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Xie C, Li L, Zhou L, Sun C, Zhang Y, Li Y. Mediating role of learned helplessness' components in the association between health literacy/social support and self-management among maintenance haemodialysis patients in Changsha, China: a cross-sectional study. BMJ Open 2023; 13:e068601. [PMID: 37640465 PMCID: PMC10462950 DOI: 10.1136/bmjopen-2022-068601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To explore the multiple mediating roles of the learned helplessness's core system in the relationship between health literacy/social support and self-management. DESIGN Cross-sectional survey design. SETTING Changsha, China. PARTICIPANTS 239 Chinese maintenance haemodialysis (MHD) patients. METHODS Two multiple mediator models were constructed based on the COM-B (Capacity, Opportunity, Motivation - Behaviour) model. A total of 239 Chinese MHD patients participated in a cross-sectional study, which included surveys on the Learned Helplessness Scale for MHD patients, Dialysis Knowledge Questionnaire, Social Support Scale and Self-Management Scale for Haemodialysis. The PROCESS macro in SPSS was used for mediated effects analysis. RESULTS Helplessness and internality partially mediated the relationship between health literacy/social support and self-management ((β=-0.212, p<0.01; β=0.240, p<0.01)/(β=-0.331, p<0.001; β=0.376, p<0.001)). The mediation effect size was 0.780 (95% CI (0.373 to 1.218)) in the health literacy model, accounting for 45.29% of the total effect, and 0.286 (95% CI (0.207 to 0.377)) in the social support model, accounting for 57.88% of the total effect. The differences in effect sizes for helplessness and internality in the two models were -0.080 (95% CI (-0.374 to 0.216)) and -0.041 (95% CI (-0.127 to 0.043)), respectively. CONCLUSION Health literacy/social support directly affects MHD patients' self-management and indirectly affects it by changing learned helplessness, such as increasing internality while reducing helplessness.
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Affiliation(s)
- Chunyan Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Li Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Urology, Xinjiang Medical University Affiliated First Hospital, Urumqi, China
| | - Lin Zhou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Cuifang Sun
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yini Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Blood Purification Center, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
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Mirzazadeh-Qashqaei F, Zarea K, Rashidi H, Haghighizadeh MH. The relationship between self-care, spiritual well-being and coping strategies in patients with type 2 diabetes mellitus. J Res Nurs 2023; 28:259-269. [PMID: 37534270 PMCID: PMC10392715 DOI: 10.1177/17449871231172401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Background Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients. Aims This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM). Methods In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used. Results The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies (r = 0.163, p < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care (p < 0.01). There was a direct and significant correlation between self-care and SWB (r = 0.385, p < 0.01). Conclusion The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM.
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Affiliation(s)
- Firouzeh Mirzazadeh-Qashqaei
- Master’s Student, Student Research Committee, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Associate Professor, Nursing Care Research Center in Chronic Diseases, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Homeira Rashidi
- Associate Professor, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences. Ahvaz, Iran
| | - Mohammad Hosein Haghighizadeh
- Senior Lecturer, Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Jalilian H, Javanshir E, Torkzadeh L, Fehresti S, Mir N, Heidari‐Jamebozorgi M, Heydari S. Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1096. [PMID: 36761031 PMCID: PMC9895320 DOI: 10.1002/hsr2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background and Aims Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers. Methods This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ 2 test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications. Results In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44). Conclusion This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elnaz Javanshir
- Cardiovascular Research CentreTabriz University of Medical SciencesTabrizIran
| | - Leila Torkzadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Nazanin Mir
- Health Management and Economics Research CenterIran University of Medical SciencesTehranIran
| | | | - Somayeh Heydari
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
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Changsieng P, Pichayapinyo P, Lagampan S, Lapvongwatana P. Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial. J Prim Care Community Health 2023; 14:21501319231181106. [PMID: 37335030 DOI: 10.1177/21501319231181106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control. AIM To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels. METHODS We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test. RESULTS One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater. CONCLUSION The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.
