Background During the transition processes, the Western Balkan countries were affected by conflicts and transition-related changes. Life expectancy in these countries is lower, while the mortality from non-communicable diseases (NCDs) is higher in comparison with western and northern parts of Europe. The primary aim of this study was to analyze the treatment possibilities for the most common NCDs in the Western Balkan countries. The secondary aim was to understand and compare the policies regarding prescribing-related competencies of family physicians. Methods In June and July 2017, a document analysis was performed of national positive medicines lists, strategic documents, and clinical guidelines for the treatment of the most frequent NCDs; arterial hypertension, diabetes, hyperlipidemia, asthma, and chronic obstructive pulmonary disease (COPD). All text phrases that referred to medicines prescribing were extracted and sorted into following domains: medicine availability, prescribing policy, and medication prescribing-related competencies. Results Possibilities for treatment of arterial hypertension, diabetes, hyperlipidemia, asthma, and COPD vary across the Western Balkan countries. This variance is reflected in the number of registered medicines, number of parallels, and number of different combinations, as well as restrictions placed on family physicians in prescribing insulin, inhaled corticosteroids, statins and angiotensin II receptor blockers (ARBs), without consultant’s recommendation. Conclusion Western Balkan countries are capable of providing essential medicines for the treatment of NCDs, with full or partial reimbursement. There are some exceptions, related to statins, newer generation of oral antidiabetic agents and some of the antihypertensive combinations. Prescribing-related competences of family physicians are limited. However, this practice is not compliant to the practices of family medicine, its principles and primary care structures, and may potentially result in increased health-care financial ramifications to both the system and patients due to frequent referrals to the specialists.

Abstract Introduction The purpose of the present study was to examine self-perceived stress of health professions students at the Faculty of Medicine Foča, and to explore its association with anxiety, depression and health-related quality of life. Methods The cross-sectional study enrolled 451 students at the Faculty of Medicine (medicine, dentistry, nursing and speech therapy). Survey instruments were distributed at the conclusion of the spring semester during the last required lecture for each year and study programme class. Perceived stress was assessed using the 14-item Perceived Stress Scale. The students were evaluated for symptoms of depression and anxiety, using Zung’s self-assessment inventory for depression and the Spielberger State-Trait Anxiety Inventory (STAI). European Quality of Life-5 dimensions were used for describing and evaluating health. Multivariate analyses were carried out using logistic regression to examine the relationship between the outcome variable and selected determinant factors. Results A high degree of stress was reported by 1.6% of students, while the majority of students had either moderate (70.6%) or low degree (27.5%) of stress. The significant independent factors associated with perceived stress were anxiety score (OR, 0.339; CI 95%, 0.276-0.403) and EQ-5D score (OR, 0.044; CI 95%, 0.033-0.085). A high degree of perceived stress (OR, 0.624; CI 95%, 0.507-0.704), the presence of depression (OR, 0.800; CI 95%, 0.513-1.087), and low quality of life were associated with anxiety (OR, 0.073; CI 95%, 0.018-0.128). Conclusion Higher levels of perceived stress predispose health professions students for anxiety and lower quality of life. The study programme was not a significant determinant of perceived stress sore.

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).

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

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

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.