OBJECTIVE The aim of the study was to assess the impact of the family socioeconomic status (SES) on health related quality of life (HRQoL) in children operated on for congenital heart defects. PATIENTS AND METHODS The study included 114 children aged 1.6-18 (mean = 10.2 +/- 4.2) years (46.5% male and 53.5% female), followed up at University Department of Pediatrics in Tuzla after cardiac surgery, and one of their parents or caretakers. Of 114 children with congenital heart defects, 54.4% had anomalies with left-right shunt, 18.4% obstructive type anomalies and 27.2% complex anomalies. Control group consisted of 127 healthy age-matched subjects (age range 1.5-18, mean = 11.2 +/- 4.2 years; 49.6% male and 50.4% female). In this prospective study, we used PedsQL 4.0 Generic Core Scale to assess HRQoL of children operated on for congenital heart defects. This measurement includes both the parent proxy and child reports. The family SES was assessed by use of Hollingshead two factor index of social position. Statistical significance of differences between respondents and control group was determined by use of t-test and ANOVA with Bonferroni test. RESULTS The reports of children operated on for congenital heart defects yielded no statistically significant difference in their HRQoL according to family SES. Parental proxy reports showed medium scores for physical health and activity to be significantly lower in children from low SES families as compared with those from medium SES families. Scores on school activities also differed significantly between patients with low and higher family SES. Parental reports revealed statistically significantly poorer HRQoL in children from low SES families in terms of physical health and activity, psychosocial and emotional health and social activities scores, as compared with the control group with low SES. Children operated on for congenital heart defects from medium and high SES families also had statistically lower school activities in comparison to control group of children from medium or high SES families. CONCLUSION The results of HRQoL according to parental proxy report indicated low SES to influence various aspects of HRQoL in children operated on for congenital heart defects. This could be explained by the fact that the risk factors associated with low SES may directly or indirectly affect not only family HRQoL but also HRQoL of children operated on for congenital heart defects. Therefore, it appears necessary for the low SES families with a child suffering from chronic disease to receive help from wider community to solve the above mentioned problem.

Objective – The research was conducted with the aim of examining how hospitalized children imagine a good paediatric nurse (PN) as well as to check if there is a difference about that imagined picture among children with acute and chronic diseases.  Subjects and methods – The research was conducted through study section and it included 80 children hospitalized at the Department of Paediatrics in Tuzla, from April 17, 2009 to January 8, 2010, aged from 8 to 15 of both genders, and who were chosen randomly. The children were divided into two groups. The first group consisted of 40 children who were hospitalized because of an acute disease and the other group consisted of 40 children with a chronic disease. Using a self structured questionnaire the authors of the study interviewed the children in the presence of their parents. In the statistical processing of data the results were presented in absolute and relative numbers, and the statistical significance of differences was tested with the I‡2 test. The difference among the examined groups was considered significant if P < 0.05.  Results – The difference in answers among children with acute and chronic disease about addressing a PN, a bad mood or impatience of a PN and about the most important characteristics of a PN was statistically significant, while the answers to questions about the facial expression of a PN and about previous experiences with a PN, parents did not find significant.  Conclusion – Children in both examined groups imagine a good PN as a person who should have a happy and kind facial expression, as well as the characteristics of a good person and an expert and a person who will provide security and support for children and their parents.

The progress of pediatric cardiology and of cardiosurgery in the last few decades have significantly reduced mortality and extended the life of children with congenital heart disease, which has resulted in creating a new population. Pediatricans in primary care level have a significant role in the health care of children with congenital heart disease. This role requires continuous follow up of the progress of pediatric cardiology and cardio-surgery, knowledge of the cardiac anamnesis of their patients, and knowledge of possible complications in the disease outcome, the side effects of medications and health needs at each specific age. The aim of this paper is to review the general and specific vital and health needs of children with congenital heart disease during their growth.

