Medical education quality evaluation.

The scientific-technological dropping back in Bosnia and Herzegovina in the postwar period tries to exceed in the different forms of education. The medical education represents mostly the transfer of the new informations, and does not contain the evaluation of their quality. In the paper is proposed the model of quality evaluation of medical education, from the aspect of successfulness and achieved degree of new acquired knowledge. The evaluation contains the assessment of the structural, processed and original elements. The structural elements evaluate the organization and used staff and material resources. The processing elements are evaluating the organization and used staff and material resources. The processing elements evaluate the applied methodology and contents of the subject. The original elements evaluate the organization and used staff and material resources. The processing elements evaluate the applied methodology and contents of the subject. The original elements evaluate the degree of the education goals realization and the level of new aquired knowledge of the students in the education. The achieved results of evaluation of quality education for the organizers of the seminar will serve as road sign for the improvement and achieving of higher degree of the successfulness and quality in every phase of education.

[Health education as a factor in decreasing traffic accidents]. / Zdravstveno-odgojne aktivnosti kao faktor smanjenja saobracajnog traumatizma.

Traffic security in post-war Bosnia and Herzegovina is getting worse. Use of motor vehicles and frequency of roads are in constant increase. Import of cars of different types, models, ages and quality caused that we are among the countries with insufficiently developed traffic security. Critical group of the traffic participants consists of young people and children. Their behaviour in traffic depends on their knowledge and attitude gained at home and school. Goal of this paper is to point out the importance of health-education activities in traffic security development. Evaluation was performed among the school children in a transit area in Bosnia and Herzegovina. Results show that school children have no enough knowledge about traffic rules; 13.4% of them don't know a single traffic sign. Even 19.9% of them got injured in traffic accidents, out of which 41.4% got injured while riding a bicycle and 22.4% as pedestrians. These initial results show that level of children's traffic culture can be raised only through systematic and permanent education within regular curriculum. Topics on traffic security should be an integral part of education programme, and presented through various subjects.

[Criteria for evaluation in family medicine]. / Kriteriji za evaluaciju u porodicnoj medicini.

For successful evaluation and the follow up of the family medicine team work it is necessary to develop evaluation criteria. Monitoring and evaluation criteria are numerous and different among countries depending on the health care development and the economic power of the country. In the present circumstances, taking in consideration health care reform through Primary Health Care (PHC) through family medicine team, the following criteria are proposed: equity, availability, cost-effectiveness, efficiency, efficacy, quality and satisfaction of user and health services providers. Indicators for the above mentioned criteria are also defined to estimate criteria achieved development. First indicator group relates on the medical-social indicator (for example number of families, structure of families and structures of concerning population) and the others social-economic indicators (GNP, expenditure in the health and social sector per capita, etc.). Second indicator group follows up the content of family medicine team work as follows: indicator of active and passive health care (for example number of doctor services, number of doctor and nurses home visits, consultation services, diagnostic procedures etc.). Third indicator group relates on the economic aspect, meaning the cost of implementation of such program, according indicator on content of work. Suggested criteria with indicators present the basic minimum databases, which would give the possibilities to have continuous overview in family medicine team functioning as well in its quality of work.

Drug resistant tumor cells have increased levels of tumor markers for invasion and metastasis.

The association between drug-resistance and three markers for invasive capacity: cathepsin D (Cath D), urokinase type plasminogen activator (uPA) and inhibitor of plasminogen activator type 1 (PAI-1) was examined in nine cervical and laryngeal carcinoma cell lines resistant to different cytostatics. The level of Cath D was measured by solid phase two-site immunoradiometric assay, while uPA and PAI-1 concentrations were determined by use of ELISA. All drug resistant cell lines had increased concentration of cathepsin D. uPA levels were similar in parental and drug resistant cervical carcinoma cells, but significantly higher in all examined drug resistant laryngeal carcinoma cells. In cervical carcinoma cells, PAI-1 concentrations were similar in parental and cisplatin resistant, but significantly higher in doxorubicin resistant cells. In laryngeal carcinoma cells, no increase in concentrations of PAI-1 was determined in the three from five resistant cell lines. There was no uPA in conditioned medium of parental or drug resistant cells. PAI-1 was detected in conditioned medium. Its levels were significantly increased in the medium of two cervical and three laryngeal drug resistant carcinoma cells. Thus, our results suggest that drug-resistance may be accompanied by increased levels of tumor associated proteases and/or its inhibitor.

[Quality assessment in primary health care]. / Procjena kvaliteta u primarnoj zdravstvenoj zastiti.

In this research paper we gave a model with a scale for assessment of health services quality in the primary health care. The model of assessment of quality is based on elements of quality--structure, process and outcome of health care. For every quality element defined indicators and variables with numeric values are shown. The proposed model was tested on the sample of hundred check ups of children aged from 0 to 1 year. The source of data was the health record, and data were collected through questionnaire for assessment of medicine team procedures. The outcome is measured through questionnaire about parents' satisfaction with services delivered. The results of research showed that the health record is only partly suitable to obtain data about contents of doctors work. Total quality of health care is estimated as lower values. The reason lies in the lower level of the content and quantity of check ups, and insufficient education of health professionals. The suggested model and evaluation scale are suitable for implementation in our health care system. The assessment of quality of work is compulsory in further evaluation of the system, regarding the obtained results.

