ZDRAVJE DELOVNO AKTIVNE POPULACIJE HEALTH OF THE WORKING-AGE POPULATION Proceedings Edited by Ana Petelin Uredniški odbor Založbe Univerze na Primorskem Gregor Pobežin, UP Fakulteta za humanistične študije Maja Meško, UP Fakulteta za management Vito Vitrih, UP FAMNIT in UP IAM Silva Bratož, UP Pedagoška fakulteta Matej Vranješ, UP Fakulteta za turistične študije – Turistica Ana Petelin, UP Fakulteta za vede o zdravstvu Janko Gravner, University of California, Davis Krstivoje Špijunović, Učiteljski fakultet Užice Miloš Zelenka, Jihočeská univerzita v Českých Budějovicích in Univerzita Konštantína Filozofa v Nitre Jonatan Vinkler, Založba Univerze na Primorskem Alen Ježovnik, Založba Univerze na Primorskem zdravje delovno aktivne populacije health of the working-age population Univerza na Primorskem ■ Fakulteta za vede o zdravju Università del Litorale ■ Facoltà di scienze del a salute University of Primorska ■ Faculty of Health Sciences Dogodek je bil izveden v okviru projekta »Podaljševanje delovne aktivnosti in zmanjševanje odsotnosti z dela v KRZS – STAR-VITAL: Združeni ukrepi za vitalnost starejših delavcev« REPUBLIKA SLOVENIJA MINISTRSTVO ZA DELO, DRUŽINO, SOCIALNE ZADEVE IN ENAKE MOŽNOSTI Projekt »Podaljševanje delovne aktivnosti in zmanjševanje odsotnosti z dela v KRZS – STAR-VITAL: Združeni ukrepi za vitalnost starejših delavcev«. Naložbo financirata Evropska unija, in sicer iz Evropskega socialnega sklada ter Republika Slovenija, in sicer Ministrstvo za delo, družino, socialne zadeve in enake možnosti. Naložba se izvaja v okviru Operativnega programa za izvajanje Evropske kohezijske politike v obdobju 2014 – 2020, v okviru 8. prednostne osi: »Spodbujanje zaposlovanja in transnacionalna mobilnost delovne sile«, 8.3. prednostne naložbe: »Aktivno in zdravo staranje«, 8.3.1. specifičnega cilja »Podaljševanje in izboljšanje delovne aktivnosti starejših, vključenih v ukrepe«. Ostali partnerji projekta Zdravje delovno aktivne populacije H ealth of the Working-Age population Edited by Ana Petelin 2020 Contents Anja Andrenšek, Matej Plevnik 7 Relationship between physical activity and work efficiency among kindergarten employees Katja Bezek, Darja Barlič - Maganja 13 Dietary polyphenols and their effect on the gut microbiota and human health Nives Bogataj, Karin Novak, Zala Jenko Pražnikar, Nina Mohorko 21 Change of Dietary Habits during Quarantine Dominika Češek, Katja Bezek, Mihaela Jurdana 29 Probiotics consumption in physically active individuals Dominika Češek, Katja Bezek, Boris Kovač 35 The effect of probiotic ice cream consumption on salivary cariogenic bacteria in healthy adults Maria de Lurdes Lopes de Freitas Lomba, Inês Abreu, Rafaela Oliveira, Rodrigo Rato, Rúben Pinto, M. Sofia Macedo 41 Health problems experienced by parents of children in long-term hospital stay Tilen Dolinar, Lidija Jakupović, Urška Ugovšek, Andrej Starc 51 Use of information telecommunications technology in asthma subjects Lidija Dornik 57 Nurses’ shift work: impact on health Grega Martin Glas, Sara Hafner, Špela Rozman, Andrej Starc 69 Use of mobile technology in healthcare Jera Gregorc, Mira Dolenc 75 Musculoskeletal disorders among preschool teachers Mojca Jevšnik, Lucija Pirc, Peter Raspor, Karmen Godič Torkar 85 Ensuring Safe Food Preparation among Slovenian Consumers Filip Krajnc, Maruša Magister, Klara Nartnik, Andrej Starc 95 The role of information and communication technology in self-management of type 2 diabetes Eva Lenart, Karin Vrtar, Sabina Ličen, Milan Hosta, Matej Plevnik 103 Relationship between breathing exercises and quality of life in adults – integrative literature review Martin Lipovšek 109 Egalitarian distribution of health maintenance using technologies for life extension 6 Marjeta Logar Čuček n 115 Hiring older people as a way to increase diversity and improve the quality of society pulatioo Martina Nagode, Katja Bezek ge p 125 Sauerkraut and sour turnip consumption habits in Slovenia rking-ao Karin Novak, Zala Jenko Pražnikar, Ana Petelin 133 The effect of kefir and milk intake on intestinal permeability he wf t Natalija Rozman, Klemen Širok 141 STAR-VITAL project: Factors for ensuring participation ealth o in health promotion programs Eva Skočir, Tereza Sever, Tadeja Vidmar, Andrej Starc pulacije | ho 147 Type 1 Diabetes Management Using Information Communication Technology ktivne p Janja Tekavc, Pia Novak 155 Distance teaching: perceived stress, psychological health elovno a and work satisfaction among classroom teachers Nikola Todorović, Valdemar Štajer, Darinka Korovoljev, zdravje d Nebojša Maksimović, Sergej Ostojić 161 Exercise at workplace: an overview https://doi.org/10.26493/978-961-293-015-8.7-11 Relationship between physical activity and work efficiency among kindergarten employees Anja Andrenšek1, Matej Plevnik2 1 Community Health Centre Brežice, Centre for Health Enhancement, Cesta bratov Milavcev 18, 8250 Brežice, Slovenia 2 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia anja.andrensek@gmail.com; matej.plevnik@fvz.upr.si Abstract Introduction: People who live a healthy lifestyle are less likely to develop chronic diseases, such as type 2 diabetes, obesity, hypertension and also osteoporosis, cancer, increased level of cholesterol, depression, anxiety, etc. The purpose of our study was to examine the correlation between physical activity and work efficiency among different job positions in kindergarten. Methods: The Global Physical Activity Questionnaire and the Work Ability Index Questionnaire were used to assess the intensity and the quantity of PA and an individual’s work efficiency. Resuts: The comparison between the groups shows that the highest physical activity at work is assessed by the employees in support services, this group also best evaluates their ability to work, 54% describe it as excellent. The amount of physical activity is statistically significantly related to the work efficiency index only in the group of teacher assistants. Discussion and conclusions: The promotion of health protection at the workplace must be adapted to the needs of each group of employees in kindergartens. It is also recommended to encourage regular physical activity of all groups of employees. Keywords: kindergarten, physical activity, work ability, workload, health enhancement Introduction Regular physical activity has a proven positive effect on physical and mental health and it also has an impact on the improved work efficiency and the overall quality of life. Reducing sedentary behaviour and maintaining regular physical activity, even if it does not meet the recommendations for the amount of physical activity, affects health, has a positive effect on preventing premature death and reducing the chances of various health risks. Regular physical activ- ity, regardless of age, gender, chronic diseases and limitations present, reduces the incidence of cardiovascular disease, stroke, cancer, type 2 diabetes, obesity and osteoporosis (Warburton and Brendin, 2016). Kindergarten brings together different groups of employees, who face different types of workload in their work: (i) kindergarten teachers, (ii) teacher assistants, (iii) administration and management of the kindergarten and (iv) employees in support services (cooks, cleaners, janitors). The most frequently studied groups of employees in kindergarten are teachers and teacher assistants. Kindergarten teachers/assistants perform a variety of work tasks that include teaching, supervision, hygiene maintenance tasks, as well as nutrition assistance. The workload is described from a metabolic point of view as low-intensity activity (Grant et al., 1995). Frequent incorrect postures and positions, fast work pace, insufficient amount of rest and lifting heavy loads increase the risk of musculoskeletal problems (Punnett and Wegman, 2004). In addition to 8 physical exertion, teachers/assistants are also exposed to high levels of psycho-n logical stress. Teachers/assistants report overwork, time pressure and high responsibility; nevertheless, they find their work interesting (Čecho, Švihrová, pulatioo Čecho, Novák and Hudečková, 2019). The purpose of our study was to deterge p mine the relationship between the level of physical activity and the work efficiency of kindergarten employees. rking-ao he w Methods f t The study was conducted in September 2019 in cooperation with the Centre for ealth o Health Enhancement Piran and two kindergartens in the Municipality of Piran. It involved 73 kindergarten employees (teachers n = 24; assistants n = 27; administration n = 5; support services n = 17). To assess the intensity and quan-pulacije | ho tity of PA and an individual’s work efficiency, we used the Global Physical Activity Questionnaire (WHO, n. d.) and the Work Ability Index Questionnaire ktivne p (European Agency for Safety and Health at Work, n. d.). The analysis of the results was performed in Microsoft Excel 2016 (Microsoft Corporation, Redmond, elovno a Washington, USA) and in SPSS ( SPSS statistics 26, IBM, New York, USA), using methods of descriptive statistics and the analysis of correlations and differences. The statistical significance was set at p < 0.05. zdravje d Results Recommendations on the amount of daily physical activity (WHO, 2011) are met by 95.2% of kindergarten teachers, 83.4% of assistants, 33.3% of employees in administration and 94.2% of employees in support services (Figure 1). The comparison between the groups shows that the highest physical activity at work is assessed by the employees in support services (Kruskal-Wallis H (3) = 16.667, p = 0.001). 9 s Figure 1: Physical activity of employees according to WHO ployee recommendation (WHO, 2011) HEPA (Health enhancing physical activity) em (WHO, 2020) recommendation garten The group of employees in support services also best evaluates their abil-inder g k ity to work; 54% describe it as excellent (Figure 2). mon y a ficienc k efor nd w ctivity a hysical a p een etw ship b ation rel Figure 2: Work ability index per the group of employees in kindergarten Very good work ability is assessed by 33.3% of kindergarten teachers, 50% of kindergarten assistants and 54.5% of employees in support services; howev- er, the number of employees should also be taken into account. The amount of physical activity is statistically significantly related to the work efficiency index only in the group of teacher assistants (χ2 (2) = 8.878, p = 0.012). Discussion Research done in kindergarten is generally performed on kindergarten teachers and assistants regarding their health status (Wirth et al., 2016), voice health and risk factors for voice loss (Helidoni et al., 2012), mental health (Čecho et al. 2019), musculoskeletal disorders and the connection between musculoskeletal disorders and mental health (Ono et al., 2002; Pirbalouti et al., 2017) and regarding ergonomic adjustments of workplace (Burford et al., 2017). Our study revealed the level of physical activity and offered an insight into the working ability among different groups of employees in kindergarten. We noticed that only in the group of teacher assistants, the amount of physical activity was 10 statistically significantly related to the work efficiency, though we expected to find correlations in all groups of employees. Regular physical activity main-n tains solid fitness, better mental health and maintains or improves work effi-pulatio ciency. However, regular physical activity is important also for the evaluation o of competency for their work among kindergarten teachers/assistants. Physi-ge p cally active preschool teachers evaluate competencies for planning, organising, implementing and evaluating physical activities higher (Retar and Lepičnik-rking-ao Vodopivec, 2017). Regular physical activity of kindergarten teachers/assistants he w is not only important regarding health and the overall quality of life but also f t as a factor of their perception of their own competencies for professional work. ealth o Conclusions Kindergarten brings together different groups of employees who face differ-pulacije | ho ent types of workload in their work. In accordance with the daily workload, the promotion of health protection and enhancement at the workplace must ktivne p be adapted to the needs of each group of employees. It is also recommended to encourage regular physical activity of all groups of employees in kindergarten. elovno a References zdravje d BURFORD, E.-M., ELLEGAST, R., WEBER, B., BREHMEN, M., GRONE-BERG, D., SINN-BEHRENDT, A. and BRUDER, R., 2017. The compar-ative analysis of postural and biomechanical parameters of preschool teachers pre- and post-intervention within the ErgoKiTa study. Ergonomics, vol. 60, no. 12, pp. 1718–1729. ČECHO, R., ŠVIHROVÁ, V., ČECHO, D., NOVÁK, M. and HUDEČKOVÁ, H., 2019. Exposure to mental load and psychosocial risks in kindergarten teachers. Zdravstveno varstvo, vol. 58, no. 3, pp. 120–128. EUROPEAN AGENCY FOR SAFETY AND HEALTH AT WORK, n. d.. Work ability index [online]. [viewed 13 December 2019]. Available from: https:/ healthy-workplaces.eu/previous/all-ages-2016/en/tools-and-publications/ practical-tools/work-ability-index GRANT, K., HABES, D. and TEPPER, A., 1995. Work activities and musculoskeletal complaints among preschool workers. Applied ergonomics, vol. 26, no. 6, pp. 405–10. HELIDONI, M., MURRY, T., CHLOUVERAKIS, G., OKALIDOU, A. and VELEGRAKIS, G., 2012. Voice risk factors in kindergarten teachers in Greece. Folia phoniatrica et logopaedica, vol. 64, no. 5, pp. 211–216. ONO, Y., IMAEDA, T., SHIMAOKA, M., HIRUTA, S., HATTORI, Y., ANDO, S., … TATSUMI, A., 2002. Associations of length of employment and working conditions with neck, shoulder and arm pain among nursery school teachers. Industrial health, vol. 40, no. 2, pp. 149–158. PIRBALOUTI, M. G., SHARIAT, A., SANGELAJI, B., TAGHAVI, M. and KA-11 MALIYEH, N. G., 2017. Prevalence of musculoskeletal disorders and its s relation to depression among workers in kindergarten. Work, vol. 58, no. ployee 4, pp. 519–525. em PUNNETT, L. and WEGMAN, D. H., 2004. Work-related musculoskeletal dis-garten orders: the epidemiologic evidence and the debate. Journal of electromy-inder ography and kinesiology: Official journal of the international society of g k electrophysiological kinesiology vol. 14, no. 1, pp. 13–23. mon y a RETAR, I. and LEPIČNIK-VODOPIVEC, J. (2017). Kompetentnost vzgojiteljev za inovativno gibalno poučevanje. Pedagoška obzorja: časopis za didak-ficienc tiko in metodiko 32(1): 17–32. k efor WARBURTON, D. E., & BREDIN, S. S. (2016). Reflections on physical activi-nd w ty and health: what should we recommend?. Canadian Journal of Cardi-ology, 32(4), 495–504. ctivity a WIRTH, T., KOZAK, A., SCHEDLBAUER, G. and NIENHAUS, A., 2016. Health behaviour, health status and occupational prospects of apprentice hysical a p nurses and kindergarten teachers in Germany: a cross-sectional study. een Journal of occupational medicine and toxicology, vol. 11, no. 26. etw WORLD HEALTH ORGANIZATION, 2011. Information sheet: global rec-ship b ommendations on physical activity for health 18–64 years old [online]. ation rel [viewed 31 July 2019]. Available from: https:/ www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf?ua=1 WORLD HEALTH ORGANIZATION, n. d. Global physical activity ques-tionnnaire (GPAQ): analysis guide [online]. [viewed 31 July 2019]. Available from: https://www.who.int/ncds/surveillance/steps/resources/ GPAQ_Analysis_Guide.pdf https://doi.org/10.26493/978-961-293-015-8.13-20 Dietary polyphenols and their effect on the gut microbiota and human health Katja Bezek, Darja Barlič - Maganja University of Primorska, Faculty of Health Sciences, Polje 42, 6300 Izola, Slovenia katja.bezek@fvz.upr.si, darja.maganja@fvz.upr.si Abstract Problem presentation: Over the past decade the oxidative stress, caused by reactive oxygen species (ROS) has been recognized as a key factor in the development of various diseases e.g. diabetes, cardiovascular diseases and neurodegenerative disorders. Antioxidant support, which can also be provided with proper nutrition, can reduce the negative effects of oxidative stress and have a positive effect on our health. Plant foods are a rich source of biologically active compounds, among them many polyphenols are very important. Due to their well-known antioxidant properties, polyphenols are associated with a number of physiological mechanisms that have protective effects on various organs, including the gastrointestinal tract. Polyphenols and their metabolites help to maintain a healthy gut primarily through microbiota modulation. They have prebiotic-like effects, they can stimulate the growth of beneficial and inhibit the growth of pathogenic bacteria. In addition, the gut microbiota plays an important role in the metabolism of polyphenols, the production of active metabolites and their bioavailability. Therefore, the interaction between dietary polyphenols and gut microbiota can be of significant benefit to human health. Purpose: The aim of this review is to summarize the data on the protective role of dietary polyphenols and their metabolites on human health in general with an emphasis on gut microbiota modulation. Conclusions: Current research indicates that there is a positive relationship between dietary polyphenols and the healthy composition of the gut microbiota. Therefore, the promotion of a diet rich in plant foods should also be considered as an important element affecting the health of the working population. Keywords: dietary polyphenols, gut microbiota, human health Introduction Dietary polyphenols represent a large class of naturally occurring chemical compounds characterized by the presence of multiple phenol structural units. As secondary metabolites, they are found widely in plant foods providing colour, flavour and astringency, and defence against exogenous stresses, like reactive oxygen species (ROS), ultraviolet radiation (UV) and plant pathogens. Due to the electron-donating phenolic groups polyphenols are well known antioxidants that prevent stress-related cellular and extracellular damage. In humans, they have been found to possess important biological activities, including anti-inflammatory, anticarcinogenic and antimicrobial activities (Zhang, 2015). Several epidemiologic studies have shown that consumption of food rich in polyphenols has beneficial effects on human health. Their antioxidant and anti-inflammatory properties have preventive effects on different chronic diseases such as cardiovascular diseases, diabetes, obesity, neu-14 rodegenerative disorders and cancer (Fraga et al., 2019; Li et al., 2014). Most polyphenols pass through the small intestine without being absorbed, thus en-n countering the gut microbiota (Ozdal et al., 2016). This has led to the devel-pulatio opment of a two-way mutual relationship between polyphenolic compounds o and gut microbiota. First, polyphenols are biotransformed by gut microbio-ge p ta that results in the increased bioavailability of their metabolites. The micro-rking-a biota is responsible for the extensive breakdown of the original polyphenolic o structures into low-molecular-weight phenolic metabolites that can be easily he wf t absorbed and may actually be responsible for the health effects derived from polyphenol-rich food consumption (Cardona et al., 2013). Second, polyphenols ealth o modulate the composition of the gut microbial community mostly through the inhibition of pathogenic bacteria and the stimulation of beneficial bacteria. The last is supported by their prebiotic properties enriching the beneficial bacteria pulacije | ho (Valdés et al., 2015). Therefore, the interactions of dietary polyphenols and gut microbiota may impact human health. ktivne p Polyphenols characterization and bioavailability elovno a Polyphenols are classified into a range of structurally related groups, with over 9000 different structures identified in various plant species. This heterogeneous zdravje d group of molecules, divided into four main classes according to their chemical structure: flavonoids (including flavonols, flavanols, flavanones, flavones, an-thocyanidins, chalcones, dihydrochalcones, dihydroflavonols and isoflavones), lignans, stilbenes and tannins. Phenolic acids (hydroxybenzoic, hydroxycinnamic, hydroxyphenylacetic, hydroxyphenylpropanoic and hydroxyphenylac-tic acids) are also frequently included in this category (Abbas et al., 2017). Most dietary polyphenols exists as polymers or in glycosylated forms, in which one or more sugar moieties are bound to phenolic or a hydroxyl group at the C-3 position (Manach et al., 2004). The basic structure of flavonoids, meaning the structure of the aglycon form, and which type of sugar moiety is at- tached strongly affect their bioavailability. Bioavailability is a crucial factor in determining their biological activity in vivo (Manach et al., 2005). The bioavailability of dietary polyphenols is, in general, low. Small amounts of their intake (about 5-10 %) may be absorbed in the small intestine, mainly those with monomeric and dimeric structures. The released aglycones enter the enterocytes by passive diffusion. Once absorbed, polyphenols reach the liver through the portal circulation. Here, they undergo biotransformation via phase I (oxidation, reduction and hydrolysis) and phase II (conjugation) reactions. These transformations produce water-soluble conjugated metabolites (glucuronide, sulphate and methyl derivatives) which are released in the systemic circulation for subsequent delivery to organs and excretion by the urine. More complex polyphenols, especially oligomeric, and polymeric structures, reach the colon almost unchanged, where they are metabolized by the gut microbiota together with conjugates excreted into the intestinal lumen through the bile. Here, they undergo microbial enzyme transformations, including 15 C-ring cleavage, decarboxylation, dehydroxylation, and demethylation. The result is the generation of less complex compounds such as phenolic acids and hy-ealth droxycinnamates (Corrêa et al., 2019). an hum Polyphenols and gut microbiota modulation nd h The human gut is an ecosystem of around 1013–1014 bacterial cells, participating biota a in several metabolic functions that the host cannot fulfil by itself. Microbiota that colonize the distal regions of the colon represent the highest concentration icro of microorganisms found in human body, as well as the most diverse. A har-ut m monious balance in their composition has been associated with maintaining he g n t health and a higher life expectancy accompanied by a satisfactory quality of life (Nicholson et al., 2012). The mechanisms by which the phenolic compounds ffect o modulate the gut microbiota still remain to be elucidated, but may involve di-heir e rect and indirect interactions. Phenolic compounds could directly stimulate or inhibit bacterial growth. Inhibition is closely related to the antimicrobial prop-nd t ls a erties of these compounds and stimulation presumably associated with the capacity of the bacteria to metabolize them (Etxeberria et al., 2013). It could be lypheno said that polyphenols possess a selective bacteriostatic or bactericidal effect, o inhibiting the growth of a wide range of potentially pathogenic bacteria and slightly affecting or even promoting the beneficial microbial population. dietary p Some microbiota members are preferred to others due to efficacy they have shown in ameliorating the gut ecosystem with positive effects at the local and systemic levels. For this reason, most studies have focused on the effects of polyphenols on Bifidobacterium and Lactobacillus, which have been observed to contribute to human health at different levels (Gibson, 2008). They enhance gut barrier function, stimulate the host immune system, prevent diarrhoea or allergies, contribute to activation of provitamins, and modulate lipid metabolism (Burcelin et al., 2012; Gibson, 2008). However, there are other bacterial species associated with negative implications, such as Clostridium dif- ficile, which has been associated with inflammatory bowel disease (Rastall et al., 2005). Therefore, it is of crucial importance to understand the inhibitory or stimulatory effect of phenolic compounds on beneficial or pathogenic bacteria. The influence of phenolic compounds on gut microbiota is summarized in details by Ozdal et al. (2016). In vitro cell culture studies were performed by different polyphenol type substances. Among flavonols tested on six bacteria species ( Bacteroides galacturonicus, Lactobacillus spp., Enterococcus caccae, Bifidobacterium catenulatum, Ruminococcus gauvreauii, and Escherichia coli) quercetin showed a dose-dependent inhibitory effect on the growth of all analysed bacterial species, whereas this effect was weaker for rutin (Duda-Chodak, 2012). In another study quercetin supplementation resulted in an altered composition of gut microbiota at different taxonomic levels, including the relative Firmicutes:Bacteroidetes ratio and inhibiting the growth of bacterial species associated with di-16 et-induced obesity such as Erysipelotrichaceae, Bacillus spp., and Eubacterium cylindroides (Etxeberria et al., 2015). n Many different polyphenols were demonstrated to influence the growth of human gut bacteria and their adhesion to enterocytes. Accordingly, narin-pulatioo genin promoted the growth of Lactobacillus rhamnosus, commensal E. coli, ge p along with inhibition of two pathogens, Staphylococcus aureus and Salmonella Typhimurium. In general, the Gram-positive enteropathogen S. aureus was rking-ao the most sensitive to naringenin, while the Gram-negative pathogen S. Typh-he w imurium and the commensal bacteria E. coli were likely to be similar in their f t sensitivity to naringenin (Parkar et al., 2008). The impact of naringenin and hesperetin was tested on six bacteria species ( Bacteroides galacturonicus, Lac-ealth o tobacillus sp., E. caccae, B. catenulatum, R. gauvreauii, and E. coli) and inhibited the growth of almost all analysed bacteria (Duda-Chodak, 2012). pulacije | ho Isoflavones are transformed by gut microbiota, although there are few studies regarding the effect of isoflavone supplementation on gut microbiota ktivne p composition. The investigated isoflavones (e.g. daidzein and genistein) induced a decrease in bacterial growth (Kawabata et al., 2013). The consumption of fla-elovno a vanol-rich foods containing epicatechin and catechin may support gut health through their ability to exert prebiotic actions (Tzounis et al., 2008). The flavan-3-ol modulates microbiota composition and inherent catabolic activity, in-zdravje d ducing changes that could affect the bioavailability and potential bioactivity of these compounds (Cueva et al., 2013). Anthocyanins and their metabolites may stimulate beneficial members of the gut microta community. Interestingly, malvidin-3-glucoside mixed with other anthocyanins exhibited a synergistic effect in promoting beneficial microbes. In vitro incubation of phenolic gallic acid in a fecal slurry reduced a group of potentially harmful bacteria such as Clostridium histolyticum without any negative effects on beneficial bacteria. In addition, it significantly reduced Bacteroides spp. growth and enhanced both the total bacterial number and the abundance of Atopobium spp. (Hidalgo et al., 2012). In another study, the influence of hydroxycinnamic acids such as caffeic acid, chlorogen-ic acid, o-coumaric acid, p-coumaric acid on the growth of a probiotic microbe ( L. rhamnosus), a commensal ( E. coli) and two pathogenic bacteria ( S. aureus, S. Typhimurium) was investigated. They compared the MIC values of all polyphenols tested and observed that flavonols, isoflavones and glycosides have low antibacterial activity, while phenolic acids were found to be at an intermediate level. On the other hand, the flavanone and flavanol had high antibacterial activity (Parkar et al., 2008). The effect of hydrolysable tannins (ellagitannins) on the growth of intestinal bacteria is inadequately characterized, and generally their antimicrobial potential has been assessed in vitro. It was observed that pomegranate by-products and punicalagins inhibited the growth of pathogenic Clostridia and S. aureus. Interestingly, probiotic lactobacilli and bifidobacteria were generally not affected by ellagitannins (Bialonska et al., 2009). In this experiment, pomegranate extract was able to increase the total bacterial number, enhancing the 17 growth of Bifidobacterium spp., Lactobacillus and Enterococcus groups, while no effect was observed for the C. histolyticum group (Bialonska et al., 2010). ealth Resveratrol, the representative of stilbenes, increased lactobacilli and bi-an hum fidobacteria as well as diminished the increase of enterobacteria in in vivo studies (Larrosa et al., 2009) not representative from a dietary point of view. Our nd h aim was to ascertain whether resveratrol can exert anti-inflammatory activi-biota a ty in vivo at an attainable dietary dose. Rats were fed with 1 mg of resveratrol/ icro kg/day (a human equivalent dose). The results of another study showed that ut m resveratrol ameliorates the dysbiosis in the gut microbiota induced by the high-he g fat diet, specific effects include an increase in the Bacteroidete:Firmicutes ra-n t tio, significant inhibition of the growth of Enterococcus faecalis, and increased growth of Lactobacillus and Bifidobacterium (Qiao et al., 2014). ffect o The main limitation of the presented studies is that the information ob-heir e tained from in vitro studies about the role of individual phenolic compounds nd t on gut microbiota cannot be directly extrapolated to what occurs in the phys-ls a iological context of the gut ecosystem. Of those performed, most were focused on a single polyphenol molecule and selected bacterial populations. Most phe-lyphenoo nolic fractions and pure phenolic compounds have been analysed without considering the bioavailability and the chemistry of phenolic compounds in the dietary p colon. Human and animal intervention studies involved very high doses of individual phenolic compound, or high amounts of foods rich in phenolic content, neither of which represents the regular diet (Ozdal et al., 2016). Therefore, there is a lack of adequate in vivo studies which are needed to understand the effect of phenolic compounds on gut microbiota. Human intervention studies will provide the best models for studying the effect of phenolic compounds on gut microbiota modulation. There may be a highly variable response to phenolic compounds according to the differences in gut microbiota composition. Future studies should provide answers about the inter-individual differences in gut microbiota while studying the effect of phenolic compounds on gut microbiota modulation from the immunological point of view. Conclusions Dietary polyphenols have increasingly interested the scientific community due to their proposed health benefits. Possible beneficial effects of polyphenols are determined by their bioavailability where the gut microbiota have an important role. Phenolic compounds are biotransformed into their smaller metabolites by gut microbiota, which contributes to increased bioavailability. At the same time, phenolic compounds can alter the gut microbiota community, resulting in a greater abundance of beneficial microbes, and a consequent increase in bioavailability. Despite the results provided and published over recent years, future studies including human trials will give more confirmatory results about the efficacy of phenolic compounds at the gut level. These results 18 may lead to the design of dietary recommendations not only to suppress or re-n duce symptoms in disease but also to provide the healthy population with simple tools to promote the maintenance of health. pulatioo ge p References rking-a Abbas, M., Saeed, F., Anjum, F. M., Afzaal, M., Tufail, T., Bashir, M. 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Preliminary research shows that good nutritional status and adequate physical activity (PA) lead to a better immune defence and prognosis in case of infectious diseases. However, people were at home most of the time and as a consequence very big lifestyle changes occurred. The aim of the present study is to investigate dietary changes during the latest quarantine. Methods: Forty-nine adults (16 men, 34.8 ± 9.1 years, BMI: 22.6 ± 2.7 kg/ m2) included in the study filled out a food frequency questionnaire (FFQ) before and during quarantine. The participants were asked to answer where and how often they bought food and to report a more than 3 kg increase in body mass (BM) during quarantine. Twenty-two participants reported their general appetite on a 1-5 scale and on a 1-10 scale for appetite for sweet and snacks. They also completed a questionnaire about PA (International Physical Activity Questionnaire – IPAQ), before and during quarantine. Energy intake (EI), PA induced energy expenditure (PAEE), and Healthy Eating Index (HEI) were determined. Baseline and quarantine values were compared with the Student’s paired t-test. Results: EI dropped from 9.68 ± 4.58 MJ/day (2311 ± 1093 kcal/day) at baseline to 7.89 ± 3.16 MJ/day (1885 ± 754 kcal/day) during quarantine (P=0.001), and PAEE dropped from 10.0 ± 7.9 MET/day at baseline to 5.0 ± 6.4 MET/day during quarantine (P=0.009). PA was lower due to lower work-related PA and free time PA. The average HEI was significantly lower during quarantine (baseline: 66.0 ± 14.8, quarantine: 63.3 ± 13.2; P=0.026) mostly due to lower intake of seafood and plant proteins, poorer ratio of unsaturated to saturated fatty acids intake (on the account of lower unsaturated fatty acids intake) and higher intake of sodium. Although general appetite remained unchanged (baseline: 3.87 ± 0.69, quarantine: 3.78 ± 0.74, P=0.58), there was a trend observed in increase of appetite for sweet (baseline: 4.43 ± 2.83, quarantine: 5.43 ± 2.61, P=0.08). However, there were no statistically significant changes in appetite for snacks (baseline: 4.30 ± 2.27, quarantine: 4.91 ± 2.47, P=0.35). More than 80% participants bought food once a week or just once or twice in four weeks. Only three participants reported ∆BM > +3 kg during quarantine. Discussion and conclusions: Despite the drop of EI and PAEE during quarantine, diet quality was poorer during quarantine. Lower diet quality and less PA during first four weeks of quarantine were not reflected in more than 3 kg increase in BM in healthy lean adults. Keywords: COVID-19 quarantine, diet quality, energy intake, physical activity Introduction On March 11th, 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 to be a pandemic (WHO, 2020). In the beginning of 22 April, half of the world population was in isolation or quarantine (Q) (Sand-n ford, 2020), which are effective tools to prevent the spread of a new infectious disease (Cetron et al, 2004)and the practice was used widely in 14th-centu-pulatio ry Europe to control the spread of bubonic and pneumonic plague. To prevent o disease transmission, ships were required to stay in harbor for 40 days before ge p disembarkation (thus the term quarantine, which derives from the Latin quad-rking-a ragina or the Italian quaranta, meaning 40. In Slovenia, gathering of people in o public was restricted and restaurants and cafes were closed ( Odlok o začasni he wf t splošni prepovedi gibanja in zbiranja ljudi na javnih mestih in površinah v Republiki Sloveniji, 2020). Big changes in lifestyle occurred in a very short period. ealth o Many people worked from home, schools and kindergartens were closed, and people were at home most of the time. The rise in unstructured time, stress, and anxiety might further lead to overeating, sedentary behaviour, and weight pulacije | ho gain (Pearl, 2020)COVID-19. Q affects food availability and the preparation of food as well (Gupta et al, 2005). Mass purchases of food, especially with long ktivne p shelf life, took place in Slovenia which was reported by the local media ( Trgovine izropane, 2020). Besides that, lay publications started to publish nutrition-elovno a al contents for food choice during Q (Jaklič, 2020). Online shops were congest-ed due to a sudden increase in demand. On the other hand, in some areas of Slovenia, local food supply from growers and farmers was established. The or-zdravje d dered locally produced food was delivered to the buyer contactless (Penjak, 2020). Local food supply offered vegetable, fruit, and also fish, meat, milk, eggs and honey (Šubic, 2020). It has been shown that people with a better nutritional status have smaller chances of infection and a better prognosis in case of infection (Zhang and Liu, 2020). It has also been shown that physical activity (PA) improves immune defence and may lower the severity of disease progression (Chen et al, 2020). Despite the previous country-wide Q in the outbreaks of SARS in 2003, H1N1 in 2009 and MERS in 2013, which took place in China, Taiwan, Canada, the United States of America, South Korea, and Saudi Arabia, there are no studies of changes in diet during Q comparing nutritional data before and during Q. The aim of this study was to investigate changes in dietary patterns during Q. Methods Table 1: Components and Scoring Standards for HEI-2015. Modified from CNPP, 2018. Component Scoring a Standard for 0 Standard for max Total Fruits b 0-5 re 0 >140 g/1000 kcal Whole Fruits c 0-5 co 0 >70 g/1000 kcal Total Vegetables d 0-5 her s 0 >176 g/1000 kcal Greens and Beans d 0-5 0 >32 g/1000 kcal Whole Grains 0-10 0 >43 g/1000 kcal Dairy 0-10 take → hig 0 >319 g/1000 kcal Total Protein Foods d 0-5 0 >71 g/1000 kcal 23 Seafood and Plant Proteins 0-5 her in 0 >23 g/1000 kcal ig FA (PUFA+MUFA)/SFA 0-10 H <1.2 g/1000 kcal >2.5 g/1000 kcal Refined Grains 0-10 - >122 g/1000 kcal <51 g/1000 kcal ealth - w Sodium 0-10 re >2 g/1000 kcal <1.1 g/1000 kcal Added sugars 0-10 her in co >26 % EI <6.5 % EI ig hildren h Saturated Fats 0-10 H take → lo er s >16 % EI <8 % EI n c HEI = sum of the above 0-100 Higher score → higher diet quality FA – fatty acids; PUFA – polyunsaturated FA; MUFA – monounsaturated FA; biotics o SFA – saturated FA; EI – energy intake ro a Proportional for intakes between standards for 0 and maximum. nd p b Includes 100 % fruit juice. c All except juice. d biota a Includes legumes. icro Participants were recruited by internet and social media to participate in a ut mf g study, which was interrupted due to the pandemic. The inclusion criteria were age 18-60 years, absence of chronic diseases and stable body mass (BM) and absence of antibiotic use 3 months prior to first measurement. The exclusion nfluence o criteria were change of diet in the last 6 months, and BM index (BMI) <18 the i kg/m2 and >30 kg/m2. 72 participants completed the first measurement before Q in January and February 2020 and were invited to fill in further questionnaires 4 weeks after the start of Q in Slovenia. 49 participants who filled in the validated food frequency questionnaire (FFQ) for Slovene population (Bizjak et al, 2014) and questionnaire on food-intake connected behaviour at baseline (B) and during Q were included in the present study. FFQ was analysed with OPEN Platform for Clinical Nutrition accessible online through the website http://opkp.si/ to obtain data on nutrient and energy intake (EI). Diet quality was evaluated with Healthy Eating Index 2015 (HEI) (Reedy et al, 2018) according to the developer’s protocol (Table 1 (CNPP, 2018)). 