Uvod. Dijabetes znacajno utice na radnu sposobnost i kvalitet života oboljelih. Profesionalna radna angažovanost ima uticaj na tok bolesti i kvalitet života. Cilj rada je ispitivanje kvaliteta života pacijenata sa dijabetesom u zavisnosti od radnog statusa i izloženosti zaposlenih stetnostima radnog mjesta. Metode. Istraživanje je obavljeno u Domu zdravlja Pale i Domu zdravlja Istocno Sarajevo u periodu od maja 2012. do novembra 2012. godine. Istraživanjem je obuhvaceno 150 bolesnika sa dijabetesom oba tipa (tipa I i tipa II), a koji su insulin zavisni u odnosu na terapijski tretman, prosjecne starosti od 56,1 godine. Bolesnici su prema statusu zaposlenosti podijeljeni na zaposlene i nezaposlene. Za ispitivanje kvaliteta života koristen je upitnik SF-36 kao i opsti upitnik kreiran za potrebe ispitivanja. Statisticka znacajnost razlika između grupa određena je primjenom χ2 testa i t-testa. Rezultati. Vrijednosti svih domena kvaliteta života kod nezaposlenih ispitanika su manje nego kod zaposlenih, kao i vrijednosti sumarnog fizickog skora (42.6 ± 9.8, p<0,001) i sumarnog mentalnog skora (37,5± 13,5, p=0,010). Vrijednosti domena: fizicko funkcionisanje, uloga-fizicka, tjelesni bol i opste zdravlje su vece kod zaposlenih koji nisu izloženi stetnostima na radnom mjestu od vrijednosti kod ispitanika izloženih stetnostima. Vrijednosti domena: vitalnost, socijalni odnosi, uloga-emocionalna i mentalno zdravlje ispitanika neizloženih stetnostima na radnom mjestu znacajno su vece od vrijednosti onih izloženih stetnostima. Zakljucak Radna angažovanost znacajno utice na kvalitet života oboljelih od dijabetesa, a profesionalne stetnosti dodatno negativno uticu na kvalitet života osoba oboljelih od dijabetesa.

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).

Contemporary societies are facing high increase of population over 65 years of age within the total population. It is a result of lifespan extension, advances in medicine and science in general, improvement of quality of life, etc. [1]. The elderly represent a vulnerable population group whose needs are numerous, diverse and highly specific. Health, social and economic needs of this category are intertwined and mutually connected as a whole, which requires specific approaches and adjustment of work in family medicine to these needs. High incidence of chronic and degenerative diseases leads to progressive decrease of functional skills in physical, psychological, but also in all other aspects of life [2, 3]. University of East Sarajevo, Bosnia and Hercegovina Original study Faculty of Medicine, Foča, Republic of Srpska1 Originalni naučni rad UDK 616-001-084-053.9:613.98 https://doi.org/10.2298/MPNS1710277P

Đorđe Božović1, Nedeljka Ivković1, Maja Račić2, Siniša Ristić3 1University of East Sarajevo, Faculty of Medicine, Department of Oral Rehabilitation, Foča, Republic of Srpska, Bosnia and Herzegovina; 2University of East Sarajevo, Faculty of Medicine, Department for Primary Care and Public Health, Foča, Republic of Srpska, Bosnia and Herzegovina; 3University of East Sarajevo, Faculty of Medicine, Department of Basic Medical Sciences – Physiology, Foča, Republic of Srpska, Bosnia and Herzegovina

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.

Introduction Effective treatments for osteoarthritis are available, yet little is known about the quality of primary care in the Republic of Srpska for this disabling condition. Objective The main objective of this study was to analyze the overall quality of osteoarthritis treatment in a family medicine setting, as well as to explore whether the achievement of quality indicators was associated with particular patient characteristics and severity of osteoarthritis. Methods The cross-sectional study included 120 patients with confirmed hand, knee, and hip osteoarthritis, recruited at seven family practices in the town of Ugljevik, Republic of Srpska, Bosnia and Herzegovina. Data were extracted from a patient questionnaire on quality indicators, as well as from their electronic and paper records, to assess care against 14 indicators. The included quality indicators were based on the Arthritis Foundation’s Quality Indicator set for Osteoarthritis. Summary achievement rates for hip, knee, or hand osteoarthritis, as well as for the total sample, were calculated. Results The mean achievement rate for all 14 quality indicators obtained from medical records was 74%, and 77% obtained from patient interview. The quality indicators concerning referral for weight reduction (23%) and pharmacological treatment (24%) had the lowest achievement rates, whereas the highest achievement rates were related to physical examination (100%), pain and functional assessment (100%), and education (90.8%). Patients physical functioning was significantly associated with the quality indicator achievement rate (p = 0.001). Conclusion Pharmacological therapy and the referral of osteoarthritis patients in need of weight reduction seem to have the greatest potential for improvement in primary health care.

Introduction: Various risk factors contribute to the occurrence of acute myocardial infarction as the most serious type of ischemic heart disease and the leading cause of sudden death worldwide. Aim of the Study: The aim of this study was to assess the frequency of changeable and unchangeable risk factors in patients with acute myocardial infarction in the Republic of Srpska. Patients and Methods: This cross-sectional study included patients treated for acute myocardial infarction at the University Clinical Center of Banja Luka, in the period from January 1st to December 31st, 2011. The patients were from the municipalities of Banja Luka and Laktaši. We analyzed the following risk factors: hypertension, total cholesterol values, diabetes, increased body weight and obesity, smoking, family history and physical inactivity. Results: Out of 273 patients, the majority were male (64%), and there was a statistically significant difference between age and sex (p <0.01) of the respondents. The most common risk factor for both genders was hypertension (70.1%), while the least frequent risk factor was diabetes mellitus (25.6%). Smokers and ex-smokers accounted for 58.1%, with a statistical significance between men and women (p <0.01). The average BMI in both genders was in the overweight category (27.69 kg / m2). A positive family history was found in almost half of the respondents (49.4%), with a statistically significant difference between age groups and family history (p = 0.036). Conclusion: Acute myocardial infarction mainly affects men in their sixties, while women are averagely affected nine years later than men. The number one risk factor for both genders is hypertension. Given the large impact of risk factors on the occurrence of acute myocardial infarction, priority must be given to the prevention and control of the aforementioned, especially in the primary health care.

OBJECTIVE The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. PATIENTS AND METHODS This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. RESULTS The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (p<0.001). The average time from the onset of symptoms to arrival at the family practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. CONCLUSION The severity of symptoms affected the patients' decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required.

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.

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.