A CASE CONTROL STUDY OF DIET AND THE RISKS OF BREAST CANCER

Uvod: Provedene su brojne studije o ishrani i karcinomu dojke. Cilj ove kontrolne studije slučaja je analizirati povezanost načina ishrane i razvoja karcinoma dojke u žena Zeničko- Dobojskog kantona. Metode: Studija je provedena anketiranjem 200 ženskih pacijenata u ordinacijama porodične medicine svih općina Zeničko-Dobojskog kantona. Istraživačku skupinu su činile 100 ispitanica s novootkrivenim karcinomom dojke dijagnostikovanom po institucionalnoj kliničkoj proceduri od januara 2003. do decembra 2007. godine. Kontrolnu skupinu su činile ispitanice, njih 100 kojima nije dijagnosticiran karcinom a koje se po dobi i demografskim karakteristikama nisu značajno razlikovale od ispitanica istraživačke skupine. Podaci o ishrani su prikupljani pomoći samo-dgovora na pitanja sadržana u Upitniku o ishrani posebno konstruisanom za ovo istraživanje. Upotrebljena je logistička regresija analizu omjera šansi prediktora ili protektora (OR) sa 95 % rasponom pouzdanosti (CI). Rezultati: Ispitanice sa dijagnosticiranim karcinomom dojke značajno manje su upražnjavale rutinski fizičku vježbu ili aktivnosti (P=0.016), imale sigurnu materijalnu egzistenciju (P=0.004), i značajno češće bile izložene premorbidno dijagnostičkoj ekspoziciji CT (0.014) u odnosu na kontrolnu skupinu. Jedini prediktor koji se može povezati sa nastankom karcinoma dojke bio je deficit unosa šumskog voća: borovnoca, kupina, malina i ribizle (β = 0,165, CI 95 % -0.001-0.143, P = 0,050) i zamjenski unos vitamina A, C i E u suplementu (OTC) više od 2X godišnje (β = 0,307, CI 95 % 0,037-0,098, P = 0,001). U uslovima smanjene fizičke aktivnosti (selektirana varijabla) značajan protektor mogu biti vlakna u mahunarkama i drugom povrću (β = -0,338, CI 95 % -0.250-0.015, P = 0,028), kao i čest unos voća u ishrani posebni grejpfruta, banana ili jabuka (β = 0,523, CI 95 % -0.051-0.298, P = 0,007). Zaključak: Karcinom dojke se može spriječiti unosom zdravih namirnica u prehrani, odnosno hrane bogate protektorima osobito bogate vlaknima, čestog i obilnog unosa voća i povrća, prirodnih voćnih sokova, maslina, mrkve i bijelog luka. Ne preporučujemo unos Vitamina A, C i E u supplementu jer doprinosi nastanku karcinoma dojke.Background: Numerous studies have observed dietary risk factors for breast cancer. We investigated the association between dietary intake factors as breast cancer risks or protectors in a case-control study in industrial Zenica- Doboj Canton in Bosnia and Herzegovina. Methods: A case control study and family ambulatory based survey was completed by 200 female patients. New breast cancer among subjects of experimental groups (n=100) was diagnosed from 1. January 2003 to 31 December 2007 using institutional clinically procedure to breast cancer diagnosis. Data were obtained using a self- rated questionnaire on diet and various food intakes as breast cancer predictor or protector. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CI) and a full assessment of confounding was included in analysis. Results: There are significant differences between groups for physical activity (P=0.016), secure existence (P=0.004) and exposure to CT (0.014). Among nutritional factors, the one serving as predictor for development of breast carcinoma was deficiency of intake of blueberry, blackberry and raspberry (β=0.165, CI 95% -0.001-0.143, P=0.050) and intake Vitamine A, C, and E more than 2 times yearly in suplements (β=0.307, CI 95% 0.037-0.098, P=0.001). In case of reduced physical activity significant protectors can be fibers in food (β= -0.338, CI 95% -0.250-0.015, P=0.028) and often intake fruits as are grapefruit, banana or apple (β=0.523, CI 95% -0.051- 0.298, P=0.007). Conclusion: Breast cancer can be prevented by consumption of adequate (healthy) food intake rich for protective factors especially: fibers in food, fruit juice, olives, fruit and vegetable, carrots and garlic. But not recomend intake of Vitamin A,C, and E in supplement because it cuold be predictor of breast cancer

