[DIFFERENCE IN THE PREVALENCE OF BURNOUT SYNDROME IN PRECLINICAL AND CLINICAL TEACHING DOCTORS OF MOSTAR SCHOOL OF MEDICINE]. / RAZLIKE U UCESTALOSTI POJAVE SINDROMA IZGARANJA U NASTAVNIKA PRETKLINICARA I KLINICARA MEDICINSKOG FAKULTETA U MOSTARU.

AIM: The aim of this study was to determine the difference in the prevalence of burnout syndrome in preclinical and clinical teaching doctors of Mostar School of Medicine in the academic year 2011/2012. Special attention was also focused on finding out the possible difference between the syndrome incidence that was correlated to gender and years of service. The main hypothesis was that the probability of burnout syndrome incidence was higher in the group of female clinical teaching doctors having more years of service. SUBJECTS AND METHODS: The study involved 62 people with high academic education employed at Mostar School of Medicine who were surveyed during a randomly selected consecutive 3-month period (February to May) of the academic year 2011/2012. The data were prospectively collected through a standardized questionnaire survey. The studied parameters were gender, years of work experience and the engagement in preclinical or clinical departments of the Medical School. RESULTS: The survey showed that 43 out of 62 (69.4%) respondents did not suffer the burnout syndrome, while moderate syndrome was recodred in 19 (30.6%) of them. No person had serious symptoms of the syndrome. The difference between the respondents who suffered the syndrome and those who did not was not statistically significant (P=0.002). Considering the gender of respondents, statistically significant differences were not confirmed (P=0.444). Considering the years of service, the highest incidence of the syndrome was found in people with more work experience (in the group of 21-25 years), but the difference between the groups was not statistically significant (P=0.271). Observing the work in preclinical and clinical departments, because of the limited number of patients we could not confirm the hypothesis. The syndrome had affected 13 (21%) clinical teaching doctors and 6 (9,7%) preclinical doctors, while the differenece between them was not statistically significant (P=0.054). CONCLUSION: Considering the results of this research, it has not been proven that the burnout syndrome occurred more frequently in doctors who were involved in clinical teaching than in doctors who tought in preclinical departments. Also, there was no difference in the appearance of the syndrome that was related to gender and years of service.

[The frequency of burnout syndrome in physicians in Mostar University Hospital]. / Ucestalost sindroma burnout kod lijecnika u Sveucilisnoj klinickoj bolnici Mostar.

AIM: To determine the prevalence of burnout syndrome in clinical physicians in Mostar University Hospital. SUBJECTS AND METHODS: The study included 94 subjects who were familiar with the purpose of research and were classified into three specialty groups. The first consisted of doctors in the Department of Internal Medicine and Department of Pediatrics, the second group of doctors in the Department of Surgery and Department of Gynecology and Obstetrics, while the third group (CL-specialization) were doctors of the Clinic of Dermatology and Venereal Diseases, Department of Otorhinolaryngology and Department of Ophthalmology. All subjects were handed anonymous questionnaire to assess burnout. The questionnaire consisted of 18 statements with numbers from 1 to 3, 1 meaning rarely, 2 often and 3 always The task was to circle an appropriate number depending on how the statement described them. Along with these statements the questionnaire contained information on the place of employment, years of work experience and gender. RESULTS: In the studied sample of respondents most (n = 81, 86.2%) didn't have symptoms of burnout syndrome. As for the people who had these symptoms, they all belonged to the moderate intensity (chi2 test = 49.19, df = 1, P < 0.001), while none had severe symptoms of this syndrome. The intensity of the symptoms in the subjects was not significantly different between males and females (chi2 test = 0.85, df = 1, P = 0.355). Also, the intensity of symptoms in the subjects did not differ significantly depending on the number of working years (exact test, P = 0.888). After the formation of three groups from seven departments involved in the research of so far perceived intensity of stress, no significant differences in the intensity of the symptoms of burnout were found between them (exact test, P = 0.536). Regarding the individual items in the overall survey sample, in five items high intensity symptoms of burnout were most often circled. The most frequently reported high intensity of the symptoms was the sense of inability to change something at work (chi2 test = 78.04, df = 14, P < 0.001) CONCLUSION: The majority of respondents did not have symptoms of burnout syndrome, and those who had them were in the moderate stage of burnout. No statistically significant differences in the incidence of burnout syndrome between the groups of specialties were found.

