Introduction: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). Aim: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. Methods: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). Results: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). Conclusion: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.

Aim: The aim of the study was to determine the differences in nutritional status and risk for malnutrition between nursing home and community-dwelling residents. Methods: Cross-sectional study included 146 nursing home residents and 300 community-dwelling elderly adults from four municipalities in Bosnia and Herzegovina. Anthropometric measurements, biochemical analyses, nutritive, functional and cognitive assessments were carried out. Nutritional status and risk for malnutrition were assessed by Mini Nutritional Assessment (MNA), Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (Screen II) and the food intake analysis for the past 24 hours. Functional status was assessed by the Lawton scale, the Katz Independence Index, Timed Up and Go test, the Functional Reach Test. Mini Cog test and Six-item cognitive impairment test were used for the evaluation of cognitive functioning. Results: The incidence of high nutritive risk by SCREEN II (100%) and being “at risk for malnutrition” by MNA (81.60%) was higher among nursing home residents compared to community-dwellers. Community-dwelling elderly people had higher BMI (27.94 ± 4.73), weight (78.40 ± 13.99), height (167.69 ± 9.74), waist circumference (97.77 ± 12.88), hip circumference (104.61 ± 11.47), mid-arm arm (27.54 ± 3.58), hip (27.54 ± 3.58) and calf circumference (34.02 ± 5.16 ). Statistical differences in regards to place of living were found in functional status (p<0.001), cognitive functioning (p<0.001) and hand grip strength (p<0.001). Conclusion: The frequency of malnutrition and high nutritional risk was higher in respondents who were living in the nursing homes compared to community-dwellers. The results of this study showed that health professionals involved in the care for institutionalized elderly people should implement routine screening of malnutrition within the comprehensive geriatric assessment in their daily practice.

Introduction: Violence at work has become an alarming problem worldwide. The real size of the problem is unknown because of underreporting. The aim of the survey was to estimate the prevalence of workplace violence (WPV) among primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants. Aim: The aim of the survey was to estimate the prevalence of workplace violence (WPV) among Primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants. Methods: A cross-sectional study was conducted between March and May 2017. The sample consisted of medical professionals employed at HCSC. The data were collected by a questionnaire with 42 questions divided into 7 blocks of topic. Descriptive statistics were used to describe the sample. Binary logistic regression analysis was used to test the association between the occurrence of violence and independent variables (gender, age, years of work experience and office setting). Results: A total of 558 out of 983 health professionals employed in Primary health care were involved in this survey. The overall prevalence of WPV was 90.3%, with 498 (89.2%) exposed to verbal violence and 417 (74.7%) exposed to indirect physical violence. Binary logistic regression analysis indicated that the following demographic and work-related characteristics were positively significantly associated with WPV: women were associated with verbal violence [Odd ratio (OR) 1.91, 95% confidence interval (CI) 1.06, 1.47] and stalking [OR= 2.06, 95% CI (1.04, 4.08)]. Office setting (urban) was significantly positively associated with indirect physical violence [OR= 1.59, 95% CI (1.03, 2.47)]. Conclusion: Almost all health professionals in Sarajevo primary health care were subjected to different types of WPV. There is a need for intervention to provide safer workplace environment. Professional, administrative, legal support and protection of health professionals by the health authorities and institution management is urgently required.

Introduction: Lower urinary tract symptoms are highly prev-alent in aging population, particularly in men. Comorbidities, such as diabetes mellitus, hypertension, heart failure and meta-bolic syndrome are contributing the progression of these symp-toms. The aim of this study is to assess the association between the degree of lower urinary tract symptoms with hypertension. Methods: Patients are men 50 – 70 years of age (n= 206), who do not have any prostate pathology and had no surgical inter-ventions regarding LUTS, nor use organ specific symptom relief therapy. The data were collected during two months, from April to June 2018. In this cross-sectional study we used IPSS ques-tionnaire to assess lower urinary tract symptoms. Results: The mean age of patients is 60.6. Of the total number of patients, 67% have hypertension. It was found that there is a significant positive correlation between the age and the IPSS, while no significant variation was detected in the total IPSS be-tween patients who suffer from hypertension and those who do not. The probability that patients with hypertension have mod-erate or severe symptoms of lower urinary tract is 1.54 times higher than in patients without hypertension. No significant correlation has been noted between the amount of cigarettes consumed annually and the severity of LUTS according to IPSS. Conclusion: In family medicine, men suffering from hyperten-sion do not have more intense lower urinary tract symptoms ac-cording to the IPSS than those who do not have hypertension, regardless of the age group. Keywords: lower urinary tract symptoms, prostate, hyperten-sion, men