Aim – The aim of the study was to evaluate the natural history and outcome in patients with the ventricular septal defect (VSD) in respect to the size and location of defects.  Patients and Methods – Retrospectivly was analysed medical documentation of patients with VSD at Pediatric Clinic in Tuzla. The following was analysed the number, location and the size of defects, treatment and outcome of diseases. Analysis of the number, the size and location of VSD was completed using electrocardiography which was performed by ultrasonic imaging device Sonotron VingMed CFM 725, and 3,5 MHz curvilinear transducer 3.5 MHz. VSD were classified as small, medium and large defects.  Results – In the period from 01.01.1995 to 31.12.2004, VSD was diagnosed in a total of 237 children, of whom 206 (87%) was an isolated, and 31 (13%) a major haemo-dynamic anomaly. In 9% children congenital heart disease was combined with anomaly of some other organ failure, including syndromes and chromosomopathy. An isolated defect was found in 230 (97%) children, and only in 7 (3%) cases was the defect multiple. A large defect was present in 33 (13.9%) children, medium size defects in 15 (6.3%) children, whilst small defects were found in 189 (79.8%) cases. Congestive heart failure was found in 23 (9.7%) children, and 213 (90.3%) were without clinical symptoms. Medical treatment was applied in 23 cases, and cardiosurgical treatment in 41 cases. Spontaneous closure of the defect was recorded in 65 (27.4%) cases, whilst 4 (1.7%) children died, and 4 (1.7%) cases developed fixed pulmonary hypertension.  Conclusion – According to our results, complications and negative outcome of disease was minimal in spite of limited cardiosurgical resources in our conditions, thanks to timely diagnosis and continuous monitoring of patients with VSD.

Critical congenital heart diseases (CHD) represent extensive and complex possibilities changes of morphology and homodynamic on the heart, which vital jeopardize child at the time of birth so as at the first weeks of its life or at the first months of its life too. The purpose of this study is to determine frequency, structure and the mode of medical treatment critical UAS in the Tuzla Canton area to harmonies with experiences and results we have reached in order to treat children who have congenital heart disease. There was discovered CHD in the 493 (8,15 per 1000 live-born) from 60.493 live-born children in Tuzla Canton area during the 10-year period start at 01.01.1995. Critical congenital heart disease was discovered in 142 children what represent total prevalence of 2,35 per 1000 live-born children. Yearly prevalence was pretty consistent in observed period of the time and it was from 1,36 to 3,24 per 1000 live born children. The most frequent UAS was complete atrio ventricular canal, which has proved in the 22,4% critical UAS. The more then one-third (36,6 %) children with critical UAS have had extra cardiac anomalies and syndromes. The balloon septostomy was performed in only two of our patients, in 41 (28,8 %) cardiac surgery was performed. Only one of the children underwent surgery in the neonatal period. In 8 patients who were no surgery treated developed pulmonary hypertension, one of them had bacterial endocarditic. Of the total 142 children with critical CHD 99 (69,7%) died. The 92 of them died before surgery, 7 of them died after the surgery; 3 of the 7 in the early after surgery period; 4 of the 7 died because of complications in a later period. Timely discovering critical UAS in Tuzla Canton area is failure in the area prenatal diagnosis. The treatment of patients is inappropriate and without possibilities of emergency invasive cardiac treatment and surgical treatment.

Congenital heart diseases (CHD) are taking high position on the list of neonatal and infant mortality, and they are significantly involved in mortality of children and adults. During cardiogenesis various genetic and non-genetic ethiological factors are starting pathogenetic mechanism what results in developing of CHD. Purpose of research is evaluation of participation of some risk-factors in developing of CHD in children on Tuzla Canton area. This research included 352 children up to 15 years old, in which was discovered CHD during period from 1.1.1994 to 31.12.1999. Using method of anamnestic questionnaire we analyzed data related to occurence of CHD in relatives, reproductive age of mother, mother's illness and taking medications in first trimester of pregnancy, and professional exposure to harmful chemicals. In 24 or 6.81% of cases CHD was registered in one of first-degree relatives, and in only one case in second-degree of relatives. It was noticeable that CHD in highest number of cases (291 or 83.14%) were present in children whose mothers were 20-35 years old, while only 18 or 5.11% of mothers aged 35 and more what is considered as high risk age for development of anomalies in general. In 70 or 20% cases CHD was associated with other systems anomalies, including syndromes and chromosomopathies. Risk-factors related to earlier pregnancies of mothers were found in 40 (11.36%) of children. Data about acute and chronic diseases of mother during pregnancy were found in 36 children. analysis of exposure to harmful chemicals during first trimester of pregnancy is showing that 39 or 11.08% mothers were exposed to nicotine, while 17 or 4.83% were taking medications. Exposure to professional poisoning were found in 5 or 1.42% of cases. Results of research are pointing on need for continued observation genetic and wide range of other potential risk-factors from environment related to development of CHD in our area. This way we could explain some specific characteristic occurrences of CHD in some areas.