Introduction: The primary healthcare reform in Bosnia and Herzegovina began in 1999. The focus was on the introduction of family medicine, in comparison to the existing dispensary model of care based on the practice of general medicine. The reform is an ongoing process, and all changes are being implemented to improve patients' satisfaction. Our objective is to analyze patients' satisfaction and the impact of socio-demographic factors on patients' satisfaction with the work of family medicine teams. Methods: This research is an observational and descriptive study conducted in family medicine clinics of the Primary Healthcare Centre in Banja Luka from February 1st to April 1st 2022. The data was gathered using the EUROPEP questionnaire which is a standardized instrument for the evaluation of patients' satisfaction with primary healthcare, as well as a questionnaire with socio-demographic information. The study comprised 250 patients from family medicine clinics in the city, suburbs, and countryside. Results: The analysis of 250 questionnaires has provided answers to 23 questions in the EUROPEP instrument assessing four domains: doctor-patient relation X̅ (4.22) SD (0.85); medical care X̅ (4.32) SD (0.90); information and support X̅ (4.04) SD (0.94); and organization of services X̅ (3.81) SD (0.98). Socio-demographic and other patient characteristics greatly impact family medicine patients' satisfaction with healthcare services. Conclusions: In general, the patients are satisfied with the care provided by the family medicine teams of the Primary Healthcare Centre in Banja Luka, and least satisfied with the organization of services. According to individual questions in the EUROPEP questionnaire, the patients are most unsatisfied with reaching their doctors by phone, receiving advice from them, spending a lot of time waiting in the waiting rooms, and scheduling their appointments.

Introduction: Prediabetes is a state of impaired glucose homeostasis manifested either by an increase in fasting glucose or a decrease in glucose tolerance. Prediabetes carries a high risk of developing diabetes and cardiovascular complications. Aim: to determine the prevalence of prediabetes in pre-obese and obese individuals and the ten-year risk of developing T2DM in these subjects. Methods: The study was conducted in the family medicine clinics of the Educational Center for Family Medicine (ECFM) of the Banja Luka Health Center and the Tesliü Health Center. The study included pre-obese and obese patients older than 18 years of age, with a body mass index greater than 27.0 kg/m2. The research instrument was a questionnaire with sociodemographic data, a questionnaire for assessing the risk of developing diabetes mellitus type 2 (FINDRISC), and patient anthropometric measurements, arterial blood pressure measurements and laboratory findings (fasting glucose, lipid status, HbA1c) were performed. Results: The research included 264 patients. The prevalence of prediabetes in obese patients is 28.03%, while in pre-obese it is 21.21%. Subjects with a larger waist circumference are more likely to have prediabetes. With increasing age, the chance of getting prediabetes increases, over 30% of obese and pre-obese people who are over 70 years old have prediabetes. In relation to gender, women have a higher chance of developing prediabetes. Data from the FINDRISC questionnaire showed that 1.52% of patients from the pre-obese category have a 50% chance of developing diabetes within ten years, while 13.6% of obese patients have a 50% chance of developing T2DM within ten years. Conclusion: The role of family medicine doctors is in early identification of patients with prediabetes and diabetes, reduction of risk factors and possibly pharmacological treatment of these patients.

<p><strong>Introduction.</strong> Cardiovascular complications are one of the leading causes of mortality releted to diabetes mellitus typ 2 (T2DM). Dyslipidemia is one of the associated risk factors for coronary artery disease (CAD) in patients with T2DM. The aims of our study were: to determine the characteristics of lipid disorders in persons with T2DM; to determine the cumulative impact of investigated risk factors (gender, age, genetic predisposition, smoking habits, diabetes mellitus, hypertension, obesity) for the occurence of the coronary artery disease; to determine the influence of lipid profile on coronary artery disease development. <strong>Methods.</strong> A cross-sectional study was conducted in the Educative Center of the Primary Health Center Banja Luka in the period 01.11.2021&ndash;30.04.2022. Adult patients (&ge;18 years) with T2DM were recruited into the study. The data about socio-demographic characteristics, lifestyle and clinical factors were collected using structural questionnaire as a tool. For all subjects, anthropometric measurements, blood pressure readings, and laboratory findings (fasting blood glucose, HbA1c, lipid profile) were taken.<strong> Results.</strong> A total of 221 patients with T2DM participated in the study, 52.03% were males. Hypertriglycerdidemia was found in 63.81% subjects, hypercholesterolemia in 56.60%, low HDL-cholesterol in 49.77% subjects and increased level of LDL-cholesterol in 39.37% subjects. Metabolic dyslipidemia (increased triglyceride levels and low HDL levels), representing the major predictor of CAD, was found in 35.29% subjects. Older age, physical inactivity, obesity, hypertension and high levels of fasting glucose in blood were significantly related to dyslipidaemia in patients with T2DM. <strong>Conclusion.</strong> The representation of dyslipidemia in our subjects with T2DM is high, what increases the risk for coronary artery disease. Therefore, it is necessary not only to implement the therapy for glucoregulation, but also the secondary preventive measures for dyslipidemia, and that is the cardiovascular prevention.</p>

