The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study aimed to identify knowledge, attitudes, and practices about AB use and AMR within the general population, stratified by age, gender, and urban/rural areas during the COVID-19 pandemic. This questionnaire-based cross-sectional study was conducted in April 2022 among patients who visited three health centers in the eastern region of Bosnia and Herzegovina. A high frequency of AB use was observed during the COVID-19 pandemic (64.2% of respondents were treated with AB). Age and place of residence have not been shown to be factors associated with AB use practices that pose a risk for AMR. However, female gender (β = 0.063; p = 0.041), better knowledge (β = 0.226; p < 0.001), and positive attitudes (β = 0.170; p < 0.001) about use of AB and towards to AMR proved to be factors associated with better practice by respondents. Women, younger respondents, and respondents from urban areas showed better knowledge, attitudes, and behavior about the use of AB and AMR during the COVID-19 pandemic.

Complications in colorectal surgery carry a high risk of morbidity and mortality, prolong hospitalization time and increase treatment costs, and the largest number of postoperative complications is related to surgical site infection (SSI). Antibiotic prophylaxis started in the fifties of the last century and changed with each new antibiotic. The following were used in order: aminoglycosides (1943), macrolides (1952), polymyxins (1958), and cephalosporins (1965). With the discovery of metronidazole in 1970, the prophylactic spectrum was extended to include anaerobic bacteria, which are an indispensable part of the flora in this anatomical region. Due to the nature of the gastrointestinal tract, it was believed that oral antibiotic prophylaxis and mechanical bowel preparation (MBP) could achieve intestinal sterilization and thus ensure a safe surgical intervention. However, studies have shown that MBP did not have an overall beneficial effect on postoperative complications and caused significant patient discomfort, so it was almost abandoned. Today, it is known that about 16% of surgical infections are caused by multiresistant bacteria, and only oral antibiotic prophylaxis is not sufficient to prevent these infections. Namely, in the race between bacterial resistance and the development of new antibiotics, antibiotics are increasingly lagging, and the treatment of complications remains a nightmare for surgeons. For this reason, the prevention of SSI in colorectal surgery is a challenge for 21st-century medicine. In modern surgery, both open and laparoscopic, the first and second generations of intravenous cephalosporins are most often used for prophylactic purposes, as antibiotics of a sufficiently broad spectrum, with favorable pharmacokinetics and rare side effects. New research indicates that in colorectal surgery, the combination of standard intravenous prophylaxis with the addition of an oral antimicrobial the day before surgery is superior when it comes to SSI prevention. However, there are still no clear recommendations on the regimen and type of antibiotics and they should be given in institutional guides and protocols, taking into account the bacterial spectrum in the local environment, as well as resistance, and the availability of appropriate drugs. Therapeutic use of antibiotics is reserved for acute conditions in colorectal surgery and its complications. For therapeutic purposes, more potent antibiotics are used against the expected pathogens, usually a combination of several antibiotics, such as third or fourth-generation cephalosporins, metronidazole, fluoroquinolones, or piperacillin/tazobactam and others. When it comes to the therapeutic use of antibiotics in colorectal surgery, research indicates that the most important thing is to recognize the infection in time and immediately start treatment, correct the therapy according to the causative agent, and also to stop the administration of antibiotics in time, to avoid unwanted complications and already advanced bacterial resistance.

Malignancy is one of the major public health problems in Bosnia and Herzegovina. Along with breakthroughs in specific oncological therapy, improving the quality of life of cancer patients and management of therapy-induced side effects need to be recognized as a priority in the comprehensive cancer patient care. Fertility loss after cancer treatment is a field requiring special attention due to its various consequences on patients themselves. Although oncofertility is well-recognized area of oncology, low- to middle-income countries are facing issues with its implementation in everyday practice. Increased awareness about fertility preservation is of high priority for all specialists who participate in the medical care of cancer patients. The absence of a systemic solution and lack of expertise led to the founding of Fertility Preservation Working Group of the Oncology Association of Bosnia and Herzegovina. We have made recommendations as an expert consensus with the ultimate goal of making the first step toward enhancement of oncofertility implementation in Bosnia and Herzegovina.

