Burnout syndrome among nurses at a military medical academy in Serbia.

OBJECTIVES: Healthcare workers are the professional group at higher risk of burnout than others. It is the underlying reason for medical errors and the general decrease in quality of patient care and is related to poor patient-healthcare worker relationships. Healthcare workers who work with military personnel have specificities compared to healthcare workers who work only with civilians. METHODS: A cross-sectional study among 171 nurses at the Military Medical Academy was conducted. The questionnaire consisted of items regarding socio-demographic and socioeconomic characteristics, lifestyle characteristics, workplace environment, workplace stress, strategies of stress management, symptoms and signs of workplace-related stress, and the Serbian version of the Maslach Burnout Inventory. RESULTS: The prevalence of burnout was 46.2%. The multivariate logistic regression analysis showed that the burnout was associated with stating that they would not choose the same profession again (OR = 4.54, 95% CI: 1.53-14.50) and with not being interested in the work (OR = 4.86, 95% CI: 1.58-14.92). CONCLUSION: The prevalence of burnout is relatively high among nurses at the Medical Military Academy in Belgrade and is associated with factors in the work environment.

Environmental and take-home lead exposure in children living in the vicinity of a lead battery smelter in Serbia.

Blood lead levels (BLLs) have been falling steadily worldwide due to restricted use of lead (Pb) and its compounds. although they remain above preindustrial Pb levels. Elevated BLL can still be found in children living near secondary Pb smelters that represent around 50% of Pb production. There have been no studies on Pb exposure in children living in Serbia ever since the 1980s. The aim of this study was to evaluate the BLLs in children living in two villages in Serbia (Zajaca, the location of a secondary lead smelter, and Paskovac, 5 km away), identify the primary determinants of children's BLLs, and investigate the impact of BLLs on children's health symptoms and school achievement. The study was conducted in 2011 on 127 children, aged 1-18 years, whose BLLs were measured using inductively coupled argon plasma mass spectrometry (ICP-MS). The median BLL in children was 12 µg/dl, with a significantly higher value of 17.5 µg/dl in Zajaca, compared to 7.6 µg/dl in Paskovac. Only 1 out of 75 and 12 out of 52 children from Zajaca and Paskovac, respectively, had BLLs below the CDC recommended 5 µg/dl level. Living near the smelter resulted in 19 times, and having a father who works in the plant 4 times higher odds of elevated BLLs. No significant effects of elevated BLLs health symptoms were seen in this study. BLLs of children living near a battery recycling plant in Serbia, an upper-middle income European country, were in the range and even higher than those of children living in developing countries. For the first time, the contribution of environmental and take-home lead exposure was quantified using mixed-effect modeling, and our results indicate a contribution of 25-40% of the take-home lead exposure to the BLLs of children living in the vicinity of a secondary lead smelter.

Reliability and Validity of the Pittsburgh Sleep Quality Index-Serbian Translation.

The aim of this study was translating and exploring psychometric properties of Serbian Pittsburgh Sleep Quality Index (PSQI) in a sample of "good" and "bad" sleepers suffering from depression or obstructive sleep apnea (OSA). Formal translation and validation were performed on a sample of healthy controls, patients with untreated OSA, and with diagnosed major depressive disorder with evaluation of internal consistency, test-retest reliability, and construct and criterion validity. Controls and OSA subgroups were recruited from a larger sample of commercial drivers. One hundred and forty subjects, 84.3% male, 22-67 years old, were included. OSA subgroup had 59 subjects and depression subgroup had 40 subjects (22 females). Mean ± SD total PSQI was 3.5 ± 2.2 in controls, 4.9 ± 3.6 in OSA subjects, and 9.0 ± 4.9 in patients with depression. Cronbach's α for total PSQI was 0.791. Subscale scores were significantly correlated to global PSQI in all subgroups. Intraclass correlation coefficient for global PSQI was 0.997 ( p < .001). Epworth Sleepiness Scale score was significantly correlated to global PSQI (ρ = 0.333, p < .001). Three subgroups differed significantly in total PSQI and PSQI ≥ 5, even after adjustments for age and gender ( p < .001). OSA patients had higher mean PSQI than controls but not significantly ( p = .272). PSQI-reported sleep latency did not correlate with PSG-measured sleep latency ( r = .130, p = .204). Total PSQI was significantly correlated to OSA severity (ρ = 0.261, p < .05). Serbian PSQI showed good internal consistency, test-retest reproducibility, and adequate construct and criterion validity, which supports further exploration of its use as a sleep quality screening tool in different target populations.

