AIM To determine the prevalence of mental and social disorders in adults who attend primary care health centers in Bosnia and Herzegovina. METHODS Sixty-nine family physicians from the Primary Care Research Network in Bosnia and Herzegovina each invited 20 randomly selected patients from their practices to complete the Patient Health Questionnaire (PHQ), which consists of 26-58 questions about symptoms and signs of depression, anxiety, somatization disorder, eating disorders, and alcoholism. A total of 1574 patients were invited to participate in the study. Physicians reviewed the PHQ and calculated the final score, which determined a provisional diagnosis. Definitive diagnosis was determined by further questioning and clinical knowledge of the patient. Data collection was performed between November 2003 and January 2004. Lists of non-participants were maintained by the physicians. RESULTS The response rate was 82%. Of 1285 respondents, 61% were women. At least one type of mental or social disorder was found in 26% of the respondents, and 12% had more than one disorder. Somatization disorder, major depression syndrome, and panic syndrome were experienced by 16%, 10%, and 14% of respondents, respectively, while 5% or less were suffering from eating disorders or alcohol abuse. More women than men had somatization disorder, panic syndrome, and binge eating disorder, while more men than women reported alcohol abuse. CONCLUSION More than one-quarter of all adults who attended family medicine centers in Bosnia and Herzegovina presented with at least one type of mental or social disturbance. New health policies, strengthened professional training, and accessible support networks need to be developed throughout the country.

Significant increase in mortality from coronary heart disease (CHD) has been seen in Bosnia and Herzegovina in the past decade. Little is known about current secondary preventive practices and treatments among patients with CHD in primary health care. The aims of this study were to evaluate the components of secondary prevention for CHD and to detect possible gender differences. This trial included 70 patients, aged 40-70 years, with established CHD from Family Medicine Teaching Center Tuzla. We evaluated components of secondary prevention (serum total cholesterol and blood pressure levels, smoking habits, body mass index, using aspirin, ACE inhibitors and lipid lowering drugs) in all participants. Results showed that significantly more men than women had diagnosis of CHD. 26/70 (37.14%) patients had myocardial infarction, with significantly higher number of men than women, but more women had angina only. Mean systolic blood pressure was 148.09+/-20.22 and diastolic 91.62+/-10.17 mmHg; mean total cholesterol level was 6.23+/-1.33 mmol/l; mean BMI was 27.9+/-3.32 kg/m(2). Blood pressure was managed according to guidelines in 19 (27.14%), and lipid concentrations in 11 (15.71%) patients. 55/70 (78.71%) patients took aspirin, only 18/70 (25.71%) patients took lipid lowering therapy, and 20/23 (86.96%) patients with heart failure took ACE inhibitors. 16/70 (22.86%) patients were current smokers, only 19/70 (27.14%) patients had healthy body mass index, while 21/70 (30%) patients were obese. Results of this study show a suboptimal secondary prevention in primary health care, which indicate more effective public health messages and changes in the healthcare system that promotes preventive strategies.

Low HDL cholesterol (HDL-C) level and smoking are known risk factors for coronary heart disease. The effect of cigarette smoking on HDL-C level was analysed in this study, with aim to determine whether smoking causes lowering its level. Study included 105 participants, aged 30-70 years, from Family Medicine Teaching Center of Dom zdravlja Tuzla. Smoking status was analysed and HDL-C level was measured after fasting for at least 12 hours in all participants. The greater number of smokers had HDL-C level < 1.03 mmol/L than non-smokers (P = 0.04). The greater number of non-smokers had HDL-C level > or = 1.54 mmol/L comparing with smokers (P = 0.001). Smokers had significantly lower mean HDL-C level than non-smokers (P = 0.003). Results suggest that cigarette smoking adversely affects HDL-C by lowering its level, which further increases the risk for developing coronary heart disease.

UNLABELLED: Prolonged forms of HAV infection are atypical forms of diseases which occur in up to 24% cases. In clinical mean those forms of disease are described as relapses (recidivisms) and recrudescence. During the three-year multi-centric study we have explored prolonged forms of HAV infection, on two geographically separated and epidemiologically different regions, from every aspect. The purpose of this study, in clinical biochemical sense, was to explore all clinical forms of this disease and determine its biochemical characteristics. This research involved 60 patients with prolonged HAV infection (PTHA) and 30 patients with conventional hepatitis A. During conventional HAV-infection the disease ends in 4 to 8 weeks. Markers of HAV, HBV and HCV infection were determined using ELISA method. Antigen HAV in stool was determined using method of reversed immuno-electro-osmopforesis. Circulating immune complexes was determined photometrical in the sediment poliethylenglicole on rollers length of 450 nm. Research has shown that the PTHA manifests in three clinical forms: recrudescence, relapse and "prolonged hepatitis A from the beginning". All forms of PTHA were often significantly icteric with a clearly shown clinical pictures (p<0.05). Every new disease episode (relapse and/or recrudescence) is in average of smaller intensity than the initial infection. CONCLUSIONS: Clinically clear PTHA infection manifests through recrudescence in 66,8 % of cases, through relapse in 26,6 % of cases and "prolonged hepatitis A from the beginning" in 6,6 % of cases. Recrudescence appears significantly often one time rather than two or more times (p<0.001). Relapse never appeared:after recrudescence, and it was not noted more than once. "Prolonged forms of disease from the beginning" could represent relapse/recrudescence whose initial disease phase remained sub clinic. Average duration of PTHA is five times longer than in the control group. Men tend to fall ill from PTHA twice as much as woman.

HDL-cholesterol is the independent negative risk factor for coronary hearth disease. Level by =1,54 mmol/l is appropriate, while level by < 1,03 mmol/l is associated with elevated risk for coronary hearth disease. Beside other factors, lifestyle has important influence on HDL-cholesterol level. Inadequate diet, obesity, smoking cigarettes, physical inactivity and excessive alcohol consumption result in lowering its level. Life-style modification (healthy diet, lowering weight in obese patients, smoking cessation, moderate alcohol consumption and regular physical activity) will have a positive effect on the HDL-cholesterol level, as on the other risk factors for cardiovascular diseases, which will improve community health.

Arterial hypertension (AH) is one of the commonest noninfective chronic disease according to its important and the role in the morbidity and mortality, which is the reason for patients coming to the family phisician. Detection and treatment of high blood pressure are the major responsibility of physician in the primary care. If the family physician team (physician and nurse) make a good assessment of the risk factors which is important in development of arterial hypertension, the appearance of disease and its complications can be prevented or delayed. The most important for prevention of arterial hypertension is adoption a healthy lifestyle and it is nonseparate part of arterial hypertension treatment.

There are three major modifiable risk factors for coronary hearth disease: smoking, hyperlipidemia and hypertension. Smoking acts synergistically with other risk factors increasing the risk for cardiovascular morbidity and mortality. Many epidemiological studies consist hard and consistent relationship between smoking and coronary hearth disease, which is related with duration and number of smoking cigarettes. On the other side. high risk for coronary hearth disease in ex smokers decreases substantially in the first 2 to 3 years, and after that degree of lowering risk decreases in such way that after 10 years former smokers have the same risk level as never smokers. Because the cardiovascular diseases are leading cause of death in world today, smoking cessation is one of the most important intervention of primary care physician for reduction morbidity and mortality from coronary hearth disease and improvement overall community health.