Faculty of Medicine

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CLINICAL OUTCOMES FROM COVID-19 INFECTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: 5 YEARS LATER
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-12-16)
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Atanasovska, Aneta
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Introduction: Evidence of impact of COVID-19 infection on course of chronic obstructive pulmonary disease (COPD) is still limited. Aim: To assess clinical outcomes of moderate COVID-19 infection in patients with moderate COPD by comparison of disease control, i.e., the frequency and severity of symptoms, level of health status impairment, values of spirometrc parameters and exacerbation risk, registered at two points in time: 2020 and 2025. Material and methods: We performed a cross-sectional study including 74 patients with moderate COPD divided in two groups. The first group (COVID-19 group) included 37 COPD patients who had COVID-19 infection of moderate severity in 2020. The second group (non-COVID-19 group) included patients with COPD who did not have coronavirus disease in the period 2020-2025. The frequency and severity of symptoms and level of health impairment were assessed by COPD Assessment Test (CAT): lung function was assessed by spirometric measurements, and exacerbation risk was predicted by exacerbation rate registered in the previous year. Conclusion: Our findings indicated significant impact of the COVID-19 infection on symptoms, patient’s health and daily life, as well as on the lung function and exacerbation risk emphasizing a need of careful monitoring of these patients upon recovery from COVID-19 infection in order to minimize the impact of infection on COPD progression.
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PREVALENCE AND CHARACTERISTICS OF CHRONIC RESPIRATORY SYMPTOMS AND LUNG FUNCTION AMONG VINEYARD WORKERS
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-12-16)
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Atanasovska, Aneta
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Bislimovska, Dragana
Aim: To determine the frequency of chronic respiratory symptoms and ventilatory function in a group of vineyard workers. Results: Most of the vineyard workers believe that they are sufficiently informed about the health risks related to their work activities and the necessary measures needed for health protection. Also, most of them use the mandatory personal protective equipment, while almost all workers during their work, to a greater or lesser extent, were exposed to occupational respiratory hazards: dust, smoke, fumes, gases and pesticides. About 45% of subjects had one or more respiratory symptoms, and the most common symptoms were cough (40%), cough with phlegm (31.1%), as well as dyspnea and wheezing (22.2%). The frequency of chronic respiratory symptoms was higher in workers with more than 15 years of exposure, with a statistically significant difference in frequency of cough, cough with phlegm, and dyspnea. The risk of respiratory symptoms was about 3 times higher in active smokers and about 2 times higher in vineyard workers with exposure duration longer than 15 years. The mean values of all spirometric parameters were within the reference values, while lung function impairment of obstructive, restrictive and combined pattern was registered in about 20% of them. The mean values of spirometric parameters in vineyard workers with exposure duration longer than 15 years were lower than those with less than 15 years of experience, with a significant difference for small airways flow indices. Conclusion: The obtained results indicate the need to improve preventive measures.</jats:p>
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COPD PREVALENCE AND CHARACTERISTICS AMONG RETIRED WORKERS
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-04)
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Atanasovska, Aneta
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Bislimovska, Dragana
Introduction:Age and exposure to noxious particles and gases are considered as important risk factors for the development of COPD. Aim of the study:To assess the prevalence of COPD in a sample of retired persons from the Skopje region.Material and methods:We performed a cross-sectional study (prevalence study) in a sample of 392 randomly selected retired persons, 207 males and 185 females, aged 56 to 84 years. Study protocol included completion of a questionnaire and pre-and post-bronchodilator spirometry.Results:The prevalence of COPD in the whole sample was 8.7% (34/392),being non-significantly higher in men (9.1%) than in women (8.1%). The difference in COPD prevalence between smoking and non-smoking retired persons was within the borders of statistical significance (10.7% vs.7.5; P=0.084). The difference in COPD prevalence between retired persons exposed to vapors, gases, dusts, and fumes (VGDF) at their workplace during their active period and retired persons with no such exposure just missed statistical significance (9.5% vs.7.4%; P=0.073). COPD prevalence in the smoking retired persons occupationally exposed to VGDF during their active period was significantly higher than its prevalence in the smoking retired persons occupationally unexposed to VGDF during their active period (12.6% vs.8.2%; P=0.036). Conclusion: Our results confirm the role of age and exposure to noxious particles and gases in the COPD development.
