Family Medicine Practice During COVID-19 Pandemic in Canton Sarajevo: Positive and Negative Aspects.

Background: After the World Health Organization declared the outbreak of a new coronavirus on 30 January 2020 a public health emergency of international importance, health authorities in Bosnia and Herzegovinaas in other countries around the world, have ordered active surveillance, early detection, isolation and management, cases, contact monitoring and prevention of the spread of infection. Objective: The aim of this study was to describe and analyze of the organization of family medicine during COVID-19 pandemic in Canton Sarajevo with its positive and negative aspects. Methods: The case study design provided an ideal framework for systematic research into the organization of primary health care in Sarajevo Canton during the COVID-19 pandemic as it is an empirical study exploring a contemporary phenomenon within its real-life context when the boundaries between phenomenon and context are not clearly visible. Multiple sources of evidence are used. Data were collected in several different ways: analyzing policies, laws, regulations, decisions related to the COVID pandemic, insight into changes in the health information system, collecting data from reports, and through a group interview (Delphi exploratory) with eleven family medicine specialists. Results: Primary care was organized as two parallel systems with family medicine in the center. The first system was COVID-19 primary care and the second was regular care for non-COVID-19 patients. Family medicine physicians despite a numerus setbacks provide health care for 106346 COVID-19 cases. Discussion: Every principal (first contact access, person-centered care, comprehensiveness, continuity of care, community based, coordination of care, and holistic modeling) of family medicine was interrupted with consequences for patients and family physicians. Conclusion: Additional research is needed to examine all facets of the family medicine and primary health care response to the COVID-19 pandemic in Sarajevo Canton.

Post-traumatic Stress Disorder, Metacognitions, Cognitive and Global Functioning in Bosnian War Veterans.

INTRODUCTION: Cognitive impairment is common finding in individuals with PTSD. Dysfunctional metacognitions in variety of anxiety disorders can represent generic vulnerability for anxiety disorders, as well as elements that contribute to maintaining the disorder. There is little empirical information about metacognition in war veterans with PTSD, and its relation to cognitive and/or social, occupational and psychological functioning. AIM: to determine the values and reciprocal correlations of different aspects of metacognition, with cognitive and global functioning in outpatient war veterans with PTSD. METHODS: The study was conducted on 25 war veterans (24 male), with confirmed diagnosis of PTSD by a trained psychiatrist, average age 48,5±6,2 (38-63) years, with average duration of symptoms of 9,9±4,7 (0,5-16) years. We used the Metacognitions questionnaire, Mini Mental Status Examination, and Global Assessment of Functioning Scale to assess metacognition, cognitive impairment, and global functioning. Median values of Metacognitions questionnaire subcomponents, Global Assessment of Functioning Scale and Mini Mental Status Examination were determined, and also reciprocal correlations of all parameters expressed with Spearman Rank Correlation. RESULTS: 12 patients (48%) had impaired cognitive function. Significant negative correlation of score on Mini Mental Status Examination, and negative beliefs about worry is observed (r=-0,4278, p=0,034), as well as non significant correlations between rest of metacognition subscales and score on Mini Mental Status Examination. Cognitive self-consciousness showed high positive correlation with Global Assessment of Functioning Scale (r =0,7436, p<0,0001). CONCLUSION: Follow up of metacognitions, cognitive and global functioning, and its relations, may have an important role in assessment of war veterans with posttraumatic stress disorder.

The Frequency of Multifactorial Syndromes in Geriatrics of Tuzla Canton Population.

