Nedeljka Ivković

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.

Quality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina

OBJECTIVES In the present study, the audit of medical files of patients with diabetes, followed in family medicine practices in the eastern region of Bosnia and Herzegovina (BiH), was carried out in order to investigate the frequency of the use of screening tests for early diagnosis of diabetes complications. METHODS The audit was conducted in 32 family medicine practices from 12 primary health care centers in the eastern part of BiH over one-year period (March 2010 to March 2011). A specially established audit team randomly selected medical files of 20 patients with diabetes from the Diabetes Registry administered by each family medicine team database. Screening tests assessed are selected according to the ADA guidelines. RESULTS Frequency of the individual screening test varied between 99%, found for at least one blood pressure measurement, and 3.8% for ABI measurement. When the frequency of optimal use of screening was analyzed, only 1% of patients received all recommended screening tests. CONCLUSION The frequency of the use of screening tests for chronic diabetes complications was found to be low in the eastern part of Bosnia and Herzegovina. Multivariate linear regression analysis showed that longer duration of diabetes and a larger number of diabetics per practice were associated with a smaller number of screening tests, but specialists in family medicine provided a higher number of screening tests compared to other physicians.

Biomarkers of Stress in Saliva / Biomarkeri stresa u pljuvački

SUMMARY Stress is defined as a state in which homeostasis, as a dynamic balance of internal conditions necessary for the proper functioning of cells or the living organism as a whole, is affected by the action of various stressors. Stress reaction occurs as a result of stress system activities, which is located in the central and peripheral nervous system. Stress evaluation involves a qualitative and quantitative analyses and valuation of certain biologically active substances (biomarkers of stress) in body fluids that are so often associated with stress. Saliva as a diagnostic medium is being increasingly used for purposes of clinical and basic research because of its composition and content as well as the advantages of the process of sampling, as compared to traditional methods of collecting blood samples and urine samples. Cortisol, as a biomarker of stress, is the most often studied salivary biomarker, which is associated with the activation of the hypothalamic-pituitaryadrenal (HPA) axis. Since stress leads to the suppression of the immune system, values of salivary secretory IgA and salivary lysozyme, as biomarkers of stress, can be analyzed. In saliva, it is difficult to monitor acute stress parameters, catecholamines, due to their low concentrations, rapid degradation and instability in the samples. Chromogranin A (CgA) and α-amylase enzyme can be used as alternative indices of adrenergic activity during stress reactions, due to their stability in saliva and reliability of the obtained values. Stress reaction and the diseases in whose pathogenesis it participates are yet another proof of the constant interaction of physical, psychological and social factors in health / disease SAŽETAK Stres se definiše kao stanje u kome je homeostaza, kao dinamička ravnoteža unutrašnjih uslova neophodnih za pravilno funkcionisanje ćelija ili živog organizma u cjelini, ugrožena djelovanjem različitih stresora. Stresna reakcija nastaje kao posljedica aktivnosti tzv. stres sistema, koji je smješten u centralnom i perifernom nervnom sistemu. Stres sistem, preko odgovarajućih medijatora, stimuliše kataboličke, lipolitičke, antireproduktivne i imunosupresivne efekte stresne reakcije s ciljem preusmjeravanja energije zbog povećane potrebe organizma u trenutku značajnim za njegovo preživljavanje. Evaluacija stresa podrazumijeva kvalitativno i kvantitativno analiziranje i vrednovanje određenih biološki aktivnih komponenti (biomarkera stresa) u tjelesnim tečnostima koje se dovode u vezu sa stresom. Pljuvačka se kao dijagnostički medijum sve češće koristi za klinička i bazična istraživanja zbog mogućnosti koje pruža, s obzirom na njen sastav i sadržaj kao i na prednosti samog procesa uzorkovanja u odnosu na tradicionalne metode prikupljanja uzoraka krvi i urina. Od biomarkera stresa, u pljuvački je najčešće ispitivan kortizol, koji se dovodi u vezu sa aktivacijom hipotalamus-hipofiza-adrenalne (HPA) osovine. S obzirom da stres dovodi do supresije imunog sistema, u pljuvački se mogu analizirati i vrijednosti sekretornog IgA i lizozima kao biomarkera stresa. Parametre akutnog stresa, kateholamine, teško je pratiti u pljuvački zbog njihove male koncentracije, brze degradacije i nestabilnosti u uzetim uzorcima. Kao alternativni indeksi adrenergičke aktivnosti tokom stresne reakcije, zbog stabilnosti u pljuvački i pouzdanosti dobijenih vrijednosti, mogu se koristiti hromogramin A (CgA) i enzim α-amilaza. Stresna reakcija i oboljenja u čijoj etiopatogenezi ona učestvuje još su jedan dokaz stalne interakcije fizičkih, psihičkih i socijalnih faktora u zdravlju/bolesti

Relationship Between Symptoms of Temporomandibular Disorders and Estrogen Levels in Women with Different Menstrual Status

