Bullying Among School Children in Postwar Bosnia and Herzegovina: Cross-Sectional Study

Aim To compare the prevalence and characteristics of bullying between two towns in Bosnia and Herzegovina – Stolac, which was exposed to firearm conflict during the 1992-1995 war in Bosnia and Herzegovina, and Posušje, which was outside of the active combat zone. Methods In this cross-sectional study, we included 484 primary school pupils attending 4th-8th grade of elementary school, 217 (44.8%) of them from Stolac and 267 (55.2%) from Posušje. The pupils were interviewed using a standardized questionnaire on the experience of bullying. Results Every sixth pupil (16.4%) experienced at least one form of bullying almost every day, while 34 (7.0%) pupils constantly bullied other children. Sixth-eighth graders were more often bullies than 4th-5th graders (P = 0.044). Girls were most often victims of bullying, while boys were most often bullies (P = 0.036). The expected difference in bullying between the two towns was not observed, except for older pupils in Posušje, who were more violent than their peers in Stolac (P = 0.044). Among the analyzed variables of sex, age, town, and school achievement, only male sex was significant predictor of bullying (P = 0.010), increasing the relative risk by 3.005 times. Conclusion Bullying among primary school pupils did not differ between areas that experienced war activities in 1992-1995. Our results could be useful in the introduction of specific prevention measures against bullying in postwar situation

THE ROLE OF FAMILY PHYSICIANS IN THE PREVENTION AND EARLY DETECTION OF CANCER IN HERZEGOVINA-NERETVA AND WEST-HERZEGOVINA CANTON

Background: This study aimed to investigate and analyze the role of general practitioners / family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. Subjects and methods: A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina- Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. Results: Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. Conclusions: The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients

THE ROLE OF FAMILY PHYSICIANS IN THE PREVENTION AND EARLY DETECTION OF CANCER IN HERZEGOVINA-NERETVA AND WEST-HERZEGOVINA CANTON

Background: This study aimed to investigate and analyze the role of general practitioners / family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. Subjects and methods: A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina- Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. Results: Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. Conclusions: The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients

Influence of warning labels on daily salt consumption and arterial pressure

Prekomjerni unos kuhinjske soli je jedan od vodećih čimbenika rizika krvožilnih bolesti. Cilj istraživanja je bio ispitati utjecaj naljepnica upozorenja, postavljenih na kućne spremnike soli, na dnevni unos soli u Mostaru (Bosna i Hercegovina). Uključeno je 150 odraslih, liječenih hipertoničara, nasumice podijeljenih u dvije skupine: kontrolna je dobila samo letak s upozorenjem o štetnosti prekomjernog unosa soli, a interventna i naljepnice upozorenja. Mjerena je 24 satna natriurija (Na 24) i arterijski tlak, na početku istraživanja, te jedan i dva mjeseca kasnije. Ishodni Na24 iznosio je 209,2±78,3 mmol/dan ili 12,3 ± 4,6 g NaCl-a, bez razlika među skupinama (P= 0,745). Nakon jedan i dva mjeseca u interventnoj skupini Na24 je pao na 183 ± 63 i 176 ± 55 mmol (P< 0,001), a u kontrolnoj na 203 ± 60 i 200 ± 58 (P= 0,147). Ukupno sniženje srednjeg arterijskog tlaka je u kontrolnoj skupini iznosilo prosječno 0,7 mm Hg, a u interventnoj 3,6 mm Hg (P= 0,375). Unos soli je neprihvatljivo visok, čak i u liječenih hipertoničara. Primjenom naljepnica upozorenja taj se unos može bitno smanjiti, no postignuti uspjeh je ipak nedostatan, a dugoročni ishodi nepoznati.Excessive salt intake is a major cardiovascular risk factor. Examined was the impact of enhanced warning on daily salt intake in Mostar (Bosnia and Herzegovina). A sample of 150 treated hypertensives was randomized in a group receiving a leaflet about the harmful effects of excessive salt, and a group receiving in addition warning stickers for household salt containers. Blood pressure (BP) and 24 h urinary sodium excretion (Na24) were measured at the start of the trial, and one and two months later. The average starting Na24 was 209,2 ± 78.3 mmol, equivalent to 12.3 ± 4.6 g NaCl, and similar inboth subgroups (P= 0.745). One month and two months later a significant decrease was observed in the intervention group (to 183 ± 63 and 176 ± 55 mmol; P<0.001) but not in the control group (to 203 ± 60 and 200± 58 mmol; P= 0.147). A noticeable decrease in BP (by some 3.6 mm Hg in mean BP; P= 0.375) was observed in the intervention group only. Salt intake is unacceptably high, even among treated hypertensive subjects. Enhanced warning achieved a marked reduction in Na24 and BP. However, these results are still insufficient and the long-term effects are unknown

