ABSTRACT Objectives: The aim of this study was to evaluate a frequency and clinical presentation of hypertension crises due to age, gender, duration and seriousness at Emergency Medical Service Department of the “Dr Mustafa Šehovic” Health Care Center Tuzla. Methods: The research was conducted in the period between November 2009 and April 2010 and involved 180 examinees of both genders, aging between 30 and 80 years of age with the diagnosis of arterial hypertension. The examinees were divided into two groups: control group consisting of examinees without hypertension crisis (95 examinees) and experimental group consisting of examinees with hypertensive crisis (85 examinees). Descriptive statistical methods were used in the statistical data processing. Results: The research results showed that there had been significantly more female examinees than the male ones (60% vs. 40%; p=0.007). The average age of male examinees was 55.83±11.06 years of age, and the average age of female examinees was 59.41±11.97 years of age. The hypertension crisis frequency was 47.22%, where the hypertensive urgencies were statistically significantly more present than the hypertensive emergencies (16.47%vs.83.53%; p<0.0001). The largest number of experimental group examinees (28.23%) belonged to the age group of 60 to 69 years of age; urgency 26.76% and emergency 35.71%. The largest number of examinees with hypertensive crisis (49.41%) appeared in the period between 6.00 p.m. and 11.59 p.m. The largest number of emergency group examinees (69.01%) had been treated for arterial hypertension for ten years, and the examinees from the emergency group (42.86%) had been treated for 10, 11 and 20 years. The average blood pressure value at the hypertensive crisis examinees was 204.82/126.58 mmHg. Conclusions: The frequency of hypertensive crises in the Emergency Medical Service Department is high and it reaches 47.22%. Hypertensive urgencies were significantly more present in terms of statistics than the hypertensive emergencies (83.53% vs. 16.47%; p<0.0001).

Introduction: Factors of cardiovascular risk (CVR) are often grouped in cases with diabetes mellitus (DM) with significant increasment of risk for CV disease . The aim of this research is to determine the frequency of CVR and and total CVR in cases with DM and to investigate connection of CRP of other factors of CVR in total cardiovascular risks. Material and methods: In 92 cases with DM weist values were taken as well as body mass index (BMI), blood pressure, sugar in blood, cholesterol, triglycerides, C reactive protein (CRP) and according to SCORE system the 10 year period of CVR were determined. Results: Out of 92 tested cases with age 55,22± 8,3 years, 63,05% were males and 36,95% were women, 81,5% were with values of sugar in blood >7mmol/l, 44,6% were with values of HbA1C>7% and 63,0% >6,5%. The value of cholesterol were >4,5mmol/l in 87%, triglycerides >1,7mmol/l in 78.3% of tested cases. 81,5% of tested cases were overweight and 49% with larger weight values. Average cardiovascular factor according to SCORE system was 3, 92± 3,7% with significant difference among sexes (M-4,86; W-2,32, p3mg/l) 52% of tested cases were with high cardiovascular risk. There is significant positive correlation between CRP and cholesterol level (p<0, 01), triglycerides, blood in sugar, HbA1c and upper values of blood pressure (p<0, 05). Significant correlation between CRP and total cardiovascular risk (p=0, 63) was not evident. Conclusion: Cases with diabetes mellitus have high level of non regulated cardiovascular risk factors. Even though there is significant correlation between CRP and and pressure values, sugar in blood, HbA1c, cholesterol, triglycerides, significant correlation between CRP and total cardiovascular risk in cases with diabetes mellitus is not evident.