AIMS To evaluate whether serum estrogen level is associated with chronic pain, masticatory dysfunction, and depressive symptoms and/or somatization in women with temporomandibular disorders (TMD) and different menstrual cycle status. METHODS A total of 64 women were allocated into one of three groups: one composed of women with normal menstrual cycles (Group 1), one composed of pregnant women (Group 2), and one composed of women in surgical menopause (Group 3). All respondents underwent a standardized clinical examination with the Research Diagnostic Criteria for TMD (RDC/TMD). Diagnoses were generated according to Axis I, and grades of chronic pain, depressive symptoms, and somatization were evaluated according to Axis II. The level of serum estradiol was measured by using the immunofluorescent method. Analysis of variance, Kruskal-Wallis test with post hoc comparisons via series of Mann-Whitney U tests, and Spearman correlation coefficient were used for comparisons between study participants. RESULTS Reported pain was decreased with the progress of pregnancy among the women from Group 2 and was the lowest at the 36th week of pregnancy. Women in surgical menopause reported higher pain intensity as well as more difficulties with chewing and eating hard and soft food compared to the other subjects. Depressive symptoms and somatization were lowest among the women with advanced pregnancy and the highest among menopausal women. CONCLUSION TMD-related chronic pain grade, masticatory dysfunction, and depressive symptoms and somatization are the highest when the estrogen level is the lowest.

Health-related quality of life in outpatients with chronic heart failure associated with sideropenic anemia

AimsThe aim of this study was to assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in outpatients with chronic congestive heart failure.MethodsThe data were collected from patients with chronic congestive heart failure admitted to a university hospital outpatient clinic who agreed to be involved in the cross-sectional study. According to the World Health Organization’s cutoffs to define anemia, the patients were further divided into two groups, with and without anemia. HrQoL was assessed using two questionnaires: a disease-specific instrument, the chronic heart failure questionnaire (CHFQ), and a generic instrument, the Sickness Impact Profile (SIP). The standardized questionnaire was used to collect data regarding patients’ gender, age, marital status, place of living, education, occupation, and duration of diseases and comorbidities. To assess the iron status, ferritin, serum iron, the total iron binding capacity/TIBC and transferrin were measured.ResultsIn total, 200 outpatients with congestive heart failure were included in the study, 100 with and 100 without anemia. Patients with anemia were mainly female, had longer duration of disease (p = 0.001) and more hospitalizations (p = 0.001). Independent associations were found between the HrQoL and hemoglobin level (p = 0.049), HrQoL and hematocrit value (p = 0.006) and HrQoL and NYHA functional class (p = 0.004). Iron deficiency was not associated with impaired HrQoL.ConclusionAnemia has a significant impact on self-perceived health. Anemic patients are more likely to have worse heart failure as indicated by a higher NYHA class, thus being at higher risk for a decline of HrQoL compared with non-anemic patients.

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.

Bolesti usta i zuba kod starih

Starenje je prirodan i ireverzibilan fizioloski proces koji zavisi od faktora nasljeđa, faktora sredine, ali i od nacina života. Pri tome bitnu ulogu imaju brojni fizioloski, bioloski, psiholoski i drugi faktori. U odnosu na starost i starenje postoje veoma izražene individualne razlike. Starost citavog organizma covjeka, kao i pojedinih organa i sistema, ne pocinje kod svih osoba u isto vrijeme, niti se razvija istom brzinom. Taj proces doprinosi pogorsanju zdravlja i konacno vodi smrti, ali pri tome nije znacajna samo dužina, vec i kvalitet života. Starenje, skoro bez izuzetka, dovodi do manjeg ili veceg smanjenja kvaliteta života. Na kvalitet života može veoma znacajno da utice i stanje usta i zuba, oboljenja ili nedostatak vecine ili svih zuba. Najcesca oralna oboljenja i stanja koja uticu na kvalitet života, i koja mijenjaju brojne funkcije orofacijalnog sistema su: gubitak zuba, parodontopatije, karijes, prekancerozne lezije usne duplje i karcinomi, kserostomija i resorpcija kosti alveolarnog grebena. Da bi se doprinijelo rjesavanju problema starih osoba, potrebno je da se stomatolozi vise bave starim osobama, da se organizuju redovni stomatoloski kontrolni pregledi, da se tom prilikom pregledaju sva tkiva usne duplje i okoline, a ne samo zubi, da se poboljsa oralna higijena i da se obezbijedi efikasna kucna stomatoloska njega, posebno nepokretnih starih osoba. Posebno je važno brigu o oralnom zdravlju ukljuciti u nacionalne programe ocuvanja opsteg zdravlja, jer je to najefikasniji put za poboljsanje oralnog zdravlja i kvaliteta života starih osoba.

Uticaj estrogena na pojavu temporomandibularnih disfunkcija

Temporomandibularne disfunkcije (TMD) su grupa klinickih stanja koja supracena bolom i poremecajem funkcija orofacijalnog sistema. Nastaju kaoposljedica narusavanja normalnog funkcionisanja i/ili ostecenja strukture,najcesce, temporomandibularnih zglobova i/ili mastikatornih misica, glavnihkomponenata orofacijalnog sistema. Smatra se da su žene izložene vecemriziku od pojave TMD u poređenju sa muskarcima, a razlog za žensku predominacijujos uvijek nije u potpunosti razjasnjen. Uticaj pola i starosne dobina distribuciju TMD upucuju na mogucu vezu između patogeneze TMD ihormonske osovine kod žena sa posebnim osvrtom na uticaj estrogena.U ovom preglednom radu sagledana je uloga estrogena u patofiziologijiTMD. Prvo je na osnovu epidemioloskih istraživanja ukazano na povezanostizmeđu nivoa estrogena i ucestalosti TMD. Zatim je prikazan uticaj estrogenana morfologiju i funkciju temporomandibularnog zgloba, kao i uticaj estrogenana mehanizme kontrole bola.