Introduction: The aim of this paper was to evaluate the managerial knowledge and skills of mid-level managers – medical doctors in Medical center of the Canton Sarajevo.Methods: A cross-sectional study of the mid-level managers in the Medical center of the Canton Sarajevo was conducted using an originally developed questionnaire for self-assessment of managerial knowledge and skills. The respondents answered each of the questions using a 5-point Likert scale. Apart from the quantitative section, the respondents could present their observations concerning the educational needs in the health care system.Results: Almost 40% of the respondents said that the process of assessing health care needs is not conducted. No statistical significance was observed in the responses according to the length of service in a managerial position. In total, 41% of the respondents were not sure whether a plan exists, even though the development of these plans should be a principal managerial responsibility in the quality management. Managers who were longer in the position reported no plans for corrective actions. This result was in contrast with the answers obtained from the managers who were in the position for a shorter period. In addition, 91% of the respondents said that they regularly discuss problems with their employees.Conclusions: Self- assessment and assessment of managerial competencies should be regular activities in a health care organization, in order to monitor the knowledge and skills, as well as to make the development plans. The results of this study could serve as the basis for planning and developing the health management education in the Canton Sarajevo.

Citation for pulished version (APA): NCD Risk Factor Collaboration (NCD-RisC), Bugge, A., Grøntved, A., Tolstrup, J. S., Andersen, L. B., Bjerregaard, P., & Eriksen, L. (2015). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331,288 participants. The Lancet Diabetes & Endocrinology, 3(8), 624-37. https://doi.org/10.1016/S2213-8587(15)00129-1

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 health In 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.

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.

Introduction The objective of the paper is to analyze and to assess prevalence of the major behavioral risk factors among adult population (25-64 years of age) in the rural and urban areas in the Federation of Bosnia and Herzegovina (FBIH).Methods Data were taken from cross-sectional population survey on the health status population in the FBIH. To ensure a sample representative for the adult population in the FBIH it was applied the two-stage stratified systematic sample. The survey covered a total of 2735 adult population aged 25-64 years, of which 1087 in the urban areas and 1648 in rural areas.Results. The prevalence of smoking among men in rural areas is significantly higher than among men in urban areas (69% vs. 55%), while the prevalence of smoking among women is higher in urban than in rural areas (45% vs. 31%). There is no statistically significant difference in prevalence of obesity and physical activity according to the age groups among men and women in the urban and rural areas. The frequency of changes in behavior related to acquiring healthy living habits in the rural areas is statistically significant among men and women, while in the urban areas there is no statistical significance among the sexes.Conclusions. The results indicate that there are no significant differences in prevalence of factor risks in urban and rural areas. Prevalence of unhealthy lifestyles is high, and the results should be used to improve standard planning of health promotion-prevention programs.

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.

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.

AIM To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-β1, 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-β1. 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-β1 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-β1 has been found (-0.18). For IL-1 α significant predictive parameters included a previous infection of hepatitis B, lower serum level of TGFβ, age, use of alcohol, lower MELD and Chilld-Pugh scores. For TGF-β1 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-β1) 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-β1 are important parameters of inflammatory activity and fibrosis evaluation in chronic liver damage.

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.

Significant increase in noncommunicable diseases, in particular cardiovascular disease, in the past few decades worldwide represents one of the major health challenges in the overall global and social development of society. Cardiovascular conditions have the highest impact on lost years of life, lost quality of life, but also on the differences in longevity in different population groups. Global statistics show that cardiovascular conditions are responsible for one third of global deaths, while coronary heart conditions are the leading cause of death worldwide. (1,2) Many population research studies corroborated that high blood pressure is an independent and significant risk factor of cardiovascular disease and coronary heart disease and most significant determinant of morbidity and mortality in developed countries. (2,3)

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.