Uvod: Depresivnost, anksiozonost i stres predstavljaju značajan javnozdravstveni problem kako u svijetu, tako i u Republici Srpskoj. Ovi mentalni poremećaji se učestalije javljaju kod pacijenata oboljelih od hroničnih bolesti. Cilj: Ispitati zastupljenost depresivnosti, anksioznosti i stresa kod oboljelih od hroničnih bolesti (hipertenzija, astma, hronična obstruktivna bolest pluća, dijabetes melitus, maligne bolesti, stanje poslije infarkta miokarda). Ispitati uticaj sociodemografskih faktora (pol, dob, stručna sprema, sadašnji radni status, porodični status) na prevalenciju depresivnosti, anksioznosti i stresa. Ispitati korišćenje anksiolitika za smanjenje prisutnih simptoma. Materijal i metode: Istraživanje je studija presjeka, provedena anketiranjem pacijenata starijih od 18 godina registrovanih u timovima porodične medicine Domu zdravlja Banja Luka u periodu od 1.08.2018. do 1.04.2019. Za procjenu postojanja anksioznosti, depresivnosti i stresa korištena je DASS– 21 skala, sociodemografski podaci su upisivani u samostalno kreiran upitnik. Pacijenti su izabrani iz registra pacijenata sa hroničnim bolestima. Rezultati: Istraživanjem je obuhvaćeno 405 pacijenata oboljelih od hroničnih bolesti. U odnosu na pacijente oboljele od drugih hroničnih bolesti u grupi pacijenata nakon infarkta miokarda statistički značajno najviše je bila izražena depresivnost (p=0.008, 95% CI 8.761-14.412); anksioznost (P= 0.002, 95% CI 19.2444-15.2038) i stres (p=0.016, 95% CI 13.130-18.655). U grupi pacijenata sa hroničnim bolestima 156 (38,5%) pacijenata koristi lijekove za smanjenje tegoba. Zaključak: Rezultati našeg istraživanja su pokazali visok nivo stresa, anksioznosti i depresivnosti kod pacijenata oboljelih od hroničnih bolesti, što upućuje na potrebu preduzimanja mjera za smanjenje stepena ovih mentalnih poremećaja.

OBJECTIVE The aim of our study was to investigate the predictors of morbidity (age, gender, smoking habits, obesity and the presence of chronic diseases) and COVID-19 outcomes. SUBJECTS AND METHODS The research was an observational descriptive study, conducted at The Family Medicine Education Center, The Primary Health Care Center, Banja Luka, in the period from 26th June to 31st December 2020. During the research period, seven family medicine teams followed their patients with COVID- 19, and recorded possible predictors for morbidity and their influence on the disease outcome. RESULTS The study included 934 patients, 46.90% of whom were male. The majority of subjects were non-smokers and overweight. Diabetes was found in 5.57% patients, hypertension in 29.44%, chronic respiratory diseases in 5.25%, cancer in 4.39% patients. In the observed sample, 29.23% subjects contracted pneumonia, 18.52% were hospitalized, while 19 (2.03%) patients with severe clinical features had a fatal outcome. Multivariable regression analysis showed a high risk of pneumonia in male patients [OR=2.45, 95% CI (1.73- 3.46)], elderly [OR=1.07, 95% CI (1.06-1.09)] and obese patients with Body Mass Index ≥30.0 kg/m2 [OR=2.55, 95% CI (1.73- 3.77)]. Male gender [OR=2.19, 95% CI (1.11-4.31)], older age [OR=1.08, 95% CI (1.05-1.11)] and hypertension [OR=2.51, 95% CI (1.06-5.91)] were the most important predictors for the development of severe clinical features in COVID 19. The statistically significant predictors of mortality were male gender [OR=7.16, 95% CI (1.56-32.86)] and older age [OR=1.12, 95% CI (1.06-1.18]. CONCLUSION Being familiar with the predictors of morbidity and poor outcome in COVID-19 is helpful for carrying out preventive measures, early diagnosis and treatment of risk groups of patients.

