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.

This paper examines indirect growth rates of the global tanker shipping market over the period 2010 – 2020. The evaluation and analysis of the relevant variables of the model and the resulting indirect growth rates have been aimed at a scientific formulation of the research findings and have been used to describe the most important theoretical principles governing the worldwide tanker shipping market over the observed period of time. The basic hypothesis has been confirmed through the indirect growth rates of the selected model variables. In this way a scientific confirmation of the hypothesis has been provided: “On the basis of scientific insights into the global tanker shipping market, it is possible to calculate the indirect growth rates of the information model for the global tanker shipping market for the period from 2010 to 2020.”

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 prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specific for nutritional status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications. The electronic databases were searched using defined key words adapted to each database and using MESH terms. Manual revision of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community: Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk. MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and continuous validation in the study with a higher level of evidence need to be conducted in family medicine.

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.

Abstract Backgrounds: The quality of life and survival of elderly depend not only on their age but on many social and health factors. In the present study, comprehensive geriatric assessment (CGA) was made in elderly patients on regular hemodialysis (HD) and those without chronic kidney disease recruited in primary health care in order to compare their sociodemographic characteristics, physical health, functional ability and social support. Method: The 106 HD patients and 300 primary care patients aged 70 years and more were studied. Data on sociodemographic characteristics, neurosensory deficits, pain, falls, polypharmacy, basic activities of daily living (ADL) questionnaire, instrumental activities of daily living (IADL) questionnaire were obtained during interview. The Timed Up and Go, Nutritional Health Checklist, Two Question Instrument for depression and Charlson comorbidity index (CCI) were applied. Results: No significant differences were found for age, gender, education level and dwelling between the two groups. A lower percentage of HD patients lived alone when compared with controls. BMI >25 kg/m2 had 43.4% of HD patients and 49.3% of controls. CCI differed significantly between HD and primary care patients (median: 6 vs. 4) and significantly more HD patients reported depression. No significant difference was found between groups for cognitive dysfunction and ADL, but HD patients had significantly lower IADL scores than controls. The mobility of HD patients was worse; 45.7% of them reported falls in the previous year but only 9.7% from the controls. Conclusions: CGA revealed that HD patients had significantly higher CCI, worse IADL score, mobility and reported more frequent falls, depression and impaired vision than primary care patients.

SUMMARY Stress is defined as a state in which homeostasis, as a dynamic balance of internal conditions necessary for the proper functioning of cells or the living organism as a whole, is affected by the action of various stressors. Stress reaction occurs as a result of stress system activities, which is located in the central and peripheral nervous system. Stress evaluation involves a qualitative and quantitative analyses and valuation of certain biologically active substances (biomarkers of stress) in body fluids that are so often associated with stress. Saliva as a diagnostic medium is being increasingly used for purposes of clinical and basic research because of its composition and content as well as the advantages of the process of sampling, as compared to traditional methods of collecting blood samples and urine samples. Cortisol, as a biomarker of stress, is the most often studied salivary biomarker, which is associated with the activation of the hypothalamic-pituitaryadrenal (HPA) axis. Since stress leads to the suppression of the immune system, values of salivary secretory IgA and salivary lysozyme, as biomarkers of stress, can be analyzed. In saliva, it is difficult to monitor acute stress parameters, catecholamines, due to their low concentrations, rapid degradation and instability in the samples. Chromogranin A (CgA) and α-amylase enzyme can be used as alternative indices of adrenergic activity during stress reactions, due to their stability in saliva and reliability of the obtained values. Stress reaction and the diseases in whose pathogenesis it participates are yet another proof of the constant interaction of physical, psychological and social factors in health / disease SAŽETAK Stres se definiše kao stanje u kome je homeostaza, kao dinamička ravnoteža unutrašnjih uslova neophodnih za pravilno funkcionisanje ćelija ili živog organizma u cjelini, ugrožena djelovanjem različitih stresora. Stresna reakcija nastaje kao posljedica aktivnosti tzv. stres sistema, koji je smješten u centralnom i perifernom nervnom sistemu. Stres sistem, preko odgovarajućih medijatora, stimuliše kataboličke, lipolitičke, antireproduktivne i imunosupresivne efekte stresne reakcije s ciljem preusmjeravanja energije zbog povećane potrebe organizma u trenutku značajnim za njegovo preživljavanje. Evaluacija stresa podrazumijeva kvalitativno i kvantitativno analiziranje i vrednovanje određenih biološki aktivnih komponenti (biomarkera stresa) u tjelesnim tečnostima koje se dovode u vezu sa stresom. Pljuvačka se kao dijagnostički medijum sve češće koristi za klinička i bazična istraživanja zbog mogućnosti koje pruža, s obzirom na njen sastav i sadržaj kao i na prednosti samog procesa uzorkovanja u odnosu na tradicionalne metode prikupljanja uzoraka krvi i urina. Od biomarkera stresa, u pljuvački je najčešće ispitivan kortizol, koji se dovodi u vezu sa aktivacijom hipotalamus-hipofiza-adrenalne (HPA) osovine. S obzirom da stres dovodi do supresije imunog sistema, u pljuvački se mogu analizirati i vrijednosti sekretornog IgA i lizozima kao biomarkera stresa. Parametre akutnog stresa, kateholamine, teško je pratiti u pljuvački zbog njihove male koncentracije, brze degradacije i nestabilnosti u uzetim uzorcima. Kao alternativni indeksi adrenergičke aktivnosti tokom stresne reakcije, zbog stabilnosti u pljuvački i pouzdanosti dobijenih vrijednosti, mogu se koristiti hromogramin A (CgA) i enzim α-amilaza. Stresna reakcija i oboljenja u čijoj etiopatogenezi ona učestvuje još su jedan dokaz stalne interakcije fizičkih, psihičkih i socijalnih faktora u zdravlju/bolesti

