Detection of anti-SARS-CoV-2 antibodies and its seroprevalence in Zavidovici municipality of Zenica-Doboj Canton, Bosnia and Herzegovina.

Objectives: Improved serological detection of specific antibodies against SARS-CoV-2 could help estimate the true number of infections. Methods: A total of 443 serum samples provided by unvaccinated patients of all ages with unknown COVID-19 status that were originally submitted for routine screening or clinical management from outpatient laboratory during the March-April 2021 (third wave) were collected. Seroprevalence of IgM/IgG antibodies was determined by lateral flow immunoassay (Tigsun, Beijing, China). Results: Among 443 serum samples, 186 (42.0%) were positive (incidence of 5.2/1000) with slight predominace of females, 104 (55.9%), highest seropositivity in 25-50 and 51-64 years age groups, 61 (32.8%) and 57 (30.6%), respectively (P < 0.05); rural population was more prevalent, 101 (54.3%) (P < 0.05) and active workers, 86 (41.1%). Almost equal number of patients was with or without symptoms, 48.4% and 51.6%, respectively. For the comparison, in the same period it was registered 296 (out of 855; 34.6%) PCR SARS-CoV-19 positive persons (incidence of 8.2/1000) with the higher gender (females) and the highest age prevalence in 51-64 years age group (36.8%). In the period March 2020-June 2021, it was registered 804 (out of 3323; 24.2%) (incidence of 22.3/1000) PCR SARS-CoV-19 positive persons with no significant gender and significant age difference (25-50 and 51-64 years group, respectively). Conclusion: In the regions with high prevalence/incidence of SARS-CoV-2 in the general population (Bosnia and Herzegovina is on the World top on the number of deaths) seroprevalence measuring can help tracking the spread of disease.

An Overview of Human Resources and Capacity in Health Care Institutions in the Federation of Bosnia and Herzegovina in the Context of Responding to the COVID 19 Pandemic.

BACKGROUND: The organization of health care system on Cantonal level with the coordination from Federal level represents a real situation with the possibility of decentralization of health care system according to the experiences of developed countries. OBJECTIVE: To make an overview of the situation at the primary and hospital health care level with the aim of assessing the existing human resources and capacity of health care institutions in FB&H, with which we entered in COVID-19 pandemic. METHODS: This retrospective study presents the efficiency of health care in FB&H measured by number of medical doctors, and other medical staff during the time period of five years. Data of the Institute for Public Health FB&H were used. The Institute for Public Health FB&H is authorised by the law to conduct and implement statistical research in the field of health care in line with relevant laws and by-laws. The Institute is obliged to report on organisational structure, human resources and medical equipment. RESULTS: Presented data include the number of health care employees in medical institutions in FB&H in the period 2015-2019 per 100,000 inhabitants and their numbers in primary health care, family medicine, secondary and tertiary level of health care in 2019. The study also presents the number of doctors of medicine, specialists and medical residents in FB&H, the number of nurses of all profiles and levels of education as well as medical staff and other employees in the public health care system in FB&H in 2019. CONCLUSIONS: The COVID-19 pandemic in FB&H has confirmed the fact that human resources in health care are insufficient, especially in the field of public health and epidemiology. The availability of these health facilities and human resource is not uniform throughout the FB&H, which may affect the capacity of the health system in some parts of the FB&H to meet the needs of providing services during COVID-19 pandemic.

Prevention of trismus with different pharmacological therapies after surgical extraction of impacted mandibular third molar.