Cardiovascular diseases (CVDs) are the major cause of disability and premature death all over the world. Annually, 17.5 million people die from CVDs, representing 30% of the total number of deaths. Despite established guidelines for the treatment of acute coronary syndrome, cardiac weakness, atrial fibrillation and CVD prevention, many patients remain inadequately treated, particularly in less developed nations. A brief overview of the development of CVDs, description of the current practice guidelines, and a cross sectional analyses of the status of CVD prevention and control in the Federation of Bosnia and Herzegovina is given. In the past 7 years, there has been a steady increase in deaths, where half of all deaths in the Federation of Bosnia and Herzegovina are attributed to CVDs. Deaths from the acute myocardial infarction had a rate of 91.0/100,000 inhabitants, a significant increase compared to 2010, when this rate was 69.2. The second leading cause of death, a stroke, with a rate of 87.1 showed a slight decrease compared to 2010, when it was 89.9. The third leading cause of death, heart failure, with a rate of 68.4, has a slight decrease compared to 2010, when the rate was 75.7. CVDs are the leading cause of mortality in Federation of Bosnia and Herzegovina, which, in addition to the large number of premature deaths, also causes major costs for the health sector and economy.

Introduction: Immunization is a lifelong preventive activity that helps prevent/reduce disease, prevent/ reduce mortality and prevent disability from specific infectious diseases. Material and Methods: Authors of this paper researched the WHO extended program of mandatory immunization of children from birth to the age of 18 years and analyzed how it has been implemented in the Federation of Bosnia and Herzegovina (FB&H), because the guidelines of the specialist physician societies on immunization of adults, elderly people and risk groups of the population are missing. Results: The paper presents the basic characteristics of the immunization program in the FB&H and the world, points to the most frequent problems that the doctor practitioner has in carrying out immunization, and also presents possible modalities of improving immunization. It is pointed out the need to develop the national guidelines and individual immunization booklets, introduction of electronic registration of immunization, and continuous education of health professionals of all profiles, population, educators, teachers and harmonious partnership relations of health workers, population, social entities and the media with the aim of achieving an appropriate lifelong vaccination.

Objectives: To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. Patients and methods: The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Results: Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. Conclusion: The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

Introduction: Managing organizational culture has been increasingly viewed as a lever for health care improvement. The aim of this study was to investigate the correlation between the type of organizational culture and patient satisfaction in the selected health care centers in the Federation of Bosnia and Herzegovina (FBIH). Methods: We conducted a cross-sectional survey in two municipal primary health care (PHC) centers in the FBIH, referred as Primary health care (PHC) center A and Primary health care (PHC) center B. A validated questionnaire, known as the Organizational Culture Assessment Instrument (OCAI), was used for the assessment of organizational culture. The questionnaire was distributed among the family health care teams at the two PHCs. Simultaneously, we carried out a survey about patient satisfaction among patients during their visits to the family health care teams. Results: We observed the differences in the type of the organizational culture between the health care centers. The hierarchical culture was found the dominant culture in PHC center A, whereas the market culture was the dominant culture in PHC center B. Also, the statistical significance (t test) was recorded in the overall patient satisfaction in the health care center with the dominated hierarchical culture followed by the clan culture (PHC center A). Conclusions: Considering the lack of similar surveys in Bosnia and Herzegovina, we believe that this study might be a good starting point for education of human resource managers in health care.

Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors and 51 students. Ten questions were taken from cardiac pathophysiology and 10 questions from pulmonary pathophysiology, and each question was assessed on the criteria of practicality and logic. A nonparametric Mann-Whitney test was used to test the difference between evaluators. On the criteria of logic, only four out of 20 items were evaluated differently by students in comparison to doctors, two items each from the fields of cardiology and pulmonology. On the criteria of practicality, for six of the 20 items there were statistically significant differences between the students and doctors, with three items each from cardiology and pulmonology. Based on these indicative results, students should be involved in the qualitative assessment of exam questions, which should be performed regularly under a strictly regulated process.

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).

Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors and 51 students. Ten questions were taken from cardiac pathophysiology and 10 questions from pulmonary pathophysiology, and each question was assessed on the criteria of practicality and logic. A nonparametric Mann-Whitney test was used to test the difference between evaluators. On the criteria of logic, only four out of 20 items were evaluated differently by students in comparison to doctors, two items each from the fields of cardiology and pulmonology. On the criteria of practicality, for six of the 20 items there were statistically significant differences between the students and doctors, with three items each from cardiology and pulmonology. Based on these indicative results, students should be involved in the qualitative assessment of exam questions, which should be performed regularly under a strictly regulated process.

Damir Secic, Dzenana Husremovic, Eldan Kapur, Zaim Jatic, Nina Hadziahmetovic, Benjamin Vojnikovic, Almir Fajkic, Amir Meholjic, Lejla Bradic, and Amila Hadzic Department of Pathophysiology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Department of Psychology, Faculty of Philosophy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Department of Anatomy, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Department of Family Medicine, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Public Institution Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; Dean’s Office, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina; and BoHeMSA, Bosnian and Herzegovinian Medical Students’ Association, Sarajevo, Bosnia and Herzegovina