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Outcomes of Sensitizer-Induced Occupational Asthma: Clinical and Functional Features in Regard to Occupational Exposure After Diagnosis
(IJCMCR Open Access, 2025-01-08)
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Kocovska-Kamcevska, Nade
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Introduction: Outcomes of sensitizer-induced Occupational Asthma (OA) and effectiveness of workplace interventions in regard to occupational exposure after diagnosis still are a matter of discussion. Aim of the study: To evaluate clinical and functional outcomes of sensitizer-induced OA in regard to causative occupational exposure after the diagnosis was established. Methods: We performed a cross-sectional study including 84 patients with sensitizer-induced OA diagnosed in the period 2015-2022. Regarding the workplace intervention after the diagnosis was established, study population was classified as subjects with continued exposure, subjects with reduced exposure and subjects with ended exposure to occupational agent associated with their disease, i.e. subjects removed to another workplace and unemployed subjects. All study subjects ompleted a questionnaire on asthma symptoms and underwent spirometric measurements. Results: Frequency of symptomatic subjects was significantly higher in the group with continued exposure than in the groups with reduced and ceased causative exposure (79.1% vs. 28.6%; P = 0.0001 and 79.1% vs. 38.9%; P = 0.0214, respectively). Frequency of symptomatic subjects in the group of subjects with reduced exposure was non-significantly higher than its frequency in the group of subjects with ceased exposure (38.9% vs. 28.6%; P = 0.4311). Mean value of FEV1 was significantly lower in the groups of subjects with continued and reduced exposure than in the group of subjects with ceased causative exposure (78.4% vs. 85.7%; P = 0.0000 and 80.9% vs. 85.7%; P = 0.0009, respectively). Significant difference was also registered between mean FEV1 value in the group of subjects with continued exposure as compared to its mean value in the group of subjects with reduced exposure (78.4% vs. 80.9%; P = 0.0437). Conclusion: Our findings indicated that cessation and reduction of exposure had better clinical and functional outcomes compared with study subjects with continued exposure. Study subjects with ended exposure had better functional outcomes compared to study subjects with reduced causative occupational exposure.
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Work Ability in Patients with COPD: Premature Retirement
(Rapid Publishing, 2024-10-09)
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Atanasovska, Aneta
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Panajotovic Radevska, Maja
Introduction: Existing evidence indicates that chronic obstructive pulmonary disease (COPD) can cause work disability in many patients with this condition. Objective: To compare frequency of premature retirement and work life duration and its relation to sex and occupation during active period between retired patients with COPD and retired subjects in whom COPD was excluded. Methods: We performed a cross-sectional study including 147 retired patients with COPD (87 males and 60 females, aged 64 to 74 years) and an equal number of retired persons in whom COPD was excluded, matched to COPD patients by sex, age and occupation group. In addition, all study subjects were classified in four occupation groups following the International Standard Classification of Occupations (ISCO-08). The study protocol included completion of an interviewer-led questionnaire and spirometry with bronchodilator test by indication. Results: Frequency of premature retirement (age less than 64 years for men and 62 years for women) was significantly higher in COPD patients than in non-COPD controls (32.6% vs. 17.7%; P = 0.022). Mean age of retirement was significantly lower in COPD patients than in non-COPD controls (55.8 ± 5.9 yrs vs. 60.1 ± 3.1 yrs; P = 0.000). Mean duration of active work life was significantly lower in COPD patients than in non-COPD controls (26.1 ± 2.8 yrs vs. 32.7 ± 3.1 yrs; P = 0.000). There was not significant difference in the distribution of premature retirement by sex in both examined groups. Significantly higher frequency of premature retirement was found in COPD patients who worked as manual workers than in those who worked in non-manual jobs (42.8% vs. 21.3%; P = 0.037). Conclusion: We found significant impact of COPD on work ability, i.e. significantly higher frequency of early retirement and significantly shortened work life in COPD patients than in subjects without COPD, indicating a need of improvement of the preventive measures and activities in order to maintain the work ability of these patients as long as possible.