Aim To assess prevention and reduction of trismus after surgically extracted impacted mandibular third molars with individual and combined therapy with corticosteroids and anti-inflammatory analgesics. Methods The research included 60 randomly selected patients (3 groups) attended to the Dental Oral Surgery of the Public Institution Healthcare Center Zenica during the period January-December 2008. Patients of both genders, 18-45 years of age, were presented without pain and other inflammatory symptoms at the time of surgery. According to a scheme established in the research protocol, two medications were administered orally: methylprednisolone(corticosteroid) 32 mg and meloxicam (non-steroidal anti-inflammatory analgesic, NSAID) 15 mg as a single drug, or a combination of both drugs. The level of trismus is assessed on the basis of differences of preoperative and postoperative values of interincisal spaces when fully opening the mouth on the second and the seventh post-operative day. The differences between groups of patients were evaluated by means of Tukey's HSD test. Results On the second and on the seventh post-operative day significantly better results were registered in the group that received only corticosteroids and in the group that received both, corticosteroids and NSAIDs compared to the group that received only NSAIDs. A tendency of trismus reduction was present in all patient groups for the second and seventh day after surgery. Conclusion Prevention and control of postoperative trismus after surgical extraction of impacted mandibular third molars with combined therapy is effective and superior comparing to individual therapy with meloxicam-or methylprednisolone alone.

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.

Development of youth friendly family medicine services in Bosnia and Herzegovina: protocol for a cluster randomized controlled trial.

BACKGROUND: Young people face many barriers in accessing health services that are responsive to their needs. The World Health Organization has led a call to develop services that address these barriers, i.e. youth-friendly health services. Addressing the needs of young people is one of the priorities of Foundation fami, an organisation working in collaboration with the Swiss Federal Department of Development and Cooperation and Geneva University Hospitals to develop quality family medicine services in Bosnia and Herzegovina. This paper describes the design of a trial to assess the effectiveness of a multifaceted intervention involving family medicine teams (primary care doctors and nurses) to improve the youth-friendliness of family medicine services in Bosnia and Herzegovina. METHODS/DESIGN: This is a stratified cluster randomised trial with a repeated cross-sectional design involving 59 health services in 10 municipalities of the canton of Zenica in Bosnia and Herzegovina. Municipalities were the unit of randomisation: five municipalities were randomised to the intervention arm and five to a wait-list control arm. Family medicine teams in the intervention arm were invited to participate in an interactive training program about youth-friendly service principles and change processes within their service. The primary outcome was the youth-friendliness of the primary care service measured using the YFHS-WHO + questionnaire, a validated tool which young people aged 15 to 24 years complete following a family medicine consultation. A total of 600 young people aged 15 to 24 years were invited to participate and complete the YFHS-WHO + questionnaire: 300 (30 per municipality) at baseline, and 300 at follow-up, three to five months after the training program. DISCUSSION: The results of this trial should provide much awaited evidence about the development of youth-friendly primary care services and inform their further development both in Bosnia and Herzegovina and worldwide. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry_ ACTRN12610000142033.

Assessment of Reporting, Attitudes and Knowledge About the Stab Incidents and Professional Risk of Viral Infection among Health Care Professionals in Primary Health Care.

CONFLICT OF INTEREST: none declared. GOAL: The goal of the research is to determine the relationship between frequency and reporting of stab incidents, attitudes and knowledge about stab incidents and occupational risk for transmission of viral infection with HBV, HCV or HIV among health care professionals employed in primary health care. MATERIAL AND METHODS: Conducted is prospective, cross-section study by questionnaires in 2012. The survey included health professionals in Primary Health Care Center in Tuzla. The final sample has 131 respondents (85% women). Statistical analysis was performed using the statistical package SPSS version 20.0. RESULTS: The prevalence rate of stab incidents throughout their career in our study was 66%; while the rate of reported incidents was 4.83 ˜ 5 times lower than the actual prevalence. In 49 out of 87 cases this was a case of hollow needle prick. The most common causes of stab incidents are the time pressure, unforeseen reactions of patients and lack of concentration. CONCLUSION: Stab incidents are often not reported in in developing countries. Training in order to raise awareness and knowledge about the problem, proper procedures, good organization of work and anti-stress program, safer disposal, conducting prophylaxis before and after exposure monitored by the relevant institutions of occupational medicine should contribute to solving this problem.

YFHS-WHO+ Questionnaire: validation of a measure of youth-friendly primary care services.

