The burnout syndrome is a response to a long term chronic emotional and interpersonal stressors that are related to workplace. It emerges as the consequence of non-harmonized relations between employees on one, and working environment on the other side. It is defined as chronic work stress that includes three dimensions: the sense of the emotional exhaustion, the negative approach to providing services (depersonalization) and the sense of reduced personal accomplishment. It occurs most often in persons who work in direct contact with other people. Medicine is one of the professions at the greatest risk of suffering from burnout syndrome. The results of the studies conducted in the neighbouring countries, in Europe and in the world showed a big prevalence of burnout syndrome among medical workers, especially in physicians. The acquired results indicate that there is a need to undertake measures for prevention of the burnout syndrome.

Introduction: Changes in lifestyle can significantly affect the management of good glycemic control and target values of blood pressure and lipids. Objective: To determine the achievement of target values of glycated hemoglobin (HbA1c), blood pressure and lipids, in participants with type 2 diabetes, who used a proper diet and controlled physical activity. Method: The study was a prospective study, conducted on participants with type 2 diabetes, from 01 October 2012 until 31 October 2013, at the Primary Health Center Banja Luka, by 60 family medicine teams. At the beginning of the study, all participants had individual counseling on lifestyle changes, eating habits, and regulation of body weight. Results: The study included 591 participants with the type 2 diabetes. At the beginning of the study, 49.92% of participants adhered to the proper diet, and at the end 76.65% of them (p<0.001). Targeted value of HbA1c ≤ 6.5% was registered in 61.70% participants at the beginning of the study and at the end of the study in 86.62% participants (p <0.001); the target value of blood pressure (≤130/80 mmHg) was registered in 56.21% at the beginning, and at the end in 79.91% (p<0.002). Targeted value of total cholesterol was registered in 59.61% at the beginning of the study, and at the end of the study in 81.91% subjects (p <0.003). Conclusion: In patients with type 2 diabetes individual counseling about lifestyle changes helps to attain optimal values of HbA1c, blood pressure, and serum lipid levels.

Introduction. The number of people over 65 is increasing in the world, and falls are rather common among them. The objective of this research was to examine the impact of depression, dementia, the number of chronic diseases and the number of used medications in the risk of falls in the elderly. Material and Methods. We carried out a prospective study during the period from March 20 to May 20, 2016. The patients were interviewed, and data were also obtained from medical records. The data collection included a socio-demographic questionnaire, the Tinetti Gait and Balance Instrument, Beck Depression Inventory and the Folstein Mini-Mental State test to assess cognitive functions. Results. The study included 208 patients older than 65 years, 81 men, 127 women. The Tinetti Gait and Balance tool revealed that onethird (63) of patients were at a high risk of falls, 35 patients at a moderate risk, and 110 patients presented with a low risk of falls. The results of our study showed a statistically significant association between dementia (p = 0.000) and depression (p = 0.000) as the risks of falling. Patients with some chronic diseases and patients continuously taking various drugs were also at higher risk of falls. Conclusion. Timely detection and treatment of depression and dementia may contribute to reducing the risk of falls in the elderly. Patients' medication lists should be reviewed to decrease the number of medications or modify the dose. Family physicians play a major role in preventing falls in the elderly.

Introduction.The aim of the study was to find out the determinants of the quality of life in primary health care patients with type 2 diabetes. Methods. The cross-sectional study included 181 patients, aged 37 to 89 years, with diabetes mellitus type 2, registered with four family medicine practices. The assessment of health status was conducted using medical history, objective examination, laboratory analyses, dilated eye exam, screening for distal symmetric neuropathy and ankle-brachial index measurement. In evaluating the impact of diabetes mellitus on patients’ health status, a generic instrument, the self-administered WHOQOL-BREF questionnaire, was used. Multivariate linear regression models were used to analyze the variables associated with the quality of life. Results. Out of 181 adult patients with type 2 diabetes mellitus, 73 (40.3%) had diabetes for less than 5 years. The mean glycated hemoglobin (A1C) was 7.55% and the mean serum levels of fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were above the recommended values. Most of the patients had comorbidities, chronic diabetes complications and used oral hypoglycemic agents in combination with insulin. The multivariate regression analysis showed that the age, psychological health, nephropathy and environment were associated with the domain of physical health. The determinants of psychological health were age, marital status and environment. Older and single patients had lower scores, whereas those with a better living environment had higher scores in the domain of social relationship. The levels of glycemic control and gender have not been shown to be significant determinants of any of the four domains. Conclusion. The factors associated with the different domains of quality of life in patients with type 2 diabetes are multiple, but mainly relate to age, living environment and diabetes complications. The results can be used as a guideline for defining measures that can improve the quality of life of patients with type 2 diabetes

