Прегледај по Аутор "Račić, Maja"
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- СтавкаBiomarkers of Stress in Saliva(University of Niš - Faculty of Medicine, Niš, 2015) Ivković, Nedeljka; Božović, Đorđe; Račić, Maja; Popović- Grubač, Dijana; Davidović, BrankicaStress 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.
- СтавкаComprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients(Taylor & Francis, 2015) Račić, Maja; Petković, Nenad; Bogićević, Koviljka; Marić, Ivko; Matović, Jelena; Pejović, Velimirka; Kovačević, Marijana; Djukanović, LjubicaBackgrounds: 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. BMI425 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.
- СтавкаDetection of diabetic polyneuropathy in a family medicine clinic by using monofilament(Military Medical Academy, 2022) Lakić, Biljana; Petrović, Verica; Račić, Maja; Stanetić, KosanaBackground/Aim. Diabetic polyneuropathy (DPN) is the most common microvascular complication of diabetes melli-tus (DM), which may be present at the time of disease detec-tion. Screening for DPN is performed for the patients with type 2 diabetes at the time of diagnosis and for type 1 diabe-tes 5 years after diagnosis. The primary aim of this study was to determine the prevalence of DNP among family medicine patients with DM aged 18 to 70 years using nylon monofila-ment. Methods. The cross-sectional study estimated the prevalence of DPN among primary care patients with DM in Banja Luka, Republic of Srpska, Bosnia and Herzegovina. Semmes-Weinstein nylon 10 g monofilament was used to de-tect DPN. Age, gender, duration of DM, type of therapy, symptoms, glycosylated hemoglobin (HbA1c), and risk fac-tors (hypertension, smoking, dyslipidemia, obesity, physical inactivity) were analyzed. Data collection took place from June 1st, 2017 to May 31st, 2018. Results. The study includ-ed 228 patients, 132 (57.9%) men and 96 (42.1%) women. There was a statistically significant difference in the presence of all symptoms of DPN (tingling, burning, light burning, and stinging) among patients with different duration of DM (p < 0.01). Multivariate logistic regression revealed that patients who had hypertension [odds ratio (OR) = 26.2; 95% confi-dence interval (CI): 4.070–168.488; p = 0.001], used oral anti-diabetic therapy (OR = 12.3; 95% CI: 1.300–116.309; p = 0.029), had tingling (OR = 5.2; 95% CI: 1.431–18.571; p = 0.012) and a longer duration of diabetes (OR = 4.27; 95% CI: 1.983–9.175; p = 0.000) were more likely to have DPN. Con-clusion. The prevalence of DPN in family medicine patients with DM using nylon monofilament was 24.2%. Determi-nants of DNP were the presence of symptoms of tingling, duration of diabetes, hypertension, and the use of oral antidi-abetic therapy alone.
- СтавкаEvaluation of biochemical markers effectiveness in elderly malnutrition assessment(Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019) Gavran, Larisa; Pavlović, Jelena; Račić, Maja; Ivković, Nedeljka; Tušek Bunc, KsenijaAim To systematically review the scientific evidence of biomarker validity, reliability, specificity and sensitivity in identifying malnutrition in the elderly. Methods Peer-reviewed journals were searched using PUBMED and EBSCO from January 1998 to April 2018. The articles included description of the association between malnutrition blood biomarkers and validated nutritional status assessment instruments and studies were conducted among community-dwelling elderly or nursing home residents. Results The research strategy identified a total of 293 studies. This literature review picked out seven articles for follow-up evaluation. A total of sixteen blood biomarkers were identified. Six studies found a significant association between the nutritional assessment score and albumin level. Conclusion Combining serum concentrations of malnutrition biomarkers with nutritional status assessment tools has a great potential in identifying the risk of malnutrition in the elderly, while also increasing sensitivity and specificity.
- СтавкаExtended Working Life Policies(Springer, 2020) Račić, Maja; Pranjić, NurkaSimilar to other European countries experiencing growth in their 65+ populations, Bosnia and Herzegovina have also been affected by an intensive population ageing process. This national phenomenon affects the pension system, the health system and the labour market. A brief description of extending working life in the socio-economic context in Bosnia and Herzegovina, including gendered statistics on employment for older workers and pension coverage, is presented in this chapter. There is a discussion on extended working life policies, pension reforms , pensions systems and policy, and relevant employment and health policies for older workers. Flexible employment policies and training for older workers have not yet been introduced in Bosnia and Herzegovina. Future policy recommendations are also discussed.
