Introduction. According to the data of the World Health Organization (WHO), mental illnesses are on the rise. The World Health Report estimates that today about 1 billion people suffer from mental and behavioral disorders or psychosocial problems such as those related to alcohol and drug abuse. Stigmatization of the mentally ill is one of the burning social problems of those people, and the attitudes and behavior of nurses/technicians significantly affect the self-stigmatization of patients, and thus their condition and recovery. The main aim of this study was to assess attitudes of nurses and nursing students towards patients with mental illnesses. Method. The research conducted is a cross-sectional study. The study covered two countries, Bosnia and Herzegovina and Serbia. In June and July 2018, 200 nurses and nursing students from the second to the fourth year of study were surveyed. Data were collected with original anonymous questionnaires, which was made for the purpose of this research. Results. Seventy percent of nurses believe that people with mental illness are discriminated against in our society, while there are statistically significant differences between respondents in relation to demographic characteristics (ch2 = 10.217; p = 0.037). Nurses working in psychiatric wards show a lower level of stigmatization compared to nurses working in other wards (ch2 = 25.553; p = 0.001). Nursing students have more negative attitudes towards mentally ill people compared to nurses (ch2 = 13.471; p = 0.009). Nurses from Serbia show a higher level of tolerance towards people with mental disabilities compared to nurses from Bosnia and Herzegovina (ch2 = 16.115; p = 0.003). Conclusion. The results of the research show that stigmatization of patients with mental illness still exists among health professionals. Undergraduate and continuing medical education of nurses should include more content related to access to the patient with mental disorders, communication skills in psychiatry, mental health promotion and prevention of stigmatization.

Djeca sa smetnjama u razvoju manifestuju teškoće u razvoju i ne dosežu zadovoljavajući nivo razvoja, naročito ako im se ne pruži podrška u vidu njege i obrazovanja. Viši nivoi empatije su značajan faktor koji može uticati na pojavu pozitivnijih stavova učenika prema vršnjacima sa smetnjama u razvoju. Cilj istraživanja je bio da se procjeni da li empatija ima uticaj na stavove učenika prema vršnjacima sa smetnjama u razvoju. Studija je obuhvatila 120 učenika 4. i 5. razreda osnovnih škola, oba pola, uzrasta 10 i 11 godina. Istraživanje je rađeno u Banjaluci tokom 2020.godine. Ispitanici su podijeljeni na dvije grupe, one koji su pohađali nastavu sa učenicima sa smetnjama u razvoju i one koji nisu. Za ispitivanje stavova učenika prema učenicima sa smetnjama u razvoju korištena je Čedok Mekmaster skala, dok je za procjenu empatije korišten Indeks međuljudskog reagovanja. Korelacionom analizom utvrđena je značajna (r=0,18; p<0,05) pozitivna povezanost između stavova učenika prema vršnjacima sa smetnjama u razvoju i zauzimanja perspektive. Učenici koji pohađaju nastavu sa učenicima sa smetnjama u razvoju imaju značajno (t=-2,3; p=0,02) niže vrijednosti ukupnog skora stavova (3,05±0,28) u odnosu na učenike koji ne pohađaju (3,16±0,28). Naše istraživanje je pokazalo da empatija imaju značajan uticaj na stavove učenika prema vršnjacima sa smetnjama u razvoju i da učenici sa višim nivoem empatije imaju pozitivniji stav prema ovim vršnjacima. Takođe, učenici koji su u inkluziji imaju negativniji stav prema vršnjacima ometenim u razvoju u odnosu na učenike koji nisu u inkluziji.

Aims. The aim of this study was to examine self-perceived compassion fatigue and compassion satisfaction among family physicians in Bosnia and Herzegovina and describe potential contributing factors. Methods. The cross-sectional study enrolled 120 family physicians. Professional quality of life compassion satisfaction and fatigue version 5 (ProQOL5) was used to assess compassion satisfaction and two components of compassion fatigue, secondary traumatic stress and burnout. The symptoms of chronic fatigue were evaluated using the Chalder fatigue scale. Results. The majority of family physicians had moderate levels of compassion satisfaction (70%), burnout (75%) and secondary traumatic stress (55.8%). Family physicians with higher levels of secondary traumatic stress reported chronic fatigue (p = 0.001), longer length of service (p = 0.024) and residency training (p = 0.041). Chronic fatigue (p = 0.001), living in a rural environment (p = 0.033), larger size of practice (p = 0.006) and high number of patients with chronic disease (p = 0.001) were associated with a higher risk of burnout. Conclusion. Family physicians with large practices, long years of experience, a high number of chronically ill patients and experiencing chronic fatigue are at risk of developing compassion fatigue. A systematic exploration of compassion fatigue in relation to working conditions might provide an appropriate starting point for the development of preventive interventions.

OBJECTIVES Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. METHODS The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants' knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). RESULTS No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. CONCLUSION The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.