PURPOSE: To develop and validate a research tool to measure the youth friendliness of primary care services from a client's perspective. METHODS: The questionnaire was initially developed in English, but as it was to be used in Bosnia and Herzegovina (BiH), it was validated in the language of this country. Items were adapted from two sources: a reproductive health services quality improvement questionnaire from the World Health Organization, and an Australian survey used to assess youth-friendly primary care services. An English-speaking international panel reviewed the list of items for face validity. After translation-back translation, the questionnaire was pretested with adolescent patients from a family practice in BiH. The stability and construct validation were then conducted with 60 young people from six different health services in BiH. Items for the final questionnaire were selected using item response theory. RESULTS: The validation and item response analysis led to a 49-item tool. Test-retest stability at 1 week was excellent (mean κ: .93). Construct validation was supported by the fact that services with the highest and the lowest scores on the questionnaire were also those that had many and few, respectively, youth-friendly characteristics, as assessed by experts, on a predefined evaluation grid. Services seeing a higher proportion of adolescents also had higher scores on the questionnaire. CONCLUSIONS: This study supports the validity of the YFHS-WHO+ questionnaire for assessing the level of youth friendliness of family medicine services for research purposes. Further validations in English and French will allow wider use of this tool in the future.

Investigation of health effects of current levels of environmental sanitation and hygienic living conditions of rural population in the municipality of Zenica.

The aim of this article is to investigate and identify all the relevant ways of epidemiology significance for transmitting infectious diseases in the existing unsatisfactory hygienic and sanitary conditions in rural areas of the municipality of Zenica, which are positively correlated with occurrence and spread of infectious intestinal diseases. The study was conducted in seven rural localities of Zenica municipality where the dominant livestock are sheep and cows, and the population is mostly dealing with individual production of cheese and milk. This research aimed to examine and identify the conditions favoring life as the primary issues that affect the increase in the risk of and maintenance of intestinal infectious diseases such as: the level of environmental sanitation in investigated villages, sanitary and hygiene habits of families living in the villages studied, ratio of population to personal hygiene, health safety of water supply, hygienic disposal of fecal waste and waste generated in the breeding of animals. The study included the monitoring and statistical analysis of the epidemiological situation in the values of average prevalence rates of the intestinal infectious diseases in the 1000 inhabitants of each village studied. The study identified five major negative epidemiological indicators that have a major impact on the appearance and maintenance of intestinal infectious diseases. The leading indicator is a negative relationship and personal hygiene attitude in the broader sense, the pending state of water supply, sanitary toilets and unresolved rubbish dump with a negative attitude and stance toward general hygiene. Identified are all the relevant ways of epidemiology importance that are positively correlated with occurrence and spread of infectious intestinal disease. Investigations of the epidemiological situation regarding the occurrence of intestinal infectious disease in the study population showed that intestinal infectious diseases in the investigated area is constantly maintained and that the average prevalence rate is shown suffering intestinal infectious diseases in the 1000 inhabitants significantly higher than the prevalence of these diseases in the urban area where they can be identified in a significant number of negative epidemiological indicators.

To classics of Arabic medicine.

The slamic authors of the medical and other works have become very known for West, but under well changed names, as for example Razes for Ar-Razi, Avicenna for Ibn Sina, Alhazen for Ibn Haitham, Avenzoar for Ibn Zuhr, Avveroes for Ibn Rusd etc. Up to those changes in the names has not come at any case come accidentally. This was the result of the religious striving to the cultural worls of the West, and not to speak about the plebs, only the giants are represented wich was imppossible to avoid. It is indusputable the great contribution of the Islamic authors to the development of the biomedical sciences. They not only succeeded to preserve the achievements of the pre Islamic authors, than they by the own researches gave the great contribution to the development of these sciences and their disciplines, and they have overgiven to us as a dowry.

Evaluation of usage of information diagnostic technology in family and general medicine.

