract]

Altemus M, Swedo SE, Leonard HL, Richter D, Rubinow DR, Potter WZ, Rapoport JL.
Changes in cerebrospinal fluid neurochemistry during treatment of obsessive-compulsive disorder with clomipramine.
Arch Gen Psychiatry. 1994 Oct;51(10):794-803.
"BACKGROUND: This study examined the effect of long-term (mean, 19 months) treatment with clomipramine hydrochloride on cerebrospinal fluid (CSF) levels of several neuropeptides and monoamine metabolites in children and adolescents with obsessive-compulsive disorder. METHODS: The CSF levels of corticotropin-releasing hormone, vasopressin, somatostatin, and oxytocin and of the monoamine metabolites 5-hydroxyindoleacetic acid, homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol were measured in 17 children and adolescents with obsessive-compulsive disorder before and after long-term treatment with clomipramine. RESULTS: Treatment resulted in significant decreases in CSF levels of corticotropin-releasing hormone (mean +/- SD, 175 +/- 32 vs 152 +/- 25 pmol/L, P < .03) and vasopressin (mean +/- SD, 1.30 +/- 0.57 vs 0.86 +/- 0.54 pmol/L, P < .02) and a trend toward a decrease in somatostatin levels (mean +/- SD, 21.3 +/- 8.5 vs 15.3 +/- 9.8 pmol/L, P < .06). Treatment also significantly increased CSF oxytocin levels (mean +/- SD, 6.05 +/- 1.60 vs 6.70 +/- 1.44 pmol/L, P < .01). Significant changes in CSF monoamine metabolite levels with treatment included significant decreases in CSF levels of 5-hydroxyindoleacetic acid (mean +/- SD, 109 +/- 31 vs 77 +/- 23 pmol/mL, P < .001), CSF homovanillic acid (mean +/- SD, 273 +/- 111 vs 237 +/- 101 pmol/mL, P < .04), and 3-methoxy-4-hydroxyphenylglycol (mean +/- SD, 42.4 +/- 10.2 vs 36.1 +/- 4.8 pmol/L, P < .02) and a significant increase in the homovanillic acid-5-hydroxyindoleacetic acid ratio (mean +/- SD, 2.44 +/- 0.46 vs 3.42 +/- 0.84, P < .0001). CONCLUSIONS: These neuropeptide results coupled with evidence that central administration of corticotropin-releasing hormone, vasopressin, and somatostatin to laboratory animals increases arousal and acquisition of conditioned behaviors whereas central administration of oxytocin has opposite behavioral effects are consistent with a role for these neuropeptides in the pathophysiologic processes and pharmacologic treatment of obsessive-compulsive disorder." [Abstract]

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Recent Obsessive-Compulsive and Somatostatin Research

1) Loncarek K
How to say "thanks" in phoenician.
Croat Med J. 2008 Jun;48(3):441-3.
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2) Calisher CH
What do we know about anything?
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3) Muula AS
HIV Infection and AIDS Among Young Women in South Africa.
Croat Med J. 2008 Jun;48(3):423-35.
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4) Marusic M
Richard horton, editor of the lancet, visits croatia to support the croatian medical journal.
Croat Med J. 2008 Jun;48(3):422.
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5) Dikici MF, Yaris F, Topsever P, Tuncay Muge F, Gurel FS, Cubukcu M, Gorpelioglu S
Factors Affecting Choice of Specialty Among First-year Medical Students of Four Universities in Different Regions of Turkey.
Croat Med J. 2008 Jun;48(3):415-20.
Aim. To determine the factors affecting medical students' choice of the specialty of family medicine. Methods. The study was conducted in the period from 2004-2006 and comprised 770 first-year medical students from Ondokuz Mayis, Karadeniz Technical, Kocaeli, and Adnan Menderes Universities, Turkey. The questionnaire included questions on demographic data and 6 "yes/no" or open-ended questions on students' career aspirations and the specialty of family medicine. Results. The response rate was 93.1% (n=717, 54.7% male). Nearly all students (n=714, 99.6%) showed an intention to specialize after receiving the medical doctor degree. A total of 187 students (26.2%) showed an intention to work in primary care without specialization "for a temporary period" to "gain some experience." Family medicine was the least preferred specialty (n=7, 0.9%). The most important reasons for the choice of specialty were "better financial opportunities" and "prestige" (n=219, 30.5%), followed by "personal development" (n=149, 20.8%), "more benefits for the patient" (n=128, 17.9%), and "wish to work in an urban area" (n=32, 4.5%). The most preferred specialties were cardiology (n=179, 25.0%), pediatrics (n=121, 16.9%), ophthalmology (n=47, 6.6%), physical therapy and rehabilitation (n=34, 4.7%), and obstetrics and gynecology (n=32, 4.5%). Conclusion. Prestige, money, and personal development are important factors in career decision-making among medical students in Turkey. This should be taken into consideration when conducting reforms at the primary level. [PubMed Citation] [Order full text from Infotrieve]


