Prevalence of burnout among health care workers in the Federation of Bosnia and Herzegovina during the coronavirus disease-2019 pandemic: a cross-sectional study.

AIM: To investigate the prevalence of burnout syndrome among health care workers in the Federation of Bosnia and Herzegovina (FBiH) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study was conducted in May and June 2021 using an online survey based on Copenhagen Burnout Inventory. The questionnaire underwent forward and backward translation, preliminary pilot testing, and was assessed for reliability and validity. Personal burnout, work-related burnout, and patient-related burnout were assessed. The survey was sent to the members of the Union of Physicians and Dentists in FBIH, who were asked to forward the link to their medical technicians and nurses. RESULTS: A total of 77% of participants experienced some form of burnout. As many as 32% experienced all three forms of burnout. Those actively involved in tackling the COVID-19 pandemic more often experienced burnout. In personal and work-related burnout domains, higher level of burnout was reported among female respondents. Higher work-related and patient-related burnout was reported by physicians compared with medical technicians/nurses. Higher level of patient-related burnout was reported in health care workers aged 30-39 and 50-59 years, among respondents working in primary care, and among physicians. CONCLUSION: The majority of health care workers showed moderate or high levels of personal and work-related burnout, with a lower level of patient-related burnout. There is a need for further research into the causes of burnout, as well as for the implementation of organizational interventions aimed to minimize workplace burnout.

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.

Long-term results of augmentation ileocystoplasty in spinal cord injury patients.

INTRODUCTION: The aim of this article was to report the long-term results of increased ileocystoplasty in 58 patients with spinal cord injury (SCI) with an impact on overall renal function and quality of life. In a representative number of patients, where we followed individual subjects for more than 20 years, we wanted to determine their quality of life and preservation of renal function after surgery. MATERIAL AND METHODS: After unsuccessful conservative therapy of urinary incontinence, increased ileocystoplasty was performed. In addition to biochemical analysis, intravenous urography (IVU) was performed preoperatively (urography and/or ultrasound assessment of the upper urinary tract) and urodynamic tests were performed in all patients preoperatively. RESULTS: After a follow-up of patients within the group (>20 years), 2 patients reported being incontinent. The median elapsed time of action was 20 (13-24) years. Vesical capacity increased in all cases postoperatively when the median vesical capacity was 420.0 (387.5-460.0) ml (p <0.001). Long-term complications included use of bladder chambers, kidney stones and urosepsis. Creatinine clearance confirmed satisfactory renal function after the elapsed time period from surgery. CONCLUSIONS: The results confirmed that augmentation ileocystoplasty had excellent long-term outcomes in the definitive therapy of refractory neurogenic detrusor overactivity in patients with SCI.

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.

Correction to: Twenty-five years on: revisiting Bosnia and Herzegovina after implementation of a family medicine development program.

Following publication of the original article [1], the authors opted to correct the name of co-author Amra Zalihic from Zahilic to Zalihic. The original article has been corrected.

Anxiety sensitivity as a predictor of academic success of medical students at the University of Mostar.

Higher education students comprise a particularly vulnerable group for the development of anxiety symptoms and disorders. The aim of our research was to examine the impact of anxiety sensitivity on the success of medical students at the University of Mostar, and to establish the differences between students depending on their sex and the year of study. One hundred students in their first and fifth year of medical school were interviewed using the ASI questionnaire, 7 days prior to their final exams. Here we demonstrate a positive correlation between anxiety sensitivity and academic success. We did not find any significant differences between the first and fifth-year medical students, nor between participants based on their sex. We conclude that anxiety can have a positive impact on the academic achievement of higher education students.

Level of Education as a Risk Factor for Extensive Prevalence of Cervical Intervertebral Disc Degenerative Changes and Chronic Neck Pain.

OBJECTIVE: The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain. METHODS: One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire. RESULTS: The entire logistic regression model containing all predictors was statistically significant, (χ2(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R2) and 13.8% (Nagelkerke R2) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001). CONCLUSION: A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.

