Construct validity of the perceived stress scale (PSS-10) in a sample of health professionals in family medicine in Bosnia and Herzegovina.

Background: The 10-item Perceived Stress Scale (PSS-10) has not been translated into Bosnian, nor has a study been conducted employing a sample of family medicine physicians and nurses to examine the instrument's reliability, validity, and factorial structure. Thus, the goal of this study was to investigate the reliability and construct validity of the Bosnian version of the PSS-10 among family medicine professionals. Study design: Cross-sectional descriptive study provided among healthcare professionals in family medicine, using Google forms questionnaire (PSS-10) in Bosnian language. Methods: Translation of PSS-10 in Bosnian is performed according to the proposed set of standardized guidelines. The questionnaire was sent on the email addresses of family physicians and nurses in whole Bosnia and Herzegovina. The collected data were subjected to reliability testing, exploratory and confirmatory factor analysis, which tested three alternative plausible models suggested by the extant literature: single factor, correlated two-factor and bifactor. Results: A total of 272 out of 440 (RR = 61.3) nurses and physician working in family medicine in Bosnia and Herzegovina completed the PSS-10 Bosnia and Herzegovina version (BH). Participants were aged 25 to 69, with a mean age of 44.7 (±10.55). Most participants were women (86.8%) and physicians (58.8%) with specialisation in family medicine (43%). The overall Cronbach's alpha was 0.87 and the test-retest reliability coefficient was 0.88. Exploratory Factor Analysis yielded 2 factors with eigenvalues of 4.77 and 1.35, accounting for 61.2% of variance. Factor 1 consisted of 6 items representing ''perceived distress'', whereas Factor 2 consisted of 4 items representing ''perceived coping''. The Confirmatory factor analysis indicated a very good fit of this bifactor model to this sample. Conclusions: Our results implies that the PSS-10-BH, as a bifactor model with good reliability and validity, may accurately measure the stress levels of family medicine physicians and nurses.

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia.

BACKGROUND: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. METHODS: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. RESULTS: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. CONCLUSIONS: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

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.

Spatio-temporal data visualization for monitoring of control measures in the prevention of the spread of COVID-19 in Bosnia and Herzegovina.

Aim The damage caused by the COVID-19 pandemic has made the prevention of its further spread at the top of the list of priorities of many governments and state institutions responsible for health and civil protection around the world. This prevention implies an effective system of epidemiological surveillance and the application of timely and effective control measures. This research focuses on the application of techniques for modelling and geovisualization of epidemic data with the aim of simple and fast communication of analytical results via geoportal. Methods The paper describes the approach applied through the project of establishing the epidemiological location-intelligence system for monitoring the effectiveness of control measures in preventing the spread of COVID-19 in Bosnia and Herzegovina. Results Epidemic data were processed and the results related to spatio-temporal analysis of the infection spread were presented by compartmental epidemic model, reproduction number R, epi-curve diagrams as well as choropleth maps for different levels of administrative units. Geovisualization of epidemic data enabled the release of numerous information from described models and indicators, providing easier visual communication of the spread of the disease and better recognition of its trend. Conclusion The approach involves the simultaneous application of epidemic models and epidemic data geovisualization, which allows a simple and rapid evaluation of the epidemic situation and the effects of control measures. This contributes to more informative decision-making related to control measures by suggesting their selective application at the local level.

The 2019 measles epidemic in Bosnia and Herzegovina: What is wrong with the mandatory vaccination program?

Measles is a highly contagious and communicable viral disease which may be prevented by a sustained vaccination program. Due to missed vaccination, two major epidemics of measles (1997-1999 and 2014-2015) have been recorded after the war in Bosnia and Herzegovina (BH) with over 10,000 patients registered. According to the World Health Organization, BH is categorized as a country with endemic transmission of measles. The last measles epidemic was between 2014 and 2015, with 5,083 documented patients in the Federation of BH. In the first four months of 2019, more than 700 measles cases were registered in the same region. Significant transmission rate has been observed in Sarajevo Canton (SC) with 570 documented measles cases. Out of 570 measles cases in SC, 92.5% were unvaccinated. The most affected were children up to 6 years of age (62.8%), with one documented case of death (7-month old infant). In addition to this report, we discussed key stakeholders and possible circumstances responsible for the epidemic. The measles epidemic is still ongoing.