6) Desa K
Letter of apology and notice of retraction.
Croat Med J. 2008 Jun;48(3):412.
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7) Campbell H, Biloglav Z, Rudan I
Reducing bias from test misclassification in burden of disease studies: use of test to actual positive ratio - new test parameter.
Croat Med J. 2008 Jun;48(3):402-14.
Aim. To address the problem of estimating disease frequency identified by a diagnostic test, which may not represent the actual number of persons with disease in a community, but rather the number of persons who tested positive. Those two values may be very different, their relationship depending on the properties of the diagnostic test applied and true prevalence of the disease in a population. Methods. We defined a new test parameter, the ratio of Test to Actual Positives (TAP), which summarizes the properties of the diagnostic test applied and true prevalence of the disease in a population, and propose that is the most useful summary measure of the potential for bias in disease frequency estimates. Results. A consideration of the relationship between the sensitivity (Se) and specificity (Sp) of the diagnostic test and the true prevalence of disease in a population can inform study design by highlighting the potential for disease misclassification bias. The effects of a decrease in Sp on the TAP ratio at very low disease prevalence are dramatic, as at 80% Sp (and any Se value including 100%), the measured disease frequency will represent a 25-fold overestimate. At a disease prevalence of 0.10, the Sp needs to be 90% or greater to achieve a TAP ratio of 1.0. However, unlike at lower levels of disease prevalence, the test Se is also an important determinant of the TAP ratio. A TAP ratio of 1.0 can be achieved by a Sp of 95% and intermediate Se (40%-60%); or a Sp of 99% and very high Se (over 90%). This illustrates how a test with poor performance characteristics in a clinical setting can perform well in a disease burden study in a population. In circumstances in which the TAP ratio suggests a potential for a large bias, we suggest correction procedures that limit disease misclassification bias and which are often counter-intuitive. We also illustrate how these methods can improve the power of intervention studies, which define outcomes by use of a diagnostic test. Conclusions. Optimal screening test characteristics for use in a population-based survey are likely to be different to those when the test is used in a clinical setting. Calibrating the test a priori to bring the TAP ratio closer to unity deals with the possible large bias in disease burden estimates based on application of diagnostic (screening) test. [PubMed Citation] [Order full text from Infotrieve]


8) Peltzer K, Matseke G, Azwihangwisi M
Evaluation of alcohol screening and brief intervention in routine practice of primary care nurses in vhembe district, South Africa.
Croat Med J. 2008 Jun;48(3):392-401.
Aim. To assess the implementation of the Alcohol Screening and Brief Intervention (SBI) strategy as part of a routine practice of nurses in 18 primary health care services in Vhembe district, South Africa. Method. We performed a cross-sectional study to assess the success of implementation of the SBI in 18 primary health care services. We examined all anonymously completed questionnaires (n=2670) collected from all practices after a 6-month implementation period. Clinic managers were interviewed on SBI implementation after 4 months of implementation. The success of implementation was assessed on the basis of perceived benefits, beliefs, values, past history, current needs, competing priorities, complexity of innovation, trialability and observability, and feedback on SBI performance. Results. In the 6-month period, nurses screened 2670 patients and found that 648 (23.4%) patients (39.1% men and 13.8% women) were hazardous or harmful drinkers. Nine clinics had good and 9 poor SBI implementation. Factors discriminating the clinics with good or poor SBI implementation included the percentage of nurses trained in SBI, support visits, clinical workload, competing priorities, team work, innovation adoption curve, perceived complexity of innovation, compatibility beliefs, trialability, and observability of SBI. Conclusion. To improve SBI implementation as a routine practice, more attention should be paid to training modalities, clinic organization, and changes in the attitudes of nurses. [PubMed Citation] [Order full text from Infotrieve]


