Nurka Pranjić

Work Ability Index, Absenteeism and Depression Among Patients with Burnout Syndrome

Goal: The aim of this study is to estimate the association of burnout syndrome and depression; burnout syndrome and sick leave; and burnout syndrome with Work Ability Index in patients who suffer from stress at work. Material and methods: The control clinical study was conducted in the Teaching Department for Professional Pathology and Toxicology at the Primary Health Care Center Tuzla in the period from 2009 to 2014. The study included 140 patients exposed to different levels of stress at work. Besides conducted interviews and anamnesis with working anamnesis, physical examination, all patients were subjected to diagnostic package of questionnaires for assessing exposure to stress at work and its effects on health and work ability and Hamilton Rating Scale for screening depression. All patients were referred to the Department with suspected distress and burnout syndrome. For this study we used a questionnaire for measuring intensity of burnout (two categories exclude suffering from burnout syndrome: successfully overcome stress at work and sometimes feel stress at work and the other two reveal the initial and very high burn-out syndrome. Studied group was consisted of patients categorized with burnout syndrome (n=88). Results: The questionnaire on the Work Ability Index (WAI) estimated characteristics of sick leave and prognostic factors with current work ability index. Lack of support at work with poor personal relations is the most common factor with the mobbing in burnout syndrome. Significantly more patients with the burnout syndrome suffered very severe depression 49%:37%; more use long sick leaves 53%:21%; several of them have poor WAI 51%:31% compared to those who are only exposed to stress at work (p=0.001). We found that the burn-out syndrome is predictor for developing depression (β=0.312, 95% CI, 0.114-0.353, p=0.001); absenteeism (β=0.285, 95% CI, 0.093-0.334, p=0.001); and a decline in working ability (β=0.413, 95% CI, 0.297-0.648). All the patients in whom it is found burnout syndrome is to provide medical and non-medical assistance in order to achieve stabilization of health and positive work orientation, mental rehabilitation and reintegration at work place. Conclusion: The process involves serious emergency measures in work organization which include improved in working environment, communication and combat against mobbing.

Prevalence of Polypharmacy and Drug Interaction Among Hospitalized Patients: Opportunities and Responsabilities in Pharmaceutical Care

Goal: Polypharmacy and drug-related problems (DRPs) have been shown to prevail in hospitalized patients. We evaluated the prevalence of polypharmacy; and investigated relationship between polypharmacy and: symptoms of DRPs, number of drugs and OTC, index of cumulative morbidity, length of exposure to polypharmacy and the number of days of hospital stay among hospitalized patients. Methodology: A study was performed in Pharmacies „Eufarm Edal“ Tuzla from 2010 to 2011. Polypharmacy was defined as using ≥ 3 drugs. The total study sample of 226 examiners were interviewed with special constructed questionnaires about DRPs. Experimental study group consisted of hospital patients with polypharmacy (n=166) and control group hospital patients without polypharmacy (n=60). Mann-Whitney test was used to test for significant self-reported symptom differences between groups and cross sectional subgroups, t- test and χ2- test for age, gender and treatment data in hospital. Results: The prevalence of polypharmacy was 74% among 226 hospitalized patients. The vulnerable age subgroup of hospitalized patients was men and hospitalized patients aged from 46 to 50 years (not geriatric patients). The prevalence of index of cumulative morbidity was 65%. The most common exposures varied by patient age and by hospital type, with various antibiotics, antidepressants, analgesics, sedatives, antihypertensives, flixotide, ranitidine and others. The prevalence of exposure to OTC and self- treatment was 80%. The prevalence of symptoms of drug-related problems were significantly differed among patients of experimental in relationship of control study group patients (P<0.001). Conclusion: In addition to helping to resolve the above mentioned issues, the results from this study could provide baseline information quantifying the problem of drug- related problems among hospitalized patients receiving polypharmacy and contribute to the formulation and implementation of risk management strategies for pharmacists and physicians in primary care health.

DISTRESS AND PTSD IN PATIENTS WITH CANCER: COHORT STUDY CASE.

