Background/Objectives: Composite hemangioendothelioma (CHE) is a rare vascular endothelial tumor with borderline malignancy. This study presents a case of CHE and an updated systematic review of previously reported cases, providing insights into recurrence patterns and survival outcomes. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, the Cochrane Library, and Web of Science up to 31 December 2024, to identify eligible case reports. Kaplan–Meier curves were used to estimate event-free survival. Results: We report a 61-year-old man with a splenic lesion associated with weight loss and abdominal pain persisting for 1 year. Intraoperative findings revealed an enlarged spleen and multiple hepatic deposits. Splenectomy and liver biopsy revealed a well-demarcated, nodular tumor measuring 160 × 145 × 100 mm, with histological and immunohistochemical findings consistent with CHE, complicated by hepatic metastasis. Of 405 potentially eligible studies, 59 were included in the review, covering cases from 2000 to 2024, with a peak in 2020 and 2023. The median age of patients was 42 years, with the most common tumor sites being the lower extremities (30.48%), followed by the face, head, and neck (20.95%), and upper extremities (18.1%). Surgical intervention was the most common treatment (60.95%). Recurrence-free survival was observed in 42.86% of cases, while 15.24% experienced recurrence with or without metastasis. Two patients (1.90%) died from the disease. The median recurrence-free survival was 48 months (95% CI: 7.3–88.7). Conclusions: CHE exhibits significant morphological variation and can mimic other vascular tumors. Accurate diagnosis is crucial for proper prognosis and avoiding overtreatment due to misdiagnosis as more aggressive neoplasms. Patients with high-risk CHE should undergo closer surveillance to ensure timely detection of progression.
Introduction This study explored the complex relationship between anxiety, depression, compassion fatigue, and satisfaction among long-term care (LTC) workers following the COVID-19 pandemic. In addition, the study assessed psychometric properties of the Professional Quality of Life (ProQOL) scale, to ensure a reliable and valid instrument for identifying compassion fatigue and satisfaction in the Serbian healthcare system. Methods A cross-sectional study was conducted across LTC facilities in the Republic of Serbia. A ProQOL was administered to physicians, nurses, and aids, to measure compassion fatigue (including burnout and secondary traumatic stress) and compassion satisfaction. The following standardized instruments were also distributed: Secondary Traumatic Stress Scale (STSS), Depression Anxiety and Stress Scale 21 (DASS-21) and 12-Item Short-Form Health 36 Survey (SF-12). Results A total of 300 LTC workers participated, mostly women (86.3%), with an average age of 45.4 ± 10.5 years and a median work experience of 15 years (range: 1 to 42 years). The study reported a significant presence of anxiety and depression symptoms (53.3% and 43.3%, respectively), with LTC workers experiencing moderate levels of compassion fatigue, as indicated by burnout (58.3%) and stress (57.3%) subscales, and moderate or high levels of compassion satisfaction (49.0% and 50.0%, respectively). The study demonstrated that anxiety impacts depression both directly and indirectly (p<0.05). Specifically, burnout and compassion satisfaction mediated the positive effect of anxiety on depression, indicating that increased anxiety led to higher burnout and lower compassion satisfaction, which resulted in greater depression (p<0.05). The three-factor structure of the ProQOL was validated (IFI, TLI, and CFI were above the cut-off of ≥0.95, and the RMSEA was below the suggested value of ≤ 0.06). The Cronbach α of the three subscales was above 0.8, indicating good scale reliability. Conclusion This study contributes to the broader literature on LTC workers wellbeing by examining the complex interplay between professional quality of life, anxiety, and depression. The findings should guide decision-makers in developing targeted interventions and policies that promote the psychological resilience and well-being of LTC workers, thereby enhancing both individual and organizational outcomes in the healthcare sector.
Background: The purpose of this meta-analysis was to examine the prevalence of hypertensive disorders of pregnancy (HDPs), particularly preeclampsia (PE), in peripartum cardiomyopathy (PPCM)-affected pregnancies, and to evaluate whether a HDP significantly alters the prognosis of PPCM, with specific reference to the recovery of left ventricular function (LVEF) and mortality. Methods: A total of 5468 potentially eligible studies were identified, and 104 were included in the meta-analysis. For pooling proportions, the inverse variance methods with logit transformation were used. Complete recovery of LVEF (>50%) and mortality were expressed by odds ratios (ORs), with 95% confidence intervals (CIs). The Peto OR (POR) was used in cases of rare events. Baseline LV function and baseline LV end-diastolic diameter (LVEDD) were summarized by the mean difference (MD) and 95% confidence interval (CI). Results: The summary estimate of the prevalence of HDPs and PE in women with PPCM was 36% and 25%, respectively. Patients with HDPs and, more specifically, PE with PPCM had a higher chance of complete recovery (OR = 1.87; 95%CI = 1.64 to 2.13; p < 0.001 and OR = 1.98; 95%CI 1.69 to 2.32; p < 0.001, respectively), a higher baseline LVEF (MD, 1.42; 95% CI 0.16 to 2.67; p = 0.03 and MD, 1.69; 95% CI 0.21 to 3.18; p = 0.03, respectively), and a smaller baseline LVEDD (MD, −1.31; 95% CI −2.50 to −0.13; p = 0.03 and MD, −2.63; 95% CI −3.75 to −1.51; p < 0.001, respectively). These results, however, did not translate into a significant difference in 12-month mortality (POR = 0.80; 95% CI = 0.57 to 1.13; p = 0.21 and POR = 1.56; 95% CI 0.90 to 2.73; p = 0.12, respectively). Conclusions: The findings of this study may contribute to evidence that can be utilized to aid in the risk stratification of patients with PPCM regarding their long-term prognoses.