Comparative Analysis of Family Medicine Education and Exams at Cathedras of Family Medicine of Universities in Southeastern Europe - "Splitska inicijativa", Sarajevo, 2017.

Education means: learning, teaching or the process of acquiring skills or behavior modification through various exercises. Traditionally, medical education meant the oral, practical and more passive transferring of knowledge and skills from the educators to students and health professionals. Today the importance of focus on educational quality, particularly in the professions operating in the services required by people is agreed by all involved. The higher educational system shoulders some critical responsibilities in the economic, social, cultural and educational development and growth in the communities. In countries that are in transition it is in charge of educating professional human workforce in every field and if the education is optimal in terms of quality, it is capable of carrying out its responsibilities. It is reason why there is the necessity behind discovering some strategies to uplift the quality of education, especially at university level.. By increasing the courses and establishing universities and higher education centers, the countries around the world have generated more opportunities for learning, especially using modern information technologies. Regarding to evaluating different educational services quality, one of the most important measures should be the way to develop programs to promote quality and also due to the shortage of resources, evaluating the services quality enables the management to allocate the limited financial resources for realization whole educational process. Advances in medicine in recent decades are in significant correlation with the advances in the new models and concepts of medical education supported by information technologies. Modern information technologies have enabled faster, more reliable and comprehensive data collection. These technologies have started to create a large number of irrelevant information, which represents a limiting factor and a real growing gap, between the medical knowledge on one hand, and the ability of students and physicians to follow its growth on the other. Furthermore, in our environment, the term technology is generally reserved for its technical component. This terminology essentially means not only the purchase of the computer and related equipment, but also the technological foresight and technological progress, which are defined as specific combination of fundamental scientific, research and development work that gives a concrete result. The quality of the teaching-learning process at the universities in former Yugoslav countries and abroad, depends mainly of infrastructure that includes an optimal teaching space, personnel and equipment, in accordance with existing standards and norms at the cantonal or entity level, which are required to implement adequately the educational curriculum for students from first to sixth year by Bologna studying concept. For all of this it is necessary to ensure adequate funding. Technologies (medical and information, including communications) have a special role and value in ensuring the quality of medical education at universities and their organizational units (faculties). "Splitska inicijativa" project, which started 6 years ago as simple intention to exchange experiences of application new model of education, based on: Bologna studying concept, and other types of under and postgraduate education, was good idea to improve also theory and practice of it within Family medicine as academic and scientific discipline. This year scope of our scientific meeting held in Sarajevo on 24th and 25th March 2017, was quality assessment of theoretical and practical education and, also, evaluation of knowledge by students exams (a-y).

Satisfaction with the program of school bullying prevention and mental health promotion - cross sectional study among primary school pupils in Mostar.

OBJECTIVE: The aim of this study was to assess the frequency of experience in school bullying and family violence, satisfaction with the preventive-promotional program, knowledge about methods for opposing violence and attitudes toward the role of the family physician in bullying prevention. MATERIALS AND METHODS: The project was conducted by family physicians, nurses and sixth year medical students. The target group were 5th to 8th grade pupils of two primary schools randomly selected by computer. Basic information about the presence and types of bullying, the long-term consequences of violence and methods to oppose violent behavior was given as an interactive lecture to large groups of pupils. After the lecture, pupils received questionnaires about their experience of school violence, satisfaction with the program and their opinion about the role of the family physician in bullying prevention. RESULTS: The results of the short term outcome evaluation of the program show that younger pupils evaluate the program better than older ones. Furthermore, we found that the frequency of experienced violence is not connected with satisfaction with the program. CONCLUSION: Most students have never experienced violence in schools and families, 5th and 6th grade students showed greater satisfaction with training, better knowledge of help in case of violence and a more positive attitude towards medical help. We found no significant differences in pupil's satisfaction with the program, knowledge about methods of opposing violence and attitudes towards the role of the family physician in bullying prevention, in relation to the frequency of experience of family violence and school violence.