9) Bagat M, Drakulic V, Sekelj Kauzlaric K, Vlahusic A, Bilic I, Matanic D
Influence of urbanization level and gross domestic product of counties in croatia on access to health care.
Croat Med J. 2008 Jun;48(3):384-91.
Aim. To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. Methods. Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. Results. There was no significant difference in the total number of physicians per 100000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. Conclusion. The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP. [PubMed Citation] [Order full text from Infotrieve]


10) Spiegel W, Pichlhofer O, Haoula D, Schneider B, Maier M
Specialty selection and relative job satisfaction of family physicians and medical specialists in austria.
Croat Med J. 2008 Jun;48(3):375-83.
Aim. To estimate the relative job satisfaction of Austrian family physicians and other specialists with respect to whether or not they obtained training in the desired specialty. Methods. In this cross-sectional study, we re-examined the previous data on allocation of medical training posts in Austria. All board-certified physicians practicing in Vienna were surveyed with a 12-item questionnaire. We analyzed the association between respondents' desired and practiced medical specialty and their answer to the question of whether they thought they would have had greater job satisfaction in a different medical specialty. We also calculated their relative job satisfaction. Results. Of 8127 licensed physicians, 2736 (34%) completed the questionnaire in two mailings. Of physicians who completed the questionnaire, 50.3% (43.2% of men) did not obtain the training in their desired specialty and 65.1% stated that they had originally desired a different specialty. There was a significant difference in relative job satisfaction between specialists who got their desired medical specialty (n=1005) and those who did not (n=697) (0.95 vs 0.62 of maximum 1, P<0.001). No significant difference in relative job satisfaction was found between family physicians who had originally wanted to become specialists (n=679) and specialists who had originally wanted to become family physicians (n=533; 0.89 vs 0.81; P=0.01; chi(2) test). Conclusion. A high percentage of family physicians in Austria had originally wanted to become practitioners of a different specialty. Among physicians who did not receive training in their desired medical specialty, family physicians showed a significantly higher relative job satisfaction than specialists. Obtaining the desired medical specialty is a strong predictor of relative job satisfaction among specialists, but not among family physicians. [PubMed Citation] [Order full text from Infotrieve]


11) Ogresta J, Rusac S, Zorec L
Relation between burnout syndrome and job satisfaction among mental health workers.
Croat Med J. 2008 Jun;48(3):364-74.
Aim. To identify predictors of burnout syndrome, such as job satisfaction and manifestations of occupational stress, in mental health workers. Method. The study included a snowball sample of 174 mental health workers in Croatia. The following measurement instruments were used: Maslach Burnout Inventory, Manifestations of Occupational Stress Survey, and Job Satisfaction Survey. We correlated dimensions of burnout syndrome with job satisfaction and manifestations of occupational stress dimensions. We also performed multiple regression analysis using three dimensions of burnout syndrome - emotional exhaustion, depersonalization, and personal accomplishment. Results. Stepwise multiple regression analysis showed that pay and rewards satisfaction (beta=-0.37), work climate (beta=-0.18), advancement opportunities (beta=0.17), the degree of psychological (beta=0.41), and physical manifestations of occupational stress (beta=0.29) were significant predictors of emotional exhaustion (R=0.76; F=30.02; P<0.001). The frequency of negative emotional and behavioral reactions toward patients and colleagues (beta=0.48), psychological (beta=0.27) and physical manifestations of occupational stress (beta=0.24), and pay and rewards satisfaction (beta=0.22) were significant predictors of depersonalization (R=0.57; F=13,01; P<0.001). Satisfaction with the work climate (beta=-0.20) was a significant predictor of lower levels of personal accomplishment (R=0.20; F=5.06; P<0.005). Conclusion. Mental health workers exhibited a moderate degree of burnout syndrome, but there were no significant differences regarding their occupation. Generally, both dimensions of job satisfaction and manifestations of occupational stress proved to be relevant predictors of burnout syndrome. [PubMed Citation] [Order full text from Infotrieve]