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Effects of Vitamin D Supplementation on Exacerbation in Patients with Severe COPD
(MedDocs Publishers LLC, 2022-07-12)
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Petrova, Tatjana
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Kamchevska Kochovska, Nade
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Introduction: Results from several studies indicated that vitamin D plays a role in a variety of immunologic processes such as modulation of inflammatory pathways and susceptibility to infections. Aim of the study: To assess the effects of vitamin D supplementation on bacterial exacerbations in patients with severe chronic obstructive pulmonary disease (COPD) with low vitamin D serum level. Methods: We performed an observational, non-randomized, open-label study including 36 patients with severe COPD who besides the recommended chronic treatment for stable disease took oral vitamin D supplementation in dose of 2000 IU daily during a six month-period (Group 1). In addition, 35 patients with severe COPD, matched to the study subjects of the Group 1 by sex, age and serum vitamin D level, who did not receive vitamin D supplementation served as controls (Group 2). Analysis of exacerbations, including their incidence and duration, as well as incidence of relapses and duration of exacerbation-free interval, was done for each study subjects based on daily diary cards maintained by all of them during the mentioned period. Results: Mean serum vitamin D levels at baseline did not differ significantly between examined groups (21.7 vs. 22.1; P = 0.457). At the end of the study its mean level was significantly higher in the Group 1 as compared to Group 2 (30.1 vs. 23.4; P = 0.000). Mean number of the first exacerbation over a six month-period was significantly lower in the Group 1 as compared to their mean number in the Group 2 (0.8 vs. 0.9; P = 0.001). Mean duration of the first exacerbation in the Group 1 (6.7 ± 1.2 days) was significantly lower as compared to its mean duration in the Group 2 (7.2 ± 1.3 days) (P = 0.033). Mean number of relapses registered in the Group 1 (0.2 ± 0.1) was significantly lower than its mean number registered in the Group 2 (0.4 ± 0.2) (P = 0.000). Mean exacerbation-free interval in the Group 1 (39.3 ± 10.1 days) was significantly longer than in the Group 2 (33.7 ± 11.8 days) (P = 0.052). Conclusion: Our findings indicated that vitamin D supplementation may impact the incidence and duration of bacterial exacerbations in patients with COPD. There is a need of further studies to elucidate the role of vitamin D supplementation on the course of COPD.
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Prevalence and Characteristics of Allergic Asthma in a Sample of Dairy Farmers
(Scientific Foundation Spiroski, 2024-01)
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Atanasovska, Aneta
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Bislimovska, Dragana
AIM: The objective of the study is to evaluate the prevalence characteristics of allergic asthma in a sample of dairy farmers. METHODS: We performed a cross-sectional study including 83 dairy farmers (mean age: 52.6 ± 8.7 years; mean exposure duration: 23.7 ± 7.6 years) compared to 80 office controls (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 past 12 months, baseline spirometry and histamine challenge, and skin prick tests to standard inhalant and occupational allergens. RESULTS: The frequency of asthma was non-significantly higher in dairy farmers than in controls (7.2% vs. 5%). The frequency of allergic asthma was non-significantly higher in dairy farmers than in controls (6% vs. 3.8%). The frequency of allergic asthma was significantly higher compared to non-allergic asthma in both groups, while the frequency of subjects with allergic asthma who are sensitized to occupational allergens (wheat, corn, rye, cow hairs, molds) was similar in dairy farmers and controls. The risk of sensitization to occupational allergens was non-significantly higher among dairy farmers with allergic asthma (OR = 1,39 [0,18–12,28] CI 95%), compared to office controls. The risk for asthma development was non-significantly higher in subjects sensitized to occupational allergens compared to those who are not sensitized to them both in dairy farmers (OR = 2.00 [0.11–40.60] CI 95%) and office controls (OR = 3.00 [0.00–197.11] CI 95%). The risk for asthma development was about 4 times higher in subjects with atopy compared to those without atopy among dairy farmers (OR = 4.00 [0.22–104.88] CI 95%), while in office controls was almost identical (OR = 1.00 [0.00–39.77] CI 95%). Having in mind sensitization to certain inhalant allergens, asthma was significantly associated with sensitization to Dermatophagoides pteronyssinus both in dairy farmers (p < 0.01) and office controls (p < 0.05). CONCLUSION: The results suggest that occupational exposure among dairy farmers was associated with a higher prevalence respiratory symptoms, lung function impairment, and allergic asthma development. Study findings also can contribute in the detection of critical points for action, predict asthma development, and indicate the need for reduction of adverse occupational exposures by appropriate preventive measures, use of respiratory protective equipment, and implementation of engineering controls.