Maja N. Račić1, Srebrenka H. Kusmuk1, Srđan R. Mašić1, Nedeljka M. Ivković2, Vedrana R. Joksimović1, Jelena M. Matović1 1Department for primary health care and public health, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina 2Department of Dentistry, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina Impact of the physician-patient relationship on the treatment outcomes of arterial hypertension Оригинални радови / Original Articles

BACKGROUND Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. AIM To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. PATIENTS AND METHODS Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. RESULTS In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. CONCLUSIONS Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Background: Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. Aim: To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. Patients and methods: Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. Results: In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. Conclusions: Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Abstract Background: Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. Methods: The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Results: Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. Conclusion: This study indicates that a high proportion of 15–18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

The aim of this paper is to give a brief overview of research and the newest theoretical considerations on internet addiction classification and treatment. Over the past years we have been increasingly facing the so-called “new age” disease of internet addiction as a serious problem affecting numerous people, especially the young population who has made social networks and other internet contents a modus vivendi. A literature search was conducted for the purpose of locating information on prevalence, diagnosis and treatment of internet and computer addiction. Certain researchers and psychiatrists believe that the excessive internet use is a symptom of other disorders, such as depression and anxiety, or impulse control disorder. However, over the past few years a consensus has been reached that this constellation of symptoms is actually an addiction disorder. The American Society of Addiction Medicine (ASAM) has recently come up with a new definition, according to which addiction represents a chronic brain disorder. Consequently, the new American Classification of Mental Disorders (DSM-V) has introduced this form of addiction under the diagnostic category dubbed “cybernetic disorder”. The field of internet addiction is advancing rapidly through its official recognition as a separate and distinct addiction disorder. Some individuals with internet addiction are at significant risk and merit professional care and treatment. There are several treatments available, but the primary prevention is the most effective intervention. Family practitioners and psychiatrists should be taught to screen their patients for this disorder.

Background: Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. Aim: The purpose of this study was to determine the impact of motivational interviewing on treatment outcomes in patients with diabetes type 2. Material and Methods: A sample of 200 patients with diabetes type 2 was randomly selected from Diabetes Registry of Heath Centre Bijeljina, Bosnia and Herzegovina. Participants were divided into two groups. Intervention group consisted of 100 participants, who were included in three months long program of motivational counselling. Control group consisted of 100 participants who obtained patient education as a part of their regular care in family practice. The measures used to portray patient’s treatment outcomes included fasting blood glucose level, HbA1c, blood pressure, cholesterol, body mass index and smoking status. Results: Although both groups experienced changes in treatment outcomes from baseline to follow up, statistically significant improvements in fasting blood glucose level (χ2=6.607; p =0.037), HbA1c levels (χ2=4.023; p =0.045), blood pressure (χ2=4.063; p=0.044) and serum cholesterol level (χ2=6.728; p=0.035) were found in the first group at follow-up compared to the second group. Statistically significant differences in body mass index and smoking status were not found between the groups. Conclusion: The findings provided important evidence concerning the positive effect of motivational interviewing, which may be the most compelling reason to implement it more widely in routine primary diabetes care.

OBJECTIVE The primary objective of this paper is to examine the impact of diabetes mellitus on the ability to work in patients with diabetes mellitus. The second objective of this paper is to examine the differences in the ability to work between patients with diabetes mellitus and patients with other chronic diseases, such as hypertension. MATERIAL AND METHODS A study was conducted in 10 family medicine practices from two primary health care centers, Pale and East Sarajevo, in the period between July 2009 and May 2010, utilising a retrospective medical records review and a cross sectional survey. The outcomes used to portray respondent's health status included functional measures and ability to work. Functional measures were analyzed using SF-36 and a general questionnaire. Absenteeism and productivity loss were retrospectively analyzed for the past ten years from a regional sick-leave database and the administrative records of the Commission for the assessment of work capacity for the Pension and Disability Insurance Fund of the Republika Srpska respectively. RESULTS Out of the total number of patients with diabetes, 24.6% had some form of disability. A statistically significant difference was found between the two groups; patients with diabetes mellitus were much more likely to have problems meeting the required standards at the workplace due to emotional and physical health issues compared to hypertensive patients. CONCLUSION Diabetes mellitus appears to reduce an individual's ability to work in comparison to patients with hypertension. There is a need to set up a diabetes mellitus prevention program and to develop and implement effective targeted intervention to help workers to manage their disease better.

Introduction: Alcoholism is the third most common psychiatric disorder among the elderly, yet it often goes undiagnosed in primary care setting. Objective: To estimate the prevalence of alcohol use disorders among elderly primary care patients in Bosnia and Herzegovina and to determine the presence of different health problems related to alcohol consumption. Method: The study was conducted in 10 family medicine practices. Family physicians randomly selected a group of 40 patients over 60 years of age registered with their practice. As a part of Comprehensive Geriatric Assessment, patients were asked to complete Alcohol Consumption Screening Questionnaire, Functional Status Questionnaire, Geriatric Depression Scale (GDS), Mini mental screening examination (MMSE), and Hamilton Anxiety Scale. Screening results were followed by additional clinical evaluation. To estimate the feasibility of Alcohol Consumption Screening Questionnaire, one family member or a caregiver of each patient was questioned about patient's habits and health problems. Results: Eighty-nine (22%) patients were current drinkers. Of those, 59% were harmful drinkers, 26% hazardous and 15% nonhazardous drinkers. Women accounted for 27% of current drinkers. MMSE revealed dementia symptoms in 37%, and symptoms of mild cognitive impairment (MCI) in 25% of current drinkers. Depression symptoms were found in 38% and anxiety symptoms in 6% of current drinkers. Functional status was decreased in hazardous and harmful drinkers. Conclusion: High percentage of older adults in Bosnia and Herzegovina is regular users of alcohol. Hazardous and harmful drinking is associated with significant morbidity. These findings demonstrate the usefulness and importance of the excess alcohol use screening in all primary care settings serving adults over age 60.