Construct validity of the perceived stress scale (PSS-10) in a sample of health professionals in family medicine in Bosnia and Herzegovina.

Background: The 10-item Perceived Stress Scale (PSS-10) has not been translated into Bosnian, nor has a study been conducted employing a sample of family medicine physicians and nurses to examine the instrument's reliability, validity, and factorial structure. Thus, the goal of this study was to investigate the reliability and construct validity of the Bosnian version of the PSS-10 among family medicine professionals. Study design: Cross-sectional descriptive study provided among healthcare professionals in family medicine, using Google forms questionnaire (PSS-10) in Bosnian language. Methods: Translation of PSS-10 in Bosnian is performed according to the proposed set of standardized guidelines. The questionnaire was sent on the email addresses of family physicians and nurses in whole Bosnia and Herzegovina. The collected data were subjected to reliability testing, exploratory and confirmatory factor analysis, which tested three alternative plausible models suggested by the extant literature: single factor, correlated two-factor and bifactor. Results: A total of 272 out of 440 (RR = 61.3) nurses and physician working in family medicine in Bosnia and Herzegovina completed the PSS-10 Bosnia and Herzegovina version (BH). Participants were aged 25 to 69, with a mean age of 44.7 (±10.55). Most participants were women (86.8%) and physicians (58.8%) with specialisation in family medicine (43%). The overall Cronbach's alpha was 0.87 and the test-retest reliability coefficient was 0.88. Exploratory Factor Analysis yielded 2 factors with eigenvalues of 4.77 and 1.35, accounting for 61.2% of variance. Factor 1 consisted of 6 items representing ''perceived distress'', whereas Factor 2 consisted of 4 items representing ''perceived coping''. The Confirmatory factor analysis indicated a very good fit of this bifactor model to this sample. Conclusions: Our results implies that the PSS-10-BH, as a bifactor model with good reliability and validity, may accurately measure the stress levels of family medicine physicians and nurses.

Family Physicians' Perceptions of Primary Health Care Use in Bosnia and Herzegovina during the Covid-19 Pandemic, a Cross-sectional Study.

OBJECTIVES: The main objective of this paper was to examine the perceptions of family physicians on the use of primary health care in Bosnia and Herzegovina during the COVID-19 pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted using a short online questionnaire that was sent to primary care physicians in Bosnia and Herzegovina from April 20th, 2022, to May 20th, 2022. RESULTS: The research sample consisted of 231 doctors of primary health care from Bosnia and Herzegovina, with an average age of 45 years and 85% women. About 70% of participants reported having COVID-19 at least once from March 2020 to March 2022. Participants had an average of 1,986 registered patients and approximately 50 encounters per day. The study revealed a high degree of reliability between test-retest measurements, with a single measure Intraclass correlation coefficient of 0.801, and internal consistency determined using Cronbach's alpha of 0.89. Participants reported that the following health services were most affected during the COVID-19 pandemic: care for patients with chronic diseases, home visits, navigating the health system with patients making appointments with specialists, cancer screening, and preventive health services. The study also found statistically significant perceived differences in the use of these health services based on age, gender, postgraduate education in family medicine, participation in COVID-19 clinics, and personal history of Covid-19. CONCLUSION: There were significant disturbances to the use of primary health care during the COVID-19 pandemic. Future research could investigate patient outcomes compared to family physician perceptions.

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.

What is the Future of Family Medicine in Bosnia and Herzegovina?

INTRODUCTION: Although during undergraduate study students have a high opinion of family medicine and often praise it, during postgraduate studies they show little interest in this medical specialty. AIM: The study aimed to examine the interest of public medical school students in family medicine as a career choice, to establish whether it changed during the study and if there was a difference in that regard among students studying at medical schools in Bosnia and Herzegovina. Hypotheses: students' attitudes change with learning about the way a family doctor works. METHODS: Descriptive cross-sectional survey. This manuscript presents a nationwide survey (63% response rate) of public medical school students in Bosnia and Herzegovina regarding their likelihood of selecting Family Medicine as a specialty. An anonymous questionnaire was distributed to all medical students on all six state universities in Bosnia and Herzegovina. Data basis of all doctors who have completed specialization programs were taken from ministries of health. RESULTS: In the period from 01/01/08 to 12/31/18, only 8.4% of all completed specializations were family medicine doctors in Bosnia and Herzegovina. Interest in family medicine, as a future career, was shown by 31% of medical students, of which over 75% were female students. The largest interest in family medicine was shown by the sixth-year medical students, stating their extensive knowledge of medicine as a reason. CONCLUSION: Students' interest in FM specialization is changing through the years of study. Unfortunately, it is not only the lack of interest, that is the cause of the small number of family medical specialities among students but also poor health policy, which should be subjected to actual reform.