Screening commercial drivers for obstructive sleep apnea: Validation of STOP-Bang questionnaire.

OBJECTIVES: The main aim has been to examine psychometric properties of STOP-Bang (snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender) scoring model (Serbian translation), an obstructive sleep apnea (OSA) screening tool, in a sample of commercial drivers. MATERIAL AND METHODS: After formal translation, validation was performed on a sample of bus and truck drivers evaluating test-retest reliability, construct and criterion validity. Overnight polysomnography or cardiorespiratory polygraphy were used for OSA diagnosis purposes. RESULTS: One hundred male participants, 24-62 years old, were included. STOP-Bang classified 69% as potential OSA patients. Polysomnography identified OSA in 57% of the sample. Test-retest reliability (Cohen's κ = 0.89) was adequate. STOP-Bang score was significantly correlated to apnea-hypopnea index (AHI) and OSA severity. Sensitivity was 100% for AHI ≥ 15, highest specificity was 53.5% (AHI ≥ 5). CONCLUSIONS: STOP-Bang showed good measurement properties, supporting its further use in OSA screening of commercial drivers. Int J Occup Med Environ Health 2016;30(5):751-761.

Chromatin Fractal Organization, Textural Patterns, and Circularity of Nuclear Envelope in Adrenal Zona Fasciculata Cells.

Despite previous research efforts in the fields of histology and cell physiology, the relationship between chromatin structural organization and nuclear shape remains unclear. The aim of this research was to test the existence and strength of correlations between mathematical parameters of chromatin microarchitecture and roundness of the nuclear envelope. On a sample of 240 nuclei of adrenal zona fasciculata cells stained using the DNA-specific Feulgen method, we quantified fractal parameters such as fractal dimension and lacunarity, as well as textural parameters such as angular second moment (ASM), entropy, inverse difference moment, contrast, and variance. Circularity of the nuclear envelope was determined from the nuclear area and perimeter. The results indicate that there is a statistically significant negative correlation between chromatin ASM and circularity. Moreover, there was a statistically significant positive correlation between chromatin fractal dimension and envelope circularity. This is the first study to demonstrate these relationships in adrenal tissue, and also one of the first studies to test the connection between circularity and fractal and gray-level co-occurrence matrix parameters in DNA-specific Feulgen stain. The results could be useful both as an addition to the current knowledge on chromatin/nuclear envelope interactions, and for design of future computer-assisted research software for evaluation of nuclear morphology.

Screening commercial drivers for obstructive sleep apnea: translation and validation of Serbian version of Berlin Questionnaire.

PURPOSE: Obstructive sleep apnea (OSA) can lead to severe health consequences. Drivers of motor vehicles with untreated or undiagnosed OSA have a greater risk of traffic accidents. Use of self-reported questionnaires is the first step in OSA diagnosis. The main aim of this study was to perform the translation and validation of Berlin Questionnaire in a sample of commercial drivers. METHODS: After formal translation, validation was performed on a sample of commercial drivers and included evaluation of internal consistency, test-retest reliability, construct and criterion validity. Full-night attended polysomnography or cardiorespiratory polygraphy was used for OSA diagnosis. RESULTS: One hundred male participants, 24-62 years old, were included. Berlin Questionnaire classified 35 % subjects as potential OSA patients. Polysomnography confirmed OSA in 58 % of the subjects. Berlin Questionnaire showed good internal consistency (Cronbach's alpha 0.82-first category, 0.73-0.95-second category). Test-retest reliability (Cohen's kappa 0.78) was adequate. Berlin score was significantly correlated with OSA category and apnea-hypopnea index (AHI). Sensitivity of Berlin Questionnaire was from 50.9 (AHI ≥ 5) to 75 % (AHI ≥ 30), while specificity ranged from 86 to 70.5 %. CONCLUSIONS: Berlin Questionnaire (Serbian version) showed good measurement properties, creating basis for further research of its usefulness as OSA screening tool in populations of interest.