LOW BACK PAIN AT NEW WORKING AMBIENT IN ERA OF NEW ECONOMY: A SYSTEMATIC REVIEW ABOUT OCCUPATIONAL RISK FACTORS

Cilj rada jest identifi kacija profesionalnih čimbenika rizika za lumbalni bolni sindrom (ILBP – od engl. Low Back Pain) u novom radnom okružju, gdje je dizanje tereta zamijenio dugotrajan rad u sjedećem položaju s prisilnim i nepravilnim ergonomskim pokretima uz nedovoljnu fi zičku aktivnost i predominaciju psihosocijalnog stresa i loše organizacije rada. Sindrom bolnih leđa je najpoznatiji među akutnim bolovima mišićno-koštanog sustava. Za bolje razumijevanje probira ranih simptoma i znakova LBP i u svrhu pravodobnog suzbijanja kumulativnog kroničnog poremećaja nužno je razumjeti razlike i sličnosti, te međusobni odnos između akutne i kronične boli LBP. U ovom su preglednom radu, koji je uključivao pacijente/zaposlenike s LBP, istražene sljedeće baze podataka: Pub Med, EMBASE, Medlinea i Web of Science. LBP je posljedica pogrešnog opterećenja cjelokupne kralježnice i prenaprezanja leđnih mišića na radnom mjestu prilikom dugotrajnog rada u sjedećem položaju s prisilnim i ponavljanim pokretima samo nekih dijelova tijela (nepravilnim ergonomskim faktorima i položajima tijela pri radu), a uz predominaciju psihosocijalnog stresa, loše organizacije posla i nedovoljne fi zičke aktivnosti.Low back pain is the second most common symptom-related reason for physician visits and the fi rst reason of working disability. Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years (67%). For many individuals, episodes of back pain are self-limited and resolve without specifi c therapy. For others, however, back pain is recurrent or chronic, causing signifi cant pain that interferes with employment and quality of life. Many occupations have been anecdotally linked to certain low back pain syndrome. However, the relationship between the work environment and the patient’s symptoms, though clearly perceived by the patient to be causative, may be less certain. The injury model of an occupational disorder proposes that specifi c work activities are the cause of the patient’s pain. The injury model for low back pain, implicating a causal connection with specifi c work activities, is complex and controversial. Determining whether a patient’s low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. In this systematic review which included patients/employees with low back pain, the following databases were searched: Pub Med, Embase, Medline and Web of science. The role of occupational mechanical exposure e.g. lifting as a risk factors for low back surgery has been debated for several decades. Diagnostic uncertainty exists even for those with back symptoms and well-described fi ndings on scan, as these fi ndings are common even in subjects without back pain, and may be unrelated to the symptoms. As an example, herniated disks can be identifi ed in signifi cant numbers of CT or MRI low back studies in subjects with no back pain. In further analysis, lifestyle factors and occupational psychosocial exposures will be addressed. Many physicians, including those practicing in primary care settings where back pain is most often seen, lack training and confi dence in addressing workplace issues. Occupational factors that have a signifi cant infl uence on the development of low back pain disorders are not only mechanical and postural order but also organisational, social and psychological. Organisational changes and physical and psychological job demands should not be overestimated as causal factors. In the early phase of a work disability more emphasis should be laid however on appropriate information and medication and, in case of persistant impairment, active treatment (after 3 weeks or relapse). There is some evidence that catastrophizing as a stress coping strategy might lead to delayed recovery. Long- term work (sick) absence can be estimated through evaluation and observation of LBP risks and characteristics of the each individual case. An early return at workplace and to activities of daily life is urgent. To reduce LBS and its consequences, employers need to adopt a multifaced approach: concentrate on improving physical conditions as well as the psychosocial and environmental aspects of working environment. In cases at risk for chronifi cation and/or with obstacles to reintegration at work an interdisciplinary workoriented rehabilitation and occupational rehabilitation interventions (occupational reintegration) should be provided

Recipe from the past for the future: public health intervention represent a process for century

