P O S I T I V E
F R E Q U E N C I E S
Words from the Editor
Every time we meet a new man we are richer for one new substance of life, for a new state, for a new experience. Then we come to the conclusion that it is beautiful to live with people sunk in goodness, when we become delighted that we move among these beautiful creatures that are like water to us, filling our lives with meaning and poetics for each thing they do, causing the pride in us of being part of the unbreakable bond from which we draw all our strength and potential of life. How wonderful is to be a part of this non deciphered circle that we call nature. The cycle of birth and death, beginning and end, sense and nonsense, the desire to belong and to love. New day. Morning coffee on the terrace. The scent that awakens and gives energy. Family together, wide smiles, open plans where to go on these hot days. The sun like a nail on the wall, firmly nailed high on a distant and non capturable sky, millions of kilometers away, showing its cruel and destructive force. Force without which there would be nothing, not the planet as it is today, nor life on it. Summer torch touching our days, our mornings, our evenings, our daily vision activation, hindering us in the work. Our bodies are dehydrated, wet and feeble. It’s time to do something for ourselves because, after all, all of us who spent time working from January to August, deserve a vacation. The holiday season is in full swing dominated by the empty streets of our cities, because everybody, according to the possibilities and wishes, went for a dose of relaxation and mental regeneration. Whether, in the mountains, the countryside, the lake, the river or the sea. But before we also go on the vacation, the team of the magazine “Medici.com” has not forgotten to materialize the essence of our activities, the issuance of the new, 70th issue of our written media. Even though it was summer, we’ve presented no less and poorer in terms of content, on your site. Drawing inspiration from the nature, watching birds, animals, primarily vegetation, which are mostly visited by bees collecting precious pollen which we later consumed as honey, it is our pleasure to recognize the superior value of life by expanding the positive energy and find its meaning. What is ours, and therefore your pride also, is the fact that “Medici.com“ walks into the international arena by solid steps. In fact, from this number of magazine, your and our printed media will have the electronic version in English. In this way, we intend to go out, from our speaking area, through the window to the world and to expand its positive impact by becoming “Medici.com internacional“ (The International Journal). On the verge of realization and positive expectations from this great step forward, after we come back from vacations and recharge our energy resources, we are approaching September and October, the months that truly abound in a large number of congresses, symposia and conferences both in our country and in the world and who respected Satellite would be “Medici.com“. Your “Medici.com“ Editor in Chief, prim. Dr. Momir Pusac
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Fund ZO RS
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“Hemofarm” Company
55 years of existence
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Five years of work
Radiotherapy Centre Banja Luka
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Academician Nebojsa Lalic
Diabetes
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Health institution Celinac
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Academician Dragan Micic
Treatment of obesity
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Notalgia paresthetica
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Belgrade, 56th Annual Conference
GIRP
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Interview, Dr. Borko Djordjevic
Cosmetic Surgery
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SMC (Scientific Medical Communications)
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MOSAIC OF MEDICAL
www.medicicom.com
Editor: prim. Dr. Momir Pusac Executive Editor: Andja S. Ilic Technical Editor: Sretko Bojic; Translation into English: Dr. Slavisa Udovicic Expert scientific council of the newsroom: Academician, Professor. Dr.Miodrag Ostojic, Academician, Professor. Dr. Drenka Secerov-Zecevic, Academician Prof. Dr. Miodrag Colic, Professor. Dr.Zoran Popovic, Professor. Dr Miodrag Jevtic, Professor. Dr. Zoran Rakocevic, Professor Dr. Vaso Antunovic, Professor Dr. Danica Grujicic, PhD Dr. Ljiljana Vujotic, Professor Dr. Srboljub Golubovic, Professor Dr. Dusko Vulic, Professor Dr. Dusko Vasic, Professor Dr. Zdenka Krivokuca, Professor Dr. Senad Mehmedbasic, Professor Dr. Sandra Lazarevic, Professor Dr. Miroslav Petkovic, Mr. sci. ph. Pero Rokvic, Mr. ph. Natasa Grubisa, Professor Dr. Snezana Pejicic, PhD.Dr. Slavica Zizic-Borjanovic, Mr. ph. Zlata Zuvela, Academician Professor Dr. Enver Zerem and Professor Dr. Elizabeta Ristanovic. Expert advice newsroom: Prim. Dr. Lela Popovic, Prim. Dr. Slavko Dunjic, Prim. Dr. Mira Popovic, Mr. ph. Dragana Reljic, Dr. Rade Dubajic, Dr Danica Mihajlovic, Mr.sci Zivana Vukovic -Kostic, Mr. sci. Med. Branislav Lolic, Prim. Dr. Boro Guzvic, Dr. Dusan Bastasic, Dr. Goran Racetovic, Dr. Slavko Pecanac, Mr. ph. Rada Krca and Natasa Aleksic Editorial: 78000 Banja Luka, Branko Copic St 15, Tel : +387 (0) 51 318 606, +387 (0) 65 603 346; e - mail: medici.com@blic.net ; www.medicicom.com Publisher: “Medici.com“ Association Banja Luka, Branko Copic St 15 Director: Vera Pusac Sales, marketing, promotion in BiH: Jelena and Bojan Brocilovic Sales and distributor for Serbia UNA PRESS doo Belgrade, tel: +381 11 2 188 704 Promotion and marketing abroad Beoimpex AD Beograd tel. +381 11 38 09 715 Legal Advisor: Lawyer Jovana Pusac from Banja Luka, tel. +387 65692377 Photo: Bojan Crnokrak, tel. 066 / 454-211; Print “Atlantik bb“ Banja Luka COMMUNICATIONS
By the Decision of the Ministry of Education and Culture of RS, No. 6-09-3783 / 03 of September 25th 2003 registered in the Register of Public Media under No. 430. Any copying, reproduction, copying part or all of the material from magazines and web editions is allowed only with the written consent of the publisher
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MOSAIC www.medicicom.com
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“Medici.com” journal is mosaic of medical communications, a professional and educational magazine for the medical profession, medical communication by concept, but also a wider readership audience - health services users. It was founded by familie Pusac, and the first issue was printed in 2003. Our goal is to spread information in the field of modern medicine on expert and scientific basis, through connection of users and providers of occupational health, in a unique and specific way publish: projects, presentations, advertisements, reports, health promotion, and in communications with world experts in various fields of medicine, and other technologies that contribute to the health, improve and preserve our health, and to show the correct address for those who suffer and direct them to the path of healing.
Formally addressing Respected Authorities of Development Strategic Partners (authors) (readers)
Let’s get together • Today, when the magazine “Medici.com” is printed, we are addressing you with a call / appeal to join the common work active / creative. • Your knowledge and your support will constantly allow improving of Public Health / Living Conditions and National Economy. • We - Invite: COUNTRY - REGION - CITIES - DEVELOPMENT GROUPS & STRATEGIC PARTNER to set up a “JOINT PARTNERSHIP” and achieve “JOINT PROGRAMS - PROJECTS” and to actively join the “MEDICI.COM” journal. • Participating in international activities: RESEARCH - DEVELOPMENT - EDUCATION AND TREATMENT, we met with respectable people of SCIENCE / KNOWLEDGE and GRATEFUL PATIENTS, which has encouraged us to continue our journey of Hippocrates and other creators - the Humanist of LIFE. Prim. Dr Momir Pusac Editor in Chief
Professor Dusko Vulic, MD, FESC, FACC Member of Scientific Council (City of Banja Luka • 2015 • Your Partner)
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inister of Health and Social Services of the Republic of Srpska Dragan Bogdanić signed Agreement on cooperation with the Johns Hopkins Department of Plastic and Reconstructive Surgery from the United States on 15 June 2015. This is one of the most prestigious medical and educational institutions of the world with about 22 faculty who are engaged in professional education, training, scientific research and health care. “The aim of today’s signing of the agreement is primarily to establish cooperation with one of the best academic institutions in the United States, and defining concrete cooperation which, with the help of experts from this university should lead to improving the work of our surgical clinic and cooperation in the field of occupational training and scientific research,” said Minister of health and Social Services Dragan Bogdanić. Minister explained that this agreement defined that at the request of the Ministry, staff of University Hospital “Johns Hopkins”, will come to the Republic of Srpska where they will hold lectures for the doctors from Republic of Srpska on different topics in the field of plastic and reconstructive surgery and to support joint research projects, additional training and training for health professionals, and students of medical schools. “The areas in which this cooperation agreement is defined are breast reconstruction, reconstruction of burns, head and neck reconstruction, maxillofacial surgery and hand surgery,” said Bogdanić.
Banja Luka, 15 June 2015, Agreement Signed
Cooperation with the Johns Hopkins University from the United States He added that this agreement will America in the field of plastic and reenable doctors to departure from the constructive surgery. Republic of Srpska on education in “This is a good project for Srpska health because we, along with investment in equipment and construction and reconstruction of facilities in this way will educate staff who will follow global trends in the field of medicine,” said Bogdanić. An authorized representative of the Medical Faculty of the “Johns Hopkins ‘ University, Dr. Branko Bojovic said that the signing of the agreement formalized cooperation between the Ministry of Health and Social Protection of the Republic of Srpska with the University “Johns Hopkins”. The signing of cooperation agreements was attended by the Prime Minister of the Republic of Srpska Zeljka Cvijanovic, Srpska Deputy Prime Minister and Minister of Justice Anton Kasipović and Minister of Science and Technology of the Republic of Srpska Jasmin Komić. N.A.
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Minister of Health and Director of Health Insurance Fund visits Italy
The partnership with Italian clinics
World Breastfeeding Week
Let the moms who work to breastfeed
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t the invitation of President of the Chamber of Commerce of Ravenna in Italy, Mr. Natalino Gigante, Minister of Health and Social Welfare Dragan Bogdanić and Director of the Health Insurance Fund of the Republic of Srpska Darko Tomaš and his associates visited the region Ravenna on July 9 this year, where they met with representatives of Italian innovative companies operating in different areas of health. Considering that this is a return visit, delegation from the Republic of Srpska discussed concrete joint proposals and projects in the field of health, with businessmen from Italy which would be financed from European funds. During the two-day visit, representatives of the Ministry and the Fund visited the hospital, “Maria Cecilia” which is known as the “jewel” in the field of health services research in the field of cardiology and cardiac surgery, with the aim of establishing a partnership in the field of treatment and education in this area Republic of Srpska already has good cooperation with the Italian clinics, such as the Health Institution ‘’Gabriele Monasterio’’ from Tuscany, when collaboration has been established in order to treat children with congenital heart diseases from RS. Protocol on cooperation was signed last year on the basis of which seven children with heart defects was treated last year. Experiences with Italian healthcare institutions have so far proved to be a very good and successful treatment for our policyholders.
orld Breastfeeding Week, which is coordinated by the World Alliance for Breastfeeding Action which takes place from the first to the seventh of August 2015 is dedicated to supporting women to breastfeed in the workplace. This year the theme of World Breastfeeding Week is “Let the mothers who work to breastfeed.” This action of the World Alliance for Breastfeeding is dedicated to joint global action to support breastfeeding women in the workplace. The mother who is breastfeeding her baby need to have the support of the work environment, wherever she works. Whether a woman is employed in a public or private company or working at home, she need to have the ability to breastfeed her baby. For the campaign of the World Breastfeeding Week 2015, the World Alliance for Breastfeeding Action and its partners at global, regional and national level, aim to empower and support all women to adequately combine work with raising children, particularly breastfeeding. ”Innocenti Declaration“ for the protection, promotion and support of breastfeeding recognized that it provides the ideal nutrition for infants and contributes to their healthy growth and development. Recognizing the importance of the first years of life as the most important period for growth and development in 2011, Republic of Srpska Government adopted the Policy for Improving Early Childhood Development in the Republic of Srpska The objective of this policy is to create optimal conditions for proper growth and development of children so that every child, regardless of the original community
and its individual features, had conditions for a healthy start in life and to achieve its full potential. In 2012, the Policy for improvement the nutrition of children under five years of age and Policy for improvement of health of the population of the Republic of Srpska 2020 is adopted. The priority lines of action defined in this document, among other things,are related to the support of healthy start in life through the promotion of fetal nutrition - optimal nutrition of pregnant women and the protection and promotion of breastfeeding and support breastfeeding. The results of the research related to nutrition of children under five years, with particular emphasis on the aspect of breastfeeding in the Republic of Srpska, suggest that the habit of exclusive breastfeeding of children is rising. “Multiple Indicator Cluster Survey in the Republic of Srpska 2011 - 2012”, pointed out that approximately 32% of children under six months exclusively breastfed, at the age of 12 to 15 months 11.4% of them is still breastfed at the age from 20 to 23 months 6.2 percent of them is still breastfed. Enormous efforts have been made in recent years in the Republic of Srpska to improve breastfeeding and create the right environment for breastfeeding through developing a network of “Baby Friendly Hospitals”. In the maternity hospitals of the Republic of Srpska, thanks to the introduction of “baby friendly” programs, breastfeeding is the only diet, and medical personnel have been trained to provide assistance to women during breastfeeding. Schools are organized for mothers in which, among other things, people talk about the advantages of breastfeeding. N.A.