Assessment of coarse and fine hand motor performance in asymptomatic subjects exposed to hand-arm vibration.

A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures.

Silicotuberculosis and silicosis as occupational diseases: report of two cases.

INTRODUCTION: Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers are at increased risk for tuberculosis and other mycobacterium-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 fold higher, depending on the severity of silicosis) than that found in healthy controls. OUTLINE OF CASES: The first patient was a 52-year-old male who was admitted in 2002 for the second time with dyspnoea, wheezing and fatigue over the last 11 years. He had worked in an iron smelting factory and was exposed to silica dust for 20 years. First hospitalization chest radiography showed bilateral pleural adhesions, diffuse lung fibrosis with signs of a specific lung process. Second hospitalization chest radiography showed bilateral massive irregular, non-homogenous calcified changes in the upper and middle parts of lungs. The patient died due to respiratory failure and chronic pulmonary heart in 2007. The main causes of his death were silicotuberculosis and chronic obstructive pulmonary disease. The second patient was a 50-year-old male who was admitted in 2005 for the second time with chest tightness, dyspnoea, wheezing and fatigue over the last 10 years. He had worked in an iron smelting factory and was exposed to silica dust for 30 years. First hospitalization chest radiography showed diffuse lung fibrosis and small nodular opacities. The patient was diagnosed with silicosis, small opacities sized level p/q, and profusion level 2/3. Second hospitalization chest radiography and CT showed diffuse lung fibrosis and small nodular opacities predominantly in the upper lobes. The patient was recognized as having an occupational disease, and received early retirement due to disability. CONCLUSION: In low-income countries, new cases of silicosis and associated lung cancer, chronic obstructive pulmonary disease and tuberculosis are likely to be seen for decades because necessary reduction of silica use will take time to be achieved.

Work ability assessment in a patient with Wilson's disease.

Wilson's disease (WD) is a rare, progressive autosomal recessive disorder characterised by impaired transport and excessive accumulation of copper in the liver, brain, and other tissues. The disease is diagnosed based on clinical manifestations and screening tests results. Work ability assessment of patients with WD is based on the analysis of liver, kidney, neurological, and cognitive impairments, and takes into account patient's level of education.This article presents a case with a 48-year-old male patient, who was admitted for work ability assessment due to polymorphic symptoms. The patient had been working as a salesman for 28 years. A detailed interview and examination by occupational health and other medical specialists revealed that the patient had been suffering from Wilson's disease from the age of 13, and had now developed hepatic manifestations (compensated liver cirrhosis with portal hypertension), neurological manifestations (dystonia, dysarthria, muscle weakness, vertigo), and psychiatric manifestations (depression, insomnia, cognitive impairment) of the disease, including problems partially caused by long-lasting treatment with copper chelating agents (neurological and haematological manifestations). There were no ocular manifestations of Wilson's disease (Kayser-Fleischer rings or sunflower cataract).The patient was assessed as having drastically diminished general work ability, dominantly due to neurological and psychiatric impairments caused by Wilson's disease.

[Cryptogenic organizing pneumonia--case report].

INTRODUCTION: Cryptogenic organising pneumonia is a particular form of inflammatory and fibroproliferative lung disease. The disease onset is subacute with cough, dyspnoea, fever, weight loss, and elevation of biological inflammatory markers. Chest imaging usually shows multifocal alveolar opacities predominating in the subpleural regions. Lung biopsy reveals budding connective tissue filling the distal airspaces. CASE OUTLINE: A 57-year-old electrician complaining of cough, dyspnoea, and fatigue was diagnosed with pneumonia and treated with antibiotics and antihistaminics. After clinical and radiographic progression of the disease, open lung biopsy was performed, some 15 months after the disease onset. The diagnosis of cryptogenic organising pneumonia was made. The patient was treated with oral and inhalatory corticosteroids and finally with cytostatics, which led to a partial improvement of his condition. However, work capacity was lost and the quality of life seriously deteriorated. CONCLUSION: The diagnosis is established by combining clinical, radiological and histological criteria. Similarities with other disease processes can lead to a delayed or erroneous diagnosis. Most patients respond well to corticosteroid therapy (prednisone or methyl-prednisolone). Relapses are frequent but can generally be controlled.