Bojan Joksimović

Self- perceived stress in relation to anxiety, depression and health-related quality of life among health professions students: A cross-sectional study from Bosnia and Herzegovina

Abstract Introduction The purpose of the present study was to examine self-perceived stress of health professions students at the Faculty of Medicine Foča, and to explore its association with anxiety, depression and health-related quality of life. Methods The cross-sectional study enrolled 451 students at the Faculty of Medicine (medicine, dentistry, nursing and speech therapy). Survey instruments were distributed at the conclusion of the spring semester during the last required lecture for each year and study programme class. Perceived stress was assessed using the 14-item Perceived Stress Scale. The students were evaluated for symptoms of depression and anxiety, using Zung’s self-assessment inventory for depression and the Spielberger State-Trait Anxiety Inventory (STAI). European Quality of Life-5 dimensions were used for describing and evaluating health. Multivariate analyses were carried out using logistic regression to examine the relationship between the outcome variable and selected determinant factors. Results A high degree of stress was reported by 1.6% of students, while the majority of students had either moderate (70.6%) or low degree (27.5%) of stress. The significant independent factors associated with perceived stress were anxiety score (OR, 0.339; CI 95%, 0.276-0.403) and EQ-5D score (OR, 0.044; CI 95%, 0.033-0.085). A high degree of perceived stress (OR, 0.624; CI 95%, 0.507-0.704), the presence of depression (OR, 0.800; CI 95%, 0.513-1.087), and low quality of life were associated with anxiety (OR, 0.073; CI 95%, 0.018-0.128). Conclusion Higher levels of perceived stress predispose health professions students for anxiety and lower quality of life. The study programme was not a significant determinant of perceived stress sore.

The effects of diabetes mellitus and hypertension on work productivity

OBJECTIVE The primary objective of this paper is to examine the impact of diabetes mellitus on the ability to work in patients with diabetes mellitus. The second objective of this paper is to examine the differences in the ability to work between patients with diabetes mellitus and patients with other chronic diseases, such as hypertension. MATERIAL AND METHODS A study was conducted in 10 family medicine practices from two primary health care centers, Pale and East Sarajevo, in the period between July 2009 and May 2010, utilising a retrospective medical records review and a cross sectional survey. The outcomes used to portray respondents health status included functional measures and ability to work. Functional measures were analyzed using SF-36 and a general questionnaire. Absenteeism and productivity loss were retrospectively analyzed for the past ten years from a regional sick-leave database and the administrative records of the Commission for the assessment of work capacity for the Pension and Disability Insurance Fund of the Republika Srpska respectively. RESULTS Out of the total number of patients with diabetes, 24.6% had some form of disability. A statistically significant difference was found between the two groups; patients with diabetes mellitus were much more likely to have problems meeting the required standards at the workplace due to emotional and physical health issues compared to hypertensive patients. CONCLUSION Diabetes mellitus appears to reduce an individuals ability to work in comparison to patients with hypertension. There is a need to set up a diabetes mellitus prevention program and to develop and implement effective targeted intervention to help workers to manage their disease better.

Compassion fatigue and compassion satisfaction among family physicians in the Republic of Srpska, Bosnia and Herzegovina

Aims. The aim of this study was to examine self-perceived compassion fatigue and compassion satisfaction among family physicians in Bosnia and Herzegovina and describe potential contributing factors. Methods. The cross-sectional study enrolled 120 family physicians. Professional quality of life compassion satisfaction and fatigue version 5 (ProQOL5) was used to assess compassion satisfaction and two components of compassion fatigue, secondary traumatic stress and burnout. The symptoms of chronic fatigue were evaluated using the Chalder fatigue scale. Results. The majority of family physicians had moderate levels of compassion satisfaction (70%), burnout (75%) and secondary traumatic stress (55.8%). Family physicians with higher levels of secondary traumatic stress reported chronic fatigue (p = 0.001), longer length of service (p = 0.024) and residency training (p = 0.041). Chronic fatigue (p = 0.001), living in a rural environment (p = 0.033), larger size of practice (p = 0.006) and high number of patients with chronic disease (p = 0.001) were associated with a higher risk of burnout. Conclusion. Family physicians with large practices, long years of experience, a high number of chronically ill patients and experiencing chronic fatigue are at risk of developing compassion fatigue. A systematic exploration of compassion fatigue in relation to working conditions might provide an appropriate starting point for the development of preventive interventions.