22 participants also filled in the International Physical Activity Questionnaire (IPAQ) (Craig et al, 2003) but diverse physical activity measures in use prevent international compari- sons. The International Physical Activity Questionnaire (IPAQ, and an appetite questionnaire at B and during Q. IPAQ data were used to calculate the PA induced energy expenditure (PAEE). To evaluate whether Q had different effect on people with different diet quality, two groups were created: HEI>66 (participants with HEI above mean value on B, N=25) and HEI<66 (participants with HEI below mean value on B, N=24). HEI on B and Q were compared between groups. The data were analysed using IBM SPSS 2.7 (IBM, USA). All variables were tested for normal distribution (Kolmogorov-Smirnov test); means and standard deviation were calculated. Student’s paired t-test was used to investigate the effect of Q on the observed parameters. Results 24 Table 2: Comparison of energy intake and diet quality between baseline n and quarantine pulatio B Q P o EI [kJ] 9706 ± 4595 7917 ± 3167 0.001 ge p HEI: 66.0 ± 14.8 63.3 ± 13.17 0.026 Total fruits 2.9 ± 1.7 3.1 ± 1.9 0.207 rking-ao Whole fruits 3.4 ± 1.9 3.5 ± 1.8 0.513 he w Total vegetables 4.6 ± 1.2 4.7 ± 1.0 0.212 f t Greens and beans 3.3 ± 2.0 3.3 ± 2.0 0.850 Whole grains 4.5 ± 3.9 4.5 ± 3.8 0.971 ealth o Dairy 2.3 ± 2.1 2.6 ± 2.3 0.448 Total protein foods 4.0 ± 1.3 3.9 ± 1.2 0.508 Seafood and plant proteins 4.3 ± 1.2 3.8 ± 1.7 0.023 pulacije | h Fatty acids 4.5 ± 4.4 3.8 ± 4.3 0.070 o Refined grains 9.3 ± 1.8 8.9 ± 2.5 0.166 Sodium 9.2 ± 1.9 8.3 ± 2.8 0.022 ktivne p Added sugars 7.1 ± 2.5 6.6 ± 2.4 0.191 Saturated fats 6.5 ± 3.7 6.1 ± 3.7 0.259 elovno a EI – energy intake; HEI – Healthy Eating Index; B – baseline; Q – quarantine. zdravje d The mean participants’ age was 34.8 ± 9.1 years, and the mean BMI was 22.6 ± 2.7 kg/m2. EI and diet quality on B and Q are presented in Table 2. PAEE dropped from 10.0 ± 7.9 MET/day at B to 5.0 ± 6.4 MET/day during Q (P=0.009). PA was lower due to lower work-related PA and lower free time PA. Although general appetite remained unchanged (B: 3.87 ± 0.69, Q: 3.78 ± 0.74, P=0.58), there was a trend in increase of appetite for sweet (B: 4.43 ± 2.83, Q: 5.43 ± 2.61, P=0.08), however, there were no statistically significant changes observed in appetite for snacks (B: 4.30 ± 2.27, Q: 4.91 ± 2.47, P=0.35). More than 80% of the participants bought food once a week or just once or twice in four weeks. Only three participants reported an increase of BM >3 kg during Q. After dividing the participants in two groups based on HEI scores on B, the groups did not differ in EI on B nor during Q. HEI dropped significantly only in HEI>66 (B: 78.3 ± 6.1, Q: 73.0 ± 7.1, P=0.000), while in HEI<66, HEI remained unchanged (B: 53.2 ± 9.2, Q: 53.1 ± 10.0, P=0.967). Discussion Our study was the first to compare nutritional data before and during Q. We observed a significant drop in EI which was surprising, as studies which retrospectively assessed changes in diet due to Q reported increased EI (Scar-mozzino and Visioli, 2020). Change in EI might have followed the change in PA, which also dropped significantly during Q, due to lower work-related PA and less free time PA, which were direct consequences of the Q. Besides lower PA, other potential side effects of Q have been pointed out, such as weight gain and behavioural addiction disorders and lower diet quality (Lippi et al, 2020). 25 Only three participants, however, reported an increase in BM >3 kg during Q, suggesting that the observed lowered EI was adequate. ealth Diet quality, on the other hand, did drop significantly. Significantly lower scores were observed for seafood and plant proteins and sodium HEI com-hildren h ponents which reflects limitations in fresh food acquisition during Q Most of n c the participants bought food just once a week or once or twice in four weeks. It was shown that food availability at home leads to a higher consumption of biotics o snacks and may lead to lower diet quality (Gorin et al, 2011). There was a trend ro in increase of appetite for sweet in our participants, but general appetite and nd p appetite for snacks did not show any significant changes. Change in econom-biota a ic status and available time for food preparation could be the reasons for wors-icro ening diet quality. Many people assume that people have more free time dur-ut m ing Q, but working from home, babysitting and teaching children may lead to f g less free time and more stress (Fister 2020). Interestingly, participants who had higher HEI before Q had significant drop in HEI score during Q, while HEI did not change in the group with lower HEI at B. This is worrying as people with nfluence o a healthier lifestyle decreased its quality. Unhealthy diet and physical inactiv-the i ity are risk factors for cardiovascular diseases, type 2 diabetes and metabolic syndrome (Paniagua 2016) obesity is a major public health problem, affecting in greater or lesser proportion all demographic groups. Obesity is estimated by body mass index (BMI, which themselves are risk factors for worse COVID-19 outcomes (Hamer et al, 2020). Higher PA and HEI were associated with lower risk of cardiovascular diseases, different types of cancers and all-cause mortality (Onvani et al, 2017). Q may thus have negative health consequences because of changes in lifestyle and diet. Prospective studies of metabolic markers are needed to observe that. Conclusions We observed significantly lowered EI and PA. 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DOI 10.1002/jmv.25707. n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.29-34 Probiotics consumption in physical y active individuals Dominika Češek, Katja Bezek, Mihaela Jurdana University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia cesek.dominika@gmail.com; katja.bezek@fvz.upr.si; mihaela.jurdana@fvz.upr.si Abstract Introduction: It is well known that physical activity (PA) recommendation has positive effects on individual’s health status. On the other hand, low levels and excessive exercise can lead to negative consequences, influencing the immune system and changing the permeability of a gut barrier leading to a higher risk for infections and inflammation. Considering the link between gastrointestinal (GI) tract and symbiotic microorganisms, or microbiota, probiotics consumption might have an indirect influence on the health status of individuals with vigorous physical activity. There is an increasing number of studies describing the probiotic effect on immune and GI tract function, affecting the respiratory infections, and the performance of active individuals. This report provides data between probiotic consumption and the health status of individuals with different levels of physical activity. Methods: Literature review was focused on the effects of probiotics on health status of general and PA population. In questionnaire-based survey 33 individuals were included. The data regarding PA, eating habits, defecation and knowledge and use of probiotics were collected and analyzed. Results: Probiotics have a beneficial effect on health status and performance in PA individuals when consumed regularly and in adequate amount. Although the participant’s knowledge about the term »probiotics« was acceptable, the knowledge about the source of probiotics in daily diet was insufficient. Probiotic consumption in form of foodstuff and dietary supplement in the selected population was inadequate. Discussion and conclusions: Due to the study limitations observed, e.g. small samples, short periods of probiotic consumption and choice of different probiotic strains, it is difficult to summarize the specific effect of the probiotic consumption on PA individuals. There is a need for additional studies with standardized protocols to confirm the health benefits of probiotics on individuals with the same level of PA. Based on the questionnaire results we can conclude that the knowledge about probiotic consumption effects of younger generations is insufficient. On behalf of this study results there is a need for educational activities among younger adults also in the aspect of probiotics consumption in relation to PA. Keywords: Gut microbiota, Probiotics, Physical activity Introduction Human GI tract is inhabited by a complex and dynamic population of microorganisms. This so-called gut microbiota has an important role in health and disease of the host. However, its diversity and density variates through the GI tract with the highest cell concentration in the lumen of the colon, where 1012 bacteria per gram of content can be found (Walburga et al., 2018). Although the adult-like gut microbiota is formed already in early life, factors such as antibi-30 otics treatment, diet (Wen and Duffy, 2017) and PA can influence the microbial n balance (Monda et al., 2017). At least 150 minutes of moderate PA or at least 75 minutes of high intensity activity has a positive health effect (WHO, 2011) that pulatioo could be mediated also by PA’s influence on gut microbiota. Moreover, aerobic ge p activity in healthy individuals has been shown as successful in balancing and enhancing functionality of gut microbiota (Dalton et al., 2019). As the inten-rking-ao sity of PA increases, GI symptoms can occur, e.g. nausea, cramping, bloating he w and diarrhoea, that can be linked to changed intestinal barrier function (Lam-f t precht and Frauwallner, 2012). Individuals with different levels of PA often consume foodstuff and dietary supplements which affect gut microbiota, e.g. pro-ealth o biotics and prebiotics (Colbey et al., 2018) to maintain GI health. Probiotics are defined as live microorganisms with beneficial effects of host’s health if admin-pulacije | h istered in sufficient amount (Hill et al., 2014). On the other hand, prebiotics are o fermentable food components which have a beneficial effect on host’s health through their impact on composition and/or gut microbiota function (Guarner ktivne p et al., 2012). The aim of this study was to answer following research questions: a) “What are the knowledge and consumption habits of live microorganisms in elovno a individuals with different levels of PA?”; b) “Can probiotics consumption affect health status of individuals with vigorous PA?”; c) “Can probiotics consump-zdravje d tion affect performance in in individuals with vigorous PA?”. Methods Theoretical part of the study included literature review on gut microbiota, PA and probiotic consumption on health of PA individuals with the use of different research bases. The literature of the past 10 years was included. Practical part of the study included preparation of the questionnaire which was published on www.1ka.si and data analysis. The link to online questionnaire was shared through e-mail and social media to addresses of selected track and field clubs and PA individuals. All participants were informed about anonymity and data use for research purposes only. Data was analysed with computer program SPSS Statistics 26.0 (IBM, Armonk, NY, USA) within connections between variables were processed. Results Probiotics consumption and its effects on physical activity Results of literature review on probiotics consumption in individuals with different levels of PA are presented in Table 1. Table 1: Effects of probiotic consumption on some health parameters in individuals with different level of PA Probiotic strain Sample Results (study duration) Reference Bifidobacterium bifidum W23, Bifidobacterium lac- Lower levels of TNF- α for 25 % in 31 tis W51, Enterococcus faecium Triathlons competi-resting state and after PA, lower- Lampre- cht et al., s W54, Lactobacil us acidophi- tors, runners, cyclists ing increased level of zonulin; (14 lus W22, Lactobacil us brevis weeks) 2012 dual W63, Lactococcus lactis W58 Reported shorter duration and low- indivi Lactobacil us fermentum Elite endurance run- Cox et al., VRI-003 ners er severity of respiratory infections; 2010 ctive (28 days) ly a L. acidophilus, Lactobacillus delbrueckii ssp. bulgaricus, B. Lower number of respiratory infec- Salarkia et bifidum, Streptococcus salivar- Endurance swimmers tions episodes, improved VO max; 2 al., 2013 hysical ius ssp. thermophilus (8 weeks) n in p Lactobacillus, Bifidobacteri- Extended time of running to fatigue in environment with higher temper- Shing et ptio um, Streptococcus Runners ature; (4 weeks) al., 2014 nsum Reported enhanced recovery after o Carbuhn c Bifidobacterium longum 35624 Swimmers PA in the last 2 weeks in offseason; (6 weeks) et al., 2018 biotics pro TNF- α. . tumor necrosis factor alpha VO2 max. . maximum rate of oxygen consumption Knowledge and consumption habits of probiotics in physically active population In the present study 33 participants were included, 19 females (58 %) and 14 males (42 %) with mean age 19.12 years. Majority (94 %) has been running more than 2 years and 76 % of them were training with high intensity. 48 % of participants did not suffer any issues during running, the rest was experiencing breathing issues. Based on Bristol’s Stool Chart (Chumpitazi et al., 2016) the most frequent stool form was type 3, a normal stool form. According to knowledge about the term probiotics the highest percentage (48 %) the answer was that they already heard for the term, but they did not know why are they beneficial. In 55 % family members were the source of information of probiotics. Only 37 % were consuming probiotic food, most commonly fermented milk products, e.g. yoghurt and cheese. Only 2 participants consumed probiotic supplements. Most of the participants agreed with claims that probiotics have beneficial effects on immune system and regular defecation. Opinions differed on breathing issues claims, enhancing GI symptoms during running and the effect on performance. Based on normality of variables, Spearman’s rank correlation coefficient was used and showed a trend of weak negative significant correlation (r = - 0,351; n = 33; p < 0,045) between variables age and time invol-s ved with running. Discussion Based on results of clinical studies, there is a trend that probiotics consumption can have an impact on health and performance in PA individuals, if there are criteria fulfilled, e.g. optimal strain use, frequent use and adequate amount of probiotics. Despite positive studies results, there are also limits, e.g. low num-32 ber of studies, small study samples, short consumption time, incomparability of studies because of different doses and strains of probiotics, unsuitable conn trol in PA and diet regime. Probiotics are often used with other compounds, pulatio e.g. prebiotics, protein supplements and antioxidants, thus the study compari-o son is even more complicated. Furthermore, there is still a lot unknown about ge p probiotics mechanisms. Despite all the studies, the generalisation of probiotics effects and guidelines formation for individuals with different level of PA can-rking-ao not be made. Moreover, since probiotic consumption can lower the concentra-he w tion of inflammation parameters, which are important in process of recovery, f t hypertrophy and physiological adaptations on training, it could have a negative impact on PA. Third research question included data analysis of the giv-ealth o en questionnaire. Knowledge about the term “probiotics” was good, although the same was not shown in probiotics sources and use. Since the main source pulacije | h of information were family members, participants could receive misinforma-o tion. Small number of participants consuming food with probiotics could also ktivne p be linked to the low milk and milk products consumption, due to insufficient knowledge on probiotics and their effects. However, they agreed that probiotics have beneficial effects on immunity and regular defecation. elovno a Conclusions zdravje d Despite the large number of studies of probiotics consumption in general population, the number of studies of probiotics consumption in PA population is still limited. Mainly, the positive effects of probiotics consumption on immune system, GI tract and respiratory system function and in performance and recovery after PA were observed. Furthermore, results are hardly or not comparable. Therefore, comprehensive meta-analysis should be performed before incorporating the probiotics into individuals diet regime based on the PA intensity. Based on the questionnaire results, we concluded that knowledge of younger generations about probiotics is limiting and could be introduced also by the nutritional counselling and workshops. References CARBUHN, A.F., REYNOLDS, S.M., CAMPBELL, C.W., BRADFORD, L.A., DECKERT, J.A., KREUTZER, A. and FRY, A.C., 2018. 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Journal of Nutrition, vol. 147, no. 7, pp. 1468-1475. [viewed 25 February 2020]. Available from: http:/ dx.doi. elovno a org/10.3945/jn.116.240754 WORLD HEALTH ORGANIZATION (WHO), 2011. Global recommendations zdravje d on physical activity for health [online] . [viewed 23 February 2020]. Available from: http:/ www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf?ua=1 https://doi.org/10.26493/978-961-293-015-8.35-40 The effect of probiotic ice cream consumption on salivary cariogenic bacteria in healthy adults Dominika Češek, Katja Bezek, Boris Kovač University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia cesek.dominika@gmail.com; katja.bezek@fvz.upr.si; boris.kovac@fvz.upr.si Abstract Introduction: Oral microbiota is one of the most important and complex microbial communities in the human body. Microbiota dysbiosis can however lead to common diseases, including dental caries and periodontitis, and also systemic diseases. Dental caries represents one of the most common chronic diseases worldwide and is characterized by the localized destruction of the mineralized tooth tissues caused by bacterial action. There is a positive correlation between dental caries, frequency and amount of consumed dietary sugars, together with other factors influencing its development, including oral hygiene, salivary flow and composition and also enamel defects. Additionally, Streptococcus mutans was shown as one of the most dental-caries related bacteria species. Since the traditional approaches are often insufficient in reducing the numbers of caries causing organisms, alternative approach such as probiotics consumption were proposed. Thus, the aim of the present study was to test the effect of probiotic ice cream on salivary cariogenic bacteria counts in healthy adults. Methods: In the double-blind, placebo-controlled study 11 healthy participants (10 females, 1 male), aged 20-50 years, were included. Saliva samples were collected using CRT® bacteria test at day 0 and after 2 weeks of ice cream consumption. Probiotic ice cream contained two probiotic strains Bifidobacterium animalis subsp. lactis BB-12® (nu-trish® BB-12®) in concentration of 2,8 x 108 CFU/g and Lactobacillus acidophilus (nu-trish® LA-5®) in concentration of 1,1 x 108 CFU/g. Participants also completed questionnaires about knowledge and frequency of probiotics and cariogenic food consumption and a questionnaire on ice cream opinion. Results: After 2 weeks of consumption, the salivary cariogenic bacteria count in the control group of participants were the same or even higher, when compared to day 0. On the other hand, for participants consuming probiotic ice cream, S. mutans counts were lower with corresponding higher Lactobacillus counts. The total viability counts of probiotic bacteria did not change with time during 120-day storage. Although the participant’s knowledge about probiotics was adequate, there was a lack of knowledge observed regarding the term “cariogenic food”. Discussion and conclusion: Despite the small sample of participants, a trend of lower salivary cariogenic S. mutans and corresponding higher Lactobacillus counts were observed in participants consuming probiotic ice cream. Based on the results, probiotics consumption could be included in the prevention of dental caries, however larger-scale study should be conducted to confirm the significance of our results. Nevertheless, due to the observed lack of knowledge about probiotics and cariogenic foods the theoretical and practical approaches should be suggested for healthier eating habits of working-age population. Keywords: oral microbiota, dental caries, Streptococcus mutans, probiotics 36 n Introduction Oral microbiota is one of the most important and complex microbial commu-pulatioo nities in the human body (Lamont et al., 2018). Moreover, there is an increas-ge p ing number of evidences demonstrating that oral microbiota dysbiosis is associated not only with oral diseases (Li et al., 2019), including dental caries and rking-ao periodontal disease (Costalonga and Herzberg, 2014), but also systemic dishe w eases (Graves et al., 2018). Dental caries, one of the most common chronic dis-f t eases worldwide, is characterized by the localized destruction of the mineralized tooth tissues caused by bacterial action (Jin et al., 2015; Marsh and Zaura, ealth o 2017). The onset of dental caries is positively correlated to the amount and frequency of consumed dietary sugars (van Loveren, 2019), which can be most-pulacije | h ly found in cariogenic foods. Additional host factors influencing dental caries o development, such as oral hygiene, salivary flow and composition, and enamel ktivne p defects, are also important (Lamont et al., 2018). Since S. mutans was characterised as one of the most common causes for dental caries development (Loesche, 1986) against which traditional approaches were not successful (Mahantesha et elovno a al., 2015), newer approaches such as probiotics have been tested (Anderson and Shi, 2006). Probiotics are live microorganisms which when administered in an zdravje d adequate amount confer health benefits on the host (FAO and WHO, 2002). Regarding dental caries, the main goal of probiotic application is to replace cariogenic with noncariogenic bacteria (Twetman and Keller, 2012). As shown before, probiotics were shown to have a beneficial effect on oral health (Bonifait et al., 2009; Devine and Marsh, 2009). The aim of the present study was to investigate the effect of daily ice cream consumption containing probiotic strains B. animalis subsp. lactis BB-12 and L. acidophilus LA-5 on salivary S. mutans counts in healthy individuals. Methods In the present double blind, placebo-controlled study 11 healthy participants, ten females, and one male, aged 20-50 years, who met the inclusion criteria were included. Inclusion criteria involved restrictions of antibiotics and probiotic dietary supplements consumption, orthodontic apparatus, and cavity injuries. Participants were scheduled for 2 visits. In the first visit, they completed two questionnaires about the knowledge and frequency of probiotic and cariogenic foods consumption and gave saliva sample, followed by a 14-day period of 60 g ice cream consumptions. In the second visit, they completed the questionnaire regarding product feedback, followed by saliva sampling using CRT® bacteria test (Ivoclar Vivadent, Liechtenstein). The ice cream base is a trade secrete (Incom d.o.o., Ajdovščina, Slovenia), while probiotic ice cream contained two probiotic strains B. animalis subsp. lactis BB-12® (nu-trish® BB-12®) and L. acidophilus (nu-trish® LA-5®) (Chr. Hansen, Denmark) in final concentration of 2,8 x 108 CFU/g and 1,1 x 108 CFU/g, respectively. As negative control ice cream with-37 out probiotics supplementation was used. For the statistical analysis, Microsoft Excel 2016 and IBM SPSS version 26 were used. dults Results ealthy a n h To begin with, most of the participants brush their teeth 1-2 times daily without the use of dental floss. The majority of participants (66,4 %) were famil-acteria i iar with the term “probiotics” and their use. However, 55,4 % of participants neither agreed, nor disagreed with the statement that probiotic consumption genic b slows down the growth of microorganisms that cause caries in the oral cavi-ario ty. Regarding the consumption of foods containing live microorganisms possessing probiotic properties, the most commonly reported were yoghurt and alivary c cheese, with minimal consumption amounts of 150 ml/week and 22,5 g/week. n s Lack of knowledge was observed in the category of “cariogenic foods”, while n o the most frequently consumed cariogenic foods were fruit juice and ice cream, ptio followed by jam and biscuits. Regarding cariogenic bacteria counts in saliva nsumo samples, the salivary S. mutans counts in the control group after 14-day ice cream consumption were the same or even higher compared to day 0 and for ream c most cases there was no change in Lactobacillus counts. In the experimental ce c group with 14-day probiotic ice cream consumption, salivary S. mutans counts were lower with corresponding higher Lactobacillus counts. Nevertheless, ac-biotic iro cording to data of appearance, taste, scent and texture of the ice cream, partic-f p ipants liked the product. ffect o the e Discussion Obesity and dental caries are widespread pathologies, triggered by common etiologic factors, such as high added sugar consumption already in childhood (Delli Bovi et al., 2017). Furthermore, fermentable dietary carbohydrates, among which sucrose is considered the most cariogenic, are the key factors involved in the initiation and development of dental caries (Paes Leme et al., 2006). Thus, low pH level as a result of carbohydrate fermentation, triggers a shift of cariogenic oral microbiota, resulting in enamel demineralization (Delli Bovi et al., 2017). Despite the low number of participants of the present study, their lack of knowledge about cariogenic foods is of big concern. Moreover, the cariogenic foods, defined with the presence of fermentable carbohydrates does not affect their shopping habits. In contrast to cariogenic foods, the knowledge about probiotics was better, since the majority of participants was familiar with the term and use. According to the consumption of listed foods, only 2 out of the 11 participants met the recommended daily intake of probiotic microorganisms. That should be a minimum of 106 CFU/ml of product (Boylston et al., 2004). Since the probiotics had been proven as successful in dental caries prevention, the aim of this study was to test the effect of probiotic ice cream on salivary cariogenic bacteria in healthy adults. Based on CRT values after partici-38 pant’s saliva sampling, it was shown that the used probiotic strains influenced salivary S. mutans counts which were lower compared to day 0. Probiotic icen cream affected also Lactobacillus counts which is important for maintaining pulatio healthy oral microbiota. o ge p Conclusion rking-ao Among participants a lack of knowledge about probiotics and cariogenic food he w was observed, therefore the theoretical and practical approaches should be f t suggested for healthier eating habits. Participants who consumed probiotic ice cream with 2 different probiotic strains had lower salivary cariogenic S. mu-ealth o tans counts and corresponding higher probiotic Lactobacillus concentration after 14-day ingestion period in comparison with participants in the control pulacije | h group. However, the main limitation of the study was low number of partici-o pants, thus a larger scale study should be conducted to confirm the significance ktivne p of our results. elovno a References ANDERSON, M.H. and SHI, W., 2006. A probiotic approach to caries man-zdravje d agement [online]. 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Caries Research, vol. 53, rking-a no. 2, pp. 168-175. [viewed 22 June 2020]. Available from: http:/ dx.doi. o org/10.1159/000489571 he wf t ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.41-49 Health problems experienced by parents of children in long-term hospital stay Maria de Lurdes Lopes de Freitas Lomba1, Inês Abreu2, Rafaela Oliveira2, Rodrigo Rato2, Rúben Pinto2, M. Sofia Macedo3 1 Health Sciences Research Unit: Nursing. Coimbra Nursing School Nursing, Portugal. 2 Coimbra Nursing School Nursing. Portugal. 3 Saudi Patient Safety center, Saudi Arabia Abstract Introduction: Nowadays, parental active engagement in children’ hospitalization has become an accepted feature. However, parental finance, social and personal costs for their involvement in their child’s care have received little attention. Moreover, a child’s hospitalization is, frequently, an event that occurs, unexpectedly, having a significative impact on parents’ health. There is a positive relationship between parental anxiety and the length of the child’s hospital admission. Aim: To synthesize and analyse the existing evidence on the health problems experienced by parents of children in a long-term hospital stay. Method: An integrative review was carried out, and scientific articles were selected from the databases MEDLINE, SciELO and CINAHL. Only parents of children (with ages between 0 and 18 years) submitted to long-term hospitalizations were included. Parents with any kind of mental or psychiatric disorder were excluded from the review. A six-step method was used to develop the revision and to analyse the results. Results: A child’s hospital stay holds major changes in the routines and well-being of a family. Parents are in need of care from nurses whose primary focus are children. Children’ hospitalization often leads to parental anxiety as well as stress and sleep disorders. This condition can also trigger other pathologies such as hypertension, obesity, diabetes mellitus type II or stroke. Anxiety has higher rates on mothers of male infants. Conclusion: A long-term childś hospitalization brings an important and challenging parental adjustment affecting their health and wellbeing. Thereby, nurses’ interventions should focus on identifying the adversities experienced by parents, so that actions can be taken that will improve the adaptation process, and consequently promote the parents’ well-being in addition to their children’s healing process. To this point, meeting family‐centred care expectations is an additional paediatrics’ nurse challenge. Future studies on the strategies used by parents during their child’s long-term hospitalization and its evaluation are needed. Keywords: long-term hospital stay; parents; anxiety; stress; sleep disorders Introduction Parents have an important role on their children health care. While the focus of healthcare professionals is mostly the child; the financial, social and emotional impact on the child’s parents is, often, overlooked. Considering that a child’s hospitalization is, in most cases, unexpected, Melnyk (2000) affirmed that hospitalization could be a stressful situation for children and their parents/families, which may interfere with the care provided and thus with the recovery of the child. As children’s recovery depend, not only on the medical care, but also in 42 the care and affection they may receive or not, it is crucial that nurses provide n attention to the child, in addition to their technical expertise (Teixeira Luz et al., 2019). pulatioo Health care professionals must be sensitive to the parent’s emotional ge p needs as parents are an integrative component of the holistic care provided to the child. This is important as the parental presence and active participa-rking-ao tion during the child’s hospitalization positively influences the health reestab-he w lishment due to stress reduction caused by the child’s exposure to the hospi-f t tal environment (Teixeira Luz et al., 2019). Yet, each family has different coping strategies, and it becomes extremely important for nurses to provide an indi-ealth o vidualized plan of care (Erdem, 2010), demonstrate empathy, compassion and kindness to engage with the children and their parents (Micalizzi et al., 2015), pulacije | h holistically. o A child’s hospitalization may trigger parental stress, surface symptoms of ktivne p anxiety and depression which will compromise their ability to give their child, proper support. (Nicholaou and Glazebrook, 2008). Given this, nurses should incite parents’ ability to cope with these symptoms (Cescutti-Butler and Gal-elovno a vin, 2003). The partnership in care between parents and nurses allows, not on-ly, for sharing of expertise, but it also provides an important sense of control zdravje d from the parents over their child’s hospital care as well as it builds a vital relationship of trust and confidence towards the healthcare team. (Mimmo et al., 2019). Although the negative impact of long-term hospital admissions on parents are recognized, there is a dispersion of knowledge in the literature, which hampers the synthesis of best available evidence and thus its application into clinical practice. To achieve the proposed objective, the defined research question is: “What are the health problems experienced by parents of children in long-term hospitalization?” Method The search was performed in March 2020, with the aim to identify health problems experienced by parents of children in long-term hospitalisations. The review is a result of six phases: 1) guiding question definition; 2) literature search; 3) studies’ categorization; 4) included studies’ appraisal; 5) results interpretation and 6) synthesis. Research was carried out using the EBSCO-host search engine, selecting CINAHL Plus with Full Text and MEDLINE with Full Text as databases, with a timeline defined between 2015 and 2020, with the purpose of obtaining the most recent scientific evidence. The search was made in Portuguese and English and included the keywords “hospitalized children”; “parents”; “health problems” and the different synonymous of each keyword. Additionally, inclusion and exclusion criteria were defined. Thereby, only studies including parents of children of paediatric age (as per the study definition of paediatric age) in long-term hospitalisations were accepted for the review. Studies including parents who suffered from mental illness were excluded. 43 The search resulted in an initial sample of 149 scientific studies. Of these, tay 44 were excluded due to repetition, 87 based on title and abstract, resulting in a final sample of 18 articles. After full-text reading of the 18 studies, 13 were ex-spital so cluded for not meeting the inclusion/exclusion criteria. The final sample resulted on five studies that answered the investigation research question and met ng-term h the inclusion criteria. (table 1) on l In order to establish the internal validity and mitigate the risk of bias during the selection process, the methodological quality of the studies was as-hildren i sessed using the Joanna Bridge Institute tools (JBI Reviewer’s Manual, 2020). f c Table 1: Identification of the included studies arents oy p Author Title Country/Year Risk factors for the development of xperienced b post-traumatic stress disorder and cop- s e A1 Aftyka A., Rybojad B., Rosa W., Wróbel A., Karakula-Juchnowicz H. ing strategies in mothers and fathers Poland, 2017 following infant hospitalization in the blemro neonatal intensive care unit. Factors influencing the caregiving per- health p A2 Hye-Yul H., Shin-Jeong K., Wayne E. formance of mothers of hospitalized South Korea, K., Kyung-Ah K. toddlers with acute respiratory diseases 2018 (ARD): a path analysis. Psychological distress (PD) and coping A3 Lakkis A., Khoury M., Mahmassani M., Ramia S., Hamadeh N. strategies in parents of children with Lebanon, 2016 cancer in Lebanon. Parents’ experience of their sleep and A4 Nassery W., Landgren K. rest when admitted to hospital with Sweden, 2018 their ill child: a qualitative study. Early traumatic stress responses in par- A5 Woolf C., Muscara F., Anderson V. A., McCarthy M. C. ents following a serious illness in their Australia, 2015 child: a systematic review. Results and discussion The type of studies included in this review are observational (A1), cross- sectional (A2 and A3), qualitative exploratory interview (A4) and a systematic review of the literature (A5). All studies focused on parents of hospitalized children due to a variety of diseases, such as cancer, respiratory diseases, amongst others. Samples of the studies range from 17 to 460 parents. All the five studies present coping strategies used by parents of hospitalized children to deal with their struggles. Results were categorized and presented according to four different themes: Parental anxiety The A2 study highlights that the number of hospitalizations and the mother’s anxiety had a negative impact in the caregiving performance while the mother-child relationship, if shown to be healthy, has a positive impact in the moth-44 er’s caregiving performance. Also, this relationship, proved to positively im-n pact the mother’s anxiety. Melnyk (2000) corroborates these ideas stating that heightened anxiety often inhibits mothers from parenting their children effec-pulatioo tively during hospitalization. Therefore, they are less likely to fulfill their pro-ge p tective, nurturing, and decision-making roles. In view of this, paediatric nurses need to plan interventions to minimize mother’s anxiety and uncertainties rking-ao regarding her child’s illness, plan of care and prognosis, which should improve he w her effectiveness as a caregiver. f t ealth o Sleep quality | h The A4 study states that enough sleep is vital for parental functioning while they stay in the hospital with their children. As parents’ priority is their child’s pulacije o well-being, they focus on the child, putting their own needs aside. Poor sleep makes parents more irritable with one another and understanding information ktivne p and making healthcare decisions becomes challenging. Additionally, it is difficult to maintain a positive attitude and bright thought about the future, mak-elovno a ing the stay at the hospital more difficult to manage. Environmental, interpersonal and organizational factors intervene in the zdravje d quality of sleep. From the environmental perspective, parents reported that sounds from the hospital machines and noises of nurses during the night interfere with their sleep. Regarding interpersonal factors, parents who had relatives with whom they could share the child’s care described it as an opportunity to catch up with their sleep. Accounting for the organizational factors, parents mentioned bureaucracy as an aspect that could develop stress and frustra-tion even before time of admission. Løyland et al, (2020) validates these findings as they declare that the cohabiting with others, lack of privacy, noise and light when trying to sleep, disruptions due to treatments and child related and family factors affect parents’ sleeping patterns. Sleep quality is also jeopardized when parents describe the shortage of healthcare providers as a potential risk for patient safety. Parental stress All three studies A1, A3 and A5 reported high prevalence of parent’s stress disorder. A1 states that mothers felt greater stress and presented a higher severity of post-traumatic stress disorder (PTSD) compared to fathers, especially if they had previous miscarriages or chronic diseases. Accounting for the fathers, the Apgar test after birth and partner’s PTSD were related to PTSD. Similarly, findings of A5 study indicate that psychosocial factors, such as prior trauma, history of mental issues, trait anxiety and parent perception of life threat to their child, were consistently associated with parental acute and posttraumatic stress symptomatology. A study based on this theme carried out by Board and Ryan-Wenger (2002) adds that one of the most significant stressors for parents was the alteration in parental role. Interestingly, although the threat or sali-45 ence of death may appear critical in the development of traumatic stress disorders in parents, many studies reported no association between objective med-tay ical characteristics (such as length of hospital stay, severity of illness, length of spital s ventilatory support, and risk of mortality) and traumatic stress symptomatolo ogy in parents. Study A1 reported that the differences in stress coping strategies among ng-term ho mothers and fathers are gender-related. Women used the following strategies n l more often than men: seeking emotional social support, religious coping, focusing on and venting emotions, positive reinterpretation, and growth (ac-hildren i tive coping) and acceptance (avoiding behaviour). Inside the group of parents f c mourning for their baby, women frequently coped with stress by focusing on emotions than the men. A study held by Tehrani et al, (2012) enhances that a arents oy p higher level of family stress can reduce the ability of the mother to cope with problems. The occurrence of PTSD symptoms depends not so much upon the stressor but on how one copes with stress. Therefore, according to A3, main-xperienced b taining family integration/strength and optimistic outlook for the situation s e was perceived as being the most helpful coping strategies. Tehrani et al. (2012) blem highlights the importance of understanding the differences related to stress-ro ors perception among nurses and parents, throughout a child’s hospital stay. If not managed properly, strategies that aim at reducing parental stress may health p not be effective. Therefore, special attention should be given to identify the stressors in nursing care, planning and parents’ education, moving stressors and treatment in the same direction, and identify factors that can reduce the mother’s ability to provide childcare and delay in treatment progress. Al-so, information provision about a child’s diagnosis was reported as a protective coping mechanism for parents and found to be associated with feelings of empowerment. Interpersonal relationships A long-term hospital stay with an ill child has consequences on interpersonal relationships. According to the parents’ interviews from A3 study, a long-term stay gives a feeling of unhappiness and isolation from the world outside the hospital. Callery (1997) declared the mothers’ sense of isolation and the lack of support they were able to draw on from immediate family. Eyigor et al. (2011), states that the fear of the child’s death, the length of the treatments, treatment-related drawbacks, distance from the caregiver’s home to the hospital, financial problems, and negative effects on family relations tend to cause family psychosocial problems. Still, by being united as a family, parents felt stronger during their time of admittance. Spouses, relatives, and siblings served as a support system that help the parents as well as the ill child both practically and emotionally. Similarly, A2 shows that family support and positive emotional exchanges affect both the mother’s and child’s emotions. Also, a good parent– child relationship was associated with better outcomes related to the child’s 46 psychological functioning and family adaptation. n When considering coping strategies to deal with the hospitalization and the decay of relationships, a coping pattern in which parents maintain social pulatioo activities and relationships, self-esteem, and psychological stability was found ge p to have a significant protective role in parental adaptation to childhood disease, as shown by A3 study. The same coping pattern was found by the authors rking-ao of A4 study, as all the participants described the importance of living their life he w as “normally” as possible including activities that reminded them that life had f t other meanings despite the child’s disease, which was deemed as helpful to relax. Those having relatives and spouses bringing food so they could eat togeth-ealth o er, described that as creating a more home-like environment, which enabled the family functioning; however, since hospital wards only allow one parent pulacije | h during nighttime, the family members got separated which was described as o difficult. Also the results of a study lead by Mason (1978) suggests that recurrently fathers are lead to believe, by the hospital’s policy, that they are not sup-ktivne p posed to be at the child’s bedside and somehow blame themselves for not protecting the child. Fortunately, parents are becoming more aware of their rights, elovno a as well as of the value to the child of their visiting freely or rooming-in. The A3 study enhances that maintaining family integration/strength and optimistic zdravje d outlook for the situation was perceived as being the most helpful coping strategy. Parents at a hospital, inevitably connected with other parents and the medical staff. A4 study reveals that, even though all the parents wanted separate rooms, some of them mentioned positive aspects with having other families’ sharing rooms, such as sharing the same experience and giving one another advice, becoming thereby significant partners in the treatment team, as reported by Mason (1978). By being on the “same boat”, parents meant that their support and recommendations were invaluable. Also, talking with the health professional about concerns was among the top 10 most helpful cop- ing mechanisms to parents, as reported by the A3 study, which highlights the importance of providing understandable medical information to parents and children, upon their request. The A4 study states that relationships with nurses were described as very positive as they lessened the parental burden by providing practical support with the treatment of their child and decreased emotional stress by continuous information. Conclusion Parents who accompany their children during a long-term hospitalization may develop anxiety, stress and sleep pattern disorders and alterations in the interpersonal relationships. Although parents prioritize their child’s best interests, the impact that the hospitalization can have on their health is highlighted as parents are aware of the deterioration of their health condition. Being these in mind, nurses must adapt their interventions to minimize the impact of hospitalization effects. Negotiation may be the key to the success 47 of the hospitalization, as it improves the quality of care for the hospitalized tay child. Clarification of the role of nurses and parents in the caring process is one of the prerequisites of this negotiation. spital so Throughout the evidence synthesis conducted, health units must develop clinical guidelines for interventions to promote parents’ sleep and rest, as ng-term h well as the implementation of effective educational programs to help mothers o and fathers enhance their knowledge and skills and participation in the care, n l with the aim of optimizing their parenthood. Achieving greater psychological support and having as a basis of care the creation of a good working relation-hildren if c ship and empathy, will establish parents a viable support for moments of greatest discouragement and stress. arents o There is already an accessible amount of studies related to some of the y p health problems experienced by parents of children in long term hospitalizations, with the great majority referring to parental stress and anxiety. Nevertheless, a greater scarcity when the main theme concerns sleep pattern disorders xperienced bs e and alterations within the interpersonal relationships. Changes and disorders blem in terms of eating patterns should be a topic to be addressed with greater atten-ro tion in future researches. Whilst there is already some research foundation on the theme, there is a need for a more in-depth and targeted search for physical, health p mental and social changes in parents of children going through long-term hospitalizations in order to identify risk groups, determining factors and strategies to support and solve the problems encountered by this research. References AFTYKA, A., RYBOJAD, B., ROSA, W., WRÓBEL, A. and KARAKUŁA-JUCH-NOWICZ, H., 2017. Risk factors for the Development of Post-Traumatic Stress Disorder and Coping Strategies in Mothers and Fathers Following Infant Hospitalization in the Neonatal Intensive Care Unit. Journal of Clinical Nursing, no. 26, pp. 4436–4445. 