"Fundamental communication skills in medical practice" as minor elective subject.

OBJECTIVE: Poor and inadequate communication affects the therapeutic relationship between doctors and patients. Guided by this idea, we organized a minor elective course entitled "communication skills". We wanted to bring closer to the students the holistic approach of the family physician to the patient, the importance of the family, its impact on the patient and vice versa, and the significance of the local community and its influence on an individual's health. The aim of this article is to explain how we organized this elective course. METHODS: The course was organized in the form of 12 hours of theory (3 lectures and 9 seminars) and 24 hours of practical training. There were 26 students from all years. Through theory, and even more through the practical part the students met with different types of patients. RESULTS: At the end of the course, students in lower years were evaluated by means of an interview, and graduate students through a practical test - a conversation with a patient. The initial results, including the students' grading of this course, were highly encouraging. Both teachers and students were highly satisfied on completion of the course. CONCLUSION: Content on communication training is rare in teaching. Practicing communication skills will empower the doctor - patient therapeutic relationship.

Adherence to pharmacological treatment of chronic nonmalignant pain in individuals aged 65 and older.

BACKGROUND: Medication nonadherence is a frequent problem in the treatment of chronic conditions. OBJECTIVE: To study the adherence to pharmacological treatment of chronic nonmalignant pain, as well as factors and patient attitudes related to nonadherence in patients aged ≥65 years. METHODS: The cross-sectional study was conducted with a self-administered questionnaire among 100 patients aged ≥65 years by five family physicians at the Health Care Centre Mostar, Bosnia and Herzegovina. RESULTS: According to their own statements, 57% of the patients were nonadherent, while 84% exhibited some form of nonadherence on the Morisky scale. The patients reported a mean pain intensity of 6.6 ± 2.2 on a visual analog scale. The most common deviation from the prescribed therapy was self-adjustment of the dose and medical regimen based on the severity of pain. Polymedication correlated positively with nonadherence. Nonsteroidal anti-inflammatory drugs were the most frequently prescribed medications. The majority of the participants (59%) believed that higher pain intensity indicates progression of the disease, and half of the participants believed that one can easily become addicted to pain medications. Nonadherence was associated with patient attitudes about addiction to analgesics and ability of analgesics to control pain. CONCLUSION.: High pain intensity and nonadherence found in this study suggest that physicians should monitor older patients with chronic nonmalignant pain more closely and pay more attention to patients' beliefs regarding analgesics to ensure better adherence to pharmacological therapy.

Education in family medicine at the University of Mostar School of Medicine.

Department of Family medicine has been formed in academic year 2002/2003, few years later after the foundation of the School of Medicine University of Mostar. The formal members of department are professor and assistants who lecture and lead seminars. In addition, physicians in rural practices contribute to teaching of family medicine. Clinical teaching of family medicine at Mostar School of Medicine is organized in the summer semester of sixth year of the study. It lasts six weeks and contains lectures, seminars and practices. Every student has right and obligation to evaluate educational process at the end of the course in a form of questionnaire and essay. Family medicine continuously receives high marks by students, especially practices. Evaluation of teaching by students is good way of giving feedback about teaching. We believe that student opinion can revise and improve teaching practice. Our good experience and good marks may prompt the changing our educational curriculum to include family medicine at each study year of medical program.

Comparison of the results of surgical and non-surgical treatment of combat urogenital injuries in Bosnia war 1992-1995.