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Associations of burnout with job demands/resources during the pandemic in health workers from Southeast European countries
(Frontiers Media SA, 2023-10-24)
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Atanasovska, Aneta
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Bislimovska, Dragana
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Brborović, Hana
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Brborović, Ognjen
Introduction: Despite several studies assessing job demands and burnout in countries from the Southeast European (SEE) region, there is still a lack of data about the psychological impact of the pandemic on health workers (HWs). Aims: The present study aimed to demonstrate and compare levels of burnout dimensions in HWs from SEE countries and to reveal the burnout–job demands/resources relationships in these workers during the pandemic. Materials and methods: During the autumn of 2020, this online multicentric cross-sectional survey studied a large group (N = 4.621) of HWs working in SEE countries. The Maslach Burnout Inventory was used for the measurement of burnout dimensions. We analyzed the job demands by using the Hospital Experience Scale. Remuneration and relationships with superiors were measured using the Questionnaire sur les Ressources et Contraintes Professionnelles (English version). Results: A series of ANOVA comparisons of means revealed the countries in which respondents showed higher mean values of emotional exhaustion (Bosnia and Herzegovina, Bulgaria, Croatia, Moldova, Montenegro, and North Macedonia) and the countries in which respondents showed lower mean values of this burnout dimension (Israel and Romania) (Welch F = 17.98, p < 0.001). We also found differences among HWs from different countries in job demands and job resources. The testing of hierarchical regression models, which have been controlled for certain confounding factors, clearly revealed that emotional exhaustion was predicted by job demands (R2 = 0.37) and job resources (R2 = 0.16). Conclusion: Preventive measures for the improvement of mental health in HWs during the pandemic and beyond have to take into account the differences between countries regarding the country context and current scientific knowledge. A modified stress test should be implemented in hospitals regarding future shocks that might include new pandemics, terrorism, catastrophes, or border conflicts.
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Work Ability in Patients with COPD: Sick Leave Frequency and Duration
(International Journal of Clinical Studies and Medical Case Reports, 2023-09-04)
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Atanasovska, Aneta
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Panajotovic-Radevska, Maja
Introduction: Findings of several studies indicated that chronic obstructive pulmonary disease (COPD) affects patients’ work ability and everyday life activities. Aim of the study: To compare frequency and duration of absence from work in workers with COPD and non-COPD controls. Methods: We performed a cross-sectional study including 114 workers with COPD (63 males and 51 females, mean age 53.2 ± 3.7) and an equal number of non-COPD controls (60 males and 54 females, mean age 52.7 ± 3.1), classified by skill level in four occupation groups. Evaluation of the study subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing. Results: Frequency of the sick leave episodes was significantly higher in workers with COPD than in non-COPD controls (44.7% vs. 20.1%; P = 0.004). In addition, frequency of sick leave episodes was higher in all occupation groups of workers with COPD than in non-COPD controls with significant difference for the workers performing physical or manual tasks (48.3% vs. 21.2%; P = 0.045). In regard to duration of sick leave episodes, the frequency of episodes lasting equal or less than 15 days and more than 15 days was higher in workers with COPD being significantly higher for episodes longer than 15 days (50.9% vs. 26.9%; P = 0.045). Conclusion: Our findings indicated significantly higher frequency of sick leave episodes, as well as significantly higher frequency of sick leave episodes lasting more than 15 days, in workers with COPD than in non-COPD controls.
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Incidence of Immunological Occupational Asthma in 2015–2022 by Occupation: Macedonian Experience
(Scientific Foundation SPIROSKI, Skopje, Republic of North Macedonia, 2023-05-02)
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Atanasovska, Aneta
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Panajotovic-Radevska, Maja
BACKGROUND: Immunologic occupational asthma (OA), a more prevalent OA type than non-immunologic OA, became an important public health problem in the last decades worldwide.AIM: To present the distribution of new diagnosed cases of immunologic OA in the RN Macedonia in the period 2015–2022 by occupation.METHODS: Immunologic OA was diagnosed by the serial measurement of peak expiratory flow rate (PEFR) at and away from work or by combination of serial PEFR measurement at and away from work and non-specific bronchial provocation at and away from work in workers with diagnosed asthma and work-relatedness of the symptoms. Sensitization to common inhalant and occupational allergens was evaluated by skin prick test.RESULTS: The annual incidence rate of the diagnosed immunologic OA in this period varied from 1.9/100,000 working population in 2015–2.6/100,000 in 2022 with a drop in 2020 and 2021, i.e.in the period of COVID-19 pandemic (0.6 and 0.5, respectively). Cleaning, bakery, cleaning, textile manufacture, wood industry, agriculture, and metal-parts manufacture were the most important occupations for the development of immunologic OA. More than a half of the new diagnosed immunologic OA cases were atopics.CONCLUSION: Our findings indicated the occupations with the highest incidence of immunologic OA that could enable targeting of preventive measures and activities to reduce the occurrence of immunologic OA as well as its adverse health outcomes.

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