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Effects of Stress s e on Mothers of Hospitalized Children in a Hospital in Iran. Iran Journal blemro of Child Neurology, vol. 6, no. 4, pp. 39-45. TEIXEIRA LUZ, R., SILVA TRINDADE, T. B., DE SOUZA LIMA, D., CAR-health p DOSO CLIMACO, L. C., SANTOS FERRAZ, I., RIBEIRO TEIXEIRA, S. C. and RODRIGUES DA SILVA, R., 2019. The Importance of the Presence of Parents during Neonatal Hospitalization. Journal of Nursing UFPE, no. 13, pp. 414–419. WOOLF, C., MUSCARA, F., ANDERSON, V. A. and MCCARTHY, M. C., 2015. Early Traumatic Stress Responses in Parents Following a Serious Illness in Their Child: A Systematic Review. Journal of Clinical Psychology in Medical Settings, vol. 23, no. 1, pp. 53-66. Available from: https:// dx- .doi.org/10.1007/s10880-015-9430-y https://doi.org/10.26493/978-961-293-015-8.51-55 Use of information telecommunications technology in asthma subjects Tilen Dolinar, Lidija Jakupović, Urška Ugovšek, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia tilen.dolinar@gmail.com, lidija.jakupovic@gmail.com, ugovseku@gmail.com, andrej.starc34@gmail.com Abstract Introduction: Asthma, a chronic respiratory disease affects approximately 235-334 million people worldwide. It is one of the most common pulmonary diseases in adults. Despite extensive effective treatment that has existed for decades, most asthma patients still have uncontrolled symptoms. Health information and communication technology has been used in healthcare to persuade the self-management of various chronic diseases. Mobile health applications could provide inexpensive and clinically effective asthma control measures. Methods: We used a descriptive method of research with a review of Slovene and foreign literature. The literature search was conducted from April 2020 to May 2020. The age of the literature was limited from 2010 to 2020. The literature was searched in the CochraneLibrary, CINAHL, PubMed and MedNar databases using keywords: information and communication technology, asthma, self- management, chronicillness, application. In the search for literature with a combination of the following keywords: information and communication technology, asthma, self-management, chronic disease, application. The selection criteria was the availability of the text in its entirety and the literature published in the period from 2010 to 2020. Articles that do not have a complete article structure, articles that do not relate to the topic of asthma were excluded. 16 articles were reviewed, 8 articles were excluded. Results: Mobile applications promise to improve behavior in asthma patients through self-management. Researchers report that about 2/3 of patients have expressed interest in using an asthma management app to improve the inhaler grip, a well-known problem among asthma patients. Currently, mobile applications alllow patients to monitor and manage their illness, obtain data, educate about the disease, and improve their health behavior. In addition to applications, smart inhalers could be put into use that improve the patient‘s quality of life and limit the excess use of health care. Discussion and conclusions: Information and communication technology in healthcare could be used in chronic diseases such as asthma, as they are relatively cost effective and can have a significant impact on improving chronic disease management and human health. Keywords: information and communication technology, asthma, self-management, chronic illness, application Introduction Asthma, a chronic respiratory disease, affects approximately 235-334 million people worldwide. It is one of the most common pulmonary diseases in adults. Despite the widespread of evidence-based guidelines and effective treatment that has existed for decades, most asthma patients still have uncontrolled symptoms. A patient with asthma has daily symptoms in a short-acting in-52 haler more than twice a week, wakes up at night due to symptoms or should n definitely enter activities due to asthma. Sharing measures self-management of asthma management are key to reducing the harmful physical and economic pulatio impacts associated with this disease (Pool et al., 2017). Because asthma caus-o es prolonged inflammation in the lungs, airway involvement severely restricts ge p airflow during respiration, causing the patient to have difficulty breathing. Parking-a tients with asthma need two types of inhalation medications: for prevention o seizures take inhaled corticosteroids to suppress the inflammation and when he w symptoms such as coughing or wheezing occur, all bronchodilators known f t as a soothing or rescue state. The most common problems that occur are im-ealth o proper grip of the inhaler, improper use of the inhalation itself and thus reduced absorption of the drug. The goal of asthma treatment should be dosed to maintain disease control and treatment. This requires an approach tailored to pulacije | h pharmacological treatment, patient education, a written action plan, training o on the proper use of inhalers, and a review of inhaler technique at each outpa-ktivne p tient visit (Zhifang et al., 2019). International guidelines emphasize the importance of a partnership between patients and healthcare professionals. Despite all these claims, many elovno a health professionals do not pay sufficient attention to education and self-management (Zhifang et al., 2019). There is evidence that patients are not prescribed zdravje d enough check-ups and do not have appropriate advice and instructions, most often this includes proper use of the inhaler. It is estimated that only 55% of adults with asthma learn to recognize early asthma symptoms, only 47% receive instructions to change the environment in which they live to improve asthma control, and only 33% have ever received an asthma treatment education plan (Pool et al., 2017). Methods In order to present the theoretical background and achieve the purpose of the work, a critical review of professional and scientific Slovenian and English lit- erature was first performed. A literature search was conducted from April 2020 to May 2020. Literature was searched in the CochraneLibrary, CINAHL, PubMed, and MedNar databases. We used literature published between 2010 and 2020. We searched for literature with various combinations of the following keywords: information and communication technology, asthma, self-management, chronic illness, application. When searching for Slovenian literature, we used combinations of the following keywords: information and communication technology, asthma, self-management, chronic disease, application. The selection criteria was the accessibility of the text as a whole. Based on the existing literature, we analyzed the use of information and telecommunication technology for people with asthma. Results Asthma is the most common chronic disease among children and also affects millions of adults. The U.S. health care system costs about $56 billion a year 53 due to its high prevalence and continued treatment throughout the lifetime of most asthma patients. Health information and communication technology has ubjects been used in healthcare to persuade the self-management of various chronic a s diseases such as asthma, diabetes, chronic obstructive pulmonary disease, etc. sthm In particular, mobile health applications could provide low-cost and clinical-in a ly effective asthma treatment measures. Applications could allow patients to gy self-manage asthma on a daily basis providing evidence-based interventions. loo Research has shown that procedures such as disseminating educational meth-chn ods and tools to monitor symptoms improve a patient’s quality of life and limit ns te the overuse of health care services. Data obtained from mobile phone sensors catio and medical devices such as smart inhalers can be used to implement self-man-uni agement measures tailored to the specific needs of patients (Tinschert et al., mm 2017). leco As the use of mobile devices and smartphones becomes more com-n te mon, patients can use asthma self-management apps. Currently, applications atio on mobile devices can enable patients to monitor and control disease, obtain rmo data, educate about the disease, and improve health behavior (Zhifang et al., f inf 2019). Mobile apps promise to improve behavior for asthma patients through use o self-management, as they can be easily incorporated into daily life. Smart mobile devices have many advantages, one of which is that they are usually always at hand, they are portable and are low cost. Researchers report that approximately 2/3 of patients have expressed interest in using an asthma management app to improve inhaler adhesion (Jácome et al., 2019). The potential of applications to improve asthma self-management varies greatly between applications. Physicians and asthmatics should therefore read application reviews carefully before deciding which application to recommend or use. In addition, currently available asthma applications unfortunately do not take full advantage of today’s technology. (Tinschert et al., 2017). Traditional self-management programs should include a written action plan on how to identify and respond to asthma exacerbations, an individualized treatment plan, including self-monitoring and goal setting, medicine management including warnings and reminders and patient education (Honkoop, 2017). Asthma subjects could use smart inhalers too. They are connected to a smartphone with a Bluetooth connection, remind patients when to take medicines, collect data to help with care, and improve patients commitment to taking asthma therapies. Smart inhalers contain a battery and measuring sensors which identifies the dose, and if a dose has been missed, they send patients reminders of missed doses. Sensors that measure the inhalation profile confirm that the dose was inhaled along with useful information about the inhaler technique. They also record the time of activation (Henry, 2019). Discussion Asthmatics could use mobile applications that allow patients to self-manage 54 asthma on a daily basis providing evidence-based interventions. Using asthma n apps as part of the set of strategies available to healthcare providers to improve quality of life among asthmatics, but it is hard to decide which app is the most pulatioo suitable (Tinschert et al., 2017). Because research has shown that the inhala-ge p tion technique is still a major problem for asthmatics, the use of smart inhalers that can recognize adhesion and inhalation technique is advised (Henry, 2019). rking-ao he w Conclusions f t Given that chronic diseases account for as much as 75% of health care costs, it ealth o is crucial to identify simple tools to help patients care for them and improve outcomes. Online tools could also be used for other chronic diseases, as they are relatively cost-effective and can have a significant impact on improving the pulacije | ho management of chronic diseases and human health. ICT can improve asthma control and the quality of life of asthmatics (Pool et al., 2017). ktivne p References elovno a TINSCHERT, P., JAKOB, R., BARATA, F., KRAMER, J.N. and KOWATSCH, T., 2017. The potential of mobile apps for improving asthma self-manage-zdravje d ment: a review of publicly available and well-adopted asthma apps. JMIR MhealthUhealth vol. 5, no. 8. [viewed 8 March 2020]. Available from: Doi: https:/ doi.org/10.2196/mhealth.7177 . GUAN, Z., SUN, L., XIAO, Q. and WANG, Y., 2019. Constructing assessment framework for the quality of asthma smart phone applications. BMC Med InformDecis Mak., vol. 19, no. 192, pp: 1–17. [viewed 8 March 2020]. Available from: doi: https:/ doi.org/10.1186/s12911-019-0923-8. JÁCOME, C., ALMEIDA, R., PEREIRA, A,M,, ARAÚJO, L., CORREIA, M., PEREIRA, M., et al. 2019. Asthma apps use and interest among patients with asthma: a multicentre study. J InvestigAllergolClinImmunol, vol. 30, no. 2, pp: 1–8, [viewed 9 March 2020]. Available from: doi: https:/ doi. org/10.18176/jiaci.0456. HONKOOP, P.J., SIMPSON, A., BONINI, M., SNOECK-STROBAND, J.B., MEAH, S., FAN CHUNG, K. et al., 2017. MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of anobservational study. BMJ Open, vol. 7, no. 1, pp: 1–7, [viewed 9 March 2020]. Available from: doi: https:/ doi.org/10.1136/bmjopen-2016-013935. POOL, A.C., KRASCHNEWSKI, J.L., POGER, J.M., SMYTH, J., STUCK-EY, H.L., CRAIG, T.J., et al. 2017. Impact of online patient reminders to improve asthma care: A randomized controlled trial. PloSOne, vol. 12, no. 2, pp: 1–17, [viewed 9 March 2020]. Available from: doi: https:/ doi. org/10.1371/journal.pone.0170447. HENRY, C., AUDIBERT, R., KELLER, M., QUAGLIA, B., VECELLIO, L. and ROCHE, N., 2019. Real-lifeinhaler adherence andtechnique: Time to 55 getsmarter! Respir Med, vol. 158, pp: 24–32, [viewed 8 March 2020]. Available from: https:/ doi.org/10.1016/j.rmed.2019.09.008. ubjectsa s sthm in agyloo chn ns te catio uni mm leco n te atiormo f inf use o https://doi.org/10.26493/978-961-293-015-8.57-67 Nurses’ shift work: impact on health Lidija Dornik Col ege of Nursing in Celje, Mariborska cesta 7, 3000 Celje University Clinical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia lidkad@gmail.com Abstract Introduction: Work is important for the survival and personal attainment of individual people, but it also affects the lifestyle of people who are in the work process and leads to various health problems that employees are facing. Shift work and night work are associated with burnout, lack of personnel and lack of control effect on burnout, personal exhaustion, long working hours are associated also with excess body weight. Quality of life, tiredness, sickness, effectiveness and overall satisfaction with the work of nurses reflects the employer ‘s sense for an appropriate time schedule, relaxation, psychological support and access to relaxation spaces. Methods: We used descriptive research method. We used the method of reviewing of the scientific literature based on accessibility, content relevance and actuality. We accessed it via an electronic link in the Celje Library. The restrictive criteria were the period January 2017 to April 2020, English language, availability for download, full text and scientific journals with the keywords “nurse”, “shift work”, “night shift” and “health” in the EBSCO and MEDLINE databases. The survey was conducted in April and May 2020. MS Word was used to display the results. Results: We have used, reviewed and processed 21 full-text articles for a review scientific article, after applying the inclusion criteria: nurse, working conditions, type of work, health link, type of publication, time period, language and availability of the full text, so 11 scientific articles are included in the final research. We found out that night work with many factors has a negative impact on the health of nurses. This is manifested as burnout, exhaustion, fatigue, depression, anxiety, concentration, chance for defects, back pain, poor eating habits, all of which have a profound effect on stress levels. The quality of sleep is also worse, the pattern of sleep is broken and insomnia increases. Discussion and conclusions: Findings show that nurses who work shifts and also do night work feel poorer quality of life, poor quality of sleep, higher stress level at work, have less time for family, social contacts and physical activity and are more prone to overweight and development of chronic diseases. All this is of concern for the general well-being of nurses and their health. Employers should be able to well organize the shift work, rest days and the workload of nurses. This would make it easier to maintain, promote the good psychophysical status of nurses and increase healthy lifestyles and health levels of employed nurses through patient-centered examples. Keywords: nurse, shift work, night shift, health Introduction Work is important for the survival and personal achievement of individual people, and at the same time work affects the lifestyle of people who are in the work process and leads to various health problems. (Ferriera dos Santos et al., 58 2018). The work of nurses takes place in shifts and cycles, it also includes a night n shift, which usually means 12 hours, from evening to early morning. Schedules are poorly defined, include compulsory work, voluntary, forced, extended pulatioo work and on-call time, and payments are poorly defined. During this time, the ge p nurses have to work to combat their natural instincts, disrupting their natural circadian rhythm, which is regulated by natural light and darkness, resulting rking-ao in lack of sleep and fatigue. Many nurses report exhaustion, extreme drowsi-he w ness during the workday, decreased attention, lack of sleep or long-term insom-f t nia, as well as falling asleep during work. (Douglas, 2014, Antill, 2016, Wheatley, 2017). The so - called long working days, 12 - hour working days, bring less ealth o| h costs for the employer. Continuity of care increases, resulting in more injuries at work, reduced patient safety. Shift work and night work with overcrowding, pulacije lack of staff, lack of control, are associated with burnout and personality ex-o haustion. Some countries have already successfully regulated the work of nurses and the overtime they perform, and this is the right path to the well-being of ktivne p nurses and their impact on their health. (Dall’ora et al., 2020a, Dall’ora et al., 2020b, Young, et al., 2018, Wheatley, 2017). elovno a Hospitals are one of the most stressful environments where nurses are under the greatest impact. Either due to physical discomfort, psychological zdravje d pressures, dysfunctional support of the work environment and negative social support of the work environment. The quality of life, fatigue, morbidity, effectiveness, and overall satisfaction with the work of nurses reflects the employer’s attitude (Shamloo, Moradi, Hosseini, 2020). Nurses are the first line of health care that cares for the nation (Williams, 2017). They represent public health, and influence the patients and their families by example, indicating healthy lifestyle, eating habits and risk management. Excess body weight and obesity is markedly higher among nurses as the work environment for nurses is not conducive. The knowledge nurses have about a healthy lifestyle does not match their lifestyle. The health and satisfaction of employed nurses affects the work and the organization in which they are employed (Ferriera dos Santos et al., 2018, Stanulewicz et al., 2020, Williams, 2017). In the research project, we would like to present, investigate whether shift work affects the health of nurses, based on a literature review, literature search strategy and restrictive criteria. Research objectives: - compare the findings of experts in research on the effects of shift work on the impact on the health of nurses, - determine whether nurses detect changes during shift work, - determine whether the impact of shift work on the health of nurses can be determined by measurements, - describe the health effects of shift work. Methods The research was based on a descriptive research method. The scientific litera-59 ture in the field of medicine was used in the research project. The selection of literature was based on accessibility, relevance and topicality, and innovative ealth research was included, which supported its results with evidence. The literature n h was accessed via an electronic link in the Celje library. Material for the research paper was collected online in the databases EBSCO and MEDLINE, ProQuest pact om and Google Scholar. In order to narrow the data, restrictive criteria were used: rk: io peer-reviewed articles, full text, year of publication for 2017 - 2020, language, if available for download, professional and scientific journals, with the keywords hift w “nurse”, “shift work”, “Night shift” and “health”. Search found 21 articles. Article review strategy: We have already excluded all articles online where there nurses’ s was no visible content, or they were in a language, other than English. A review of the databases gave us 21 results, after the review we eliminated 3 articles that did not contain basic criteria. The remaining 18 articles were read and reviewed, and 7 more articles were excluded according to the inclusion and exclusion criteria. The other 11 articles were included in the survey for the review article. The survey was conducted in April and May 2020. MS Word was used to display the results. When searching for articles, we decided to include the inclusion and exclusion criteria shown in Table I. The inclusion criteria were that nurses or health professionals were involved, that working conditions were shift work or night work, that there was an impact on health, that the article was freely published in the period from January 2017 to January 2020 in English and accessible as full text. Table 1: Inclusion and exclusion criteria Criteria Inclusion criteria Exclusion criteria Healthcare worker/nurse Healthcare workers or nurses included All other professions Working conditions Shift work/night shift work Only day shifts Impact on health Present in text Not present in text Type of publications scientific review, research articles Other type of articles Time period January 2017 – April 2020 Older literature Language English language All other languages Results Shift work can have detrimental effects on human health. In Table 2 the results of our research, which includes 11 articles, are shown. It lists the author, methodology, purpose, sample, and finding. 60 Table 2: Author, year and country, type of study, duration, n and intervention, aim, environment and sample and results pulatioo Author, year, Type of study, ge p and country duration, and Aim Environment intervention and sample Results Investigate patient rking-ao safety management system and activi- he w ties and intention f t Long working Hayashi et al., Questionnaire to participate in the 40 hospitals hours, night, shifts 2020 surveys 2x second survey in and few days off, ealth o 1. relationship with 100 healthcare were associated with Japan 1 year (2015 – working hours in a 2016) week, the number workers low patient safety of night shifts in a culture pulacije | ho month and the num- ber of days off in a month ktivne p At the end of night Psychomotor 75 female em- shifts reaction times ployees work- increased and num- elovno a Vigilance Task (PVT) test ing day and ber of lapses are bout at the end night shifts, higher compared 25 year or old- to day shifts. Dif- zdravje d Behrens et al., of two con- 2019 secutive day To mean reaction er, not pregnant ferences between 2. and three con- time, percentage tor breast feed- in the number of secutive night of lapses and false ing within the false starts they did- Germany shifts, respec- starts last 6 months, n`t observe. Reac- tively. not taking ovar- tion times improved ian stimulation across consecu- 3 years (2012 – therapy, not have tive day and night - 2015) previous diagno- shifts, frequency of sis of cancer lapses increased af- ter the third night Author, year, Type of study, and country duration, and Aim Environment intervention and sample Results Prevalence of low- er back pain is high among Japa- 12 hospitals nese nurses and in- Fujii et al., 2019 Self - reported If they have lower questionnaire back pain in the last terfered with their 3. four weeks, and if it 3.066 nurses (no work. Fear avoid-lower back pain ance beliefs about Japan 1 year (2015 – lasted for more than 2016) 3 months 1.265, with lower physical activi- back pain 1.801) ty might be poten- tial target for lower back pain manage- ment. Organisational cli- mate, focused on in- Dehring et al., Cross – sec- Organisational cli- mate factors and Two healthcare creasing supervisor 4. 2018 tional study health outcomes dif- services in Mel- support may mit-fered across shift bourne igate the potential 61 Australia 1 year (2013) types 108 nursing staff negative health out- comes experienced by shift workers ealth Mental health sta- No significant dif- n h Chatterjee, Saha, Quantitative tus and quality of 70 critical ward ference of two 5. 2018 and survey re- sleep among nurses nurses wards on mental pact o 70 general ward health status, poor m India search of critical and gener- nurses quality of sleep - in rk: i al ward o critical ward Find out relation- hift w ship between lack of Shift work does af- sleep and the effects fect sleep patterns on Quality of Life, and Quality of Life, nurses’ s Owens, On – line sur- how shift work ef- nurses feel fatigued, 6. Moultrie, 2017 vey fects sleep patterns, 138 nurses on day/night shifts when working long USA 2 weeks correlation between shifts as well as con- the lack of sleep and secutive shifts and nurse fatigue - re- it also affect their lated to long shift sleep patterns. hours worked Author, year, Type of study, and country duration, and Aim Environment intervention and sample Results Sleep disturbanc- es are highly preva- lent among clinical nurses in gener- al hospitals in Chi- na (female gender, Cross – sec- ICU and Emergency tional study Department, many years of service, (Pittsburgh Determine the prev- hight night shift fre- Dong et al., 2017 Sleep Quality alence of sleep dis- 5.012 clinical quency, profession- 7. Index (PSQI) turbances among nurses al status: primary China – 20 - minute and intermediate, test clinical nurses meas- - female uring Quality of Life employment sta- tus: temporary, poor 8 months (May Quality of Life: poor – December mental health, low 62 2015) perceived health, high occupation- n al stress (high psy- chological demand, pulatio low job control, low o workplace social ge p support) Explore any asso- 8.199 male and No significant asso- rking-a Cross – sec- female nurs- ciation was found o Wickremaratne ciation between et al., 2017 tional study colorectal cancer es and midwives between rotat- he w 8. and rotating shift from Austral- ing shift work and f t Australia 2 years (2006 – ia, New Zealand, colorectal cancer 2008) work in nurses and midwives and the United in nurses and mid- Kingdom wives ealth o Cross – sec- tional study Rotating shift - work No links between Structured can be associat- 725 nurses and night shift work pulacije | h Peplonska et al., midwives (347 o questionnaire ed with the two tu- and BRCA1 and 9. 2017 mours suppressors rotating night shifts, 363-day BRCA2 genes were Poland 2 years (2008 – and DNA repair shifts, 40 – 60 observed. Smoking ktivne p 2010) genes: BRCA1 and can contribute to 1 year (2014 – BRCA2 years old) epigenetic events 2015) elovno a zdravje d Author, year, Type of study, and country duration, and Aim Environment intervention and sample Results 7 days wear- ing multisen- sory acceler- ometer (Sense Wear BodyMe- dia armband) and detailed food diary, Shift working had measures phys- Does working regu- no influence on ical activity lar hours or rotating 46 volunteer physical activi- participants of ty during working Raskoden et al., (METs), Qual- shift scan effect pa-ity of sleep as- rameters of general University Med- hours appears to be 10. 2017 sessed by Pitts- health and nutrition ical Depart-compensated for ment (23 rotat- during off – hours. Germany burgh Sleeping (physical activity, Quality Index sleep quality, met- ing shifts, 21 non Nutritional status (PSQI), and abolic activity, and – shift regular and stress level can stress load us- stress levels) hours) effect on health – ing Trier In- associated condi- 63 ventory for tions Chronic Stress Questionnaire ealth (TICS) n h 1 year (2013 – pact om 2014) Investigate the rela- rk: io tionships between Cross – sec- burnout and three hift w Chang et al., tional study components (emo- Burnout was relat- 11. 2017 tional exhaustion, ed to components of 1 year (2011) depersonalisation, 571 nurses nursing professional nurses’ s Taiwan and reduced person- commitment Questionnaire al achievement) of nursing professional commitment Discussion and conclusions Nurses face many challenges during their professional work. During the encounter of suffering, the relief of problems, pain, encounters with death, sometimes on a daily basis, poor wages, poor work organization, during stress and anxiety, schedules and shift work also bring their consequences. Behrens et al. (2019) and Lieberman et al. (2020) find that shift work affects the concentration of nurses, they sleep less, are exhausted, it also affects the number of work errors, prolongs reaction time by performing consecutive shift work or night shifts, while Hayashi et al. (2020) argues that patient safety is related to the number of working hours, night shifts, and lack of nurses’ days off. Nurses who work at night may not be able to provide a high standard of care due to the organization due to the negative effects of fatigue on the quality of care and safety, also say Antill et al. (2016). Dehring et al. (2018) say nurses working shifts are more prone to distress, anxiety, insomnia, depression, and social dysfunction, but the organizational climate and increase in supervisors could alleviate this. Catterjee and Saha (2018) claim that nurses working in the intensive care unit have poorer quality of sleep, while Owens and Moultrie (2017) find that shift work affects sleep quality, sleep patterns, quality of life, exhaustion with fewer family and social activities. Also Dong et al. (2017) argue that poor working conditions and shift work affect sleep disorders and high levels of occupational stress due to high psychological stress, low control over one’s own work and poor social support of the work environment, which is reflected in poorer mental health and poorer general health. Douglas (2014) and Lieberman et al. (2020) similarly find that we humans have a natural need to sleep about 8 hours a night and that shift work, especially at night, has a bad effect on health, family and social life and, due to lack of concentration, can affect safety when driv-ing home or to work. Raskoden et al. (2017) say that shift work has no effect on physical activity but has influences on eating habits and higher levels of stress. Härter Griep et al. (2014) found that night work was associated with excess 64 body weight and obesity and that nurses would need strategies for a healthy lifestyle at night as well as a regulated diet in the workplace. Chang et al. (2017) n they say that burnout has a negative connection with affectivity and norms of professional affiliation which are depersonalization, emotional exhaustion, pulatioo and reduced chances of achievement. Fujii et al. (2019) found that lower back ge p pain was associated with some nurses working in certain wards. As shift work has the potential to adversely affect the health and safety of nurses, organiza-rking-ao tions should ensure appropriate schedules through leadership and good man-he w agement, which is a major challenge and a burning issue. Douglas (2014), and f t Wickremaratne et al. (2017) found in their study that there was no significant association between colorectal cancer and shift work of nurses and midwives, ealth o Shi et al. (2020) and Lieberman et al. (2020), on the contrary, found in their research that the risk of cancer and colorectal cancer is higher for nurses who pulacije | h work night shifts, especially for those who do such work for a long time. Pep-o lonska et al. (2017) notes that the study did not show an association between ktivne p night shift work and tumor markers for breast and ovarian cancer. Trossman (2015) however, writes that in some states of America nurses are encouraged to go to rest or fall asleep briefly during night work, not to struggle with their cir-elovno a cadian rhythm and not to disturb the biological clock, to be able to plan their own schedule, train attention, recognize fatigue, control sleep, and have educa-zdravje d tion on balancing work and private life. Organizations that employ nurses should, with good organization, careful scheduling, take care of the health of nurses, and at the same time take care to reduce errors for the benefit of patients. Nurses who take good care of their health, are aware of the risks of habits and take care of a healthy diet can be an example and good teachers to patients in the future. Many nurses perform shift work, including night shifts. Night shifts disturb the circadian rhythm of a person, which, with insufficient breaks and rest, leads to fatigue, overwork, burnout, bad mood, bad relationships at work, at home, and increases the risk of chronic diseases and even cancer. Night work is burdensome for nurses, the longer they are exposed to it, the greater the risk to their health, professional attitude, the increased possibility of mistakes, and at the same time they work in a stressful environment where they have no support, sometimes social work relationships are broken. The health and satisfaction of nurses affects the work and the organization where they are employed. References ANTILL, S., 2016. Shift Work’s Impact on Patient Safety. Oncology Nursing Society Connect, vol. 31, no. 5, pp. 38 – 39. DOI: doi: 10.1097/ NNA.0000000000000546. BEHRENS, T., BUREK, K., PALLAPIES, K., KÖSTERS, L., LEHNERT, M., BEINE, A., WICHERT, K., KANTERMANN, T., VETTER, C., BRÜNING T., RABSTEIN, S., 2019. Decreased psychomotor vigilance of female shift workers after working night shifts. PLoS ONE, vol. 14, no. 7, pp. 1 – 17, DOI: 65 https:/ doi.org/10.1371/journal.pone.0219087. CHANG, H. Y., SHYU, Y.-I. L., WONG, M.-K., CHU, T.-L., LO, Y.-Y., 2017. ealth How does burnout impact the three components of nursing profession-n h al commitment? Nordic College of Caring Science, vol. 31, no. 4, pp. 1003 – 1010, DOI: 10.1111/scs.12425. pact om CHATTERJEE, I., SAHA, D., 2018. Mental health status and quality of sleep rk: io of critical ward and general ward nurses. Indian Journal of Health and Well-being, vol. 9 no. 6, pp. 823-828. hift w DALL’ORA, C., GRIFFITHS, P., EMMANUEL, T., RAFFERTY, A. M., EW-INGS, S., 2020a. 12‐hr shifts in nursing: Do they remove unproductive nurses’ s time and information loss or do they reduce education and discussion opportunities for nurses? A cross‐sectional study in 12 European countries. 