The mediating role of depressive, anxiety, and physical symptoms on work ability index in employed women with breast cancer: a prospective study from Croatia.

AIM: To explore the relationship between the current work ability index (WAI) and depressive and anxiety symptoms in breast cancer (BC) patients and the role of depressive, anxiety, and physical symptoms in mediating this relationship. METHODS: This prospective study enrolled 83 employed women with BC. At baseline assessment (in the first three months following BC diagnosis) and follow-up assessment (one year after baseline), participants completed the WAI, Beck Depression Inventory-II, State-Trait Anxiety Inventory, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire with a breast cancer-specific module. Mediation analyses were conducted to explore the mechanism by which depressive, anxiety, and physical symptoms influenced the relationship between WAI and depressive and anxiety symptoms. RESULTS: WAI was negatively associated with depressive and anxiety symptoms. The effect of baseline depressive and trait anxiety symptoms on WAI at follow-up was mediated by both depressive and trait anxiety symptoms, as well as by physical symptoms at follow-up. The effect of baseline state anxiety symptoms on WAI at follow-up was mediated only by state anxiety symptoms at follow-up. CONCLUSIONS: Baseline depressive and anxiety symptoms affect WAI at follow-up not only through persisting depressive and anxiety symptoms observed at follow-up but also through physical symptoms at follow-up. This indicates that efforts aimed at improving psychological health may result in simultaneous improvements in both psychological and physical health, as well as the resulting WAI.

Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study.

The COVID-19 pandemic led to the implementation of interventions to provide emotional and psychological support to healthcare workers in many countries. This ecological study aims to describe the strategies implemented in different countries to support healthcare professionals during the outbreak. Data were collected through an online survey about the measures to address the impact of the pandemic on the mental health of healthcare workers. Healthcare professionals, researchers, and academics were invited to respond to the survey. Fifty-six professionals from 35 countries contributed data to this study. Ten countries (28.6%) reported that they did not launch any national interventions. Both developed and developing countries launched similar initiatives. There was no relationship between the existence of any type of initiative in a country with the incidence, lethality, and mortality rates of the country due to COVID-19, and per capita income in 2020. The 24 h hotline for psychological support was the most frequent intervention. Tools for self-rescue by using apps or websites were extensively used, too. Other common interventions were the development of action protocols, availability of regular and updated information, implantation of distance learning systems, early detection of infection programs for professionals, economic reinforcements, hiring of staff reinforcement, and modification of leave and vacation dates.

Malaria among Croatian seafarers between 2004 and 2014: evaluation of chemoprophylaxis use and occupational disease reporting.

In Croatia, malaria was eradicated in 1964 and has since been imported, ten cases a year in average, mostly by Croatian migrant workers, seafarers in particular. About 80 % of registered cases were infected in Africa and the main reason for infection was negligence in the use of chemoprophylaxis. The aim of the study was to establish the incidence of malaria among Croatian seafarers from 2004 to 2014, how many of them took chemoprophylaxis properly, and whether malaria was acknowledged as occupational disease. To get our answers we analysed epidemiological surveys of the Croatian Institute of Public Health completed by patients and reviewed epidemiological bulletins and the national Register of Occupational Diseases. Over the investigated period, a total of 102 people fell ill with malaria, of whom 25 were seafarers. Seventeen did not take chemoprophylaxis at all and eight took them without following instructions. In addition, none of them had malaria recognised as occupational disease under Croatian law, nor is there any information that they exercised their rights in any other way. All this clearly points out that seafarers and their employers need to be informed much better about the benefits of preventive measures and their labour rights.

Phenolic Profiles of Leaves, Grapes and Wine of Grapevine Variety Vranac (Vitis vinifera L.) from Montenegro.

Vranac, an old autochthonous red grapevine variety of Montenegro, was first mentioned in a historical document published in the 15th century. As currently the study of indigenous varieties is of particular importance, the subject of this work was detailed characterization of phenolic compounds in the autochthonous grapevine variety Vranac, from the Montenegrin Podgorica subregion. Phenolic profiles of leaves, berries (skin, seeds, and pulp were examined separately) and young monovarietal wine were determined using ultra-high performance liquid chromatography (UHPLC) with linear trap quadrupole (LTQ)-Orbitrap XL mass spectrometry (MS). Total phenolic content (TPC) and radical scavenging activity (RSA) were higher for the grape seeds extracts, followed by extracts of grape skins and pulps. As expected, the total anthocyanin content (TAC) was higher in grape skin than in wine. A total of one hundred twenty nine compounds (forty two phenolic acids and their derivatives, twenty three flavan-3-ols, twenty one flavanols, five stilbenes and thirty eight anthocyanins) were identified in the investigated extracts. To our best knowledge, this is the first report of tentative identification of (epi)catechin 3-O-coumarate in grape seed and chalcan-flavan 3-ol dimers in wine and grape seed.

