NON-COMMUNICABLE CHRONIC DISEASES RISK PREVALENCE OF FAMILY MEDICINE PATIENTS IN THE FEDERATION OF BOSNIA AND HERZEGOVINA.

AIM: The aim of this study is to represent the prevalence of non-communicable diseases risks among patients of family medicine practices in the Federation of Bosnia and Herzegovina. Risks prevalence was obtained from an organized massive screening being performed by 100 family medicine teams in four cities of the Federation of B&H during 2013. MATERIAL AND METHODS: Our concept of "preventive treatment of a patient" included detecting and monitoring the following chronic non-communicable diseases risk factors: (a) hypertension; (b) obesity; (c) smoking; (d) physical inactivity; and (e) dyslipidemia; (f) diabetes mellitus. Our sample of examined patients was 46.638. RESULTS: Highest risk prevalence within entire F B&H is observed for dyslipidemia (90.3%) and physical inactivity (64.7%). Lowest prevalence was found for blood sugar and hypertension at 19.2% and 21.6%, respectively. Smoking prevalence of the examined patients was 28.4%. Prevalence of the obesity as health risk (ITM > 30) was 25.5 %. It is of interest that statistically significant differences of individual risk prevalence among cities are evident. Risk distribution among cities ranked from highest to lowest prevalence, shows clearly that Sarajevo is leading in four risks compared to the other cities, while Zenica is ranked lowest for four risk factors. The examined population of the four cities can be ranked from lowest to highest prevalence of the examined risk factors as follows: Sarajevo, Mostar, Tuzla, and Zenica.

Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

AIM: To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. METHODS: In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. RESULTS: Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). Patients with lower level of education were more likely: to be ordered for physical examination (p = 0.001), to buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p < 0.001); to pay unofficially to someone from medical staff (p < 0.001); to feel that they could be better treated (p = 0.032) and they had longer waiting for health service in primary care practice (p < 0.001). Older population had better assessment of secondary (p = 0.040) and tertiary health care practices (p = 0.034); needed more time is needed to reach health facilities (p = 0.016), longer waiting for health service in primary care practice (p < 0.001); more likely to have health problems in the past 12 months but they did not request medical treatment (p = 0.008); more likely to be ordered for physical examination (p < 0.001); more likely to buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). CONCLUSION: The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

RURAL - URBAN DIFFERENCES IN HEALTH CARE QUALITY ASSESSMENT.

AIM: To determine the rural-urban differences in primary care practice, hospital inpatient care and total services. METHODS: This cross-sectional study used data from Zenica-Doboj Canton in Federation of Bosnia and Herzegovina (FBiH). The overall sample size for the study was 1,995. Individual interviews were conducted in one randomly selected day of the week, except Monday and Friday, on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. RESULTS: Out of total number (n=1 995), 47.9% was urban population and median of age was 42 years for both populations. The most of urban residents (81.4%) had finished high school or higher education compared with rural residents (58.5%) (p < 0.001). There are significant differences in employment status between rural and urban population (p < 0.001). Rural residents are more likely to travel more than 15 minutes to see their health facilities compared with urban residents (61.7% vs. 24.4%, respectively). Median of distance (kilometers) from residence location to the nearest hospital was statistically significantly higher in rural Me = 8.0 (5.0 do 14.5) km compared to urban population Me = 1.5 (1.0 to 3.0) km (p < 0.001). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). CONCLUSION: There are significant differences in the overall health care assessment of rural populations as compared to urban populations.

Suicide frequency in West-Herzegovina Canton for the period 1984-2008.

The aim of this study was to examine trends of the number of suicides in four municipalities of West-Herzegovina Canton (Siroki Brijeg, Ljubuski, Grude, Posusje) during the period 1984 through 2008, as well as case distribution by gender, age and how the suicides were committed. Study results showed the total number of cases during the studied period was 134. Number of suicide cases in the prewar period during 8 years (1984-1991) was 33. During the war period (1992-1995) the number of cases dropped to 15. Statistically significant growth of number of suicides (86 cases) in 12 postwar years (1996-2008), compared to prewar and war figures, is interesting. Gender distribution research results showed presence of statistically significant difference in number of cases with males and females, with 106 and 28, respectively (p < 0.01). Age distribution research showed that suicide cases are more frequent with two age groups (20-29 and over 60 years), with statistically significant difference compared to figures for the other groups. Breakdown of manner how suicide was committed is the following: hanging (32%), fire weapon (22.8%), drowning in water storage cisterns (11.2%) and other manners (14.60%). Significant growth of suicide number in postwar period indicates the need for further research of socio-economic determinants of health and war traumas with the objective of putting some light on etiological factors of this cause of death.

[Politics and strategy of privatization in health care system of Bosnia & Herzegovina. Private practice or private property?]. / Politika i strategija privatizacije u zdravstvu F BiH. Privatna praksa ili privatno vlasnistvo?

The aim of this study was to present a professionally sound option to conduct privatization process within the health care system of the Federation of Bosnia and Herzegovina. The purpose of this text is to represent a milestone for launching a wider public debate and preparation of privatization in-depth plan. Due to complexity of such action, it is not allowed to let it be spontaneous. It is recommended to the Federal Ministry of Health to take over the leadership in order to prepare a comprehensive document entitled "Policy and Strategy of Privatization of Health Care System in the Federation of Bosnia and Herzegovina". After preparation of the privatization concept, the wide public debate would be launched, as well as an appropriate support of the Government and Parliament. Hereinbefore mentioned document should provide answers to important issues, such as: privatization aims; subsectors eligible for privatization; ways of market regulations for providers of care and health insurance; payment mechanisms within public and private sector; issues of competition and solidarity, as well as equality and equity in health.

Effect of lactate on insulin action in rats.

The aim of the study was to explore the effect of lactate on insulin-stimulated glucose uptake in rats. Thirty Wistar rats, weighing 250 - 300 g. were arbitrarily divided into one of three groups (n =10): insulin (1 IU/kg) treated group, lactate (80 mg/kg), and insulin plus lactate treated groups. Blood glucose levels were measured in venous samples collected from the tail vein over 3 hour period after insulin or/and lactate administration in 30-minute intervals. To estimate the influence of lactate on insulin blood level, a total of 20 rats were divided into 4 groups (n = 5): saline, insulin, lactate, and insulin plus lactate treated group, respectively. Sixty minutes after the appropriate application of the same doses of insulin, lactate, and lactate plus insulin, as in the previous part of the experiment, plasma insulin and blood glucose levels were determined in blood samples drawn from the abdominal aorta. Lactate in combination with insulin, in comparison to insulin application alone, caused a dramatic increase in plasma insulin level (p<0,001) and more profound hypoglicaemia (p<0,001). The results of this investigation indicate that lactate application significantly increases the rate of glucose uptake from peripheral blood caused by exogenous insulin action. The possible involvement of lactate in the mechanism of enhanced glucose uptake due to insulin action after physical exercise is discussed.