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Relationship of patient safety culture with factors influ-pulatio encing working environment such as working hours, the number of night o shifts, and the number of days off among healthcare workers in Japan: a ge p cross - sectional study. BMC Health Services Research, vol. 20, no. 1, pp. 1 rking-a – 9, DOI: 10.1186/s12913-020-05114-8 o YOUNG, C., WHITE, M., DORRINGTON, M., 2018. Nurse Staffing Improve-he wf t ments Through Interprofessional Strategic Workforce Action Planning. Nursing Economics. vol. 36, no. 4, pp. 163 – 169. ealth o LIEBERMAN, H. R., AGARWAL S., CALDWELL J. A., FULGONI, V. L., 2020. Demographics, sleep, and daily patterns of caffeine intake of shift workers in a nationally representative sample of the US adult population. Sleep pulacije | ho Research Society, vol. 40, no. 3, pp. 1 – 8, DOI: 10.1093/sleep/zsz240 OWENS, B., MOULTRIE, D., 2017. The Impact of Shift work on Nurses` Qual-ktivne p ity of Sleep. The ABNF Journal, vol. 28, no. 3, pp. 59 – 63. PEPLONSKA, B., BUKOWSKA, A., WIECZOREK, E., PRYZBEK, M., elovno a ZIENOLDDINY, S., RESZKA, E., 2017. Rotating night work, lifestyle factors, obesity, and promoter methylation in BRCA1 and BRCA2 genes zdravje d among nurses and midwives. PLoS ONE, vol. 12, no. 6, pp. 1 – 19, DOI: https://doi.org/10.1371/journal. RASKODEN, F. C., KRÜGER, J., VOGT, L. J., GÄRTNER S., HANNICH, H. J., STEVELING, A., LERCH. M. M., AGHDASSI, A. A., 2017 . Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel. PLoS ONE, vol. 12, no. 1, pp. 1 – 22, DOI: 10.1371/journal.pone.0169983 STANULEWICZ, N., KNOX E., NARAYANASAMY E., SHIVJI N., KHUNTI K., BLAKE, H., 2019. Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. International Jour- nal of Environmental Research and Public Health, vol. 17, no. 17. pp. 2-3, DOI:10.3390/ijerph17010017 SHAMLOO, G., MOHAMMAD MORADI, A., BAGHER HOSSEINI, S., 2020. Environmental Factors Affecting Health-Related Quality of Life: Nurses’ Narrative Analysis. Journal of Qualitative Research in Health Sciences, vol. 8, no. 4, pp. 37 – 48. SHI, Y., LIU, L., HAMADA, T., NOWAK, J. A., GIANNAKIS, M., MA, Y., SONG, M., NEVO, D., KOSUMI, K., GU, M., KIM, S. A., MORIKA-WA, T., WU, K., SUI, J., PAPANTONIOU, K., WANG, M., CHANS, A. T., FUCHS, C. S., MEYERHARDS, J. A., GIOVANNUCCI, E., OGI-NO, S., SCHERNHAMMER, E. S., NISHIHARA, R., ZGANG, X., 2020. Night - Shift Work Duration and Risk of Colorectal Cancer According to IRS1 and IRS2 Expression. American Association for Cancer Research, vol. 29, no. 1, pp. 133 – 138, DOI: 10.1158/1055-9965.EPI-19-0325 TROSSMAN, S., 2015. More than just tired. American Nurse, vol. 47, no. 1, pp. 67 1 – 6. WHEATLEY, C., 2017. Nursing Overtime: Should It Be Regulated? Nursing ealth Economics. vol. 35, no. 4, pp. 213 – 217. n h WICKREMARATNE, K., STRAND, H., ZHAO, I., 2017. Rotating shift work pact om and colorectal cancer among nurses and midwives: a crosssectional rk: i study. Australian Journal of Advanced Nursing, vol. 34, no. 4, pp. 6 – 13. o WILLIAMS, G. M., 2017. Obesity Among Night Shift Nurses: Time to Inter-hift w vene . American Journal of Public Health, vol. 107, no. 1, pp. 41 – 42, DOI: 10.2105/AJPH.2016.303511 nurses’ s https://doi.org/10.26493/978-961-293-015-8.69-73 Use of mobile technology in healthcare Grega Martin Glas, Sara Hafner, Špela Rozman, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia hafner.sara@gmail.com Abstract Introduction: It has been shown that ICT (Information Communication Technology) has the potential to provide better healthcare services. In the last decade, mobile technology has become very sophisticated and widely spread among people. It provides a new set of tools to improve the health professional-patient relationship. There have been developed many mobile applications that may be potentially useful for healthcare purposes. The literature review is aimed to present the role of mobile technology in healthcare. Methods: A descriptive research method with a critical review of English scientific and professional literature was performed, using Science Direct, CINAHL with Full Text, MEDLINE, and Google scholar. The keywords with the use of Bool›s operators AND/OR were: smartphones, mobile technology, and healthcare. Literature inclusion criteria were articles published between 2014 and 2019, freely accessible and primarily reviewed articles with clearly defined objectives and methods in the English language. We reviewed 15 articles, the excluded ones did not match our inclusion criteria. The literature search took place in February and March 2020. Data were analyzed using the content analysis method. Results: The results showed that mobile technology can benefit patients as well as healthcare professionals. Patients can use them as devices that help to perform daily tasks for a healthier life or easier management of chronic diseases. Mobile technology can empower the patients, so they can take control of their health condition. Healthcare professionals can use it for additional or different learning options or as a tool in patient-centered care. The use of mobile technology can influence communication and relationship between patients and healthcare professionals, also, it breaks down barriers, such as language and long-distance. Adopting mobile health technology perceived an overall positive impact among patients, indicating they are ready to transition from traditional clinical encounters to modern treatment ways. Nevertheless, caution and professional perspective based on knowledge and ethical considerations are needed when implementing new technology in healthcare. Discussion and conclusions: The use of mobile technology and mobile health interventions has increased significantly. Even though mobile phone-based interventions have the potential to improve treatment outcomes, there are still challenges relating to new technologies that must be taken into consideration. To be able to understand how different factors affect the development process from a technical and human perspective there is a need for evaluation of mobile technology. It is necessary to conduct more studies with greater variety in research design and users on mobile applications to evaluate their effectiveness. Keywords: smartphones, mobile technology, ICT, healthcare 70 Introduction n Within the last two decades, we have witnessed remarkable technological development of information and communication technologies and their imple-pulatioo mentation into healthcare (Cannon, 2018). Technological progress has resulted ge p in several movements: a need to address the rising burden of chronic diseases, an exponential increase in developing smaller and cheaper devices, and devel-rking-ao oping a patient-centered healthcare model. Miniaturization of diagnostic in-he w struments have led to promises to improve patient care, individual well-being, f t healthcare outcomes, encourage healthy behaviors, reduce healthcare costs and provide widely accessible services (Philips and Merril, 2015; Bhavnani et ealth o al., 2016; Aceto et al., 2018). Mobile health (mHealth) is defined by the practice of medicine that is pulacije | ho supported by portable diagnostic services. While technological development offers many benefits, it also raises many ethically relevant questions, regard-ktivne p ing widespread device use and their safety (Bhavnani et al., 2016; Lucivero and Jongsma, 2018). elovno a This literature review aims to present the role of mobile technology in healthcare. zdravje d Methods A descriptive research method with a critical review of English scientific and professional literature was performed, using Science Direct, CINAHL with Full Text, MEDLINE, and Google scholar. The keywords with the use of Bool’s operators AND/OR were: smartphones, mobile technology, and healthcare. Literature inclusion criteria were articles published between 2014 and 2019, freely accessible and primarily reviewed articles with clearly defined objectives and methods in English language. We reviewed 15 articles, the excluded ones did not match our inclusion criteria. The literature search took place in February and March 2020. Data were analyzed using the content analysis method. Results Through applying our inclusion criteria we were able to find five articles on the use of mobile technology in healthcare. All of the studies are based on a literature review (table 1). Table 1: Overview of the review studies Authors and year of publication Purpose of research Methodology Results mHealth provides bidi- rectional communication, Quadah and To explore the influence of A systematic, narrative re- regular contact, and con-Leutsch, 2019 mHealth applications view of literature tinuous care. It enables 71 placing the patient at the center of discussion. mHealth reduces barri- Grekin et al., 2019 To consider mHealth in- Literature review and ers, associated with cost, terventions viewpoint transportation, and treat- ealthcare ment-related stigma. n h Evaluation on how various gy ilo Hallberg et al., To describe the develop- factors affect the develop- 2020 ment and evaluation of Literature review ment process from both a mHealth technical and human per- echno spective is important. bile t Assessment criteria for de- o vices evaluation: design, f m Nouri et al., 2018 To assess the quality of information/content, usa- use o mHealth apps Literature review bility, functionality, ethical issues, security and privacy and user-perceived value. Developers of the devic- Lucivero and Jong- To overview bioethical is- es need to ensure that they sma, 2018 sues raised by mHealth Literature review will be used only for the intended purpose, in cer- tain contexts. To describe the experienc- User-centered mHealth Birkhoff and es of mHealth applications Integrative review of the provides individualized Smeltzer, 2017 among chronic disease literature support to chronic illness populations populations. Discussion The problem of the doctor-patient relationship in the form of depersonalization arises due to the absence of face-to-face interaction, nonverbal communication, and the opportunity to observe the patient (Quadah and Leutsch, 2019). Patients are burdened with professional tasks they are not qualified for (Lucivero and Jongsma, 2015; Cvirkel, 2018). Mobile technology has the potential to provide services to areas and people that are difficult to reach. Those kinds of services may not reach the ones who are most in need of care, due to lack of mobile phones, internet connection, low-income, and elderly people (Chib et al., 2014; Lucivero and Jongsma, 2015). New revolutionary devices need to be assessed carefully concerning their plausibility (Lucivero and Jongsma, 2015). There are still many uncertainties, including the selection of appropriate devices, privacy and security issues, the lack of evaluation standards, limited quality control, and the pressure to move into the mainstream of healthcare (Noouri et al., 2018). Possibilities for abuse of sensitive health information and unforeseen effects need to be explored (Lucivero and Jongsma, 2015). Conclusions In the next decade, we expect even greater convergence of technology and healthcare, resulting in the development of new technologies. To achieve the 72 potential of mobile technology in healthcare, we have to identify methods for n patient engagement, to develop the necessary tools to streamline clinical integration and data analytics, and to outline the regulatory factors. There is a need pulatioo to evaluate which patients are suitable for device-based self-care. Mobile tech-ge p nology is argued to be an efficient and cost-effective solution for prevention, monitoring, and management. Technical and ethical concerns arise, which de-rking-ao mands structured verification and evaluation of mobile technology and the he w clinical impact of these technologies, due to overly positive promises. f t References ealth o ACETO, G., PERSICO, V. and PESCAPE, A., 2018. The role of information and communication technologies in healthcare: taxonomies, perspectives, pulacije | ho and challenges. Journal of Network and Computer Applications, vol. 107, pp. 125–154. Available from: https:/ doi.org/10.1016/j.jnca.2018.02.008 ktivne p BHAVNANI, S., NARULA, J. and SENGUPTA, P.P., 2016. Mobile technology and the digitization of healthcare . European Heart Journal, vol. 37, no. elovno a 18, pp. 1428–1438. Available from: https:/ doi.org/10.1093/eurheartj/ehv770 BIRKHOFF, S.D. and SMELTZER, S.C., 2017. Perceptions of smartphone zdravje d user-centered mobile health tracking apps across various chronic illness populations: an integrative review. Journal of Nursing Scholarship, vol. 49, no. 4, pp. 1–8. Available from: https:/ doi.org/10.1111/jnu.12298 CANNON, C., 2018. Telehealth, mobile applications and wearable devices are expanding cancer care beyond walls. Seminars in Oncology Nursing, vol. 34, no. 2, pp. 118–125. Available from: https:/ doi.org/10.1016/j.soncn.2018.03.002 CHIB A., HELENA M. and CAR J., 2014. mHealth adoption in low-resource environments: a review of the use of mobile healthcare in developing countries. Journal of Health Communications, vol. 20, no. 1, pp. 1–31. Available from: https:/ doi.org/10.1080/10810730.2013.864735 CVIRKEL, T., 2018. The ethics of mHealth: moving forward. Journal of Dentistry, vol 74, pp. S15–S20. Available from: https:/ doi.org/10.1016/j. jdent.2018.04.024 DENIS, F., LETHROSNE, C., POUREL, N., MOLINIER, O., POIN-TREAU, Y., DOMONT, J., BOURGEOIS, H.P., SENELLART, H., TREMO-LIERES, P., LIZEE, T., et al., 2016. Overall survival in patients with lung cancer using a web-application-guided follow-up compared to standard modalities: Results of phase III randomized trial. Journal of Clinical Oncology, vol. 34, no. 18. Available from: https:/ ascopubs.org/doi/abs/10.1200/JCO.2016.34.18_suppl. LBA9006 GREKIN, E.R., BEATTY, J.R. and ONDERSMA, S.J., 2019. Mobile health interventions: exploring the use of common relationship factors. JMIR mHealth uHealth, vol. 7, no. 4, pp. e11245. Available from: https:/ doi.org/10.2196/11245 KOIVUNEN, M. and SARANTO, K., 2018. Nursing professionals’ experiences of the facilitators and barriers to the use of telehealth applications: a sys-73 tematic review of qualitative studies. Scandinavian Journal of Caring Sciences, no. 32, pp. 24–44. Available from: http:/ dx.doi.org.nukweb.nuk.uni-lj.si/10.1111/ scs.12445. ealthcare LUCIVERO, F. and JONGSMA K.R., 2018. A mobile revolution for health-n h care? Setting agenda for bioethics. Political philosophy and medical ethics, vol. gy ilo 44, no. 10, pp. 1–5. Available from: https:/ doi.org/10.1136/medethics-2017-104741 echno NOURI R., NIAKAN KALHORI S.R., GHAZI SAEEDI M., MARCH-AND G. and YASINI M., 2018. Criteria for assessing the quality of mHealth bile to apps: a systematic review. Journal of the American Medical Informatics Associ-f m ation, vol. 25, no. 8, pp. 1089–1098. Available from: https:/ doi.org/10.1093/jamia/ use o ocy050 PHILIPS, A.B. and MERRILL, J.A., 2018. Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare. Journal of Biomedical Informatics, no. 58, pp. 114–121. Available from: http://dx. doi.org/10.1016/j.jbi.2015.09.014 QUDAH, B. and LUETSCH, K., 2019. The influence of mobile health applications on patient – healthcare provider relationships: a systematic, narrative review. Patient Education and Counseling, vol. 102, no. 6, pp. 1080–1089. Available from: https:/ doi.org/10.1016/j.pec.2019.01.021 https://doi.org/10.26493/978-961-293-015-8.75-83 Musculoskeletal disorders among preschool teachers Jera Gregorc, Mira Dolenc University of Ljubljana, Faculty of Education, Kardeljeva ploščad 16, 1000 Ljubljana, Slovenia jera.gregorc@pef.uni-lj.si Abstract Introduction: The profession of pre-school teacher (PST) is physically and mentally demanding and thus poses a risk to musculoskeletal disorders. The purpose of the study is therefore to determine how often musculoskeletal disorders occur among PST, which parts of the body are most affected, and to analyze whether there is a connection between pain perception and the risk factors. Methods: The research has included 155 PST from different kindergartens in the Central Slovenian region, who have answered questions from the reconstructed Cornell Musculoskeletal Discomfort Questionnaires CMDQ (German version: Kreuzfeld et al., 2016). The questionnaire was divided into 3 sections. The first part covered demographic questions, the second questions about stress and frequency and intensity of motor/sport activities, and the third part was a self-evaluation assessment of muscle and joint pain. Data were processed with the statistical package SPSS - 22.0. Descriptive and inferential statistics were used (Hi-square test of equal probabilities, t-test for independent samples, and bivariate correlation analysis). Results: We found out that more than half of PST detect musculoskeletal disorders, most commonly in the lower back (52%). PST more frequently and intensely perceive problems in the neck, shoulders and upper and lower back than in the arms or knees. We also found that those PST who evaluate their work more stressfully have more problems with muscle and joint pain. Among the most problematic pain-relieving activities, PST emphasized leaning, lifting of children, sitting on children’s chairs and squatting. Discussion and conclusions: Based on the data obtained, we believe it would be reasonable to offer PST of biomechanics education and training and the use of proper load-lifting techniques, to make ergonomic adjustments in the playroom, and to carry out shorter work-appropriate exercise programs. Keywords: musculoskeletal disorders, preschool teacher, risk factors Introduction The term musculoskeletal disorders (MSDs) refers to any discomfort, problem, or pain in the musculoskeletal system (Korhan and Memon, 2019). Joint and back pain are the most commonly self-reported impairments to health among the population of Slovenia and other developed parts of the world (NIJZ, 2014). The prevalence of lifelong back pain is 70 to 80 percent, and the prevalence is 25 to 45 percent in one year. At any given time, 15 to 20 percent of people experience back pain (Vengust, 2014). According to the World Health Organization, as many as 20% to 30% of people in the world live with muscle and joint pain, with lower back pain predominating (WHO, 2019). Risk factors for the emergence of MSDs are different and can act alone or in combination (Voglar and Šarabon, 2014). We roughly divide them in-to three groups (Voglar and Šarabon, 2014; Zamri et al., 2017; Jaafar and Rah-man, 2017): personality, psychosocial, and physical. Given that the nature of the 76 educator’s work is intertwined with all three groups of risk factors, it is possi-n ble to conclude that educators often have MSDs. Physical risk factors are most commonly associated with back pain due to the lifting and carrying children pulatio as well as moving furniture and sports equipment (Doan et al., 2017). Psycho-o social risk factors are associated with educators’ occupations due to time pres-ge p sures, meeting children’s needs, coping with conflict situations, working with rking-a children’s parents, and maintaining positive interpersonal relationships during o the simultaneous employment of an educator and an assistant (Ng et al., 2019). he wf t Working with children requires responsibility, a lot of energy, attention, alert-ness, sensitivity, and empathy, and so both stress and burnout occur among ed-ealth o ucators (Sottimano et al., 2018). However, personality risk factors do not represent significantly different adjustments and treatments as in other occupations. Frequency indices, which show the number of cases of absence from work pulacije | ho due to diseases of the musculoskeletal system and connective tissue, were slightly lower in the education sector until 2013 compared to all other business activ-ktivne p ities, and from 2014 up to and including 2018, they exceeded the values applying to all employees in Slovenia (National Institute of Public Health, 2019). In a elovno a systematic review of the literature, Erick and Smith (2011) found that the prevalence rate of MSDs among teachers and educators ranges between 40% and 95%. zdravje d Among the most endangered body segments are injuries to the back, neck, and upper extremities. Due to the prevalence of MSDs and growing problems in the education sector, and due to the simultaneous and intertwined risk factors for the development of MSDs among educators in this study, we wanted to find out how often and how intensely educators feel pain in muscles and joints, which parts of the body are most often affected and what the connection is of perceived pain with various risk factors. Methods A sample of respondents The sample of respondents was non-specific. The study involved 155 educators of pre-school children from various kindergartens in Slovenia, who respond-ed to the invitation to participate. Among them, 95.5% were women, and 4.5% were men. The breakdown of the age of the respondents was as follows: 26.5% of the surveyed educators were aged between 20 and 30, 34.8% were between 31 and 40, and 38.7% were aged 41 and over. 51.6% of the surveyed educators had been working from 0 to 10 years, 28.4% from 11 to 20 years, 8.4% from 21 to 30 years, and 11.6% from 31 to 40 years. More than half of the respondents, or rather 62.6%, worked in the second age group last year, while 37.4% worked in the first age group. A sample of variables 77 The sample of variables represents a combination of three sets of questions. s We compiled the first two sets ourselves, while the third represents a recon-eacher struction of the CMDQ questionnaire (Cornell Musculoskeletal Discomfort l t Questionnaires) (German version: Kreuzfeld et al., 2016). The first part contained demographic variables (gender, age, job, the total number of years in reschoo education, the age group in which they were employed in the last year), the g p second part contained questions about the assessment of job satisfaction, feel-mons a ings of stress and physical activities, while the third part covered questions on der the assessment of musculoskeletal disorders (perceptions of pain in individual isor parts of the body, and the activities in which pain is felt as well as the patient’s etal d sick leave). skel The organization and process of data collection usculom The survey questionnaire was sent by post in-line with prior arrangements with the kindergartens’ management. The educators participated in the research anonymously and voluntarily. In the end, the completed questionnaires were collected, and the data was entered into a computer. The entire process of data collection and processing took place anonymously. Methods of data processing The collected data was processed with the IBM SPSS Statistics 25 software package (Statistical Package for The Social Science). Descriptive statistics (averages, standard deviations, asymmetry and flatness coefficients, minima, maxima) and inference statistics (Hi-square test of equal probabilities, t-test for independent samples, as well as bivariate correlation analysis) were used for processing. Results We will first present the frequency and intensity of MSD educators in our sample. Then a set of questions about satisfaction, fatigue, and stress at work as well as a set about the physical activity of educators. Finally, we will show the connection between them. The frequency and intensity of MSD among educators Table 1: A self-assessment of the frequency and intensity of MSD pain in different parts of the body among educators. Frequency Intensity Average No. of de- T-test T-test viations for one sample Average No. of de- viations for one sample (t = 3.22) (t = 3.01) 78 (x̄) (σ) t p (x̄) (σ) t p neck 2.65 1.365 -5.18 0.00 2.54 1.31 -4.36 0.00 n shoulders 2.67 1.395 -4.90 0.00 2.50 1.23 -5.01 0.00 the upper part pulatioo of the back 2.79 1.332 -3.98 0.00 2.55 1.21 -4.65 0.00 ge p the lower part of the back 3.23 1.219 +0.07 0.94 3.01 1.25 +0.03 0.98 knees 2.02 1.189 -12.48 0.00 1.98 1.18 -10.61 0.00 rking-ao hands 1.93 1.193 -13.39 0.00 1.90 1.15 -11.79 0.00 he wf t Legend: x̄ - average value on a five-point scale, σ - standard deviation, t - t-test value; p - statistical insignificance (p ≤ 0.05) ealth o Educators assessed the frequency and intensity of pain in each part of the body on a five-point scale. Table 1 shows that, on average, in the last year, they pulacije | ho experienced the lowest frequency and intensity of knee and arm pain, followed by neck and shoulder pain. Both the frequency and intensity of pain is greatest ktivne p in the upper and lower back. The frequency and intensity of pain are statistically and significantly different from the average in all parts of the body except elovno a the lower back, which means that educators statistically and typically most often and most intensely feel pain and discomfort in the lower back. zdravje d Satisfaction, fatigue, and stress Educators were then asked about satisfaction, fatigue, and stress in the workplace. We found that the vast majority are satisfied, or rather 94.9% of educators are very satisfied or satisfied with their work. The average value on the 5-point satisfaction scale is 4.46, with a standard deviation of 0.65. An analysis of the questions related to fatigue shows that 63.8% of educators are often and occasionally tired at work, while 29% are rarely tired. The average value on the 5-degree fatigue scale is 3.12, with a standard deviation of 0.93. The analysis of questions about stress shows that 44.5% of educators experience the work of an educator as moderately stressful, 29.7% quite stressful, 16.1% slightly stressful, and 8.4% very stressful. 1.3% of educators do not experience work as stressful. Physical activity Analysis of the data shows that 58.0% of educators are often or very often physically active, while 41.9% are occasionally, rarely, or never physically active. In 51.0% of the respondents, the intensity of exercise is medium, in 31.3% it is high or very high, while in 18.7% it is low or very low. From the data analysis, we can also determine the assessment of the frequency and intensity of the physical activity of the educators, namely on a 5-point scale where the frequency is estimated with x = 3.70 (σ = 0.90) and the intensity x̄ = 3.13 σ = 0.84). Analysis of the relationship between the frequency and intensity of MSD with selected risk factors 79 We discovered an association between the assessment of the experience of s stress and the frequency of pain perceived in different parts of the body. We found that there was a statistically significant, weak positive association (at a eacher characteristic level of p <0.01) between the assessment of workplace stress and l t the frequency of perceived problems or discomfort in the neck (r = 0.272), x in the shoulders (r = 0.301), in the upper back (r = 0.312), in the lower back x x reschoog p (r = 0.289), in the knees (r = 0.324) and in the arms (r = 0.354). With an in-x x x crease in the feeling of experiencing stress, the perception of problems in the mons a neck, shoulders, upper and lower back, knees, and arms are also statistical-der ly significantly more frequent. Relationships between physical activity and in-isor tensity or rather the frequency of pain was not confirmed. Analysis of t-test etal d results for dependent samples (t = 1.839, p = 0.068) also did not reveal differ-skel ences in the intensity and frequency of pain between educators of the first and second age groups. usculom Discussion In the research, we wanted to analyse the frequency and the degree of intensity of pain in individual parts of the body and to determine a possible connection between these and the experience of stress, physical activity, and the age of children where the educators are employed. Based on their own self-assessment, educators evaluated the frequency and intensity of pain they perceived in individual parts of the body over the past twelve months. 91.6% of educators noticed pain in the lower back, 76.8% in the upper back, 75.5% in the neck, 74.2% in the shoulders, 53.5% in the knees, and 48.4% in the arms. Compared to other studies (Ng et al., 2019; Converso et al., 2018; Koch et al., 2015), educators in our study expressed similar or more frequent, but more intense pain. Converso et al. (2018) found that when working with children, educators most often experience pain in the upper back (84%), followed by the neck (75.6%), lower back (56.3%), shoulders (49.6%) and the knees (38.7%). Sottimano et al. (2018) pointed out that 63.3% of educators have cervical pain and 67.5% lumbosacral pain. Koch et al. (2015) found aut that 40% of educators have lower back pain, followed by neck and shoulder pain. Pirbalouti et al. (2017) found that 30.5% of educators have pain in the lower back and slightly less in the neck and shoulders. With additional analysis, we found in our sample of educators that the frequency and intensity of lower back pain were statistically and significantly predominant over other parts of the body. Although the causes of pain cannot be found exclusively in the work environment, as they are also influenced by personality and other risk factors, work in kindergarten still involves quite a few psychosocial (Sottimano et al., 2018; Converso et al., 2018) and physical (Mayer et al., 2012) risk factors. An analysis of our survey data showed that as many as 67.6% of educators believe that lower back pain is related to their work, and a good half (52.3%) believe that the work environment is the cause of upper back pain. Regarding pain in the neck, shoulders, arms, and knees, however, most educators believe that the cause of 80 them does not come from the work they do. n In the second part, we determined the level of satisfaction, fatigue, and experience of stress at work. All three factors are classified as psychosocial risk pulatioo factors for MSD (Hauke et al., 2011). The results of the survey showed that as ge p many as 94.9% of educators are satisfied or very satisfied at work, so we believe that the factor of satisfaction at work could not be defined as one of the risk fac-rking-ao tors for MSD among educators. On the other hand, as many as 70.3% of edu-he w cators are occasionally, often, or very often tired at work. Fatigue is shown in a f t decrease in efficiency and functionality and in a decrease in work motivation and an increased feeling of being overloaded. Fatigue can disrupt the function-ealth o ing of biological functions and the mental state of the personality (Balantič et al., 2016). Therefore, fatigue can also contribute to a greater psychological bur-pulacije | h den on employees. o In the third part, we determined the frequency and intensity of the phys-ktivne p ical activity of educators. Various studies emphasize the importance of physical exercise and its preventive and curative impact on MSD (Chatzitheodorou et al., 2007; Erick and Smith, 2013; Kim et al., 2015; Rošker et al., 2014; Voglar elovno a and Šarabon, 2014). We found that 58.0% of educators are often or very often physically active, and 41.9% are occasionally, rarely, or never physically active. zdravje d In the last part, we examined the possible connections between selected risk factors (physical inactivity, stress, fatigue, type of work) with the frequency and intensity of MSD. We found a weak positive association between the experience of stress and the frequency and intensity of pain in some parts of the body. We were unable to confirm a negative or positive association between physical activity and the frequency and intensity of pain. We also failed to confirm a connection with the type of work or rather the age group of children. Given the nature of work in the first age group, which frequently involves lifting children to changing tables, highchairs, cribs, and generally more assistance in meeting children’s basic needs, we expected educators working in the first age group to have more problems with muscle and bone pain. Converso et al. (2015), who examined differences between first and second age educators in psychophysical health, found that first age educators are more likely to complain about milder forms of MSDs. Conclusions A synthesis of the results directs us to consider the reasons for an increase in the presence of MSD among educators. Further research and comparisons in relation to the rise of MSDs in comparable occupations are necessary. It would make sense to research what is known about preventive measures and their degree of compliance. References BALANTIČ, Z., POLAJNAR, A. and JEVŠNIK, S., 2016. Ergonomija v teoriji in 81 praksi. 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Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia. Plos One, vol. 12, no. 2. 83 s eacherl t reschoog p mons a der isor etal d skel usculom https://doi.org/10.26493/978-961-293-015-8.85-93 Ensuring Safe Food Preparation among Slovenian Consumers Mojca Jevšnik1, Lucija Pirc1, Peter Raspor2, Karmen Godič Torkar1 1University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia 2Retired Professor mojca.jevsnik@zf.uni-lj.si; pirc.lucija@gmail.com; karmen.torkar@zf.uni-lj.si; peter.raspor@guest.arnes.si Abstract Introduction: According to EFSA, most foodborne diseases still develop at home. Consumers have insufficient knowledge of food safety and fail to transfer it properly into daily practice. The purpose of the research is to identify consumers’ food safety knowledge and attitudes, their handling of selected foods and the hygiene in the kitchen. Methods: The mixed method approach was used. The knowledge of 380 consumers was examined with a survey questionnaire. In the second part of the study we observed 16 consumers during their preparation of specific foods, using an observation checklist. Eight consumers were older than 65, while eight were younger than 35 with small children. The hygiene conditions in the consumers’ kitchens were examined using contact agar plates for determination of the number of different groups of microorgansims, while the cleaning adequacy was determined by measuring the ATP bioluminescence. Results: A lack of knowledge on certain topics regarding food safety was established; the consumers aged 36 to 55 and women demonstrated the highest level of knowledge. In some cases, the consumers who were being observed did not take proper action when preparing the food and therefore increased the risk of the cross-contamination of foods, food contact surfaces and kitchen utensils. Most consumers believe that they prepare foods according to food safely requirements. The increased number of total bacterial count, coliform bacteria and the Escherichia coli bacteria was detected in only 12.75% of consumers’ kitchens observed. The results of ATP measurements showed that more than half of the samples of surfaces were not cleaned satisfactorily. Discussion and conclusions: Greatest emphasis has to be put on the cleaning of home kitchens. Even though consumers have some knowledge on food safety (e.g. preventing cross-contamination, storing leftovers, using separate kitchen towels), they often fail to put that knowledge into practice. Consumers should pay more attention to personal hygiene, especially to washing their hands more often and more thoroughly. They should clean surfaces for food preparation, utensils, cutlery and dishes in their kitchens more thoroughly and promptly. They should pay more attention to preventing cross-contamination from surfaces that come into contact with food. Keywords: Consumers, Food safety, Hygiene, Knowledge Introduction An integrated approach is essential for food safety, as it takes into account the fact that food supply is linked to the food supply chain from farm to fork. Consumers also play an important role in ensuring food safety, as they represent the final link in this food supply chain (Jevšnik et al., 2008). Among all reported cases of foodborne infections and poisonings in the European Union, the European Food Safety Authority (EFSA, 2018) in its annual report highlighted inadequate heat treatment of food as the main known cause of disease in 86 households. The second most common cause was an inadequate food storage n temperature. As an important cause of infections and food poisoning, they al-so pointed out food hygiene, which includes cleaning, washing and handling of pulatioo food during its preparation. ge p Many consumers are unaware of the fact that also their home environment poses a risk of foodborne disease outbreaks (Byrd-Brebenner et al., 2013). rking-ao Research findings show that consumers most often associate foodborne disease he w with the catering industry or food establishments (Jevšnik et al., 2013). Most f t of the food is prepared by consumers at home (Byrd-Brebenner et al., 2013), so knowledge about food preparation in their home kitchen is all the more im-ealth o portant, as it reduces the likelihood of foodborne diseases (Meysenburg et al., 2014). Proper consumer behaviour in food preparation is, in addition to the pulacije | ho knowledge of food hygiene, a key element in ensuring consumer safety (Ovca et al., 2014; Jevšnik et al., 2013; Kendall et al., 2013). The lack of knowledge and ktivne p mishandling of food during preparation is more common in consumer groups of young adults (18 to 29 years), men, and people older than 60 years (Jevšnik elovno a et al., 2008; Leal et al., 2017). In studies that gathered data through questionnaires and by observing consumers during food preparation, it was observed that many consumers correctly answered questions about food safety and good zdravje d hygiene practice. However, the results of observing consumers during food preparation show that they often act contrary to what they state in the questionnaires (Tomaszewska et al., 2017; Mazengia et al., 2015; Sampers et al., 2012; Clayton & Griffith, 2004), the chances of foodborne infections are thus much higher than shown in epidemiological data (Lange et al., 2016; Byrd-Brebenner et al., 2013; Kendall et al., 2013). Irregularities in food handling at home are related to improper hand washing, improper separation of equipment and utensils, inadequate food storage, cross-contamination and insufficient heat treatment of food (Odeyemi et al., 2019; Gong et al., 2016; Burke et al., 2016; Bearth et al., 2014; Ergonul, 2013; Jevšnik et al., 2008). The purpose of our research was to determine the knowledge of consumers about providing safe food, their behaviour during the preparation of selected foods and the hygienic conditions in home kitchens. Due to the scope of the research, the paper presents only the results of a questionnaire on consumer knowledge of food safety. Methods Consumer surveys on ensuring safe food preparation To test consumers’ knowledge of food safety, we used a validated questionnaire, mostly based on a questionnaire from the Food and Drug Administration (2010). Additional questions were added in order to compare the data with the previous Slovenian survey on consumer knowledge of food safety from 2008 (Jevšnik et al., 2008). The questionnaire was entered into the 1KA online survey application and a web link to the survey questionnaire was sent to consumers via e-mail 87 and social networks. A t-test for independent samples with the significance lev-s el of p < 0,05 was used for the statistical analysis of the obtained data. er sumon Results ian c Due to the scope of the research, the paper presents only the results regarding loven consumer knowledge in the field of food safety. The online survey was started g s in November 2018 and completed in April 2019. Only relevant units that were mon fully (n = 260) or partially completed (n = 80), a total of 340 survey, were used a for the analysis of the questionnaire. The largest number of respondents who aration completed the questionnaire was from the first age group (n=171, 50%), followed rep by respondents from the second age group (n = 107, 31 %) and from the third age d p group (n=62, 19 %) (Table 1). oo afe f Demographic data suring s Table 1 shows the demographic data of the surveyed consumers, i.e. age groups, en level of education and gender. Table 1. Demographic data of surveyed consumers (n = 340) Survey questionnaire n % Age groups 1st age group (18 to 35 years) 171 50 2nd age group (36 to 55 years) 107 31 3rd age group (over 56 years) 62 19 Level of education Primary, secondary and higher education 185 55 University education, master’s degree, doctorate 155 45 Gender Men 63 19 Women 277 81 Results of the questionnaire Important results of the questionnaire are presented separately according to content areas. We begin by establishing that more than half of the respondents (65 %) believe that foodborne diseases are rare in domestic households. 