Influence of warning labels on daily salt consumption and arterial pressure

Prekomjerni unos kuhinjske soli je jedan od vodećih čimbenika rizika krvožilnih bolesti. Cilj istraživanja je bio ispitati utjecaj naljepnica upozorenja, postavljenih na kućne spremnike soli, na dnevni unos soli u Mostaru (Bosna i Hercegovina). Uključeno je 150 odraslih, liječenih hipertoničara, nasumice podijeljenih u dvije skupine: kontrolna je dobila samo letak s upozorenjem o štetnosti prekomjernog unosa soli, a interventna i naljepnice upozorenja. Mjerena je 24 satna natriurija (Na 24) i arterijski tlak, na početku istraživanja, te jedan i dva mjeseca kasnije. Ishodni Na24 iznosio je 209,2±78,3 mmol/dan ili 12,3 ± 4,6 g NaCl-a, bez razlika među skupinama (P= 0,745). Nakon jedan i dva mjeseca u interventnoj skupini Na24 je pao na 183 ± 63 i 176 ± 55 mmol (P< 0,001), a u kontrolnoj na 203 ± 60 i 200 ± 58 (P= 0,147). Ukupno sniženje srednjeg arterijskog tlaka je u kontrolnoj skupini iznosilo prosječno 0,7 mm Hg, a u interventnoj 3,6 mm Hg (P= 0,375). Unos soli je neprihvatljivo visok, čak i u liječenih hipertoničara. Primjenom naljepnica upozorenja taj se unos može bitno smanjiti, no postignuti uspjeh je ipak nedostatan, a dugoročni ishodi nepoznati.Excessive salt intake is a major cardiovascular risk factor. Examined was the impact of enhanced warning on daily salt intake in Mostar (Bosnia and Herzegovina). A sample of 150 treated hypertensives was randomized in a group receiving a leaflet about the harmful effects of excessive salt, and a group receiving in addition warning stickers for household salt containers. Blood pressure (BP) and 24 h urinary sodium excretion (Na24) were measured at the start of the trial, and one and two months later. The average starting Na24 was 209,2 ± 78.3 mmol, equivalent to 12.3 ± 4.6 g NaCl, and similar inboth subgroups (P= 0.745). One month and two months later a significant decrease was observed in the intervention group (to 183 ± 63 and 176 ± 55 mmol; P<0.001) but not in the control group (to 203 ± 60 and 200± 58 mmol; P= 0.147). A noticeable decrease in BP (by some 3.6 mm Hg in mean BP; P= 0.375) was observed in the intervention group only. Salt intake is unacceptably high, even among treated hypertensive subjects. Enhanced warning achieved a marked reduction in Na24 and BP. However, these results are still insufficient and the long-term effects are unknown

PSYCHIATRIC AND HEALTH IMPACT OF PRIMARY AND SECONDARY TRAUMATIZATION IN WIVES OF VETERANS WITH POSTTRAUMATIC STRESS DISORDER