In the poor Bosnia, in the early 20(th) century endemic syphilis was widespread. Combating this disease entailed the necessity of etiology research, diagnosis and clinical nature of the disease, as well as the insight into the epidemiological image of this unresolved health problem. Thanks to the visionary, the enthusiasm and persistence of the expert team of doctors from that time in Croatia, School of Public Health and the Rockefeller Foundation as financial support, conditions were created to conduct population monitoring and research called "survey". The team of experts from Croatia and Bosnia led by Dr. Ante Vuletic began this important public health intervention in Central Bosnia underneath the mountain Vlasic 1934. In villages of mountain Vlasic people were living in very difficult social and unsanitary conditions. "Interviewers" worked in makeshift clinics in the rural schools Opare, Rankovici, Vitovlje Mehorica, Turbe, Bila and Gornji Vakuf. A hundred years later, a team of university professors from the School of Public Health "Andrija Stampar" led by Professor Silvije Viletic followed the footsteps of century "survey" on Vlasic in the summer of 2014. They determined that with the integrated approach to population monitoring and testing endemic syphilis in Bosnia was successfully suppressed

Mobbing, Stress, and Work Ability Index among Physicians in Bosnia and Herzegovina: Survey Study

Aim: To assess the frequency of reported mobbing and the association among mobbing, working environment factors, stress, health outcome, personality type, and work ability index in a sample of physicians in Bosnia and Herzegovina. Method: We conducted a questionnaire survey using a validated self-reported questionnaire among 511 physicians in national health sector of Bosnia and Herzegovina. The questions covered five major categories of mobbing behavior. Characteristics of the work, perceived work environment and its effects, stress, health, and satisfaction with work and life were assessed by the standardized abridged form of Occupational Stress Questionnaire (OSQ). A standardized questionnaire Work Ability Index (WAI) was used to determine the relation between mobbing and work ability. Results: Of 511 surveyed physicians, 387 (76%) physicians self-reported mobbing behavior in the working environment and 136 (26%) was exposed to persistent mobbing. More than a half of the physicians experienced threats to their professional status and almost a half felt isolated. Logistic regression analysis showed that lack of motivation, loss of self-esteem, loss of confidence, fatigue, and depressiveness were significantly associated with lack of support from colleagues. Intention to leave work was associated with lack of support from colleagues (OR 2.3, 95% CI, 1.065-3.535, t = 4.296, P = 0.003) and lack of support from superiors (OR 1.526, 95% CI, 0.976-2.076, t = 5.753; P = 0.001). Isolation or exclusion and threats to professional status were predictors for mental health symptoms. Persistent mobbing experience was a significant predictor for sick leave. Conclusion: Exposure to persistent threat to professional status and isolation or exclusion as forms of mobbing are associated with mental health disturbances and lack of self-esteem and confidence. Setting up a system of support for physicians exposed to mobbing may have important benefits