Secondary traumatisation and systemic traumatic stress.

Traditionally, research has been focused on the development of symptoms in direct trauma survivors. However, during the last two decades researchers and clinicians have started exploring the way individual traumatic stress exposure affects trauma victims' spouses, children and professional caregivers. Studying trauma within the family is a part of what is called systemic traumatology, a study of groups, institutions and other human systems that show stress reactions directly caused by a traumatic event or series of events. The effect of an individual's traumatic stress on family members and on persons in direct contact is conceptualized as secondary traumatisation. In its narrow sense, secondary traumatisation involves a transfer of nightmares, intrusive thoughts, flashbacks and other Posttraumatic Stress Disorder symptoms, which are typically experienced by individuals suffering from PTSD, onto their immediate surroundings. In its broader sense, the term refers to any kind of distress transfer from a trauma victim to their immediate surroundings, and includes a broad spectrum of distress manifestation along with that resembling Posttraumatic Stress Disorder. Beyond that, a family member's PTSD is potentially transferable to subsequent generations, interfering with the psychological development of children.

Atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients.

Atrial fibrillation is one of the most frequent arrhythmias diagnosed in clinical practice and it is also relatively common in dialysis patients. Atrioventricular and intraventricular conduction disturbances are less investigated in hemodialysis patients and data about their prevalence are insufficient. The objective of this study was to determine the prevalence of atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients and to analyze different clinical risk factors. The study included 140 patients on long-term hemodialysis treatment. The presence of atrial fibrillation, atrioventricular blocks and bundle branch blocks was determined by electrocardiogram. Patients were divided into groups depending on the presence or absence of atrial fibrillation/bundle branch blocks and investigated variables were compared. Atrial fibrillation was present in 11 (7.9%) of the 140 patients. In multivariate analysis, age and higher concentration of uric acid were associated with atrial fibrillation. Prevalence of first-degree atrioventricular block was 2.9% (4 patients) and second- and third-degree atrioventricular blocks were not found. Prevalence of bundle branch blocks was 17.1% (24 patients): 5% of patients had a complete right bundle branch block, 6.4% had an incomplete right bundle branch block, 3.6% had a complete left bundle branch block and 2.1% of patients had an incomplete left bundle branch block. The prevalence of atrial fibrillation and bundle branch blocks in this study was relatively high in patients on hemodialysis and greater than that observed in general population. Presence of atrial fibrillation was associated with older age and higher concentration of uric acid.

[Psychological adjustment to chronic stress in parents of children with intellectual disability]. / Psiholoska prilagodba na kronicni stres roditelja djece s intelektualnim teskocama.

AIM: To investigate whether mothers and fathers of children with intellectual disability differ when it comes to resistance factors (deailing with stress, marital quality, personality traits) and adjustement (psychical symptoms and subjective health complaints, pleasant and unpleasant mood). SUBJECTS AND METHODS: The researchencompassed 30 married couples, 30 mathers and 30 fathers, all of wich are parents of children whit intellectual disability who treat in Service for psychophysical and speech difficulties in Mostar, Centre for special needs "Mary our hope" in Siroki Brijeg and Centre "Nazareth" in Mostar. Materials are delivered to parents on arrival at chech-in to special education. The research was conducted from Semptebre 2010 to May 2011. The study used a survey that consisted of five questionnaires: the Standardizerd questionaire of coping with stress, Standardizerd questionaire severity of subjective health symptoms, Standardizerd questionaire of quality of marriage, Standardizerd questionaire of a mood and Standardizerd questionaire of five-factor model of personality. The survey was anonymus. The collected dana was tested with corresponding statistical methods. RESULTS: Mothers frequently (P = 0,005) and intense (P = 0,005) perceived subjective health symptoms as compered to fathers. Mothers frequently (P = 0,043) and intense (P = 0,033) experienced gastrointestinal symptoms compared to fathers. They also more frequent (P = 0,000) and more intense (P = 0,001) experienced pseudoneurological symptoms. Flu symptoms are more frequent (P = 0,008) and more intense (P = 0,005) in mothers. There is not statistically significant difference in the frequency and intensity of muscle and allergic symptoms. Fathers are emotionally stable than mothers (P = 0,000). In other protective factors we adid not find statistically significant differences in measures of adjustment. CONCLUSION: With regard to measures to adjustment, mothers and fathers of children with intellectual disability differ in overall frequency and intensity of subjective health symptoms. Here we hightlight the gastointestinal, pseudoneurological and flu symptoms. In termes of protective facrors fathers are emotionally stable than the mothers.