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inister of Health and Social Welfare of the Republic of Srpska Dragan Bogdanić visited the Trebinje hospital on fourth of July and handed a decision to Zdravka Vreća that this institution acquired the status of a certified institution. The certification process, in which are equally involved public and private health institutions, is leading to standardization of work and increase the safety of health care delivery. This is,after Prijedor Hospital, the second hospital in the RS, and the first in Eastern Herzegovina that has received this status, which leads to the standardization of work and increase the safety and quality of health care provision. Obtaining the status of certified institutions is important for Trebinje Hospital and for all health institutions in the RS, for better complying with certain procedures and protocols, and achieveing better protection of patients and staff. This process will improve and rationalize work process, services and work will be cheaper and it will provide further guidance in the development of this health institution. The important thing is to assess the treatment of the patient and the patient’s way of entering a hospital of this type until the end of treatment, “said Bogdanić. Minister Bogdanić stated that the certification process in the Srpska has begun, and that the final assessment in the certification process, conducted by the Agency for certification, accreditation and quality improvement of healthcare in RS, except in hospitals in Prijedor and Trebinje,is conducted in 20 health centers, the Department of Dentistry, Department of Physical Med-
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Trebinje Hospital
Certificate to Trebinje Hospital
Dr Zdravka Vreća and Dragan Bogdanić
icine and Rehabilitation “Dr Miroslav Zotović”, two private dental clinics, 16 private specialist clinics and 118 pharmacies, while around 80 health institutions is still in this process. In the certification program all the parameters are evaluated - infrastructure, all diagnostic, therapeutic and interventional processes that are performed in a medical institution, or dealing with the patient from entering
the hospital,until the end of treatment. According to Bogdanić, Trebinje Hospital was “one of the rational hospitals in Srpska which organization and operation are well aligned, as well as a way of providing health care services and operates successfully in accordance with the funds received from the Health Insurance Fund RS”. Director of the hospital Trebinje Zdravka Vreća said that the process of certification in Trebinje hospital lasted five years, “We acquired the status of certified hospitals in October 2014 and I am pleased to point out that all the requirements for safe and highquality health care for our patients are fulfilled. We achieved safety, not only for patients but also for employees. Also,we provided better teamwork and good communication between employees and healthcare users. We invested about seven million marks in equipment, with significant resources on educating our personnel and environmental protection, to satisfied our patients with the health care that we raised at the highest possible level,” said Dr. Vreća. Vreća has stated that she planned significant investments in Trebinje hospital: “We are planning the reconstruction and equipping of the dialysis center, because 28 patients from the entire region comes to dialysis daily in our hospital, equipping individual departments where the equipment is outdated, the introduction of video - assisted bronchoscope to our pulmonary department, equipping the laboratory diagnostics, intensive care departments and angio - department, with the introduction of a completely new procedure not only in our hospital, but in the entire region,” said Dr. Vreća. After the ceremony, which was attended by the heads of all departments and the head nurse of Trebinje Hospital, Minister Bogdanić visited internally and surgical department.
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nconditionally, all these years of our existence, through professional development, acceptance of innovation in the provision and implementation of health promotion, prevention, early detection and treatment of oral and dental clinics we strive to create conditions that will allow us to provide the maximum level of quality and safety of health protection to our patients. Although we have always worked to improve the quality and safety of our services, we considered that the implementation of certification standards for dental clinics in our hospital will improve these two aspects. We started the process of preparing for certification independently, but due to the volume of work we were not able to clarify the requirements of the standard, as well as the way of their implementation. We requested help from the Institute for Public Health, and the Centre for Health Management, which has the experience
in the preparation of medical institutions for certification. The staff from the Center for Health Management developed a book of procedures for the needs of
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The first certified private dental clinic in the Republic of Srpska
General dentistry clinic “Krčić 2” our ambulance and ensured full compliance with the requirements of the documents, which made our work easier and ensured that the entire process was documented through conducting various forms of records. We have invested a lot of effort and energy together to end this tough process. The credit for the success of
achieving and obtaining the status of the first certified private dental clinic in the Republic of Srpska belong to all staff of the ambulance, but pri-
Dr. Petko Krčić, director of ZU Dental clinic “Krčić 2”
marily experienced and valuable dental nurses. As the certification process comes to an end, the process of improving the system of quality and safety of health care in our clinic is not over. We established a system to continuously improve the quality and safe environment for our patients and staff, through continuous monitoring of performance. In addition to continuing work on the quality and safety of health care, our services are provided in the modern equipped space in the business center of the Jewish street in Banja Luka. Also, during the provision of services, we will continue to use proven materials and equipment from renowned manufacturers, for our patients, in addition to receive adequate service. We recognize the importance of the introduction of certification standards and after completion of the certification process in the dental clinic “Krčić 2” in Banja Luka, we continued with preparations to introduce certification standards in the dental clinic “Krčić 2” in Kotor Varos, which was founded in 1989. and registered as the first private dental clinic in the Republic of Srpska and a third in Bosnia and Herzegovina.
Jewish bb (business center) Banja Luka, Republic of Srpska, Bosnia and Herzegovina Tel: +387 51212342 Fax: +387 51212342 E-mail: info@stomatologijakrcic.com www.stomatologijakrcic.com 11
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reasury management, reduce contribution rates and a simultaneous increase in excise taxes on tobacco and alcohol as a new source of income for health insurance funds in BiH, are among the most important news that Reform agenda predicts, which was recently adopted by the Council of Ministers , as well as the governments of RS and FBiH. “The reform of the health sector implies discharge of debts, the introduction of the treasury system and the definition of new models and sources of funding, with the precise standardization of the network of health care institutions” , according to the Agenda, adding that, the financial and technical assistance of the World Bank will be requested for the reform of the health sector. The Reform Agenda emphasizes that it is necessary to implement a reduction burden on labor by reducing contributions for health insurance, but it is also necessary to provide additional revenue-budget funds to cover the losses that will be incurred due to the reduction in the contribution rate. “The authorities in Bosnia and Herzegovina will support an increase in excise taxes on tobacco and alcohol, which will be a direct income of the Fund for Health Insurance of Republic of Srpska and health insurance funds in the Federation and the cantons and the Brcko District by the end of 2015”, according to the Agenda. Also, it is written in the Agenda, a significant reduction in social security contributions (especially for those with lower incomes) will reduce labor costs, than, it will help to attract investors and lead to more employees in the formal sector (and reduce the dominance of employment in the informal sector), but that would also be impossible to implement without providing additional resources for non-budgetary funds. “We will ask the World Bank, through the DPL program, to provide technical and financial support for the reorganization of the health sector. Entity, cantonal and Brcko District governments will use these resources for the settlement of unpaid debts in the health sector, especially the contribution for health by the end of 2015”, accord12
What does the Reform agenda in health care predict
Treasury management, new sources of revenue, smaller contributions to health care Prepared by the Public Relations HIF RS
ing to the Agenda. The reform agenda predicts strive for discouraging work in the informal economy, through preventing the application of lower income as a basis for calculation and payment of taxes and contributions. We remind you that the RS Health Insurance Fund was first to initiate the introduction of additional sources of revenue to fund health care from excise tax on tobacco and alcohol, several years ago. Our earlier analysis showed that, on that basis, healthcare of RS could get about 70 million, which is, for example, enough to fund the annual cost of prescription drugs. Additional taxation of products which are harmful to health is a logical commitment not only in terms of increased revenue from an increase insurance risk, but also from the point of impact on the responsibility of citizens to the preservation of their own health. For this reason, HIF RS fully supports this proposal, which is contained
in the Reform Agenda, and which was previously adopted by the Government of the Republic of Srpska. It was proposed earlier that the contributions for health insurance should be reduced to reduce the burden on labor. In this regard the attitude of HIF RS is clear: We support the relief of economy, if the reduce of income would be replaced by additional sources of funding the health insurance, because only in this way, it can still provide the smooth functioning and financing of the health system . Also, the Fund supports the item in the Reform Agenda, which provides suppression of labor in the gray zone and registration of workers on lower incomes to which contributions are paid, because funds are losing a significant portion of revenue in this way, that could be used to improve the health care of the insured .Otherwise, these proposals are already contained in a set of reform laws proposed earlier by the Government of the Republic of Srpska.
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anagement of RS Health Insurance Fund and Health Institution ‘’Acibadem’’ from Turkey signed a protocol on cooperation which formalizes the cooperation so far and anticipate the signing of the contract which will enable the treatment of the insured person from the Republic of Srpska in this institution by significantly more favorable terms. In fact, so far the insured, whose treatment was not possible in hospitals in the RS, as well as in institutions out-
side the RS with which the Fund has a contract, were sent in ‘’Acibadem’’ for treatment. Generally, they were an oncology patients who required complex diagnostic and other interventions. Based on previous successful cooperation, at the meeting which was held in Banja Luka, both sides agreed that the future cooperation is going to
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epresentatives of the Health Insurance Fund of the Republic of Spska, as well as the funds of the Federation of BiH and Brcko District have reached an agreement with the National Health Insurance Fund of the Slovenia that, as of next year, insured Slovenia citizens can use the European Health Insurance Card during a temporary stay in the Republic of Srpska and Bosnia and Herzegovina. So, from 1 January 2016, insured Slovenia citizens, will not have to take out the appropriate forms before arriving in BiH. In the case that they need immediate medical help, they can use the European Health Insurance Card, which is used in all EU countries. The agreement for using the European card in Bosnia and Herzegovina has been made on the basis of the Convention on social insurance between BiH and Slovenia, and which regulates the rights of the insured from one country during their stay in another country. In accordance with this convention, we recall, the insured from RS, before departure to Slovenia or other countries with which BiH has signed the convention on social security, should take the appropriate document from the competent
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Cooperation with the medical institution ‘’Acibadem’’
Contract and cheaper treatment soon
be based and specify by the contract that would allow the treatment of insured persons from RS at lower prices than before. Also, the education and collaboration of physicians from the RS with the doctors of the institution was agreed, which will improve health care in the RS. The details of the contract that should be signed soon was dis-
cussed at the meeting as well as the health services that are most needed for patients from the RS, which will be provided in the institution. Therefore, cooperation with the ‘Acibadem’ group offers the possibility of treatment with modern methods for the patients from the Republic of Srpska, at the expense of the Health Insurance Fund of RS. The “Acibadem” is a world leader in the integrated model of health care, and provides diagnosis and treatment of virtually all areas - oncology, reproduction, organ transplantation, orthopedics, nuclear medicine and robotic surgery, genetic and pathological analysis, etc.. With 18 hospitals and 13 health centers’ Acibadem ‘’ is the second largest chain of health care in the world.
An agreement with Slovenia
With European insurance card in the Republic of Srpska office of the Fund, based on the confirmation from the family doctor about the health, which can be used in the event that they need emergency medical care during their stay in the country. Agreement on the use of the Euro-
pean Health Insurance Card for insured persons in Slovenia who temporarily stay in BiH, was signed by the directors of institutes / funds of RS, Slovenia, the Federation and Brcko District. We want to remind readers on recently signed agreement with representatives of the Austrian house of health insurance, thanks to which the insured from Austria on 1 July this year, can also use the European health insurance card during their stay in BiH. A European health insurance card is used by more than 170 million insured in countries from the European Union that allows them to, under appropriate conditions, use health care in all member countries. 13
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An official reception in Banja Luka
55 years of the company “Hemofarm” Beginning of June 2015 marked the Week of “Hemofarm” in which the company has a number of activities celebrated the 55 years of existence.
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eneral manager of “Hemofarm” Banja Luka, Aleksandar Veselinovic said that the company achieved new records last year, in the production of tablets as the number of packages and the number of units produced. - I’m talking about more than 200 million packages and 4 billion tablets produced in the last year. The factory in Banja Luka has produced more than 20 million packs of drugs and more than 700 million tablets, said Veslinović and announced the expansion of production capacity in Banja Luka from September to produce more than one billion tablets per year. He said that in the forthcoming period new investments in “Hemofarm” are expected: - Stada group, of which we are a member for almost a decade, has been planning to invest more than 20 million in a factory in Serbia and the region, in order to expand production capacity and construction of new plants. Veselinovic pointed out that “Hemofarm”, by the quality of business and quality of its products, treatment of employees and the community, all these years is constantly dedicated to improving the overall health system and society in general - I believe that the past decade has shown that we are a company that cares about people with a constant effort to raise awareness about the importance of preventing disease and preserving health. “Hemofarm” Banja Luka is the only drug plant in the RS, which employs about 200 workers. By technological solutions is one of the most modern factories in this part of the Balkans. The founder of a factory in Banja Luka, the Vrsac “Hemofarm”, which is member of the German STADA Group since 2006, is one of the largest generic pharmaceutical companies. A Gift to citizens of Banja Luka On the occasion of 55 years of the company, in Banja Luka, Sarajevo and Tuzla, operated the “Healthy buses” in 14
which citizens had the opportunity to talk with the medical representatives of “Hemofarm” about the importance of prevention, healthy lifestyles, as well as to try vitamin products. Several dozen citizens of Banja Luka had a chance to talk with the doctors from “Hemofarm” in the Park “Petar Ko-
cic” about health, disease prevention and to measure blood pressure. As part of the Week of “Hemofarm”, the company has gave a theater play “Father and Son” directed by Nicholas Pejaković from the National Theatre of the Republic of Srpska as a present to the citizens of Banja Luka.
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Recipe for success
The new plant for production of ampoules Serbian and regional pharmaceutical leader “Hemofarm” celebrated 55 years of successful business by opening the new factory plant for ampoules, worth 4.37 million euros. 50 people will work in the new facility, in the plant in Vrsac. The whole production process, from the preparation of solutions, ampoule filling, to packaging, will take place in the area of 600 m2. Estimated volume of production this year is 25 million ampoules, and plan for next year is 60 million. The products will be exported to Russia, the EU, Iraq, Libya, the countries of the Western Balkans, but most of all the products are for Serbia. On the occasion of the jubilee of “Hemofarm”, the Serbian Prime Minister Aleksandar Vucic, accompanied by the German Ambassador in Serbia Heinz Wilhelm, visited a new plant for the production of ampoules. The delegation included the Minister of Health Zlatibor Loncar, Minister of Economy Zeljko Sertic and President of the Serbian Chamber of Commerce, Mark Čadež. - I am proud of the fact that the new facility in “Hemofarm” is made by Serbian engineers, especially as this year the German company is going to invest 22 million euros. Asking representatives of the German company, what more can the state do to enable them to do better business, I was told that the Serbian government did everything they can to preserve stability in the country and in the region and they are going to continue to pass legislation that will improve the business environment. I am proud for this because there are a lot of things we do not know and when we do
not know, we ask the Germans how to do it and they tell us. So we will continue to work - said Aleksandar Vucic. - What you see here is the result of dedicated work of our employees who have been working, with a lot of motivation and enthusiasm, on the preparation of the new part of the production. STADA invested in “Hemofarm” more than 150 million from 2006, and this year we plan to invest an additional 22 million. Today, among others, is an example of the partnership between the state and the economy. It is important to say that the state and the economy are natural allies in some way and that their aim is practically the same - the benefit of society. We believe in the vision of the Government of Serbia and we have a clear strategy, but we believe that it occurs in small steps – said the General Manager of “Hemofarm” Ronald Seeliger, during a tour of the facility. The new plant, measuring 600 square meters, will work complete production process from the preparation of solution, filling in ampoules to the packaging of the final product.