INTRODUCTION: In recent decades, the development and improvement of technology is rapidly advancing. The development of science, new materials, information technology, new procedures and other modern achievements were his first confirmation sought to improve living conditions, particularly in achieving better health conditions. In an effort to improve living conditions, solve the problem of severe diseases and to facilitate treatment, new technologies, almost always find its first application in medicine. In such conditions of general pressure of new modern technologies, health professionals often succumb to uncritically use these technologies. METHODOLOGY: Analyzing data collected from 30,000 research papers that have done 30 doctors of family medicine and 30 doctors of general medicine, and from interviews conducted with all 60 doctors who participated in the research. RESULTS: a) Teams of family medicine have a significantly higher professional education, and it should be noted that there was no significant difference in length of service of employees; b) Teams of family medicine have significantly less committed population on which the care; c) Teams of family medicine in an average have fewer visits per day than the teams in general medicine; d) Information diagnostic technologies are more accessible to family medicine teams. CONCLUSION: It is necessary to introduce a technology assessment as a standard scientific methods in decision making and the creation of the health system. In fact, it is necessary to establish and enable institutions to assess health technologies and join the developed world in creating better health care.

Evaluation of an information system model for primary health care.

Today, at the era of information technologies Bosnia and Herzegovina does not have organized action for creation of standardized Computer-Based Information Systems (CBISs) in health. These CBISs would enable collection of defined and comparable data and therefore ensure adequate analysis, observation and decision making on a local community level as well on the general level of health information system. Thanks to enthusiasts, local CBISs are created in health care facilities. Those individual local CBISs have similar solutions based on the experience of previous good functioning. Therefore, we can expect that a standardized state CBIS will be formed with the minimal focused action of people in charge. The Zavidovici Medical Center has a CBIS which has been working long enough so that we can analyze the results of usage of such an information system. The system has a modular character, oriented on analysis and documentation of data, and on support for management and decision-making functions. Analyzing the results reached by implementation of such a CBIS, we can conclude that we have achieved better results in patient administration and work organization and that we have less patients in dispensary of primary health care by 20%, shorter time in treatment of patients by 7%, reduced consumption of essential medicines by 8%, costs of treatment in medical facilities are down by 5% and patients have more a positive view toward the services provided now than they had earlier. Moreover, substantial savings in radio and laboratory diagnostics procedures have been achieved by reducing time for doing lab reports, savings in materials and through minimizing human error.

How to rationally use information diagnostic technologies in family and general medicine practice.

CONFLICT OF INTEREST: NONE DECLARED New discoveries in technology indeed enabled significant improvement of health care in the last three decades. Only during the last few years a significant breakthrough is achieved in the field of antiviral drugs, biotechnology, digital diagnostic technology, molecular diagnosis, tissues and organs transplantation as well as surgical and information technologies, which all contributed to the improvement of health care. Rapid growth of medical technology has led to the increase in costs of health care, increased access to these technologies and improvement of health care that is permanently encouraging the further development of technology. Technology encompasses the skills, knowledge and ability to understand, use and create useful things. It is the practical application of knowledge. Evaluation of health technology is the systematic evaluation of characteristics, results or impact of health technologies. The primary purpose of evaluation is to provide information to responsible parties for the technology in the health care system, which will be used in decision-making and introduction of these technologies. Information technology in medicine and health care represents all medical and health technology in the process of work, monitoring and evaluation done using computer technology. Progress of medical science in recent years especially needs to thank to the development of information technologies. The health care system of Bosnia and Herzegovina is currently operating in the two sub-systems of primary health care. One is inherited from the past system, in which the primary health care is provided by general practitioners, specialists in general practice, as well as gynecologists, pediatricians and pulmologists, and the second subsystem occurs when in PHC is introduced the system of family medicine doctors and family medicine specialists. Family medicine, based on the concept of orientation towards the methods which are more effective, rational and cost-effective health care, use of defined procedures and evidence-based medicine, and more adequate education can empower and stimulate general practice doctors, especially family medicine specialists, who have passed various forms of training and courses in this area, to more rational and efficient use of diagnostic technology in their daily practice, without unnecessary duplication of tests. With this they make savings to the healthcare system, improve the financial position of overall health system, especially in the PHC segment, increase satisfaction of doctors providing that health care, but also the users of health services.

[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.

Analysis of the electroencephalogram and pain characteristic in patients before and after carbamazepine treatment.