Evaluation of patients cooperation in hypertension control.

INTRODUCTION: Hypertension (high blood pressure) is one of the most widely spread diseases of our time and one of the leading risk factors for heart and vascular diseases, particularly stroke and coronary heart disease. According to the World Health Organization (WHO) cardiovascular diseases are the leading cause of death in the world of who dies each year about 17 million persons, of which 5 million in Europe. The World Health Organization estimates based on monitoring of demographic trends, trends in mortality and morbidity as economic models, further growth of cardiovascular diseases, especially in developing countries. GOAL: Correlate the success of antihypertensive therapy and provoking factors, and to determine the degree of satisfaction with the effect of antihypertensive therapy of the patient. MATERIAL AND METHODS: The study was conducted at the Primary Health Care Center Stari Grad - Sarajevo. Conducted is study that included 80 patients. Data for this study were collected by a questionnaire. The questionnaire was completed by the examiner using interviews with patients and their relatives (parents, guardians).After sorting, control and grouping the data were imported into the statistical software package SPSS 20.0, where after defining variables was performed statistical analysis. RESULTS: The average age of male respondents was 60.80±13.03 and 63.50 ± 7.48 years of female respondents. The average value of systolic blood pressure amounted to 148mmHg (130-180), while the average value of diastolic blood pressure was 88.75mmHg (70-120). Student's t test showed that the average value of systolic pressure was statistically significantly different from the reference value (t=2.387, DF=19, p=0.028), and also the average values of diastolic blood pressure were statistically significantly different compared to baseline (p=3.561, DF=19, p=0.002). Of the total number of subjects included in this study good blood pressure control had 58 participants, and the average value of systolic blood pressure was 122mmHg and diastolic 74mmHg. With poor regulation of blood pressure were 22 patients, with average values of systolic pressure of 155.5mmHg and diastolic 92 mmHg. The most common additional factor influencing the increase in blood pressure of patients surveyed was stress is 65 % (n=52), followed by heat 20% (n=16), and salty foods was a provoking factor in 15% (n=12) subjects. By analyzing the frequency of controlling blood pressure has been determined that respondents on average control blood pressure once a week, and control frequency is in range from daily to monthly. The average value of the blood pressure of subjects who regularly used antihypertensive therapy amounted to 125/69 mmHg, while the respondents who did not regularly use the antihypertensive therapy that value was 157/96 mmHg.

Ten year trends in cardiovascular risk factors in the Federation of bosnia and herzegovina.

INTRODUCTION: Results of routine health statistics show that in the Federation of Bosnia and Herzegovina (FBIH) are the leading causes of death of population are diseases of circulatory system (53% in 2012) namely, cardiomyopathy, heart failure and acute myocardial infarction. This data are red alert for immediate and imminent action. METHODS: Two cross-sectional population surveys were conducted in 2002 and 2012 in the FBIH among adult population aged 25-64 years for assessment and distribution of major risk factors for cardiovascular diseases (CVD), preferably hypertension, obesity and smoking. RESULTS: Overall prevalence of hypertension among adult population in the FBIH in year 2012 was 41%, similar as in 2002. Prevalence of obesity in 2012 among men was higher compared to 2002, stood at 20.3%, while for women it was 24.1%. Total of 61.3% of men and 35.9% of women said they were daily smokers, while the percentage in 2002 was 49.3% among men and 29.8% among women and the difference was statistically significant. CONCLUSIONS: Distributions of the major risk factors for CVD are worsening in the adult population in the FBIH, especially in middle age men, what can result in serious deterioration of health and increased rates of chronic diseases, especially CVD.

Awareness, Treatment, and control of Hypertension among Adult Population in the Federation of Bosnia and Herzegovina over the Past Decade.