General Director of “Hemofarm” Ronald Seeliger shared his recipe for success with XVIII generation of Summer School of Economics students entitled “How to fight youth unemployment? – Danger of losing (another) a generation “, organized by the Institute of Economic Sciences and by the financial support of the Konrad Adenauer Foundation and Findomestic Bank. General Manager of “Hemofarm”, said that, given the global situation, the countries in the region do not have the luxury to choose from which sector the foreign investors will be. Addressing the participants of the XVIII generation of Summer School of Economics, organized by the Institute of Economic Sciences in Belgrade, Seeliger also emphasized that countries in the region should provide the best possible conditions so that investors can come and stay. Participants of the Summer School are the best students of the Faculty of Social Sciences in Serbia, Bosnia and Herzegovina, Macedonia, Montenegro, Slovenia. All of them were trying to get as much advices and informations through dialogue and numerous of questions which can be useful on the path to business success. Speaking specifically on the topic “The prospect of foreign investors and the labor market in Serbia”, the manager of “Hemofarm” praised the workforce, qualification and motivation of workers in Serbia. He said that the academic education here is at a high level, the workers are productive and that there is the large availability of skilled workers. - It does not matter what you study, but what will you do from that education. If you want to be successful, it is vital that you are dedicated to your work. You must be ambitious, motivated and work on it every day - said Ronald Seeliger. M.C.
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omebody still remember the time when cancer patients from the Republic of Srpska were sent for treatment abroad, mainly in Sremska Kamenica and the Institute for Oncology and Radiology in Belgrade. This practice has been a thing of the past for five years because the Government of the Republic of Srpska ensured a permanent solution for the treatment of cancer patients by forming the first center for radiotherapy in Banja Luka, as part of their own health care system. At the international tender, announced in 2008, the company ‘’ Affidea ‘’ from the Netherlands (previously called ‘’ Euromedic International ‘’) was selected as the best bidder for the construction and operational management of the Centre for radiotherapy. In order to meet all the obligations undertaken by the local tender, and the contract which was signed, ‘’ Affidea ‘’ has registered its local entity in the Republic of Srpska / Bosnia and Herzegovina under the name of International Medical Centers of Banja Luka (IMC BL) to which they have transferred its obligations in construction, equipping and operational management of the Centre for radiotherapy Banja Luka for the duration of the contract. ‘’ Affidea ‘’ has invested 19 million in the health of the Republic of Srpska so far.
About the Center for radiotherapy Banja Luka
Centre for radiotherapy Banja Luka is the first center that was established in the Republic of Srpska and provides services for all oncology patients in the Republic of Srpska, which have been sent for treatment in other reference centers in the country and abroad so far. IMC Banja Luka has built a center for radiotherapy Banja Luka in a record time (11 months), and equipped by the brand new medical equipment of US manufacturers ‘’Varian Medical Systems‘’ for the provision of teletherapy 16
Five years of work of the Centre for radiotherapy in Banja Luka Prepared by Dijana Stričić
and brachytherapy, as well as equipment manufacturers ‘General Electric’. Thus equipped, the Center for radiotherapy Banja Luka is the most modern center for radiotherapy in the region. The first patient was admitted to the Center for radiotherapy on 2 August 2010. From the beginning, the Centre for radiotherapy in Banja Luka has pro-
In August 2010, the magazine “Medici.com” published an article about the start of the first center for radiotherapy in Banja Luka in the Republic of Srpska. Today, Center celebrates five years of their existence.
vided a set of radiotherapy services to the level of 3D conformal radiotherapy, which still represents the gold standard in the treatment of cancer patients. In order to monitor the latest developments, the Centre will continuously supplement its list of services with modern treatments in the next five years, according to evidence-based medicine.
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‘’Affidea’’ BV, a Dutch holding company, is one of the largest investors in public-private partnership in the health sector in Europe. A shareholder of the company is Waypoint Capital, based in Geneva. ‘’Affidea’’ is leading a medical centers of high quality, mainly in the fields of diagnostics, laboratory and radiation oncology. They Own 153 medical centers in 14 European countries, in Switzerland, Italy, Poland, Portugal, Greece, Croatia, Ireland, Hungary, the RS BiH, Turkey, Czech Republic, Lithuania, Romania and Bulgaria and providing services to 4 million patients per year. Today ‘’Affidea’’ leads 10 radiation oncology centers in Poland, Turkey and RS-BiH, with a total installed base of 21 linear accelerator, 10 brachial therapy modalities, three Gamma Knife and working more on the strategy of further strengthening and growth in the field of radiation oncology.
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The intensity modulated radiotherapy (IMRT) was introduced in 2011, which maximizes sparing surrounding healthy tissue located in the immediate vicinity of the tumor, and the next year IGRT techniques (pictorial guided radiotherapy) was fully implemented. Technological development of the center was continued during 2013 and 2014, when VMAT rotational therapy was implemented in clinical practice. This technology also necessitated additional investment in new modern linear accelerator with a system for skilled, CBCT and respiratory synchronous radiotherapy. With this step, the Centre has increased capacity from two to three therapeutic devices for external radiotherapy, which involves increasing the capacity by 30%. In the fifth year of its existence, the Centre has introduced a stereotaxic radiation brain tumor and extracranial tumors, as well as respiratory synchronous radiotherapy. It is important to emphasize that the Center for radiotherapy Banja Luka is the only one in the wider region (Croatia, Serbia, Montenegro, Macedonia, Bosnia and Herzegovina Federation) in which the standard is applied in all the techniques mentioned earlier. This means that there is no need for sending patients from the Republic of Srpska in any radiotherapy center abroad because all the latest techniques of radiation is provided in the IMC Banja Luka. The implementation of modern techniques of radiation significantly enhances the quality of life of patients, survival rate, reduces total cost of treatment of cancer patients and increases overall economic excellence of the country. Oncology problem of the individual is always the problem of the family (which increases the number of days of absence from work), and the society in general. There is no waiting list at the Center for radiotherapy Banja Luka - the patient begins with the implementation of radiotherapy treatment within 48 hours of initial examination of any of these levels of complexity and all the costs of treatment with radiotherapy in IMC Banja Luka pays the Health Insurance Fund of the Republic of Srpska for its policyholders. The patient, the policyholder, pays nothing with his own money. Despite the last generation technology radiotherapy equipment, IMC Banja Luka is proud to say that the Centre for radiotherapy Ban17
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ja Luka permanently employed medical experts of all profiles that came in Banja Luka from radiotherapy centers from the wider region (Novi Sad, Belgrade, Skopje, Podgorica, Tuzla, Sarajevo). In addition, IMC Banja Luka is educating local medical staff who will completely take over the operational work of the Centre for radiotherapy Banja Luka in the future. Today the Center for radiotherapy in Banja Luka is recognized as radiotherapy institution that provides services for 120 to 140 patients per day.
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The partnership with the Houston Methodist Hospital In addition to the strong expansion strategy in the field of radiation oncology, “Affidea” has found a strategic partner in the Houston Methodist Hospital in Texas, USA. This hospital is from year to year in the list of “best hospital” according to “US News & World Report,” and in 2014 was among the best US hospitals in 11 specialties including the Radiation Oncology. The partnership between the companies “Affidea” and Houston Methodist Hospital focuses on the continual adoption of clinical protocols, training of medical staff, control and audit quality and safety operating procedures “Affideinih” centers for radiotherapy, giving “second opinion” and consultation with complex cases, in order to apply superior clinical, labor and quality standards for radiation oncology in Europe. All “Affidea” centers for radiotherapy wear the label of Houston Methodist Hospital.
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Interview with Academician Prof. Dr. Nebojsa Lalic, the current coordinator for diabetes in Serbian Ministry of Health
The individualization of the treatment of diabetes
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n RS medical circles academician Prof. Dr. Nebojsa Lalic is known for his selfless professional engagement on the modernization of diabetic care. His expertise is recognized in the international level. He was quoted in many world renowned medical journals, which confirms the competence of scientific workers. Closer focusing on this area started in the last years of the study in the School of Medicine, University of Belgrade. The first work experience was also at the Department of Endocrinology, Clinical Center of Serbia. He was later training in Boston, Diabetes Center, one of the most prestigious institutions in the world. That is the way I was professional and scientific profiled in a rather broad, but specific areas of diabetes research. It was insulin resistance and its possible consequences, says academician Lalic, whose CV is characterized by the management functions: the former Director of the Institute of Endocrinology in Belgrade. However, it seems that he is closer to an academic career, which began sometime in 1991. A Professor of Medicine, University of Belgrade in 1999. The research and educational work in the field of diabetes manifests with the participation in numerous projects, some of which have been with the European partners. Among them, academician Lalic particular stands out the one that allowed them to major technological breakthrough, and was implemented in collaboration with 20 centers of the EU countries. For ten years, he 20
devoted himself to public health and the health-care organization of Serbian citizens who are suffering from diabetes (President of the Serbian Republic Commission for diabetes). Now he is the coordinator for the Diabetes of Serbian Ministry of Health. He Recalls that he participating in the projects in RS which are focused on improving the diabetic care since 2002. I’ve always approached it as another challenge, especially from the point that we are one cultural-national space and what is implemented in Serbia should be applied here, reveals in this interview with “Medici.com” academic Lalic. Medici.com How do you see implementation of the project “Diabetes mellitus in the RS“ from your professional angle? There is a huge advantage of this project, even in some areas that have not been applied in Serbia. It is the uniformity of its structure, and a number of programs that are made at a single methodology.That allowed to introduce modern diabetes protection to the same degree throughout the RS, on the other side to monitor and evaluate. It is known that the RS started from a low level of development of this form of health care. This program is provided to do a modern construction that provides uniform protection for patients regardless of where in RS are they living. Among that, the ongoing evaluation. Does it provides or
not? I think it’s very important not to leave the orientation towards a structured and intensive approach. Because many studies have shown that intense approach of physicians (medical team) to patients is the basis for successful treatment of diabetes. It is not a question about extent use of the most modern therapeutic methods, but the question of facing intense approach to achieving therapeutic goals. Medici.com It is known that there are established guidelines for good clinical practice in Serbia for the type II diabetes as well as its prevention. You put a lot of effort there, also. What is the time distance and what determined them so they must be innovated? In developed countries with a good system of monitoring and evaluation, the fact is that there is a rapid change in attitudes, recommendations, etc., especially in diabetology, a period of 4-5 years is considered to be optimized to renew these guidelines. Unfortunately, in countries such as ours, that process depends on the financial resources that are normally not provided for health care in the regular budget. Then it becomes a question of some external help and that is limiting their innovation a lot. We succeeded to restore guidelines in Serbia after 10 years. I think that in the RS it was partially done faster. The fact is that guidelines had to be understood in the health system. They are not
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obligatory criterion of which can not be waived, but everybody needs to know why a particular patient deviates from them. Guidelines often do not provide answers for all situations, but is determined to act typically in different situations. This is essential not only for successful treatment, but also for the organization of the health system. That is the way to achieve significant savings in health care of the population. Medici.com The tendency of growth in the number of diabetic patients in the world, as well as in our national framework is still present. What is the cause in your opinion? It is still, unfortunately, not known. It is assumed that the cause is in transition, globalization leading to neglect the principles of proper nutrition and adequate movement. All of this combined with stress situations by people who are prone to diabetes leads to the manifestation of the disease. However, a bigger problem than that is its complications. Diabetes causes disabilities that can compromise even the economic activity of a country. The United Nations concluded that this disease is obstacle to the realization of the Millennium goals of humanity, because of diabetes suffer not only the elderly but also younger full workforce. Therefore, it is not only an insidious disease, but already has a major negative significance for society. Medici.com Let’s turn the story in the direction of modern treatment of diabetes. Diabetes is not just a disease whose basic forms are known and it is diagnosed based on them, but it is a disease that can then develop later. Each of these stages brings certain specific
features with it different from the previous phase. And it requires the use of new drugs or a combination of them. It is impossible to define a number of drugs that could be replaced to finish the job. This requires that the treatment of diabetes should be individualized not only because we say that it should be in all of medicine, but because diabetes is based on pathophysiological mechanisms, and mechanisms of disease. Patients with disease in the first five years does not need the same medication as the one who have diabetes for 15-20 years. I emphasize that these are very different drugs. That’s why doctors, diabetic teams must have a variety of drug classes at its disposal that can be combined to effectively treat these patients. It is usually difficult to visualize those who are not in this area, as well as financial authorities, those that determine budget policy, because it raises the question: Well why so many drugs? It is often thought to be due to hyperactivity of the pharmaceutical industry, of course, it can not be excluded. But You need to know, and remember, that behind all this there is the nature of the disease which is such that individual combination of a spectrum of drugs is really necessary. If You dill with such a situation in a too restrictive way then it will definitely be a fail treatment for many patients. There are no minimum diabetes drugs, and the rest after that upgrade. In fact, for now there are only drugs that can help in this or that stage of the disease and the therapistphysician decides what his priority. Of course, we’re talking about conscientious physicians and correct operation. I am excluding abuse. But, if they exist, if there are a case of forcing certain products of the pharmaceutical industry then it is already not medicine, but something else.