Goal was to compare the results of surgical and non-surgical treatments of combat injuries of genitourinary system and to compare our data with data collected in the recent studies. The study was designed as a retrospective review of data collected in prospective databases. The data extracted from inpatients' medical records included demographics, mechanisms and type of injury, distribution of the lesions, clinical presentation features, applied diagnostic studies, treatment modalities, types of complication and results of treatment. Among 4.125 patients treated in the Mostar War Hospital, 111 had injury of genitourinary tract: 62 underwent a surgical and 49 non-surgical treatment. Mortality among operated patients was 16 (26%). Complications were noted in 47 patients (42%); in 33 (70%) were manifested as early complications, and 14 (30) as delayed ones (p = 0.006). Among the surgically treated patients, 40 (36%) had some complication, in comparison to 8 (7.2%) patients with complications among non-surgically treated patients; which represent a statistically significant difference (p < 0.05). In this study, there was a surprisingly high number of non-surgically treated patients, and this sub-group of UGT trauma patients had in some ways the superior treatment results in comparison with surgically treated patients. Conservatively treated patients had lower rate of complications, no mortality, and no patients with permanent disability.

Differences in quality of life after stroke and myocardial infarction.

INTRODUCTION: There is obvious decline in quality of life after MI and stroke. The main factors that reduce quality of life in these patients were the inability of returning to normal activities, pain and the development of depression / anxiety. We wanted to know what has the biggest influence on recovery and differences in quality of life in patients after stroke and heart attack. SUBJECTS AND METHODS: Cross-sectional study was conducted using HADS and WHOQOL-Bref questionnaire. Criteria for exclusion were diabetes, previous depression, cancer or other co morbidities that influenced the quality of life. It has been surveyed total of 396 patients, of whom 378 patients satisfied the criteria of inclusion in the study. Based on the personal data of patients, they were divided according to gender, age, educational level, and social support expressed by number of members with whom patient lives. RESULTS: In all the observed parameters of the SU group had better results than the stroke group. The recovery after a stroke affected age, length of education and depression. Age, gender and length of education influence on a heart attack recovery. Disease duration did not affect the quality of life in either group. Significantly more patients after a stroke had depression compared to MI (p<0.001). Anxiety was not found significant in differences between groups (p=0.051). Metabolic syndrome was more frequent in the stroke group, but the difference between groups was not significant (stroke/MI) (p=0.098). In the group of stroke patients who had MS patients more often had depression (p=0.003) for different of respondents from the group with MI. CONCLUSION: Quality of life was significantly worse in patients after stroke compared to those with MI. The recovery from stroke was most significantly impacted by depression and age and level of education, while the recovery from heart attack was at most affected by gender, age and level of education.

Association between psychosomatic and traumatic symptoms in early adolescence.

INTRODUCTION: This study investigates association between psychosomatic and traumatic symptoms among adolescents. SUBJECTS AND METHODS: This cross-sectional survey using self-completion questionnaires was conducted among 868 adolescent in grade 6th, 7th and 8th of primary schools in Mostar (Bosnia and Herzegovina). RESULTS: Psychosomatic symptoms are strongly associated with traumatic symptoms, with exception of symptom of anger. The association is the highest between anxiety, depression and PTS symptoms on the one side and cardiovascular symptoms on the other side. CONCLUSION: According to our results, psychosomatic symptoms are strongly associated with psychosomatic symptoms in early adolescence.

Gender and quality of life after cerebral stroke.

The aim of this work is to investigate the influence of gender on recovery after cerebral stroke.It is believed that functional outcome of cerebral stroke (CS) depends on gender. Female gender is mildly negative prognostic factor in after stroke results. Two hundred and two patients who had first ischemic cerebral stroke were questioned with help of, HADS and WHOQOL-Bref questionnaires, looking for differences in recovery depending on gender. Average patients' age was 72+/-13 (ME+/-IR) years. The youngest patient had 40 years, and the oldest 92 years, and medium range was 52 years. There were 112 males and 90 females. Quality of life was equally graded by both male and female after CS (p=0.208). Male patients had significantly better results in physical (p=0.035) and psychological (p=0.020) domain of life quality. After CS, male patients had better results only in memory dimension (p=0.003). Anxiety was statistically more frequent among female patients (p=0.009). Gender did not influence frequency of metabolic syndrome in patients with CS. Quality of life after CS was better in male patients, and statistically significant difference has been shown in physical, psychological domain and memory dimension. Female patients were more anxious then male after CS.