INTRODUCTION: There are four main multifactorial syndromes in geriatrics the so-called "4N", which specifically occur at elderly patients. Listed syndromes often occur related, and they can be the cause and the result of many other syndromes at geriatric patients. OBJECTIVE: determine the difference in the assessment of the level of immobility, instability, dependence, urinary incontinence ("4N") in elderly groups. MATERIALS AND METHODS: The research included total 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. For fast orientation the redone questionnaire was used for our conditions: examination in clinics for usual elderly problems "Short list for examination". For the assessment of the mental abilities reduction at elderly we used "Short portable mental status questionnaire" (SPMSQ). RESULTS: In total sample the research included 200 elderly respondents, 45% in experimental group and 55% in control group. 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. We notice nearly equal distribution of falling risk according to groups (50%, 47%). In total sample there were 62% mobile, 22,5% limited mobility, and 4% immobile. Dependence frequency was more represented at examination group respondents (p=0,002). Dependence chances (OR) were 2,05 times larger (95 %CI=1,12-3,75) in examination group than in control group respondents. Frequency of urinary incontinence problem is significantly represented at all our respondents (42,2% v.s. 35%). CONCLUSION: Permanent gerontology and geriatrics training is needed both family medicine doctors and other experts in the field of elderly health protection and preventive health measures, pharmacotherapy, palliative care, especially about four main geriatrics syndromes at elderly.

Therapeutic Effects of Curcumin on Ultrasonic Morphological Characteristics of Liver in Patients with Metabolic Syndrome.

INTRODUCTION: Metabolic syndrome (METS) represent a simultaneous presence of multiple metabolic disorders in one person. Prevalence is increasing worldwide, which is probably related to increased obesity and sedentary lifestyle. Non-alcoholic steatosis or "fatty liver" is a metabolic disease caused by fat dysfunction. It can be a sign of some other disease, and can often be found in patients with metabolic disorders. Ultrasound is an acceptable method for the identification of fatty steatosis. There is evidence that when turmeric is used as a herbal diet, with its active metabolite of curcumin, can repair fatty acidosis and thus prevent progression of fatty steatosis complications such as cirrhosis and liver cancer. Goal. The aim of the study was to determine the effects of 400 mg curcuminaddition to the nutrition on ultrasound morphological characteristics of the liver in METS patients. METHODOLOGY: A prospective cohort study was conducted on 100 subjects with METS, treated in the family medicine practice of the Tuzla Canton, aged 35-70 years. The therapeutic effects of 400 mg curcumin on ultrasound-morphological characteristics of the liver were followed, validated by ultrasound in 50 respondents of experimental groups with METS. The data were processed by the IBM SPSS Statistics 21 statistical analysis program using parametric techniques andStudent's t-test for paired samples. RESULTS: There were 65% of women in the study. There were no statistically significant differences in the age of respondents within the analyzed groups. The use of 400 mg curcumin per day was statistically significantly improved ultrasound morphological characteristics of the liver in subjects with METS. CONCLUSION: All respondents with METS who used curcumin had beneficial effects on the morphological characteristics of the liver. Curcumin had stronger effects on subjects with METS and DM type 2 than others.

Qualitative Evaluation of Cardiovascular Diseases Management in Family Medicine Team in One Year Level.

INTRODUCTION: Cardiovascular diseases (CVD) are the leading death cause in modern world and are the most public health problem. WHO program for CVD contains: prevention, command and follow up of CVD in global level. AIM: Investigate CVD frequency in family medicine team in 2012.year (one year period of time) and qualitative management prevention and clinical services management quality of CVD together with recommended standards. PATIENTS AND METHODS: clinical revision of clinical standard practice patients with CVD was provided in Family medicine team in Public Health Centre Tuzla for the period of time from January 01 2012 - December 31 2012. For quality of realized services, AKAZ standards were based for: chapter 2. Health promotion and diseases prevention 2.5. preventive clinical services; chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke. From CVD register next parameters had been used: age, gender, disease diagnose, therapy, blood pressure values, total cholesterol values, ß blockers therapy, anticoagulant therapy prescription, smoker status, stop smoking recommendation and influenza vaccination recommendation. STATISTICAL APPROACH: All results were taken in Excel program and statistically analyzed. Descriptive standard tests were taken with measurement of central tendency and dispersion. For significant differentials achieved with χ² chances relation was taken (Odds Ratio-OR) with 95% relevant security. All tests were leveled in statistical significant from 95% (p<0,05). RESULTS: Considering total registered habitants number 1448 (males 624 females 824) total diseases of usually CVD in Team 1 family medicine 531 (36,67%). The most frequent disease was hypertension which was presented in 30,31% of registered patients but in total CVD illness was present in 82,67%. In relation with total patients number (531), female prevalence from CVD 345:186 males vs. 65%:35%; P=0,001 and was statistically significantly higher. Almost patients were in age from ≥65 years. Nearly all the standards for chapter 2. Health promotion and diseases prevention and chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke are met in larger percentages than the minimum, however, bad quality signs we have found in total cholesterol control were values of total cholesterol were ≤ 5mmol/l achieved only in 27.58% patients with CVD. Stop smoking recommendation in smokers with TIA and Stroke (total 10 smokers) was registered in 20,00% patients. Indicator was not achieved,(min level 25%). CONCLUSION: Role of family medicine team is extremely important in patient care who suffer from chronically noncontagious diseases such as CVD, as one of them. Considering that in our country preventive programs for CVD are at small level, results of this study are acceptable. Our plans for personal continuous educations and patient educations about healthy life style are pointed for higher or average of achieved standards and of course everything what have to be done should be written in personal dates of patients.