Introduction: embarrassed emotional experience may affect the ability to oncology patient effectively cope with cancer, symptoms and treatment. Distress extends a long period, from common, normal feelings of vulnerability, sadness and fears to problems of PTSD, depression, anxiety, panic, social isolation and the perception of spiritual crisis. The aim of the research is to determine the level of distress and PTSD in cancer patients. Patients and Methods: In a prospective, cohort study cases from 2011- 2014 were included patients with cancer who are treated under the supervision of his chosen family medicine doctor. Including a factor for the participation of patients in the study is that from the moment of diagnosis of malignant disease passed <12 months. The total sample was 174 of the planned 200 (response rate=87%). The subjects were divided into three groups. A key factor in the creation of the group was the time elapsed from the moment of acknowledgment and confirmation of the diagnosis: T1 <14 days, n=56 patients; T2>14 days-<6 months, n=79 patients; T3>6 months n=39 patients. To achieve the set goals of the research was used instruments of 3 questionnaires: Questionnaire on the clinical characteristics of patients with malignant disease, demographic and individual characteristics; questionnaire distress oncology patient–hospital scales of depression and anxiety, HADS scale (Hospital Anxiety and Depression Scale - HADS) and a rapid test for self-assessment of the symptoms of PTSD. Results: Age of patients was 54.63 ± 11:46 years, and the age of the respondents when they were diagnosed with cancer 54.34 ± 11.26 years. The prevalence of distress was a high 76% 82x higher than expected), and PTSD 55%. Predictors of burnout syndrome in cancer patients are all important determinants of malignant disease: the time elapsed since the diagnosis of the disease which determines the clinical status of malignant disease (β=0.280; P=0.001; 95% CI, 0742-2259), discovered metastases (β=0.304; P=0.001; 95% CI -2621 to 0978) and treatments (β=0.160; P=0.031, 95% CI 0050 to 1.060). Conclusion: The problem of distress in cancer patients is widespread and has a high prevalence of 76% in our environment, while still absent intervention and treatment.

Impact of work place stresses on work ability index in patients with depressive disorders

INTRODUCTION Depression seriously affects ones ability to perform work tasks and function at work. We studied the impact of both the individual and work factors on work ability index in patients suffering from depression. MATERIAL AND METHODS The prospective study, which was conducted by using questionnaires, included 210 patients with depression, who had been on sick leave from 60 to 360 days. The individual factors were evaluated by the standardized abridged form of Occupational Stress Questionnaire, while the work place factors in relation to work ability were evaluated by the work ability index. RESULTS Poor work ability was observed in 151 (71%) of subjects suffering from depression. All workplace stresses, lack of support by colleagues and supervisors, ergonomically not adjusted work and huge work load are statistically associated with poor work ability index (P=0.001). More than 95% of variables of the evaluated work ability index are the result of varying in the group of stresses at work place (R2=0.95). Perception of bad health condition (Rsq=0.412, P=0.001), low level of life satisfaction (Rsq=0.309, P=0.001), low level of motivation and work knowledge (Rsq=0.309, P=0.001) are predictors for poor work ability. The work ability cannot be related with age and sex. CONCLUSION The key activities for maintaining the work ability at the times when epidemic of depression emerges, as it is nowadays, are timely carrying out the psycho-treatments, mental and professional rehabilitation, occupational therapy and adapted work place.