BACKGROUND: Many studies throughout the world show that hypertension is not effectively treated and controlled, which continued to pose an important challenge in health systems in the world. DESIGN AND METHODS: Population surveys were carried out in 2002 and 2012 in the Federation of Bosnia and Herzegovina (FBIH) on representative sample at the age of 25-64. The surveys used systematic stratified sample. Questionnaires and anthropometric measure protocols were adapted from internationally recommended surveys. RESULTS: In the past ten years there has been a slight increase in hypertension prevalence in researched population (41% vs. 42%). Percentage of hypertensive male and female respondents who are not aware of their hypertension actually dropped in the past decade from 54.3% to 51.4%. In 2002 total number of hypertensive respondents aware of their hypertension included 8.1% of male respondents and 10.3% female respondents whose condition was not treated and this rate effectively dropped during the 10-year period. Number of hypertensive, treated, and uncontrolled respondents dropped as reported in the 2012 survey; consequently percentage of hypertensive, treated, and controlled respondents in the 2012 survey increased, in particular in female population. CONCLUSIONS: Investments in primary health care, improved availability, and improved quality of health care in the FBIH in the past 10 years can explain increased rate of hypertension detection and treatment; however, efforts should be continued to introduce hypertension screening programs and hypertension control programs. Significance for public healthIn spite of wide knowledge of pathophysiology and epidemiology in development of hypertension, ability to easily diagnose it, availability of efficient medications, hypertension continues to have high prevalence and setting up hypertension controls poses significant public health challenge. Recently conducted cross-sectional population surveys in the Federation of Bosnia and Herzegovina give us opportunity to follow the trend for hypertension and implement public health measures to reduce or eliminate causes of high blood pressure in population and at the same time with implementation of medical treatment.

Frequency of blood pressure measuring according to the degree of working population education in canton sarajevo.

INTRODUCTION: Hypertension (high blood pressure) is one of the most widely spread modern diseases and one of the leading risk factors for heart and blood vessel diseases, particularly stroke and coronary heart disease. The prevalence of hypertension is about 25% in adults. Many studies show that blood pressure tends to have lower values among people with higher education levels. GOAL: To determine the frequency of measurement and control of blood pressure in relation to the level of education of the active working population of the Sarajevo Canton. MATERIAL AND METHODS: The study was conducted on 443 subjects randomly selected from the categories of the active working population of the Sarajevo Canton. The study was conducted at the Center for Heart, Clinical Center University of Sarajevo University through the project "Prevention of risk factors for cardiovascular disease in the active working population of the Sarajevo Canton". Respondents were at age in range from 18-65 years, who have voluntarily joined the study. RESULTS: Of 443 (100%) of the respondents 153 (34.5%) were males compared to females whose participation in the sample was 290 (65.5%). Regarding the structure of respondents, the majority of them 213 (48.1%) graduated faculty, 142 (32, 1%) graduated secondary vocational schools and 66 (14.9%) with a higher degree, with the lowest number with completed grammar school (1.4%) and secondary school (0.5%). Blood pressure never measure 16 (3.6%) of respondents, which is not insignificant number, more than 5 years ago 23 (5.2%), within last 1-5 years 90 (20.3%), in the past 12 months 88 (19.9% ) and 226 (51%) measured the blood pressure in the past 6 months. Blood pressure never controlled 4.33% of respondents with secondary or higher education and 2.82% of the respondents with university education. Chi-square test showed a difference between education and the prevalence of blood pressure, χ2=7.812; DF=8; p=0.045. CONCLUSION: Monitoring of blood pressure and frequent measurement can in large number prevent progression of hypertension, which can often remain unnoticed if the blood pressure is not measured regularly. Lower levels of education may be associated with lower socioeconomic status of healthy subjects, as well as the low level of health education, which may be factors that contribute to improper diet, lack of physical activity, smoking, so indirectly affect the occurrence of the disease. Education can be a potential risk factor for high blood pressure during their lifetime and thus the risk factor for other cardiovascular diseases.

Non-invasive liver fibrosis markers: use of serum levels of cytokines IL 1α and TGF ß1 in management of chronic liver diseases.

AIM: To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-ß1, along with routinely used laboratory tests, in the differential - diagnostic procedure of chronic hepatitis of infectious and noninfectious etiology. METHODS: A total of 150 subjects were divided into two groups, depending on the infectious or noninfectious etiology of liver damage, and the control group. Apart from standard laboratory tests, the analysis included serum levels of cytokines: IL-1α and TGF-ß1. RESULTS: A high degree of correlation of serum level of IL-1α with viral hepatitis has been found, especially with active replication of genetic material ( HBV-DNA or HCV-RNA-PCR positive), p less 0.01. The highest mean concentration of TGF-ß1 was noted in the group of malignant and toxic hepatitis, p less 0.0001. A negative correlation between the concentration of IL-1α and TGF-ß1 has been found (-0.18). For IL-1 α significant predictive parameters included a previous infection of hepatitis B, lower serum level of TGFß, age, use of alcohol, lower MELD and Chilld-Pugh scores. For TGF-ß1 significant predictive parameters were age, lower MELD and Child-Pugh scores, history of receiving transfusions, lower serum level of IL-1α, higher serum level of fibrinogen. A predictive model has been delivered MELD = (TGF-ß1) x 0,001- (IL-1 α) x 0,085 + CTP x 1,771-2,052; ( ± 2.04, R2=0,61; p less 0,001). CONCLUSION: Inflammatory and immune parameters, analyzed together could significantly contribute to the understanding of chronic liver damage and thus differential diagnostic procedure. IL-1α and TGF-ß1 are important parameters of inflammatory activity and fibrosis evaluation in chronic liver damage.