12) Gmajnic R, Pribic S, Lukic A, Ebling B, Cupic N, Markovic I
Effect of surgical training course on performance of minor surgical procedures in family medicine physicians' offices: an observational study.
Croat Med J. 2008 Jun;48(3):358-63.
Aim. To examine the influence of a practical surgical course on the number of minor surgical procedures performed by family physicians. Methods. We compared the number of minor surgical procedures performed by family physicians in 59 offices in the city of Osijek and surrounding rural area during 12 months before and after the 40-hour practical surgical course held in September 2006 by surgeons and family medicine specialists. Minor surgical procedures taught in the course included management of ingrown toenails, abscesses/comedones, and minor wounds, anesthesia application, disinfection, use and sterilization of surgical instruments, and antibiotic treatment. Results. The number of minor surgical procedures performed in family medicine offices almost doubled (503 vs 906 after the course, P<0.001, Wilcoxon test). The median number of abscesses/comedones treatments per physician increased from 1 to 6 (P<0.001, Wilcoxon test), the number of managed wounds increased from 111 to 217 (P<0.001, Wilcoxon test). The increase in ingrown toenail resections was also significant (from 120 to 186, P=0.004, Wilcoxon test). Fifty percent of physicians did not treat patients surgically, irrespective of the training. We found no association between the number of performed procedures and age, length of employment, or location of the physician's office (urban vs rural). However, we found that male physicians performed more surgical treatments both before and after the course (abscesses/comedones: P<0.001 and P=0.108 respectively; ingrown toenail resections: P=0.008 and P=0.008 respectively; minor wounds: P=0.030 and P<0.001; respectively). Conclusion. Practical courses can encourage practitioners to treat the patients surgically in their offices and, thus, increase the number of services offered in primary care. Female physicians should be more encouraged to perform minor surgical procedures in their offices. [PubMed Citation] [Order full text from Infotrieve]


13) Eldar R, Marincek C, Kullmann L
Need for rehabilitation teamwork training in europe.
Croat Med J. 2008 Jun;48(3):352-7.
Teamwork is the cornerstone of rehabilitation medicine. Rehabilitation workers in European countries are well educated in their own disciplines and attain appropriate professional knowledge; however, they lack educational opportunities for acquiring skills and attitudes necessary for effective teamwork, mainly communication, cooperation, and leadership. Consequently, teamwork is compromised and rehabilitation effectiveness reduced. Therefore, training in these components of professional competence needs scaling up in order to increase their impact on rehabilitation care. [PubMed Citation] [Order full text from Infotrieve]


14) Kukolja-Taradi S, Dogas Z, Dabic M, Drenjancevic Peric I
Scaling-up Undergraduate Medical Education: Enabling Virtual Mobility by Online Elective Courses.
Croat Med J. 2008 Jun;48(3):344-51.
Aim. To evaluate online elective courses at Croatian medical schools with respect to the virtual mobility of national teachers and students and virtual team collaboration. Methods. A student-centered virtual learning environment developed within the framework of the European Union Tempus Programme allowed national educational services to design and deliver online undergraduate elective courses. Three online elective courses were created for second-year medical students of four Croatian medical schools by using Moodle, an open-source learning management system. The courses supported problem-, project-, and decision-based learning and required students to work in small collaborative teams using problem-solving and decision-making activities. The purpose was to foster teamwork and produce better outcomes than those potentially achieved through individual work. We evaluated the results of these online courses on the basis of the course test results and students' evaluation questionnaires. Results. Of 68 students enrolled in all e-courses, 97% (n=66) successfully passed the final exam. An anonymous online questionnaire was filled out by 83% (n=50) of the students. The majority expressed their satisfaction with the online electives, mostly because they had more contact with tutors and peers (n=47), better possibilities of self-assessment (n=38), more flexible learning (n=33), better access to learning materials (n=32), faster and easier information retrieval (n=31), and better quality of communication with tutors and peers (n=28). Although 38 of 50 students claimed that participating in e-courses was more demanding than participating in traditional electives, more than half (n=27) would enroll in an e-course again. Conclusion. Elective e-courses may be a successful model of how faculty and students at higher education institutions can collaborate and integrate e-learning into their current curricula. [PubMed Citation] [Order full text from Infotrieve]


