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Background: The failure of mucus clearance in bronchiectasis can be improved by chest physiotherapy or/and mucoactive agents., Aim: To assess the effects of long-term use of carbocysteine on frequency and duration of exacerbations in patients with bronchiectasis., Methods: We performed an observational, non-randomized, open study (a real-life study) including 64 patients with bronchiectasis divided into two groups, examined group (EG) and control group (CG). All participants were treated with appropriate treatment for the stable disease, but in the study, subjects of EG two capsules 375 mg carbocysteine three times a day was added over three months. Daily diary cards realised collection of data regarding the occurrence and duration of exacerbation in all study subjects., Results: Over the study period 43 exacerbations were documented, 17 in the EG and 26 in the CG, 10 (23.4%) of which required hospital treatment (four in the EG [23.5%] and six in the CG [23.1%]). A mean number of exacerbations over the study period was significantly lower in the EG (0.5 ± 0.1) as compared to their mean number in the CG (0.8 ± 0.2) (P = 0.0000). Mean duration of exacerbations expressed in days needed for complete resolution of symptoms or return of the symptoms to their baseline severity in the EG was significantly shorter than the mean duration of exacerbations in the CG (10.1 ± 2.6 vs 12.8 ± 2.1; P = 0.0000). The frequency of adverse effects, i.e. mild gastrointestinal manifestations and headache which did not require discontinuation of the treatment, in the EG during the study period was 15.6%., Conclusion: Our findings indicated positive effects of carbocysteine regarding the frequency and duration of exacerbations, as well as its good tolerability in the patients with bronchiectasis., (Copyright: © 2019 Jordan Minov, Sasho Stoleski, Tatjana Petrova, Kristin Vasilevska, Dragan Mijakoski, Jovanka Karadzinska-Bislimovska.)

Aim: To evaluate the prevalence of chronic respiratory symptoms, lung function impairment, and chronic obstructive respiratory diseases in dairy farmers. Our objective is to then examine their relation to exposure duration and to explore the usefulness of job exposure matrices as tools for exposure assessment, and predictors for respiratory health impairment., Methods: A cross-sectional study was performed, including 83 dairy farmers (mean age: 52.6 ± 8.7 years; mean exposure duration: 23.7 ± 7.6 years) and 80 office workers as a control group (mean age: 52.7 ± 8.2 years) matched for age, smoking habits, and socioeconomic status. Methods of evaluating examined subjects included a questionnaire on respiratory symptoms in the last 12 months, spirometry and histamine challenge, as well as the use of job exposure matrices (JEM)., Results: Dairy farmers had a significantly higher prevalence of cough (38.5), phlegm (27.7%), and wheezing (21.7%), than controls (p < 0.05). All mean baseline spirometric parameters were lower in dairy farmers compared to the controls, but statistical significance was confirmed only for MEF25, MEF50, and MEF75% (p = 0.010, p = 0.001, and p = 0.004, respectively). The prevalence of bronchial hyperresponsiveness, asthma, and chronic obstructive pulmonary disease was higher in dairy farmers but without statistical significance. JEM were useful tools for exposure assessment and predictors of factors for asthma and COPD development., Conclusion: The results suggest that occupational exposure among crop farmers is associated with a higher prevalence of respiratory symptoms, lung function impairment, and a higher prevalence of chronic respiratory diseases. JEM showed good potential for farming exposure evaluation and promoted their applicability within the diagnostic algorithm focused on respiratory health assessment., (Copyright: © 2019 Saso Stoleski, Jordan Minov, Jovanka Karadzinska-Bislimovska, Dragan Mijakoski, Aneta Atanasovska, Dragana Bislimovska.)

Background: Bacterial infections are involved in more than a half of the exacerbations of chronic obstructive pulmonary disease (COPD)., Aim: To evaluate the efficacy and safety of moxifloxacin in the outpatient treatment of moderate exacerbations of bacterial origin in the COPD patients., Methods: We performed a prospective, observational study including 64 COPD patients with moderate exacerbation of bacterial origin empirically treated with moxifloxacin. In 31 of them, moxifloxacin was used as an initial antibiotic (Group 1), whereas in 33 of them moxifloxacin was used after treatment failure with another antibiotic (Group 2). All patients have treated 7 days with moxifloxacin 400 mg once daily per os, and they were followed up for 20 days, with an intermediate visit at 3, 5 and 7 days at which the duration of symptoms and the side effects of the drug were evaluated., Results: We registered high clinical success rate, i.e. the complete resolution of the symptoms or their return to the baseline severity, similar in both groups (84.3% in all study subjects, 83.9% in the Group 1 and 84.8% in the Group 2). The mean time to complete resolution of the cardinal symptoms or their return to the baseline severity was 5.2 ± 1.1 days. Also, the mean time to complete resolution of the certain cardinal symptoms (increased dyspnea, increased sputum volume and increased sputum purulence) or their return to the baseline severity is given 4.9, 4.7 and 4.2 days, respectively. The incidence of adverse effects during the treatment with moxifloxacin in all study subjects was 10.9%, 9.6% in Group 1 and 12.1% in Group 2. There was no serious adverse effect that required discontinuation of the treatment. Relapse during a 20 days follow-up period was registered in 7.4% of the all study subjects with complete resolution of the cardinal symptoms or their return to the baseline severity, i.e. in two patients from both Group 1 and Group 2 (7.6% and 7.1%, respectively). 4., Conclusion: Our findings suggest high efficacy and good tolerability of moxifloxacin in the treatment of moderate COPD exacerbations of bacterial origin.