Background: Along with primary traumatization, wives of PTSD-diagnosed war veterans often become victims of the altered and dysfunctional state of their partners, which adds to the severity of symptoms of primary traumatization and furthers the development of other mental disorders. The aim of this study was to compare the effects of primary and secondary traumatization in wives of PTSD-diagnosed war veterans and wives of war veterans without PTSD. Subjects and methods: The experimental group consisted of 154 wives whose veteran husbands had been treated in Mostar Clinical Hospital for psychotrauma-induced PTSD. The control group was formed of 77 wives of war veterans who do not suffer from PTSD. The research used a general demographic questionnaire, the Harvard Trauma Questionnaire (HTQ) and the MINI International Neuropsychiatric Interview. Results: Wives of veterans with chronic PTSD experienced a significantly greater number of traumatic events (t=2.66; p=0.008) and had higher scores of PTSD symptoms (t=8.93; p<0.001). A significantly larger number of these women reported chronic somatic diseases (χ²=4.553; p=0.033). Furthermore, wives of PTSD-affected veterans significantly more frequently met criteria for current depression episode (χ²=20.65; p<0.001), past depression episode (χ²=24.40; p<0.001), depression with melancholic features (χ²=19.20; p<0.001), dysthymia (χ²=7.15; p=0.007), panic disorder with agoraphobia (χ²=5.28; p=0.022), PTSD (χ²=18.39; ss=1; p<0.001) and generalized anxiety disorder (χ²=19.58; p<0.001). This group also showed a higher level of suicidality (χ²=8.95; p=0.003). Conclusion: The findings of this research show how mental difficulties experienced by wives of PTSD-diagnosed war veterans affect the interrelationship of their primary and secondary traumatization

Caregiver Burden and Burnout in Partners of War Veterans with Post-traumatic Stress Disorder

War veterans diagnosed with chronic post-traumatic stress disorder (PTSD) experience serious difficulties in social, professional and family life. Consequently, their wives often become indirect victims of their husbands’ dysfunction. The purpose of this study was to assess the caregiver burden and burnout level in partners of veterans suffering from PTSD, especially in cases where partners suffer from their own PTSD symptoms. The experimental group consisted of 154 wives or partners of war veterans treated for PTSD caused by the war trauma in University Hospital Mostar. The control group was made of 77 wives or partners of war veterans without PTSD. The study was based on the General Demographic Questionnaire, the Harvard Trauma Questionnaire, Bosnia-Herzegovina version, Caregiving and the Experience of Subjective and Objective Burden and the Maslach Burnout Inventory. The wives of PTSD affected veterans scored significantly higher in all subscales of the Caregiver Burden Questionnaire and the Burnout Inventory. The results indicated that subjective demand burden, subjective stress and burnout were significantly higher in relationships in which both partners suffer from PTSD compared to couples in which only the veteran suffers from PTSD and couples in which none of the partners has PTSD. Living with a veteran diagnosed with PTSD places a heavy burden on the wife and poses a serious risk of burnout, which has to be taken into account in treatment planning

Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding

The most of the known effects of selective serotonin reuptake inhibitors, beneficial or harmful, are associated with the inhibitory action of the serotonin reuptake transporter. This mechanism is present not only in neurons, but also in other cells such as platelets. Serotoninergic mechanism seems to have an important role in hemostasis, which has long been underestimated. Abnormal activation may lead to a prothrombotic state in patients treated with selective serotonin reuptake inhibitors. On one hand there may be an increased risk of bleeding, and on the other hand reduction in thrombotic risk may be possible. Serotonin is critical to maintain a platelet haemostatic function, such as platelet aggregation. Evidences from the studies support the hypothesis that antidepressants with a relevant blockade of action of serotonin reuptake mechanism may increase the risk of bleeding, which can occur anywhere in the body. Epidemiological evidences are, however, the most robust for upper gastrointestinal bleeding. It is estimated that this bleeding can occur in 1 in 100 to 1 in 1.000 patient-years of exposure to the high-affinity selective serotonin reuptake inhibitors, with very old patients at the highest risk. The increased risk may be of particular relevance when selective serotonin reuptake inhibitors are taken simultaneously with nonsteroidal anti-inflammatory drugs, low dose of aspirin or warfarin

Formen der Gewalt bei Kindern und Sicherheitsfaktor an bosnisch-herzegowinischen Schulen