The challenge of return to work in workers with cancer: employer priorities despite variation in social policies related to work and health.

PURPOSE: This study explored employer's perspectives on (1) their experience of good practice related to workers diagnosed with cancer and their return to work (RTW), and (2) their perceived needs necessary to achieve good practice as reported by employers from nine separate countries. METHODS: Twenty-five semi-structured interviews were held in eight European countries and Israel with two to three employers typically including HR managers or line managers from both profit and non-profit organisations of different sizes and sectors. Interviews were recorded and transcribed verbatim. A grounded theory/thematic analysis approach was completed. RESULTS: Employers' experience with RTW assistance for workers with cancer appears to be a dynamic process. Results indicate that good practice includes six phases: (1) reacting to disclosure, (2) collecting information, (3) decision-making related to initial actions, (4) remaining in touch, (5) decision-making on RTW, and (6) follow-up. The exact details of the process are shaped by country, employer type, and worker characteristics; however, there was consistency related to the need for (1) structured procedures, (2) collaboration, (3) communication skills training, (4) information on cancer, and (5) financial resources for realizing RTW support measures. CONCLUSIONS: Notwithstanding variations at country, employer, and worker levels, the employers from all nine countries reported that good practice regarding RTW assistance in workers with a history of cancer consists of the six phases above. Employers indicate that they would benefit from shared collaboration and resources that support good practice for this human resource matter. IMPLICATIONS FOR CANCER SURVIVORS: Further research and development based on the six phases of employer support as a framework for a tool or strategy to support workers with a history of cancer across countries and organisations is warranted.

Measures to Improve Integration of Healthcare in Federation of Bosnia and Herzegovina.

INTRODUCTION: In its annual report for 2008, the World Health Organization (WHO) states fragmentation is one of the five most common shortcomings experienced by health systems in health care provision, while an integrated healthcare model can significantly improve efficacy/efficiency, reduce visits to doctors, improve patient satisfaction, and ensure safe and quality healthcare. AIM: The aim of our study is to point out importance of the cooperation between healthcare professionals from different sectors, institutions and levels of care involved in patient treatment and care and to propose measures for integration including criteria for clinical review and audit. METHODS: In this paper, feedback and results from three workshops held in Tuzla on October 16th, 2007, Bihac on December 9th, 2013, and Sarajevo on November 24th, 2018, were analyzed. All three workshops used the same methodology: first they have had a lecture on the topic of "Interface theory and protection blocks in the health system" and the second part took the form of six working groups in accordance with participants' affinities and places of employment. RESULTS: The measures proposed to improve the interface are included: Development and adoption existing of clinical practice guidelines and pathways; Maintain joint working group meetings; Eliminate conflicts between PHC and hospital care and seek consensus through formal cooperation. Criteria for clinical audit of the PHC-hospital interface are: annual analysis of unnecessary or inadequate referrals as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities related to screening programs and patient path analysis. DISCUSSION: Standardized communication protocols should be used to improve communication between health professionals at different levels and to moderate integration processes and protect data. CONCLUSION: Regular communication between healthcare professionals across the various institutions and levels of health care is a prerequisite for organizational, functional, service and clinical integration.

Case report of Mikulicz's disease: A modern concept of an old entity.

Introduction: Modern knowlegde defines Mikulicz´s disease as a part of immunoglobulin G4-related disease. The main feature is the presence of lymphoplasmacytic infiltrates, immunoglobulin G4 plasma cells positivity, distinctive storiform fibrosis and moderate eosinophilia. Case Report: A 59-years old male presented with a mild keratoconjuctivitis sicca and enlarged lacrimal and salivary glands during the last two years. Althought clinical presentation of the patient was typical, earlier testing did not pinpoint Mikulicz ´s disease. By typical clinical presentation, elevated serum immunoglobulin G4 level and histopathological finding of lacrimal glands tissue we diagnosed Mikulicz´s disease successfully treated with corticosteroid therapy. Conclusion: We reported the first case of IgG4-related Mikulicz´s disease in Serbia. Our report highlights IgG4-related Mikulicz` s disease as an important differential diagnosis with Sjögren`s syndrome and lymphoproliferative disease in rheumatological practice.

