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 2 mg 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.

Objective. This study was undertaken with the aim to compare the effects of home-based habilitation programmes with the effects of hospital-based habilitation programme for children with cerebral palsy (CP) on motor performance and daily functioning. Patients and methods. The study was conducted on a sample of 60 children with cerebral palsy. First group included 30 children, 5 to 12 years old, who had a continued physical home treatment and education in public/special school. The second group consisted of 30 children, from Banja Luka region, who continued inpatient habilitation programme and training. Habilitation outcomes were analysed by measuring muscle tone (using original Tardieu Scale), muscle strength, range of motion (ROM), gross motor functions (gross motor function measure-88) and the Barthel Index of activities of daily living (ADL). Results. The proportion of clinically significant change in gross motor functions, ADLs, ROM and muscle strength didn’t show major differences between the two groups. Conclusion. There were no significant differences in effectiveness between home-based and hospital-based habilitation programmes according to the treatment outcomes. The effectiveness of home-based programme increases when supplemented by frequent consultations with the rehabilitation team members and occasional out-patient physical therapy treatment, education as well as counselling and support for parents. Original Article

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.

AIM To determine the validity and psychobiological significance of salivary cortisol as a biomarker of stress in the experiments. RESULTS Stress is defined as a state in which homeostasis is jeopardized by the action of various external and internal stressors. The effect of cortisol is made through specific receptors located in the cytoplasm of the target cells. Determining blood cortisol levels, which has been the most widely used method, is characterized by certain shortcomings. The process of taking blood samples from the vein is accompanied by additional stress, which results in falsely positive results. Another flaw is found in the fact that cortisol taken and measured from serum or plasma represents total cortisol, not the free, biologically active one. Cortisol response lags behind ACTH by 5-20 minutes, with peak blood levels achieved in 10-30 min. The transfer of cortisol from blood to saliva takes place rather quickly, within no more than 2-3 min. CONCLUSION Although, the studies on correlation between saliva cortisol concentrations and free levels of this hormone in blood samples are lacking, salivary cortisol offer a novel approach in research of stress biomarkers with its ease of collection and potentially wide scope for application.

Introduction: Quality of life is an important health outcome in its own right, representing the ultimate goal of all health interventions. Diabetes mellitus significantly affects the quality of life of patients. Objective: To evaluate the quality of life in patients suffering from type 2 diabetes mellitus in relation to the duration of the disease and the degree of glycemic control. Method: A prospective - descriptive study was conducted by interviewing patients with diabetes mellitus type 2, registered with two family medicine practices based at Family Medicine Teaching Center Banja Luka, as well as taking data from their medical records, during the period of 01.08 - 31.12.2011. As the instruments for this research the questionnaire SF-36 (for assessing the quality of life) and general questionnaire that contained data on age, sex, disease duration, Body Mass Index (BMI), glucose and HbA1c values were used. The patients were divided into 3 groups according to the duration of the disease. The first group included patients with a disease duration of up to 5 years, the second group with disease duration of 6-13 years and a third group of patients who have had diabetes 14 or more years. Results: The study included 95 patients suffering from type 2 diabetes mellitus. There were 42 (44%) male patients and 53 (56%) female patients. The HbA1c values taken from the patient's health records were used as a parameter for the control of diabetes. The target HbA1c value of <6.5 mmol/L was found in only 13 patients, with a HbA1c 6.6 to 7.5 mmol/L in 44 patients, and a HbA1c value of over 7.5 mmol/L in 38 patients. In relation to the duration of disease, statistically significant differences between the formed groups in any of the functional areas were not found. Among patients in the groups formed according to the degree of glycemic control statistically significant differences were found in the following areas of functioning: energy/fatigue (p=0.006), emotional functioning (p=0.008), social functioning (p=0.040) and pain (p=0.042). Conclusion: The duration of the disease does not affect the quality of life of patients suffering from type 2 diabetes mellitus, but degree of glycemic control is affecting the quality of life in patients. However patients with the best glycemic control did not have the best quality of life. .