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Medici.com It all requires continuous education for diabetologists. Yes. This is the basis of modern medicine, especially in areas that are extremely propulsive in the sense that there is a lot of new information. It may not be strategic but it is important, theoretical and practical and that come every year or two. In the field of diabetology in Serbia 2006, we applied some four recommendations that were fundamentally different. These are things that doctors must learn and it in the right way. You do not have to know the way how it happened or left themselves to find out. But there is this tertiary level of health care, as an academic environment, to provide them with rapid transfer of knowledge through various courses of continuing medical education, symposia, conferences, etc., says academician Prof. Dr. Nebojsa Lalic, who is at a symposium in Banjaluka with international participation, held from June, 26-27 this year. Working title was: Diabetes, obesity and metabolic syndrome talked about incretin-based therapy in diabetes. In the accompanying symposium his presentation was on the GLP-1 receptor agonist in the therapeutic algorithm of treatment of type 2 DM Recall, academician Lalic works at the Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia in Belgrade and has been a full professor at the Medical Faculty of the city as well as a regular member of the Serbian Academy of Arts and Sciences. The abovementioned symposium is organized by the Association of Endocrinology and Diabetes RS and Diabetes Center of endocrinology of the University Hospital of the Clinical Center of Banja Luka. Angie S. Ilic
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mall town on the river Vrbanja hugged trough on both its sides, stretching great length with beautiful landscapes decorated with hills covered with trees, whose branches and tops swaying warm summer breezes. Team of the journal “Medici.com”, had the honor to come to visit this hospitable municipality, see, receive impressions and talk to the first man of the Health Center “Sveti vracevi” Celinac, Mr. PhD. Drasko Kupresak, a family medicine specialist.
Introducing: Health center “Sveti vracevi” Celinac
Interview with the manager Dr. Drasko Kupresak Prepared by: Bojan Brocilovic
Mr. Kupresak, can you tell us a few words about the history of the Health institution in Celinac? Health institution in Celinac was founded in 1975. This year we celebrate the anniversary of 40 years of existence. From the start to the present day Health institution passed various stages in its development. At first it was as a small rural clinic but then, as a number of residents and the settlement was rising, needs for health care grew also. Today it is a stylish, modern and fully equipped health center, which operates on 1640m2 (central building) and provides primary health care for about 16,800 residents of the municipality Čelinac on 362 km2. In addition to the main building of the Health institution, three regional clinics are included, located in the villages of the Ukrina, Branesci and Josavka. How does Health institution in Celinac work today? Better equipped and more functional, in many ways, Health institution is essentially designed by the model of family medicine. What is important to say is that
Dr Drasko Kupresak was born on October 8th, 1966. He finished primary school, high school and the Faculty of Medicine (1996) in Banja Luka. He is working at the “Sveti vracevi” health institution from June, 1996 with an interruption from 2006 to 2010. He served as Assistant Manager and Chairman of the Board of the health institution in Čelinac from 2002-2006. He worked in the Agency for accreditation and quality health care promotion in RS, which was part of the Ministry of Health and Social Welfare as the Chief of Standardization Sector in the period 2006-2010. He completed his specialization in family medicine at the Medical Faculty in Banja Luka in the period 1999-2002., the training of trainers in the field of Health by WHO in 1998, Quality management in health care in 2002, training of trainers in the field of quality in health care in 2002, training of trainers in family medicine TOT-Quins University, Canada in 2003. He completed post graduate studies in the field of health management at the University of Business Engineering and Management in Banja Luka in the period 2008-2010. He defended his master’s thesis in February 2011 on the theme “Management of accredited family medicine teams aimed to improve the quality of health care.” At the University of Belgrade - Business Economics and Management on April 22, 2014, defended his doctoral thesis in the field of health management on the theme: “Development of a model management team of family medicine in order to improve the quality of health care.” He is President of the Association of family medicine doctors in Republic of Srpska since 2006, member of the European board of family medicine doctors in front of the Republic of Srpska since 2006 and a member of the Board of Global family doctor since 2011. He participated in many projects of the local to international significance.
the Health institution Čelinac, according to the decision of the RS Government in 1998, was declared as a pilot area for the implementation of the project of family medicine. This project, which was realized by the World Health Organization in cooperation with the Ministry of 24
Health and Social Welfare is comprised of two components: training and equipping teams of family medicine. So the history, and the first steps of what family medicine is today in the whole of the territory of the Republic of Srpska was made at these Health institution.
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grams of this center, which consist of the analysis, evaluation, advice and targeting teenagers and young adults who are at risk of adopting the wrong habits is commendable. In addition, there are services that include x-ray diagnostic and ultrasound diagnostics, laboratory, well-equipped dental office, and SHP which has been considerably improved and modernized as well as service for hygienic and epidemiological work. In addition to these there are, no less important, the Maintenance of cleanliness and hygiene, transport service, administrative and technical staff.
Can you draw a parallel between the time of the early model of the family medicine and previous experience with this model? From that moment until today, there have been large and significant changes in the health system in the Republic of Srpska and Health institution Čelinac adapted to new circumstances. They were reflected in the introduction of specialization in family medicine, a new way of contracting HIF RS, the new standards and norms, and to the introduction of accreditation and certification programs. Today Health institution has 8 registered family medicine teams 5 teams of these are working in the central building, where they provide health care for registered patients ranging from 1500 to 2500 inhabitants. The other three teams are working at the small villages are adapted to the conditions and population. I would point out, as an example, the team number 7 in Ukrina which provides health care for about 2,400 residents, who have supporting laboratory and who is adapted to modern methods of health care. The essence of such an organization is decentralization and the convergence of family medicine services to individuals, which is the basic idea of change. The standard of equipment and services is defined, so we are going to try to solve the most of the health problems of the population as close to its place of residence. The explicit progress in development is existence of rural family medicine teams with equipment (ECG, spirometer, a minilab, inhaler, etc.) which is necessary for the proclaimed model of work. The concept and idea of providing health care through family medicine model is to capitalize on prevention pro-
grams, because prevention, in this poor societies and municipalities, which also includes the municipalities of Čelinac, is a key strategy that ensures to consume funds for health care as little as possible, and to invest more in improving the healthy lifestyle and improvement of health resources to the screening examination, which are the most significant of early detection of health problems and their optimal treatment. Overall, family medicine has brought some improvements in terms of quality perception of health issues and continuity. I was kind of thinking that we have established foundations and build the house but the finer works that require a systematic approach in order to achieve the proclaimed goals are in front of us. My feeling is that we have not exploited the value of this model in the most rational way and we are on the halfway to its development. Can you tell us something about the internal organization of the Health institution? Health institution”Sveti vraci” Celinac is organized like most of the health centers in the Republic of Srpska. As part of the Health institution Čelinac, there are 10 organized services that are interconnected and operate as a unit. Family medicine is the basis, the foundation of the organization, but there are other services and subsystems that contribute by providing comprehensive primary level of health care. There are primarily pediatrics and gynecology which complete segments of health care for children and women, Mental Health Center, which provides treatment for mental illnesses for residents of the municipality. The existence of many prevention pro-
How many employees does Health institution have? When it comes to the number of employees in the health center “Sveti vracevi” Čelinac, there are 68 of them now. The educational structure is defined by the standards and norms in health care and includes 14 doctors, of which 9 specialists, 5 doctors of general practitioners, 35 nurses, 5 dentists, 14 people from administrative and maintenance service. It is a collective that is characterized by the fact that most employees are female and middle aged. This personnel structure is inherited and is not optimal from the perspective of looking at the needs and financing of health care. Therefore, in the coming period, we will have to take care of competences and make plans for the development of human resources of all kinds in order to create conditions for effective and better health care. Does Health institution engage other doctors, specialists from various fields to perform specific examination etc.? In addition to the basic organizational structure of the work processes, the specialist consultants are involved, who are providing professional logistics to family medicine in primary health care. They are primarily the consultants in the field of orthopedics, internal medicine, dermatology, physical medicine and other aimed to help family medicine to solve most of the health problems in the prehospital stage. We are making easier for the patients, because the majority of specialists are coming to the health center and conducts their work on-site. This concept of work, which was supported by the Health Insurance Fund and the Ministry of Health and Social Welfare has allowed the reduction of unnecessary hospitalizations and increased the 25
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number of the well-prepared patients which are going to specialist at the right time, thus avoiding the additional costs of diagnosis and repeating of findings. Which form of management You used for the Health Center and what are your goals? When it comes to the management of the Health center,, I am including a number of activities, in my four-year term, that are aimed at creating the organizational structure and work processes that will enable the improvement of the quality of health care and health needs of patients in the broadest sense. This primarily refers to establish a different cultural communication and management, to create a positive atmosphere and motivate workers to provide the best possible service. Of course, all processes will be well-defined in terms of description and scope of the order through the prism of individual responsibility for establishing a different system of function. We aim to push the development of the system from the inside, and how to do it differently, but through positive examples and rewards for good results. They can be from money reward to a socially acceptable. We will stimulate learning, and individual professional development, because without such an approach, we do not see the prospects for development of Health center. The important aspect is the good cooperation with the institutions of the health system, first of all, the Ministry of Health and the Health Insurance Fund as well as local government. Our goal is to get local authorities more involved in solving health problems, that is based on the European Charter and having a citizen / user in the center of events. This is, perhaps, presumptuous for a moment where we are when it comes to social awareness and economic development, but we have to take big steps into these processes. Therefore, we plan to run a number of projects to Parliament, which are vital to the community, and which would gather the widest front, to overcome some bad decisions. I say this in terms of regulatory constraints that are limiting for small environment, the functioning of the emergency services in particular. Also, we plan to conduct research on the health needs in order to adapt our services to customers. Our plan is to include non-governmental sector, to organize round tables and forums and through this model include these interest groups to tell us to potential problems and possible solutions. These are 26
large and strategic things that we insist pediatrics, gynecology, family medicine, laboratory, ambulance service and other. in the future. And most of the measures we have imWhat kind of equipment and plemented in the first quarter of its own space has a health center “Sveti efforts and with support from our partvracevi� Celinac? ners, the pharmaceutical companies and As for the equipment and infrastruc- local governments. Regarding the proture, Health center Celinac has experi- cesses, the focus is on the organization enced a significant upgrade and improve of work of emergency services, family for the last 10 years through a variety of medicine and diagnostic services. We arrangements. The Government of Re- have introduced specific model of the public of Srpska, in cooperation with the working teams in the service thus creMinistry of Health and Social Welfare and ating conditions for efficient work. Work the local community, has reconstructed teams are clearly defined and emphasize the central building of the Health Cen- teamwork. Also, a big step is made for ter, as well as some regional ambulance. the treatment of first order emergency We have a modern building that is more cases. The previous practice was that, functional than before. This creates the in such cases the driver comes alone. preconditions for greater satisfaction for We improved the process and now the patients and staff. I’m not satisfied with entire work team comes to the scene. It the fact that some services, in spatial has brought pleasure to the community. terms, have better position than fam- Given the limitations of the funding for ily medicine, but we have the time to emergency services we formed a model resolve failures. The major problem is of spare teams, with the great efforts of the outdated equipment (ultrasound ma- employees, that change a team that was chines and some laboratory equipment) on the service. I hope we will, in the comand the lack of vehicles and office furni- ing period, in cooperation with other facture. This will be our priorities in seeking tors, first of all with the local community, get to the systemic solutions because long-term solutions. we consider this essential to the comWhat is the new things that You munity. We introduced a second shift for introduce in the current form of or- family medicine teams, which have ensured the availability of health care users ganization? Whit these program of work we have who are unable to come to check-ups in defined a number of measures that seek the morning. In terms of laboratories, in to improve working conditions, process- addition to improving the conditions for es and outcomes of health care. We have admission and operation technicians, we adapted the measures to the needs and have included the submission of findings current situation. They are classified as via e-mail, and the plan is to introduce a short and long term in order to create a model of appointments in order to oversustainable system in the economic, as come the problem of congestion that is well as in the clinical sense. First of all, present. The conditions in the pediatric they include activities to improve working clinic are improved because we felt that conditions for individual services such as we must create a more pleasant envi-
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ronment to our youngest to come to the doctor without fear and as painless as possible. We were working to improve the conditions of the female population. Conditions have been created to ensure privacy and clinical efficacy. We are now forming a local center for KME which will be implementing daily programs for all types of workers in order to ensure permanent progress because the changes in medicine are fast, you may say dramatic, that we have caught up with them so we could keep the quality. On the legal regulatory aspect, we have done a lot to establish a framework for the operation. At the recent board of directors we have adjusted some acts to our goals. In this context, we have adopted a series of important documents, from the ordinance on specialization to decisions on donations, in order to make all processes more transparent. I want to emphasize as important fact that, we have made a step forward when it comes to dental care, which is reflected in the opening of clinics in rural areas. We have made it easier for residents of Ukrina and Branesci which gravitates around 3-4000 people. Statistics that we used indicate that it was necessary. A rarity is that we have realized this idea by our own forces, and the local community provided the space. By doing all of this, we have demonstrated a common concern for the population. Does the Health Center use the information technology, and to what extent? Regarding the informatics systems in primary health care, in the last ten years we started with the modernization and improvement of this aspect of the work in family medicine, and other services.
It is reflected through the introduction of electronic records and prescriptions. Initially there were fears, sometimes justified, sometimes not, because there is a low level of computer literacy, which is inherent in our society. However, in recent times there is considerable progress. The general problem is usually the inner network and maintenance of small health centers that do not have professional staff in this area. We are trying to develop a rational model of functioning of a computer system that would be in the service of health workers. Our system consists of 42 local personal computers the same number of printers, two servers which serve to save data of health services, reporting to the various levels of superiors as well as financial management. The problem is the computers are pretty much old and their current performance is not at the very top level. Also, I would point out the problem of maintenance of equipment, which is quite challenging. In recent months we have carried out an analysis of the current situation and make a plan that by the end of the year, we will establish the new operative system, which will have a good technical support to solve all the failures in the short term so we will not endanger the provision of services. I would point out that we are among the first to implement a new program for family medicine. After some time, there have been certain problems which are solved very quickly, and are related to the speed, data security and others. Systemic problems will be solved in cooperation with the Ministry of Health and Social Welfare, especially in the security and storage of databases that are owned by health centers. This is a crucial question to be answered in
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the future. Our position is that the unified and integrated information system would be a response to modern challenges and would enable timely records, reduce costs and give a good basis for a comprehensive analysis in real time.