Subjective and perceptual analysis of voice quality and relationship with neurological disfunction in multiple sclerosis patients.

OBJECTIVE: The aim of the present study was to evaluate subjective voice changes by voice handicap index (VHI) and voice related quality of life questionnaire (VRQL) and perceptual voice changes by Grade Roughness Breathiness Asthenia Strain (GRBAS) scale and to compare these findings with expanded disability status scale (EDSS) in multiple sclerosis (MS) patients. METHODS: The patient group was composed of 36 MS patients, (mean age 45.2 ± 12.9, 13 male and 23 female) and compared with 32 healthy sex and age match individuals without neurological and voice symptoms. RESULTS: The mean VHI was significantly higher in patients group (15.64 to 5.43; p=0.043). Forty-four percent of MS patients (52% of female patients) report voice problems. According to the GRBAS scale, differences between two groups were significant for Grade, Roughness, Breathiness and Strain items. The mean EDSS was 2.69 ± 1.1, for a male patients 2.54 ± 1.1 and for female 2.78 ± 1.3. There was no correlation between the EDSS and the total VHI score, between the EDSS and each of the three item of VHI, between the EDSS and VRQL, nor between the EDSS and components of GRBAS scale except for EDSS and asthenia item, (r=-0.5213, p=0.011). CONCLUSIONS: Significant number of MS patients experienced voice problems. We did not establish any significant correlation between the intensity of the voice disorders and EDSS, except between EDSS and asthenia item of the GRBAS scale. The patients with low EDSS may have serious voice problems and vice versa.

Gambling severity, impulsivity, and psychopathology: comparison of treatment- and community-recruited pathological gamblers.

BACKGROUND AND OBJECTIVES: Because most studies of pathological gambling gather data from participants recruited from treatment, this study compared community and treatment-enrolled pathological gamblers (PGs) with respect to demographics, gambling severity, impulsivity, and psychopathology. METHODS: One hundred six PGs were recruited as part of two larger studies in Farmington, Connecticut (n= 61) and Windsor, Ontario (n= 45) using radio advertising, word of mouth, and/or newspaper ads, as well as a gambling treatment program at each location. RESULTS: Community (n= 49) and treatment-enrolled (n= 57) PGs did not differ on age, education, gender, race, employment, or marital status. Treatment-enrolled PGs were more likely to report past year illegal behaviors, preoccupation with gambling, and higher scores on the Barratt Impulsiveness Scale (BIS) Attention Impulsivity subscale. Assessment of psychopathology in the Ontario study indicated that treatment-enrolled PGs were more likely to present with Major Depressive and Dysthymic Disorders. Community-recruited PGs in the Connecticut study were overall more likely to present with any substance use disorder relative to their treatment-enrolled counterparts. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our findings inform intervention and research within the field of pathological gambling. Specifically, the distressing aspects of pathological gambling, such as legal issues, preoccupation with gambling, and depression, may be present more in treatment-enrolled PGs than in those recruited from the community. Such emotional disturbances should be further explored to increase motivation and treatment adherence in PGs. In addition, due to relative absence of overall differences between the groups, research findings utilizing treatment-enrolled PGs may be a good representation of both groups.

[The long-term remission of rheumatoid arthritis with a single cycle of rituximab].

INTRODUCTION: Rituximab selectively targets CD20+ B cells and presumably protects joints in rheumatoid arthritis. Complete remissions after a single treatment with rituximab, in some cases for longer than 1 year, are observed in only the minority of patients. We reported a patient suffering from refractory rheumatoid arthritis who responded to rituximab with sustained remission. CASE REPORT: A 78-year-old woman was diagnosed with seropositive rheumatoid arthritis in 2001. The disease remained active despite conventional disease modifying drugs. In February 2007 the disease was highly active. Two infusions of rituximab 1 000 mg on days 1 and 15 were performed. Concomitant treatment consisted of metotrexate 10 mg/week and prednisolone 5 mg/day. The patients were assessed every month after receiving rituximab. Remission was achieved three months later. The patient was retreated with a second cycle of rituximab in December 2009 due to arthritic flare. CONCLUSION: This case report showed that the rituximab treatment was feasible and led to a clinically relevant and long lasting improvement in disease activity.

Work ability as a major determinant of clinical nurses' quality of life.