THE INFLUENCE OF INDIVIDUAL AND WORK-RELATED FACTORS ON SICK LEAVE AMONG PATIENTS WITH DEPRESSIVE DISORDERS

Zaposlenici koji boluju od depresije gube više dana bolovanja nego oni koji nisu depresivni. U ovome radu istraživan je utjecaj individualnih i faktora rada na bolovanje u pacijenata s depresijom. Proveli smo istraživanje upitnicima. Istraživanje je obuhvatilo 210 pacijenata s depresijom, a koji su na bolovanju od 0 do 360 dana. Vodilja nam je bilo bolovanje ≥ 60 dana. Skraćenim standardnim upitnikom za stres na radu (OSQ) procijenjeni su individualni faktori. Indeksom radne sposobnosti (WAI) procijenjeni su faktori radnog mjesta u odnosu na bolovanje. Prosječan broj izgubljenih radnih dana u naših ispitanika bio je 161 ± 100. 89 (maksimalno 360 dana). Bolovanje nije bilo ujedinjeno s dobi. Više od 51% varijabiliteta dužine bolovanja je rezultat variranja u skupini individualnih faktora (R2=0,51). Visoka razina opterećenja na poslu uz odsutnost socijalne podrške kolega je statistički značajno ujedinjena s duljinom bolovanja. Putem logistične regresijske analize ustanovili smo da su prediktori bolovanja: pad razine motivacije (Rsq= 0.043, P= 0.003), niska razina zadovoljstva životom (Rsq=0.049, P=0.002) i niska razina zadovoljstva zdravljem (Rsq=0.061, P=0.001). Niska razina znanja (P=0.001) bio je značajan prediktor bolovanja. Doživljeni pritisak na poslu posebno ujedinjen s odsutnošću podrške je prediktor bolovanja u pacijenata s depresijom.Employees with depressive disorders lose more days from work than people who are not depressed. We examined the influence of individual and work-related factors on sick leave among patients with depression. We conducted a questionnaire-type survey among 210 patients suffering from depression who were on sick leave from 0 to 360 days. Our object of interest were sick leaves of duration ≥ 60 days. Self-perceived work-related and individual factors were assessed by the standardized abridged form of Occupational Stress Questionnaire (OSQ). A standardized questionnaire Work Ability Index (WAI) was used to determine the relation between work-related factors and sick leave absence. The median duration of sick leave in the past year was 161 ± 100.89 days (maximum 360 days). Sick leave was not associated with age. More than 51 per cent of the duration of sick leave were the result of variability in the group of individual factors (R2=0,51). High level of strain in conjunction with low level of social support from colleagues was significantly associated with the duration of sick leave. Logistic regression analysis showed that lack of motivation for work (Rsq= 0.043, P= 0.003), low level of satisfaction with life (Rsq=0.049, P=0.002) and low level of satisfaction with health status (Rsq=0.061, P=0.001) were predictors for sick leave. Low level of knowledge (P=0.001) was a significant predictor for sick leave. Perceived high strain at work, especially when combined with low social support is predictive of sick leave in patients with depression

80th Anniversary of the Publication of Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb

Certain regions of Bosnia and Herzegovina were prominent European sites of endemic syphilis. In 1934 and 1935 the School of Public Health in Zagreb, later the Andrija Štampar School of Public Health, conducted two surveys on endemic syphilis in Bosnia and Herzegovina. The surveys were well-described in the monograph published in 1939 by the School, under the title Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb (“Endemski sifilis u Bosni anketa Škole narodnog zdravlja u Zagrebu”). This paper provides a description of the publication for the first time, presents the most important data from it, and explores its significance from the historical perspectiv

THE ASSESSMENT OF THE EFFICIENCY OF COGNITIVE BEHAVIORAL ADVISORY METHODS FOR SMOKING CESATION IN FAMILY MEDICINE PRACTICE