AIM To analyse the difference in documentation of standard parameters for monitoring DM type 2 between Family Medicine Teams (FMT) and Teams on Program Additional Training (PAT). METHODS Study was conducted as 20 medical chart audits of diabetic type 2 patients randomly selected per 3 FMT from Zenica and 3 PAT from Kakanj. According to the chart, we assess sex, age, glucose in blood-GB, blood pressure-BP, total cholesterol-TC, body mass index-BMI, HbA1c, foot exam, eye exam and urinoanalisis and have any of the tests been done in the past year. RESULTS 60 medical chart from FMT and 60 medical charts from PAT teams were reviewed. FMT vs. PAT teams recorded: BG 58% vs. 30% (X2 = 8.651, p = 0.003); BP 70% vs.33% (X2 = 14.716, p = 0.0001); TC 35% vs.22% (X2 = 2.011, p = 0.156); BMI 48% vs.28% (X2 = 4.266, p = 0.038); HbA1c 41% vs.75% (X2 = 12.377, p = 0.0004); foot exam 26% vs. 78% (X2 = 28.158, p < 0.0001); eye exam 48% vs. 65% (X2 = 2.749, p = 0.097) and urinoanalisis 38% vs.88% (X2 = 30.179, p < 0.0001). CONCLUSION FMT recorded a higher number of metabolic parameters for macrovascular risk factors (BG, BP and BMI) than microvascular risk factors (HbA1c, foot exam and urinoanalisis) which are were better controlling by PAT teams.

AIM To evaluate HbA1c level for diabetic type 2 patients after the implementation of guidelines for diabetes mellitus (GDM) in primary health care settings. According to recommendations of the European Society of Cardiology and European Association for the Study of Diabetes, HbA1c ≤ 6.5 % is considered as optimal level. METHODS A retrospective analysis randomly selected medical records of DM type 2 patients who were older than 18 before and after the review. Nineteen Family Medicine Teams (FMT) reviewed every second record (46 per FMT) in the family medicine facilities in Zenica two years prior and after the introduction of the Diabetes Mellitus 2 Guidelines. All noted values of HbA1c and all FMTs have been divided to those which reached an optimal level of HbA1c ≤ 6.5 % and those with an inadequate level (non-optimal level of HbA1c p< 6.5 %). RESULTS Records of 853 patients with type 2 diabetes were analyzed. A total number of HbA1c recorded in the FMT medical records increased significantly after the GDM implementation from 103 (12.1%) to 318 (37.3%). A significant improvement towards an optimal level of HbA1c was noted after the implementation GDM by all FMTs together (7 vs. 92; 6.7% vs. 28.9%; p<0.0001). Only FMT 4 and FMT 14 (2 vs.19; P < 0.05) reached the optimal level of HbA1c. CONCLUSIONS Family medicine teams improved the level of HbA1c according to the recommended guidelines for diabetes mellitus after their application. Quality variations of care extended to diabetics have been noted in individual family medicine teams.

Background. Transfusion therapy represents a rational model of therapy which is frequently used in neonatal period. Aim.to investigate predictive role of blood group, Rh factor and gestational age in transfusions reaction in neonates. Patients and methods. we evaluated 95 neonates gestational age between 28 and 42 weeks treated with blood components. All neonates were treated in the Unit of Neonatology at Department of Gynecology and Obstetrics at University Clinical Center Tuzla in the period of 01.01.2006.-31.12.2008. Results. During the period of investigation there were 12 526 born neonates gestational age from 28 to 42 weeks. Incidence of transfusion reaction was 0, 37%. The median of gestational age in the complete sample was 38 weeks, with interquartile range from 35 to 39 weeks, with 28 weeks minimum and 40 weeks maximum. The incidence of transfusion reaction in relation with the blood group was most evident in recipients in blood group type A, but there were no statistically significant differences in incidence of transfusion reactions between four blood groups (X2=6.352; df=3; p=0.097). There was no statistically significant difference in incidence of transfusion reaction according to the Rh factor (X2=0.755; df=1; p=0.385). Investigation of transfusion reaction according to the blood group and Rh factor showed no statistically significant difference (X2=8.063; df=7; p=0.327). The logistic regressional analyses showed that the gestational age is significant predictor of appearance of transfusion reaction (OR=0.867; %95 CI=0.756 do 0.993; p=0.04). Conclusion. Transfusion reactions in neonates are not rare. The blood group and Rh factor are not valid in prediction of transfusion reaction while the gestational age is good predictor in appearance of transfusion reaction.