1Medicinski fakultet, Katedra porodične medicine, Univerzitet u Banjaluci, 2Medicinski fakultet, Katedra porodične medicine, Univerzitet u Sarajevu, 3Medicinski fakultet, Foča, Katedra porodične medicine, Univerzitet u Istočnom Sarajevu, 4Dom zdravlja, Banjaluka, Bosna i Hercegovina Obrazac propisivanja benzodiazepina ambulantnim pacijentima koji nemaju dijagnozu mentalnih bolesti Retrospektivna studija

Background: Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life. Objective. The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes. Method. The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%. Results. Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p<0.001) had unregulated glycemia (HbA1c≥7.0). Polyneuropathy was present in 23.3% of patients with HbA1c≤7.0%, while 41.0% of patients had HbA1c≥7.0% (p<0.043). Nephropathy with HbA1c≤7.0% was present in 36.8% of cases compared to patients with HbA1c≥7.0 in whom the prevalence was 36.8% (p<0.004). Out of total, 25.6% had retinopathy with HbA1c≤7.0%, while in 41.9% of patients with HbA1c≥7.0% (p <0.067). Diabetic ulcer foot was present in 13 patients with HbA1c≥7 (11.1%) compared to patients with HbA1c≤7.0% where there was no occurrence of this complication 0.0% (p<0.021). At the same time, 5.6% of patients had a diabetic foot ulcer with polyneuropathy (p=0.010), 4.4% had neuropathy (p=0.058) and 5.6% had retinopathy (p=0.014). Conclusion: The high incidence of extracutaneous microvascular complications and diabetic foot ulcer in patients with type 2 diabetes requires a multidisciplinary approach of medical professionals that includes prevention of risk factors and good regulation of glycemia.

Introduction Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23. Aim To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics. Material and methods The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG. Results Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, p = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, p = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0–22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, p < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0–22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, p = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD (p for interaction = 0.12) as well as according to diabetes status (p for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a p for interaction < 0.1. Conclusions Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.

Introduction: Although during undergraduate study students have a high opinion of family medicine and often praise it, during postgraduate studies they show little interest in this medical specialty. Aim: The study aimed to examine the interest of public medical school students in family medicine as a career choice, to establish whether it changed during the study and if there was a difference in that regard among students studying at medical schools in Bosnia and Herzegovina. Hypotheses: students’ attitudes change with learning about the way a family doctor works. Methods: Descriptive cross-sectional survey. This manuscript presents a nationwide survey (63% response rate) of public medical school students in Bosnia and Herzegovina regarding their likelihood of selecting Family Medicine as a specialty. An anonymous questionnaire was distributed to all medical students on all six state universities in Bosnia and Herzegovina. Data basis of all doctors who have completed specialization programs were taken from ministries of health. Results: In the period from 01/01/08 to 12/31/18, only 8.4% of all completed specializations were family medicine doctors in Bosnia and Herzegovina. Interest in family medicine, as a future career, was shown by 31% of medical students, of which over 75% were female students. The largest interest in family medicine was shown by the sixth-year medical students, stating their extensive knowledge of medicine as a reason. Conclusion: Students’ interest in FM specialization is changing through the years of study. Unfortunately, it is not only the lack of interest, that is the cause of the small number of family medical specialities among students but also poor health policy, which should be subjected to actual reform.

Introduction: The most common mental disorders in the elderly are depression and dementia. Objective: Examine the impact of sociodemographic characteristics on the appearance of depression and dementia in elder patients treated in Primary Health Center (PHC), Banja Luka. Method: The study included 208 patients over 65 years of age, selected by random selection method, registered in 6 family medicine teams at the PHC Banja Luka in the period from March to May 2016. Respondents completed the Sociodemographic Questionnaire, Beck’s Depression Inventory, and Folstein Mini-Mental State Examination (MMSE) for dementia assessment. Different statistical procedures were used in the data processing: descriptive analysis in the form of frequencies and percentages, Chi-square test, T-test. The results of the research were statistically analyzed by SPSS 11.5 program. Results: The study included 208 patients older than 65, of whom 38.9% were male. Impaired cognition was found in 7.2% and moderate depression in 24.5% of patients. Dementia was statistically significantly (p = 0.000) more present in the eldest respondents ≥ 81 years, while depression was mostly present in patients aged 76-80. Physically active individuals were significantly less affected by depression (p = 0.001) and dementia (p = 0.000). Dementia and depression occurred more frequently in people living alone and people with a low level of education. Conclusion: A family physician plays an important role in the early detection of depression and dementia in the elderly, the identification of risk factors, prevention, and treatment of these patients.