GOAL OF THE STUDY: To determine the changes of the electroencephalogram and the changes of the quantity in percentage terms of alpha, beta, theta and delta waves in the electroencephalogram in migraine patients after a carbamazepine treatment. Analyze pain characteristics after the carbamazepine treatment of these patients and the efficiency of the carbamazepine treatment in the prevention of new attacks. PATIENTS, METHODS, RESULTS: A retrospective-prospective study has been conducted on 40 persons of approximately 42,9 years of age, with normal cranium CT finding, craniogram and fundus. They were divided in two groups: Group A--21 person who prophylactically took a daily dosage of 400 mg Carbamezepin and during acute pain attacks Naproksen; and group B--19 persons who prophylactically took daily dosage of 400 mg Carbamezepin. EEG test was done twice--before and after the medication, in order to check the concentration of different waves in the EEG in percentages. The T-test doesn't show a statistically significant difference between the alpha (p 0,719), beta 1 (p 0,865), beta 2 (p 0,710), theta (p 0,867) and delta (p 0,272) waves for the group A and for the group B alpha (p 0,996), beta 1 (p 0,920), beta 2 (p 0,826), theta (p 0,324) and delta (p 0,820) waves, on the significance level p 0,05 in the EEG at the beginning and the EEG at the end of the examination. The t-test does show a statistically significant difference between the intensity, frequency, duration and relief of pain at the beginning and at the end of the examination for both test groups. CONCLUSION: Carbamazepin and Paracetamol do not cause changes in the EEG nor in the quantity in percentage terms of concentration of different waves in the control EEG in patients with vascular headaches. Statistically Carbamazepin and Paracetamol significantly change characteristics of pain and can be used for migraine treatment and prophylaxis.

The advantages and limitations of international classification of diseases, injuries and causes of death from aspect of existing health care system of bosnia and herzegovina.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: The International classification of diseases (ICD) is the most important classification in medicine. It is used by all medical professionals. CONCEPT: The basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category. ADVANTAGES AND DISADVANTAGES: The health care provider institutions such as hospitals are subjects that should facilitate implementation of medical applications that follows the patient medical condition and facts connected with him. The definitive diagnosis that can be coded using ICD can be achieved after several visits of patient and rarely during the first visit. CONCLUSION: The ICD classification is one of the oldest and most important classifications in medicine. In the scope of ICD are all fields of medicine. It is used in statistical purpose and as a coding system in medical databases.

[Assessment effectiveness of hematological laboratory usage in ambulance of family medicine in Zenica]. / Procjena efektivnosti upotrebe hematoloskog laboratorija u ambulanti porodicne medicine u Zenici.

AIM AND PURPOSE: Estimation of hematological laboratory effectiveness usage in family medicine, by an assessment of appropriate testing indications and efficiency of testing interpretation. METHODS: For each patient who was sent to hematological testing, physicians fulfilled the questionnaire. Data gathered was used for computation of diagnostic technology operational characteristics: sensitivity, specificity, predictive values, clinical effectiveness, diagnostic odds ratio and error odds ratio. The data were served for interpretation assessment of testing results. For assessment of indications for hematological testing accuracy setting we used: the number needles (unwanted) testing according to operating diagnosis, number of confirmed operating diagnosis, and number of cases in which testing influence to therapy selection or health improving. RESULTS: The results have shown sensitivity value of 0.88, specificity value of 0.97, positive predictive value of 0.98, and negative predictive value of 0.85. Effectiveness of diagnostic technology was 0.92, diagnostic odds ratio was 238 and error odds ratio was 0.2. Unwanted haematological testing has noted in 37.3% cases, but pre-test diagnosis had confirmed in 51.8% cases. The testing contribution to improving health status of patients was noted in 57.8% of cases. CONCLUSION: The results have shown high level of accuracy, effectiveness and diagnostic odds ratio. However, poor assessment of testing indications has shown poor contribution to improving of patient health status.

Establishing of quality control in health care system.

Importance of establishing quality control in health care system was given in this paper. It is necessary to standardize the protocols in any kind of medical treatment. Only main protocols and guidelines allow us to compare its usefulness in everyday practice doctors, medical teams and medical institutions. First, it is necessary to calculate life expectancy tables for population to whom health care system is established. Than, collecting of the data should be systematically performed by health care providers. So, if we use guidelines and standardized protocols in everyday practice we could compare medical work and with other countries which are in our interest.