OBJECTIVE Patients and medical professionals have a common misconception that cardiovascular diseases (CVD) predominantly affect men, which can lead to less prescribing of cardiovascular drugs to women. This study examined whether there were sex differences in the administration of cardiovascular (CV) drugs in patients admitted to the intensive care unit of the Internal Medicine Clinic of Foča University Hospital (ICFUH). MATERIALS AND METHODS The study comprised 332 patients hospitalized at the ICFUH from January 1st to June 30th, 2019. The following data on leading CVD and risks related to CV drug administration were collected: age, hyperlipidemia (HLD), diabetes mellitus (DM), chronic kidney disease (CKD), liver disease (LD), heart failure (HF), hypertension (HTN), myocardial infarction (MI), and stroke (S). The amount of the CV drugs of interest (statins, antiplatelet drugs, calcium channel blockers, ACE inhibitors, beta blockers, diuretics) administered during hospitalization was expressed as the Defined Daily Dose (DDD)/100 bed-days (BD) for patients of both sexes separately. RESULTS During hospitalization in the intensive care unit of ICFUH, female patients were less likely to be treated with statins than male patients (30.1 vs. 57.5 DDD/100 BD, P<0.05). There was no difference between sexes regarding the use of antihypertensive drugs. Women were less likely to be treated by antiplatelet therapy, more precisely by acetylsalicylic acid (30.4 vs. 36.9 DDD/100 BD, P<0.05). CONCLUSION Our study indicates that there were sex differences in CV drug administration in ICFUH. Presuming that drugs used during hospitalization were at least partially a continuation of the previous therapy prescribed by the family doctor, it is possible that such differences exist in primary care.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards (MTB) from health-care institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization, and optimization of the procedures for the diagnosis, treatment, and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a MTB comprised of at least: A medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.

Received 2018-11-12 Received in revised form 2019-05-22 Accepted 2019-05-29 INTRODUCTION Breast cancer is the most common malignant disease in women (1). It makes up about 26.5% of all newly discovered malignancies in the European female population and is responsible for 17.5% of the deaths. In males, this type of cancer is rare (one man per 100 women) (2). The frequency of the disease differs in various parts of the world. It is rarely seen before the age of 30, it rises with age and reaches its maximum around the age of 50 (3). The incidence of breast cancer in the world increases by 1-2% per year, and it is estimated that in the first decade of the third millennium, almost one million of women will suffer from breast cancer (4). However, in spite of the increasing possibilities of treatment, survival depends primarily on the extent and stage of the disease at the time of detection. In the early stage of the disease in which the largest number of patients is detected, healing is quite possible. Still, 24-30% of patients with lymph node negative and 50-60% with lymph node positive breast cancer will develop relapse. At the moment of diagnosis metastatic disease is present in 6-10% of patients (5). Treatment of breast cancer is multidisciplinary. Combination of surgical treatment, radiation and systemic therapeutic treatment ensure good results in patient survival. The type and order of particular treatments must be planned multidisciplinary by surgeons-oncologists, radiotherapists and internists-oncologists (6). Clinical features of tumor such as size, the existence of tumor cells in the armpit lymph nodes, and distant metastases are considered essential in determining prognosis and choices of treatment. Prognostic factors, derived from breast tissue after biopsy or surgery, have significance in measuring tumor aggressiveness and general disease prognosis. The standard prognostic parameters are patient (menopausal status, age) and tumor related (tumor size, histological type, axillary lymphatic status, tumor gradient, ER, PR and HER2 status). Some of them (ER, PR and HER2 status) have a predictive value because the best therapeutic modality is chosen based on these. According to St. Gallen Consensus and ESMO recommendations from year 2013 breast cancers fall into different types according to histopathological findings and results of predictive and prognostic tests. Based on this, specific therapeutic approach is recommended. When luminal A type patient receive only endocrine therapy, and chemotherapy is considered only in cases of high risk tumor (with four or more positive lymph nodes, tumor size T3 or tumor grade 3). When luminal B-like type (HER2 negative) patient is treated using chemotherapy and endocrine therapy. When luminal B-like (HER2 positive) patient is treated using chemotherapy, anti-HER2 and endocrine therapy. In case of non-luminal (HER2 positive) breast cancer type chemoand anti-HER2 therapy is recommended. In patients with basal-like (triple-negative) cancer application of chemotherapy is indicated (7).