62 % of respondents believe that people more often get infected and/or poisoned by food consumed in restaurants. Washing hands The questionnaire found that 60 % of consumers always wash their hands before preparing food, while the rest almost always (31 %) or sometimes (9 %) wash their hands. Statistically significant differences in hand washing were found between the age groups of respondents, as half of consumers from the 1st age group and almost two thirds from the 2nd and 3rd age groups always 88 wash their hands (p = 0.024, r = -0.111) (Figure 1). n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d Figure 1: Shares (%) of respondents’ answers regarding hand washing before food preparation by age groups (n = 290). Among the 290 respondents, 26 % wash their hands for 10 seconds or less, 46 % for 11 to 20 seconds, 10 % for 20 seconds or more, while the others pay no attention to the washing time. Significantly, more men (43 %) than women (23 %) wash their hands for only 10 seconds or less, while a higher proportion of women (20 %) than men (6 %) do not pay attention to the time of wash- ing hands. It is statistically proven that women wash their hands longer than men (p = 0.008). After washing their hands, 37 % of the respondents use a kitchen towel to wipe their hands, followed by those who use paper towels (26 %) and those who use a kitchen towel that is also used to dry the dishes (22 %). Statistically significant differences were observed between age groups (p = 0.042, r = 0.125) and levels of education (p = 0.006, r = 0.107). Improper wiping of hands with a kitchen towel that is used for the dishes is the most common with consumers from the 1st age group (29%) and those with a university degree, master’s degree or doctorate (27 %). Paper towels are most often used by consumers from the 3rd age group (34 %) and those with completed primary, secondary or higher education. Washing food cutting board after use 89 Half of consumers in the 2nd age group (51 %) use a second vegetable cutting s board after cutting red meat or poultry. A second cutting board is used by 44 % er of respondents in the 1st age group and only 33 % of respondents in the 3rd age sumon group of over 56 year olds (p = 0.027, r = -0.103). After use, 44 % of the respondents wash the board with detergent and warm water (38% of all women and 27% ian c of men surveyed), and 17 % of respondents wash it only with water, more men loven (29 %) than women (11%) (p < 0.001, r = -0.220) and most of the consumers from g s the 3rd age group (23 %). mon a Knowledge of appropriate temperatures aration rep About a third (30 %) of surveyed consumers have a thermometer in their home d p refrigerator to measure its temperature. 51 % of the respondents do not know oo the temperatures in their refrigerators. Among those who state that they have a afe f thermometer, just over a half of them (54 %) know the temperatures. As many as 40 % of the respondents never check the temperature, or they only check it suring sen when the food is too warm or too cold to the touch (32 %), the rest check the temperature daily, once a month or weekly (28 %). The respondents were asked to indicate the temperature in their home refrigerator. The mean value of the temperatures reported was 5.4 °C, the highest 18°C and lowest -20°C. Most consumers (31 %) stated that the temperature was 5 °C. Respondents clean refrigerators as needed (68 %), every month (22 %) or once a week (9 %). Knowledge of microorganisms found in home kitchens The best knowledge of microorganisms was found in younger consumers from the 1st age group, and the least in respondents from the 3rd age group. The bacteria Yersinia enterocolitica (79 %), Bacilus cereus (75 %) and Clostridium per-fringens (71 %) , are the least known, while Salmonella (96 %), Escherichia coli O157 (56 %) and Staphylococcus aureus (40 %) are the best known. Consumers with a university degree or more are best acquainted with the selected microorganisms. Food thawing Frozen meat is properly thawed by 52 % of respondents (34 % in the refrigerator, 11 % under running cold water and 7 % in the microwave oven). 42 % of respondents defrost meat on the kitchen counter, while 6 % of respondents never defrost frozen meat. Food handling after heat treatment 50 % of respondents leave the prepared dish at room temperature for less than two hours to cool down, 28 % of them for more than two hours and 21 % pay no attention to it. The majority of consumers surveyed (88 %) handle roasted meat correctly, as after heat treatment they do not put it in the container in which 90 the raw meat was stored. n Discussion pulatioo The aim of the research was to determine the knowledge of consumers about ge p ensuring food safety. It was assumed that consumers with a higher level of education would have more knowledge in the field of food safety, but this can-rking-ao not be fully confirmed, as it was found that there are only certain areas where he w consumers with a higher level of education (university education and more) f t show better knowledge than those with a lower level of education (primary, secondary or higher school). These areas are: knowledge of microorganisms ealth o that can cause food contamination, wiping hands after washing, and food defrosting procedures. The Food Safety Survey by the Food and Drug Adminis-pulacije | h tration (2010) found that food is handled the least safely by the youngest Amer-o ican consumers, by the oldest and by those with the highest level of education. ktivne p Proper hand washing before and during food preparation is done more consistently by female consumers than by male ones, as 62 % of women and 51 elovno a % of men always wash their hands before preparing food. If we compare the results with a previous study among Slovenian consumers conducted by Jevšnik and co-workers (2008), we see that the majority of consumers (86 %) always zdravje d wash their hands before preparing food. Our present research came to poorer results, as only 60 % of all respondents always wash their hands before preparing food. In the study by Jevšnik et al. (2008), it was found that more than half of consumers wash their hands for less than 10 seconds, which is almost half more than in this recent study, where about a quarter report hand washing time of less than 10 seconds. 67 % of respondents wash their hands with soap and warm water after handling raw red meat, chicken or fish, which is more than in the study by Jevšnik et al., where that share was 57 %. In our recent study, it was found that 30 % of the respondents have a thermometer in their home refrigerator to check the temperature. Better results are shown in a survey of American consumers, where 42 % of respondents have a thermometer in the refrigerator, with an average temperature of 3.6 °C (Food and Drug Administration, 2010). The average temperature stated by the surveyed consumers in our study is slightly higher and amounts to 5.4 °C. Half of the respondents stated that they are not familiar with the temperatures in home refrigerators. 40 % of the respondents never check the temperature, followed by those who check the temperature when the food is too hot or too cold to the touch. The questionnaire results show that slightly less than half of the respondents defrost food at room temperature, while the rest carry out the procedure correctly, in the refrigerator, under running cold water or in the microwave ov-en. Lower results were reported by Sterniša et al. (2018) and Jevšnik et al. (2008), where almost three quarters (73 %) or half (50 %) of respondents thawed frozen meat at room temperature. Studies from abroad found that meat is thawed at room temperature by 44 % of Nigerian consumers (Adebowale et al., 2017), 47 91 % of African and Asian consumers (Odeyemi et al., 2019) and 73 % of consult-ser ed Belgian consumers (Stratev et al., 2017), as well as more than half of Turkish sum consumers (Ergonul, 2013). on The best knowledge of microorganisms that can cause foodborne diseas-ian c es is shown in consumers younger than 35 years, which can be attributed to the loven fact that they have greater access to information than older consumers. In gen-g s eral, the knowledge of pathogenic microorganisms is poor. More than half of mon the surveyed consumers know only two types of bacteria, namely Salmonel-a la and Escherichia coli O157, which is more than noted by Gong et al. (2016), as aration more than half of Chinese consumers have never heard of these bacteria. repd p oo Conclusion afe f The study provided insight into consumer knowledge about how to ensure food safety when working with food at home. Deficiencies were found in the suring s consumers’ knowledge regarding food defrosting procedures, food hygiene, en knowledge about pathogenic microorganisms in food, the use of thermometers in refrigerators and checking the core temperature of food during heat treatment. The highest level of knowledge was shown by consumers aged 36 to 55, in particularly female showed better performance. Respondents are largely convinced that foodborne infections occur primarily in restaurants, not at home. Statistics by the European Food Safety Authority show just the opposite. The largest share of infections occur at the end of the chain, on the consumers’ side. 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Food Control, vol. 85, pp. suring s 76–84. en https://doi.org/10.26493/978-961-293-015-8.95-101 The role of information and communication technology in self-management of type 2 diabetes Filip Krajnc, Maruša Magister, Klara Nartnik, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia krajncfilip@gmail.com, marusa.magister04@gmail.com, klaraaara@gmail.com, andrej. starc34@gmail.com Abstract Introduction: Type 2 diabetes is a chronic disease which represents a substantial burden on healthcare across the world. The use of information and communication technology (ICT) in self-management of diabetes is becoming more common, as it enables effective self-management and control over your health. Technology such as computers, smart phones, tablets and mobile apps can overcome time and location barriers by monitoring data such as blood glucose levels from home and can establish communication between patients and healthcare personnel. Previous studies have shown that despite numerous benefits, prevalence of ICT use in self-management of type 2 diabetes is low. Methods: The descriptive research method with a systematic literature review was used in the following databases: Google Schoolar, PubMed, CINAHL and Medline. The search proceeded with the help of Boolean logical operator AND, together with the key words: »Patient«, »Type 2 Diabetes«, »Self-management«, »Information and communication technology«. A systematic literature review was conducted in the first half of March 2020. PRISMA methodology was used to display decisions about usefulness of reviewed sources and seven of those sources were selected for further analysis. Results: Patients with type 2 diabetes are willing to use ICT and are aware of its benefits, but the prevalence remains low. Ignorance about computers, smart phones or more specifically mobile apps and the possibility of personal information breaches are the most common barriers to ICT use. Results show that the use of ICT contributes to a statistically significant reduction of glycated hemoglobin (HbA1c), however studies are divided about the reduction of body weight and body mass index (BMI). Patients want ICT to include different communication channels, enable possibilities for exchanging experiences and connection with different healthcare systems and to offer written and visual individualized information about their disease. Discussion and conclusions: Because the use of ICT enables simpler monitoring of diabetes and reduces the possibilities of complications, its use is becoming ever more necessary, due to the fast ageing population and an increasing rate of chronic disease. This way of self-managing disease will simplify medical treatment for patients living in the countryside because of faster and easier access to medical assistance. In addition, healthcare personnel will be relieved of unnecessary treatment and will be able to take preventative measures faster and more easily through continuous patient monitoring. Developing new ICT for the management of chronic diseases such as type 2 diabetes requires collaboration between healthcare personnel and ICT experts; in addition, we must consider the patient’s wishes and needs. Keywords: patient, type 2 diabetes, self-management, information and communication technology 96 Introduction n Type 2 diabetes mellitus (T2DM) is a chronic disease that represents a major cause of morbidity and mortality and has a substantial burden on healthcare pulatioo across the world (WHO – World Health Organization, 2018). In 2019 the prev-ge p alence of diabetes was estimated to be 9,3 % worldwide (463 million of people) and by 2030 they expect an increase to 10.9 % (700 million of people) (Saeedi et rking-ao al., 2019). Improperly managed diabetes leads to serious damage to the heart, he w blood vessels, eyes, kidneys, nerves, and limb amputation (WHO, 2018). Ac-f t tive and efficient management of diabetes, which can be exceedingly difficult (Nyenwe et al., 2011), is key to prevent or minimize these complications (CDC ealth o – Centers for Disease Control and Prevention, 2019). Information and communication technology (ICT) is generally defined as technology used to commu-pulacije | h nicate, manipulate, and store data by electronic means (Perron et al., 2010). The o use of ICT is becoming more common, as it enables effective self-management of diabetes, patient empowerment, and control over your health (Yamaguchi et ktivne p al., 2019). ICT such as computers, smart phones, tablets, and mobile apps can overcome time and location barriers by monitoring data such as blood glucose elovno a levels from home (Arnhold et al., 2014), establish communication between patients and healthcare personnel and help patients learn more about their ongo-zdravje d ing self-care (Cui et al., 2016). Methods We conducted a systematic literature review with a descriptive analysis of the sources. The literature was searched in the following databases: Google Scholar, PubMed, CINAHL, and Medline. Keywords used to search for relevant articles included: “Patient”, “Type 2 Diabetes”, “Self-management”, and “Information and Communication Technology”. The search proceeded with the help of Boolean logical operator AND for connecting the search terms. English-language articles, published between 2015 and 2020 that were available in full, 97 iabetes ype 2 d Figure 1: PRIZMA diagram f t were identified and reviewed. PRISMA methodology (Figure 1) was used to dis-ent o play decisions about the usefulness of reviewed sources. anagem elf-m Results n s Results of a descriptive analysis of the studies are presented in Table 1. gy ilo Table 1: Overview of studies echno n t Author Purpose of research Methodology Results Participants who received unicatiom smartphone-based self-man- mo agement intervention had better self-efficacy, self-care nd c Aminud- To determine the effective- activities, health related qual- n a din et al., ness of smartphone-based A systematic review and meta-analysis. ity of life and lower glycat- atio 2019 interventions. ed haemoglobin compared rm to the control group. The ef- nfo fects on body mass index and f i blood pressure were not sta- le o tistically significant. o the r Author Purpose of research Methodology Results ICT reduce health care per- sonnel’s workload and enable To identify the ICT tools faster and easier completion Ayanlade used for diabetes manage- Questionnaire, observation, of their daily tasks. Patients et al., 2019 ment and assesses the level of and structured interviews. acknowledge the usefulness adoption of the tools. of ICT because it helps with their disease management plans. ICT self-management service needs to offer different com- Gardsten To identify patients’ wish- Participatory design: Future munication channels, pos-et al., 2017 es and needs for an ICT sibilities for exchanging ex- self-management service. workshop method. periences and written and visualized individualized in- formation. Patients had positive percep- Georgss- tions toward ICT tool. After 6 To understand patients‘ per- Descriptive study us- months of using the ICT tool 98 son and Staggers, ceptions of using ICT for dia- ing a questionnaire and they saw clear benefits in us-betes self-management. semi-structured interview. ing the technology and had n 2017 favourable behavioural dis- ease outcomes. pulatioo Clinical evaluation after 3 months of intervention ge p To evaluate impact of ICT showed statistically signifi- Lehocki et on clinical outcomes (glycat- Prospective, non-interven-tional, observational, multi- cant change of HbA1c in both rking-a al., 2015 ed haemoglobin (HbA1c) and patient groups. Results also o metabolic parameters). centre study. showed statistically signifi- he w cant tendency to decrease in f t weight and BMI. Barriers to ICT adoption for ealth o diabetes self-management are: expensive ICTs, lack of To identify the technological literacy, partic- Petersen et challenges and barriers for Qualitative study with semi ipants’ perceptions that mo- pulacije | ho al., 2018 the adoption of ICT tools for structured interviews. bile technologies are useless, diabetes self-management. the mistrust of technology and the preference for face- ktivne p to-face interaction with med- ical staff. Only 16 % patients with dia- elovno a betes currently use ICT and a total of 50 % expressed the To examine the prevalence willingness to use ICT in fu- zdravje d ture. Factors associated with Shibuta et and patient characteristics as- A cross-sectional interview the willingness are not having al., 2017 sociated with willingness to use ICT in self-management survey. nephropathy, outpatient visits of diabetes. once a month or more, cur- rent use of personal comput- ers and/or smartphones and having greater diabetes relat- ed emotional distress. Discussion Prevalence of patients using ICT-based self-management tools is low (16 %) (Shibuta et al., 2016). The most common tools they used were applications, spreadsheet software and pedometer functions in mobile phones. On the other hand, most of the patients with type 2 diabetes were willing to use ICT-based tools in future and thought it is useful (Shibuta et al., 2016). In the study from Georgsson and Stagegers (2017) patients saw clear benefits in using the technology and had favourable behavioural disease outcomes after 6 months using ICT-based self-management tool. These types of tools were also accepted by the health care personnel, who claimed it helped them with continuous monitoring of the patient’s health status, especially for patients that live in the countryside. It also helps take preventive measures sooner, relieve them unnecessary work and enables faster and easier accomplishment of their daily tasks (Ayanlade et al., 2019). Psychosocial factors which influence patients’ willingness to use ICT are the patients’ attitude toward ICT, the effectiveness and level of expected success of such technology, and the strive imported by the patients (Shibuta et al., 2016). Other factors associated with the willingness are not having nephropathy, frequent visits to diabetes physicians once a month or 99 more and current use of personal computers and/or smartphones (Shibuta et al., 2016). Patients suggested that ICT should include different communication channels, enable possibilities for exchanging experiences and connection with iabetes different healthcare systems and to offer written and visual individualized in-ype 2 d formation about their disease (Gardsten et al., 2017). Patients were unwilling to f t use an ICT based self-management tool because it seemed burdensome, diffi-ent o cult to use and too complex, especially for older patients. For some patients it seemed boring, ineffective, and too time consuming. Others thought that their anagem current self-management activities were enough for them or their health con-elf-m dition did not allow them to use ICT based tools (Shibuta et al., 2016; Petersen n s et al., 2018). Other barriers included fear of data insecurity, mistrust of technol-gy ilo ogy and the preference of face-to-face interaction with health care personnel (Petersen et al., 2018; Ayanlade et al., 2019). It was shown that patients found echno ICT based tools helpful in making diabetes self-managment plans (Ayanlade et n t al., 2019). They also used ICT to facilitate data logging and as an incentive for better adherence to disease management principles. Studies show that the use unicatiom of ICT contributes to a statistically significant reduction of glycated haemoglo-mo bin (HbA1c) (Lehocki et al., 2015; Aminuddin et al., 2019). Patients that used nd c ICT-based self-management tools also showed better self-efficacy, self-care ac-n a tivities and health related quality of life (Aminuddin et al., 2019). Studies are atiorm however divided about the reduction of body weight and BMI (Lehocki et al., nfo 2015; Aminuddin et al., 2019). f i le oo Conclusion the r Patients with diabetes are aware of ICT’s benefits, importance, and usefulness in self-management, yet its usage remains low. ICT has a positive effect on both patients and health care personnel. It is a matter of fact that ICT is becoming more necessary, due to the fast ageing population and an increasing rate of chronic diseases. Therefore, it is important to know and understand the res- ervations patients with diabetes have toward ICT, so they can be successfully eliminated. When developing new and improved ICT we must consider the patients’ needs and wishes. References AMINUDDIN, H.B., JIAO, N., JIANG, Y., HONG, J. and WANG, W., 2019. Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and me-ta-analysis [in press]. International journal of nursing studies. [viewed 19 April 2020]. Available from: 10.1016/j.ijnurstu.2019.02.003 ARNHOLD, M., QUADE, M. and KIRCH, W., 2014. Mobile applications for diabetics: a systematic review and expert-based usability evaluation con-0 sidering the special requirements of diabetes patients age 50 years or old-10 er [online]. Journal of Medical Internet Research, vol. 16, no. 4, pp. e104. n [viewed 3 May 2020]. Available from: http://dx.doi.org/10.2196/jmir.2968 AYANLADE, O.M., OYEBISI, T.O. and KOLAWOLE, B.A., 2019. Health infor-pulatioo mation technology acceptance Framework for diabetes management [on-ge p line]. Heliyonvol. 5, no. 5, pp. e01735 [viewed 7 May 2020]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539785/ rking-ao CDC – CENTERS FOR DISEASE CONTROL AND PREVENTION, 2019. he w Put the brakes on diabetes complications [online]. [viewed 20 May 2020]. f t Available from: https://www.cdc.gov/diabetes/library/features/prevent-complications.html ealth o CUI, M., WU, X., MAO, J., WANG, X., NIE, M. and BARENGO, N.C., 2016. 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PETERSEN, P., PATHER, S. and TUCKER, W.D., 2018. User acceptance of ICT for diabetes self-management in the Western Cape, South Africa [online]. 1 [viewed 3 May 2020]. Available from: https://www.researchgate.net/pub-10 lication/326368952_User_acceptance_of_ICT_for_diabetes_self-man-agement_in_the_Western_Cape_South_Africa iabetes SAEEDI, P., PETERSOHN, I., SALPEA, P., MALANDA, B., KARURANGA, S., UNWIN, N., COLAGIURI, S., GUARIGUATA, L., MOTALA, A.A., ype 2 df t OGURTSOVA, K., et al., 2019. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the ent o International Diabetes Federation Diabetes Atlas, 9th edition. [online]. Diabetes Research and Clinical Practice, vol. 157. [viewed 10 June 2020]. anagem Available from: http://dx.doi.org/10.1016/j.diabres.2019.107843 elf-mn s SHIBUTA, T., WAKI, K., TOMIZAWA, N., IGARASHI, A., YAMAMOTO-gy i MITANI, N., YAMAGUCHI, S., FUJITA, H., KIMURA, S., FUJIU, K., lo WAKI, H., et al., 2017. Willingness of patients with diabetes to use an echno ICT-based self-management tool: a cross-sectional study [online]. BMJ n t Open Diabetes Research & Care, vol. 5, pp. e000322. [viewed 17 April 2020]. Available from: http://dx.doi.org/10.1136/bmjdrc-2016-000322 unicatiom WHO – WORLD HEALTH ORGANIZATION, 2018. Diabetes. Key facts [on-mo line]. [viewed 23 May 2020]. Available from: https://www.who.int/news-nd c room/fact-sheets/detail/diabetes n a YAMAGUCHI, S., WAKI, K., NANNYA, Y., NANGAKU, M., KADOWA-atiorm KI, T. and OHE, K., 2019. Usage patterns of GlucoNote, a self-manage-nfo ment smartphone app, based on ResearchKit for patients with type 2 f i diabetes and prediabetes [online]. JMIR mHealth and uHealth, vol. 7, le oo no. 4, pp. e132004. [viewed 22 May 2020]. Available from: http://dx.doi. the r org/10.2196/13204 https://doi.org/10.26493/978-961-293-015-8.103-107 Relationship between breathing exercises and quality of life in adults – integrative literature review Eva Lenart1, Karin Vrtar1, Sabina Ličen1, Milan Hosta2, Matej Plevnik1 1 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia 2 TEDU Institute, Žabnica 82C, 1357 Notranje Gorice, Slovenia ewa.lenart.1@gmail.com; karin.vrtar@gmail.com; sabina.licen@fvz.upr.si; milan.hosta@spolint.org; matej.plevnik@fvz.upr.si Abstract Respiratory disorders are a common occurrence in adults, also occurring in people without medically diagnosed medical conditions. The most common is the hyperventilation syndrome, which is present in 6% to 10% of adults and has an impact on health. The purpose of our study was to review the literature on the association of breathing exercises with improving lung function and to assess the quality of life in adults. The research used an integrative review of the scientific literature. 7 relevant studies were identified. The results suggest a connection among breathing exercises, the quality of life and the improvement of lung function, as well as between breathing exercises and the decrease in the number of hyperventilation attacks, the improvement of lung capacity and the improvement of body component of the assessment of the quality of life and the decrease in ambulance visits. Breathing exercises in healthy adults are associated with the assessment of the quality of life and the improvement of lung function, as well as with the fact that this field is poorly researched. Keywords: breathing, exercise, lifestyle, quality of life, breathing technique Introduction Breathing is a basic physiological function, the main task of which is to supply the body with oxygen and remove carbon dioxide. Breathing, however, changes all the time – it is related to our physical activities (McConnell, 2011), emotions (Gilbert, 2014; Jerath et al., 2015), well-being, as well as external stimuli, such as various odours or air pollution. We do not pay much attention to these risk factors until we notice symptoms that disrupt our breathing pattern. However, a broken respiratory pattern indicates a respiratory disorder. Respirato- ry disorders are a common occurrence in adults and they also occur in people without medically diagnosed medical conditions (Hagman, Janson & Emtner, 2011). The most common is the hyperventilation syndrome, which is present in 6% to 10% of adults (Chaitow, Bradley & Gilbert, 2014). The overall respiratory capacity associated with the use of optimal breathing patterns also has an impact on health. The reasons are mainly exposure to stressful situations or unconscious fears that can cause anxiety, depression and stress (Jerath, 2015). These conditions are associated with excessive frequency and volume of respiration, which usually leads to hyperventilation (Chenivesse et al., 2013). On a psychological and physical level, such a condition can express itself as fatigue, dizziness, tingling, weakness, headache, and the like. These are the signs with which we can describe respiratory disorders (Chaitow et al., 2014). Since disorders are not necessarily always present and come in onset, the condition is difficult to recognize and diagnose, and is often confused with asthma (Hagman 4 et al., 2011). Healthcare professionals have few information about these condi-10 tions, leading to a misunderstanding of the phenomenon and inappropriate ac-n tion (Vidotto, Carvalho, Harvey & Jones, 2019). The purpose of our study was to review the literature on the association of breathing exercises with improv-pulatioo ing lung function and to assess the quality of life in adults. ge p Methods rking-ao The research used an integrative review of scientific literature, which was ac-he w cessed in April 2020 via electronic databases PubMed, Google Scholar and f t Science Direct. The search string included the following keywords and their synonyms: respiration, performance, adults, quality of life, lifestyle. In all da-ealth o tabases, we used an advanced search with the included Boolean operator AND / IN between two or more keywords. We took into account the inclusion crite-pulacije | h ria, namely the publication of papers between 2010 and 2020, the adult popula-o tion between 18 and 65 years of age and the accessibility to the full text; and the ktivne p exclusion criterion: a medically diagnosed medical condition. elovno a Results The results show a connection between breathing exercises and the general zdravje d quality of life and health factors in adults without medically diagnosed medical conditions. We note a lack of research that would study breathing techniques and their impact on the improvement of lung function and research on the assessment of the quality of life in healthy adults without the presence of diagnosed diseases. Out of 52 items found, 7 relevant studies were identified. The results suggest a connection among breathing exercises, the quality of life and the improvement of lung function, as well among breathing exercises and the decrease in the number of hyperventilation attacks, the improvement of lung capacity and the improvement of body component of the assessment of the quality of life and the decrease in ambulance visits. The results also show that breathing techniques can be an alternative treatment for stress; anx- iety, depression and some emotional problems, and that diaphragmatic breathing exercises can affect attention, the presence of outburst events and reduce blood cortisol levels. Jones et al. (2013) conducted a systematic review of the field of respiratory distress and hyperventilation in adults. In the review, one research was included, which showed that relaxation therapy and breathing techniques can clearly reduce the frequency and severity of hyperventilation attacks. Chenivesse et al. (2014) demonstrated that individuals with a present hyperventilation syndrome had a statistically lower quality of life score measured with SF-36 compared to asthmatics or COPD patients. Santino et al. (2020) found that breathing techniques after 4 months of exercise had a positive effect on the symptoms of hyperventilation, which was assessed with the Nijmegen questionnaire. Respiratory techniques also affect the improvement of quality of li fe and lung function. Research on female teachers has shown that breathing exercises can improve the maximum phonation time and the maximum number of utter-105 ances time (MCD). These are the methods that show the lung capacity of an individual (Saiban, Prathanee & Piromchai, 2017). In a five-year study, Hagman eview et al. (2011) showed that respiratory training in individuals with respiratory dysfunction can improve the physical component of the quality of life as measured by SF-36 from 42 to 47 (p = 0.03). The number of emergency medical vis-iterature r its decreased from 18 to 2, and the number of symptoms as a result of respiratory disturbances also decreased. People had fewer general breathing problems in their daily lives and during exercise. Jerath et al. (2015) found in a study that ntegrative l breathing techniques can be an alternative treatment for stress, anxiety, depression and some emotional problems. Ma et al. (2017) demonstrated that 8 dults – i weeks of diaphragmatic breathing training can affect attention, affect and low-n a er cortisol levels in the body. ife if l Discussion uality o In recent years, the popularity of breathing techniques has been growing, but nd q they still have a mystical touch of the East. Despite the lack of evidence, these techniques have long been used as a method of treating disorders in respirato-xercises a ry patterns and the hyperventilation syndrome. Respiratory techniques affect the respiratory system, the cardiovascular system, the cardiorespiratory system and the autonomic nervous system (Russo, Santarelli & O’Rourke, 2017). reathing e Thus, the main task of breathing exercises is to reduce the frequency of respira-een b tion and increase the volume of respiration. Most often, patients learn to con-etw trol breathing with relaxed abdominal breathing and use the lower chest in nship b different positions: sitting, lying down, standing. Buteyk’s method of breathing is one of the first to spread from Russia across the world and it has been relatio used to treat many chronic diseases, most commonly in patients with asthma. Breathing exercises also include yogic pranayama, which emphasizes mental concentration in order to reduce the frequency of breathing and normalize the relationship between the inhalation and the exhalation with a pause after each inhalation and exhalation. These techniques can always be adapted to the needs of a patient. The goal of breathing exercises is to encourage patients to gradually change their breathing patterns, restore them and maintain them. In this way, the respiratory centre in the brain is newly “programmed” and allows inhalation to occur in the presence of a higher concentration of carbon dioxide. The research results give us mixed information, mainly because the field associated with respiratory techniques, lung function and quality of life is poorly researched. There is a connection between breathing exercises and factors of the overall quality of life and health in adults without medically diagnosed medical conditions. Since hyperventilation is not a disease but a disorder, it can be argued that in individuals with respiratory pattern disorders, the health-related quality of life improved (Chenivesse et al., 2013) and the number of respiratory disorders in daily life and during physical activity decreased. Stress caused respiratory disorders less often, there was also a decrease in emer-610 gency medical visits (Hagman et al., 2011). However, people with respiratory pattern disorders have higher BMI values. Obesity is a common reason leading n to shortness of breath and a more frequent occurrence of anxiety, depression, pulatio sleep apnoea and gastro-oesophageal reflux (Sedeh et al., 2020). Identifying o problems in the breathing pattern due to exertion, air obstruction or disturge p bances in the breathing pattern is not easy. When symptoms remain unex-rking-a plained, fear of the disease may increase and the possibility of physical activity o may decrease, which in turn increases the risk of developing chronic diseases. he wf t Conclusion ealth o Breathing techniques have great potential in improving the quality of life in adults, especially those who unconsciously over-breathe or hyperventilate. Re-pulacije | h search in healthy adults is lacking; however, on the basis of our short review, o we can conclude that breathing exercises in healthy adults are connected to the ktivne p assessment of the quality of life and the improvement of lung function. We al-so noticed that this field is poorly researched. elovno a References zdravje d Chaitow, L., Bradley, D. & Gilber, C. (2014). What are breathing pattern disorders. In L. Chaitow, D. Bradley & C. Gilbert (Eds ), Recognizing and treating breathing disorders: a multidisciplinary approach (pp. 1-9). UK: Elsevier Chenivesse, C., Similowski, T., Bautin, N., Fournier, C., Robin, S., Wallaert, B. in Perez, T. (2014). Severely impaired health-related quality of life in chronic hyperventilation patients: exploratory data. Respiratory medicine, 108(3), 517-523. doi: 10.1016/j.rmed.2013.10.024 Gilbert, C. (2014). Interaction of psyhological and emotional variables with breathing dysfunction. In L. Chaitow, D. Bradley & C. Gilbert (Eds), Rec- ognizing and treating breathing disorders: a multidisciplinary approach (pp. 79-91). UK: Elsevier. Hagman, C., Janson, C., in Emtner, M. (2011). Breathing retraining-a five-year follow-up of patients with dysfunctional breathing. Respiratory medicine, 105(8), 1153-1159. DOI: 10.1016/j.rmed.2011.03.006 Jerath, R., Crawford, M. W., Barnes, V. A., in Harden, K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Applied psychophysiology and biofeedback, 40(2), 107-115. doi: 10.1007/s10484-015-9279-8. Jones, M., Harvey, A., Marston, L. in O’Connell NE. (2013). Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults (Review). The Cochrane database of systematic review (5). doi: 10.1002/14651858.CD009041.pub2. Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., ... in Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect 7 and stress in healthy adults. Frontiers in psychology, 8, 874. doi: 10.3389/ 10 fpsyg.2017.00874 Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., ... & Li, Y. F. eview (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in psychology, 8, 874. iterature r McConnell, A. (2011). Breathe strong, perform better. United States: Human Kinet-ics. Russo, M. A, Santarelli, D. M & O’Rourke, D. (2017). The physiological effects of ntegrative l slow breathing in the healthy human. Breathe (Sheff), 13(4): 298–309. doi: 10.1183/20734735.009817 dults – i n a Saiban, Y., Prathanee, B. in Piromchai, P. (2017). Effects of the Self-Training ife i Breathing Exercise on Maximum Phonation Time in Teachers. J Med As-f l soc Thai, 100(6), S153-S159. Santino, T. A., Chaves, G. S., Freitas, D. A., Fregonezi, G. A., & Mendonça, K. uality o M. (2020). Breathing exercises for adults with asthma. Cochrane Data-nd q base of Systematic Reviews, (3). Sedeh, F. B., Von Bülow, A., Backer, V., Bodtger, U., Petersen, U. S., Vest, S., . . in xercises a Porsbjerg, C. (2020). The impact of dysfunctional breathing on the level of asthma control in difficult asthma. Respiratory Medicine, 163, 105894. doi: 10.1016/j.rmed.2020.105894 reathing e Vidotto, L.S., de Carvalho, C.R.F, Harvey, A. & Jones, M. (2019). Dysfunctional een b etw breathing: what do we kno w. Jornal Brasileiro de Pneumologia. 