Screening for Depression Patients in Family Medicine

ABSTRACT Goal: The aims are to establish the prevalence of newfound, unidentified cases of depressive disorder by screening with the Becks Depression scale; To establish a comparative relationship with self-identified cases of depression in the patients in the family medicine; To assess the significance of the BDI in screening practice of family medicine. Patients and methods: A prospective study was conducted anonymously by Becks Depression scale (Beck Depression Questionnaire org.-BDI) and specially created short questionnaire. The study included 250 randomly selected patients (20-60 years), users of services in family medicine in “Dom Zdravlja” Zenica, and the final number of respondents with included in the study was 126 (51 male, 75 female; response or response rate 50.4%). Exclusion factor was previously diagnosed and treated mental disorder. Participation was voluntary and respondents acknowledge the validity of completing the questionnaire. BDI consists of 21 items. Answers to questions about symptoms were ranked according to the Likert type scale responses from 0-4 (from irrelevant to very much). Respondents expressed themselves on personal perception of depression, whether are or not depressed. Results: Depression was observed in 48% of patients compared to 31% in self estimate depression analyzed the questionnaires. The negative trend in the misrecognition of depression is -17% (48:31). Depression was significantly more frequent in unemployed compared to employed respondents (p=0.001). The leading symptom in both sexes is the perception of lost hope (59% of cases). Conclusion: All respondents in family medicine care in Zenica showed a high percentage of newly detected (17%) patients with previously unrecognized depression. BDI is a really simple and effective screening tool for the detection and identification of persons with symptoms of depression.

Assessment of Reporting, Attitudes and Knowledge About the Stab Incidents and Professional Risk of Viral Infection among Health Care Professionals in Primary Health Care

Conflict of interest: none declared. Goal The goal of the research is to determine the relationship between frequency and reporting of stab incidents, attitudes and knowledge about stab incidents and occupational risk for transmission of viral infection with HBV, HCV or HIV among health care professionals employed in primary health care. Material and methods Conducted is prospective, cross-section study by questionnaires in 2012. The survey included health professionals in Primary Health Care Center in Tuzla. The final sample has 131 respondents (85% women). Statistical analysis was performed using the statistical package SPSS version 20.0. Results The prevalence rate of stab incidents throughout their career in our study was 66%; while the rate of reported incidents was 4.83 ˜ 5 times lower than the actual prevalence. In 49 out of 87 cases this was a case of hollow needle prick. The most common causes of stab incidents are the time pressure, unforeseen reactions of patients and lack of concentration. Conclusion Stab incidents are often not reported in in developing countries. Training in order to raise awareness and knowledge about the problem, proper procedures, good organization of work and anti-stress program, safer disposal, conducting prophylaxis before and after exposure monitored by the relevant institutions of occupational medicine should contribute to solving this problem.

Quality of life factor as breast cancer risks.

Background: Numerous studies have observed risk factors for breast cancer. We investigated the association between quality life factors as breast cancer risks in a case-control study in industrial Zenica- Doboj Canton in Bosnia and Herzegovina. Methods: The case-control study was included 200 women, 100 without (control subjects) and 100 women with diagnosed breast cancer. We used questionnaires about breast cancer risks“ as study tool. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CI) and a full assessment of confounding was included in analysis. Results: Breast cancer was positive associated with increasing age of life (from 45 years and more; OR= 1.25); further relative breast cancer history (OR= 4.42; 95%CI, 0.483-4.043); exposure to CT (OR=2.02; 95%CI, 1,254-3.261); never birth child (OR= 1.394; 95%CI, 0.808-2,407); used replacement hormonal therapy (OR= 1.826; 95%CI, 1.637-10.590); arrival time of menstruation (OR=2.651; 95%CI, 1.303-1.571); length of smoking status (OR=1.534; 95%CI, 0.756-3.098), alcohol consumption (OR=1.728; 95% CI, 0.396-7.533); exposure to CT per year (p=0.009), routine physical inactivity (p=0.009) and replacement hormones treatment (p=0.036). Conclusion: Inverse associations of breast cancer and poverty, arival time of menopause were observed. The link between breast cancer and a distant-cousin- degree family history of breast cancer was inverse association with breast cancer too. These results provide further evidence that, for most women, physical activity may reduce the risk of invasive breast cancer.