- СтавкаFamily physicians’ perspectives on clinical guidelines, a survey from the Republic of Srpska, Bosnia and Herzegovina(Taylor & Francis, 2016) Račić, Maja; Eremija, Svjetlana; Mašić, Srđan; Joksimović, Bojan N.; Stanetić, KosanaBackground: 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.
- СтавкаHandgrip Strength Cut-Off Values for the Undernutrition Risk Screening among Elderly Men and Women in Bosnia and Herzegovina(Hindawi, 2019) Račić, Maja; Pavlović, Jelena; Ivković, NedeljkaObjectives: To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina. Design: Cross-sectional study. Setting: Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina. Participants: 300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer. Results: According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65-74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65-74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65-74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65-74 years), 19.50 kgF (≥75 years for women). Conclusion: HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in Bosnia and Herzegovina.
- СтавкаMedicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries(Frontiers, 2017) Pekez-Pavlisko, Tanja; Račić, Maja; Kusmuk, SrebrenkaBackground: 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 healthcare financial ramifications to both the system and patients due to frequent referrals to the specialists.
- СтавкаOutcomes of intrahospital antimicrobial stewardship programs related to prevention of Clostridium difficile infection outbreaks(Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2018) Mijović, Biljana; Dubravac-Tanasković, Milena; Račić, Maja; Bojanić, Janja; Stanić, Slobodan; Banković Lazarević, DušicaAim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C. difficile associated disease (CDAD) among adult inpatients. Results Implementation of ASP interventions was associated with CDAD incidence reduction in 62.5% studies, but no significant differences were reported for the duration of hospitalization, readmission and mortality rate. Improvements in prescribing patterns (decreased antimicrobial use or increased rational use) and microbial outcomes (decreased rates of selected antimicrobial-resistant bacteria) were reported. Evidence on the effects of ASP is mainly limited to the results of studies low in methodological quality with great heterogeneity of outcomes, interventions, and units in which CDAD incidence data were reported. Conclusion Despite the low strength of evidence of reviewed studies, consistency of findings suggest the positive impact of antimicrobial stewardship programs on the prevention and control of nosocomial CDAD. The significance of this problem imposes randomized control trial use as the best instrument to provide highquality evidence. Further studies need to systematically analyse changes in all antibiotic use and its outcomes
- СтавкаQuality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina(Elsevier, 2015) Račić, Maja; Kusmuk, Srebrenka; Mašić, Srđan; Ristić, Siniša; Ivković, Nedeljka; Djukanović, Ljubica; Božović, DjordjeObjectives: In the present study, the audit of medical files of patients with diabetes, followed in family medicine practices in the eastern region of Bosnia and Herzegovina (BiH), was carried out in order to investigate the frequency of the use of screening tests for early diagnosis of diabetes complications. Methods: The audit was conducted in 32 family medicine practices from 12 primary health care centers in the eastern part of BiH over one-year period (March 2010 to March 2011). A specially established audit team randomly selected medical files of 20 patients with diabetes from the Diabetes Registry administered by each family medicine team database. Screening tests assessed are selected according to the ADA guidelines. Results: Frequency of the individual screening test varied between 99%, found for at least one blood pressure measurement, and 3.8% for ABI measurement. When the frequency of optimal use of screening was analyzed, only 1% of patients received all recommended screening tests. Conclusion: The frequency of the use of screening tests for chronic diabetes complications was found to be low in the eastern part of Bosnia and Herzegovina. Multivariate linear regression analysis showed that longer duration of diabetes and a larger number of diabetics per practice were associated with a smaller number of screening tests, but specialists in family medicine provided a higher number of screening tests compared to other physicians
- СтавкаQuality of osteoarthritis care in family medicine – A cross-sectional study(Serbian Medical Association, 2016) Račić, Maja; Tošić, Milena; Mašić, SrdjanIntroduction 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.
- СтавкаSalivary Cortisol Levels as a Biological Marker of Stress Reaction(Academy of Medical Sciences of Bosnia and Herzegovina, 2013) Bozovic, Djordje; Račić, Maja; Ivkovic, NedeljkaAim: 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. he 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. he process of taking blood samples from the vein is accompanied by additional stress, which results in falsely positive results. Another law 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. he 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.