45(1). doi: 10.1590/1806-3713/e20170347. nship b relatio 810 n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.109-114 Egalitarian distribution of health maintenance using technologies for life extension Martin Lipovšek University of Ljubljana, Faculty of Arts, Aškerčeva cesta 2, 1000 Ljubljana, Slovenia martin.lipovsek@gmail.com Abstract Background and purpose: Background of our paper is the thesis that, under certain conditions, life-extension medical technologies should be available to all citizens through free public health care. The purpose of the proposed thesis is multifaceted. First, by offering life extension, which we define as medical and pharmacological therapies that work against the biological aging process and some of which can be expected in the near future, we would maintain and strengthen the health of the population - including the working population. As a result of these interventions in the body, this population would be more vital in old age and could thus remain active for a longer period of time. Secondly, prolonging life is something that the majority of the population wants - to be healthy and live longer. This thesis can be firmly supported by empirical sociological research. And third, if prolonging life under certain conditions, the main condition of which is recalculated financial eligibility, would be part of public health (and not just what only the rich can buy), it would satisfy our idea of social justice as we can perceive it through egalitarian political-philosophical theories. Presentation of the content: For the above thesis it is possible to present arguments for and against. If we rely on the tradition of the liberal philosophical position represented by John Rawls, we can defend the position presented above. The main argument here is the application of the veil of ignorance to the concrete question of the fair distribution of medical devices. But there are also arguments from some other ethical and political-philosophical traditions. The concept of justice in prolonging life has been extensively written about by dr. Adrian Bunn, to whom we also refer in the article. Conclusions: With the expected arrival of life extension, new questions open up and new ethical and political-philosophical dilemmas emerge. One of these new questions is whether or not to provide some of these new technologies to all citizens to choose freely. The liberal political- philosophical tradition not only allows such new technologies, but under certain conditions places an ethical requirement on society that these technologies are accessible to all, not just to the rich. Keywords: Key words: public health, life extension, philosophy Introduction The starting point of our paper is the thesis that, under certain conditions, life extension medical technologies should be available to all citizens through free public health care. Medical technologies to prolong life, or in other words longevity technologies, are understood as medical and pharmacological therapies that work against the biological process of ageing (slowing down, stopping, re-generating the body) and some of them can be expected in the near future. As a result of these interventions in the body, the population could be vital longer into old age and thus remain active for a longer period of time. Lipovšek (Li-110 povšek, 2019) has already written about them in Slovenia, and on a global scale n they are presented through the works of de Gray (de Gray, 2008), Sinclair (Sinclair, 2019) and Otin (Lopez-Otin et al, 2013). pulatioo Our thesis at the beginning of this paper appeals to the state to set re-ge p quirements for the operation of free public health. The authors advocate approach of egalitarianism represented by the philosophy of John Rawls (Rawls, rking-ao 2011) and an additional theoretical assumption. In short, John Rawls places his he w philosophy of justice on the following foundation. The theory is based on lex-f t ical priority. The first principle is “Everyone should have the same right to the ealth o most comprehensive system of equal fundamental freedoms, compatible with a similar system of freedoms for all” (Rawls 1971, pp. 302-3) (Kymlicka 2015, p. 94). The second principle reads: “Social and economic inequalities must be reg-pulacije | ho ulated in such a way that they are at the same time: a) for the greatest benefit of those at their worst, and b) linked to public services and positions accessible to ktivne p all under conditions of fair equality of opportunities. First priority rule (priority of freedom) - the principles of justice must be classified lexically and there-elovno a fore freedom can only be restricted in the name of freedom. Second priority rule (priority of justice over efficiency and well-being) - The second principle of justice is in lexical order over efficiency and before the principle of maximiz-zdravje d ing the sum of benefits; and the fairness of opportunities precedes the principle of difference”(Rawls 1971, pp. 302-3) (Kymlicka 2015, p. 95). An additional theoretical assumption that the state would distribute life extension services rather than money cannot, unfortunately, be fully substantiated in this paper due to limitations. In practice, it can be quickly defended - because the state may have a greater interest in distributing services than individuals to buy life extensions. A philosophical rationale, however, would require extensive argumentation and consideration of whether it can be derived from Rawls ’philosophy. To make the initial thesis from the beginning of the article clear, we will present what we mean by the phrase “certain conditions”. Certain conditions may be such that the state is bound by ethics and justice to provide life extension unconditionally or is conditionally bound to do so. In our paper, we will only talk about the first option, because the second option would require a discussion that would significantly exceed the limitations of this writing. Let us first look at the specific conditions in which we claim that the state is obliged to extend life unconditionally. We will also use an example to illustrate the conditions. Some of the conditions for life extension must be: life extension technologies are easy to distribute, the cost is relatively low, efficiency is scientifically validated and quantified, the gain of extra healthy years of life is relatively large, side effects are relatively negligible and people can freely choose whether or not to participate in life extension technologies. The key condition, however, is that after a certain number of years, when the program of free distribution of life extension technologies begins, the state treasury has gained or at least lost nothing financially with the costs of the program. By this, we mean that if we add up the costs of these technologies and all the costs involved (bu-111 reaucracy, distribution, control, awareness, the cost of waiting for the return of n state investment in the program), these are less than or equal to the inflow in-to the state treasury because of the following things. Successful and effective xtensio life extension technologies are pushing the ratio of healthy years of life to sick ife e years of life significantly in favour of healthy years. As a result, the costs the r lo public health system has with these people are much lower. People with longer gies f and healthier lives can work longer and thus pay taxes for longer. For exam-lo ple, by looking after grandchildren and great-grandchildren, by being consult-echno ants in companies and institutions, by workong in socially beneficial organiza-tions they also benefit the society. A realistic example in which the state would sing t be unconditionally obliged to provide life extension is if we had evidence that metformin is extremely effective. A multi-year study of TAME in the USA is currently being prepared, which will scientifically study the effect of metform-aintenance u in on life expectancy and health on a very large sample of people (Tame trial, 2020). Metformin is exceptionally cheap due to the expired patent, 100 tablets ealth mf h in Slovenia cost 5€ (Javna agencija RS, 2019). Realistically, we can imagine that n o metformin will turn out to be a drug that statistically adds a few healthy years of life to the average person. And from accurate data, we could calculate whether the state investment in the metformin program would be fully refunded or istributio not. The state would be conditionally obliged to prolong life if the total cost of the life extension program was greater than the financial income from it. We use the word conditionally because in this case it would be necessary to take egalitarian d money away from other areas of the budget (health or overall), which would mean setting priorities. For example, if metformin were very expensive and the funds could only be drawn from the health fund, there could be a dilemma as to whether the funds could be used for people who want to prolong their lives or treat cancer. We can argue for a practical defense of a situation in which certain conditions are met, so that the provision of life extension can be described as uncon- ditionally necessary. The health and sustainability of the working population would be strengthened. Social investment in people (schooling and training) would be maintained for a longer period of time. If people would like to do this themselves, we can also assume that they would be happier because of it. Oth-erwise, they could stop using life extension technologies on a regular basis (the authors of the article also defend the opinion that based on the argument from autonomy, people should also have the right to euthanasia if they suffer im-mensely). The general argument against prolonging life is the problem of limited global resources. However, since we are not talking about a miracle potion for immortality but for a few more years of health that would help the economy or leave intact, then we see that this accusation is not solid. According to our scenario, we have intact investment opportunities in green technologies. The practical defence also includes the opinion of the people - they clearly want life extension technologies, which means that there is a democratic will and prefer-112 ence for these technologies. The opinion of Slovenes was found in a sociological survey from the spring of 2020 on 761 respondents. The results of the research n were presented at two conferences - the international conference Metchnikoff Day Conference and the Slovenian conference Being a hundred years young. pulatioo To the question “If I had the opportunity, I would use biomedical therapies if ge p they enable us a longer and healthier life.” 24% of people answered with strongly agree, 57% agree, 15% disagree and 4% strongly disagree. People want more rking-ao activities of the state: “I want the state to invest in the development of biomedi-he w cal therapies that would enable longer and healthier life.” On this question, 26% f t of people answered with I completely agree, 56% agree, 12% disagree and 6% completely disagree. In the end, it is evident that the desire for universal access ealth o to life extension is almost unanimous: “I would be angry if biomedical therapies that enable a longer and healthier life were available only to the rich.” 64% pulacije | h answered with I strongly agree, 31% agree and only 3% disagree and 2% strong-o ly disagree (Metchnikoff day, 2020) (Biti mlad sto let, 2020). ktivne p Several political-philosophical theories could be used to philosophical-ly address our question. For example, libertarianism, utilitarianism, lexical elovno a egalitarianism, and Rawlsian egalitarianism were addressed by Adrian Bunn (Bunn, 2015). We limit ourselves to the last of these. This does not mean that other theories are not relevant or important for some future research. In the zdravje d case where the state is committed to the conditional provision of life extension technologies, the second principle of Rawls’ philosophy, point a), comes into play. We can ask what it is like in the case where the state is committed to the unconditional provision of life extension technologies. In this case, we argue, however, Rawls ’logic follows the first principle of his philosophy of justice presented. Namely, the right to life is a fundamental freedom and also the right to health. And if the exercise of these two rights does not conflict with the rights of other people, as in our case (for example, a cancer patient is not harmed in any way), then people can unconditionally claim the above rights for themselves. Their demand stems from the principle of freedom, not just from the principle of equal distribution of economic goods. If a state follows Rawls’ logic of justice and the additional theoretical assumption that it must provide services not just money, then it is obligated to do what the initial thesis of the paper speaks of. Conclusion To conclude, Aubrey de Gray, at the conference Being Hundred Years Young (Biti mlad sto let, 2020), when he was asked about the fairness of life extension technologies, he simply answered that this is not a problem at all. When efficient technologies will come, they will pay for themselves and states will therefore provide them to all the citizens. References BUNN, A., 2015. How Long Ought We To Live: The Ethics of Life Extension. Aus-113 tralia: Charles Sturt University [online]. [viewed 2 February 2020] Available from: https://researchoutput.csu.edu.au/en/publications/how-long-n ought-we-to-live-the-ethics-of-life-extension-3 xtensio BITI MLAD STO LET, 2020. Online conference. 11., 12. June 2020 [online]. Avail-ife e able from: https://www.youtube.com/channel/UCntIac4uqExLp4qMx-r lo vz25eQ/videos gies f DE GREY, A. D. N. J., 2008. Ending aging: the rejuvenation breakthroughs that lo could reverse human aging in our lifetime. New York: St. Martin’s Griffin. echno 433 p. JAVNA AGENCIJA RS ZA ZDRAVILA IN MEDICINSKE PRIPOMOČKE, sing t 2019. Seznam veljavnih cen zdravil. 60-3/2019 [online]. [viewed 10. Ju-ly 2019]. Available from: https://www.jazmp.si/fileadmin/datoteke/sez-nami/SFE/Cene/cene_20190215.pdf aintenance u KYMLICKA, W., 2015. Sodobna politična filozofija: uvod, Ljubljana: Krtina. ealth m Editor: Igor Pribac. 685 p. f h LIPOVŠEK, M., 2019. Etična in družbena vprašanja ob podaljševanju življenja v n o bližnji prihodnosti. in: IGNJATOVIĆ, M., KANJUO-MRČELA, A, KU-HAR, R. eds. Znanost in družbe prihodnosti. Slovensko sociološko srečanje, istributio Bled, 18.-19. oktober 2019. Ljubljana: Slovensko sociološko društvo. pp. 49-53. LÓPEZ-OTÍN, C., BLASCO, M. A., PARTRIDGE, L., SERRANO, M., KRO-egalitarian d EMER, G., 2013. The hallmarks of aging. Cell, 153(6), pp. 1194–1217. RAWLS, J., 2011. Pravičnost kot poštenost : reformulacija. Ljubljana: Krtina. Other authors: ZAKRAJŠEK, K,, PRIBAC, I. 274 str. SINCLAIR, D. A. AND M. D. LAPLANTE, 2019. Lifespan: Why We Age—and Why We Don’t Have To, Atria Books. 432 p. TAME TRIAL, 2020 [online]. [viewed 13. July 2020]. Available from: https:// www.afar.org/tame-trial THE 1ST METCHNIKOFF’S DAY ONLINE CONFERENCE – AGING, IMMUNITY AND COVID-19, 2020. May 16, 2020 [online]. Available from: http://www.longevityalliance.org/?q=1st-metchnikoff-s-day-online-conference-aging-immunity-and-covid-19-may-16-2020&fbclid=IwAR2y-tke5OQzVLTq4BKW8w2lxgPgib6N61UTjm1qFVqxTYgXKjc4UqCgr14 114 n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.115-124 Hiring older people as a way to increase diversity and improve the quality of society Marjeta Logar Čuček Ljubljana University Medical Centre, Department of Oral and Maxillofacial Surgery, Zaloška cesta 2, 1000 Ljubljana, Slovenia marjetalogar@gmail.com Abstract Introduction: The co-called »new reality«, as observed both in Slovenia and abroad, does not favour the employment of older population. Older people, who are still active, are labelled as high-risk groups that need special health care. The society expects an active participation of every individual– being knowledgeable about the world, understanding the events and environment leads us to value expertize, work experience and critical reasoning of older employees. They need to be given an active role, but not under conditions that drive a worker into absenteeism, failing to appear at work, even without health reasons, or presenteeism, being present at work at all costs. The latter, in particular, should not be admissible. The current situation clearly shows that each individual should be able to, if they fall ill, quarantine themselves. An employee who understands when their behaviour might endanger others, should never be dismissed by an employer as old or useless. The purpose of this study is to find out to what extent the two phenomena have been researched at the post-graduate level at medical faculties, faculty of health sciences or health care faculties in Slovenia, considering various risk factors present at work and maintaining effort to extend the years of service of older employees. Methods: Master’s and Doctoral theses from chosen faculties, published online between 2015 and 20202, have been studied by using the PRISM protocol. The identified hits have been described, analysed and evaluated. Results: Abstenteeism has been researched in different postgraduate study programmes, including health studies, whereas presenteeism, which is increasingly observed in current time, has so far not been dealt with in the scope that would provide a more thorough insight into finding solutions. The employment of older population is presented in the sense of maintaining their physical fitness, partially also as a stress-coping mechanism. The influences of other psychosocial factors still remain insufficiently explored, considering the complexity of the issue. Discussion and conclusion: Both absenteeism and presenteeism are frequently the result of a fear of the »impossible« or »loss«. The changes in society are more often than not dependent on the changes in an individual’s value system. New values slowly but surely take root in all pores of society; the process is greatly accelerated by development and science. The research into the consequences of aging society and longevity and the growing importance of employment of older population has so far not been widely conducted on the academic level and, consequently, changes and improvements have not been implemented in real life yet. Monitoring and analysing of improvements are of vital importance. The improvements that have already been achieved in the field of equal treatment of older people in employment can be cancelled out, sometimes very subtly, by a change on the global, or even local level. Activities intended to increase the years of service of older population should, therefore, not be pushed aside as less important. Diversity, as a key characteristic of humanity, even in the golden years, 116 leads to outstanding results and higher quality of life. n Keywords: employment, working conditions, excessive workload, pulatioo presenteeism, absenteeism ge p Introduction rking-ao Increasing the duration and improving the employment of older population he w has until recently been a goal of economic entities and political decision. This f t has led to the need to increase the period of active service due to the fact that older employees, who can draw on the knowledge and experience obtained ealth o over several decades, have a desire to learn and are able to adapt to the new economic circumstances, are of vital importance to active and productive soci-pulacije | h ety (Novoselc, 2019; Logar Čuček, 2020). o At the moment, the so-called »new normal«, resulting from the conse-ktivne p quences of the epidemics and the consequent economic downturn, both at home and abroad, significantly contributes to increasingly unfavourable conditions for older population since longer employment is not encouraged. The elovno a principle of lower market flexibility and higher job protection is coming into the foreground, together with lowering the percentage of precarious jobs (Gas-zdravje d pari, 2020), which could also mean encouraging older employees to retire. The companies that make use of the so-called exit strategies, i.e. early retirement and lay-offs, tend to fall behind those that are successful in overcoming demographic and competition challenges (Van Dalen et al., 2015). Identifying job risk factors and their mitigation, creating the culture of health and good work, together with adapting working hours and job accessibility, all lead to the creation of jobs that are beneficial for all age groups and not only for older population (Tratnik, 2019). Frequently employees cope with the pressure at work, by absenteeism or absence from work, or presenteeism, coming to work despite the need for re- cuperation (Logar, 2011; Logar Čuček, 2020). There are many sides to absenteeism, owing to that fact that it is practised by humans. Employees stay away from work from a variety of reasons (Kirkham et al., 2015). To a smaller extent, absenteeism is the result of non-medical reasons which are often manifested as justifiable absence from work (Bilban, 2007). No matter what form absenteeism takes, its reasons and duration, it can decrease the activity of older employees and consequently lead to premature retirement (Wargo-Sugler-is et al, 2017). Presenteeism is one of the »side-ways« of management. Many organisations wrongly assume that a low level of sick leave signifies good employee health. Consequently, employees appear in their workplaces despite being ill, feeling unwell, suffering from psychological problems. Many of them are wor-ried about their job security and are not willing to take risks – especially people with families and those just a couple of years before retirement (Lalič and 117 Hromin, 2012). In some employees, presenteeism is a matter of individual decision (Brečko 2012; Boštjančič and Sajinčič, 2016). ciety The purpose of reviewing published materials at the post-graduate levels of s at three medical faculties in Slovenia was to study Master’s theses and Doctoral dissertations that deal with the phenomena of absenteeism and presenteeism uality o in older employees. he q The objective of the study was to ascertain to what extent the phenomena of absenteeism and presenteeism of older employees are studied in Slove-prove tm nia at health-related institutions and to prepare suggestions for such research. nd i The research question posed was: What is the purpose and role of post-graduate research on the influence of absenteeism and presenteeism on iversity a older employees? ncrease do i Methods ay t Review methods s a w A review of Master’s theses and Doctoral dissertations, published online be-ple aeo tween 2015 and 2020, was used. Faculty databases were chosen for finding references since the objective was to find out to what extent the area of older em-lder p ployees is researched at the post-graduate level. The following combinations of key words in Slovene language were used as search entries: older employ-hiring o ees, employment of older populations, absenteeism and presenteeism in older employees; later on, words which represent the conditions for successful work of different generations, such as promotion of health, lifelong learning were added. The search was carried out in the period between May 2020 and June 2020. The search was limited by the following inclusion and exclusion criteria: search period between 2015 and 2020, Slovene language, and freely available data. Review results Database search strategy came up with 66 hits. After checking their relevance, 20 hits were excluded. According to content relevance, 46 hits were obtained. After considering all limiting criteria, 6 hits were used for final reference. Figure 1 shows searching for Master’s theses and Doctoral dissertations. A sche-matic presentation has been used, as enabled by PRISM scheme (Moher et al., 2009). 118 n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d Figure 1: Results of the references review based on the PRISM Data processing description Data was analysed with the use of qualitative content analysis; according to Vogrinec (2008) open coding represents a key procedure of text analysis. A qualitative analysis was carried out in six steps, namely materials organising, coding, determining coding units based on key subject matter and purpose of systematic references review, selection and defining applicable key words and categories, defining categories and making conclusions by achieving a better understanding of the issues and needs of older employees. Results Table 1 shows all references included in materials review. Using qualitative content analysis of the acquired materials, three categories with applicable codes were identified (Table 2). The categories include: (1) The influence of rheumatic disease on absenteeism; (2) The importance of lifelong learning for the application of knowledge at work; (3) The measures for improving physical and mental health in all periods of life. In the following stage of materials review, the categories were changed into subcategories and a single category was formed. This category offers a comprehensive explanation of the purpose and objectives of materials review (Table 2). Table 1: A review of the key findings of the research included in qualitative 119 content analysis ciety Author, year Research typology Research objective Sample Key findings of s To find out if there are sta- tistically relevant differenc- es in the quality of life of Patients taking biological uality o patients suffering from in- medicines have fewer ab- sences from work; they as- he q flammatory rheumatic dis- Križanec, 2016 Qualitative re- sess their quality of life search ease treated with biological n = 180 medicines in comparison higher; a need for great- prove t er health-educational work m to patients using standard medicines; to find out to shown. nd i what extent the disease can influence absenteeism. To establish the presence iversity a of elements of a learning Employees have demon- Robnik, 2016 Quantitative re- organisation and employ- strated a high level of moti- search ees‘ viewpoints regarding n = 57 vation for attending train- ncrease d the introduction of train- ing courses. o i ing courses. ay t To recognise the view- s a w points regarding acquir- Knowledge obtained in Lešnik, 2016 Quantitative re- ing new knowledge and to n =104 training courses is put into ple a search transfer knowledge from eo the management to the practice in the work place. employees. lder p The HPP programme is fo- To study the development cused on improving health hiring o of health-related absen- and includes preventive ac- Topličanec, Quantitative re- teeism and presenteeism; n = 198 tivities. Own health con- 2018 search; case study to identify the limitations trol is enabled in working of health promotion pro- environment; it reduc- grammes (HPP). es health-related absentee- ism and contributes to low- er presenteeism. Author, year Research typology Research objective Sample Key findings To compare the frequen- cy of physical exercise on the basis of age, gender and Differences in gender, age Raduha, 2017 Descriptive quali- and education level do not tative research education level; to express n = 115 viewpoints regarding the influence the level of physi- importance of regular ex- cal activity. ercise. Back pain increases with age; it is connected with To study a part of the life- workplace stress and also unhealthy lifestyle. Ergo- Saje Zupanc, Quantitative sur- style of nurses and work- nomic technical accessories 2015 vey research place risk factors in ex- n = 461 plaining the incidence of are underused in clinical back pain. practice. It is vital to intro- duce aerobic exercise and take additional care of em- ployees‘ physical health. 012 Table 2: Code allocation by category n Category Subcategories Codes Author pulatio The cooperation of nurses with o rheumatic patients treated with ge p The influence of rheu- biological medicines; the influ- matic disease on absen- ence of biological medicines on Križanec, 2015 teeism. the quality of life; lower levels of rking-ao absence from work, absentee- ism; the presence of pain. he wf t Factors which positive- The importance of learning and ly influence the decrease The importance of life- knowledge for an individual and in absenteeism and pre- long learning for apply- organisation; knowledge trans-Robnik, 2016; ealth o senteeism in (older) em- ing new knowledge and fer; cross-generational coopera- Lešnik, 2016 ployees skills in the work place. tion; innovativeness. Education and training in the pulacije | h area of physical health mainte- o Measures for improv- ing physical and men- nance; recognising negative ori- Raduha, 2017; tal health in all life pe- entation towards physical ac- Topličanec, 2018; ktivne p riods. tivity; focused physical activity Saje Zupanc, 2015 in the workplace; coping with stressful situations. elovno a Discussion zdravje d In the reviewed works, older employees are predominantly dealt with in that period of life when typically, due to various health issues and advanced age, they are no longer able to actively participate in the labour market. The health care of older employees, the development of social contacts, suitable communication, etc. are some of the research topics (Saje Zupanc, 2015; Raduha, 2017; Topličan-ec, 2018). The study of those segments of life which would allow an individual to keep an active role in society is carried out in »fragmental form« and is subor-dinate to other age groups. The society is faced with longevity, at the same time, Slovenia is a country that does not live according to the principles of active aging, as promoted by the European Union (Walker and Zaidi, 2016). In the research that was conducted as a part of her Master‘s thesis by Križanc (2016), absenteeism is presented as a consequence of an illness or insufficient results of treatment with conventional medicines. There are several studies at different post-graduate level programmes that deal with the phenomenon of absenteeism, yet only few at healthcare faculties. On the other hand, presenteeism, which has been recognised as a problem only recently, has not been researched in the scope that would provide a greater insight into finding specific solutions. Absenteeism and even more so presenteeism are often the consequence of fear of the »impossible« or »loss« and are harmful both for the employee and organisation, financially as well as medically (Vučković, 2010; Logar, 2011). Both phenomena are unacceptable: absenteeism also because it offers employees a possibility for abusing the sick leave system; and presenteeism, in which an employee understands that their medical state might be endangering to others but can be labelled as incapable, old and fit for retirement if they remain absent from work. Both society and the government need to in-112 troduce measures that will allow a person to be ill and recover in peace but at the same time prevent employees from abusing the system (Logar et al., 2015). ciety Taking care of health, by maintaining physical fitness and partially also of s managing stress, is dealt with in the reviewed materials without a special focus on older employees, which is confirmed also by other researchers (Logar, 2011; uality o Ovčar, 2015; Jakop, 2016; Jagodič, 2019). The influences of psycho-social factors he q are not presented or rather they are not studied thoroughly enough, owning to their complexity and the fact that they are becoming the key causes of illness prove tm development. The connection between health and socio-economic position of nd i older employees is key. Employees with lower levels of education, lower positions at work and lower income tend to suffer from cancer, cardio-vascular diseases and lower life expectancy (Manfreda, 2020). Preventive measures can go iversity a a long way in maintaining and improving people‘s health. They include various activities in health promotion programmes which are suitable for different ncrease d generations (Saje Zupanc, 2015; Raduha, 2017; Topličanec, 2018). o i ay t One of the activities that helps to maintain good health is lifelong learning. The theses review demonstrated that many theses were prepared and stud-s a w ies carried out regarding learning organisation, the need for lifelong learn-ple aeo ing, passing the knowledge from generation to generation, which encourages cross-generational cooperation and strengthens knowledge of teams and orlder p ganisations (Robnik, 2016; Lešnik, 2016). hiring o Older employees already are or are about to become our reality. It is necessary to act in three ways: developmental strategy, management training, senior and junior staff training to achieve synergy – and in older employees also for quality aging before and after retirement (Ramovš et al., 2020). The limitations of the survey conducted include a sample that is too small, owning to the fact that at healthcare faculties (Master‘s and Doctoral study) there is almost no published material about employment of older population, absenteeism and presenteeism. The phenomena of absenteeism and presentee- ism in connection with older employees are mentioned together with other topics of research but not directly. It is of vital importance that a more exhaustive study of this issue is conducted and that more Master‘s and Doctoral theses deal with the employment of older employees. Too often it happens that older employees are discriminated against in their workplaces, despite the fact that life expectancy is rising and labour force is shrinking. Conclusion Aging society and increasing longevity with all their implications have a considerable impact on the employment of older population. It is of vital importance for the medical field to start considering the necessity to prolong the active service of employees. Modern times dictate research into older employees on the academic level since progress largely depends on the inclusion of all people in all their diversity. 212 n References BILBAN, M., 2007. 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WARGO-SUGLERIS M., ROBBINS W., LANE C.J and PHILLIPS L.R., 2018. rking-ao Job satisfaction, work environment, and successful aging: determinants of delaying retirement among acute care nursis [online]. Journal of Ad-he wf t vanced Nursing, vol. 74, no. 4, pp. 900-913. [viewed 26 June 2020]. Available from: http:/ dx.doi.10.1111/jan.13504 ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.125-131 Sauerkraut and sour turnip consumption habits in Slovenia Martina Nagode, Katja Bezek University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Isola, Slovenia martina.nagode@hotmail.com; katja.bezek@fvz.upr.si Abstract Introduction: Fermentation is one of the earliest methods of food preservation. Along with the extended shelf life of foods, the fermentation process provides also higher safety and better organoleptic properties of the products. The fermentation can be carried out by the naturally occurring microbial community or by the addition of the so-called starter cultures. The metabolic activity of microorganisms significantly affects the bioavailability and concentration of bioactive compounds in the product. However, the viability and number of beneficial living microorganisms depend on many factors, such as storage and processing conditions of the foods. Methods: In order to obtain the data on the knowledge and eating habits of sauerkraut and sour turnip among Slovene people, an online questionnaire was prepared. The obtained data were analysed using IBM SPSS Statistics 26 and Microsoft Excel. Results: In the present questionnaire-based survey 175 individuals were included (24 M; 151 W). The majority of the participants showed great knowledge about fermented foods and their health benefits. Moreover, half of participants prepare fermented foods at home. In the last month the vast majority consumed cooked (n = 152) or raw (n = 121) sauerkraut, while the lower proportions consumed cooked (n = 54) or raw turnip (n = 95). Only a few (n = 14) did not consume any. Among consumers on average 204 g of cooked and 179 g of raw sauerkraut and 188 g of cooked and 136 g of raw sour turnip was consumed in the last month. Discussion and conclusion: By regular and adequate consumption of sauerkraut and sour turnip, both raw and heat-treated, a beneficial effect on the immune and digestive system and the general health of the working-age population could be achieved. However, live probiotic microorganisms can positively affect human health only when consumed in sufficient concentration, which is at least 108 to 1010 CFU per day. The last could be achieved by a daily intake of 100 g of product with at least 106 CFU ml-1 live microorganisms. Considering this study results, the intake of live microorganisms only by raw sauerkraut or turnip consumption among Slovene people is not sufficient to achieve a probiotic effect. Keywords: sauerkraut, sour turnip, fermentation, microorganisms Introduction Fermentation is a traditional food preservation method used to extend shelf-life, safety, and impart desirable organoleptic properties of the foods (Shiferaw Terefe, 2016). This food processing technology utilizes the growth and metabolic activity of microorganisms for the stabilization and transformation of food raw materials (Di Cagno, Coda, De Angelis and Gobbeti, 2013). Fermentation of vegetables, fruits, and grains most often includes lactic acid fermenta-612 tion involving different species of lactic acid bacteria (LAB) (Steinkraus, 1992). In addition to spontaneous fermentation, the controlled fermentation can be n carried out by the addition of starter culture, a standardized community of microorganisms. However, the diversity of the microbiota markedly depends pulatioo on the intrinsic and extrinsic parameters of the plant matrix (Di Cagno et al., ge p 2013). Furthermore, the growth of spoilage and pathogenic organisms is inhibited by high salt concentrations, LAB metabolites, and the consequent decline rking-ao of pH value (Shiferaw Terefe, 2016). he w Sauerkraut is one of the most common and oldest forms of raw vegeta-f t ble preservation. It is produced by spontaneous fermentation of cabbage under anaerobic conditions, with the addition of salt. The fermentation process takes ealth o several weeks at a temperature of 15 to 20 °C (Oregon et al., 2016). Important strains of bacteria present in sauerkraut are Leuconostoc mesenteroides, Lacto-pulacije | h bacillus plantarum, and other genera like Leuconostoc, Lactobacillus, Pediococ-o cus and Weissella (Touret, Oliveira and Semedo - Lemsaddek, 2018). Like sau-ktivne p erkraut, the sour turnip was an important food in ancient times, consumed mainly in the winter months. Raw material is prepared by placing the washed turnip into a vat, in Italian culture the turnip was alternatively layered with elovno a grape skins. Before covering the vat, a mix of water and salt or water only is added and left for 30 to 40 days at 12 to 15 °C. The most commonly represent-zdravje d ed LAB are Lactobacillus hilgardii and Pedicoccus parvulus (Maifreni, Marino and Conte, 2004). Nevertheless, due to the presence of live microorganisms that possess probiotics properties, antimicrobial, antioxidant and peptide production, fermented foods are known for its beneficial nutritional and functional properties for consumer’s health (Septembre-Malaterre, Remize and Poucheret, 2018; Şanlier, Gökcen and Sezgin, 2017). Methods In the first part of the study literature review on the fermentation process with the focus on vegetables was made including the scientific articles not older than 10 years. To obtain the data on the knowledge and eating habits of sauerkraut and sour turnip among Slovene people, an online questionnaire was prepared. The obtained data were processed using Microsoft Excel and SPSS Statistics 26.0 (IBM, Armonk, NY, USA). Results The health benefits of fermented vegetables can be associated with their prebiotic and/or probiotic potential, due to the presence of live microorganisms and their metabolites, such as bioactive peptides, short-chain fatty acids or polysac-charides (Septembre-Malaterre, et al., 2018; Şanlier et al., 2017). Probiotics are live microorganisms that, when consumed in sufficient amounts, may confer a health benefit for the host (FAO/WHO, 2002). They help maintain good balance and composition of the intestinal flora, preventing the invasion of pathogenic microorganisms (Tripathi and Giri, 2014), improve immunity and cal-712 cium absorption, reduce the risk of intestinal diseases (Homayouni, Pavahoo and Azizi, 2012), lower serum cholesterol and blood pressure (Rašić, 2003). Most of the commercially used probiotics belong to LAB group, including Lac-lovenian s tobacillus, Leuconostoc, Streptococcus, and Enterococcus genera (Yadav, 2017). To achieve positive effects, foods should contain the required minimum num-abits i ber of live microorganisms with a probiotic effect at the time of ingestion. The n h ptio recommended standard for probiotics live cell counts is at least 106 CFU mL-1 of the product (Neffe-Skocińska, Rzepkowska, Szydłowska and Kołożyn-Krajew-nsumo ska, 2018). Furthermore, many LAB species have antimicrobial activity due to the production of antimicrobial active metabolites, such as organic acids, hy-urnip c drogen peroxide and other compounds, such as bacteriocins and antifungal ur to peptides (Reis, Paula, Casarotti and Penna, 2012). Moreover, produced bioac-nd s tive peptides are known for the functional properties, such as immunomodula-tory, antithrombic and antihypertensive effect (Tamang et. al., 2016). In the present study, we focused mainly on sauerkraut and sour turnip, sauerkraut a both a result of LAB fermentation. In data analysis of a questionnaire-based survey 175 individuals were included (24 M; 151 W). Based on the study results, the majority of the participants showed excessive knowledge about fermented foods and their health benefits (Table 1). To begin with, half of the participants prepare fermented foods at home. The majority (> 60 %) of them agreed with statements as follows: (i) salt addition inhibits the action of unwanted microorganisms and allows the reproduction of the desired ones; (ii) temperature is an important factor in the fermentation process; (iii) an anaerobic environment must be established for fermentation; (iv) sugars are converted to acids during fermentation and (v) that the pH of the food before and after fermentation varies. Although, the majority of them knew that fermented foods have an extended shelf life (81 %), only half of them agreed that fermented foods are more microbiologically safe. Table 1: Respondents agreement with the statements Statement I do not agree I neither agree not disagree I agree We need to add salt, which inhibits the action of unwanted microorganisms and allows the repro-14 (8 %) 34 (19 %) 127 (73 %) duction of the desired ones. Temperature is an important factor in the fermen- tation process. 6 (3 %) 18 (10 %) 151 (86 %) We need to provide anaerobic conditions. 23 (13 %) 40 (23 %) 112 (64 %) In the fermentation process, sugars are converted to acids. 