AIMS AND OBJECTIVES: To examine quality of life determinants among clinical nurses in Croatia with an emphasis on their work ability. BACKGROUND: An important personnel management challenge is to explore factors that stimulate or hinder the development of individual work ability and quality of life throughout a career. DESIGN: A cross-sectional study. METHODS: The study was performed during 2007-2008 in six randomly selected hospitals in Croatia. The self-administered questionnaires included the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health, the Quality of Life questionnaire (WHOQL-BREF) developed by the World Health Organization and additional socio-demographic questions. A total number of 1212 nurses completed the questionnaires, giving a response rate of 67(.) 3%. Binary logistic regression was performed to assess how socio-demographic characteristics and work ability groups predict each of the WHOQL-BREF domains. RESULTS: Having a satisfactory WAI score (WAI ≥ 37) was significantly the most important predictor for all quality of life domains, with the odds ratios (OR) being as follows: OR = 6(.) 8 (95% CI: 4(.) 8-9(.) 6) for the physical domain, OR = 2(.) 3 (95% CI: 1(.) 7-3(.) 1) for the psychological domain, OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 4) for the social relationship domain and OR = 1(.) 7 (95% CI: 1(.) 3-2(.) 3) for the environmental domain. CONCLUSIONS: Satisfactory work ability was a major quality of life determinant in all WHOQL-BREF domains with the highest odds ratio for the physical domain. Maintaining clinical nurses' work ability is an important issue, because it is foundational for the quality of life of the workforce. RELEVANCE TO CLINICAL PRACTICE: Our study provides quantified estimates of the extent to which a satisfactory WAI score predicts a better score in physical, psychosocial, social relationships and environmental domain of nurses' quality of life. Therefore, maintaining or improving nurses' work ability remains the essential aim of hospital managers.

Work-related stress and work ability among Croatian university hospital midwives.

OBJECTIVE: to explore the sources and levels of stress at work and work ability among Croatian midwives. BACKGROUND: midwives are subjected to multiple stressors. Among health-care professionals, psychological distress for a prolonged period of time has negative effects on the worker's health, work ability and quality of patient care. 'Work ability' is a term describing a worker's resources related to physical, mental and social demands at work. As a measure of work ability in midwifery, the Work Ability Index (WAI) is considered to be a very predictive instrument; midwives with a poor WAI score usually leave their current job within five years. SETTING: university hospitals in Zagreb, Croatia. DESIGN: cross-sectional design survey. PARTICIPANTS: 300 health-care workers (105 qualified midwives and 195 paediatric nurses) were invited to complete the questionnaire. The total response rate was 53% (158/300). The sample included 14.7% of all hospital-based midwives in Zagreb hospitals. METHODS: the Occupational Stress Assessment Questionnaire (OSAQ) for health-care workers and the WAI questionnaire. FINDINGS: over three-quarters of the midwives (46/60, 76.7%) believed that their job was stressful, and considered that insufficient work resources caused the most stress. More than half of the midwives associated an insufficient number of coworkers, unexpected situations, inadequate income, night work, incurable patients and poor organisation at work with a high level of stress. The perceived specific stressors differed between midwives and paediatric nurses in the same hospital. Insufficient work resources and poor organisation at work were more common stressors among midwives than paediatric nurses (p<0.05). Midwives and nurses differed significantly with respect to age (p=0.002). Midwives were younger and had spent fewer years working in their current workplace compared with paediatric nurses (p<0.001). Also, midwives had a lower level of education than paediatric nurses (p=0.044). The mean WAI score for midwives was 40.0 [95% confidence interval (CI) 38.4-41.4], compared with 37.5 (95% CI 36.4-38.8) for paediatric nurses, both indicating good work ability. After adjusting for age, the difference in WAI score between the groups of workers was not significant. CONCLUSIONS: Croatian midwives experienced work-related stress due to: insufficient work resources, insufficient number of coworkers, poor organisation at work, communication with superiors and emotional work. Midwives' work ability in relation to the demands of their job was good. These results confirmed that the WAI score decreases significantly with age. IMPLICATIONS FOR PRACTICE: hospital management needs to improve organisational factors and resources, as well as midwives' education and position in the health-care system.

[Maintenance of work ability among hospital health care professionals]. / Ocuvanje radne sposobnosti bolnickih zdravstvenih djelatnika.