Background/Aim. Postoperative cognitive dysfunction (POCD) occurs very often in operated patients. This increasingly frequent complication compromises the recovery of operated patients, impairs the quality of life of patients and their families, prolongs the length of hospital stay, and increases the cost of treatment. The aim of the study was to examine the association between the apolipoprotein E (APOE) ?4 allele and sociodemographic and clinical characteristics with the occurrence of POCD seven days and three months after colon cancer surgery (CCS) under general anesthesia (GA). Methods. A total of 113 patients aged 18 to 87 years who underwent CCS under GA in the period from 2021 to 2023 participated in the study. Preoperative preparation, anesthesia, and postoperative treatment were uniform and standardized for all patients. The assessment of cognitive status was conducted using the Mini Mental State Examination psychometric test on the day before surgery, on the seventh postoperative day, and three months after surgery. Results. Seven days after surgery, a statistically significant impairment of cognitive functions was found in patients with the APOE ?4 allele in their genotype (p = 0.007). Patients 65 years old or above were more likely to have POCD three months after surgery compared to younger patients (80.0% vs. 52.9%; p = 0.003). Conclusion. The presence of the APOE ?4 allele is a potential predictor of the occurrence of POCD seven days after surgery, and age is a significant sociodemographic factor for the occurrence of POCD three months after CCS is performed under GA.
Background Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread ‘copy-paste culture’ among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students’ limited understanding of this act. The purpose of this study was to assess medical students’ attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires. Methods This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students’ attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model’s fit to the data. Results The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach’s alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001). Conclusion Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students’ interest in scientific research and maximize their impact on the full preservation of research ethics and integrity. Supplementary Information The online version contains supplementary material available at 10.1186/s13010-024-00161-z.
Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics “Banjica”, Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach’s alpha > 0.9 for most domains. The values for the fit indices Tucker–Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.
<p><strong>Introduction. </strong>The COVID-19 pandemic has had a significant impact on the mental health of individuals with chronic diseases. Contributing factors include limited access to healthcare during lockdowns, fear of infection, and heightened stress due to poorer outcomes of COVID-19 infection in this population. The aim of this study was to examine the presence of depression, anxiety, and stress in the second year of the COVID-19 pandemic among individuals with pre-ex<br />isting cardiovascular, malignant, chronic respiratory diseases, or diabetes mellitus.<br /><strong>Methods. </strong>A cross-sectional study was conducted among the general population of the eastern region of Republic of Srpska during December 2021 and January 2022. Depression, anxiety, and stress were assessed using the DASS-21 scale, while data on comorbidities were collected through a questionnaire from an epidemiological population-genetic study conducted concurrently. <br /><strong>Results.</strong> A total of 1,372 participants from the eastern region of Republic of Srpska were included in the study, consisting of 40.0% males and 60.0% females. Participants were aged 20 years and older, with an average age of 50.6 years. The study found that depression, anxiety, and stress were statistically significantly more prevalent among participants with pre-existing cardiovascular or chronic respiratory diseases compared to those without such conditions. Additionally, participants with a history of malignant diseases or diabetes mellitus were significantly more depressed and anxious than <br />those without these conditions.<br /><strong>Conclusion. </strong>The findings of this study may contribute to the development of policies aimed at improving mental health and preventing mental disorders in individuals with comorbidities.</p>
Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic’s second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.
Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a “component disorder“ of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.