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Affiliation(s)
- Piyanat Changsieng
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Panan Pichayapinyo
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Sunee Lagampan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Punyarat Lapvongwatana
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
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Mehraeen E, Mehrtak M, Janfaza N, Karimi A, Heydari M, Mirzapour P, Mehranfar A. Design and Development of a Mobile-Based Self-Care Application for Patients with Type 2 Diabetes. J Diabetes Sci Technol 2022; 16:1008-1015. [PMID: 33840235 PMCID: PMC9264443 DOI: 10.1177/19322968211007124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mobile-based applications play a leading role in changes in life-style, improve medication adherence, and provide a unique opportunity to aid patients with type 2 diabetes mellitus (T2DM) elevate their healthcare level. Therefore, we aim to design and develop a mobile-based self-care application for patients with T2DM. METHODS The present study was an applied and developmental study to design and develop a mobile-based self-care application for people living with T2DM conducted in 2020. The design and development of the T2DM self-care application were done in 2 main phases of determining the key features and capabilities, and design and development of the T2DM self-care mobile app. RESULTS We identified the main model and a set of capabilities and features for the T2DM self-care application. By content analysis on 32 different applications and a previous study by the author, 18 features were extracted for the T2DM self-care mobile app. JAVA programming languages were used to design T2DM applications. Moreover, because of the cost-effectiveness, the Android operating system (AOS) was selected as a platform, and because of the widespread use of smartphones; these phones were chosen as the format of T2DM self-care application. CONCLUSIONS In this study, we design and develop a mobile-based self-care application for patients with type 2 diabetes that shows potential in solving the shortcomings of mobile apps for diabetes care. By utilizing the T2DM self-care mobile app we are able to deploy a self-care application with a wide range of functionality such as text messaging, blood glucose monitoring, insulin dose suggestions, educational messaging, metabolic management, pedometer counts, and reporting. Future studies are needed to develop self-care applications for a different type of diabetes with different functions of diabetes care.
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Affiliation(s)
- Esmaeil Mehraeen
- Department of Health Information
Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Mohammad Mehrtak
- School of Medicine and Allied
Medical Sciences, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Nazanin Janfaza
- Internal Medicine Department,
Imam Khomeini Hospital Complex, School of Medicine, Tehran University of
Medical Sciences, Tehran, Iran
| | - Amirali Karimi
- School of Medicine, Tehran
University of Medical Sciences, Tehran, Iran
| | - Mohammad Heydari
- Department of Health Information
Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Pegah Mirzapour
- Iranian Research Center for
HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran
University of Medical Sciences, Tehran, Iran
| | - Adele Mehranfar
- Department of Electrical and
Computer Engineering, Isfahan University of Medical Sciences, Isfahan,
Iran
- Adele Mehranfar, MD, Department of
Electrical and Computer Engineering, Isfahan University of Medical
Sciences, Isfahan, 137859458, Iran.
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Barriers to Diabetes Patients' Self-Care Practices in Eastern Ethiopia: A Qualitative Study from the Health Care Providers Perspective. Diabetes Metab Syndr Obes 2021; 14:4335-4349. [PMID: 34712054 PMCID: PMC8547594 DOI: 10.2147/dmso.s335731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia. METHODS Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question. RESULTS Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers. CONCLUSION Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Gvozdanović Z, Farčić N, Šimić H, Buljanović V, Gvozdanović L, Katalinić S, Pačarić S, Gvozdanović D, Dujmić Ž, Miškić B, Barać I, Prlić N. The Impact of Education, COVID-19 and Risk Factors on the Quality of Life in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2332. [PMID: 33673454 PMCID: PMC7956830 DOI: 10.3390/ijerph18052332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
- Zvjezdana Gvozdanović
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Nikolina Farčić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- Department of Surgery, University Hospital Centre Osijek, Osijek 31 000, Croatia
| | - Hrvoje Šimić
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Vikica Buljanović
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Lea Gvozdanović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Sven Katalinić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Stana Pačarić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- Department of Surgery, University Hospital Centre Osijek, Osijek 31 000, Croatia
| | - Domagoj Gvozdanović
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Željka Dujmić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- General Hospital “Dr. Josip Benčević” Slavonski Brod, Slavonski Brod 35 000, Croatia
| | - Blaženka Miškić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- General Hospital “Dr. Josip Benčević” Slavonski Brod, Slavonski Brod 35 000, Croatia
| | - Ivana Barać
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Nada Prlić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
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