Need for orthodontic treatment among children in Foča

Introduction. Orthodontic treatment is a common dental procedure in developed countries. Assessment of orthodontic treatment need is important for health services planning and population trends monitoring. The aim of this study was to assess the need for orthodontic treatment among children in Foca, Bosnia and Herzegovina. Methods. The study involved 81 students of two primary schools in the municipality of Foca, aged 11-13 years. The subjects underwent clinical examinations, the dental impressions were taken, study models were made and analyzed, and digital photographs of anterior dentition were taken too. Index of Complexity, Outcome and Need (ICON) was used to assess the need for orthodontic treatment. The number of orthodontists, which would be sufficient to meet the needs of this population of children, was estimated. Results. ICON index results showed that 56.8% of children needed orthodontic treatment. There was no statistical significance in the need for orthodontic treatment between the subjects of different gender and age. The study showed that 22.2% of boys and 34.6% of girls needed orthodontic treatment. In relation to age, 21% of eleven- and 21% of twelve-year-olds needed orthodontic treatment and 14.8% of thirteen-year-olds. The incidence of crowding was 80.2%. Crossbite was present in 23.5% of examined students, open bite in 2.5%, deep bite in 29.6% and irregular dental esthetics anterior teeth in 28.4%. Class II/1 malocclusion was found in 39.5% of children, II/2 class in 9.9%, class I in 38.3%, while class III malocclusion was found in 9.9% of examined children. Conclusion. The study shows that a large percentage of children in Foca need orthodontic treatment. Percentage of the need for orthodontic treatment is higher in comparison to most of the countries in Europe and the world. The development of prevention programs and early caries therapy can greatly reduce the need for orthodontic treatment.

Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma

BACKGROUND Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. AIM To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. PATIENTS AND METHODS Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. RESULTS In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. CONCLUSIONS Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Family physicians' perspectives on clinical guidelines, a survey from the Republic of Srpska, Bosnia and Herzegovina.

Abstract Background: Despite considerable efforts to promote and support clinical practice guidelines (CPGs) use, adherence has often been suboptimal universally. Objectives: The aim of this study was to assess to which extent family physicians (FPs) in Republic of Srpska (RS), Bosnia and Herzegovina (BiH) accept or reject the concept and practice of CPGs and evidence-based medicine (EBM). Methods: A cross-sectional survey was conducted among FPs from the RS, BiH in the period between January and March 2014. Recruitment of FPs was performed combining two different strategies, in-person recruitment at family medicine conferences and mailed invitations. The Questionnaire included19 questions from the existing Healthcare Monitor Questionnaire, divided into four thematic blocks and 11 self-designed questions. Results: Seventy-seven per cent of 131 interviewed physicians reported already using guidelines in the treatment of patients, while 22.9% of them are undecided or disagree. As the reason for rejecting guidelines, 13.0% of the physicians stated they did not support their content, 12.2% found that limited knowledge about guidelines prevented their application, and another 12.2% reported that the current guidelines were not practical enough. All groups would rather not use guidelines developed by a governmental institution. Conclusion: Most physicians in the RS, BiH accept and declare application of CPG. However, a substantial percentage remains sceptical, using CPGs only as an exception, or rejecting them due to their content or impracticability. Key Messages Most physicians declare application of clinical practice guidelines. Substantial percentage of physicians remains sceptical, using CPGs only exceptionally. Further studies are needed to promote the use of CPG and the concept of EBM.

Prevalence and determinants of smoking initiation among school students in Bosnia and Herzegovina

Abstract Background: Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. Methods: The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Results: Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. Conclusion: This study indicates that a high proportion of 15–18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

Izloženost stresu medicinskih sestara i tehničara u Kliničkom centru Foča

Uvod. Sestrinstvo je, po svojoj prirodi, profesija koja podrazumjeva visoknivo stresa. Stres ili stresogena reakcija je odgovor organizma na stresogenusituaciju. Zdravstveni radnici su izloženi profesionalnom sagorijevanju prirodomsvoga posla, narocito u klinicko bolnickoj praksi. Cilj ovog rada bio jeda se izvrsi identifikacija i analiza stresogenih faktora i procjeni nivo stresana radnom mjestu medicinskih sestara i tehnicara.Metode. Istraživanje je sprovedeno u službi internog odjeljenja i službi neuroloskogodjeljenja Klinickog centra Foca, a uzorak su cinile zaposlene medicinskesestre i tehnicari u ovim službama, koji su anketirani putem anonimnogepidemioloskog upitnika u periodu između februara i marta 2012. godine.Rezultati. Sve anketirane medicinske sestre i tehnicari imaju srednje obrazovanje.Vecina ispitanika je ženskog pola, na internom odjeljenju 100% i naneuroloskom odjeljenju 80%. Preko 30 godina radnog staža ima 75% zdravstvenihradnika na internom odjeljenju i 90% na neuroloskom odjeljenju. Odukupnog broja anketiranih medicinskih sestara i tehnicara 80%, na internomodjeljenju smatra da je izloženo stresu, a 20% da nije izloženo stresu. Svizdravstveni radnici na internom odjeljenju i 95% na neuroloskom odjeljenju,smatraju da su međuljudski odnosi u ovim službama zadovoljavajuci.Najveci broj zdravstvenih radnika na internom odjeljenju (75%) i nesto viseod polovine zdravstvenih radnika na neuroloskom odjeljenju (55%) smatrada primarni stresor za zdravstvene radnike jesu profesionalni zahtjevi. Svianketirani zdravstveni radnici su u mogucnosti da redovno koriste godisnjeodmore. Najveci broj zdravstvenih radnika (70%) izložen je opasnostima istetnostima u obje službe.Zakljucak. Prikazani rezultati ukazuju da je izloženost zdravstvenih radnikastresu na poslu prisutna u velikom procentu. Svi zdravstveni radnici su umogucnosti da koriste redovno godisnje odmore, a glavni izvor stresa jepreopterecenost poslom i profesionalni zahtjevi.