Bosnia and herzegovina healthcare system preparedness for pandemic influenza as of 2010.

OBJECTIVES: To determine if Bosnia and Herzegovina healthcare system is prepared for influenza pandemic; and to indicate strengths and weaknesses in planed resolution of pandemic influenza in Bosnia and Herzegovina healthcare system. METHODOLOGY: Qualitative systematic review, comparing established elements of healthcare systems with WHO's guidelines on pandemic preparedness. Critical evaluations of available findings on preparedness of healthcare system of Bosnia and Herzegovina (B&H) compared in details to preparedness of healthcare system of United Kingdom (UK) but in certain elements with some other European countries. RESULTS AND DISCUSSION: Analysis of preparedness plans of B&H and UK are presented in details, with comparison of B&H with eight other countries by WHO guidelines categories and phases of pandemic preparedness and contingency plans. CONCLUSIONS: Disregarding the obstacles in B&H health care system policy Bosnia and Herzegovina has preparedness plans, that are made based on WHO's guidelines but unlike all other analyzed countries does not have contingency plan. This can be seen as strength while weaknesses of B&H's healthcare system are: late forming of preparedness plan with poor implementation of set activities, and lack of contingency plan.

Cardiovascular risk factors research in Bosnia and Herzegovina.

This study describes the current situation of cardiovascular risk factors research in the Bosnia and Herzegovina, with special emphasis on the Herzegovina region. The available data for the analysis includes various secondary sources, including project reports, official vital statistics data and other sources. Currently, there is a substantial lack of relevant information, which is available from occasional surveys or isolated studies. One of the main problems in detailed analysis is the lack of detailed and reliable census data, which causes problems in calculation of various rates and disables the creation of representative population samples for the field work and subsequent analysis. Comparison of the available information with neighbouring Croatia indicates interesting mixture of relatively high prevalence of some risk factors and rather low prevalence of others; almost 50% of men reported smoking on a daily basis, while only 16.5% of men were obese, while 40% of them had blood pressure over 140/90 mmHg. The results provide useful but incomplete information for the policy, thus suggesting that broader scope of public health research is needed in the region coupled with the census data, in order to provide better information for health policy and ultimately delivery of the optimal health care to the entire population.

Cardiovascular risk factors in the Federation of Bosnia and Herzegovina.

BACKGROUND: Federation of Bosnia and Herzegovina (FBiH) has high cardiovascular disease mortality as other countries in Eastern Europe and situation has even deteriorated in the post war period. Reliable information on risk factor levels and patterns needed in prevention planning and disease management has been lacking. METHODS: A cross sectional population survey was conducted in the FBiH in autumn 2002. A random sample of population, aged 25-64 years, was taken using a three stage stratified sampling methodology. Altogether, 2750 persons participated in the survey (1121 men and 1629 women). The survey was done according to internationally established standards and protocols. RESULTS: The mean systolic blood pressure was 132 mmHg among men and 135 mmHg among women. The mean diastolic blood pressure was 84 mmHg in both genders. Almost 40% of the participants were recognized as hypertensive (blood pressure level over 140/90 mmHg). The prevalence of hypertension among men was 36% and among women 45%. The mean Body Mass Index (BMI) was 26.5 kg/m(2) among males and 27.0 kg/m(2) among females. About 75% of both men and women were overweight (BMI > 25 kg/m(2)) and 16% of men and 20% of women were obese (BMI > 30 kg/m(2)). About 50% of men and 30% of women reported to be daily smokers. CONCLUSIONS: As a whole the non-communicable disease risk factor levels in the FBiH seems to be relatively high. The data can be utilized in health promotion planning and as a baseline for future monitoring activities with possibility of international comparison of results.