Aim: The purpose of the paper was to assess job demands, burnout, and teamwork in healthcare professionals (HPs) working in a general hospital that was analysed at two points in time with a time lag of three years., Methods: Time 1 respondents (N = 325) were HPs who participated during the first wave of data collection (2011). Time 2 respondents (N = 197) were HPs from the same hospital who responded at Time 2 (2014). Job demands, burnout, and teamwork were measured with Hospital Experience Scale, Maslach Burnout Inventory, and Hospital Survey on Patient Safety Culture, respectively., Results: Significantly higher scores of emotional exhaustion (21.03 vs. 15.37, t = 5.1, p < 0.001), depersonalization (4.48 vs. 2.75, t = 3.8, p < 0.001), as well as organizational (2.51 vs. 2.34, t = 2.38, p = 0.017), emotional (2.46 vs. 2.25, t = 3.68, p < 0.001), and cognitive (2.82 vs. 2.64, t = 2.68, p = 0.008) job demands were found at Time 2. Teamwork levels were similar at both points in time (Time 1 = 3.84 vs. Time 2 = 3.84, t = 0.043, p = 0.97)., Conclusion: Actual longitudinal study revealed significantly higher mean values of emotional exhaustion and depersonalization in 2014 that could be explained by significantly increased job demands between analysed points in time.

Objective: To assess the mean serum eosinophil cationic protein (s-ECP) concentrations among crop and dairy farmers and office controls, and further examine its relation to exposure duration, smoking habit, as well as presence or absence of asthma., Methods: A cross-sectional survey was performed including examined group (EG), composed by agricultural workers (87 crop - EG1 and 83 dairy farmers - EG2), and control group (CG) composed by 80 office workers within the same enterprise. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed and smoking history. Evaluation of examined subjects also included lung function tests, diagnosis of asthma, and measurement of s-ECP as a marker of inflammation., Results: The main finding of the present study is that s-ECP concentrations were raised in subjects with asthma independent of the smoking habit. The mean s-ECP concentrations were higher in subjects of EG1 and EG2 compared with those in CG, but without reaching statistical significance. Mean s-ECP concentrations were significantly higher among subjects in EG1 exposed more than 20 years, while mean s-ECP concentrations were non-significantly higher in subjects of EG2 exposed more than 20 years, compared to those exposed less than 20 years. Mean s-ECP concentrations were higher among smokers within all three groups, but without reaching statistical significance between smokers and non-smokers. Mean s-ECP concentrations were significantly higher in subjects with asthma within EG1 (P = 0.049) and EG2 (P = 0.040), but also within those in CG (P = 0.046)., Conclusion: Data obtained suggest that airway inflammation is present in farmers with asthma, and s-ECP is an important biomarker in means of reflecting disease severity and prognosis among exposed workers.

Background: 1,3/1,6-β-glucans are recognised as immunomodulators in human and veterinary medicine for over 50 years., Aim: To assess the effects of pleuran (1,3/1,6-β-glucan from Pleurotus ostreatus ) on incidence and duration of bacterial exacerbations in patients with COPD., Methods: We performed an observational, non-randomized, open-label study including 32 COPD patients (Group D) in whom besides the recommended chronic treatment for the stable disease were administered supplement combination containing pleuran 100 mg, vitamin C 60 mg and zinc 5 mg once daily over a three month-period (Group 1). Also, an equal number of Group D COPD patients who besides the recommended treatment for stable disease received the supplement combination containing vitamin C 60 mg and zinc 5 mg once daily, matched to the study subjects of the Group 1 by sex and age served as control (Group 2)., Results: Over the study period 57 exacerbations (24 in the Group 1 and 33 in the Group 2) were documented. A mean number of exacerbations over the study period was significantly lower in the Group1 (0.7 ± 0.4) as compared to their mean number in the Group 2 (1.0 ± 0.6) (P = 0.0218). Furthermore, a mean duration of exacerbations expressed in days needed for cure or clinical improvement (i.e. complete resolution of symptoms or return of the symptoms to their baseline severity) in the Group 1 (6.7 ± 0.8 days) was significantly shorter than the mean duration of exacerbations in the Group 2 (7.4 ± 1.3 days) (P = 0.0118). There was not reported any adverse effect during the study period by study subjects from both examined groups., Conclusion: Our findings indicated that pleuran might impact the incidence and duration of bacterial exacerbations in patients with COPD. There is a need for further studies for more precise determination of the influence of pleuran on the course of COPD.