INTRODUCTION The clinical and epidemiological data show that proper nutrition plays an important role in maintaining health and combating the danger of developing some chronic diseases in the elderly population. Nutrition is an important factor in many physiological and pathological changes that accompany the aging process. More than 50% of elderly patients are suffering from malnutrition which is information that concerns. Due to various factors, older people are potentially vulnerable groups at risk of malnutrition. Loneliness, isolation from society and neglect of parents by children is a big problem to many people in old age. OBJECTIVE To determine differences in nutritional status of elderly people living alone compared to those who live in family surroundings. SUBJECT AND METHODS The study was conducted in the municipality of Tuzla in 2009-2010, in outpatient family medicine Simin Han. The survey covered a total of 200 elderly subjects (age >65 years). Subject group consisted of 45% of people living alone, and 55% control group consisted of elderly patients who live in traditional family surroundings. Questionnaires used in this study are General geriatric assessment questionnaire and Mini nutritional status. RESULTS The average age (+/- SD) was 75.4 +/- 6.2 years in subject group, while the same in the control group was 74.9 +/- 5.6 years. In subject group significantly more patients are on the verge of poverty. There are significant differences in the classification of financial status, according to the groups (p = 0.043). Members of subject groups have significantly lower BMI categories (p = 0.03) compared with the control group. In our study, people who live alone are at increased risk of malnutrition (p = 0030), have reduced the number of daily meals, significantly lower daily intake of protein, fruits and vegetables in the diet in relation to persons living in a family environment. Significantly more patients with loss of appetite live alone. According to the existence of self-reported food problems significantly more people are in subject group. There is a difference value score "Small assessment of nutrition" between the two groups (p = 0.001). About 22% of the total number of respondents said they have not so good health status compared to others. CONCLUSIONS Loneliness is a significant predictor of anorexia nervosa, the risk of malnutrition and malnutrition. Results indicate that it is necessary to work on improving the status and protection of elderly.

1 Kljucne rijeci: stres, mobing, žrtve mobinga, privremena sprijecenost za rad SAŽETAK: Mobing ili psiholosko zlostavljanje usmjereno je prema jednom pojedincu koji je stavljen u poziciju u kojoj je bespomocan i u nemogucnosti da se zastiti od stalnih maltretirajucih aktivnosti. Mobing ima negativne posljedice na zdravlje zaposlenih, sto povecava stopu izostanka s posla zbog bolovanja. Cilj rada je procijeniti ucinke mobinga na privremenu sprijecenost za rad (apsentizam) u medicinskih tehnicara. Prospektivnom studijom poprecnog presjeka analizirali smo stopu prevalencije mobinga i njegove ucinke na apsentizam u medicinskih tehnicara u primarnoj njezi. U istraživanju smo se koristili validnim upitnikom samoodgovorom među 274 (239 žena i 35 muskaraca) medicinskih tehnicara. Za analizu rezultata primjenjivao se standardni Statisticki paket za drustvena istraživanja (SPSS) verzija 10.0. Statisticke hipoteze testirane su na razini od α = 0.05. Među ispitanicima 87% bile su žene. Oko 54% ispitanika imalo je iskustvo mobinga u prethodnoj godini, a 24% (36/147) bilo je perzistentno izloženo mobing ponasanju (žrtve mobinga). Ispitanici s iskustvom mobinga statisticki cesce su imali sve simptome vezane za stres i mobing, izuzev depresije i nesanice. Oko 22% ispitanika se izjasnilo da se koristilo privremenom sprijecenoscu za rad (bolovanjem). Srednja vrijednost izgubljenih radnih dana po ispitaniku je M±SD= 6,76±22,00 (rang: 1-180) dana. Bolovanje kao i dužina bolovanja su statisticki znacajno udruženi s ocjenom trenutne radne sposobnosti, ocjenom odnosa zdravlja i radnih zadataka (WAI) i mobingom (P=0,001). Mobing je rasirena pojava među zdravstvenim radnicima. Vise od pola medicinskih sestaratehnicara je bilo izloženo mobingu u prethodnoj godini. Osobe koje su prijavile mobing dva su puta cesce bile na bolovanju.