- СтавкаSalivary cortisol responses to acute stress in students with myofascial pain(Serbian Medical Association, 2018) Božović, Đorđe; Ivković, Nedeljka; Račić, Maja; Ristić. SinišaIntroduction/Objective Temporomandibular disorders (TMD) are characterized by the appearance of musculoskeletal pain and dysfunction of the masticatory system. The aims of this study were to evaluate the salivary cortisol levels in students with chronic myofascial pain (MFP) related to TMD during oral exam, as well as to analyze the correlation between salivary cortisol levels, TMD-related MFP, the level of anxiety, depression symptoms, somatization, and perceived stress. Methods The study included 60 university students, who were allocated either into the group of students with MFP (n = 30) or into the control group of healthy students (n = 30). The level of salivary cortisol was measured on the exam day and during the control day when the students had no exams. Depression symptoms, somatization, perceived stress and anxiety were evaluated according to Axis II RDC/TMD, Perceived Stress Scale and State–Trait Anxiety Inventory. Results Levels of salivary cortisol were significantly higher in the group of students with MFP in all phases of measurements compared to the control group (p < 0.01). Students with MFP also showed significantly higher depression symptoms, somatization, and trait anxiety scores than the control group. No significant group differences were found on the scales measuring state anxiety and perceived stress. The level of salivary cortisol was found to be in correlation with depression symptoms, state anxiety, and perceived stress, but not with chronic pain, somatization, and trait anxiety in students with TMD. Conclusion Salivary cortisol could be an important indicator of psychological distress in TMD.
- СтавкаScreening of undiagnosed depression among elderly primary care patients: a cross-sectional study from the Republic of Srpska, Bosnia and Herzegovina(Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2020) Stanetić, Kosana; Petrović, Verica; Stanetić, Bojan; Kević, Vesna; Stanetić, Mirko; Matović, Jelena; Kusmuk, Srebrenka; Račić, MajaAim To examine the prevalence of undiagnosed depression among primary care elderly patients in the entity of the Republic of Srpska (Bosnia and Herzegovina) as well as the sociodemographic and clinical risk factors associated with depression. Methods A cross-sectional study was conducted between April and June 2019 in nine towns of the Republic of Srpska. The study sample included 1,198 primary care patients older than 65 years of age. Research instruments included a sociodemographic questionnaire and Geriatric Depression Scale - Short Form (GDS-SF). Results Positive screening test (GDS-SF score > 5), which indicates depression was found in 484 (40.4%) participants. Multivariate regression analysis showed that lower education levels [OR = 1.565, 95% CI (1.13-2.17)], divorced and widowed [OR = 1.366, 95% CI (1.16-1.62)], poor financial situation [OR = 1.690 , 95% CI (1.25-2.29)], non-home residents [OR = 2.200, 95% CI (1.41- 3.44)], non-hobby patients [OR = 2.115, 95% CI (1.54-2.91) ], non-friends [OR = 3.881, 95% CI (2.70-5.57)], patients suffering from chronic pain [OR = 2.414, 95% CI (1.72-3.39)], patients with daily life limitation activities [OR = 1.415, 95% CI (1.03-1.95)], patients with three or more chronic diseases [OR = 1.593, 95% CI (1.12-2.27)], patients using five or more drugs [OR = 1.425. 95% CI (1.00-2.03)], and patients with history of previous depression [OR = 2.858, 95% CI (1.94-4.21)] were at higher risk for depression. Conclusion The prevalence of undiagnosed depression in the elderly in Republic of Srpska is high. Future strategies are needed to strengthen screening of geriatric depression in primary health care.
- СтавкаThe effects of interprofessional diabetes education on the knowledge of medical, dentistry and nursing students(Academy of Sciences and Arts of Bosnia and Herzegovina, 2017) Račić, Maja; Joksimović, Bojan N.; Cicmil, Smiljka; Kusmuk, Srebrenka; Ivković, Nedeljka; Hadživuković, Natalija; Kulić, Milan; Mijović, Biljana; Mirić, Mirjana; Joksimović, Vedrana R.; Dubravac, MilenaObjectives. Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. Methods. The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants’ knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). Results. No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. Conclusion. The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.
- СтавкаThe role of the psychiatrist in obtaining informed consent from patients with somatic and mental comorbidity. Report of one case(Sociedad Medica de Santiago, Chile, 2014) Medenica, Snezana; Račić, Maja; Vukovic, Mira; Ristic, Sinisa; Karic, JasminaThe 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.
- СтавкаTwenty-five years on: revisiting Bosnia and Herzegovina after implementation of a family medicine development program(Springer, 2020) Hodgetts, Geoffrey; Brown, Glenn; Batić-Mujanović, Olivera; Gavran, Larisa; Jatić, Zaim; Račić, Maja; Tešanović, Gordana; Zahilić, Amra; Martin, Mary; Birtwhistle, RichardBackground: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited Bosnia and Herzegovina (B-H) 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, Health Center Directors and Association Leaders. Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes were analyzed using an interpretative phenomenological approach to identify major themes and subthemes. Results: Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources). Conclusions: Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in B-H to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.