Aim: To assess the mean serum C-reactive protein concentrations among farmers and office controls, and further examined its relation to exposure duration, smoking habit, as well as presence or absence of COPD., Methods: A cross-sectional survey was performed including examined group (EG), composed of agricultural workers (87 crop - EG1 and 83 dairy farmers - EG2), and control group (CG) composed by 80 office workers. Evaluation of subjects included a questionnaire on chronic respiratory symptoms, lung function tests, COPD diagnostics, and measurement of CRP serum concentrations., Results: Serum CRP concentrations were raised in stable COPD patients independent of smoking habit or exposure duration. The mean CRP serum concentrations were higher in the subjects of EG1 and EG2 compared with those in CG, but without statistical significance. This count for mean CRP serum concentrations in subjects of EG1 and EG2 exposed more than 20 years and for those in smokers in all three groups as well. The mean CRP serum concentrations were significantly higher in subjects with COPD within EG1 (P=0.049) and EG2 (P=0.040), while those in CG were not., Conclusion: Data obtained suggest that systemic inflammation is present in farmers with COPD and CRP is an important biomarker in COPD in means of reflecting disease severity and prognosis of exposed farmers.

Aim: The purpose of the actual study was to evaluate the relationship between the formation of anti-inflammatory cytokine IL10 and several indicators of moderate and severe preeclampsia in the third trimester of pregnancy., Material and Methods: Examination of the indicators of preeclampsia and maternal IL10 levels was conducted in 50 women with pregnancies complicated by varying degrees of preeclampsia in the third trimester of gestation as well as in 50 normotensive patients, hospitalized at the University Clinic of Gynecology and Obstetrics, Skopje, Republic of Macedonia. The levels of IL10 were determined with a commercial test developed by Orgenium Laboratories (Finland), using reagents from AviBion ELISA research kits. Patients with preeclampsia were categorized into moderate and severe preeclampsia group according to the degree of preeclampsia. Logistic regression analysis was used to determine the predictive value of different parameters for the occurrence of severe preeclampsia. Odds ratios and 95% Confidence Intervals were calculated in order to quantify independent associations., Results: The regression analysis detected systolic blood pressure (160 mmHg or higher), diastolic blood pressure (100 mmHg or higher), persistent proteinuria in pregnancy, serum LDH concentration (450 U/L or higher) and reduced serum concentrations of IL10 as significant predictors of severe preeclampsia in pregnant women after adjusting for age., Conclusion: The findings of significantly lower serum IL10 concentrations in patients with severe preeclampsia in comparison with respective concentrations in patients with moderate preeclampsia can be considered as major pathognomonic laboratory sign of severe preeclampsia.

Background: Teaching is considered a highly stressful occupation, with work-related stress levels among teachers being among the highest compared to other professions. Unfortunately there are very few studies regarding the levels of work-related stress among teachers in the Republic of Macedonia., Aim: To identify the level of self-perceived work-related stress among teachers in elementary schools and its relationship to gender, age, position in the workplace, the level of education and working experience., Material and Methods: We performed a descriptive-analytical model of a cross-sectional study that involved 300 teachers employed in nine elementary schools. Evaluation of examined subjects included completion of a specially designed questionnaire., Results: We found that the majority of interviewed teachers perceive their work-related stress as moderate. The level of work-related stress was significantly high related to the gender, age, position in workplace, as well as working experience (p < 0.01), while it was significant related to level of education (p < 0.05). Significantly greater number of lower-grade teachers perceives the workplace as extremely stressful as compared to the upper-grade teachers (18.5% vs. 5.45%), while the same is true for female respondents as compared to the male ones (15.38% vs. 3.8%). In addition, our results show that teachers with university education significantly more often associate their workplace with stronger stress than their colleagues with high education (13.48% vs. 9.4%). We also found that there is no significant difference of stress levels between new and more experienced teachers., Conclusion: Our findings confirm that the majority of interviewed teachers perceived their work-related stress as high or very high. In terms of the relationship between the level of teachers' stress and certain demographic and job characteristics, according to our results, the level of work-related stress has shown significantly high relation to gender, age, levels of grades taught as well as working experience, and significant relation to the level of education.

