[LOW BACK PAIN AT NEW WORKING AMBIENT IN ERA OF NEW ECONOMY: A SYSTEMATIC REVIEW ABOUT OCCUPATIONAL RISK FACTORS]. / LUMBALNI BOLNI SINDROM U NOVOM RADNOM OKRUZJU U ERI NOVE EKONOMIJE: PROFESIONALNI CIMBENICI RIZIKA.

Low back pain is the second most common symptom-related reason for physician visits and the first reason of working disability. Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years (67%). For many individuals, episodes of back pain are self-limited and resolve without specific therapy. For others, however, back pain is recurrent or chronic, causing significant pain that interferes with employment and quality of life. Many occupations have been anecdotally linked to certain low back pain syndrome. However, the relationship between the work environment and the patient's symptoms, though clearly perceived by the patient to be causative, may be less certain. The injury model of an occupational disorder proposes that specific work activities are the cause of the patient's pain. The injury model for low back pain; implicating a causal connection with specific work activities, is complex and controversial. Determining whether a patient's low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. In this systematic review which included patients/employees with low back pain, the following databases were searched: Pub Med, Embase, Medline and Web of science. The role of occupational mechanical exposure e.g. lifting as a risk factors for low back surgery has been debated for several decades. Diagnostic uncertainty exists even for those with back symptoms and well-described findings on scan, as these findings are common even in subjects without back pain, and may be unrelated to the symptoms. As an example, herniated disks can be identified in significant numbers of CT or MRI low back studies in subjects with no back pain. In further analysis, lifestyle factors and occupational psychosocial exposures will be addressed. Many physicians, including those practicing in primary care settings where back pain is most often seen, lack training and confidence in addressing workplace issues. Occupational factors that have a significant influence on the development of low back pain disorders are not only mechanical and postural order but also organisational, social and psychological. Organisational changes and physical and psychological job demands should not be overestimated as causal factors. In the early phase of a work disability more emphasis should be laid however on appropriate information and medication and, in case of persistant impairment, active treatment (after 3 weeks or relapse). There is some evidence that catastrophizing as a stress coping strategy might lead to delayed recovery. Long-term work (sick) absence can be estimated through evaluation and observation of LBP risks and characteristics of the each individual case. An early return at workplace and to activities of daily life is urgent. To reduce LBS and its consequences, employers need to adopt a multifaced approach: concentrate on improving physical conditions as well as the psychosocial and environmental aspects of working environment. In cases at risk for chronification and/or with obstacles to reintegration at work an interdisciplinary work-oriented rehabilitation and occupational rehabilitation interventions (occupational reintegration) should be provided.

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 (ß=0.312, 95% CI, 0.114-0.353, p=0.001); absenteeism (ß=0.285, 95% CI, 0.093-0.334, p=0.001); and a decline in working ability (ß=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.

[Correlation between C-reactive protein levels with leading risk factors for cardiovascular disease in men].

INTRODUCTION: The aim of this study was to estimate the correlation between C-reactive protein levels and leading risk factors for cardiovascular disease in men. MATERIAL AND METHODS: The study included 183 working capable men chosen randomly from the regular systematical check-up in Health Centre Banja Luka in 2006. Standard laboratory methods were used to establish the following: total cholesterol, triglyceride and HDL-cholestreol level and LDL-cholesterol level was calculated. High sensitive C-reactive protein level was measured by immunuturbidimetric method CRP (Latex) HS Roche Diagnostic. RESULTS: Average values of high sensitive C-reactive protein for the whole group was 1.69 mg/L, total cholesterol 5.73 mmol/L, HDL-cholesterol 1.38 mmol/L, LDL-cholesterol 3.40 mmol/L. The average value for the systolic blood pressure was 132.9 mmHg, diastolic blood pressure 85.4 mmHg, and body mass index 28.47 kg/m2. Out of the overall number of examinees, 74 were smokers (40.4%) and 109 (59.6%) nonsmokers. The statistical analysis showed that there was a statistically significant difference between C-reactive protein level in the group with diastolic blood pressure below 90 mmHg and above (p < 0.05); as well as statistically significant difference between the group with desirable body mass index and the group with increased BMI (p < 0.05). DISCUSSION: The results of our study show that there is a significant correlation between CRP levels and high blood pressure, and in persons with increased body mass index. However, there was no correlation between CRP levels and total cholesterol HDL and LDL cholesterol levels. CONCLUSION: High sensitive CRP screening is useful in early detection and prevention of cardiovascular diseases

Mobbing, stress, and work ability index among physicians in Bosnia and Herzegovina: survey study.

AIM: To assess the frequency of reported mobbing and the association among mobbing, working environment factors, stress, health outcome, personality type, and work ability index in a sample of physicians in Bosnia and Herzegovina. METHOD: We conducted a questionnaire survey using a validated self-reported questionnaire among 511 physicians in national health sector of Bosnia and Herzegovina. The questions covered five major categories of mobbing behavior. Characteristics of the work, perceived work environment and its effects, stress, health, and satisfaction with work and life were assessed by the standardized abridged form of Occupational Stress Questionnaire (OSQ). A standardized questionnaire Work Ability Index (WAI) was used to determine the relation between mobbing and work ability. RESULTS: Of 511 surveyed physicians, 387 (76%) physicians self-reported mobbing behavior in the working environment and 136 (26%) was exposed to persistent mobbing. More than a half of the physicians experienced threats to their professional status and almost a half felt isolated. Logistic regression analysis showed that lack of motivation, loss of self-esteem, loss of confidence, fatigue, and depressiveness were significantly associated with lack of support from colleagues. Intention to leave work was associated with lack of support from colleagues (OR 2.3, 95% CI, 1.065-3.535; t =4.296, P =0.003) and lack of support from superiors (OR 1.526, 95% CI, 0.976-2.076; t =5.753; P =0.001). Isolation or exclusion and threats to professional status were predictors for mental health symptoms. Persistent mobbing experience was a significant predictor for sick leave. CONCLUSION: Exposure to persistent threat to professional status and isolation or exclusion as forms of mobbing are associated with mental health disturbances and lack of self-esteem and confidence. Setting up a system of support for physicians exposed to mobbing may have important benefits.