Aim To examine the prevalence of undiagnosed depression among primary care elderly patients in the entity of the Republic of Srpska (Bosnia and Herzegovina) as well as the sociodemographic and clinical risk factors associated with depression. Methods A cross-sectional study was conducted between April and June 2019 in nine towns of the Republic of Srpska. The study sample included 1,198 primary care patients older than 65 years of age. Research instruments included a sociodemographic questionnaire and Geriatric Depression Scale - Short Form (GDS-SF). Results Positive screening test (GDS-SF score > 5), which indicates depression was found in 484 (40.4%) participants. Multivariate regression analysis showed that lower education levels [OR = 1.565, 95% CI (1.13-2.17)], divorced and widowed [OR = 1.366, 95% CI (1.16-1.62)], poor financial situation [OR = 1.690 , 95% CI (1.25-2.29)], non-home residents [OR = 2.200, 95% CI (1.41- 3.44)], non-hobby patients [OR = 2.115, 95% CI (1.54-2.91) ], non-friends [OR = 3.881, 95% CI (2.70-5.57)], patients suffering from chronic pain [OR = 2.414, 95% CI (1.72-3.39)], patients with daily life limitation activities [OR = 1.415, 95% CI (1.03-1.95)], patients with three or more chronic diseases [OR = 1.593, 95% CI (1.12-2.27)], patients using five or more drugs [OR = 1.425. 95% CI (1.00-2.03)], and patients with history of previous depression [OR = 2.858, 95% CI (1.94-4.21)] were at higher risk for depression. Conclusion The prevalence of undiagnosed depression in the elderly in Republic of Srpska is high. Future strategies are needed to strengthen screening of geriatric depression in primary health care.

Introduction. Diabetic polyneuropathy (DPN) is the most common microvascular complication of diabetes mellitus (DM), which may be present at the time of disease detection. Screening for DPN is performed for the patients with type 2 diabetes at the time of diagnosis and for type 1 diabetes 5 years after diagnosis. The primary objective of this study was to determine the prevalence of DNP among family medicine patients with diabetes mellitus aged 18 to 70 years using nylon monofilament. Methods. The cross-sectional study estimated the prevalence of DPN among primary care patients with DM in Banja Luka. Seemes-Weinstein nylon 10g monofilament was used to detect DPN. Age, sex, duration of diabetes, type of therapy, symptoms, glycosylated hemoglobin (HbA1c) and risk factors (hypertension, smoking, dyslipidemia, obesity, physical inactivity) were analyzed. Data collection took place from 01/06/2017 to 31/05/2018. Results. The study included 228 patients, 132 (57.9%) men and 96 (42.1%) women. There was a statistically significant difference in the duration of diabetes and the presence of all symptoms of DPN (tingling, burning, light burning and stinging) with respect to the presence of polyneuropathy (p <0.01). Multivariate logistic regression revealed that patients who had hypertension (OR=26.2; 95% CI: 4.070-168.488; p=0.001), used oral antidiabetic therapy (OR=12.3; 95% CI: 1.300 -116.309; p=0.029 ) had tingling (OR=5.2; 95% CI: 1.431- 18.571 p=0.012;)and a longer duration (OR=4.27; 95% CI: 1.983-9.175; p=0.000) of diabetes were more likely to have DPN. Conclusion. The prevalence of DPN in patients with diabetes is 24.2%. Determinants of DNP are the presence of symptoms of tingling, duration of diabetes, hypertension, dyslipidemia, and the use of oral antidiabetic therapy alone.