Background: Burnout results from a prolonged response to chronic emotional and interpersonal workplace stressors. The focus of research has been widened to job engagement., Aim: Purpose of the study was to examine associations between burnout, job engagement, work demands, and organisational culture (OC) and to demonstrate differences between physicians and nurses working in general hospital in Skopje, Republic of Macedonia., Material and Methods: Maslach Burnout Inventory and Utrecht Work Engagement Scale were used for assessment of burnout and job engagement. Work demands and OC were measured with Hospital Experience Scale and Competing Values Framework, respectively., Results: Higher scores of dedication, hierarchy OC, and organizational work demands were found in physicians. Nurses demonstrated higher scores of clan OC. Burnout negatively correlated with clan and market OC in physicians and nurses. Job engagement positively correlated with clan and market OC in nurses. Different work demands were related to different dimensions of burnout and/or job engagement. Our findings support job demands-resources (JD-R) model (Demerouti and Bakker)., Conclusions: Data obtained can be used in implementation of specific organizational interventions in the hospital setting. Providing adequate JD-R interaction can lead to prevention of burnout in health professionals (HPs) and contribute positively to better job engagement in HPs and higher quality of patient care.

Background: Few studies have examined teamwork as mediator and moderator of work demands-burnout and job engagement-job satisfaction relationships in healthcare workers (HCWs) in South-East Europe., Aim: To assess mediation and moderation effect of teamwork on the relationship between independent (work demands or job engagement) and dependent (burnout or job satisfaction) variables., Methods: Work demands, burnout, job engagement, and job satisfaction were measured with Hospital Experience Scale, Maslach Burnout Inventory, Utrecht Work Engagement Scale, and Job Satisfaction Survey, respectively. Hospital Survey on Patient Safety Culture was used for assessment of teamwork. In order to examine role of teamwork as a mediating variable we fit series of regression models for burnout and job satisfaction. We also fit regression models predicting outcome (burnout or job satisfaction) from predictor (work demands or job engagement) and moderator (teamwork) variable., Results: Teamwork was partial mediator of work demands-burnout relationship and full mediator of job engagement-job satisfaction relationship. We found that only job engagement-job satisfaction relationship was moderated by teamwork., Conclusions: Occupational health services should target detection of burnout in HCWs and implementation of organizational interventions in hospitals, taking into account findings that teamwork predicted reduced burnout and higher job satisfaction.

Background: Burnout syndrome develops in health professionals (HPs) as a result of exposure to chronic emotional and interpersonal workplace stressors. Research demonstrates the links between burnout, work demands, and job satisfaction in hospital HPs., Aims: To examine the associations between burnout, work demands and job satisfaction, and to demonstrate the mediation effect of emotional exhaustion on the relationship between work demands and job satisfaction in surgery clinic HPs., Methods: Maslach Burnout Inventory was used for assessment of burnout. Work demands and job satisfaction were measured with Hospital Experience Scale and Job Satisfaction Survey, respectively. In order to examine the role of emotional exhaustion, depersonalization, and work demands, controlling for age, hospital tenure, and unit tenure, a hierarchical multiple regression models were tested for each job satisfaction factor., Results: Job satisfaction was negatively predicted by emotional exhaustion. Certain types of work demands negatively predicted different factors of job satisfaction. Emotional exhaustion was a significant partial mediator of the relationship between work demands and job satisfaction., Conclusions: Adequate management of work demands, particularly excessive workload, time pressure, and lack of staff can lead to prevention of burnout and reduced job satisfaction in surgery clinic HPs, and contribute to better quality of patient care.

Introduction: Job exposure in agricultural workers often leads to respiratory impairment., Aim: To assess the influence of exposure duration and smoking on chronic respiratory symptoms and ventilatory capacity in agricultural workers., Methods: A cross-sectional study covered 75 agricultural workers, compared with an equal number of office workers matched by age, exposure duration and smoking status. Standardized questionnaire was used to obtain data on chronic respiratory symptoms, job and smoking history. Lung functional testing was performed by spirometry., Results: The prevalence of respiratory symptoms was higher in agricultural workers, with significant difference for cough (P = 0.034), and dyspnea (P = 0.028). Chronic respiratory symptoms among agricultural workers were significantly associated with duration of exposure (P < 0.05) and daily smoking (P < 0.01), as well as with daily smoking in controls (P < 0.01). The average values of spirometric parameters in exposed workers were significantly different for MEF50 (P = 0.002), MEF75 (P = 0.000), and MEF25-75 (P = 0.049). Obstructive changes in small airways in exposed workers were strongly related to exposure duration (P < 0.05) and smoking (P < 0.01). Agricultural workers with job exposure more than 15 years had more expressed adverse respiratory symptoms and lung function decline., Conclusion: The results confirmed the influence of agricultural exposure and daily smoking on chronic respiratory symptoms and airflow limitation, primarily targeting the small airways.