15) Skela Savic B, Pagon M
Relationship between nurses and physicians in terms of organizational culture: who is responsible for subordination of nurses?
Croat Med J. 2008 Jun;48(3):334-43.
Aim. To investigate how nurses and physicians perceive organizational culture, their integration into the organizational processes, and relations within a health care team. Methods We performed a cross-sectional study that included 106 physicians and 558 nurses from 14 Slovenian hospitals in December 2005. The hospitals were randomly selected. We distributed the questionnaires on the same day to physicians and nurses during a morning shift. The total number of distributed questionnaires represented a 20% of each personnel category at each hospital. The following variables were studied: organizational culture, integration of nurses and physicians in hospital processes, and subordination of nurses to physicians. Results Physicians and nurses favored a culture of internal focus, stability, and control. Both groups estimated that they had a low level of personal involvement in their organizations and indicated insufficient involvement in work teams, while nurses also felt that they were subordinated (mean+/-standard deviation, 3.6+/-0.9 on a scale from 1 to 5) to physicians (2.7+/-1.0; P<0.001). Control orientation correlated positively with the subordination of nurses (PP<0.005) and negatively with personal integration in an organization (PP<0.005). Conclusion We found out that subordination of nurses can be explained by market culture, level of personal involvement, and the level of education. Our research showed that the professional growth of nurses was mainly threatened by organizational factors such as hierarchy, control orientation, a lack of cooperation and team building between physicians and nurses, as well as insufficient inclusion of both physicians and nurses into change implementation activities. [PubMed Citation] [Order full text from Infotrieve]


16) Wirth M
Professionals with delivery skills: backbone of the health system and key to reaching the maternal health millennium development goal.
Croat Med J. 2008 Jun;48(3):318-33.
The attainment of the fifth Millennium Development Goal requires adequate national reserves of skilled birth attendants. Nurses, midwives, and their equivalents form the frontline of the formal health system are a critical element of global efforts to reduce ill-health and poverty in the poorest areas of the world. Planning and policies supporting these cadres of workers must be placed high on the development agenda and championed by key international and national players. This article first sets forth an argument for the equity and efficiency of nurses, midwives, and their equivalents as the cadre largely responsible for maternal health. Second, it traces the root causes of neglect of this critical cadre, including a vacuum in political will in the context of poverty, lack of protections for frontline workers, the historical political position of the field of midwifery, lack of a pipeline of secondary school graduates, and gender inequity. Investment in the largely female cadre that cares for the majority of the world's poorer women has simply not been a high enough priority. Five key policy recommendations include harnessing political will and adequate metrics, protection of frontline workers' safety and livelihoods, ensuring an adequate pipeline with a focus on girls' education, donor support for training and professional organizations, and a rapid scale-up of a robust cadre of delivery care professionals. Finally, a call for unified international support of rapid scale-up of cadres of delivery care workers is put forth. [PubMed Citation] [Order full text from Infotrieve]


17) Rudan I, Chopra M, Kapiriri L, Gibson J, Ann Lansang M, Carneiro I, Ameratunga S, Tsai AC, Chan KY, Tomlinson M, Hess SY, Campbell H, El Arifeen S, Black RE
Setting priorities in global child health research investments: universal challenges and conceptual framework.
Croat Med J. 2008 Jun;48(3):307-17.
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18) Kalauz S, Orlic-Sumic M, Simunec D
Nursing in croatia: past, present, and future.
Croat Med J. 2008 Jun;48(3):298-306.
In the health care system of the Republic of Croatia, there are 30000 nurses. More than 7000 of them have college or university professional qualifications. Nursing education consists of secondary-level vocational education followed by two cycles of university-level education - baccalaureate and diploma cycle. A PhD cycle, which would allow the development of scientific career for nurses, does not exist. The secondary-level vocational school qualifications are not recognized by the European Union educational system, requiring a necessary reform in that field. The education of nurses should be attuned with the needs of health care institutions, and nursing care should be based on modern categorization of patients, standards of nursing practice, and clearly defined responsibilities. However, the Croatian Ministry of Health has not yet defined the necessary number of nurses in Croatia or their required educational level. Licensing registered nurses is another great problem that the health care system is facing, because Croatian nurses with only secondary vocational qualifications do not meet the requirements for licensing. The current legislation on nursing is still only formal and not implemented on a wide scale in the health care system. Considering the new trends, nurses in Croatia should work on developing a new systematization of workplaces and more accurate assessment of the job complexity index and nursing salary. [PubMed Citation] [Order full text from Infotrieve]


19) Rudan I, Ivanis A
Scaling-up of Training and Education for Health Workers.
Croat Med J. 2008 Jun;48(3):295-7.
[PubMed Citation] [Order full text from Infotrieve]


20) Pecotic-Jericevic S, Vlak T, Rota-Ceprnja A, Viskovic M, Franulovic-Golja N, Eldar R
Kalos rehabilitation hospital in vela luka, croatia.
Croat Med J. 2008 Jun;48(3):291-4.
[PubMed Citation] [Order full text from Infotrieve]