Cancer mortality, recent trends and perspectives.

Considering that a register for cancer was established in Federation of Bosnia and Herzegovina only recently, basic reliable source for the analysis of cancer mortality trends are the data on death cases caused by such diseases. Lack of census as well as standardized mortality rate data makes the study even more difficult to make. The aim of the study is the analysis of the malign diseases trend in the post-war period according to the available data. The study is the descriptive work on the analysis of the system using linear regression methods for expected trend for the total population and age group from 0 to 64 years. Registered rate of cancer mortality in Federation of Bosnia and Herzegovina in 2004 was 142 per 100000 inhabitants, and indicates input stream in the analyzed period. Total increase in mortality of males and females is 2.5% per year. It is expected that in 2020 around 5000 inhabitants of Federation of Bosnia and Herzegovina will die of some malign disease. Trend of mortality of malign diseases in males is higher than in females and more probable in older population. There is a tendency of mortality decrease in the group of 0-64 years of age. Mortality list of the most frequent locations of cancer has undergone changes. Liver cancer, colon cancer, sigma and rectum cancer as well as lung and breast cancer lead the list. Objective ageing of the population, technological drawbacks, insufficient primary and secondary prevention worsened by socio-economic life conditions will affect the increase in number of people with malign diseases in Bosnia and Herzegovina.

[Model of integrated management of hypertension--population approach]. / Model integriranog menadzmenta hipertenzije--populacioni pristup.

Actual transitional moment in Bosnia and Herzegovina has the significant health implication. Several population surveys conducted in the past 10 years period showed the rather high prevalence of main cardiovascular risk factors, including hypertension. It was proof that cardiovascular risk factors are preventable. Hence, development and establishment of a model of integrated management of hypertension in actual moment in BIH is necessities due to relatively high level of prevalence of hypertension and limited financial resources in health sector. This paper shows a possible model a model of integrated management of hypertension at population level with active participation of actors from three managerial levels--strategic, tactical and operational.

[Development of the management potential in health system of Bosnia and Herzegovina]. / Razvoj upravljackih potencijala u zdravstvenom sistemu Bosne i Hercegovine.

In this moment in the health sector of Bosnia and Herzegovina, the need for reform is especially highlighted in sector of the management and organization of the health protection, on all levels, from the administrative level up to clinical institutions for professionals, from who the professional managerial skills are requested. Only on this way, the creation of the health system based on the EU standards will be possible, using the modern managerial techniques. Because of that, in reform strategies of both entities, it has been necessary to develop the wider concept of development and strengthening of the health management, on all levels of managerial process--strategic planning, decision making, control of the use of health services, programme planning, monitoring and evaluation. The first pre-condition is revision of the education programme on all levels, from the secondary education, pregraduate, postgraduate education, and continued training.

[Mucosal damage caused by nonsteroidal anti-inflammatory agents in H. pylori infection]. / Ostecenje sluznice uzrokovane nesteroidnim antiinflamatornim lijekovima kod prisustva H. pylori infekcije.

BACKGROUND: The pathogenic role of Helicobacter pylori (H. pylori) infection in the setting of NSAID use is still controversial. Aim of the study is to prove increased incidence of gastric mucosa damage in H. pylori positive NSAID users compared to H. pylori negative patients. METHODS: Patients with dyspeptic symptoms (n = 160, average age 62.13 +/- 6.24, ranged from 51 to 77 years) were divided in two groups: 80 patients (45 male, 35 female) with positive history of using NSAID and same group with negative history for NSAID. All patients underwent endoscopy, examined to H. pylori presence by rapid unease test. Patients with ulcer or erosions (> 5) were evaluated and grade of gastric mucosa damage were done according to Forrest classification of gastrointestinal bleeding. RESULTS: In first group 69/80 of examined patients were H. pylori positive, in second group 56/80 were H. pylori positive (X2 = 5.266; p = 0.022). In gastric mucosa bleeding, caused with NSAIDs, H. pylori was not diagnosed more often compared to other group (p > 0.05). CONCLUSION: Patients with NSAID induced gastric injury were significantly greater incidence of H. pylori infection compared to patients without history of NSAIDs abuse. H. pylori was not significantly present in complication of ulcer disease (bleeding) caused by NSAID.