Case-control study: posttraumatic stress disorder and habits of war veterans.

AIM: To correlate habits (abuse of tobacco, alcohol, psychoactive substances and drugs) of war veterans and the frequency of symptoms in persons with PTSD and those without it. METHODS: We have carried out a prospective research (case-control study) over the period between September of 2005 and June 2006. The sample consisted of two groups of examinees: 60 males, war veterans with PTSD and 60 males, war veterans without PTSD. The group of war veterans without PTSD was formed using matching criteria (same age, level of education). Both groups included married males. Research was performed using a questionnaire designed for this study. RESULTS: A higher number of war veterans without PTSD were employed compared to war veterans with PTSD (chi2=45.753; df=4; p<0.050). A higher number of war veterans with PTSD used psychoactive substances during the war period compared to war veterans without PTSD (18.3% vs. 3.3%). We have observed that 85% of examinees with PTSD have used anxiolitic drugs in the period of research, compared to only 5% of those without PTSD (chi2=77.576; df=1; P<0.050). All examinees with PTSD had some form of sleep disorders comparing to 70% of those without PTSD (chi2=50.595; df=3; P<0.050). Analysis of alcohol abuse showed a statisticaly significant difference between the examined groups (chi2=9.654; df=2; P=0.008). CONCLUSION: A higher number of war veterans without PTSD had employment in comparison to the group of war veterans with PTSD. A higher number of war veterans with PTSD had some form of sleeping disorder, used psychoactive substances and anxiolitic drugs during the war period, and had alcohol abuse in comparison to the group of war veterans without PTSD.

Influence of posttraumatic stress disorder of the fathers on other family members.

The purpose of this work is to analyze the frequency of depression and anxiety and children behaviour in families whose heads of the family (father) suffer from post-traumatic stress disorder (PTSD). The study was conducted from September 2005 until July 2006, with patients living in Mostar. The frequency of depression and anxiety in family members older than 18 years, and changes of the behaviour in children younger than 18 years of age were measured. The data were collected from 60 men and their families who had been diagnosed with PTSD by their psychiatrist. The control group was formed using matching criteria (age of the head of the family, his education, religion, family income and number of children). In this study, three questionnaires were used: one specially designed for this study, covering general information about family members, and a personal opinion of each family member about the family situation and relations within the family; Hopkins symptoms checklist - 25 (HSCL-25) for evaluation of depression and anxiety for subjects older than 18; and General Health Questionnaire (GHQ) for children 5 to 18 years of age, which was completed by their mothers. More wives from the PTSD families had depression than wives from the controlled group (chi2=21,099; df=1; P<0,050). There was no difference between groups in frequency of depression and anxiety (chi2=0,003; df=1; P=0,959) for children older than 18 years. No difference in answers between groups of children younger than 18 years were found in the General Health Questionnaire. However, we found significant differences in separate questions. Mothers, who filled the questionnaire form, reported that children from fathers who had PTSD experienced stomach pain more often (chi2=10,474;df=2; P=0,005), eating problems (chi2=14,204;df=2; P=0,001) and breathing problems (chi2=9,748;df=2; P=0,008), than children from fathers who did not have PTSD. Children from fathers with PTSD were more easily upset (chi2=7,586; df=2; P=0,023) and worried more often (chi2=12,093; df=2; P=0,002), they were also more aggressive towards other children (chi2=6,156; df=1; P=0,013). The controlled group of children who wanted to help with the house work was larger than the tested group (chi2=10,383; df=2; P=0,006). More children from the controlled group missed school than from the other group of surveyed children (chi2=6,056; df=2; P=0,048). A significantly larger number of women, whose husbands had PTSD, were depressed, unlike women whose husbands were not ill. There was no significant difference in depression manifestation in a group of children older than 18, as well as in behaviour of a group of children younger than 18, but significant differences in some provided answers were found, that indicate the differences between controlled and tested groups.