BACKGROUND Blood pressure (BP) is one of the important parameters for controlling Diabetes Mellitus (DM). European Society of Cardiology recommended optimal level for DM BP < 130/80 mmHg. AIM We wanted to assess the level of BP for our DM patients after using specific guidelines for DM. METHODOLOGY Retrospective medical record (audit) has been conducted among 853 DM patients older then 18 years. We checked patient charts among 19 FM teams two years before (May 2003-May 2005) and two years after (May 2005-May 2007) implementation of the DM guidelines in Family Medicine (FM) clinic in Zenica. We divided FM teams based on their patients BP values; optimal level of BP < 130/80 mmHg; suboptimal level when systolic BP 130-140mmHg and diastolic 85-90 mmHg and that with inadequate level with BP>140/90mmHg. RESULTS 853 DM patient charts were analysed, 46 per FM team. Average age of DM patients was greater than 60 years and average age of doctors was 46.6. Percentage of BP inadequate level was smaller after implementation of DM guidelines in most of FM teams. For optimal level BP < 130/80 mmHg, significant improvement was seen after implementation of DM guidelines for: 6/19 teams (p < 0.0001), 2/19 teams (p < 0.001) and 2/19 teams (p < 0.01). CONCLUSION After implementation of BP guidelines for DM patients, BP can be improved in patients treated by FM teams and guidelines should be used.

INTRODUCTION Special attention needs to be given to resolution of obesity problem among children because many studies indicate that majority of persons that have suffered from obesity during their child age still have the same problems when they become adults. Incorrect nutritional habits cause health problems at later age. The purpose of this study is to determine the frequency of overweight and obesity occurrence among school-age children, as well as risk factors that certainly lead to obesity. METHODS This research was conducted on sample of 530 pupils from one elementary school from suburban area. Assessed children were from seven to fourteen years old. Anthropometric measurements were taken and questionnaires and general medical examinations followed with the statistical processing of collected data. RESULTS Based on the Body Mass Index (BMI) considering age and gender of examined subjects we have found that 14.7% subjects were overweight and 7.3% of children were obese. Also, we have determined that children often use food that is identified as risk factor for obesity. Overweight and obesity are directly related to amount of time spent in front of TV set or personal computer (p = 0.01). Children that were overweight in 57.1% cases would prefer to change their nutritional habits and 68.4% of obese children would like to do so as well. Children that were obese, in high percent would like to change habits regarding their physical activity (57.9% of them) and overweight children in 33.8% cases. CONCLUSION It is necessary to encourage young people to develop healthy nutritional habits, to promote physical activity and sports, and definitely to strongly advice against the sedentary lifestyle. It is crucial to educate parents on healthy nutritional habits and physical activity because they have the strongest influence on their children. Also, effort needs to be taken in schools by increasing number of physical education classes and to provide healthy food in school canteens in order to ensure improvement of physical activity and healthy nutritional habits among children.

Numerous studies had shown that lifestyle modifications canreduce the risk for subsequent coronary events or death in patientswith pre-exiting coronary heart disease (CHD). Stoppingsmoking, regular physical activity and making healthyfood choices are an integral part of total risk management inpatients with CHD. We evaluated gender differences in lifestylecomponents of secondary prevention for CHD (smokingstatus, physical activity and dietary fat intake) in patientswith established CHD. This prospective trial included 130randomly selected patients from Family Medicine TeachingCenter Tuzla (66 men and 64 women), aged 40-80 years,with established CHD. We determined smoking status in allparticipants and assessed dietary fat intake by using modifiedDietary Intake Nutrition Evaluation method (DINE). We assessedintensity of physical activity in all participants by usingBorg scale for perceived exertion. Mean age of participantswas 64.9 ± 7.8 years; 28/130 patients were daily smokers(22%), while 60/130 patients were ex-smokers (46%). Morethan one third of patients had never smoked (32%), with significantlymore women than men (p = 0.003). Mean dietaryfat intake was 35.4 ± 6.0 g/day; 59/130 patients self-reportedregular physical activity (45%). Mean intensity of physical activitywas 9.3 ± 1.6 and significantly higher in men than inwomen (p = 0.002). Results of this study showed unhealthylifestyles in patients with coronary heart disease that indicatesthe need for more effective intervention by primary careteams to change behavior and modify lifestyles in order toreduce risk for recurrent coronary events.