Influence of Unemployment on Mental Health of the Working Age Population

Introduction: Bosnia and Herzegovina has one of the highest unemployment rates in the Balkan region (43.2%), so unemployment is one of the most serious public concerns in our country. Aim: To analyze the influence of unemployment on mental health of the working age population who attend primary care center. Material and Methods: The study was carried out in the municipality of Bosanska Krupa, which has the highest unemployment rate in the Federation of Bosnia and Herzegovina (56%), and included 510 randomly selected working age patients (aged 23-65 years). We used the General Health Questionnaire-28 (GHQ-28) to evaluate mental health of the working age population. Results: There were significantly more women than men (53.5% vs. 46.5%; p=0.02). The mean age of participants was 51.04±12.84 years. The experimental group included 318 (62.35%) unemployed working age participants: 160 (50.3%) had been unemployed for more than 5 years and had had no work experience, while 158 (49.7%) unemployed participants had had a previous work experience of more than five years. The control group included 192 (37.65%) employed working age participants. Unemployment had a significant influence on mental health of the working age population. The unemployed participants had a significantly poorer mental health compared to the employed (p=0.0003). A predictor of impaired mental health was a job loss. A significantly greater mental health impairment occured in the group of unemployed participants with previous work experience of more than five years compared to the unemployed participants who had had no work experience (p=0.001) and employed (p=0.000). Conclusion: Unemployment has a negative impact and leads to impaired mental health of the working age population in Bosnia and Herzegovina. A job loss has a predictive role. It indicates that social and health policies must be developed in order to improve well-being of the working age population.

Recipe from the past for the future: public health intervention represent a process for century

In the poor Bosnia, in the early 20th century endemic syphilis was widespread. Combating this disease entailed the necessity of etiology research, diagnosis and clinical nature of the disease, as well as the insight into the epidemiological image of this unresolved health problem. Thanks to the visionary, the enthusiasm and persistence of the expert team of doctors from that time in Croatia, School of Public Health and the Rockefeller Foundation as financial support, conditions were created to conduct population monitoring and research called “survey”. The team of experts from Croatia and Bosnia led by Dr. Ante Vuletic began this important public health intervention in Central Bosnia underneath the mountain Vlasic 1934. In villages of mountain Vlasic people were living in very difficult social and unsanitary conditions. “Interviewers” worked in makeshift clinics in the rural schools Opare, Rankovici, Vitovlje Mehorica, Turbe, Bila and Gornji Vakuf. A hundred years later, a team of university professors from the School of Public Health “Andrija Stampar” led by Professor Silvije Viletic followed the footsteps of century “survey” on Vlasic in the summer of 2014. They determined that with the integrated approach to population monitoring and testing endemic syphilis in Bosnia was successfully suppressed.

Female breast cancer in relation to exposure to medical iatrogenic diagnostic radiation during life

Aim of the study Exposure to radiation and aging are the leading causes of breast cancer among female patients. We aimed to investigate and assess the relationship between exposure to medical, diagnostic and iatrogenic radiation and breast cancer using a questionnaire among 100 newly diagnosed female breast cancer patients and 100 control female subjects without cancer. Material and methods A case control study using a family ambulatory based survey was conducted among 200 female patients from all municipalities of Zenica-Doboj Canton. New cases of breast cancer among subjects of experimental groups (n = 100) were diagnosed between 1 January 2003 and 31 December 2007 using the institutional clinical procedure for breast cancer diagnosis. Data were obtained using a self-rated questionnaire on radiation as a breast carcinogen. Data analysis was performed using SPSS version 19.0. Results There were no significant differences between the two groups and their subgroups for individual data and demographics except for prevalence of decreased family financial situation (practical poverty) among subjects with breast cancer in relation to control subjects (31%: 17% among control subjects; p = 0.001). Female patients who are exposed to iatrogenic radiation before the 3rd year of life (OR = 1.29; 95% CI: 0.839–1.985) and those who are exposed to CT more than twice per year are more than twice as likely to have breast carcinoma (OR = 2.02; 95% CI: 1.254–3.261) compared to control subjects. Poverty and low family income are vulnerability factors associated with elevated levels of breast carcinoma. This result is not in accordance with prior study results. ConcIusions It is necessary to develop an adequate registration system of iatrogenic exposure to radiation for each patient of any age, particularly for children aged < 3 years and for CT iatrogenic exposure.