<p><strong>Introduction. </strong>Frailty is common in elderly persons and carries a high risk of poor health outcomes, including increased mortality, institutionalization, falls, and hospitalization. The aim of the work was to determine the risk factors for frailty in elderly persons.</p> <p><strong>Methods. </strong>The research was conducted in Bijeljina and Foča, in the period from February to June 2022, and was approved by the Ethics Committee of the Faculty of Medicine in Foča. A total of 243 respondents over the age of 65 took part in the research. When it comes to the instruments, the sociodemographic questionnaire, the EQ-5D-5L health questionnaire, the general sarcopenia rapid screening questionnaire SARC-F and the Kessler scale for the assessment of psychological distress were used.</p> <p><strong>Results.</strong> There were 43.6% of males and 56.4% of females participating in the research. One quarter (25%) of respondents evaluated their health as weak. Sarcopenia was identified in 28% of respondents, while 18.1% had a moderate and 11.9% a serious disorder in the field of psychological distress.</p> <p><strong>Conclusion. </strong>The presence of psychological distress and sarcopenia in a high percentage, as well as weak health status in the people over 65, is evident, which represents potential risk factors for frailty.</p>
ABSTRACT Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska, Bosnia and Hercegovina. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians’ training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.
Healthcare workers (HCW) in primary healthcare centres in the Republic of Srpska, Bosnia and Herzegovina, are on the first combat line with COVID-19. This study aimed to assess the seroprevalence of SARS-CoV-2 among HCW at the primary healthcare centres and to analyse the risk exposure to COVID-19, clinical signs and vaccination status. A cross-sectional study was conducted among HCW at the selected primary healthcare centres between 19 March and 30 April 2021. Antibodies against the SARS-CoV-2 virus were detected by enzyme-linked immunosorbent assay (ELISA). A total of 1,023 HCW (mean age 45 years; 71% female) were included in the study. The anti-SARS-CoV-2 antibodies were detected in 69.5% of all participants. There was a significant difference in seropositivity among primary healthcare centres from different geographical regions. As many as 432 (42%) of all participants had confirmed COVID-19 symptoms before the study and, 84.8% of them were seropositive. This study showed that 702 primary HCW were vaccinated with any of these vaccines: Sputnik V, Sinopharm, Pfizer/Biontech. High titre of SARS-CoV-2 antibodies was found amongst those who received one (92.6%) or both (97.2%) doses of vaccines. In this study, we report high prevalence of SARS-CoV-2 antibody among HCW in primary healthcare in the Republic of Srpska, Bosnia and Herzegovina during the third pandemic wave.
The aim of the study was to assess the seroprevalence of SARS-CoV-2 in the Republic of Srpska, Bosnia and Herzegovina, and to analyse the knowledge, attitudes and practices of the population toward COVID-19. This population-based study was conducted in a group of 1,855 randomly selected individuals from all municipalities from 1 December 2020 to 15 January 2021. All individuals were asked to sign a consent form and to fill in a questionnaire, following which a blood samples were collected. Total anti-SARS-CoV-2 antibodies were determined in serum specimens using the total Ab ELISA assay. The overall seroprevalence rate was 40.3%. Subjects aged <65 years were 2.06 times more likely to be seropositive than those aged ≥65, and 30% of seropositive individuals presented no COVID-19 symptoms. The household members of seropositive individuals were 2.24 times more likely to develop COVID-19 symptoms than the household members of seronegative individuals. More than 95% of respondents believe that preventive measures are very important to control the infection transmission. Majority of respondents wear the masks properly, maintain the required physical distance whenever possible and wash hands with soap. Nearly 50% of individuals were of the opinion that the vaccine could prevent the infection. This study showed that an overall SARS-CoV-2 seropositivity rate by the middle of January 2021 was very high. Attitudes and practices regarding the COVID-19 indicate that additional efforts should be taken in order to improve the health education with a focus on preventive measures and vaccination.
Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.
Introduction The aim of the study was to assess the prevalence of burnout syndrome among nursery teachers in Belgrade's preschool institutions, and to assess the role of personality traits in its development. Materials and methods A cross-sectional study was conducted in all Belgrade’s preschool institutions. A stratified cluster sampling method was used to obtain a representative sample. Burnout was measured using the Maslach Burnout Inventory- General Survey (MBI-GS). The MBI-GS adaptation was based on an internationally accepted methodology for translation and cultural adaptation. Psychometric properties of the Serbian version of the MBI-GS were analyzed through the examination of factorial structure and internal consistency. A shortened version of Big Five Plus Two questionnaire was used to measure Personality traits. Results Three hundred two health care professionals were enrolled. The mean age was 38±9.2 years and all were female. Confirmatory factor analysis validated the three-factor structure of the questionnaire (exhaustion, cynicism and professional efficacy). Overall, 251 (83.1%) respondents were found to have moderate burnout. In multiple regression analysis, positive valence and conscientiousness were significantly associated with professional efficacy. Aggressiveness, neuroticism, openness, and age, were significantly associated with exhaustion. Aggressiveness, neuroticism and additional jobs showed association with cynicism. Conclusion Present study provided the evidence for the appropriate metric properties of the Serbian version of MBI-GS. Most nurses demonstrated moderate burnout level. Personality traits are characteristics that affect presence of burnout syndrome in healthcare professionals working in preschool institutions.
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