Health center “Sveti vracevi� Vidovdanska 5 78240 Čelinac Republic of Srpska Bosnia and Herzegovina Phone: +387 51551-044 Fax: +387 51555-260 dzcelinac@teol.net http://www.dzcelinac.org
What are the long-term plans? In these regions, due to turbulence and a high level of political influence,it is difficult to talk about long-term plans. A goal that requires a long period of time is certainly to achieve deeper cooperation with the Municipal Assembly, then the non-governmental sector, the police, the Red Cross and the Centre for Social Welfare in order to include the wider community in addressing health issues. In this context, we will be very active in the designing of specific projects which should facilitate the resolution of specific problems for which we estimate that there are restrictions of any kind. The tendency is that the spirit of the Charter of Local Administration user, in this case the patient should be in the center stage no matter how it sounded pretentious. Of course, the idea is to provide a system in which the health professionals are going to feel safe and satisfied because the quality has two sides of the coin. We will look for solutions which will enable continuous professional development model for rewarding quality work, team work to the development of objective indicators. Ultimately, the desire is to explore the needs of patients and residents to do a thorough analysis of the health status of the population of the municipality in order to come to the best policy. Also, improving communication with the public and to present the results of health center will be one of the imperatives. Of course, in the context of economic relations we are fully aware of the gravity of the moment and that the strategy for survival and development must be based on respect for all factors. 27
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besity have been not only aesthetic, but a serious health problem, for a long time. It is on the list of diseases by the World Health Organisation. This is where the story begins with the academic prof. Dr. Dragan Micic, who, in addition to regular membership in SASA, more recently become a member of the Academy of Sciences and Arts of RS. Professor of internal medicine, endocrinology specialists, current director of the Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, our authoritative interlocutor and vice president of the European Association for studying the obesity in Southern Europe whose area of operation includes: Serbia, Bosnia and Herzegovina, Bulgaria, Greece, Turkey, Malta, Italy, Spain and Portugal. - With these positions I have a lot of good insight into the current state of prevention and the epidemic of obesity as well as in some therapeutic models that are practiced. I am also a regular participant of the European Congress on Obesity. One such, a month and a half ago, took place in Prague, where I talked about the use of medical products in the treatment of obesity. On the same subject I was lecturing at the symposium in Banja Luka which was held on June, says prof. Dr Micic with whom we continue to talk about our subject title: “The use of drugs in the treatment of obesity - the current state”. - There is a lot of new staff this year, due to the fact that two new drug appeared on the market. One is a “Saxenda”. It is a mixture of “Novo Nordisk “which is an injectable drug. It is used to treat obesity in a dose of three milligrams and it is registered in all European Union countries. It has not appeared on the market yet, but it has been registered. The second product, which is also registered and for which is expected the distribution in Europe is called “Mysimba”. It is a combination of naltrexone and bupropionate. The product is in tablet form, first registered in the US and then in Europe. It is expected that the application of these compositions significantly improve our therapeutic options. So far we have only had a drug “Orlistat”, product of pharmaceutical companie’ Rosh “from Switzerland, which was first registered in 1999 in the European market, and in 2007 in the United States. We now have two new treatment options. Moreover, in the United States two oral drugs were registered,”Lorcaserin”and the socalled. “Qsymia “that is a combination of phentermine and topiramate, which 30
Interview with Academician Prof. Dr. Dragan Micic, vice president of the European Association for the Study of Obesity in Southern Europe
The use of drugs in the treatment of obesity - current state block the opiate time. To simplify the story. It would be an attempt to block our ”hedonistic mechanism” because of which we consume too much food, or to simply stop in time. Medici.com Whether it can cause addiction of this medicine? - This medicine is usually used for the treatment of opiate addiction. It should not create addiction, but rather the other way around. can also give very good results in the treatment of obesity. Unfortunately, they did not get the approval of the European Medicines Agency, so they are not on the European market. Related with this listed preparations, it is expected that all of our therapeutic efforts for trying to stop the epidemic of obesity would be more efficient, and that in a few years more than 50% of drugs that can be used for the treatment of obesity will be a combination of different therapeutic approaches and mechanisms, because it is thought that one mechanism obviously can not solve the big problem. I really like this second product that is occurring, and may be linked to our hedonism. It has been shown that we quickly achieve energy homeostasis, something we spend we immediately make up with the food. If there was not obesity that would be just fine. However, there is one part of our hedonism (pleasure of food) and we do not stop consuming it even when we compensate energy loss, but we continue to eat and make excess energy that deposit in the form of fat deposits in the periphery. And that makes us obese. It all depends on endogenous opiates and this product uses one of their blocker. It’s a drug called “naltrexone “which should
Medici.com Drug use is combined with the side effects. - Yes, each of these drugs has them. Fortunately, they are not so dangerous, they are more awkward, which means they can be some sort of gastro-intestinal effects, constipation, diarrhea, nausea, vomiting. Their continued use leads to a decrease these side effects. But I want to emphasize that the essence of treatment of obesity is not the use of medicinal products. They have only one additional therapeutic agent for the patient. The point is to change the lifestyle and it is the basic - elementary approach, insisting on reducing calorie intake and increasing the volume of physical activity. Every day I work with obese patients. They tell me: “Doctor, I do not eat anything but I am not moving down with the weight”. When you ask them: “Did you move”?, the answer is no. And that is the key, because it spends calories. That is why our therapeutic advice is very simple: 10-15 minutes of brisk walking (it is journey that should make you sweat easily), because obese people often have problems with blood pressure, lipids, diabetes. It has to be done gradually, patient has to train every day.
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Medici.com How much time does it take to “melt” pounds? - All depends on how much the patient is at risk. You have cases when it is necessary to reduce body weight very quickly ( hypertension crisis, diabetes). Then we must access so-called liquid diet with those shakes. That is the recovery in food that contains a certain number of calories. Experience has shown that is the quickest way to achieve weight loss. However, there arises the effect of sponge - where rapidly lose weight quickly and go back, because usually the body loses water. We insist that this loss is 5% of initial body weight for a period of three months. So, if someone has 100 kg, it is then 5kg in three months,
and it is 1.5 kg on a monthly basis. It is not easy to lose any weight, but in this way the individual can achieve a decent weight in one year. I repeat, we do not want the sudden loss, but gradually progressively, as this will result in a significant reduction in the risk for hypertension, the occurrence of diabetes etc. Medici.com At what age the education on healthy habits should start? - Very early. The attitude is that obese children are future obese adult patients. Therefore, children are a major aspect of our attention not only here, but also at European level, as it is believed that we will succeed to prevent obesity in future generations by their proper education. Based on the current state forecasts are that the next generation will live shorter than their parents due to the occurrence of a number of diseases, which is the cause by the obesity. Today’s children are very receptive population for various advertisements that are mainly related to high-calorie food intake. It must be limited, or to prescribe by law
how it can be done and how much. Another negative effect is that today’s parents do not have time to deal with children and their snacks. They usually give them money to buy something when they start going to school. A school is a crowd around these shops with highly caloric food (bottles of soft drink with lots of sugar, plus a hamburger. This is the energy bomb. For child everything is delicious, but not at all healthy. People are trying to return school lunches that will be controlled by nutritionists, which would give them precisely what they lack, and what to eat during the day, and that it is not calorie bomb. A legislative measures will be necessary to restore function of the old school kitchen. The whole world is trying the same.
Medici.com We are witnesses of a very aggressive advertising of all sorts of diets for obese people. What is your message to potential customers of such services? - There are many such products and patients often ask me what I think about them? Our former President of European Association did a study where one has tested more than 50 such products advertised for weight loss. None of them passed the test proving the effect for this purpose. You know, in medicine, when we examine something, we always work with placebo for a year or two, following, and then evaluate the effects. All of these products do not have this type of testing. Virtually none of them is medically examined as required for obesity treating medicine. They all carrying the mark the - extra dietary supplement. The only thing that is tested is they are non-toxic, not dangerous to use for humans. However, the right action, their story of the fabulous losses of body weight, is not medically proven. There’s another phenomenon that can not be rationally de-
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fined. Patients prefer to be natural, not to be a medicine. When you prescribe him a medicine,he asks: “Doctor, is this chemistry?”, I would not take it, I prefer “whale teeth”, “cactus“ and so on. Everything is possible as advertised, just not what the doctor says. Then I ask him: “Do I look like Lucrezia Borgia to You, do you think that I would deliberately poisoned You with a drug? You are reading advertisements for stuff on the Internet or anywhere you can find it, which doesn’t have any check behind it, and I recommend you something which has passed stringent medical particular elements, vividly describes this mental ‘screw’ of our people”, says prof. Dr Micic, with the hope that time will probably change such thinking. Medici.com You said at the beginning that obesity is associated with sexual activity. - We conducted a survey for overweight young people who are coming over for the issue of reproduction (those who have a problem to make a baby). None of them did not measure their body weight. And the Danes are doing a survey among its officers. By reducing the weight, sperm count tremendously jumps. It is very simple what you should suggest your husband. The same goes for obese women, who have trouble conceiving. The insulin resistance may occur, which can cause polycystic ovaries. Reduction of body weight can correct many of these phenomena. Medici.com Why is the number of obese people is increasing, again? - We did not find an adequate therapeutic model that would be able to stop. The prevention and therapy are failed. Everyone is aware of that and now initiatives in Europe are made. Specifically, five years ago, we signed the European Charter for the fight against obesity. All the ministers of the all European countries, including Serbia, signed this and thus committed their governments to take part in this struggle. Obviously, we did not have the results. Therefore, considering the new knowledge, we should again appeal to governments. We have to have political support. The company and the relevant ministries must be behind this in order to synchronize the action, the academic professor Dragan Micic summarize from its rich scientific and professional milieu of contemporary views on the problem of obesity. Angie S. Ilic
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otalgia paresthetica (NP) is a sensory neuropathic disorder, which is usually manifested in the skin back, unilaterally and infrascapular. In the beginning tingling sensation and pruritus occurs. NP also can be accompanied by pain, burning, hypersensitivity. The skin usually does not change, but it can be seen a small oval or hyperpigmentation pale-pink plaque, clearly limited without induration, in the region of back. Plaque is around 3-10cm. NP usually becomes a chronic condition with periods of remission and occasional exacerbation, but it is not a life-threatening. Etiology of NP is not known, but there is two possible mechanisms of occurrence: 1) increased sensory sensitivity of the affected part of the skin, 2) neuropathy due to cervical-thoracic degenerative damage (damage discus) or direct nerve injury. A heritage is mentioned in the etiology (eg. Sipple syndrome), inBrachial-radial pruritus Neuropathic pruritus (itch) is associated with a pathological process that can occur at any point along the afferent flow of the nervous system and can cause injury to the peripheral nervous system. Etiopathogenesis: They can cause injury to the peripheral nervous system, such as post-herpetic neuropathy, pruritus and brachial-radial NP. Clinical features: Many of the clinical features of neuropathic itch are similar to the characteristics of neuropathic pain. Patients complain of itching associated with burning, stabbing and severe pain. Brachial-radial pruritus: is the intense itching that occurs commonly between the shoulder and elbow of one or both hands. It’s a puzzling situation with controversial causes; some authors believe that the brachial-radial pruritus is photodermatosis, while others considered it as a consequence of compression of cervical nerve roots. Notalgija paresthetica: This is a special mono-neuropathy that affects the skin over or near the scapula. Patients complain of itching of upper and middle part of the back. Treatment: It is usually difficult, and Capsaicin and local analgesics are the treatment of choice. Conclusion: Brachial-radial pruritus and NP are pathological conditions that are often not recognized and therefore it is very important to take a detailed medical history and perform a detailed clinical examination in order to recognize the symptoms and choose the appropriate treatment options. J Berny-Moreno
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Notalgia paresthetica
Prof. Dr. Bogdan Zrnić, spec. Dermatovenerologist, Head of the Department of Dermatology, Faculty of Medicine Banja Luka
creased dermal innervation and viscero cutaneous reflex mechanisms. Histopathology in the region of skin, where the sensitivity is present, usually shows signs of inflammatory hyperpigmentation, the deposits of amyloid have been found in some cases, but they are most likely the secondary type as a result of chronic itching and scratching. Since the NP can arise from the previous spinal injury or damage due to degenerative cervical-thoracic spine, it is necessary to examine the spine. Secondary skin changes are usually in the form of lichenification, excoriation, eczema, xerosis or sec. bacterial infections. It may be associated with mild
Differential diagnosis should pay attention to: contact dermatitis, brachial-radial pruritus, arthropod bite, atopic dermatitis, herpes zoster, xerosis, fixed drug eruptions... Laboratory tests are made to exclude other diseases accompanied by pruritus and in the case of intensifying pain or muscle spasms X-ray of the spine, or MRI, to rule out degenerative disease. In the first appearing of the NP in patients it is important to take a detailed medical history of osteoarthritis, previous cervix trauma, accidents, previous spinal cord injury, cervical disc disease or malignancy. There is no specific effective drug
sensory events by type of light touch, vibration or tingling. It can be associated with muscle spasm. Notalgia paresthetica usually remain undiagnosed because there are no changes on the skin, and the pain is purely subjective type. The disease occurs in all racial groups, and it is more common in the older population of 4080 years. NP occurs in both sexes, with a little of the female predominance.
for NP. What comes to mind as a possible therapeutic option is cream based on capsaicin, a topical anesthetic cream (pramoxine, lidocaine), topical steroids, topical creams that are cooled based on menthol, eucalyptus, etc. If it is necessary, and oral non-steroidal anti-inflammatory drugs or oral muscle relaxants can be engaged. With persistent complaints present, a physical therapy (TENS) and acupuncture can be encluded.