Bosnia and Herzegovina is a country in Southeastern Europe located on the Balkan Peninsula. During communist rule, the health care system in the former Yugoslavia was centralized. Primary medical care was provided by specialists in centralized polyclinics or health centers, and in smaller community-based clinics called ambulates, staffed by general practitioners (without formal residency training) and nurses. With the end to the war in 1995, the BiH government, with support from international organizations and multilateral agencies such as the World Bank, began a health care reform program to restructure its health system. The reforms aimed to develop a new model of PHC centered on family medicine. The Family Medicine Development Project in Bosnia and Herzegovina was an initiative funded by the Canadian International Development Agency (CIDA) that was sparked by a visit to Queen’s University by the Dean of the Medical School in Sarajevo in 1995. He came specifically to encourage the Department of Family Medicine to look into the possibility of helping our country establish an effective primary care infrastructure based on the Canadian family medicine model. The project introduced family medicine into undergraduate curricula, established three-years long program of residency in family medicine in 1999, created departments of family medicine in all medical schools, helped with the process of establishing a professional college of family doctors, worked with ministries of health to establish supportive policies for these activities, and regularly provided continuing medical education programs for family practitioners during the 13 years of the project.

The number of elderly with chronic kidney disease (CKD) is constantly increasing worldwide, and irregular screening of CKD leads to disease discovering usually in advanced stages. The aim of the study was to examine the presence of CKD biomarkers in the elderly primary care patients, and to analyze whether the presence of diabetes and hypertension in elderly increases the risk for microalbuminuria and reduction of glomerular filtration rate (GFR). Cross-sectional study included 90 patients older than 65 years of age who are registered in the Family medicine teaching centre of Health centre Bijeljina. Patients were divided into three groups: first consisted of 30 patients who had neither hypertension nor diabetes nor other chronic disease, second of 30 patients with type 2 diabetes mellitus and third of 30 patients with arterial hypertension. Data on patients were obtained by interview, analysis of medical records and physical examinations. Serum and urine creatinine, proteinuria, microalbuminuria (MAU, turbidimetry), and urinary sediment were analyzed. Biomarkers of chronic kidney disease (GFR <60 mL / min / 1.73m2, proteinuria and mikroalbuminurija ¬MAU) were found in 20 (22.2%) patients. Among them, 14 had normal GFR and MAU (12) or MAU and proteinuria (2), whereas 6 had GFR <60 mL / min / 1.73m2 of which 3 had proteinuria and / or MAU. The group with diabetes had significantly more MAU compared to the other two groups, while the groups with diabetes and hypertension had slightly more proteinuria and erythrocyturia than control group. Hypertension and diabetes in the elderly may result in development of CKD biomarkers, so prevention and regular screening of CKD in the patients with these two diseases are necessary.

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.

The nature of mental disorders, the attitudes and prejudices of the social community towards psychiatric patients, the behavior and treatment of mental patients, all bring about numerous dilemmas and prejudices. When a patient is diagnosed with a mental disorder, he may suffer restrictions in the field of general human rights. However, the biggest problems in clinical practice occur in the treatment of patients who, besides their mental disorder also have a somatic disease. We report a 56-years-old female with a severe renal failure who refused to undergo dialysis. Following the patient's refusal to sign an informed consent, a psychiatrist was called in for consultation and diagnosed an acute psychotic reaction. To manage the delusions and acute psychotic reactions, risperidone in the dose of 2mg was started. After 22 days, the patient still had marked psychotic symptoms. A psychiatrist, a nephrologist and an anesthesiologist, in the presence of the spouse on the grounds of her life-threatening condition, decided to apply the necessary medical procedures even without the patient's consent. A day after the start of dialysis the patient still had delusional ideas, but without the presence of anxiety, and the patient no longer offered resistance to dialysis. Four days after the first dialysis, the patient was calm, had vague memories about the entire previous period, and signed the informed consent concerning her further treatment.