13 (7 %) 50 (29 %) 112 (64 %) The pH value of a food changes (pH value allows us to define a substance as acidic, neutral or basic). 2 (1 %) 24 (14 %) 149 (85 %) Fermented foods have an extended shelf life. 7 (4 %) 27 (15 %) 141 (81 %) Fermented foods are more microbiologically safe. 14 (8 %) 67 (38 %) 94 (54 %) Fermented foods are richer in vitamins. 33 (19 %) 70 (40 %) 72 (41 %) 812 Regarding the consumption in the last month, the vast majority conn sumed cooked (n = 152) or raw (n = 121) sauerkraut, while the lower proportions consumed cooked (n = 54) or raw turnip (n = 95). Only a few (n = 14) did pulatioo not consumed any. On average 204 ± 176 g of cooked and 179 ± 150 g of raw sau-ge p erkraut and 188 ± 172 g of cooked and 136 ± 136 g of raw sour turnip was consumed in the last month. rking-ao he w Discussion f t During food fermentation, functional microorganisms transform raw materi-ealth o al constituents, thereby enhancing the nutrition value, sensory properties and safety, degrading toxic substances, producing antioxidant and antimicrobial substances (Tamang Shin et al., 2016). Sauerkraut and sour turnip are locally pulacije | ho produced processed vegetables and are also used as major components of traditional Slovenian foods (Korošec, Golob, Bertoncelj, Stibil and Koroušić Sel-ktivne p jak, 2013). As expected, this study participants showed good knowledge about the fermentation process. Surprisingly, the lowest level of agreement was for elovno a a statement about the fermented foods being a better source of vitamins than raw material. However, as reviewed before, the probiotic, antimicrobial and antioxidant effects of fermented vegetables have a beneficial potential for hu-zdravje d man health (Tamang Shin et al., 2016). We focused mainly on the probiotic effects of sauerkraut and sour turnip. Live microorganisms with a probiotic potential can have a positive effect on our health only if consumed in sufficient amount, which means at least 108 to 1010 CFU per day (FAO/WHO, 2002). This would mean consuming 100 g of food with at least 106 CFU mL-1. Oregon et al. (2016) found that 100 g of sauerkraut contains 5×106 CFU. Considering present study results, the intake of live microorganisms e.g. by 179 g of raw sauerkraut per month, meaning 3×105 CFU per day is not in accordance with recommendations. Furthermore, the microorganisms found in sauerkraut and sour turnip are diverse and not all have probiotic effects (Zabat, Sano, Wurster, Cabral and Belenky, 2018). It should also be noticed that many fermented foods are heat-treated after fermentation to enhance food safety, which can significantly influence the number of microorganisms (Rezac, Kok, Heermann and Hutkins, 2018). Conclusions The live microorganisms with probiotic properties present in fermented foods have a beneficial effect on intestines, prevent the action of pathogenic microorganisms, improve the immune system, and general health. Considering this study results, the intake of live microorganisms only by raw sauerkraut or sour turnip consumption among Slovene people is not sufficient to achieve a probiotic effect. Therefore, the intake of probiotic microorganisms with other foods or dietary supplements is recommended. With regard of the questionnaire results, the benefits of Slovene traditional food should be more promoted. 912 References lovenia Di Cagno, R., Coda, R., De Angelis, M. and Gobbeti, M., 2013. 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Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ n s PMC5977097/ abits i n h ptio nsumo urnip c ur to nd s sauerkraut a https://doi.org/10.26493/978-961-293-015-8.133-139 The effect of kefir and milk intake on intestinal permeability Karin Novak, Zala Jenko Pražnikar, Ana Petelin University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia karin.novak@fvz.upr.si, zala.praznikar@fvz.upr.si, ana.petelin@fvz.upr.si Abstract We performed a longitudinal intervention study that lasted 4 months at the UP Faculty of Health Sciences in Izola. The participants were divided into two groups, each alternately consuming kefir or milk for 21 days, with two washout periods in-between. Venous blood was sampled (fasted) after each phase and the participants completed a questionnaire on gastrointestinal symptoms and a Bristol stool scale. Kefir supplementation resulted in a greater improvement of serum zonulin levels whereas significant yet similar improvement in lipid profile, serum glucose levels, inflammation markers and appetite were found in both supplementations. We did not observe significant changes in the incidence of gastrointestinal symptoms, with the exception of significantly decreased sensation of bloating after kefir intake. The average number of defecations increased after kefir intake and decreased after milk intake. The percentage of participants who defecated at a consistent time each day decreased after kefir intake and increased after milk intake. We conducted one of the first studies comparing the effects of kefir and milk on the human intestine. Our research shows that daily kefir consumption could be an effective strategy for individuals with constipation and bloating. There is still a lack of solid evidence for the use of probiotics for most medical conditions. Keywords: kefir, milk, zonulin, intestinal permeability, inflammation Introduction Cow’s milk and fermented dairy products, such as yogurt, buttermilk and kefir, have been a major part of our diet for many years (Kok and Hutkins, 2018) and have beneficial health effects (Bourrie et al., 2016). The intake of dairy products has been linked with reduced risk of obesity, hypertension, type 2 di- abetes and heart disease (Li et al., 2018). Kefir is a fermented dairy product containing a large number of lactic acid bacteria and yeasts (Kim et al., 2017). The largest bacterial community in the human body is located in the gastrointestinal tract (Bischoff et al., 2014) and it’s known that a diverse gut microbiota and increased intestinal permeability plays a key role in inflammation that accompanies chronic diseases and in maintaining health (Kim et al., 2017). It modulates the expression of many genes in the gut that are associated with immunity, nutrient absorption, energy metabolism, and gut barrier function (Bell et al., 2018). The human gut is surrounded by a layer of epithelial cells that forms a barrier between the environment and the host. Increased intestinal permeability is thought to be an important element in the pathogenesis of chronic inflammatory diseases, in addition to genetic and environmental factors. Zonulin is so far the only known physiological intercellular modulator of intestinal 4 tight junctions (Sturgeon and Fasano, 2016) and it’s a biomarker showing al-13 tered intestinal barrier function in many autoimmune, neurodegenerative and n tumor diseases (Fasano, 2012). The specific pathophysiological role of zonulin in various diseases is not well known, but elevated zonulin levels are thought pulatioo to be a key factor in the onset of the inflammatory process (Sturgeon and Fas-ge p ano, 2016). Despite the prevalence of dairy products, there has been very little research done on the effects of kefir and milk intake on the intestine, especial-rking-ao ly in humans. he wf t Methods ealth o We performed a longitudinal intervention study, which lasted from March to June 2018 at the Faculty of Health Sciences in Izola. The study included 28 pulacije | h healthy individuals (13 men and 15 women) aged between 31 and 64 years, with a o BMI between 25 and 30 kg/m2. The exclusion criteria were: any acute or chron-ktivne p ic illness, lactose intolerance or milk allergy, taking medication, BMI < 25 kg/ m2 or BMI > 30 kg/m2, pregnancy and lactation, significant body weight change elovno a in the last 3 months. The participants were divided into two groups, each alternately consuming kefir (250 ml daily) or milk (250 ml daily) for 21 days, with zdravje d two washout periods in-between. During the washout periods complete absti-tence from fermented dairy products was required. After each phase venous blood was sampled (fasted) and was then analyzed with Cobas c 111 analyzer (Roche Diagnostics) and with enzyme-linked immunosorbent assay (ELISA) for serum zonulin levels. After each phase participants completed a questionnaire on gastrointestinal symptoms – nausea, bloating, borborygmus, stomach pain, flatulence and heartburn. They also completed a Bristol stool scale. Participants were instructed to try to keep their diet as normal as possible throughout the study. Results Serum zonulin levels Table 1 shows the mean and standard deviation of serum zonulin values before and after kefir and milk intervention. Table 1: Mean serum zonulin levels before and after kefir and milk intervention Before kefir After kefir Before milk After milk Mean Mean Mean Mean Serum zonulin levels (ng/ml) 1,089±1,425 0,940±0,923 0,866±0,864 0,837±0,913 The results of the Wilcoxon test of predicted ranks showed that both kefir 5 intervention (z = -0,222; p = 0,824) and milk intervention (z = -0,336; p = 0,737) 13 did not have a statistically significant effect on the change in serum zonulin levels. Analysis of covariance (ANCOVA), with gender, age, BMI and baseline eability zonulin levels as covariates, showed that the change in serum zonulin levels af-erm ter kefir intervention was statistically significant (p < 0,001), but not after milk intervention (p = 0,162). Kefir supplementation resulted in a greater improvement of serum zonulin levels whereas significant yet similar improvement in ntestinal pn i lipid profile, serum glucose levels, inflammation markers and appetite were found in both supplementations. CRP and adiponectin were not significant-ntake o ly affected by neither of the two interventions (Jenko Pražnikar et al., 2020). ilk i nd m Gastrointestinal symptoms efir af k Table 2 shows the mean value of the occurrence of gastrointestinal symptoms before and after kefir and milk intervention and the results of paired-samples ffect o t-test. It showed a statistically significant change only in the feeling of bloating the e before and after the kefir intervention (p = 0,043), whereas the other changes in the incidence of gastrointestinal symptoms were not statistically significant. Table 2: The occurrence of gastrointestinal symptoms before and after kefir and milk intervention and paired-samples t-test Before kefir After kefir Paired-samples Before t-test milk After milk Paired samples t-test Gastrointes- tinal symp- Mean Mean t p Mean Mean t p toms* Nausea 0,29±0,76 0,29±0,71 0,000 1,000 0,12±0,43 0,31±0,79 -1,044 0,306 Bloating 1,00±0,96 0,70±0,87 2,126 0,043 0,92±0,93 1,13±1,15 -0,816 0,423 Borborygmus 0,92±0,94 0,92±0,94 0,000 1,000 0,84±0,80 0,60±0,96 1,186 0,247 Before kefir After kefir Paired-samples Before t-test milk After milk Paired samples t-test Gastrointes- tinal symp- Mean Mean t p Mean Mean t p toms* Stomach pain 0,74±1,06 0,52±0,89 1,185 0,247 0,64±0,92 0,50±0,93 0,485 0,632 Flatulence 1,50±0,91 1,35±0,94 0,811 0,425 1,52±0,92 1,52±1,05 0,000 1,000 Heartburn 0,89±1,07 0,58±0,90 1,397 0,175 0,72±0,94 0,56±0,87 0,778 0,444 Legend: * Gastrointestinal symptom values are expressed on a scale from 0 to 5, with 0 representing the absence of a gastrointestinal symptom and 5 representing the maximum intensity of occurrence of a gastrointestinal symptom. An independent samples t-test to compare changes in the occurrence of gastrointestinal symptoms after intervention with kefir and milk has shown 613 no statistically significant difference in the the altered incidence of nausea (t = -0,895; p = 0,375), bloating (t = -1,788; p = 0,080), borborygmus (t = 1,051; p = n 0,298), stomach pain (t = -0,712; p = 0,480), flatulence (t = -0,786; p = 0,435) and pulatio heartburn (t = -0,907; p = 0,369) between the groups. o ge p Stool consistency, frequency and time of defecation rking-ao Table 3 shows stool consistency, frequency and time of defecation. Participants he w rated their stool consistency with a Bristol stool scale from 1 to 7, with 1 and 2 f t representing harder stool, 3 and 4 stool of appropriate consistency, and 5, 6 and 7 representing softer stool. Stool consistency became softer after both kefir and ealth o milk intervention. In each stage of the study participants defecated on average from 0,5 to 3 times per day. Frequency of defecation was slightly increased af-pulacije | h ter kefir intervention and decreased after milk intervention. The percentage of o participants who defecated at a consistent time each day decreased after kefir intervention and increased after milk intervention. ktivne p Table 3: Average number of defecation before and after intervention elovno a with kefir and milk zdravje d Before kefir After kefir Before milk After milk Stool consistency 3,6 3,8 3,8 3,9 Number of defecations 1,3 1,4 1,4 1,3 Defecating at a consistent time (%) 78,3 70,0 69,9 77,3 Discussion Kefir intervention resulted in a greater improvement of serum zonulin levels than milk intervention. Some studies have found beneficial effects of various probiotics on the serum zonulin levels and intestinal permeability (Liu et al., 2013; Stenman et al., 2016), while some haven’t (Stadlbauer et al., 2015; Mokkala et al., 2018). CRP and adiponectin were not significantly affected by neither of the two interventions. We did not observe significant changes in the incidence of gastrointestinal symptoms, with the exception of significantly decreased sensation of bloating after kefir intervention. In most studies, consumption of kefir or other probiotics had beneficial effects on most gastrointestinal symptoms (Kato-Kataoka et al., 2016; Lee et al., 2018; Yılmaz et al., 2019). Stool consistency became softer after both kefir and milk intervention. The average number of defecations increased after kefir intervention and decreased after milk intervention. The percentage of participants who defecated at a consistent time each day decreased after kefir intervention and increased after milk intervention. Some other studies also found a beneficial effect of both kefir and milk on stool consistency or there were no differences compared to the control group (Moreira et al., 2017; Maki et al., 2018), while some studies have shown a benefi-7 cial effect of kefir or other probiotics on stool consistency, with the effect being 13 significantly different from the control group (Lee et al., 2018; Yoon et al., 2018). eability Conclusions erm We conducted one of the first studies comparing the effects of kefir and milk on zonulin levels and gastrointestinal symptoms in healthy asymptomatic individuals. We have shown that daily consumption of kefir could be an effective ntestinal pn i strategy for individuals with constipation and bloating problems. There is still a lack of solid evidence for the use of probiotics for most medical conditions. ntake o ilk i References nd m Bell, V., Ferrão, J., Pimentel, L., Pintado, M. and Fernandes, T. 2018. One health, efir a fermented foods and gut microbiota. Foods, vol. 7, no. 12. f k Bischoff, S. C., Barbara, G., Buurman, W., Ockhuizen, T., Schulzke, J.-D., Seri-ffect o no, M., … and Wells, J. M. 2014. Intestinal permeability – a new target for the e disease prevention and therapy. BMC Gastroenterology, vol. 14, pp. 1–25. Bourrie, B. C. T., Willing, B. P. and Cotter, P. D. 2016. The microbiota and health promoting characteristics of the fermented beverage kefir. Frontiers in microbiology, vol. 7, pp. 1–17. Fasano, A. 2012. Zonulin, regulation of tight junctions, and autoimmune diseases. Annals of the New York academy of sciences, vol. 1258, pp. 25–33. Jenko Pražnikar, Z., Kenig, S., Vardjan, T., Černelič Bizjak, M. and Petelin, A. 2020. Effects of kefir or milk supplementation on zonulin in overweight subjects. Journal of dairy science, vol. 103, no. 5, pp. 3961–3070. Kato-Kataoka, A., Nishida, K., Takada, M., Kawai, M., Kikuchi-Hayakawa, H., Suda, K., … and Rokutan, K. 2016. Fermented milk containing Lactobacillus casei strain Shirota preserves the diversity of the gut microbiota and relieves abdominal dysfunction in healthy medical students exposed to academic stress. Applied and environmental microbiology, vol. 82, no. 12, pp. 3649–3658. Kim, D.-H., Kim, H., Jeong, D., Kang, I.-B., Chon, J.-W., Kim, H.-S., … and Seo, K.-H. 2017. Kefir alleviates obesity and hepatic steatosis in high-fat di-et-fed mice by modulation of gut microbiota and mycobiota: targeted and untargeted community analysis with correlation of biomarkers. The journal of nutritional biochemistry, vol. 44, pp. 35–43. Kok, C. R. and Hutkins, R. 2018. Yogurt and other fermented foods as sources of health-promoting bacteria. Nutrition reviews, vol. 76, no. 1, pp. 4-15. Lee, S.-H., Joo, N.-S., Kim, K.-M. and Kim, K.-N. 2018. The therapeutic effect of a multistrain probiotic on diarrhea-predominant irritable bowel syndrome: a pilot study. Gastroenterology research and practice, vol. 2018, pp. 1–8. 8 Li, X., Yin, J., Zhu, Y., Wang, X., Hu, X., Bao, W., … and Liu, L. 2018. Effects of 13 whole milk supplementation on gut microbiota and cardiometabolic bi-n omarkers in subjects with and without lactose malabsorption. Nutrients, vol. 10, no. 10, pp. 1–14. pulatioo Liu, Z.-H., Huang, M.-J., Zhang, X.-W., Wang, L., Huang, N.-Q., Peng, H., … ge p and Wang, J.-P. 2013. The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious rking-ao complications after colorectal cancer surgery: a double-center and dou-he w ble-blind randomized clinical trial. The American journal of clinical nu-f t trition, vol. 97, no. 1, pp. 117–126. ealth o Maki, R., Matsukawa, M., Matsuduka, A., Hashinaga, M., Anai, H., Yamaoka, Y., … in Fujii, C. 2018. Therapeutic effect of lyophilized, kefir-fermented milk on constipation among persons with mental and physical disabili-pulacije | ho ties. Japan journal of nursing science, vol. 15, no. 3, pp. 218–225. Mokkala, K., Pussinen, P., Houttu, N., Koivuniemi, E., Vahlberg, T. and Laitin-ktivne p en, K. 2018. The impact of probiotics and n-3 long-chain polyunsaturated fatty acids on intestinal permeability in pregnancy: a randomised clinical elovno a trial. Beneficial microbes, vol. 9, no. 2, pp. 199–208. Moreira, T. R., Leonhardt, D. and Conde, S. R. 2017. Influence of drinking a zdravje d probiotic fermented milk beverage containing Bifidobacterium animalis on the symptoms of constipation. Arquivos de gastroenterologia, vol. 54, no. 3, pp. 206–210. Stadlbauer, V., Leber, B., Lemesch, S., Trajanoski, S., Bashir, M., Horvath, A., … and Sourij, H. 2015. Lactobacillus casei Shirota supplementation does not restore gut microbiota composition and gut barrier in metabolic syndrome: a randomized pilot study. PloS one, vol. 10, no. 10, pp. 1–14. Stenman, L. K., Lehtinen, M. J., Meland, N., Christensen, J. E., Yeung, N., Saarinen, M. T., … and Lahtinen, S. 2016. Probiotic with or without fib-er controls body fat mass, associated with serum zonulin, in overweight and obese adults – randomized controlled trial. EBioMedicine, vol. 13, pp. 190–200. Sturgeon, C. and Fasano, A. 2016. Zonulin, a regulator of epithelial and en-dothelial barrier functions, and its involvement in chronic inflammatory diseases. Tissue barriers, vol. 4, no. 4, pp. 1–19. https://doi.org/10.1080/ 21688370.2016.1251384 Yılmaz, İ., Dolar, M. E. and Özpınar, H. 2019. Effect of administering kefir on the changes in fecal microbiota and symptoms of inflammatory bowel disease: a randomized controlled trial. The Turkish journal of gastroenterology, vol. 30, no. 3, pp. 242–253. Yoon, J. Y., Cha, J. M., Oh, J. K., Tan, P. L., Kim, S. H., Kwak, M. S., … and Shin, H. P. 2018. Probiotics ameliorate stool consistency in patients with chronic constipation: a randomized, double-blind, placebo-controlled study. Digestive diseases and sciences, vol. 63, no. 10, pp. 2754–2764. 913 eability erm ntestinal pn i ntake o ilk i nd m efir af k ffect o the e https://doi.org/10.26493/978-961-293-015-8.141-146 STAR-VITAL project: Factors for ensuring participation in health promotion programs Natalija Rozman1, Klemen Širok2 1 National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia 2 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia natalija.rozman@nijz.si; klemen.sirok@fvz.upr.si Abstract Introduction: To ensure sustainable and healthy jobs, the STAR-VITAL project encourages stakeholders to tackle the challenges of an aging workforce. Free of charge, we carry out individualized workplace wellbeing activities for employees and managers in companies. Participants are - in addition to other measures such as workshops, mentoring and coaching – also admitted into customized communication campaigns based on customer relations management (CRM) information platform, with aim to change their health related behaviour. This approach (with the internal name ePlatform), which is presented below, primarily addresses the general challenge of low levels of participation or active involvement of employees in workplace wellbeing programs. Methods: CRM systems are used to manage interactions with current and potential customers, using analysis of customer interaction history with a business to improve customer relationship with a focus on customer retention and encourage purchasing behaviour. The CRM based ePlatform enables advanced personalized web-based and mobile device communication, mobile surveying, GDPR form management, API data sharing, advanced user segmentation, and advanced monitoring and users’ interests’ statistics. The wealth of data generated by ePlatform also enables identification of factors related to the intensity of employee and company involvement in workplace wellbeing measures: work specifics, exposure to health risk factors, current lifestyle, company specifics, industry specifics, employee’s health issues, demographic characteristics. Results: As the project runs in several waves, we present the results of the first group of 31 (out of 80) companies, which are represented by 74 managers, involved in the campaign. The campaign for management consists of nine activities, aimed at the development and successful implementation of a workplace wellbeing program. The use of the ePlatform so far shows a 68% success rate (21 out of 31 companies are currently actively participating). With the help of analysis of variance, in the coming months we will identify those differences between individuals and companies that are related to the intensity of participation in campaigns and the implementation of planned activities. Discussion and conclusions: Proper use of ePlatform enables improved support and empowerment of workers and companies in changing workplace and behaviours, leading to improved care for their own health and prolongation of work activity. To maximize the impact, it is necessary to identify approaches, activities and/or factors that motivate those involved to participate and to change their health and wellbeing behaviour. Keywords: responsiveness, participation, CRM, measures, health promotion 214 Introduction n Despite numerous guidelines, strategies, projects, platforms and measures in pulatio the field of workplace wellbeing, challenge remains how to awaken the intero ge p ests of both workers and companies, as these measures do not bring immediate health or financial benefits. The reasons for this are multifaceted and reach rking-a both at the level of the employee (lack of interest, ignorance, poor relationship o with the employer, .. ), companies (inadequate organizational culture, values of he wf t management, absence of age management, …), narrower and wider social environment (social values, prevailing lifestyles and habits) and regulatory frame-ealth o work (absence of subsidies or tax incentives supporting workplace wellbeing) (Bal et al., 2011; Loeppke et al., 2013; WHO, 2020). In the STAR-VITAL project, we are aware of the need to develop new approaches and systems for more ef-pulacije | ho fective take-up and retention of employees in health promotion programs and healthy workplace measures, which are ultimately aimed at retaining an aging ktivne p workforce. In the STAR – VITAL project (https://www.star-vital.si/o-projektu) we elovno a help companies free of charge in establishing, adapting and integrating concrete measures to protect and promote the health and wellbeing of employ-zdravje d ees in order to ensure sustainable and healthy workplaces - especially for older employees (45+). Project activities are designed to enable an individualized application of measures and identification and awakening of the interests of both employees and managers. An important measure within the project is the ePlatform, which works through the internet or e-mail and is adapted for the use on mobile devices. ePlatform is an innovative approach to promote and monitor the introduction of workplace wellbeing programmes for workers and companies’ management in the fields of ergonomics and movement, stress, communication, nutrition, managerial practices, sleep, absenteeism – presentism and age management (STAR-VITAL, 2020). The purpose of this paper is to present the solution for more effective promotion of employee participation in workplace wellbeing programs by using appropriate IT solutions (ePlatform). We also present the factors that encourage or inhibit the participation and willingness of employees to change their behaviours, related to ensuring health at work. Methods The ePlatform is based on a CRM (customer relationship management) solution, which basically enables a modern marketing approach for communicat-ing and influencing purchase related behaviour. CRM is the strongest and the most efficient approach in maintaining and creating relationships with customers (Juneja, 2020). If many previous approaches and measures implemented in Slovenia are based on pull approach, where the offered content passive-ly waits for the potential interest of customers (e.g. Zrno zdravja, Čili za delo, 3 ASI…), the ePlatform on the other hand additionally brings a push approach, 14 in which employees segmented according to their identified needs are being s actively persuaded, stimulated and encouraged with tailored communication gram campaigns to change their behaviour (ePrvak d.o.o., 2020). ro n p The ePlatform enables: advanced personalized communication through otio the internet and mobile devices, surveying via mobile devices, management of mro GDPR forms, API data exchange, advanced user segmentation and advanced statistics for monitoring communication and user interests. The wealth of da-ealth p ta generated by the ePlatform also enables the identification of determinants n hn i related to the intensity of workers’ and companies’ involvement in workplace wellbeing measures: nature of work, exposure to health risk factors, current lifestyle, company specifics, industry specifics, presence health problems, de-articipatio mographic characteristics, etc. nsuring p Results r eo rs f In the absence of subsidies and direct financial incentives to employers or supportive legislation, employers are the ones who largely moderate what will hap-acto pen to workplace wellbeing programs or/and older employees in the workplace. ject: f That is why the first activity within the ePlatform is the campaign aimed at a ro company’s management. In the first wave, we included 31 companies out of the planned 80, represented by 74 employees in different managerial positions. star-vital p The campaign for company managers consists of nine e-mails, that re-cipients receive weekly. In case of their unresponsiveness (unread message), the user automatically receives an encouragement message with a reminder. The entire campaign lasts 56 days. The contents of the campaign follows the steps to the successful implementation of the workplace wellbeing program in the company: (1) presentation of steps in the process of establishing the workplace wellbeing program, (2) implementation of a screening questionnaire on the health of the company/employees, (3) identification of necessary measures and good practices through the analysis of the screening questionnaire and introduction with the STAR-VITAL Wiki page (repository of 150+ known occupational health promotion and workplace wellbeing measures), (4) elaboration or supplementation of the existing health promotion plan, (5 and 6) adaptation of already implemented measures, (7) introduction of change management and (8) a system for monitoring the quality of the implementation of the workplace wellbeing in the company. In the last step (9), we encourage the company to celebrate the achieved goals on an ongoing basis. The success rate of the campaign for the management at the time of writing (March 2020) reached 82% (23 active companies out of 28), while the latest results (July 2020) show a 68% (21 active companies out of 31). The current average share of read e-mail content in the campaign for managers is 60%. All STAR-VITAL measures are being evaluated by participants, ePlatform content 4 including. In ePlatform users numerically evaluate the content on a scale from 14 5 (highest score) to 1. The current satisfaction rating of the received content for the managers is 4.5. It also needs to be mentioned that so far 25 companies or n 869 employees have completed the screening questionnaire. We have already pulatio included many of them in campaigns in the field of physical activity and ergo-o nomics, nutrition and stress. ge p rking-ao Discussion he w In the STAR-VITAL project, we encourage stakeholders (companies and em-f t ployees) to actively promote occupational health and wellbeing through various channels. The greatest potential for constant communication and user pro-ealth o motion is the ePlatform, which our analysis also confirms. The results indicate a high share of user (company) activity, satisfaction with received content and a pulacije | h satisfactory level of content readability. Campaign performance varies in time o (holiday leaves and events when emails are treated as SPAM). The situation related to COVID-19 also proved to be an important factor, pushing a significant ktivne p part of companies to face the challenges of stopping their operations and production, which consequently meant a stalemate in workplace wellbeing activ-elovno a ities. Factors important for the successful introduction and implementation of zdravje d occupational/workplace health promotion and wellbeing, have already been explored by numerous authors (Archer, 2012; Bakker, 2015; Spence, 2015; Schmid et al., 2017; Santos, 2019). In the STAR-VITAL project, based on the richness of data monitored by the ePlatform (CRM system), we will upgrade these studies and determine whether the readiness and level of active participation of stakeholders (employees, companies) are also influenced by other, less researched factors: line of business, management support in the implementation of health promotion, company specifics, demographic characteristics, personal values of health promoters and company management, awareness of expected benefits, perceived level of (health) problems in employees or personnel problems in the company, etc. Analysis of variance and later also multilevel modelling will be used for the analysis. Conclusions Regardless of the fact that many activities in the field of workplace wellbeing are currently being carried out in Slovenia, their introduction and implementation in a practical environment is still a challenge. With the proper use of the ePlatform, we are on the way to provide greater support and empowerment for both employees and companies to change their behaviour at work (and outside work), which leads to greater care for their own health and prolongation of work activity. To make the impact even better, it is necessary to identify the approaches, activities and/or factors that motivate those involved to participate and change behaviour. 514 References s Archer S., 2012. Health is wealth: The rise of workplace wellness. IDEA Fitness Journal, vol. 9, pp. 38–44. gramro Bakker A. B., 2015. Towards a multilevel approach of employee wellbeing. Eu-n p ropean Journal of Work and Organizational Psychology, vol. 24, pp. 839– otiom 843. Available from: 10.1080/1359432X.2015.1071423 ro Bal A.C., Reiss A.E., Rudolph C.W and Baltes B.B, 2011. Examining positive ealth p and negative perceptions of older workers: a meta-analysis. The Journals n h of Gerontology, Series B: Psychological Sciences and Social Sciences, vol. n i 66, pp. 687–698. Emily S., 2019. “Introducing the Workplace Well-Being Program Implemen-articipatio tation Model: A Model to Inform the Establishment of Organizational Well-Being Programs”. Master of Applied Positive Psychology (MAPP) nsuring p Capstone Projects. Available from: 163.https://repository.upenn.edu/ r eo mapp_capstone/163 rs f ePrvak d.o.o., 2020. Kako vam marketing automation prihrani čas in izboljša acto prodajo? [viewed 6 July 2020]. Available from: https://www.eprvak.si/ ject: f marketing-automation/ ro Juneja P., 2020. Management Study Guide. Customer Relationship Management - What is CRM? [viewed 6 July 2020]. Available from: https:/ www. managementstudyguide.com/what-is-crm.htm star-vital p Loeppke R.R., Schill L.A., Chosewood L.C., Grosch J.W., Allweiss P. and Burton W.N. et al., 2013. Advancing workplace health protection and promotion for an aging workforce. Journal of Occupational and Environmental Medicine, vol. 55, no. 5, pp. 500-506. Schmid J. A., Jarczok,M. N., Sonntag,D., Herr,R. M., Fischer J. E. and Schmidt B, 2017. Associations between supportive leadership behavior and the costs of absenteeism and presenteeism: An epidemiological and econom- ic approach. Journal of Occupational and Environmental Medicine, vol. 59, pp. 141–147. Spence G. B., 2015. Workplace wellbeing programs: If you build it they may NOT come … because it’s not what they really need! International Journal of Wellbeing, vol. 5, pp. 109–124. Available from: 10.5502/ijw.v5i2.7 STAR-VITAL, 2020. O projektu. [viewed 3 July 2020]. Available from: https:/ www.star-vital.si/o-projektu World Health Organization, 2020. Healthy workplaces: a WHO global model for action. Five Keys to Healthy Workplaces. [viewed 3 July 2020]. Available from: https://www.who.int/occupational_health/5_keys_EN_web. pdf?ua=1 614 n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.147-153 Type 1 Diabetes Management Using Information Communication Technology Eva Skočir, Tereza Sever, Tadeja Vidmar, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia eva.skocir05@gmail.com; tery.sever@gmail.com; tejci.vidmar@gmail.com; andrej.starc34@gmail.com Abstract Introduction: The incidence of diabetes type 1 is increasing. Meanwhile, diabetes represents one of the greatest risks for comorbidity with other diseases and late complications associated with diabetes, thus a great burden for the health system. Diabetes complications occur more often if the disease is poorly managed. Type 1 diabetes is often diagnosed in children and young adults who represent a big part of the working population. Methods: We used the descriptive method with a systematic overview of scientific and professional literature. We searched through CINAHL, Medline, ScienceDirect databases. The key words we searched for were: diabetes type 1, information technology in healthcare, diabetes management, diabetes control, diabetes self-management, disease management, information communication technology and sladkorna bolezen tipa 1. We typed them into a search engine in various yet meaningful combinations in Slovene and English language. Hundreds of sources of literature have been found. Based on the suitability of the titles a selection was made. Furthermore, based on reading of abstracts, we decided to include 19 sources in preparation of the article. Inclusion criteria when deciding which sources to use were: sources published after 2014; resources that have full access online; available articles for free; professional and scientific literature only; Slovenian and English sources only. The literature search took place in the second half of February and the first half of March 2020. Results: Progress in the field of information and communication technology opens up possibilities for improved health care for patients with diabetes, which is a step toward easier and better diabetes management. Blood glucose monitors continuously measure blood sugar and transmit measurements to the apps on smartphones or directly to the insulin pumps. These pumps then connect to computers where a better overview of the blood sugar status is enabled. Various smartphone applications provide online consultation and support for patients. This development creates greater chance for better patient-focused health care. New technologies offer opportunities to overcome barriers, such as geographical distance and lack of access to information that may occur regardless of the patient‘s age. Discussion and conclusions: Devices such as insulin pumps and various devices for continuous measurement of blood sugar are increasingly interconnecting with each other or with various programmes and applications on PCs and smartphones, therefore allowing individuals a better control of their blood sugar and helping healthcare professionals identify patterns and options in order to help the patient. Technology use is a tool that leads towards decrease of numbers of patients with diabetes complications. Consequently, a higher percentage of individuals that are capable of pursuing their profession are reducing the burden of health care, insurance companies and the state. 