Prema široj definiciji, nasilje među djecom podrazumijeva da jedno dijete ili više djece uzastopno i namjerno uznemiruje, napada ili ozljeđuje drugo dijete. Ono može biti fizičko, verbalno, emocionalno, spolno ili ekonomsko. Fizički i psihički simptomi češće su prisutni među žrtvama školskoga nasilja. Cilj je ove studije utvrditi vrste nasilja među školskom djecom u dva grada Bosne i Hercegovine i usporediti ih prema dobi, spolu i gradu istraživanja te ispitati osjećaj sigurnosti na pojedinim mjestima u školi. Ovo poprečno istraživanje obuhvatilo je 484 učenika IV-VIII razreda osnovne škole u gradovima Stolac i Posušje. Rezultati istraživanja pokazuju da je najčešći oblik nasilja u školi verbalno nasilje (59%), a najrjeđi spolno nasilje (2,24%). U počinjenom nasilju dječaci češće provode fizičko, a djevojčice verbalno nasilje. Osjećaj sigurnosti učenika najveći je u učionici, a najmanji u zahodu. U pogledu sigurnosti na pojedinim mjestima u školi nije nađena razlika među ispitivanim gradovima, osim u školskom dvorištu. Tako se učenici Stoca osjećaju nesigurnije na školskom dvorištu (31 ili 14,3%) nego njihovi vršnjaci u Posušju (10 ili 3,7%).A broad definition of school bullying is when one or more pupils repeatedly disturb, attack or hurt other students. It could be direct and indirect, verbal and physical. Physical and psychical symptoms are found more frequently among school bullying victims. The aim of this study is to find out what are the types of bullying according to age, gender and town of study, and sense of safety in different school premises. This cross-sectional study enrolled 484 fourth to eight graders in two primary schools. Results of the study show that the most frequently reported type of victimization is verbal (59%) and the rarest one is sexual (2.24%). The boys are more frequently engaged in physical bullying than the girls, while the girls used verbal type of bullying more frequently. Pupil\u27s sense of safety was highest in the classroom, and lowest in the toilette. In terms of safety in different school premises there are no differences between the towns, except concerning school playground: pupils from Stolac were more unsafe at the playground (31 or 14.3%) than their peers in Posušje (10 or 3.7%).Kindergewalt im weiteren Sinne meint anhaltende und absichtliche Beunruhigung oder Angriffe und Gewalttätigkeiten eines Kindes oder mehrerer Kinder gegen einen oder mehrere Altersgenossen. Diese Attacken können physischer, verbaler, emotionaler und sexueller Natur sein oder auf die Erpressung von Geld abzielen. Physische und psychische Symptome sind bei Gewaltopfern an Schulen häufiger festzustellen. Mit dieser Studie sollten verschiedene Formen von Gewalt unter Schulkindern zweier bosnischherzegowinischer Städte ermittelt und untereinander verglichen werden; des Weiteren wollten die Autoren herausfinden, an welchen Orten des Schulgeländes sich die Schüler sicher fühlen. An der Untersuchung nahmen insgesamt 484 Grundschüler der Klassen 4–8* aus Stolac und Posušje teil. Die häufigste Form von Gewalt besteht demnach in verbalen Attacken (59%), am seltensten kommt es zu sexuellen Übergriffen (2,24%). Physische Gewaltanwendung ist meist Jungen zuzuschreiben, während Mädchen eher auf verbaler Ebene gewalttätig werden. Am sichersten fühlen sich die Schüler in den Klassenzimmern, auf den Toiletten hingegen ist das Gefühl der Unsicherheit am größten. Diesbezüglich besteht auch kein Unterschied zwischen den Städten, in denen die Untersuchung durchgeführt wurde, ausgenommen der Schulhof. Demnach fühlen sich die in Stolac befragten Schüler auf ihrem Schulhof weniger sicher (31 Schüler bzw. 14,3%), ihre Altersgenossen in Posušje hingegen schon eher (10 Schüler bzw. 3,7%)