AIM: The aim of this study was to investigate the values of the Work Ability Index (WAI) and to analyze the factors that may be associated with work ability among hospital health care professionals. METHODS: A total of 1856 health care professionals employed at 5 Zagreb hospitals participated in this cross-sectional study. Data were collected using the Work Ability Index Questionnaire and Occupational Stress Assessment Questionnaire for hospital health care professionals. RESULTS: The average WAI of all participants was 38.68+/-6.28, indicating very good work ability. WAI was significantly higher in men than in women, 40.43+/-5.81 and 38.27+/-6.32, respectively (p<0.001). Younger participants had greater WAI compared with those of older age groups (p<0.001). There was a substantial difference in the proportions of participants in the categories of WAI (poor, good, very good and excellent) between physicians and nurses (p<0.001). Although physicians were considerably older than nurses (p<0.001), the proportion of those with excellent WAI was greater among physicians than among nurses, suggesting that the jobs of highly educated participants, which are characterized by broad decision-making latitude and promotion possibilities maintain work ability better in comparison with low decision-making latitude jobs and low control jobs. About 5 percent of all participants had poor WAI. We identified the following significant predictors of suboptimal WAI among health care professionals: female sex, age, service accrual, and stressors related to organization and financial issues (p<0.001), risks and hazards (p=0.040), and shift work (p=0.001). CONCLUSION: The average WAI of all participants indicated very good work ability, but small percent of them had poor WAI. Our results suggest the need of preventive measures that would target maintenance of work ability at an organizational and individual level. The organizational level should include the provision of a sufficient number of workers, adequate financial resources for work and adequate salaries, less paperwork, positive collaboration with the public, especially media, and education of medical staff on the risks and hazards at work. The individual level should include individual assessment of sensitivity to night work and shift work considering age and health status, and training in stress management techniques.

Work-related stress, education and work ability among hospital nurses.

AIM: This paper is a report of a study conducted to determine which occupational stressors are present in nurses' working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses' work ability; and to determine if educational level predicts nurses' work ability. BACKGROUND: Nurses' occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability. METHOD: A cross-sectional study was conducted in 2006-2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire. FINDINGS: We identified six major groups of occupational stressors: 'Organization of work and financial issues', 'public criticism', 'hazards at workplace', 'interpersonal conflicts at workplace', 'shift work' and 'professional and intellectual demands'. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1.69, 95% confidence interval 122-236), lower educational level (odds ratio = 1.69, 95% confidence interval 122-236) and older age (odds ratio = 1.07, 95% confidence interval 1.05-1.09). CONCLUSION: Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses' occupational stress levels, thus maintaining their work ability.

Harassment in workplace among school teachers: development of a survey.

AIM: To develop a questionnaire on harassment in the workplace among teachers at primary and secondary schools. METHODS: We analyzed the existing questionnaires on harassment in the workplace and developed a new one was to specifically address harassment of teachers in the public education sector. The questionnaire was then experimentally applied to a sample of 764 primary and secondary school teachers in Split Dalmatia County, Croatia. It included three scales -exposure to harassment, witnessing harassment, and disturbance by harassment. Validity of the three scales was examined by factor analysis. RESULTS: All three scales showed satisfactory metric characteristics: Cronbach alpha coefficient was 0.93 for exposure scale, 0.95 for witnessing scale, and 0.97 for disturbance scale. Out of 764 teachers surveyed, 164 (22.4%) were exposed to and 192 (31.7%) witnessed different kinds of harassment in the previous 12 months. There were significantly more of those who experienced harassment as witnesses (chi(2)(1)=249.301; P<0.001) than as direct victims. Eighty-six teachers (11.5%) reported having psychological and 76 (10.1%) physical health problems caused by their work. Exclusion as a consequence of harassment disturbed women more than men (chi(2)(1)=5.27; P=0.022). Those who were exposed to harassment had significantly lower median age (42; range 23-68) than those who were not exposed (45; range 23-65) (U=31401.50; z=2.129; P=0.033). CONCLUSION: The questionnaire registered wide spectrum of harassment types, indicating the need for continuous monitoring and systematic work on the prevention of these phenomena. The study showed that exposure to harassment is associated with age, indicating that younger teachers should be the target population for detection and prevention of workplace harassment.

Review of cognitive, cognitive-behavioral, and neural-based interventions for Attention-Deficit/Hyperactivity Disorder (ADHD).

Primary evidence-based treatment approaches for ADHD involve pharmacological and behavioral treatments. However, there continue to be investigations of cognitive-behavioral, cognitive, and neural-based intervention approaches that are not considered evidence-based practice. These particular treatments are summarized, as they all involve training in cognitive skills or cognitive strategies. We identified 26 studies (six cognitive-behavioral, six cognitive, and 14 neural-based), and calculated effect sizes where appropriate. Overall, our analysis suggests that further research is needed to determine the efficacy of these approaches on both cognitive and behavioral outcome measures, but that some of these methods show promise for treating ADHD. We discuss some important conceptual and methodological issues that need to be taken into account for future research in order to evaluate the clinical efficacy of these approaches.