Diagnoses of personality disorders between 1879 and 1929 in the largest Croatian psychiatric hospital.

AIM: To study demographic characteristics, comorbidities, and diagnoses of patients admitted for personality disorders to Psychiatric Hospital Vrapce between 1879 and 1929. METHODS: Data were collected from the archives of Vrapce Psychiatric Hospital for a 50-year period from November 1879 to December 1929. The ratio between the number of patients with personality disorder and the number of all admitted patients was determined. We used 3 systems of definitions of personality disorder: for cases before 1923, we used Prichard's concept of moral insanity and unpublished definitions of one of the hospital managers at that time; for cases after 1923, we used Schneider's classification of psychopathic personalities and unpublished definitions of one of the hospital managers at that time. RESULTS: The total number of admissions during the study period was 18 960, 141 (0.74%) of which were for a personality disorder. Of the admitted patients, 85.8% were men and 59.7% were single. The average age was 29.7 } 9.5 years. Most of them (61.7%) were sent to the hospital by courts or police, and the median length of stay was 92 days (interquartile range, 92.0 - 127.5 days). The first patient with a personality disorder was admitted in 1889 with a diagnosis of moral insanity. Until 1920, only 3 terms were used for personality disorder: moral insanity, psychopathic inferiority, and psychopathy. The term was subdivided only after that year. Of the 141 patients admitted for personality disorder, 34 (24.1%) were discharged with comorbid disorders, mainly substance abuse. The most common single comorbid diagnosis was Ganser syndrome (prison psychosis). CONCLUSION: Archives of the Vrapce Psychiatric Hospital contain reliable data about the earliest nomenclature of personality disorders, the increase in the prevalence of personality disorders, and further subdivision of the term personality disorder. Nomenclature for these disorders used at the Vrapce Psychiatric Hospital was consistent with that used in clinical practice in other parts of the world at the time.

The meteorological factors associated with suicide.

Looking through the history, people have always been associating suicide with weather conditions, trying to understand and identify the relationship between meteorological factors and suicide. The aim of this study was to determine and analyze the meteorological conditions in the time of attempted or committed suicides, and examine the possible link between the changes of meteorological factors and the frequency of suicidal behavior. Retrospective study of pairs covered the period from January 2003 to January 2006. Examinees included in the study were persons who committed or attempted suicide in the region of Mostar. Meteorological factors included the days of attempts or committing of suicide, with meteorological factors of the day immediately prior to the days of attempts or committing of suicide, as well as with average monthly values of meteorological factors. Meteorological factors of the days with suicidal behavior were similar to the day prior to the days with suicidal behavior, but there was significant difference between meteorological factors of the days with suicidal behavior and average monthly values of meteorological factors: maximum pressure was significantly lower in the days with suicidal risk, as well as pressure gradient. Regarding the seasonal periods, examinees most frequently attempted to commit suicide in April. Results indicate that meteorological factors do not act as an acute stress factor for suicide behavior, but its change over time may be the trigger for a suicide attempt.

Quality of life after colorectal cancer surgery in patients from University Clinical Hospital Mostar, Bosnia and Herzegovina.

Quality of life (QoL) has become an important outcome measure for patients with cancer, but results from population-based studies are infrequently published. The objective of this study was to asses QoL in patients who underwent the colorectal cancer (CRC) surgery and to compare it to the QoL of general population. The patients who were admitted from January 2004 until May 2006 at the Department of Gastrointestinal Surgery at the Clinical Hospital Mostar, Bosnia and Herzegovina were divided in three groups: group of CRC patients who had received surgery and as a result of surgical treatment have colostomy, group of CRC patients who had received surgery in the same period and don't have colostomy and the third group that consisted of controls. QLQ-C30 and QLQ-CR38 questionnaires by the European Organization for Cancer Research and Treatment (EORTC) were used. A total of 67 patients were included in this study, supplemented by the thirty healthy examinees. Healthy group had significantly better results in physical functioning compared with colorectal cancer patients and better results in cognitive and social functioning. Also, they reported symptoms of diarrhea and constipation less frequently than the group with colostomy and. The group with colostomy had poorer results in emotional functioning than the group without colostomy, and also reported significantly poorer results for domain "body image". Healthy group showed better results in sexual enjoinment than the patient with colorectal cancer. Patients without colostomy reported more micturition and defecation problems and female sexual problems compared to the healthy group. Generally we found that healthy population had better results than the CRC patients, while the patients with stoma had worse results than the nonstoma patients. The results presented here suggest that psychological treatment should be an integral part of the CRC treatment plan.