Uvod Korist od prestanka pušenja je nemjerljiva u bilo kojoj životnoj dobi. Cilj istraživanja je komparativna evaluacija i procjena efikasnosti krajnjeg rezultata prestanka pušenja metodama tri najčešće primjenjivane bihevioralno- kognitivne nefarmakološke intervencije u svakodnevnom radu porodičnog ljekara. U procesu odvikavanja korišten je 5P model. Metode i ispitanici: Program bihevioralno kognitivnih intervencija za prestanak pušenja je proveden u ambulantama porodične medicine u Domu zdravlja Zenica, u registriranih pacijenata- pušača dobi >od 17 godina, u periodu 2005. do 2009. godine. Ukupno je realizovano 8.366 intervencija-savjetovanja. Promotivne intervencije provedene su u tri faze primjenom različitih aktivnosti čiji je krajnji rezultat prestanak pušenja bilježen i evaluiran za svaku posebno: 1. kratkotrajni intervju o pušačkom statusu i sistematična identifikacije pušačkog statusa u 375 zdravstvenih kartona pacijenata i evaluacija efikasnosti tretmana (re-test) uz ponovljenu aktivnost u periodu od 6-12 mjeseci kasnije; 2. individualno kratkotrajno savjetovanje u trajanju od 3-10 minuta u okviru nekog terapeutskog odnosa i evaluacija efikasnosti tretmana (re-test) uz ponovljenu aktivnost u periodu od 6-12 mjeseci kasnije; 3. kontinuirano, kontrolirano savjetovanje pušača sa zakazivanjem posjeta za podršku pri prestanku pušenja do postizanja cilja. Ovaj metod sadržava 5 faza: inicirano predrazmišljanje, razmišljanje, pripremu, aktivnost prestanak pušenja i održavanje. Efekti kontinuiranog savjetovanje pušača sa zakazivanjem posjeta praćeni su u 100 pacijenata istraživačke skupine. Rezultati: Primjenom individualnog kratkotrajnog savjetovanja u okviru terapeutskog odnosa ljekar- pacijent postiže se zadovoljavajući efekat prestanka pušenja u 11% odnosno u 655 od ukupno 5984 pacijenata. Najbolja efikasnost prestanka pušenja postiže se primjenom kontinuiranog, kontroliranog savjetovanja pušača sa zakazivanjem posjeta za podršku jer je 55% ili 55 pacijenata od ukupno 100 prestalo pušiti. Zaključak Zlatni standard u borbi protiv pušenja je planirano promotivno kontinuirano savjetovanje pušača sa zakazivanjem posjeta.Introduction The benefits of patient`s cessation smoking are important in any age. The goal of the research is a comparative evaluation and assessment of outcome of the three most commonly used cognitive behavioral- pharmacological interventions during smoking cessation procedures regarding 5A model in the daily work of a family medicine physicians. Methods and patients: The behavioral cognitive intervention of cessation smoking was conducted in a Family medicine centre at the Primary health care home in Zenica among registered patients-smokers aged >17 years, from 2005 to 2009. A total of 8366 interventions were realized counseling. Interventions were carried out in three stages using various activities whose end result quitting recorded and evaluated for each particular: 1 brief interview about smoking status and systematic identification of smoking status in 375 medical records of patients and evaluation of treatment effectiveness (re-test) with repeated activity in the period of 6-12 months later; second individual short-term counseling for a period of 3-10 minutes in the framework of a therapeutic relationship and evaluation of treatment effectiveness (retest) with repeated activity for a period of 6-12 months later, 3 continuous, controlled advising smokers to schedule visits for smoking cessation support to achieve the goal. This method includes five stages: Initiated before thinking, reflection, preparation, action and maintenance of smoking cessation. Effects of continuous counseling smokers to schedule visits were observed in 100 patients, the research group. Results: Applying the results of individual brief counseling in the therapeutic relationship physicianpatient achieves a satisfactory effect of smoking cessation in 11% or 655 of the total of 5984 patients. The best efficiency is achieved by smoking cessation applying continuous, controlled counseling smokers to schedule visits for support because the 55% or 55 out of 100 patients to stop smoking. Conclusion: The gold standard in the fight against smoking is planned promotional continuously advising smokers to schedule a visit

80th Anniversary of the Publication of Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb

Certain regions of Bosnia and Herzegovina were prominent European sites of endemic syphilis. In 1934 and 1935 the School of Public Health in Zagreb, later the Andrija Štampar School of Public Health, conducted two surveys on endemic syphilis in Bosnia and Herzegovina. The surveys were well-described in the monograph published in 1939 by the School, under the title Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb (“Endemski sifilis u Bosni anketa Škole narodnog zdravlja u Zagrebu”). This paper provides a description of the publication for the first time, presents the most important data from it, and explores its significance from the historical perspective

Is Adrenal Exhaustion Synonym of Syndrome Burnout at Workplace?

The objective of this study is the assessment of the association of burnout syndrome with adrenal exhaustion specific symptoms and signs among 116 patients who were exposed to violence or mobbing at workplace and who were treated during 2005 to 2008 in Department of Occupational Pathology and Toxicology Tuzla; to detect symptoms and signs of adrenal exhaustion differences between patients who were exposed to act of violence as acute catastrophic event and patients who were long – term exposed to mobbing or chronic distress at workplace. Material and methods: Data of 86 employees who were exposed to mobbing >1 years (chronic distress syndrome) and data of 30 employees who were exposed to act of violence as acute traumatic crisis situation (evaluation in first week after acute stress situation and post control observation 6 months later). Tools for assessment were Clinical examination and Questionnaires: Occupational stress questionnaire (OSQ short version), self – constructed Questionnaire about symptoms and signs of Adrenal exhaustion; self – constructed mobbing questionnaire; and Maslach – Burnout Inventory. Results: The patients expressed their traumatic experiences during exposure to stress more than 1 year (long – term exposure) which were compared with acute stress experiences (mostly high level of stress intensity.Conclusion: when workers constant expose to repeat mobbing behavior or have perception of extended distress reaction after act of violence at workplace they are suffering of Syndrome burnout and clinical picture of adrenal fatigue