[Structural basis to quality assurance in medical education]. / Strukturni prilaz osiguranju kvaliteta medicinske edukacije.

Medical education, especially continuous one, is considered as a very important strategy in assuring health care quality. It represents the most dynamic structural element of the health care quality. In this presentation we used the structural approach to quality assurance, through examination of medical literature utilisation trends from a number of health professionals and students of biomedical schools. In the research we used questionnaires which contained the questions related to the motivation of the subjects to use the medical literature and its availability to them. 34 students of biomedical schools were interviewed through questionnaires, 45 students of high nursery school and 32 medical doctors. The results showed that motivation of the subjects in the survey, both students and medical doctors to use medical literature is significant. However the possibility to use professional literature in their libraries is very limited because of the lack of new literature. Only 3% of interviewed medical doctors and students use Internet in their education. Technological delay in the process of education in Bosnia and Herzegovina caused by the war will significantly influence the level of health care quality in our country in the next period.

[Medicine and industry learning from each other]. / Medicina i industrija uce jedna od druge.

This paper presents a comparative review of the quality control methods in the industry and health care system with emphasis placed on hospitals. These standards were applied for the first time in the medical sector in 1995 in German hospital, which then was given the quality certificate. According to experience the application of standards ISO 9000, 9001 and 9002 in the hospital requires certain modification because the quality control in the health care is targeted on the process of production and not only on the outcome of the provided service. Unfortunately in the countries of former Yugoslavia there is no greater interest yet.

[Organization of emergency medicine based on the frequency and severity of emergency conditions]. / Organizacija urgentne medicine u svjetlu ucestalosti i tezine urgentnih stanja.

The spontaneous development of the organization and practice of emergency medicine created a number of types of emergency medicine units. Long time, these units were developed in out-hospital institutions such as health centres. Together with these services, all acute hospitals have had full day,s emergency services for definite care of urgent conditions. The authors give principles of this activity organization in the light of expected incidence and severity of urgent conditions related to the number of population which gravitate to particular hospital or other health services. Starting from the assumption that expected frequency of urgent conditions per 100 persons in 24 hours is between 0.50-0.75, the authors present the model of health care organization of such cases including family doctor, health station, health centre, hospital.

[Expected trends in mortality of malignant diseases in the population of Bosnia and Herzegovina]. / Ocekivani trend kretanja mortaliteta malignih oboljenja u stanovnistvu Bosne i Hercegovine.

Inclusion of malignant neoplasms' reports in this republic is not complete, it the reason that data on mortality are the most competent for analyse. General rate of malignant diseases' mortality is increased, but it is lower than the same rates in developed European countries, in Slovenia, Croatia and vojvodina. Men become ill more frequent than women. Increased mortality of malignant diseases of trachea, bronchii and lungs, then stomach and liver in expected in total population. Increased mortality of breast cancer as well as cancer of trachea, bronchii and lungs, then liver and stomach is also expected. In male population increased mortality of cancer of trachea, bronchii and lungs, then stomach is expected, particularly at the age of 35 and later. A Expected mortality trend of cancer Bosnia and Herzegovina will have growing tendency during next period. Better registration of death causes, objective getting old of population, inadequate primary and secondary prevention, and non-existing causal therapy for longer period will all influence on mentioned growing tendency.

[Speech development in children of mothers who used hormone preparations during pregnancy]. / Stanje razvoja govora kod djece cije su majke koristile hormonske preparate tokom trudnoce.

The exposition to sex hormones during pregnancy and their effects on fetus and newborns growth and development has been the subject of numerous researches. The former researches pointed out that the sex hormones used during pregnancy may have the negative effects on fetal growth. The aim of this study is to investigate the effects of the hormones used during pregnancy on the growth and development of children until the age of seventh year. The study includes 528 children; 235 of them have been exposed to hormones during pregnancy and the others 293 who have not been exposed to hormones "in utero". The selection of the newborns and their mothers has been made according to the hormonal exposures during pregnancy and the delivery term. The results indicate that the average values of children's weight and length on the delivery in hormonal group have been lower than in the control group. The children in the hormonal group had the earlier development of the speech and less number of disorders. The assessment of various growth factors and children's development represents a special methodological and evaluation problem, because many factors have influence on the development of speech in children.

[Evaluation of health legislation within the context of the goals and strategies for "Health for All by the Year 2000" in Bosnia and Herzegovina]. / Evaluacija zdravstvene regulative u kontekstu ciljeva i strategije "Zdravlje za sve do 2000. godine" u Bosni i Hercegovini.

In this paper significant changes have been presented concerning to the health legislation of Bosnia and Herzegovina in the period from 1970 till today. These changes could have had an effect on the changes in the health system as well as in the health status of the population. This is all aimed at achieving strategy and targets for Health for All by the year 2000. Certain systematic solutions for achieving strategy and targets exist in the health legislation of Bosnia and Herzegovina (Law on health care the 1986), but they are set without clear content and holders of office. We could notice the absence of legislative support for resolving group of targets 13-17 and partially 32-38.