Uvod. Analizirati elemente interakcije koji doprinose uspostavljanju kvalitetau komunikaciji između ljekara i bolesnika sa dijabetesom na nivou primarnezdravstvene zastite. Analizirati uticaj odnosa ljekar - bolesnik na ishodelijecenja dijabetesa.Metode. Studijom je obuhvaceno osam ljekara i sezdeset bolesnika oboljelihod dijabetes mellitus-a tip 2, izabranih prema specificnim kriterijumima.Ljekari su podijeljeni u dvije grupe. Eksperimentalnu grupu su cinili ljekarisa zavrsenom obukom iz komunikologije. Kontrolnu grupu su cinila cetiriljekara opste prakse bez obuke iz medicinske komunikologije. Svaki ljekar jepratio grupu od sedam ili osam bolesnika sa dijabetesom.Interakcija između ljekara i bolesnika je procjenjivana primjenom Bales-oveanalize interakcijskog procesa. Tokom devet mjeseci praceni su funkcionalniishodi tretmana, vrijednosti glikemije i HbA1c, saradnja i zadovoljstvo bolesnika.Rezultati. Razlike u ponasanja ljekara eksperimentalne i kontrolne grupe subile visoko znacajne po svim kategorijama Bales-ove analize. Kontrola vrijednostiglikemije i Hb1Ac je bila bolja kod ispitanika koji su: imali kontrolunad konsultacijom, aktivno ucestvovali u lijecenju, pokazivali emocije, tražiliinformacije i razmjenjivali misljenje sa ljekarom. Ispitanici eksperimentalnegrupe su imali statisticki znacajna poboljsanja funkcionalnih parametara imanje funkcionalnih ogranicenja nakon devet mjeseci, te su bili statistickiznacajno zadovoljniji njegom i karakteristikama ljekara.Zakljucak. Dobra komunikacija sa bolesnikom znacajno utice na poboljsanjeishoda lijecenja bolesnika sa dijabetesom. Praktikovanje modela njege usmjereneka bolesniku dovodi do potpunije razmjene informacija između bolesnika iljekara, vece zdravstvene aktivnosti i odgovornosti bolesnika, te uspostavljanjaefikasnije saradnje i zadovoljstva bolesnika. Obuku iz medicinske komunikologijetreba sprovoditi na svim nivoima studija medicine.

<p><strong>Introduction. </strong>The Delphi technique is a procedure where a panel of experts distributes questionnaires and collects back information for the purpose of coming to a group consensus on a specified topic. The aim of the study was to examine the effectiveness of the Delphi technique in determining educational needs of family physicians and nurses.<strong> Methods. </strong>The first group of participants included 12 doctors and 24 nurses, employed at the Health Center Foča. The second group of participants included 17 doctors and 31 nurses, employed at the Health Center Pale. In the research the Delphi technique with three iterative questionnaires was used. <strong>Results.</strong> The doctors and nurses in both groups came to consensus about the topics, methodology and lecturers. In both groups, the case survey and practical demonstrations had the greatest mean value while only 13% of the participants indicated the traditional didactic methods. At the Health Center Pale they did not come to consensus about the kind of supervision. At the Health Center Foča they did not come to consensus about the method of evaluation. <strong>Conclusion. </strong>The Delphi technique is a flexible and quick method of investigation which can be used for analyzing educational needs. This technique becomes more valid and effective in as much as the group of experts are able to follow and analyze the information until they come to a consensus. Continuing education for doctors and nurses should be based on problem-oriented learning instead of the traditional didactic method.</p>

Elder mistreatment is a widespread medical and social problem that is often under‐recognised by primary care physicians. The primary aim of this study was to estimate the prevalence of elder mistreatment among elderly patients with mental disorders in Bosnia and Herzegovina. One‐hundred‐and‐eighty‐four patients with different mental disorders were asked to complete the EAST questionnaire as part of a comprehensive geriatric assessment. Screening results were evaluated, and patients who had responses associated with ‘mistreatment’ were invited back to the clinics for additional clinical evaluation. Different types of mistreatment were identified in 71% of all patients. This led to a conclusion that screening for elder mistreatment should be a part of the routine health assessment for all older persons and a part of comprehensive geriatric assessment.