Health care system in Bosnia and Herzegovina is undergoing major reforms, including reorganization of primary health care offices from being general medicine in primary health care units into family medicine practices according to European accreditation standards. To be successful, general practitioner’s teams have to acquire new skills and knowledge from the fields of family medicine in order to get close to accreditation standards Twenty general practitioners teams from three Federal cantons conducted medical record clinical revision on diabetes mellitus according to standards provided by Bosnia and Herzegovina Federal Agency for Healthcare Quality and Accreditation. The results of medical records clinical revision on 210 females and 190 males on diabetes mellitus were not satisfactory. Proportion of positive inspection results was the best in the group of blood pressure readings recorded in the record, but the number of patients with foot examination (40%); BMI (39%) and HgbA1C (20,75%) noted in the record during the last year was significantly low comparing to requested standards. Good preparation for future work as family medicine teams who will work under European standards provided by Federal Agency for Healthcare Quality and Accreditation needs continuation of education for doctors in general medicine field and should be recommended as a standard.

Deep venous thrombosis (DVT) is common condition, which principally affects the veins in the lower leg and thigh. It is the most common in adults over 60 years of age, but it can occur in any age group. More than 200,000 new cases of deep venous thrombosis occur annually. Of these, 30 percent of patients die within 30 days from onset, one fifth of the patients suffer sudden death due to pulmonary embolism, and about 30 percent of patients develop recurrent DVT within 10 years. The most common risk factors for developing the deep venous thrombosis are recent surgery or hospitalization. Other risk factors, which include advanced age, obesity, infection, immobilization, fractures, childbirth within the last 6 months, use of combined (estrogen-containing) forms of hormonal contraception, smoking and air travel ('economy class syndrome'), are some of the better-known causes of DVT. Over the last 10 years, new strategies for diagnosing suspected DVT have been introduced. One of them is use of clinical criteria that takes into account signs, symptoms and risk factor for developing DVT and which can be accurately applied to categorize probability of DVT. These clinical criteria are also useful to identify patients that can have benefit from prolonged anticoagulant therapy. Pulmonary embolism, which is the worst complication of DVT, can be life threatening, so the establishing of accurate diagnosis and rapid treatment of DVT help to prevent this problem and to save patient's life.

Smoking causes decrease of HDL-cholesterol (HDL-C) levels and increase of total cholesterol, triglyceride and LDL-cholesterol (LDL-C) levels. Low HDL-C levels and high cholesterol and LDL-C levels are associated with a higher risk for cardiovascular diseases. The aim of this study was to examine the effect of smoking status on serum lipid and lipoproteins levels among patients in family medicine practice. This trial was designed to detect differences in serum total cholesterol, triglyceride, LDL-C and HDL-C levels between smokers and non-smokers. We had placed a limit of 300 patients for data collection. We excluded 195 patients who met excluding criteria (diagnosis of diabetes mellitus, renal and hepatic failure, hypothyroidism; using beta blockers, thiazide diuretics, hormonal replacement therapy and corticosteroids; more than light physical activity; alcohol consumption and obesity), so the sample size included 105 randomly selected patients from Family Medicine Teaching Center Tuzla, mean age 52.05 +/- 11.61 years. Main outcomes were smoking status in all participants and serum total cholesterol, triglyceride, LDL-C and HDL-C levels in smokers and non-smokers. Our results showed that smoking prevalence was 49.52%. Smokers had significantly higher serum total cholesterol (P=0.01), triglyceride (P=0.002) and LDL-C level (P=0.03) and significantly lower HDL-C level (P=0.003) comparing with nonsmokers. There was no significant difference in serum lipid and lipoprotein levels between ex-smokers and never smokers. These results suggest that cigarette smoking adversely affects serum lipid and lipoprotein levels which further increases the risk for cardiovascular morbidity and mortality.