Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina.
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AIM: To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina. METHODS: The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure > or =140 mm Hg (> or =130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure > or =90 mm Hg (> or =80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension. RESULTS: The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P=0.006; respectively). CONCLUSION: This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin. (+info)
Prevalence of mental and social disorders in adults attending primary care centers in Bosnia and Herzegovina.
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AIM: To determine the prevalence of mental and social disorders in adults who attend primary care health centers in Bosnia and Herzegovina. METHODS: Sixty-nine family physicians from the Primary Care Research Network in Bosnia and Herzegovina each invited 20 randomly selected patients from their practices to complete the Patient Health Questionnaire (PHQ), which consists of 26-58 questions about symptoms and signs of depression, anxiety, somatization disorder, eating disorders, and alcoholism. A total of 1574 patients were invited to participate in the study. Physicians reviewed the PHQ and calculated the final score, which determined a provisional diagnosis. Definitive diagnosis was determined by further questioning and clinical knowledge of the patient. Data collection was performed between November 2003 and January 2004. Lists of non-participants were maintained by the physicians. RESULTS: The response rate was 82%. Of 1285 respondents, 61% were women. At least one type of mental or social disorder was found in 26% of the respondents, and 12% had more than one disorder. Somatization disorder, major depression syndrome, and panic syndrome were experienced by 16%, 10%, and 14% of respondents, respectively, while 5% or less were suffering from eating disorders or alcohol abuse. More women than men had somatization disorder, panic syndrome, and binge eating disorder, while more men than women reported alcohol abuse. CONCLUSION: More than one-quarter of all adults who attended family medicine centers in Bosnia and Herzegovina presented with at least one type of mental or social disturbance. New health policies, strengthened professional training, and accessible support networks need to be developed throughout the country. (+info)
Antibiotic resistance of coliform organisms from community-acquired urinary tract infections in Zenica-Doboj Canton, Bosnia and Herzegovina.
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OBJECTIVES: To collect routine susceptibility data for coliforms isolated from patients with community-acquired urinary tract infections (UTIs) in Zenica-Doboj Canton, Bosnia and Herzegovina and to relate them to bacterial identification and patient demographics with a view to guiding empirical therapy. METHODS: During 1998-2001, 54 638 consecutive urine samples were analysed by standard procedures. Antimicrobial susceptibility testing for 15 antimicrobials was performed by the disc diffusion method. RESULTS: A total of 10 765 Escherichia coli and other coliforms were isolated, of which 5043 (46.8%) were duplicates. Resistance rates were significantly higher in duplicate isolates for almost all antibiotics tested (P<0.05), except for ampicillin, cefazolin, aztreonam and co-trimoxazole. Inclusion of coliforms other than E. coli (25.8%) significantly increased resistance rates for all tested antibiotics (P<0.001) except imipenem. Overall coliform resistance rates were significantly higher in males than in females (P<0.001). CONCLUSIONS: Due to high ampicillin and trimethoprim/sulfamethoxazole resistance rates for all subsets analysed it is highly recommended to perform urinalysis and antibiotic susceptibility testing in all patients, except in the age group 0-6 years of male patients and in the age group 20-64 years of female patients, in which empirical therapy with these antibiotics can be applied. Nitrofurantoin should also be considered as the first-line therapy, especially in children. It is important for physicians to know susceptibility data for UTIs in order to optimize the use of empirical therapy. (+info)
Perinatal and maternal outcomes in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina.
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AIM: To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war. METHODS: We retrospectively collected data on a total of 59,707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period. RESULTS: There were 23,194 live births in the prewar, 18,302 in the war, and 18,211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3 per thousand before vs 15.1 per thousand after the war, P<0.001). After the war, both perinatal mortality (14.4 per thousand) and early neonatal mortality (6.6 per thousand) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100,000 deliveries during the war was significantly higher than that before (39 per 100,000 deliveries) and after (12 per 100,000 deliveries) the war (P<0.001 for both). CONCLUSION: Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care. (+info)
Consequences of domestic violence on women's mental health in Bosnia and Herzegovina.