Notalgia paraesthetica
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tigmatization of the people with mental disorders, as marking them as negative, marginalization or avoidance of the environment because they have a mental disorder based on preconceived negative attitudes - prejudice. Stigma deprives people of dignity and prevents their full participation in society. The most noticeable is the people who have severe mental disorders with chronic course (psychotic disorders, especially schizophrenia) and it is present in all societies since the beginning of civilization. A line between stigma and discrimination is thin. As a part of the reforms in the system of mental health, in our country the biggest attention is focused on the fight against stigma, and in the last five years the Mental Health Project in Bosnia and Herzegovina (which is carried out with the support of the Swiss Government and with the strategic direction of the Ministries of Health) as special component included combat against stigma associated with mental illness and the reduction of discrimination directed to people with mental disorders, particularly those with severe mental illness, although all components of this important project as the ultimate goal has the empowerment and continuous, high-quality support to those suffering from schizophrenia and related disorders. In Phase I (2010-2014) this has been accomplished by encouraging and supporting the establishment of user associations in the fifteen cities in BiH and awarding small grants for their promotion in local communities and the interconnection between them, as well as public institutions and professionals in the field of mental health with them. Phase II of Project of mental health in BiH, which will be done in the next four years (2014-2018) is focused on the further strengthening of beneficiaries of mental health care and more active role in fighting the stigma of mental illness and preventing discrimination against persons with mental disorders by creating anti-stigma programs and programs of social inclusion, which should be achieved as the main outcome, by reducing discrimination against people with mental disorders at the community level. As an important activity recognized by the Mental Health Project in Bosnia and Herzegovina, a work is focused in several directions: the preparatory period on drafting the Guide to anti36
Anti-stigma programs in the field of mental health
stigma programs in the field of mental health, when the expert group formed by the competent Ministries of Health, appointed ten members from the ranks Users (most active users associations in both entities), makers of health policy (assistant Entity Ministers of Health), for professionals in the field of mental health (psychiatrists), representatives of the entity Institute for Public Health and communication experts / media
professionals, who made, in a given time period of time, Draft Guidelines for conducting anti-stigma program, as the first document of its kind in our country. In addition, some members of this working group has conducted qualitative research, a needs assessment for the implementation of specific antistigma programs in selected communities in Bosnia and Herzegovina. Based on previously established assessments
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conducted by the leader of this component of the project (Dr. Amra Delic) and her associates in all the communities that have user associations, and following the recommendations of the Swiss expert consultant, the famous professor Norman Sartorius (with whom the expert group had two consultative meetings) about the need to implement future anti-stigma programs in several local communities, qualitative research for the needs of the Working Group was conducted with members of user associations and their families in five cities: Banja Luka, Zvornik, Sarajevo, Mostar and Tuzla. During the coming year pilot antistigma programs are going to be implemented in Banja Luka and Sarajevo. With the support of the Ministries of Health, and by the preferences and suggestions by user associations in the two cities, a members of the Local working group were appointed for drawing up and implementing antistigma programs, which are composed of all relevant persons from the public, NGOs and the media milieu and Culture, in the direction of making high-quality programs that would be implemented in Banja Luka and Sarajevo during 2015/2016. Local working groups held meetings in June and designated subgroups of drafting anti-stigma program in Banja Luka and Sarajevo, where the important role was assumed by users from local user associations. After the training of members of local working groups, set for late August, users associations will applied to your programs for grants Project Mental Health in Bosnia and Herzegovina for implementation of specific anti-stigma programs in their communities, and the plan is to start these programs on the World Mental Health Day, October 10th This will provide a direct contribution to the celebration of this important date in mental health, which this year has the motto Dignity in mental health. All activities that were carried out, particularly those that follow, highly motivated members of user associations to show their previous, very impressive achievements and make it closer to everyone in the communities where they live and make their full contribution to their development, and we should never forget that there is no health without mental health. Prepared by: Dr. Goran RaÄ?etović, psychiatrists, leader of the Working Group for drafting the Guide to conduct anti-stigma program
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Social inclusion in mental health
W
ithin the implementation of the project of mental health in Bosnia and Herzegovina implemented by XY Association in partnership with the Ministry of Health and Social Protection of the Republic of Srpska and the Ministry of Health of the Federation of Bosnia and Herzegovina, which was funded by the Swiss government, an internal call is announced for associations of users of mental health services for financing / co-financing projects of social inclusion in the field of mental health in 2015/2016. for the following communities: Brcko, Doboj, Ilidza, Kljuc, Mostar, Mrkonjic Grad, Prijedor, Sanski Most, Srebrenica, Trebinje, Tuzla, Zenica and Zvornik. One of the outcomes of mental health project in Bosnia and Herzegovina under component 3 is reduced discrimination against people with mental disorders at the community level. The focus of interventions in the fight against stigma and discrimination is to establish a longterm sustainable mechanisms which will contribute to reduce discrimination directed towards these people and providing equal opportunities for all. These include: a) development and implementation of sustainable anti-stigma programs and activities at the community level; b) strengthening the capacity of user associations to establish partnerships; and c) increasing the level of social inclusion of users of mental health services by providing system support of their initiatives. It is expected that, at the individual level, active participation will contribute to improve the general functionality, recovery and reintegration of people with mental disorders, which should result in reducing the stigma and inequality, and improving the quality of their life and the life of their families. At the same time, pro-active role of all the people in the community, including professionals in the field of mental health, should contribute to improve the quality of services for vulnerable groups and gender specific, through socially-inclusive practice and the recovery-oriented approach, with monitoring and evaluation of the effectiveness of the implemented programs. It is planned to mention the outcome is achieved through the following two direct results: a) Conducted gender-sensitive anti-stigma programs in the community, targeted to specific population groups;
b) Increased capacity of user associations for community partnerships and support social inclusion of people with mental disorders. With the results relating to increasing the capacity of user associations for community partnerships and support social inclusion of people with mental disorders, Mental Health Project in Bosnia and Herzegovina will support the empowerment of users, meaning that they believe in their potential and to have the opportunity to realize their social roles and needs by active participation in the design, implementation and evaluation of interventions of social inclusion. Entity ministries of health appointed the members of the expert group for drafting the Manual for intervention in the social inclusion of users of mental health services according to the principles of collaborative practice and it has been made in March 2015 on the basis of which have been implemented two regional education interventions of social inclusion in mental health, where they jointly attended by representatives of user associations and representatives of mental health (from the centers for mental health and psychiatric clinic / department / hospital). After the training and sensitizing relevant services and organizations in the community to establish equal partnership through intra- and inter-sector cooperation, Mental Health Project in Bosnia and Herzegovina has announced a call for internal financing / co-financing of social inclusion in the field of mental health in the period October 2015 - October 2016. It is recommended that project proposals are consistent with the previously assessed needs and priorities identified in the focus groups held in October / November 2014 and reflect the practical application of the knowledge acquired during the training carried out in June 2015. The allocation of grants is intended for associations of users of mental health services who have a severe mental disorder, and who cooperate with the mental health project in Bosnia and Herzegovina as part of Phase II (March 1, 2014 - February 28, 2018). In the current year, five smaller grants of the project for 2015 will be awarded in Bosnia and Herzegovina, for projects in the fields of social inclusion interventions. Prepared by Tanja Bajic, Mental Health Project in Bosnia and Herzegovina
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P H A R M A C Y
International recognition of efficiency and safety of
“Bosnalijek” product
A
t the “Bosnalijek” satellite symposium, President of the Scientific Society of Gastroenterology Russia Professor Dr. Leonid Lazebnik gave a presentation on “The role of Enterofuryl in the eradication of Helicobacter pylori.” Renowned Russian Professor Lazebnik through its exposure to the experts presented his experiences in detail about the treatment of Helicobacter pylori with Enterofuryl. “We have a positive experience with Enterofuryl in Russia and its effect is confirmed. Therefore, it is our national recommendations, we use Enterofuryl for treatment of Helicobacter pylori, throughout our country“, said among other things, distinguished professor. Professor Lazebnik pointed out, during the meeting with the media, the pleasure of working with the largest BiH pharmaceutical company “Bosnalijek” and added: “I spoke with the director of ‘Bosnalijek’ on organizing an international Advisory Board for Enterofuryl because Helicobacter pylori did not show resistance to this drug.” “Bosnalijek” Satellite Symposium on “The Role of Enterofuryl in Helico38
bacter pylori eradication” was held as a part of its 5th congress of gastroenterologists and hepatologists in Mostar, on June 13th 2015. In order to provide continued support for major professional events, “Bosnalijek” was a silver sponsor of the Fifth Congress of Gastroenterology and Hepatology of Bosnia and Herzegovina with international participation, which was held in Mostar from June 11th to 14th 2015. Prof. Leonid Lazebnik and Nedim Uzunović, director of “Bosnalijek”
Prof. Dr. Lazebnik is a prominent Russian professor from the Moscow State University of Medicine and Prevention, PhD, Head of the Department for treatment, prevention and geriatrics and chairman of Gastroenterology scientific community of Russia. At the Congress a topics from all areas of gastroenterology and hepatology were presented, and related parts radiology and endoscopy, with special emphasis on the world’s novelties. In addition to experts from Bosnia and Herzegovina, Congress brought together top experts from the region and around the world, which was a great opportunity to exchange experiences and ideas and collaborate to the practical, as well as in the scientific sense. More information about the “Bosnalijek” is available on the website: www.bosnalijek.ba.
NAT U R E
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uantum medicine is symbiosis of holistic, a comprehensive approach to the treatment of men supported by modern technology, unification of energy and modern, complementary and alternative branches of medicine. The rapid development of modern, primarily computer technology is becoming more accessible and have more and more supporters in the official medicine. The development of modern physics has brought mankind to the knowledge that is the essence of life and all that surrounds us is energy. On the revision of the energetic flows in the body, a new medical approach, called quantum medicine, is based. Each cell represents the electromagnetic unit that sends electromagnetic waves that are the result of biochemical processes in it. When the electromagnetic field in the normal cells is disrupted, the biochemical processes is changing, leading to various diseases. Changes first occurre in the electromagnetic activity and the bioenergetic level and then coming up to the visible organic changes, to illness. A holistic approach to the management observes the man and life, and thus health problems as a combination of energetic forms and vibrations, which in turn are constantly changing and dynamic (dis) balance. Quantum approach to treatment is based on the fact that every living organism is a source of electromagnetic radiation. Diagnosis is based on the fact that healthy organs or body parts are sending a healthy vibration (frequency), as opposed to sick distorted waves. Thanks to modern technology we are now able to measure these vibrations and then to be therapeutic, we can correct it, than treat it. The stimuli, electromagnetic pulses, frequency, which is sent in the body during therapy actually stimulate the body in self-healing. Often, these modern techniques of treatment, is called medicine of the 21st century. However, for thousands of years have known the knowledge and skills of healthy living, prevention and treatment as part of traditional Chinese medicine (acupuncture, herbalistic, tai chi, chi gong), Indian ayurveda, yoga, aromatherapy, crystal therapy, sound therapy, dance, various herb culture... etc. All of these methods consider the man as the harmony or disharmony of body, mind, soul and the environment; means as a whole. With the development of electronics, cybernetics and computer technol40
Medicine of the 21st century
Quantum Medicine
Among the known advocates and researchers of the quantum field in relation to the human body are: Rupert Sheldrake, Robert Beck, Dietmar Cymbal, Rainer Viehueger, Reinhold Voll, James Oschman, and Bruce Lipton; physicists including Professor Amit Goswami, Dr Peter Marcer, Dr. Ervin Laszlo, and former astronaut Edgar Mitchell, PhD; medically trained visionaries such as Dr. Deepak Chopra and Dr. Larry Dössei; and leading researchers such as Peter Fraser, Victor Sims and many others. Human beings are formed by cells, thoughts, emotions, feelings, energy and awareness. All this is holistic linked, choreographed to form a functional person. To find out what is that amazing connect and directs many aspects of our being, it is necessary to look beyond the boundaries of conventional biology and chemistry. We have to take into account the human bio-field (or energy field), and accept both theories - the ancient wisdom of healing and healing and “Cutting Edge” physics. The science of bio-field (biological or bio-field) is still unknown in conventional academic circles and the general public, but for those open-minded, for those far-sighted people who are open to newer aspects and scientific achievements to what comes next in biology and medicine, and to accept, it’s exciting, it’s time for research. It promises to revolutionize medicine in the next few decades, it has led to a completely new approach in clinical practice, which will make it non-invasive, efficient, and humane.
Dr. Radojka Prelević works as a quantum medicine doctor in Manchester, where she is living for 25 years, but she has a practice in Belgrade, “Quantum One”, where she is examining patients once a month. She is an active member of the Royal Society of Physicians of Great Britain, a member of the British Association of Alternative Medicine, a member of the China Medical Institute in London (completed and acupuncture), the British Association of energy medicine, and since she was working in Belgrade last few years, she is a member of the Serbian Medical Chamber, Association Acupuncture and Quantum Medicine at the Serbian Medical Society.
ogy this millennial knowledge received a certificate and official doctrine, and it is a fact that our body is essentially a condensed energy that is moving quickly on a myriad of different vibrations. If we know how to detect and understand them, we will know and recognize that “the proper information of the changed information” and that correcting bring their body into a state of equilibrium - biological health. Re-establishment of “interpersonal communication” between cells during therapeutic procedures we actually begin “healing process”. In the book “The vibratory medicine,” Dr. Richard Gerber explains that: “Einstein’s theory applied to the vibratory theory sees human beings as a network of complex energy fields that interact with the physical-cell system. The knowledge that all matter is energy in constant motion, is the basis of an understanding that human beings are viewed as dynamic energy systems. So, in addition to anatomical and morphological structures of the body that we see with our eyes, there is a so-called electromagnetic skeleton of a man through the circulating electromagnetic waves by creating their own coherent field of the man. Bioresonance is the area of energy medicine and quantum medicine. Diagnosis and therapy is done at the same time, at the moment when the camera detects the electromagnetic frequencies
that are in fact the information collected from the body. Bioresonance uses electromagnetic frequency patterns collected from the body that analyzes and corrects if they have been modified in order to return the body to a state of biological balance. The human body emits electromagnetic waves. These waves reflect biochemical processes that occur in the body. In addition to the physiological (healthy) frequencies, there are those pathological (diseased) caused by various toxins, injuries, infections...