The Association among Glycemic Control and Depression Symptoms in Patients with Type 2 Diabetes.

INTRODUCTION: Diabetes and depression are two common and major non-communicable diseases with significant disease burdens worldwide. AIM: The aim of this study is to obtain the association among A1C levels and symptoms of depression in patients with type 2 diabetes in family medicine offices. METHODS: This cross-sectional study was carried out between June 2016 and July 2017. We recruited 150 adults with type 2 diabetes from various family medicine offices. The study questionnaire had two parts; the first one for participants and the second one for family medicine physicians. Participants completed the part of the questionnaire with the PHQ-9 scale and questions regarding demographic data. Family medicine physicians completed the part of the questionnaire with questions concerning clinical data. A univariate and multivariate linear regression analysis was conducted to identify significant predictors of depressive symptoms revealed by the PHQ-9 score. RESULTS: Multiple linear regression showed that the level of A1C was a significant predictor of the PHQ-9 score in all three models. Increases in the A1C level were followed by increases in depressive symptoms. Other significant predictors of a positive PHQ-9 score were smoking, level of education and income. CONCLUSION: The level of A1C as an indicator of glycemic control has been shown to have a significant association with the scores of the PHQ-9 questionnaire, which identifies the intensity of symptoms of depression. An increase in the level of A1C is followed by an increase in the intensity of symptoms of depression.

Frequency and Forms of Workplace Violence in Primary Health Care.

INTRODUCTION: Violence at work has become an alarming problem worldwide. The real size of the problem is unknown because of underreporting. The aim of the survey was to estimate the prevalence of workplace violence (WPV) among primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants. AIM: The aim of the survey was to estimate the prevalence of workplace violence (WPV) among Primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants. METHODS: A cross-sectional study was conducted between March and May 2017. The sample consisted of medical professionals employed at HCSC. The data were collected by a questionnaire with 42 questions divided into 7 blocks of topic. Descriptive statistics were used to describe the sample. Binary logistic regression analysis was used to test the association between the occurrence of violence and independent variables (gender, age, years of work experience and office setting). RESULTS: A total of 558 out of 983 health professionals employed in Primary health care were involved in this survey. The overall prevalence of WPV was 90.3%, with 498 (89.2%) exposed to verbal violence and 417 (74.7%) exposed to indirect physical violence. Binary logistic regression analysis indicated that the following demographic and work-related characteristics were positively significantly associated with WPV: women were associated with verbal violence [Odd ratio (OR) 1.91, 95% confidence interval (CI) 1.06, 1.47] and stalking [OR= 2.06, 95% CI (1.04, 4.08)]. Office setting (urban) was significantly positively associated with indirect physical violence [OR= 1.59, 95% CI (1.03, 2.47)]. CONCLUSION: Almost all health professionals in Sarajevo primary health care were subjected to different types of WPV. There is a need for intervention to provide safer workplace environment. Professional, administrative, legal support and protection of health professionals by the health authorities and institution management is urgently required.

Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

OBJECTIVES: To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. PATIENTS AND METHODS: The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. RESULTS: Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. CONCLUSION: The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

Efficacy of carbocisteine in the treatment of chronic obstructive pulmonary disease and impact on the quality of life.

Aim To investigate the effects of carbocisteine treatment in the reduction of frequency of productive cough episodes, preventing disease progression and improving the quality of life as well as the tolerability of the administered treatment and patient compliance during the study. Methods This observational, non-interventional, multicenter, cohort study included 501 patients with chronic obstructive pulmonary disease (COPD) who were administrated carbocisteine capsules 375 mg and followed up during the next 15 days. The patients were observed at 3 points, baseline and two additional assessments. General clinical condition of patients, along with the spirometry testing at all three points were examined. Thr quality of life was assessed on the 1st and 3rd observation with Leicester Cough Questionnaire. Tolerability and patient compliance were measured throughout the study. Results There was a significant change of forced expiratory volume in 1 second (FEV1) status between the second and third observation (p=0.002). Examination of general symptoms showed a statistically significant reduction in cough by 74.9%, in sputum production by 48.5%, in dyspnea by 29% and in fatigue by 50%. After the administration of carbocisteine the median value of overall quality of life was 3.79 (3.63 - 3.89). Conclusion 375mg carbocisteine capsules were found to be effective and well-tolerated in the treatment of COPD, with a small percentage of reported mild adverse reactions and with a significant improvement of quality of life.