Olivera Batić-Mujanović

Clinical Presentation of Hypertensive Crises in Emergency Medical Services

Objectives: The objective of this study is to evaluate the incidence and clinical presentation of hypertensive crises in the Emergency medical services of the Community Health Centre “Dr. Mustafa Šehović” Tuzla in relation to age, sex, duration and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestations. Methods: The study was conducted between November 2009 and April 2010 and included 180 subjects of both sexes, aged 30-80 with a diagnosis of arterial hypertension. All subjects were divided into two groups: a control group, which consisted of subjects without hypertensive crisis (95 subjects) and an experimental group that consisted of subjects with hypertensive crisis (85 subjects). Results: The study results indicate that female subjects were significantly over- represented compared to men (60% vs. 40 %, p=0.007). The average age of the male subjects was 55.83±11.06 years, while the female subjects’ average age was 59.41±11.97 years. The incidence of hypertensive crisis was 47.22%, with hypertensive urgency significantly more represented than emergency (16.47% vs. 83.53%, p<0.0001). The majority of subjects in the experimental group (28.23%) belonged to the age group of 60-69 years of age: 26.76% urgency and 35.71% emergency. The most common accompanying symptoms in hypertensive subjects were headache (75%), chest pain (48.33%), vertigo (44.44%), shortness of breath (38.88%) and nausea (33.89%). The most common symptoms in subjects with hypertensive crisis were headache (74.11%), chest pain and shortness of breath (62.35%), vertigo (49.41%), and nausea and vomiting (41.17%). Conclusions: Chest pain, shortness of breath, nausea and vomiting were significantly over-represented in subjects with hypertensive crisis (p<0.005). Clinical manifestations of hypertensive emergencies in almost all subjects included acute coronary syndrome, and only one subject had acute pulmonary edema.

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.

Geriatric Depression in Family Medicine

Introduction: Elderly persons often suffer from depression, without anyone around them noticing. Depression is more common at physically ill elderly person then at their physically healthy contemporary. It is important mental health problem of developed society, because it is still faintly revealed thus insufficiently treated. Objective: To explore the existence of geriatric depression in elderly persons living on their own and those who live in family environment. Materials and methods: The research included 200 elderly respondents, experimental group made of elderly persons (>65 years) living alone. Control group included elderly persons living in a family environment. Universal geriatric questionnaire was made for this research. To assess the presence of depression at respondents we used “The scale of geriatric depression”. Results: The average age (±SD) was 75,4±6,2 years in the experimental group, while in the control group the average age was 74,9±5,6 years. In the experimental group there is significantly larger number of elderly persons that are neglected (p=0,001). Elderly respondents surrounded by loneliness are more depressive than elderly living in the family environment. Statistically geriatric depression is significantly connected with inability for everyday activities, with decreased result of cognitive abilities and indicated result of dementia (P=0.001). Conclusion: Depression is an important mental health problem of the developed society, because it is still faintly discovered and by that insufficiently treated. Organizing approach to different aspects of geriatric health, doctors of the primary protection can improve care of their elderly patients.

Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding

1Family medicine education center at Health Center Tuzla, Bosnia and Herzegovina 1University of Tuzla Faculty of medicine, Department of family medicine, Bosnia and Herzegovina 2Family medicine education center at Health Center Zenica, Bosnia and Herzegovina 3Family medicine education center at Health Center Mostar, Bosnia and Herzegovina Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding Едукативни чланци / Educational Articles

Effect of combination therapy on cardiovascular risk in the pit miners with hypertension, metabolic syndrome and depression.

Background: Higher cardiovascular (CV) morbidity and mortality in depressed patient has demonstrated repeatedly. Aim: Determine the degree of occurrence of hypertension, metabolic syndrome (MetS) and depression in the pit miners and the impact of the six-month holistic treatment of all CV risk factors and depression in the overall CV risk in miners with hypertension, MetS and depression. Methods: From 492 pit miners was taken smoking status, measured blood pressure, waist circumference and body mass index. Analysis was done using the concentration of sugar in blood, triglycerides, total cholesterol, HDL, LDL cholesterol and determined total CV risk. All respondents filled self-assessment Becks depression scale. Prevalence MetS hypertension and depression were determined. Group of 67 patients with joint hypertension, MetS and depression that is treated six months with psychotropic and somatotropin medication, was singled out. After six months, the effect of therapy on the risk factors and total CV was assessed. Results: Among 492 miners 67 (13,61%) of them had hypertension, MetS and depression. After six months treatment, it showed statistically significant reduction in blood pressure (p=0,0001), waist circumference (p=0,0001) ,total (p=0,002), HDL (p=0,007) and LDL cholesterol (p=0,003), smoking (p=0,002), Becks scale results (p=0,007) and reduction in total CV risk. Conclusion: After six month of combine therapy in respondents has led to reduced CV risk and level of all factors, except BMI and triglycerides.