Znanje i stavovi učenika osnovne i srednje škole o upotrebi droga

Uvod. Zloupotreba psihoaktivnih supstanci u populaciji adolescenata predstavljajedan od najvecih psihosocijalnih problema savremenog drustva. Ciljovog istraživanja je utvrđivanje nivoa znanja i stavova ucenika osnovne isrednje skole, uzrasta od 11 do 18 godina, o nacinima dobijanja droga, stetnimefektima na ljudsko zdravlje, kao i posljedicama koje se mogu javiti usljedupotrebe droga.Metode. Anterospektivna deskriptivna studija je sprovedena u Osnovnojskoli i Srednjoskolskom centru u Gacku, u periodu septembar-oktobar 2011.godine. U istraživanju je koristen upitnik od 15 pitanja. Anketirani su ucenicivisih razreda osnovne skole ( VI-IX razreda) i ucenici I-IV razreda srednjeskole. Anketiranje je bilo anonimno.Rezultati. U studiji je ucestvovalo 367 ucenika (80% od ukupnog brojaucenika) osnovne skole i 370 ucenika (85% od ukupnog broja ucenika) srednjeskole.Ucenici srednje skole su imali vise tacnih odgovora (3281) od ucenikaosnovne skole (3241).Ucenici osnovne skole dali su najvise tacnih odgovorana pitanje broj 3 (76,69%), a najmanje na 10. pitanje (38.75%). Ucenici srednjihskola dali su najvise tacnih odgovora na 3. pitanje (72,47%), a najmanje na 8.pitanje (45,23). Ucenici srednje skole su imali vise tacnih odgovora od ucenikaosnovne skole na 13. pitanje (p<0,0001).Zakljucak. Trideset do pedeset procenata adolescenata nije upoznato sapojmom i vrstama zavisnosti i opasnostima koje narkomanija donosi, stoukazuje na znacaj kontinuirane edukacije mladih o stetnostima upotrebe drogei drugih supstanci. Skole pružaju adekvatno okruženje za implementacijupreventivnih programa, ciji bi cilj bio smanjenje faktora rizika i povecanjeprotektivnih faktora protiv upotrebe psihoaktivnih supstanci.

Procjena kvaliteta rada u organizaciji sestrinske službe Doma zdravlja Foča

Uvod. Unapređenje kvaliteta rada zdravstvenih ustanova, kao i svakodnevnihaktivnosti svih zaposlenih u zdravstvu je kontinuirani proces ciji je cilj dostizanjeviseg nivoa efektivnosti u radu, kao i vece zadovoljstvo pacijenata.Ciljevi ovog istraživanja su bili da se ispitaju stavovi medicinskih sestara i nivonjihovog zadovoljstva kvalitetom rada u organizaciji sestrinske službe, da seuporedi sistem kvaliteta na svakom odjeljenju posebno, i da li se standardi ikriterijumi zdravstvene njege sprovode po sistemu kvaliteta.Metode. Studija je izvedena među 30 medicinskih sestara zaposlenih u službamapedijatrije, porodicne medicine i hitne pomoci Doma zdravlja Foca, kojesu anketirane u periodu avgust – septembar 2011. godine putem anonimnogciljanog upitnika.Rezultati. Sve anketirane medicinske sestre imaju srednje obrazovanje. Vecinaispitanika (27) je zadovoljna radnom opremom. Po pitanju međuljudskihodnosa u Domu zdravlja Foca u službi pedijatrije 7 ispitanika smatra da sumeđusobni odnosi odlicni, a tri da su zadovoljavajuci, dok u službi hitnepomoci tri ispitanika smatraju da su međuljudski odnosi u njihovoj službiodlicni, dok 3 smatra da su losi. U službi porodicne medicine svih 10 ispitanikasmatra da su međuljudski odnosi zadovoljavajuci.Zakljucak. Nasi rezultati ukazuju da je obrazovni nivo sestara nezadovoljavajuci.Radni prostor i oprema su zadovoljavajuci, medicinske sestre nedovoljnopostuju standarde u radu ali žele da unaprijede kvalitet svoga rada.