Education means: learning, teaching or the process of acquiring skills or behavior modification through various exercises. Traditionally, medical education meant the oral, practical and more passive transferring of knowledge and skills from the educators to students and health professionals. Today the importance of focus on educational quality, particularly in the professions operating in the services required by people is agreed by all involved. The higher educational system shoulders some critical responsibilities in the economic, social, cultural and educational development and growth in the communities. In countries that are in transition it is in charge of educating professional human workforce in every field and if the education is optimal in terms of quality, it is capable of carrying out its responsibilities. It is reason why there is the necessity behind discovering some strategies to uplift the quality of education, especially at university level.. By increasing the courses and establishing universities and higher education centers, the countries around the world have generated more opportunities for learning, especially using modern information technologies. Regarding to evaluating different educational services quality, one of the most important measures should be the way to develop programs to promote quality and also due to the shortage of resources, evaluating the services quality enables the management to allocate the limited financial resources for realization whole educational process. Advances in medicine in recent decades are in significant correlation with the advances in the new models and concepts of medical education supported by information technologies. Modern information technologies have enabled faster, more reliable and comprehensive data collection. These technologies have started to create a large number of irrelevant information, which represents a limiting factor and a real growing gap, between the medical knowledge on one hand, and the ability of students and physicians to follow its growth on the other. Furthermore, in our environment, the term technology is generally reserved for its technical component. This terminology essentially means not only the purchase of the computer and related equipment, but also the technological foresight and technological progress, which are defined as specific combination of fundamental scientific, research and development work that gives a concrete result. The quality of the teaching-learning process at the universities in former Yugoslav countries and abroad, depends mainly of infrastructure that includes an optimal teaching space, personnel and equipment, in accordance with existing standards and norms at the cantonal or entity level, which are required to implement adequately the educational curriculum for students from first to sixth year by Bologna studying concept. For all of this it is necessary to ensure adequate funding. Technologies (medical and information, including communications) have a special role and value in ensuring the quality of medical education at universities and their organizational units (faculties). “Splitska inicijativa” project, which started 6 years ago as simple intention to exchange experiences of application new model of education, based on: Bologna studying concept, and other types of under and postgraduate education, was good idea to improve also theory and practice of it within Family medicine as academic and scientific discipline. This year scope of our scientific meeting held in Sarajevo on 24th and 25th March 2017, was quality assessment of theoretical and practical education and, also, evaluation of knowledge by students exams (a-y).

Kosana D. Stanetić1, Suzana M. Savić1, Bojan M. Stanetić2, Olja M. Šiljegović3, Bojana S. Đajić4 1Primary Health Center Banja Luka, Department of family medicine, Medical faculty, University of Banja Luka, Bosnia and Herzegovina 2Department of Cardiology, University Clinical Center of the Republic of Srspka, Banja Luka, Bosnia and Herzegovina 3Primary Health Center Doboj, Bosnia and Herzegovina 4Primary Health Center Gradiška, Bosnia and Herzegovina The prevalence of polypharmacy in elderly: a cross section study from Bosnia and Herzegovina Оригинални радови / Original Articles

Introducti on. Burnout syndrome is the result of chronic emotional stress. It is characterized by high levels of emotional exhaustion and depersonalization, and reduced level of personal accomplishment. The aim of this study was to determine the level of stress and risk ror burnout syndrome in doctors employed in health centers and hospitals, and to investigate the impact of socio-derrdgraphic characteristics on the level of stress and the o ccurrence of burnout syndrome. MATERIAL AND METHODS A cross-sectional study was conducted in the period from October I to December 31, 2015 in three health centers and in the University Clinical Center of the Republic of Srpska. The survey was anonymous. A socio-demographic questionnaire and a questionnaire for self-assessment of the level of stress and Maslach Burnout Inventory were used as research instruments. Out of 151 doctors included in the study, 49% were family physicians, and 51% were hospital doctors. RESULTS The analysis of responses to questionnaires for self-assessment of stress level revealed that 51.7% of participants had high levels of stress (52.7% of family physicians, 50.6% of doctors working in hospital). A high degree of emotional exhaustion was found in 27.2% of participants (29.7% of fam ily physicians, 24.6% of doctors working in hospital), high depersonalization was found in 23.8% of participants (25.7% of family physicians, 22. 1% of doctors working in hospital), a low level of personal accomplishment was found in 39.7% of participants (37.8% of family physicians. 41.6% of doctors working in hospital). No statistically significant difference regarding stress degree, emotional exhaustion and depersonalizaion and personal accomplishment was found between hospital doctors and family physicians. The physicians aged over 45 years had a significantly (p = 0.030) higher level of emotional exhaustion than their younger colleagues. CONCLUSION This study found that there was a high risk of burnout syndrome in physicians in the Republic of Srpska. Although the exposure to professional stress was higher in family physicians than in hospital doctors, the obtained difference was not statistically significant.

Abstract Background: Despite considerable efforts to promote and support clinical practice guidelines (CPGs) use, adherence has often been suboptimal universally. Objectives: The aim of this study was to assess to which extent family physicians (FPs) in Republic of Srpska (RS), Bosnia and Herzegovina (BiH) accept or reject the concept and practice of CPGs and evidence-based medicine (EBM). Methods: A cross-sectional survey was conducted among FPs from the RS, BiH in the period between January and March 2014. Recruitment of FPs was performed combining two different strategies, in-person recruitment at family medicine conferences and mailed invitations. The Questionnaire included19 questions from the existing Healthcare Monitor Questionnaire, divided into four thematic blocks and 11 self-designed questions. Results: Seventy-seven per cent of 131 interviewed physicians reported already using guidelines in the treatment of patients, while 22.9% of them are undecided or disagree. As the reason for rejecting guidelines, 13.0% of the physicians stated they did not support their content, 12.2% found that limited knowledge about guidelines prevented their application, and another 12.2% reported that the current guidelines were not practical enough. All groups would rather not use guidelines developed by a governmental institution. Conclusion: Most physicians in the RS, BiH accept and declare application of CPG. However, a substantial percentage remains sceptical, using CPGs only as an exception, or rejecting them due to their content or impracticability. Key Messages Most physicians declare application of clinical practice guidelines. Substantial percentage of physicians remains sceptical, using CPGs only exceptionally. Further studies are needed to promote the use of CPG and the concept of EBM.