Screening for depression patients in family medicine.

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 Beck's 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.

Stress at work and burnout syndrome in hospital doctors.

INTRODUCTION: Reforming the health care system in Bosnia and Herzegovina began in 1998 through various forms of amendments to existing health plans and programs. There has been the introduction of new technologies, flow of new information from the profession, excessive demands on employers, financial constraints, etc. The hospital doctors in the workplace suffer from too many stressors. Burnout syndrome at work is a form of chronic stress reactions to stressors, and develops as a result of inefficient coping with and solving every day, demanding stressful situations related to professional duties. GOAL: The goals of this study were: to identify the specific stressors of high intensity in the hospital physicians work environment, to discover whether and how certain stressors can affect the appearance of burnout syndrome at work in a hospital physician, to determine whether certain individual factors influence the occurrence of burnout syndrome at work. METHODS AND SUBJECTS: We made the intersection study involving the use of questionnaires, in order to assess the stressors and burnout syndrome in hospital among doctors of the University Clinical Center in Tuzla. RESULTS: The study comprised 34.7% hospital doctors (specialists and doctors on specialization) of a total 423 employees in various departments of the University Hospital Clinical Center in Tuzla. High level of emotional exhaustion was recorded in 37.4%, a high level of depersonalization in 45.6%, and a low level in perceptions of personal accomplishments in 50.3% of respondents. CONCLUSIONS: Continuous exposure to stressors at the workplace, such as work at shifts, excessive workload, poor communication with superiors, and lack of continuous education of hospital physicians can lead to mental and physical exhaustion, professional burnout. Management of the University Clinical Center Tuzla should in the future address the structural reorganization of workplaces, as well as ongoing prevention interventions in other domains of risk factors or stressors, that this study identified.

Incidence and types of sleep disorders in patients with stroke.

INTRODUCTION: Sleep disorders (SD) after stroke (stroke) are common occurrences, and most often in sleep apnea, insomnia and daytime sleepiness. GOALS. Research goals were to determine the types of SD and their frequency in patients with stroke in relation to the type of stroke and side of lesion. MATERIALS AND METHODS: The study analyzed 200 patients with acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla in the period from 1st August 2007 to 1st June 2008. All patients have confirmed the existence of stroke by computerized tomography. SD was verified according to the General Curriculum of sleep, the Berlin questionnaire and Epvort scale. Stroke, by type, were divided into hemorrhagic and ischemic, and the localization of the stroke to right and left cerebral hemispheres. RESULTS: Of the total number of respondents, 78% had SD. Very serious level of SD had 42% of respondents, 20% moderate, and 16% of medium-severe degree. There was no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (76.8%: 82.5%, p = 0.58). In relation to the side of lesion there was more patient with SD and stroke in the right cerebral hemisphere, but there were no statistically significant differences (39.5%: 33%, p = 0.1). According Epvort scale sleep apnea and snoring was present in 86%, daytime sleepiness in 49.5% and narcolepsy 0.5%. CONCLUSIONS: Sleep disturbance as a neuropsychological disorder has a significant incidence in the acute phase of stroke. SD is slightly more common in hemorrhagic stroke and stroke in the right hemisphere. Sleep Apnea and snoring are the most common types of SD in patients with stroke.

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

INTRODUCTION: Depression seriously affects one's 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.