Hypertensive disorders in pregnancy: a 5-year analysis of the wartime and postwar period in South-Western region of Bosnia and Herzegovina.

Hypertensive disorders are among the most common complications in pregnancy and a major cause of perinatal morbidity and mortality. The aim of this study was to investigate the risk factors and adverse perinatal outcomes of pregnancies in mothers with hypertensive disorders, as well as the adequacy of prenatal care during the wartime and postwar period in South-Western region of Bosnia and Herzegovina. This study included a total of 542 pregnancies with hypertensive disorders during 5-year study period (1995-1999) and 1559 randomly selected controls. Data on risk factors, adverse perinatal outcomes (for singleton pregnancies only) and prenatal care on pregnant women were extracted from the medical records and compared with controls. Chi-square test and crude odds ratio (OR) with 95% confidence interval (95% CI) were used in statistical analysis. The average five-year incidence of hypertensive pregnancy disorders was 6.5% and it was significantly higher in 1995, the last year of the war, than in the postwar period (1996-1999) (p = 0.02). Factors significantly associated with hypertensive pregnancy disorders were maternal age > 34, nulliparity, multifetal gestation and male newborn (p < 0.001; except p = 0.002 for male newborn). Severe forms of hypertensive disorders were significantly associated with adverse perinatal outcomes: preterm birth (OR 2.6, 95% CI 1.08-6.3), cesarean delivery (OR 9.2, 95% CI 5.4-15.6), fetal growth restriction (OR 63.8, 95% CI 34.8-117.0), and stillbirth (OR 5.5, 95% CI 2.1-14.1). Women with hypertensive pregnancy disorders had significantly lower number of prenatal care visits than controls (p < 0.001). There was a high proportion of normally formed macerated stillbirths in the study (27 out of 30 or 90%) and in the control group (10 out of 12 or 83%). In conclusion, severity of the disorder and adequacy of prenatal care are strongly associated with adverse perinatal outcome related to hypertensive pregnancy disorders.

Depression and anxiety in patients on chronic hemodialysis in University Clinical Hospital Mostar.

Depression and anxiety are prevailing mental problem in patients on chronic hemodialysis and they have great influence on outcome of illness. Additionally, these disorders are rarely identified in that population of patients and they are insufficiently treated. The aim of this study was to assess the prevalence of depression and anxiety in patients on chronic hemodialysis in University Clinical Hospital Mostar and to examine the correlation between the demographic variables and the time spent on dialysis with depression and anxiety levels. The experimental group consisted of 56 patients on chronic hemodialysis in Mostar Clinical Hospital. The control group 1 consisted of 53 patients diagnosed with a chronic illness and treated for at least a year, while the control group 2 consisted of 51 persons who were not diagnosed with any chronic somatic or mental illness. Demographic data were collected using the constructed questionnaire. The Beck Depression Inventory-BDI was used to determine depression, while the Spielberger State-Trait Anxiety Inventory-STAI was used to determine anxiety. We recorded significantly higher prevalence of depression in patients on chronic dialysis (51.8%) than in patients with a chronic illness (41.5%) and persons without chronic illnesses (9.8%; p < 0.001). Trait anxiety level was significantly higher in hemodialysed patients compared to the other two groups (p = 0.006) but there were no significant differences in state anxiety level. The study has not shown any significant difference in the prevalence of depression and anxiety level regarding the differences in sex, gender and education level, apart from a higher level of state anxiety in patients with a lower education level (p = 0.032). These results indicate that patients on hemodialysis have a significantly higher level of depression and a higher level of trait anxiety compared to patients with chronic illnesses and especially compared to general population.

Macrosomic births at Mostar Clinical Hospital: a 2-year review.