Introduction. The aim of this study was to determine the prevalence of microvascular complications in type 1 and type 2 diabetes mellitus patients in relation to glycated hemoglobin. Material and Methods. This cross-sectional study analyzed the prevalence of microvascular complications in patients with diabetes mellitus registered at the Primary Health Center Banja Luka. Demographic data, duration of diabetes, blood pressure, glycated hemoglobin, dyslipidemia, type of therapy, presence of retinopathy, neuropathy and nephropathy were analyzed. Data collection was done from December 2017 to November 2018. Results. The study included 228 patients, 132 (57.9%) men and 96 (42.1%) women. The most common microvascular complication was diabetic neuropathy (24.2%). The mean glycated hemoglobin level in patients with diabetic complications was 7.75 ? 1.66%. Although all participants with complications had unregulated diabetes mellitus (glycated hemoglobin > 7%), a statistically significant difference was found in regard to microalbuminuria (> 30 mg/24 h) and/or proteinuria (> 0.15 g/24 h) and/or decreased creatinine clearance (< 1.5 ml/sec) and their mean glycated hemoglobin (p = 0.025), while for other complications (neuropathy and retinopathy) the same was not confirmed. Multivariate logistic regression analysis confirmed that microalbuminuria and/or proteinuria and/or decreased creatinine clearance (odds ratio = 2.174; 95% confidence interval: 1.040 - 4.543; p = 0.039) as well as elevated diastolic blood pressure (odds ratio = 1.09; 95% confidence interval: 1.024 - 1.162; p = 0.007) were factors associated with glycated hemoglobin > 7%. Conclusion. The most common microvascular complication in patients with both types of diabetes mellitus is diabetic neuropathy with a prevalence of 24.2%. The presence of microalbuminuria and/or proteinuria and/ or decreased creatinine clearance were associated with glycated hemoglobin > 7% and elevated diastolic blood pressure.

OBJECTIVE To investigate the level and causes of stress and the risk of onset of burnout syndrome among physicians employed at the Primary Health Care Centre, Banja Luka. SUBJECTS AND METHODS Between March 1, 2018, and May 31, 2018 all physicians from the Primary Health Care Centre, Banja Luka were offered the following questionnaires to fill in: a socio-demographic questionnaire, a questionnaire for self-assessment of the level of stress and the Maslach Burnout Inventory for assessment of the risk of burnout syndrome. RESULTS Out of 211 physicians, 85.8% were female. A high level of stress was found in 77.7% of the subjects. Older doctors had higher levels of emotional exhaustion compared to younger doctors with a shorter length of service (r=0.236, P=0.01). Emotional exhaustion was significantly correlated with a high level of depersonalization, a low level of personal accomplishment and a high level of stress (r=0.380, r=-0.174 and r=0.574, P=0.01, P=0.04 and P<0.01, respectively). Depersonalization correlated with a low level of personal accomplishment and stress (r=-0.347 and r=0.283, P<0.01 and P=0.01, respectively), while the level of personal accomplishment was in a negative correlation with stress (r=-0.281, P=0.01). A high stress level was associated with a high degree of emotional exhaustion (OR 56.543; 95% CI 11.35-213.09; P<0.001) as well as lack of personal accomplishment (OR 0.155; 95% CI 0.04-0.50; P=0.003). CONCLUSION A high level of stress was associated with older age, female gender, as well as with a high degree of emotional exhaustion and a lack of personal accomplishment. Preventive measures are warranted.

Introduction. Burnout syndrome is a common problem among healthcare workers. The aim of the study was to investigate the level of stress, components of burnout syndrome and the most common causes of workplace stress among the physicians working in the Primary Health Care Center Banja Luka, after which the obtained results concerning family physicians and the physicians of other specialties were compared. Methods. The observational study was conducted by interviewing physicians during the period March to May 2018. All employed physicians were provided with the following questionnaires: The socio-demographic questionnaire, the questionnaire for self-assessment of the level of stress, the questionnaire about the most frequent causes of stress at work and the Maslach Burnout Inventory. Results. The study included 211 physicians, out of a total of 246 physicians (127 family physicians and 84 physicians of other specialties) working in the Primary Health Care Center Banja Luka. There was a significantly higher level of stress (p = 0.011), emotional exhaustion (p < 0.001) and depersonalization (p < 0.001) among family physicians compared to the physicians of other specialties. There was a significant difference in the presence of all causes of stress among family physicians, except the stress concerning the patients requiring emergency care. The multivariate logistic regression analysis found that stress was significantly associated with emotional exhaustion in both groups and with personal accomplishment in family physicians. In family physicians, there was a significant association between a high level of depersonalization and personal accomplishment. In physicians of other specialties significant association was found between education and emotional exhaustion as well as personal accomplishment, and between female gender and high level of depersonalization. Conclusion. The level of stress and the burnout syndrome were considerably more present in family physicians compared to physicians of other specialties.