There is a daily increase in the number of patients with malignant diseases, but with the advances in modern oncology research, the number of survivors treated with malignant diseases is becoming larger and larger. The survival rate after completing oncology therapy is increasing on a daily basis, so that malignant diseases belonging to the category of terminal diseases are now referred to as 'chronic illnesses'. In this specific group of patients, the risk from cardiovascular diseases is increasing nowadays. A new challenge for the future cardiologists will certainly pose the treatment of this group of patients. A cardiological approach in oncological patient treatment is an important issue. The cardiologist focuses on risk stratification and prevention of cardiovascular complications in the oncological patient in relation to his or her pre-existing condition, and in relation to the type of specific oncology therapy applied, and on further follow-up during therapy and after its completion. This implies that it is necessary to create cardio-oncology teams in our institutions treating the oncological patients. There is a considerable need for education in a new field, which presents the intersection between two clinical disciplines, i.e. cardiology and oncology, and for special education of cardiologists concerning all types of chemotherapy and their potential cardiotoxic effects. The oncologist, on the other hand, must be trained to recognize any possible early signs and symptoms of cardiac complications concerning the therapy applied and to seek further cardiac care for the patients. The aim of this review article is to assist the doctors treating this group of patients in their daily practice and to highlight the need for a multidisciplinary approach, as well as the creation of a cardio-oncology team for a comprehensive and integrative approach to a cardio-oncological patient.

Over the last two decades Croatia’s wood industry has recorded mostly negative trends reflected in an unfavorable structure of production (dominated by primary products), the decline in employment and unfavorable foreign trade balance for furniture products, as one of the highest value-adding products. In order to reverse the negative trends various forms of association in the wood industry have been proposed to propel growth of this important economic sector. In the last fifteen years in Croatia a significant interest has been dedicated to strategic alliances. Policymakers believe there is a great potential in clusters. The wood industry has been identified as one of the key strategic industries; different activities have been developed and a number of measures have been adopted by the Government to support the establishment of clusters. So today we have as many as 12 active clusters, which can be divided into two groups: operational clusters and clusters that represent advisory bodies and as such have no productive function. The main objective of this paper is the presentation of mapping of clusters in Croatia’s wood industry with a specific purpose of assessing clusters from the eastern part of Croatia (Wood Cluster of Vukovar-Srijem County, and Wood Cluster of Slavonia). If we compare the findings of our research with data obtained by the relevant international institutions, it follows that most of the clusters in Croatia do not have the required characteristics for mapping which makes their statistical monitoring and eventually management difficult. The paper includes an example of managing operational cluster in Austria with the aim to highlight the possibilities and benefits which can be achieved by clustering. For the purpose of this paper the method of deck research was used. All relevant scientific and professional papers by domestic and foreign authors related to the research topic were studied. The results were interpreted by using the methods of comparative analysis, compilation, description, classification, inductive and deductive analysis and case study method. The aim of this research is to compare strategic management of wood clusters in Croatia with successful wood clusters in European union (Austria).