8 Keywords: type 1 diabetes mellitus, healthcare professionals, active 14 working population, technology, diabetes complications n Introduction pulatioo The incidence of diabetes type 1 is increasing (NIJZ, 2020; WHO, 2020). Un-ge p controlled blood glucose level and uncontrolled diabetes as its consequence, lead to serious damages of various organ systems in the body, especially the rking-ao nerves and blood vessels (WHO, 2020). he w Type 1 diabetes is representing between 5 and 10% of all diabetes cases in f t the world. Type 1 diabetes occurs when the production of insulin is deficient. ealth o The cause, nor the means to prevent type 1 diabetes are not known. (Tauschmann and Hovorka, 2018; WHO, 2020). Diabetes type 1 is incurable, and lifelong management of the disease is required (Tauschmann and Hovorka, 2018). pulacije | ho The management depends upon daily administrations of insulin, frequent blood sugar monitoring and calculating carbohydrate intake (Haslund-Thom-ktivne p sen et al., 2020). Regular glucose monitoring enables appropriate adjustment of the insulin doses and consequently higher chances to achieve normoglycaemia elovno a (Nana et al., 2019). Retaining blood glucose within the optimal level significantly reduces the risk of complications. Diabetes complications occur more often if the disease is poorly managed (Haslund-Thomsen et al. 2020). The treat-zdravje d ment differs among patients. It depends upon one’s habits and characteristics (Rodríguez-Rodríguez et al., 2018). Diabetes type 1 is often diagnosed in young adults and children, that in time, represent a big part of the working population (Haslund-Thomsen et al., 2020). Meanwhile, diabetes represents one of the greatest risks for comorbidity with other diseases and late complications associated with diabetes, thus a great burden for the health system. The rising number of new cases has become a global problem that, besides public health and health systems, significantly affects also the economy and social development, causing health complications and consequently high costs of therapy (Cerna and Maresova, 2016). Methods We used the descriptive method with a systematic overview of scientific and professional literature. We searched through CINAHL, Medline, ScienceDirect databases. The key words we searched for were: diabetes type 1, information technology in healthcare, diabetes management, diabetes control, diabetes self-management, disease management, information communication technology and sladkorna bolezen tipa 1. We typed them into a search engine in various yet meaningful combinations in Slovene and English language. Hundreds of sources of literature have been found. Based on the suitability of the titles a selection was made. Furthermore, based on reading of abstracts, we decided to include 19 sources in preparation of the article. Inclusion criteria were: sources published after 2014; resources that have full access online; available articles for free; professional and scientific literature only; Slovenian and English sources only. We searched also on the official websites of WHO (World Health 9 Organization) and NIJZ (Nacionalni inštitut za javno zdravje RS). The litera-14 ture search took place in the second half of February and the first half of March gy 2020. lo hnoec t Results In the past, the only option of managing the disease was manual checking of the blood glucose via finger picking and manual administration of the insu-unicationm lin, but in the last years technology has become an indispensable accessory in om c helping and easing self-management of the disease (Rodríguez-Rodríguez et ation al., 2018). Elementary way of applying insulin are insulin pens. In 1990s insu-m lin pumps became widely available and brought a huge improvement in health care of patients with diabetes. Modernization of insulin pumps has enabled sing infor implementation of adjunctive technologies, such as bolus calculators and furt uen thermore combining monitoring blood glucose and applying insulin with interconnected sensors of blood glucose, insulin pumps and diverse mobile ap-anagem plications that are rapidly gaining popularity in last years (Tauschmann and Hovorka, 2018). Even though the therapy with insulin pumps and other devic-iabetes m es is on average more expensive than therapy with daily injections, the costs are in long term reduced from fewer diabetic complications that follow improved type 1 d diabetes control (Beck et al., 2019). Technology and glucose monitoring - Blood glucose meters: smaller than in the past; testing blood glucose via finger picking. - Continuous glucose monitors: provide up to 1440 measurements per day – one measurement per minute; are interconnected with mobile apps and insulin pumps or can transfer data to programmes on computer (Beck et. Al., 2019, Haslund-Thomsen et al., 2020; Ro-dríguez-Rodríguez et al., 2018). Technology and insulin application - Smart pens and mobile applications: Smart pens can connect with smartphone applications wirelessly and share data. Doses, time, bolus calculation and more can be saved in the app. Smartphone application nowadays offer recording of blood-glucose data, food intake, dose recommendations and tracking of physical exercise. - Insulin pumps: connected to the patient with a tubing system; enabling continuous delivery of insulin, include bolus calculators; ability to programme multiple basal rates; can connect with a computer and send data to the programme; can connect with mobile applications; malfunctions of pumps and infusion sets may occur. - Automated insulin delivery systems, often named artificial pancre-as consist of continuous glucose monitor, an insulin pump, and an 015 algorithm – using glucose concentration and previous insulin delivery data to regulate insulin delivery (Beck et al., 2019; Rodríguez-n Rodríguez et al., 2018). pulatioo Progress in the field of information and communication technology opens ge p up possibilities for improved health care for patients with diabetes, which is a step toward easier and better diabetes management (Nana et al., 2019). rking-ao Blood glucose monitors continuously measure blood sugar and transmit he w measurements to the apps on smartphones or directly to the insulin pumps. f t These pumps then connect to computers. Various smartphone applications ealth o provide online consultation and support for patients. This development creates greater chance for better patient-focused health care. New technologies offer opportunities to overcome barriers, such as geographical distance and lack pulacije | ho of access to information that may occur regardless of the patient’s age (Lanzo-la, 2016). ktivne p Telemonitoring improves control of blood sugar, helps to reduce HbA1c. There were found positive effects on associated diseases, such as hypertension, elovno a dyspnea, etc. patient empowerment and better quality of life (Andrès et al., 2019; Kitsiou et al., 2017). zdravje d Discussion Use of ICT is enabling individuals a better control of their blood sugar and helping healthcare professionals identify patterns and options in order to help the patient. Technology use is a tool that leads towards decrease of numbers of patients with diabetes complications. Consequently, a higher percentage of individuals that are capable of pursuing their profession is reducing the burden on health care, insurance companies and the state (Dadgar and Joshi, 2018; Kitsiou, 2017; Krishnan and Selvam, 2019; Murillo, 2017; Offringa, 2018; Wu Y, 2017). Only 20% of patients with diabetes type 1 do not keep any record. Paper documentation is most common among the patients that do keep record, and only 4% use mobile apps. Reasons for not using apps are: paper documentation preference, considering their use as a waste of time, or considering it too difficult. With the development of technologies, we can expect higher number of users in the future. Besides following blood glucose levels, the treatment of diabetes also involves monitoring one’s weight, intake of carbohydrates, insulin dosage, and physical activity (Cerna and Maresova, 2016; Dinath and Mearns, 2019). To be able to give proper advice about the apps and also type of device that would be the most suitable for a patient, specific information is required: the patient’s personality, technical skills, daily regimen, attitude to diabetes, preferences in data visualization and functionalities, willingness to learn new things, and motivational means (Holubová et al., 2019). 115 Conclusions gylo It is necessary to emphasize the important role that diabetic patients have in hno the development of information and communication technologies. They need ec t to be included in the innovation process, as they are the key actors, that can contribute to the development of health informatics in this field (Kanstrup, 2015). unicationm om c References ationm ANDRÈS E., MEYER L., ZULFIQAR A.A., HAJJAM M., TALHA S., BA-HOUGNE T., ERVÉ, S., HAJJAM, J., DOUCET, J., JEANDIDIER, N., ET AL., 2019. 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Available from: doi: 10.2196/mhealth.6522. ationm sing infor t uen anagem iabetes m type 1 d https://doi.org/10.26493/978-961-293-015-8.155-160 Distance teaching: perceived stress, psychological health and work satisfaction among classroom teachers Janja Tekavc, Pia Novak University of Maribor, Faculty of Education, Koroška cesta 160, Maribor, Slovenia janja.tekavc@um.si; pia.novak@student.um.si Abstract Ninety-one Slovenian classroom teachers participated in a study and completed an online questionnaire about their perceived level of stress, wellbeing and work satisfaction during the period of distance teaching due to epidemic of COVID-19. The results revealed that teachers perceived similar amount of work-related stress during the period of distance teaching as in general classroom setting. The majority of teachers experienced none to minor symptoms of psychological distress due to distance teaching working conditions, and reported being predominantly satisfied with their work during the epidemic of COVID-19. Keywords: COVID-19, distance work, teaching, psychological distress, wellbeing Introduction The pandemic of COVID-19 is presenting us with “uncertain times,” in which the future of an individual as well as the whole society presents as unclear. The pandemic emerges as a stressful and even traumatic event that requires individuals to make sense of the new situation and choose appropriate coping actions. Psychological theories and research on stress and individual coping are of great relevance to understand individual responses and reactions to merging stressors associated with the COVID-19 pandemic (Guan et al., 2020). The influence of the pandemic of COVID-19 has represented a career transition to many people (Rudolph and Zacher, 2020). During the epidemic of COVID-19, the majority of the Slovenian active population encountered a changed way of working. Among them were also Slovenian teachers who carried out distance teaching during the measures introduced in the fight against the spread of the COVID-19 virus. Teachers’ work is in general associated with increased level of stress, especially when teachers are exposed to many changes in the work process (De Simone et al., 2016). Research shows that teachers’ perceived stress is consistently correlated with their wellbeing. Further, teachers’ perceptions of stress and sense of wellbeing are central to their ability to teach well (MacIntyre et al., 2019). The aim of this research was to assess the perceived level of current and general stress in classroom teachers during the period of distance teaching due to COVID-19, their psychological wellbeing, and the level of satisfaction with their work. Methods 6 Participants and procedure 15 An invitation to an online questionnaire was sent to primary school teach-n ers via social network groups (i.e., Facebook, Twitter) at the beginning of sixth week of online teaching, which represented the middle of the work-at-home pe-pulatioo riod for teachers in Slovenia during COVID-19 epidemics. The online question-ge p naire was developed on previous qualitative data inquiry (i.e. interviews with several teachers) and included: demographic questions, information about the rking-ao current level of perceived stress during distance online teaching, general stress he w during previous periods of teaching, current distress and psychological well-f t being markers, and satisfaction with life and work. Ninety-one Slovene female teachers completed an online questionnaire. The mean age of participants was ealth o 40.90 years (SD = 19.26) and the participants had a mean of 13.66 years of teaching experience (SD = 9.85). pulacije | ho Measures ktivne p We used the following measures: (1) Demographic and background information: participants’ age, seniority in primary school teaching, the grade they elovno a currently teach, and the number of students they currently have in their class; (2) Perceived psychological stress: we used single-item measures of stress to zdravje d capture the extent to which participants reported experiencing stress during the period of distance learning (i.e., current stress) as well as their typical level of stress during traditional classroom teaching (i.e., general stress); (3) Current distress symptoms: using scales that ranged from 1 (not at all) to 4 (very much), the participants reported the extent to which they were experiencing different psychological distress symptoms; (4) Work satisfaction: using a scale that ranged from 1 (not at all) to 5 (very much), the participants indicated the extent of their satisfaction with their current work and private life. Statistical methods General descriptive statistical analysis using the statistical program SPSS version 26 was used to evaluate the data. Paired samples t-tests were performed to examine differences between current and general stress with two-tailed tests of significance and confidence intervals being based on the level of p < .05. Results In the present study, participants reported very similar scores for current stress (M = 3.10, SD = 0.60) and for general stress (M = 3.11, SD = 0.50; t[91] = -0.86, p = .39). Table 1: Teachers’ experience of psychological distress symptoms during the period of distance teaching. 715 Frequency (%) s Psychological distress symptoms 4 - Very of- M SD 1 - Never 2 -Occasion- ally 3 - Often ten / all- ways eacher t Restlessness 14 49 19 17 2.4 0.93 Mouth dryness 41 44 9 6 1.8 0.85 Absence of positive feelings 48 34 12 5 1.7 0.87 lassroom Breathing issues 66 23 8 4 1.5 0.82 g c Lack of proactivity 54 35 10 1 1.6 0.71 mon a Overacting 22 48 17 13 2.2 0.93 Shaking 76 14 8 2 1.4 0.72 Nervousness 28 38 19 15 2.2 1.02 Concern 51 35 8 6 1.7 0.87 atisfactionk s Nothing to be happy about 59 27 8 6 1.6 0.89 or Irritation 20 41 22 17 2.4 1.00 nd w Tension, hard to relax 18 47 23 12 2.3 0.90 Sadness 31 43 15 11 2.1 0.95 ealth a Impatience 28 38 24 11 2.2 0.96 Anxiety 53 28 14 5 1.7 0.90 gical h Lack of enthusiasm 58 28 9 5 1.6 0.86 lo Feelings of worthlessness 56 29 9 6 1.7 0.89 Oversensitiveness 19 40 30 11 2.3 0.91 sycho Increased heart rate 48 31 17 3 1.8 0.86 Fear 44 38 14 4 1.8 0.85 tress, p s Feelings of meaningless 78 13 5 3 1.3 0.73 ceiveder Legend: M, mean; SD, Standard deviation Table 1 presents different symptoms which usually appear with experi-eaching: pe t encing a psychological distress and the extent to which participants rated their observation of the occurrence of these symptoms among themselves during distanc the period of distance teaching. On a scale ranging from 1 (not at all) to 4 (very much), the arithmetic means of the symptoms ranged from the minimum of 1.3 to the maximum of 2.4. The symptoms with the highest mean are indicated in the table. Participants’ level of satisfaction with different aspects of their work and private life during the period of distance teaching is presented in Table 2. On a scale ranging from 1 (very dissatisfied) to 5 (very satisfied), the arithmetic means of the dimensions ranged from the minimum of 2.6 to the maximum of 4.2. The participants indicated the highest level of satisfaction with quality of learning materials they provided for their students during the period of distance teaching, the availability of the working materials they needed for their work at home, and their communication with the students and their parents. They were least satisfied with the amount of time they dedicated for their work as well as for their private life. Table 2: Teachers’ level of satisfaction with work and life during the period 8 of distance teaching. 15 n Level of satisfaction (frequency %) Dimension M SD 1 2 3 4 5 pulatio Quality of work 2 14 25 47 11 3.5 0.95 o Teaching approach 3 15 30 42 10 3.4 0.98 ge p Availability of working materials 0 2 8 65 25 4.1 0.64 Quality of learning materials 0 0 7 64 30 4.2 0.56 rking-ao Private life 7 23 27 29 14 3.2 1.15 he w Time dedicated for work 20 34 21 21 4 2.6 1.16 f t Time dedicated for private life 19 34 18 23 7 2.6 1.21 Personal relationships 9 19 20 30 23 3.4 1.27 ealth o Partner and family support 3 7 13 46 31 3.9 1.00 Communication with co-workers 0 5 19 53 23 3.9 0.80 Communication with students pulacije | h and parents 0 3 20 49 27 4 0.78 o Legend: M, Mean; SD, Standard deviation ktivne p Level of satisfaction … 1 – very dissatisfied, 2 – dissatisfied, 3 – not satisfied, not dissatisfied, 4 – satisfied, 5 – very satisfied elovno a Discussion The purpose of the present study was to investigate primary school teachers’ zdravje d perceived level of stress, wellbeing and satisfaction with their work and life during the period of distance teaching due to epidemic of COVID-19. The results revealed a similar level of perceived stress between general teaching setting and distance learning conditions. This is somewhat different from the study findings of the Slovene National Education Institute about distance education during epidemic of COVID-19 (2020), in which teachers reported perceiving distance teaching as stressful and demanding. The majority of teachers in our study reported never or only occasionally experiencing different symptoms of psychological distress during the period of distance teaching. This is in line with some foreign studies (See, Wardle and Collie, 2020) in which the majority of teachers reported being happy and cheerful, calm and relaxed during the period of distance teaching due to lockdown. Despite the fact that distance teaching was not connected to significant psychological distress for the majority of participants in our study, we found that among the most common symptoms of psychological distress were different signs of increased nervous tension (e.g., restlessness, nervousness, irritation, and inability to relax), which implies that for some teachers the whole situation of working at home was however demanding. The difficultness of this situation is probably connected not only to their changed working conditions, but also to changes in teachers’ private home settings as a consequence of their confinement in their home because of the epidemic (e.g., taking care of their children’s school work, having their spouse working at home in the same time). In general, teachers in our sample reported being satisfied with their working conditions, private life, and social support they received during the 915 epidemic of COVID-19. They seemed to be the most satisfied with the avail-s ability of materials they were able to reach by using information communication technologies (ICTs), the materials they provided for their students, as eacher t well as with their communication with students and their parents. We could argue that the situation with COVID-19 allowed the teachers to get acquainted with information communication technologies (ICTs) and strengthen their lassroom g c competencies in their use. Participants in our study appeared the least satisfied with the amount of time they dedicated for their work and private life, with mon a spending too much time for their work and as a consequence being left with inadequate time for themselves. This supports the notion that the influence of the pandemic of COVID-19 has represented a career transition to many people atisfactionk s (Rudolph and Zacher, 2020) including teachers, forcing them to face and invest or time and energy to adapt to the new working demands. nd w This study offers a very important and current insight into teachers’ coping with changed working conditions due to epidemic of COVID-19. However, ealth a some weaknesses can be identified, such as (1) small sample of participants; (2) participants were invited to participate via social networks, which could rep-gical hlo resent the fact that mostly of the teachers who are very skilled in using ICTs were involved in this study; (3) time of data gathering (i.e., sixth week of dis-sycho tance teaching) in which the majority of teachers might have already success-tress, p fully managed the transition from face-to-face teaching to distance teaching. s ceiveder Conclusions In light with preparing for the possible upcoming outbreaks of COVID-19 and changed educational settings, this study offers some valuable insight in-eaching: pe t to teachers’ perceptions of distance teaching and its impact on their health and wellbeing. Despite representing a transition which required an active adapta-distanc tion, the period of distance teaching due to epidemic of COVID-19 did not appear as a significantly stressful situation for teachers in our study. Participants reported facing only minor or no psychological symptoms of distress and in general experienced satisfaction with their work and life during the pandemic. In order to more thoroughly investigate the impacts of distance teaching on teachers and design its optimal procedures, future research is needed, including larger and more representative sample of teachers, longitudinal approach, and other methods of inquiry (e.g., qualitative approach). References DE SIMONE, S., CICOTTO, G., & LAMPIS, J., 2016. Occupational stress, job satisfaction and physical health in teachers. European Review of Applied Psychology, vol. 66, no. 2, pp. 65-77. GUAN, Y., DENG, H., & ZHOU, X., 2020. Understanding the impact of the COVID-19 pandemic on career development: Insights from cultural psy-0 chology. Journal of Vocational Behavior, [viewed 27 June 2020]. Available 16 from: https://pubmed.ncbi.nlm.nih.gov/32382162/ n MACINTYRE, P. D., ROSS, J., TALBOT, K., MERCER, S., GREGERSEN, T., & BANGA, C. A., 2019. Stressors, personality and wellbeing among lan-pulatioo guage teachers. System, vol. 82, pp. 26-38. ge p RUDOLPH, C. W., & ZACHER, H., 2020. COVID-19 and careers: On the futil-ity of generational explanations. Journal of Vocational Behavior, [viewed rking-ao 27 June 2020]. Available from: https:/ pubmed.ncbi.nlm.nih.gov/32390654/ he w SEE, B. H., WARDLE, L., & COLLIE, P. (2020). ‘Teachers’ wellbeing and workf t load during Covid-19 lockdown.’ Working paper. [viewed 27 June 2020]. Available from: http:/ dro.dur.ac.uk/31114/1/31114.pdf?DDD29+vqhv43 ealth o ZAVOD REPUBLIKE SLOVENIJE ZA ŠOLSTVO, 2020. Analiza izobraževanja na daljavo v času epidemije Covid-19 v Sloveniji. Delno poročilo. [viewed pulacije | h 20 July 2020]. Available from: https://www.zrss.si/digitalnaknjiznica/Izo-o brazevanjeNaDaljavo/100/ ktivne p elovno a zdravje d https://doi.org/10.26493/978-961-293-015-8.161-168 Exercise at workplace: an overview Nikola Todorović, Valdemar Štajer, Darinka Korovoljev, Nebojša Maksimović, Sergej Ostojić Faculty of Sports and Physical Education, University of Novi Sad, Lovćenska 16, Novi Sad 21000, Serbia nikolatodorovic1708@gmail.com; stajervaldemar@yahoo.com; nebojsam@uns.ac.rs; korovljev.darinka@gmail.com; sergej.ostojic@uns.ac.rs Abstract Introduction: Exercise programs may have a significant impact on worker(s) efficiency and the implementation of an exercise intervention at the workplace could be positively related to the reduction of unnecessary societal costs. The aim of this review is to systematically analyze the evidence from studies that examined workplace interventions which implemented physical exercise programs and subsequent impact on work performance and health. Methods: Research on available literature was conducted on PubMed (Medline) and Kobson database. Only randomized controlled trials (RCTs) including exercise or physical activity at the worksite were examined. Results: Following the review of the literature, we found 309 studies that included the keywords: exercise, workplace, health, intervention. After reading the abstract or full text, a total of 10 studies were included in the research. Most studies, five of them, based their interventions on resistance training and/or strength training, two studies examined the effects of flexibility exercises, while the remaining three studies examined the effects of several different types of training. The results of most studies indicated improvements in health, work productivity, and motivation. Discussion and conclusion: Altogether, studies retrieved for analysis in our review demonstrate that there is moderate to strong evidence to perform exercise at the workplace. The benefits depend on the length and the type of intervention. The evidence supports the use of short, simple exercise for workers at the worksite. Strength exercises have led to the greatest benefits. In terms of intensity, opinions are divided, but both moderate and high-intensity exercises appear to lead to improvements. Exercise length is estimated to be optimal for about 10-15 minutes per session. Keywords: Exercise; Physical activity; Workplace exercise; Worksite exercise; Intervention; Health Introduction There is strong evidence that physical activity (PA) can prevent and have a beneficial effect on a wide range of physical and psychological disorders, along with the promotion of the longevity (Physical Activity Guidelines Advisory Committee, 2008). General recommendations of the World Health Organization (WHO) are 150 min of moderate-intensity at least, or 75 min of vigorous-intensity aerobic PA or equivalent of a mixture of these two activities. WHO recognizes well-being as an important marker of health and plays an important role in relationships between employee and employer, as well as job satisfaction and productivity. The problem in most developed countries is the increasing number of sedentary populations. Workplaces require less physical effort from workers as a consequence of technological development. In study of (Parry and Straker, 2013), it is shown that workers spend most of their time sitting, while in studies (Thorp et al., 2012; Wallmann-Sperlich et al., 2017) re-216 sults shown that workers spend more than 70% of their working hours sitting. Physically active people obtain more physical and mental health benefits com-n pared to sedentary people. (Pate et al., 1995; Hu et al., 2000). Around 70% of world population does not meet the minimum requirements for health-related pulatioo physical activity. Physical activity is a leading risk factor (together with smok-ge p ing, hypertension, and dyslipidemia) for cardiovascular diseases (Ostojić et al., 2013). Based on the fact that the most adults spend around 8 hours a day at their rking-ao workplace, and that job as mentioned is based on sitting, offering physical ac-he w tivity programs at the workplace could be an efficient way to enhance levels of f t activity. Workplace exercise is a specific exercise program for workers, carried out at a worksite, with the aim of improving of the several general qualities of ealth o life outcomes as well as specific outcomes, such are muscle strength and flexibility (Dishman et al., 2009; Grande et al., 2014). These programs are important pulacije | h for improving the workability of employees and improving health in general. o Poor operability is associated with loss in productivity, work disability and early retirement (Kuoppala et al., 2008). In this review article, the goal is to ana-ktivne p lyze current workplace interventions. The findings of this growing problem can help with improving future workout programs. elovno a Methods zdravje d This paper reports on workplace-based exercise interventions, mostly based on strength and flexibility intervention. The main outcome of the reviewed intervention was to improve workability and health outcomes. The reviewer N.T conducted independently the article selection process. The reviewer screened the articles initially, based on the title and abstract, in order to determine whether the trial met the inclusion criteria. The full text was retrieved and reviewed in detail if the criteria were met. The approach of this systematic review was based on the PRISMA statement and the Cochrane handbook for systematic reviews of interventions (Higgins and Green, 2011). A systematic search of the literature was conducted on PubMed (Medline) and Kobson database. Arti- cles with all data relating to exercise intervention at work were reviewed. Level 1 randomized controlled trials (RCTs) were included in the study. Also, information from other sources, in which the trials of the quality lacked, were included. The search was performed during January 2020. Only English language articles published in peer-reviewed journals were considered. Studies from January 2010 to January 2020 were analyzed to review findings from studies reflecting modern-day intervention and approaches. Studies were not excluded, because of any of the following factors: sex, the position at work, or age groups. Results The initial search for the literature detected 309 articles about workplace intervention; still, 299 were excluded after being determined that they are unre-lated to workplace exercise interventions or failed to meet the inclusion criteria, or both. Total of 10 studies were included. Only randomized control trials 3 were included. Most of the included studies contained either strength training 16 or flexibility training. Total of 1590 subjects participated in these studies. The main goal of the interventions was to improve health and productivity. The characteristics of the analyzed studies are presented in (Table 1). Altogether, verview n o studies retrieved for analysis in our review demonstrate that there is moderate to strong evidence to perform an exercise at the workplace. The benefits depend on the length of the study and the type of intervention. The benefits depend on rkplace: ao the length of the study and type of intervention. t w Discussion and conclusion exercise a Walking is considered to be the form of physical activity most widely accepted in the masses. It is one of the most basic physical activities. All the people spend most of their lives walking, anyway. The idea of the study (Torrente et al., 2017) was to determine the effects of active break at work and walking in the park and their effect on the stress and blood flow. The idea of reducing cortisol, as a stress hormone with walking in the park, was supported by previous studies which stated that walks in natural surroundings had lower cortisol values compared to urban walks (Lee et al. 2011). An interesting study (Jakobsen et al., 2017) examined the impact of exercise with colleagues at worksite versus exercise at home. The result of their study indicated the greater benefits of exercise at worksite. The subjects felt better and were more energetic after the intervention. These results were in agreement with previous research of Dugdill and colleagues (2008). This might be the result of the greater commitment to the exercise program and the influence of the social factor. The earlier study by the same group of researchers (Jakobsen et al., 2015) found that group exercise with colleagues during work prevents operability deterioration. Svensson and colleagues (2009) demonstrated that a 14-month prevention program, that combined physical training, patient transfer techniques, and stress management reduced self-reported sickness absence compared to a control group. It is very interesting question about which type of physical activity could have Table 1: The characteristics of the analyzed studies f 3 1 o. o 0 66 20 48 50 N sub. 132 15 37 35 200 200 ion eeks eeks eeks ear eeks eeks eeks eeks eeks urat 1 y NR D 10 w 10 w 4 w 12 w 6 w 12 w 10 w 10 w y type T T T T T T T T T T RC RC RC RC RC RC RC RC RC RC Stud or - - ve g f er one eek; houl ealth g; 3- one g fi one ses inin n ex t 60-80% ci ra g tio outh + 3-5 gs; C-n er es a w oxin ion inin nd 2 min. g a ra eck / s se; C- h ntrol/n 5 a h t g; C- n g ex im 4 gt inin er m inin ci ; 2- b ra elaxa lkin inin nd n er er 16 ra ervent or 1 e p tren f r ra chin et ; 4-co ody im h ex Int stance t eek f f s tret oga 1-3 t gt s hair n esi utes o ark wa vised t vised t f s gom gonomic t r p one t tren otion e- 5x10min ne es a w pper b ax one 5 min uper gonomics a 2m super ; s om ike er assage c pulatio se o om - no o Elastic r tim I- 10min o the u C- er I-1 ci I-S V0 un 15min o I- 60min Y C- N I-er der pr I-5x10min H C I :5x10min C:5x10min 1- b m ge p ean 9;C rking-ao Age M 44 45; I 41; C NR 45; I 41; C 25; I 2 40; I 38; C 41 42 42 42; I 40;C he w - - - - - - - - f t e e e e e e e e cts sex nd F nd F nd F nd F nd F nd F nd F nd F ealth o Subje ale ale ale a le ale a le ale a le ale a le ale a le ale a le ale a le ale a le M ma M ma M ma M ma M ma M ma M ma Fem Fem M ma ar 4 4 7 4 10 7 16 pulacije | h Ye 201 201 201 2015 201 20 2019 201 2015 20 o - ork ork, - ktivne p ork, - tal heu nal c . vi f w f W tio en f W earch ealth ealth f R ed . o t & . o f O . o t & f en es ealth ealth urnal . o y . o M en . o y en niza onm elovno a Jo our our ga our vir our our tal r ublic h ublic h nd H .Jour onm . J tional ublic h lth onm lth . J en C p C p s a atolog vir lth cholog stein ea vir ea Inter m Scand. J en hea Scand. J and Or Psy Inter cupa and En H Ein Scand. J En H Inter ronm and p BM BM Stres zdravje d ebis l. l. l. l. l. nd Z l. l. l. Study l. en et a sen a te et a en et a l et a en et a en et a dstrup et a tun nde et a g et a nder et ra artfie ollseiff A Sun Torren K G H Tin Jakobs Jakobs W Legend: RCT - randomized control trail; NR - not reported; WE - Workplace exercise, Home - Exercise at home; I - Intervention group; C - Control group the most effects. There are, of course, many factors that could affect this. The study of (Wollseiffen et al., 2016) examined how different types of activities influence work performance and decision-making tasks. The results indicate that it might be possible that higher intensity activities had a bigger impact on these parameters. This theory is also supported by the study of (Sperlich et al., 2018) in which interruption of prolonged sitting with 6-min session of HI-IT, induced more evident circulatory and metabolic responses and improved certain aspects of perception. On the other hand, many authors believe that moderate-intensity could lead to employee health benefits. The studies (Ket-tunen et al., 2015; Hartfiel et al., 2011) have examined the impact of light and moderate-intensity exercise. Such interventions indicated to influence the reduction of the stress. Moderate intensity is easier to apply to beginners, and longer adherence to the training program with this intensity may be achieved. Simple short training is well accepted among workers, but we must not prescribe physical exercise patterns by default. Musculoskeletal disorders repre-165 sented the most common work-related health problem. In most of the review studies, we had strength exercise interventions. This exercise is by far the most effective in preventing any musculoskeletal disorders. In the study (Sundstrup verview n o et al., 2014) sixty-six randomly assigned workers with pain in upper-limb and work disability, exhibited of either strength training of upper body in 10 weeks (3 times per week, 10 minutes per session) or ergonomic training. Implement rkplace: ao of strength training at the workplace, prevented deterioration of operability, t w chronic pain and disability. Workers with neck pain improved workability after the 12-week intervention of strength training (Ting et al.,2019). Stretching exercise a at worksite could be an effective way of improving workability and decreased pain. Unfortunately in the study of Gradnde et al. (2014), they didn’t find any statistically significant evidence, maybe due to a small sample size and uncontrolled adherence to exercise. In order to curb exercise volume, we need to take into account individual preferences to increase motivation and long-term adherence (Anderson and Zebis, 2014). Approximately 10 min may be an optimal duration of exercise programs. The overview showed moderate evidence of past interventions. It provided insight into possible future solutions when design-ing an exercise program at work. The results of the studies analyzed are inconsistent, but it could be established that the strength exercises and high-intensity exercise interventions showed stronger effects on worker health and productivity. Exercise at work should be encouraged, in brief, but the effective boost of strength and flexibility training. Acknowledgements This study is co-funded by the Erasmus+ Programme of the European Union SPORTE4HEALTH References ANDERSEN L.L. & ZEBIS M.K.. Process evaluation of workplace interventions with physical exercise to reduce musculoskeletal disorders. 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Stress and Health,32(5):514-523. 816 n pulatioo ge p rking-ao he wf t ealth o pulacije | ho ktivne p elovno a zdravje d Zdravje delovno aktivne populacije Health of the Working-Age Population Proceedings Uredila / Edited by Ana Petelin Recenzenti / Reviewers ■ Patrik Pucer, Boštjan Žvanut, Nejc Šarabon, Matej Voglar, Denisa Manojlović, Dorjana Zerbo Šporin, Mirko Prosen, Sabina Ličen, Igor Karnjuš, Urška Bogataj, Doroteja Rebec, David Ravnik, Ana Petelin, Karin Novak, Darja Barlič- Maganja, Boris Kovač, Ester Benko, Matej Plevnik, Urška Čeklić, Klemen Širok Oblikovanje in prelom / Design and Typesetting ■ Jonatan Vinkler Izdajatelj / Published by ■ University of Primorska Press Titov trg 4, si-6000 Koper, Koper 2020 Glavni urednik/Editor-in-Chief ■ Jonatan Vinkler Vodja založbe/Managing Editor ■ Alen Ježovnik ISBN 978-961-293-015-8 http://www.hippocampus.si/ISBN/978-961-293-015-8.pdf ISBN 978-961-293-016-5 http://www.hippocampus.si/ISBN/978-961-293-016-5/index.html DOI: https://doi.org/10.26493/978-961-293-015-8 © 2020 University of Primorska Press Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=27363843 ISBN 978-961-293-015-8 (pdf) ISBN 978-961-293-016-5 (html) Document Outline Petelin, Ana. 2020. Ed. Zdravje delovno aktivne populacije / Health of the Working-Age Population. Proceedings. Koper: University of Primorska Press. Contents Anja Andrenšek, Matej Plevnik ▪︎ Relationship between physical activity and work efficiency among kindergarten employees Abstract Introduction Methods Results Discussion Conclusions References Katja Bezek, Darja Barlič - Maganja ▪︎ Dietary polyphenols and their effect on the gut microbiota and human health Abstract Introduction Polyphenols characterization and bioavailability Polyphenols and gut microbiota modulation Conclusions References Nives Bogataj, Karin Novak, Zala Jenko Pražnikar, Nina Mohorko ▪︎ Change of Dietary Habits during Quarantine Abstract Introduction Methods Results Discussion Conclusions References Dominika Češek, Katja Bezek, Mihaela Jurdana ▪︎ Probiotics consumption in physically active individuals Abstract Introduction Methods Results Probiotics consumption and its effects on physical activity Knowledge and consumption habits of probiotics in physically active population Discussion Conclusions References Dominika Češek, Katja Bezek, Boris Kovač ▪︎ The effect of probiotic ice cream consumption on salivary cariogenic bacteria in healthy adults Introduction Methods Results Discussion Conclusion References Maria de Lurdes Lopes de Freitas Lomba, Inês Abreu, Rafaela Oliveira, Rodrigo Rato, Rúben Pinto, M. Sofia Macedo ▪︎ Health problems experienced by parents of children in long-term hospital stay Abstract Introduction Method Results and discussion Parental anxiety Sleep quality Parental stress Interpersonal relationships Conclusion References Tilen Dolinar, Lidija Jakupović, Urška Ugovšek, Andrej Starc ▪︎ Use of information telecommunications technology in asthma subjects Abstract Introduction Methods Results Discussion Conclusions References Lidija Dornik ▪︎ Nurses’ shift work: impact on health Abstract Introduction Methods Results Discussion and conclusions References Grega Martin Glas, Sara Hafner, Špela Rozman, Andrej Starc ▪︎ Use of mobile technology in healthcare Abstract Introduction Methods Results Discussion Conclusions References Jera Gregorc, Mira Dolenc ▪︎ Musculoskeletal disorders among preschool teachers Abstract Introduction Methods A sample of respondents A sample of variables The organization and process of data collection Methods of data processing Results The frequency and intensity of MSD among educators Satisfaction, fatigue, and stress Physical activity Analysis of the relationship between the frequency and intensity of MSD with selected risk factors Discussion Conclusions References Mojca Jevšnik, Lucija Pirc, Peter Raspor, Karmen Godič Torkar ▪︎ Ensuring Safe Food Preparation among Slovenian Consumers Abstract Introduction Methods Consumer surveys on ensuring safe food preparation Results Demographic data Results of the questionnaire Washing hands Washing food cutting board after use Knowledge of appropriate temperatures Knowledge of microorganisms found in home kitchens Food thawing Food handling after heat treatment Discussion Conclusion References Filip Krajnc, Maruša Magister, Klara Nartnik, Andrej Starc ▪︎ The role of information and communication technology in self-management Abstract Introduction Methods Results Discussion Conclusion References Eva Lenart, Karin Vrtar, Sabina Ličen, Milan Hosta, Matej Plevnik ▪︎ Relationship between breathing exercises and quality of life in adults – integrative literature review Abstract Introduction Methods Results Discussion Conclusion References Martin Lipovšek ▪︎ Egalitarian distribution of health maintenance using technologies for life extension Abstract Introduction Conclusion References Marjeta Logar Čuček ▪︎ Hiring older people as a way to increase diversity and improve the quality of society Abstract Introduction Methods Review methods Review results Data processing description Results Discussion Conclusion References Martina Nagode, Katja Bezek ▪︎ Sauerkraut and sour turnip consumption habits in Slovenia Abstract Introduction Methods Results Discussion Conclusions References Karin Novak, Zala Jenko Pražnikar, Ana Petelin ▪︎ The effect of kefir and milk intake on intestinal permeability Abstract Introduction Methods Results Serum zonulin levels Gastrointestinal symptoms Stool consistency, frequency and time of defecation Discussion Conclusions References Natalija Rozman, Klemen Širok ▪︎ STAR-VITAL project: Factors for ensuring participation in health promotion programs Abstract Introduction Methods Results Discussion Conclusions References Eva Skočir, Tereza Sever, Tadeja Vidmar, Andrej Starc ▪︎ Type 1 Diabetes Management Using Information Communication Technology Abstract Introduction Methods Results Discussion Conclusions References Janja Tekavc, Pia Novak ▪︎ Distance teaching: perceived stress, psychological health and work satisfaction among classroom teachers Abstract Introduction Methods Participants and procedure Measures Statistical methods Results Discussion Conclusions References Nikola Todorović, Valdemar Štajer, Darinka Korovoljev, Nebojša Maksimović, Sergej Ostojić ▪︎ Exercise at workplace: an overview Abstract Introduction Methods Results Discussion and conclusion Acknowledgements References Colophone