HEALTH - SERBIA 56th Annual Conference of the General Assembly of the European Association of Pharmaceutical Wholesalers with full assortment (GIRP)
B
elgrade hosted the 56th annual conference of the General Assembly of the European Association of Pharmaceutical Wholesalers with full assortment (GIRP), June 8th and 9th. At important gathering organized by GIRP’s, and with the active support of the Serbian Chamber of Commerce (PKS) and the Association of Pharmaceutical Wholesalers PKS gathered representatives of institutions, domestic and foreign pharmaceutical manufacturers and external drug associations from Europe. The Serbian pharmaceutical market is underdeveloped, but it is well regulated and it is estimated that last year was worth 640 million euros. To secure and safe for medicines to be available to end-users, it is important to follow the European regulation in this area, it was said at the opening of the 56th annual conference of the General Assembly of the European Association of Pharmaceutical Wholesalers with full assortment (GIRP), which was first held in Belgrade. On behalf of the host country, participants were addressed by Economy Minister Zeljko Sertic and President of the Serbian Chamber Marko Čadež. Welcoming the participants Zeljko Sertic, Minister of Economy of Serbia, said that the state is trying to help the development and efficient operation of the pharmaceutical industry and recalled that Serbia had big giants, and that the one of the biggest was the “Galenika”, which has not yet found its owner. The Minister said that the government is ready to talk to foreign partners that would facilitate the renewal and continuation of production in the company. “Today, Serbia allocates 277 euros per capital, for health care, in accordance with their capabilities, or six percent of GDP - considerably less than the EU countries. With the reforms we are undertaking, supported by the European integration process, investment in health will be increased and used more efficiently, the health system will 42
Belgrade gathered European pharmaceutical elite
be modernized with the ultimate aim of human health is better, “said Mark Čadež, President of the Serbian Chamber of Commerce (PKS). “In that process, pharmaceutical market has an important role, which is one of the most profitable, the most risky and most regulated markets worldwide, as well as wholesalers, which should
Minister Sertić on behalf of the government received a donation from GIRP a EUR 10,000
Economy Minister Zeljko Sertic received, on behalf of the Government of Serbia, the donation of the European Association of Pharmaceutical Wholesalers (GIRP) in the amount of 10,000 euros, intended for the treatment of diseases, conditions or injuries that can not be successfully treated in Serbia. On behalf of the Serbian government, the minister presented gratitude for this gesture to the President of the General Assembly GIRP, Rene Zenia. President Zenia, in behalf of the organization, symbolically handed over a check to Sertić and money, € 10,000 was paid to the account of the Budget Fund for treatment of diseases, conditions or injuries that can not be successfully treated in Serbia.
provide a safe, ongoing basis, in, cost-effective and quick supply of quality medical products,” said Čadež. PKS President explained that the Serbian pharmaceutical market, after a big climb from 2004 to 2008, when it increased three times in the last five years has stabilized and remains on the same level. Even 75 percent of this market supplies 15 largest drug wholesalers - a member of the Chamber, and our family of wholesalers. All members of the group meet the strict requirements stipulated by the Ordinance on the conditions for the wholesale distribution of medicines and medical devices, guides to good practice in the distribution of medicines, as well as implemented the ISO quality standards in the business, added Čadež. Miomir Nikolic, President of the Association of Pharmaceutical Wholesalers Chamber of Commerce, said that Serbia, although not included in the European system of verification of drugs, prevents the presence of counterfeit medicines in the legal supply flows, by mechanisms of sticking control stamps, labeling and monitoring of drugs in the number series. In terms of the quality of drugs, Serbian regulatory bodies are ensuring that all drugs sold in Serbia must meet the same standards that exist in the
HEALTH-SERBIA
EU. Serbian wholesalers are responsible for the range, the planned response to demand, labeling of drugs, withdrawal series or manage the disposal of medical waste. Wholesalers also protect the supply chain and distribution of traffic counterfeit drugs. In 2014, the average cost of the reimbursed drugs was 2.6 euros, while in January central tender for the procurement of drugs has been implemented for the first time. The three largest wholesalers - members of SCA Group, last year achieved a turnover of approximately 530 million euros. A reliable partner of the Serbian health care system and at the same wholesalers, are the most cost effective distribution model, because the delivery method achieves significant cost savings for hospitals and state pharmacies, said the president of the group. Each additional impact on reducing the revenues and margins for wholesaler, could jeopardize the ability of pharmaceutical wholesalers to provide quality services supply. The quality and frequency of shipments of medicines are the same for less expensive and more expensive medicines, and therefore costs are the same, but the margins are not. Only full range can provide viability of wholesalers. Unfortunately, many of them do not understand it, neither institutions nor the manufacturers, many of them want direct distribution high-frequency and expensive drugs and one of the main roles of GIRP is to point out the importance and power of wholesaler with a complete range when it comes to ensuring a safe and continuous supply of medicines for patients in Europe, said Miomir Nikolic, President of the Association of Pharmaceutical Wholesalers SCA further on. Nikolic also pointed out some of the recent achievements of the Group SCA wholesaler. At the end of 2012, the Serbian government has reacted to a liquidity crisis which highlighted the group and accepted the accumulated debts in the health sector due high budget expenditures are converted into public debt, which will be repaid in three years. Since then, the terms of payment from the Republic Health Insurance Fund (NHIF) have improved, with 150 days in
2013 to 90 days in 2015. Although the payments from the NHIF since then are regular and timely, arrears of health facilities are again on the rise. This indicates that the reform of health care financing is necessary. The group recognized the necessity of introducing centralized procurement of drugs with all the advantages and disadvantages, supported the tender and cooperated with all interested parties. In Serbia, not only pharmaceutical legislation is subject to frequent changes. Serbian wholesaler group provides an active contribution to the drafting of legislation with the full support of Chamber of Commerce and Industry of Serbia, said the president of the group. The participants of the conference, at the opening, was welcomed by Rene Zeni, president GIRP, which was presented by the Association of European wholesalers. GIRP is an international non-profit organization based in Brussels, bringing together wholesalers with a complete assortment. It has 37 full members, of which 26 national associations of European countries, gathering more than 750 pharmaceutical wholesalers, with operations in 32 European countries. GIRP promote the role of wholesaler in promoting and preserving public health and defend jointly defined policy for providing a safe and continuous supply of medicines for all patients in Europe. It has also an important role in designing the legislative and regulatory policies that have a direct impact on the business of wholesalers. It represents the interests of its members before the highest authorities of the European Union. Group SCA wholesaler admitted to GIRP 2011 as a full member, with ability to vote. It was a great success, because the organization in its statute changed the criteria for admission of new members, which is Serbia, a country that is not an EU member, for which is allowed full membership. On the first day of the conference there was some of the host country under the title “What is on the radar of Serbian pharmaceutical supply chain.” Delegate Group SCA wholesaler in GIRPin Lovorka Nikolic gave an overview of
the pharmaceutical market in Serbia and spoke about the challenges that all participants in the chain are facing. She said, in her speech, that in the past two years there have been significant changes in the procurement of drugs when pharmacies and hospitals in question, and that the cost of health care in Serbia is among the lowest in Europe. During the two day gathering, participants of annual assembly of GIRP discussed the optimization models of health care, effective supply chain management, new trends in the pharmaceutical market, the development of private pharmacies, control of the market, as well as other current topics. Health service owes billions for Medicines Health institutions in Serbia currently owe wholesalers 3.2 Billion of Dinars and wholesalers are therefore forced to borrow money to pay for producers and ensure the operation, said the President of the Association of Pharmaceutical Wholesalers PKS, Miomir Nikolic. “Factory seek bank guarantees from us and regularity of payments. As soon as we do not pay one stop supply and this is something that is regulated by contracts. We pay them in 60 days, the health fund pays the institutions in 90 days, and institutions, when they do have the money, they first do the payment of wages, “Nikolic told reporters at a conference GIRP, the European Association of Pharmaceutical Wholesalers. He reminded that the payment is required for regular supply, planning and predictability and that the situation created with public debt in 2012, should not be repeated. We do not want from health care institutions to spend more than they are budgeted, but they must be reasonable in spending the funds that is been entrusted to them, Nikolic said, adding that citizens should not worry because it will always be a drugs and wholesalers are doing everything to ensure continuity of supply. M.C. 43
W
HEALTH-SERBIA
e have excellent doctors, the only limiting factor is the equipment - mark the world known pulmonologist. The world’s leading pulmonologists shared their experiences at the expert meeting, held on July 25th and 26th in Belgrade, introducing new methods in the treatment of lung cancer and chronic obstructive pulmonary disease. International conference “News in interventional pulmonology,” organized by the Department of Pulmonology, Clinical Center of Serbia (KCS) and Respiratory Association of Serbia. The meeting was opened by prof. Dr. Dragana Jovanovic, pulmonologist, president of Respiratory Society of Serbia and the director of the Clinic for Pulmonary Diseases CCS, who is also, the Program director of the internationally extremely important event in professional circles. The work of the expert meeting was managed by prof. Dr. Atul C. Mehta in Cleveland (USA), one of the world known interventional pulmonologist.
The speakers were top experts, the leading European and Serbian pulmonologists, who shared their experiences and views in order to familiarize participants with papers and modern trends in diagnosis and therapy of three diseases (bronchial carcinoma, COPD and sarcoidosis). Priceless information about the current problems in interventional pulmonology, after the following theoretical part, went both days, continued to the practical part of the meeting in the Department of Pulmonology Clinic bronchoscopy KCS, where participants had the opportunity to know, after the theoretical lectures, practical application of the models: trans-bronchial needle aspiration biopsy ( TBNA), endo-bronchial ultrasound (EBUS) and placing endo-bronchial prosthesis for the treatment of emphysema (COIL). Respiratory diseases are among the four leading health problem, and in recent years interventional pulmonology occupies a more important place in the therapeutic methods for the treatment of cancer and the chronic obstructive pulmonary disease. 44
Top pulmonologists exchanged knowledge
News in interventional pulmonology Prof. Dr. Dragana Jovanovic, pulmonologist, president of Respiratory Society of Serbia and the director of the Clinic for Pulmonary Diseases KCS said that about 20 percent of the population, in the world and in our country, suffers from asthma and lung cancer takes most of life among men. She noted that it is important to diagnose the disease in proper time, in order to allow patients a better quality of life. “The technical training,education and continuous training are important, and this is an opportunity for doctors from Serbia to hear the latest findings on various intervention methods in pulmonology,” explains Jovanovic. Spasoje Popević, Chief of Cabinet of Interventional Pulmonology Clinic for Pulmonary Diseases KCS said that the meeting truly went great because all the names of world and European interventional pulmonology were there. “First of all we are honored by the presence of prof. Mehta, one of the doyens of interventional pulmonology in the world, who taught us many things. We
“From what I saw in the hospital, I think that you are,actually, high level institution, so that the top pulmonologists can do all the important procedures here”,said Bilaceroglu. Prof. Dr. Atul C. Mehta in Cleveland (USA), one of the world’s most significant interventional pulmonologist Physicians, said: “You have excellent and well trained doctors. The thing that is limiting the work is the equipment for bronchoscopy and interventional pulmonology, which is rather expensive.This is the only limiting factor in Serbia, “said Mehta. In particular, in the most severe disease, the lung cancer, it is important to know how the disease is extended and how it spreads. “The whole bronchoscopy and interventional pulmonology is a process of continuous learning. We are keeping pace with modern technologies and our patient and his or her needs are at the spotlight. This method, endo-bronchial ultrasound, is expensive, but the Clinical Center would have to have it as a major
had the opportunity to hear first-hand experience of a man who’s doing it for over 30 years and, most importantly, we have practiced the techniques with him on models and we have gained new skills,“ Popević added. Semra Bilaceroglu, assistant professor at the pulmonology, and the future president of the European Association Bronchology and interventional pulmonology, who is working at a hospital in Izmir, Turkey,, said she was the third time in Belgrade at the expert meeting and that each time she is looking forward to meetings with colleagues.
tertiary center in charge of the whole of Serbia, “said Popević and explained that endo-bronchial ultrasound helps doctors to do, in one intervention, bronchoscopy and ultrasound examination of the airways and environmental respiratory tract and to take a biopsy from the all suspicious lymph glands. “In this way, histological physicians determine very precise, the extent and stage of the disease in order to make decisions about the proper treatment of patients,” said Spasoje Popević, Chief of Cabinet of Interventional Pulmonology Clinic for Pulmonary Diseases KCS. B.L.
Hotel �Palisad�, Zlatibor, Serbia 29th october-1th november 2015. www.uksrb.org
XX CONGRESS SOCIETY OF CARDIOLOGY OF SERBIA with international participation
Organizer of congress Society of Cardiology of Serbia
Technical Secretariat of the Congress Society of Cardiology of Serbia e mail: perisic.zoran@me.com, branko.beleslin@gmail.com, Technical Organizer of the Congress Rubicon travel, Belgrad Fon: +381 11 3981 411, +381 11 41 41 511 www.rubicontravel.rs email: kongresi@rubicontravel.rs www.rubicontravel.rs
H E A LT H - M O N T E N E G R O
Interview
Dr. Borko Djordjevic
Cosmetic Surgery
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osmetic surgery is as old as man. People have always wanted to look more beautiful and modern techniques enable them to realize it. It is an art that may not always be associated with perfect beauty - every patient is a unique individual, which is how I approach and suggest the best solutions. The least important is, so to speak, to sell the operation. It is more important to have a very satisfied patient after surgery – says prof. Dr. Borko Djordjevic, a plastic surgeon, for the magazine “Medici.com”. If for someone can be said that he has achieved the “American dream”, it is Dr. Borko Djordjevic. BBC ranked him among the ten best-known and most successful plastic surgeons in the world. Prof. Djordjevic is one of the most famous plastic surgeons in the United States and the world, and his patients are the most prominent public figures of America. In recognition of his contribution to the development of America, Palm Springs, in which the world’s richest men have houses, gave him a commemorative star on the sidewalk of the city. He was educated at the University of Belgrade, where he earned a Doctor of Medical Sciences degree. He specialized in general surgery at the Mountainside Hospital in New Jersey and graduate hospital (The Graduate Hospital) University of Pennsylvania in Philadelphia, Pennsylvania. Also, Dr. Borko Djordjevic, specialized in the Department of Plastic and Reconstructive 48
Surgery, hand surgery and genital and aesthetic surgery at Ohio State University - affiliated hospitals Riverside Methodist Hospital in Columbus, Ohio. The surgeon of Serbian origin Dr. Borko Djordjevic, who built a career in America for decades, embellishing Hollywood stars like Joan Collins, Betty Ford, Elton John, Larry King... Today spends most of his time in Igalo, where he has a private hospital. It might seem paradoxical, but people who are naturally beautiful first go to aesthetic corrections. And they are mostly women. These persons accept aging very hard and the way of adaptation the years is accompanied by a special mental state. These people are very sensitive and when they notice they are losing popularity and power, which had previously possessed, feel very disappointed and completely lose their confidence. Precisely in this way, through plastic surgery, they tend to regain their appearance, and with that and everything else that was based on it: popularity, success, self-confidence. The second category of women is ones who suffers marital and family debacle in the sixth decade of life and then is forced to seek a new life. In America, the average life expectancy has increased with an average life of about 80 years. Women live longer than men, so they are even with 60 years of opportunities to enter into new marital relationship. The trend is that women have 2 to 3 marriages and because of that, they need aesthetic rejuvenation.