Stress and work ability in oil industry workers.

This cross-sectional study conducted between March and June 2006 examined stress at work and work ability of 180 people with different workplaces within an oil company. Office, laboratory, and oil-field workers were invited to complete the "Occupational Stress Assessment Questionnaire--the Oil Industry Version and Work Ability Index (WAI) Questionnaire". The overall response rate was 69.4%, and the final sample size was 125 workers who completed the questionnaires (57 office, 41 laboratory, 27 oil-field workers). Office, laboratory, and oil-field workers differed significantly with respect to age (P<0.001). The oldest were oil-field workers and the youngest were office workers. The average WAI score for office workers was 44.9, for laboratory workers 43.2 and for field workers 39.7, indicating satisfying work ability. After adjusting for age, the difference in WAI score between the groups of workers was still significant (P<0.001). Over 75% of all workers believed their job was stressful, but the perception of specific stressors depended on the workplace.

[Stress at work among military doctors: a preliminary study]. / Stresori na radnom mjestu vojnih lijecnika: preliminarno istrazivanje.

OBJECTIVE: This preliminary study examined the sources of work stress in military physicians. SUBJECTS AND METHODS: Forty-eight medical doctors (24 military and 24 civilian) completed a questionnaire on stressors at the work place. The participation in the study was anonymous and voluntary. Out of 24 military physicians, 14 were military general practitioners (mean age 40.5, 14 female), and 10 were consultants of different specialties (mean age 43.5, 7 male and 3 female). Civilian physicians included 13 general practitioners working at primary health care system (mean age 37, 3 male and 10 female), and 11 consultants of different specialties working at out of hospital practice (average age 37, 6 male and 5 female). The questionnaire included items aiming to obtain demographic characteristics (sex, age, marital status, children, academic degree, clinical specialty, work place, average time in practice, average time at current position) and 37 items to determine occupational stressors. The stressors were related to work management, professional demands, interpersonal and patient-doctor relationship. Differences in recognizing work stressors between the groups of civilian and military physicians were statistically analyzed by using chi-squared-test. RESULTS: The leading work stressors identified by military physicians were inadequate salary, being bypassed for promotion, inadequate continuous education, poor resources, poor communication with superiors, poor management, trouble with superiors, excessive paperwork, unpredictable situations, and 24-hour standby. Civilian physicians reported inadequate salary, poor resources, poor management, misinformed patients, lack of co-workers, lack of time, unpredictable situations, exposure to indictment, dealing with incurable patients and exposure to public criticism and judgment. In comparison with civilian physicians, military physicians significantly more frequently reported inadequate salary (p<0.01), being bypassed for promotion (p<0.005), poor communication with superiors (p<0.05) and inadequate continuing education (p<0.025). In the group of military physicians, military general practitioners identified more stressors with a higher frequency. Nine out of top ten stressors were reported by at least one half of military general practitioners. Poor communication with superiors (12/14), lack of appropriate continuing education (10/14) and trouble with superiors (9/14) were predominantly reported by military general practitioners. DISCUSSION: Our preliminary study has suggested that military physicians, especially military general practitioners, recognize more stressors and at higher frequency than civilian physicians. The ten leading stressors reported by the two study groups differed, however, both groups reported inadequate salary, poor resources, poor management and unpredictable situations among the first ten. Many studies tackling occupational stress in physicians, suggest that they are at risk of work stress. Several studies have found job stress to be a significant source of distress for military personnel during peacetime assignment. However, to our knowledge, no studies on work stress in military physicians have been published. Some of the most important stressors identified by our military physicians, such as poor resources, poor management, excessive paperwork, unpredictable situations and 24-hour standby are well known stressors the physicians are dealing with. Compared with studies on work stress in military personnel, our group more frequently reported inadequate salary, being bypassed to promotion, poor communication and trouble with their superiors. CONCLUSIONS: Our preliminary results suggest that military physicians recognize different stressors and to a greater extent than civilian physicians. The reported stressors suggest specific professional environment of military physicians. Stress at work needs careful and thorough consideration, not only because it can cause health problems and emotional suffering in military physicians, but also because it can diminish the quality of medical care that they are expected to provide. The stressors that are remediable should be identified and the job stress reduction procedures should be performed.