NUTRITION AND NUTRITINAL SUPPLEMENTS IN PREVENTION OF OSTEOPENIA AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN

Uvod: Moderni način života sve više eliminira kretanje i zdravu prehranu, što pogoduje smanjenju gustoće kostiju u vidu osteopenije i osteoporoze. Osteopenija se definira kao mineralna gustoća kostiju gdje je T- vrijednost između -1.0 do -2.5, a iznad -2.5 je stanje osteoporoze. Osteopenija se češće javlja kod žena u postmenopauzi zbog gubitka estrogena. Osteoporoza je kronično oboljenje koštanog sistema kod žena koje svojim progresivnim tokom i komplikacijama praćenim visokim stupnjem onesposobljenosti i mortaliteta ima značajne medicinske, ekonomske i socijalne posljedice na pojedinca i ukupno društvo. Metode: Na bazi prikupljenih podataka iz znanstvenih studija opisani su mogući utjecaji magnezija, cinka i preslice u prevenciji osteopenije i osteoporoze. Analizirani su rezultati istraživanja nutritivnog tretmana ostopenije i osteoporoze, s posebnim akcentom na upotrebu magnezija, cinka i biljnih pripravaka. Rezultati: U cilju prevencije posljedica osteopenije, odnosno osteoporoze, preporučuje se da žene u menopauzi jedu soju i sojine prerađevine kao izvor fitoestrogena. Povišen unos kalcija putem namirnica bogatih kalcijem ima važnu ulogu u održavanju zdravlja kostiju. Unos vitamina D može pomoći u održavanje čvrstoće kostiju, dok cink pojačava djelovanje vitamina D, doprinosi boljem apsorbiranju kalcija i njegovom korištenju u procesu obrazovanja nove kosti. Magnezij se pokazao efikasan u prevenciji gubitka koštane mase. Od ljekovitog bilja moze se koristiti preslica (Eqisetum arvense), cimicifuga (Cimicifuga racemosa) i crvena djetelina (Trifolium pratense). Prethodna istraživanja pokazuju da uzimanje preparata na bazi preslice može znatno usporiti smanjenje gustoće kostiju kod žena u postmenopauzi s osteoporozom. Zaključci: U cilju prevencije osteopenije i osteoporoze tokom menopauze se preporučuje dodatan unos sa haranom i dodacima prehrani Ca i vitamina D, posebno kod rizičnih skupina. Prethodna istraživanja pokazuju da se unosom Mg, Zn kao i preslice može usporiti razvitak osteopenije i osteoporoze.Introduction: Modern living style eliminates physical activity and healthy nutrition. That leads to reduction of Ca level in bones, and causes osteopenia and osteoporosis. Osteopenia is state where bone density is reduced with T between /1.0 and -2.5. Osteoporosis is state with bone density is caracterised with T under -2.5. Osteopenia is caused with low level of estrogenes, so it is common for women in menopause. Osteoporosis is desease with progresive nature, and it have consequences on society in terms of economy and medicine. Methods: Based on collected facts there is showed that level of Mg, Zn and Eqiusetum arvense have some good results on osteopenia and osteoporosis treatments. Results: It is recommended that woman in menopause should take soy in theirs diet as source of fitoestrogenes. High intake of Ca in food and as suplements has good results on bone density. There are some arguments that daily intake of Mg can increase bone density. Zn boosts activity of Mg, and because of that, and others Zn functions, it is needed to assure enough Zn in nutrition. Some of herbs that could be used are Equisetum arvense, Cimicifuga racemosa, Trifolium pratense. Conclusions: If we want to prevent osteopenia and osteoporosis in menopause it is needed to take an extra levels of Ca, vitamine D in food and as suplements. That is particularly important in groups with high risks. Researches showing that daily intake of Mg, Zn and Equisetum arvende could slow down envolvement of osteopenia and osteoporosis