Zdravstvo je sastavnica socijalne infrastrukture te je kao takvo podložno državnim intervencijama i administrativnom donosenju odluka. Osim sto je temeljna ljudska potreba, zdravlje ostvaruje i mnogobrojne ekonomske implikacije, a efektivno koristenje zdravstvene prevencije utjece na smanjenje koristenja medicinskih usluga i povezanih visokih troskova zdravstva. Javno zdravstvo podrazumijeva administrativno donosenje odluka te je, stoga, potrebno eksplicitno vrednovati troskove i koristi od zdravstvenih intervencija, odnosno potrebno je voditi racuna o njihovoj troskovnoj efikasnosti. Kako tržisna ravnoteža podrazumijeva usklađenost ponude i potražnje, cilj ovog rada je naglasiti važnost i potrebitost ne samo vrednovanja na strani ponude (provođenje ekonomskih evaluacija), vec i vrednovanja cimbenika na strani potražnje (preferencija korisnika zdravstvenih usluga) koristeci se metodom izrecenih preferencija.

Rational and efficient use of pubic resources is crucial in order to reduce the healthcare costs and consequently to decrease the problem of excessive indebtedness of public healthcare providers in Croatia. Given the growing prevalence of chronic disease (e.g. cancer), secondary prevention (screenings of risky population) has the potential for achieving significant savings in the health care system. Nowadays, many national health care systems are focusing on disease preventing activities. Pap test is proven to be the most cost-effective method of early detection of cervical cancer. Unfortunately, with the model of opportunistic screening a large percentage of women rarely undergo the Pap test, which points to a need for an organized screening program. One of the goals of such programs is to detect a larger population of women with pathological cell changes. The purpose of this paper is to analyze the justification for the implementation of organized screening for cervical cancer by examining the relationship between the number of Pap tests and number of pathological Pap test results as a share in abnormal Pap test results. The estimation is carried out within vector autoregressive (VAR) model and Granger causality testing. Standard Granger causality analysis was helpful in establishing the direction of causal links between the variables of interest, while the signs of these relationships are examined by using impulse response function. Findings suggest that there is a unidirectional causality that runs from number of conducted Pap smears to the share of pathological in abnormal Pap results. Also, results indicate that Pap smears cause a positive response in the share of pathological in abnormal Pap results. This indicates that as the number of conducted Pap smears increases (which can only be done as part of organized screening programs) there will be more cases of an early detection of disease, which could result in healthier population and decrease in health care costs, resulting in less insolvency problems for individuals as well as for the public health care.

Given that in times of crisis the burden of chronic disease is increasing, preventive interventions are becoming more important as they affect the maintenance and improvement of the population’s health, therefore reducing government spending on the sick leave and disability benefits. As public healthcare is characterized by administrative decision-making and relying on non-market mechanisms in the resource allocation, it requires the implementation of economic evaluations. This discussion shows that because the specifics of public healthcare complicate the data collection of revealed (market) preferences, it is necessary to rely on stated preferences of respondents in order to evaluate the economic value of health interventions as well to improve public health care interventions and make them more patients oriented. Also, this article explores the method of discrete choice experiment along with its applications in healthcare, which seeks to identify the marginal rate of substitution between relevant attributes of public healthcare intervention and its impact on the patients' choice, hence enabling a broad application of the method.

Abstract The main goal of this paper is to elaborate the importance of health literacy in cost-effective utilization of health care services which influence the efficiency of the entire health care sector. In order to complement the theoretical framework of the economic implications and the circular influence of health literacy on the economy, an empirical analysis was carried out using S–TOFHLA. The results suggest that the patients’ personal characteristics and the accessibility to health care services influence the level of health literacy which affects the health care costs.

The agency problem in healthcare is caused by information asymmetry between the principal and the agent and is different than the agency problem in other economic fields due to the specificities of healthcare systems. Although other principal-agent relationships are present in healthcare, the most common one is the one between the patient - principal, and his physician - agent. Bearing in mind that there is a certain conflict of interests between the patient and the physician, the ultimate goal is to create an incentive compatible contract which will maximize utility of both the principal and the agent. A well designed payment system in healthcare has a great importance in influencing physicians’ behavior and when determining the payment system which will contribute the most to the motivation of the physician to maximize the patient’s utility, the guiding principles should be optimal use of resources and effective resource allocation to ensure an efficient healthcare system.