The aim of this research was to determine the incidence, risk factors and perinatal outcome of the macrosomic infants (birth weight > or = 4000 g). The retrospective research was performed using a case-control study conducted at Mostar Clinical Hospital. Total of 379 women gave singleton term births to macrosomic newborn in the period from January 1st, 2004 to December 31st, 2005 (observed group). Another 379 singleton normal birthweight term newborns (birth weight < 4000 g, but not small for gestational age), of the same maternal parity and age, who were delivered in the same period, formed the control group. The incidence of macrosomic births was 13, 1%. In the study group, significantly higher number of cases of postdatism (> 42 weeks of gestation) (P<0,001), maternal obesity (prepregnancy BMI> 26 kg/m2) (P<0,001), gestational diabetes mellitus (P=0,033), hypertension (P=0,025) and male infant (P<0,001) were observed. Cesarean delivery (P<0,001), intrapartal complications (cephalopelvic disproportion P<0.001, perineal trauma P=0,042) and newborn birth trauma (clavicular fracture P=0,038, brachial palsy P=0,021) occurred significantly more often in the macrosomic group. There was only one fetal death in the macrosomic group. In the control group there were no cases of perinatal deaths. To conclude, it is important to emphasize the significance of proper diagnosis of fetal macrosomia and management of macrosomic birth, since we have seen a growing number of macrosomic births during the last decades, and have faced a problem of increased risks of adverse perinatal outcome.

Infections in Hospitalised Patients with Multiple Myeloma: Main Characteristics and Risk Factors.

OBJECTIVE: Multiple myeloma is a common haematological malignancy and immune dysfunction is the hallmark of the disease. It leads to an increased infection risk, which is still a major cause of mortality. The infection spectrum and characteristics have evolved with the introduction of novel agents. An understanding of risk factors that increase susceptibility to infections is critical in fighting them. This retrospective investigation aimed to establish the incidence and main characteristics of infections in non-transplanted hospitalised myeloma patients in our department over a 3-year period, as well as factors associated with infections. MATERIALS AND METHODS: A total of 240 hospitalised patients with multiple myeloma (120 males and 120 females; average age: 69 years, range: 41-89 years) who were diagnosed or treated in our department from January 2008 to December 2010 were included in this study and their data were retrospectively analysed. RESULTS: Infections were identified in 17.9% of hospitalised patients. The most common pathogen found was Pseudomonas aeruginosa. The frequency of gram-positive and gram-negative pathogens was similar. In 37.2% of cases, the agent was not isolated. The most common sites of infections were the urinary system and the blood (septicemia). The frequency of infection increased with duration of disease and the rate of reinfection was 41.9%. The patients treated with bortezomib had the highest infection occurrence. Fatal outcome occurred in 9.3% of cases. CONCLUSION: The factors associated with infections in this investigation were female sex, 3B clinical stage of disease, increased serum creatinine and ferritin levels, neutropenia, poor general condition, and presence of catheters. Myeloma patients with one or more of these mentioned risk factors should be monitored with particular care in order to decrease the incidence and severity of infective complications.

Marital quality and relationship satisfaction in war veterans and their wives in Bosnia and Herzegovina.

BACKGROUND: Posttraumatic stress disorder (PTSD) in war veterans and its complex emotional and behavioral characteristics affect veterans' partners and the quality of their relationships. Although most research focuses on the effects of veterans' PTSD on their partners/wives and their relationships, not many findings have been established on partner adjustment and marriage quality when wives suffer from PTSD as well. OBJECTIVE: The aim of the research was to examine the relationship between war-related posttraumatic stress symptoms and partner's marital satisfaction in couples where one or both partners suffer from PTSD. DESIGN: The Harvard Trauma Questionnaire and Dyadic Adjustment Scale encompassed 154 war veterans and their wives who had been treated at Mostar Clinical Hospital in Bosnia and Herzegovina for combat-related PTSD as well as 77 veterans who did not suffer from PTSD and their wives. RESULTS: Veterans' PTSD is related to lower levels of marital adjustment of their wives. Marital adjustment was significantly lower in couples where both partners had PTSD compared with couples where only the veteran had PTSD or neither partner had PTSD. Female partner's marital adjustment is best explained by his avoidance symptoms and her own level of depressiveness and re-experiencing symptoms. CONCLUSIONS: The results highlight the importance of recognizing PTSD in wives of traumatized veterans as well as the importance of family approach in the treatment of PTSD.