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AIM: To assess psychological consequences of domestic violence, and determine the frequency and forms of domestic violence against women in Bosnia and Herzegovina. METHODS: The study was carried out in the Tuzla Canton region in the period from 2000 to 2002, and included 283 women aged 43+/-9.6 years. Out of 283 women, 104 received psychiatric treatment at the Department for Psychiatry of the University Clinical Center Tuzla, 50 women were refugees; and 129 were domicile inhabitants of the Tuzla Canton. Domestic Violence Inventory, Cornell Index, Symptom Checklist-90-Revised, PTSD Checklist Version for Civilians, and Beck Depression Inventory were used for data collection. Basic sociodemographic data and information from the medical documentation of the Department for Psychiatry of the University Clinical Center Tuzla was also collected. RESULTS: Out of 283 women, 215 (75.9%) were physically, psychologically, and sexually abused by their husbands. Among the abused, 107 (50.7%) experienced a combination of various forms of domestic violence. The frequency of domestic violence was high among psychiatric patients (78.3%). Victims of domestic violence had a significantly higher rate of general neuroticism, depression, somatization, sensitivity, obsessive-compulsive symptoms, anxiety, and paranoid tendency than women who were not abused. The prevalence of posttraumatic stress disorder (PTSD) symptoms according to the type of trauma was higher in women with the history of childhood abuse (8/11) and domestic violence (53/67) than in women who experienced war trauma (26/57) and the loss of loved ones (24/83). The majority of 104 psychiatric patients suffered from PTSD in comorbidity with depression (n=45), followed by depression (n=17), dissociative disorder (n=13), psychotic disorder (n=7), and borderline personality disorder with depression (n=7). The intensity of psychological symptoms, depression, and Global Severity Index for Psychological Symptoms (GSI) were in significant positive correlation with the frequency of psychological (r=0.45, P<0.001), physical (r=0.43, P<0.001), and sexual abuse (r=0.37, P<0.001). CONCLUSION: Domestic violence in various forms had long-term consequences on mental health of women. This should be taken into account when treating women with war-related trauma. (+info)
Mobbing, stress, and work ability index among physicians in Bosnia and Herzegovina: survey study.
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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. (+info)
Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina.
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Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of BiH, policies or the innovation are not simply disseminated, but rather assimilated into the health system. The assimilation and implementation of the new PHC model relied on the consensus of a diverse group of adopters; the changes brought by the reforms were aligned with the expectations of the adopters: this created a 'receptive context' for adoption and diffusion of the innovation. The new family-medicine-centred PHC service model had a major impact on professional identity, inter-professional relationships and organizational routines. The post-conflict context was perceived as an opportunity to introduce the new model and implement transformational change, while the complex government structure meant the process of diffusion was as important as the innovation itself. In BiH, a holistic approach-comprising multifaceted and simultaneous interventions at multiple levels of the health system-reduced 'policy resistance' and enhanced the adoption and diffusion of the PHC reforms. (+info)
Should discrepant accounts given by asylum seekers be taken as proof of deceit?
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BACKGROUND: In order to recognise a refugee in a receiving state, decision makers have to make a judgment based on background information and the account given by the individual asylum seeker. Whilst recognising that this is a very difficult decision, we examine one of the assumptions made in this process: that an account which is inconsistent is probably fabricated for the purposes of deceitfully gaining asylum status. We review some of the psychological processes at work when a person applies for asylum, and report a study offering empirical evidence of some of the reasons why accounts of traumatic experiences may be inconsistent. METHODS: In the study reported, 39 Kosovan and Bosnian (UNHCR) program refugees in the UK were interviewed on two occasions about a traumatic and a non-traumatic event in their past. They were asked specific questions about the events on each occasion. FINDINGS: All participants changed some responses between the first and second interview. There were more changes between interviews in peripheral detail than in the central gist of the account. Changes in peripheral detail were especially likely for memories of traumatic events. Participants with higher levels of Post Traumatic Stress Disorder (PTSD) were also more inconsistent when there was a longer delay between interviews. INTERPRETATIONS: We consider this and similar studies in the light of asylum decision making, proposing that these decisions, often a matter of life and death to the applicant, must be based not on lay assumptions, but on established empirical knowledge. (+info)