- Unlike American women, who are prone to try out all the plastic surgery, our women do not go to extremes. They generally want to reduce the nose or breast implants. In fact, large breasts are their biggest fetish and it only has prone to exaggeration - says prof. Djordjevic. While for most of the women the most important is the look of the breasts, men usually take off belly fat. - Younger men come to increase the volume of breasts if they are too skinny and small, or to remove the fat if they are obese. However, more often patients are mature businessmen who come to tighten the eyelids and to rejuvenate reveals our source. The rejuvenation of this “Serbian magician” is performed without a knife and artificial materials. The procedure is done under local anesthesia, and patients can go home after only one day. - This is a new and non-invasive method that promotes the work with stem cells obtained from fat tissue. Their injection is forming cells, which have the potential of creating a new complexion and in a revolutionary way they rejuvenate old tissue - without knife - says prof. Djordjevic.
Mediteranski hirurški centar za plastičnu i rekonstruktivnu hirurgiju - Igalo, Crna Gora DOBRODOŠLI U AMERICAN AESTHETIC SURGERY CENTER PROCEDURE: Dermapen Fejslifting Liposukcija Operacija nosa Zatezanje stomaka Hemijski piling Uvećanje grudi Nakon lečenja od gojaznosti Botox Silikoni American Aesthetic Surgery Center Sava Ilica 5, Igalo, CG Tel. +38231332770 Fax, +382 31 332771 Mob. +382 69 043 333 www.mediteranskihiruskicentar.com
H E A LT H - M O N T E N E G R O
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overnment session, held on July 30th 2015, adopted the document “Structural reforms in the health system� with the Action Plan for its implementation from 2015 to 2017. The Ministry of Health, in order to observe the condition of the entire health system, conducted an analysis of all the factors and indicators that guide the health system, to identify key priority areas, which could be the basis for the reduction of consumption and the possibilities of its financial sustainability and further development. This analysis gave guidelines for improving the system, which are covered by structural reforms aimed at bringing the existing recognized weaknesses and upgrade systems by the scientific and technological requirements, with the aim of establishing a financially sustainable health care system with the savings on the efficiency of the provision of adequate quality of health service and bigger safety of the patient. As the health system is not a static category and its financial sustainability can not be planned nor fully anticipate, and bearing in mind that health is not a free resource and can not be maintained without cost, the need to introduce structural changes in those areas are a priority areas of activity. Compared with the situation at the beginning of the transition, structural reforms should contribute to centralize the health care system, to be better funded and generally efficient. Regarding to the functioning and coordination of health care levels, training of medical personnel is planned at all levels of health care, reducing hospital beds on the redevelopment of the hospital infrastructure and the definition of the basic package of services that are offered to citizens annually. All this has been done to achieve the improvement of health services in hospitals, reducing the number of unnecessary referrals of patients to the tertiary level of health care and savings funds. In order to overcome the problem of uneven utilization of existing staff capacities, which resulted in the problem of waiting lists, structural reform provides a measure of redistribution of working time, a larger number and competence of doctors in primary health care, which will result in relief of secondary and tertiary health care, reducing the number of health service curative medicine, which are the most expensive form of medical services, and the uniformity of the quality of provided medical services to patients. 50
The Ministry of Health of Montenegro
Structural reforms in the health system Prof. Budimir Segrt, Minister of Health of Montenegro
In order to rationalize the expenses of temporary inability to work (right to sick leave), which has the tendency of grow, completed analysis of the envisaged activities is established with the aim of normative regulation of this area in a way that will strengthen the personal responsibility of the doctor in the assessment and application of criteria which would establish the basis for the temporary inability to work, as well as in terms of the duration of sick leaves issued. The latest reform seeks to prevent the growth of costs of medicines, which are with the cost for specialized care, the fastest growing item of health care spending. The single most important measure is the introduction of more restrictive list of drugs that can be obtained without payment, and the inclusion of a large number of generic drugs on the list. An analysis of the pharmaceutical sector showed that drugs, that are issued at the expense of the Health Insurance Fund, are uneconomic, and clear and concrete measures are given in this document to improve the pharmaceutical industry, regulatory and market drugs reviewing basic and supplementary lists of medicines, and the expected
effects of financial savings through the rationalization of consumption. By recognizing the need to provide additional sources of financing, through the introduction of allocation of a certain percentage of concession fee and fee of excise products for the health part, because the use of goods that are the subject of concessions and excise taxes, limits the use of certain natural resources, which can have a negative impact on the health of the population. That’s why, the initiatives are planned to amend legislation which would constitute the basis for acquiring additional sources of revenue for the health system. The document contained measures to reduce hospital capacity, their conversion and separation in terms of treatment of chronic health problems, longterm care and palliative care, which will contribute to the rational use of hospital capacity, better and more efficient hospital care. In this way, health care services will be financed, rather than hospital capacity, as has been the case so far. In terms of technical tasks in the function of providing health services to citizens, the analysis has identified high prevalence of the administrative
H HEEAALLT T HH - M- O SE NR TE BN IA EGRO
and technical staff in health facilities, which is a source of big and irrational consumption. Structural reforms will be addressed through this public-private partnership and these operations will be entrust to professional agencies, with the timely settlement of the status of nonmedical staff. The further activities are planned in terms of standardization and accreditation of health institutions to improve the procedures, criteria and standards of the health system, which will strengthen citizens’ confidence in the quality of health services. This would be provided by structural reforms, for the establishment of a centralized and controlled health management, through the implementation of the necessary training, necessary for the strengthening of managerial knowledge and skills, in the condition of reduced cash flow. It will put emphasis on the training of staff, as well as the obligation of health institutions to provide the facilities for conducting continuing medical education through appropriate programs, and with the timely provision of new, skilled staff and enhanced educational one role KC CG. Regarding the rescheduling of working hours, the proposed measures for the introduction of work in the shifts in the secondary and tertiary levels, should result in more available specialized health care and reducing waiting lists. It is planned to continue the elaboration and establishment of a unique IT system, by taking the measures for its improvement, which will provide necessary data for monitoring and analysis of economic and financial operations. With the introduction of payment by diagnostic groups DRG as an indicator to control spending, the emphasis on achieving a higher level of competitiveness in the health system will take place, so that hospitals offer the possibility that some of the financial surpluses are reinvested in improving the services they provide. All of these activities on the implementation of structural reforms of the health system have been developed in the Action Plan, with defined implementers for the implementation of activities and deadlines for their execution and implementation. The obligation of the implementation of the necessary measures is to send the information to the government to monitor and inspect the degree of progress in improving the sustainability of the health system. PR Service of the Ministry of Health
Belgrade, July 22th 2015.
Cooperation in the field of public health
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oc. Dr Boban Mugosa, director of the Institute for Public Health of Montenegro, and prim. Dr. sc. med. Dragan Ilic, director of the Institute for Public Health of Serbia “Dr Milan Jovanovic Batut”, signed an agreement on cooperation in the field of public health in Belgrade. The agreement was signed in the presence of Cedomir Fustic, minister counselor at the Embassy of Montenegro in Belgrade, and Dr. Vesna Knjeginjic, Assistant Minister of Health of Serbia. Director of the Institute for Public Health of Montenegro doc. Dr Boban Mugosa said that the agreement represents a formal framework that will allow the joint work in the European framework of activities to improve the welfare of the people. Minister Counsellor at the Embassy of Montenegro in Belgrade, Cedomir Fustic assessed that in the total bilateral cooperation of Serbia and Montenegro, health cooperation is one of the most important. Deputy Minister of Health of the Republic of Serbia Vesna Knjeginjic, pointed out that the Institute of Public Health of Serbia is leader in the field of public health and the Ministry of Health relies heavily on the work of the institution. Agreement on cooperation in the field of public health, which are signed by the directors of the Institute of Public Health of Montenegro and the Institute of Public Health of Serbia, foresees cooperation of expert teams of national institutes, exchange of experience and capacity, especially in the areas of health promotion, prevention and control of non-infectious and infectious disease, and environmental protection. Specific areas of cooperation will include joint activities to strengthen regional cooperation and participation in international projects.
Minister Segrt spoke with Dr. Marit Koki
M
inister of Health, Prof.dr. Budimir Segrt and his associates, received the Director of the European Centre for Infectious Disease Control (ECDC) Dr. Marit Koki and her associates on July 29th 2015. The Ministry of Health, as part of negotiations with the European Commission for Chapter 28, Minister Segrt said, has good cooperation with ECDC, who indicated in front of the European Commission is negotiating about controlling infectious diseases. He introduced Dr. Koki with the planned activities of the Ministry of Health to improve the quality and efficiency of the health system, primarily by creating program of structural reforms in the health sector. Dr Koki has expressed satisfaction with the cooperation with Montenegrin health institutions and provided support planned projects, especially those relating to the strengthening of public health. The planned activities aimed at the adoption of the Action Plan for infectious diseases were also discussed at the meeting, which will be the basis for the activities of the Ministry of Health in the control and surveillance of infectious diseases. It was agreed to identify priorities that will allow adequate monitoring of infectious diseases in Montenegro, while in the same time fulfill the obligations of Chapter 28, relating to the surveillance of infectious diseases. Medical cg
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SCIENTIFIC
medical communications
VOLUMEN VII ISSUE 64. AUGUST 2015.
53
T
his is one of the first books on psychiatry in the Serbian language, which was published as an e-book on the Internet in our country and is entitled: Introduction to Social Psychiatry - theoretical basis and practical application (Psychosocial approach to the mentally ill person). The book contains a number of sections, a total of twelve parts and 20 chapters with more titles and subtitles, which included almost all related to social psychiatry at home and abroad. This book is derived from the author’s many years of work as a professor of psychiatry at the Medical Faculty of the University of Belgrade and many years of work and experience in the prestigious Institute for Mental Health in Belgrade. The author is a lecturer in social psychiatry at the Medical Faculty and head of the social psychiatry sector at the university for many years. Positive opinion on the book gave academician Prof. Dr. Dusan Kecamović from Sydney, Australia, and Prof. Norman Satrorius from Geneva, who was a longtime director of the Department of Mental Health World Health Organization and president of the World Psychiatric Association. An exhaustive reference is given at the end of the book, for those who are more interested in this part of psychiatry. The author of this monumental book used big experience of other authors in the world and the country for which he is particularly grateful, with the hope that they are correctly interpreted and quoted. The book was carefully read, at the time it was handwritten, by Dr Snezana Djordjevic, from the Psychiatric Hospital in Kovin and Mr.Dr. Ivica Mladenovic with the Institute for Mental Health in Belgrade. As the title says, very extensive and comprehensive chapter in social psychiatry is given in the first part of the book as a special field of psychiatry and public health. Also, attention is drawn to the chapter on the application of epidemiological methods in psychiatry. In this chapter, important epidemiological data were given, on the prevalence of mental disorders in Serbia. This section, with more titles and subtitles, contains all the important epidemiological parameters that are important for Psychiatry and detailed overview of the application of this method in clinical studies. A section on the various forms of treatment and individual social-psychiatric treatment method in modern psychiatry is noteworthy. Especially interesting is the section on the first ways of establishing contact with the psychiatric patient, through the first interview and teamwork in psychiatry. Equally interesting is the chapter on evaluation methods of treatment in psychiatry today, which
S M C - B O O K
Theoretical basis and practical application (Psychosocial approach to mentally ill person)
Introduction to Social Psychiatry Prof. Dr. Marko Munjiza
includes the subheadings relating to the economic costs of different forms of treatment in psychiatry. There are also chapters relating to the organization of psychiatric services, followed by an overview of the sociology of mental disorders, rehabilita-
tion in psychiatry and psycho-social consequences of mental disorders. A chapter, in the form of an epilogue draw our attention, synthesis with the author’s vision of the future of psychiatry and resigned at the end of the book. 55
S M C - E x p e r t
M e e t i n g s
IV conference of the Association of General / Family Medicine of South-Eastern Europe
Contemporary Challenges in family medicine
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Prof. Dr Igor Svab
ankarjev dom in Ljubljana hosted the IV Conference of the Association of General / Family Medicine of South-Eastern Europe from June 4th to 6th 2015, organized by the Association of Family Medicine doctors of Slovenia, under the patronage of the President of the Republic of Slovenia Mr. Borut Pahor. The motto of the conference was “Modern Challenges in Family Medicine” (Contemporary Challenges in family medicine). The gathering was attended by 900 doctors from Albania, Austria, Belgium,
Bosnia and Herzegovina, Bulgaria, Montenegro, Denmark, the Netherlands, Croatian, Italy, Macedonia, Romania, Serbia, Turkey and the host country, Slovenia. The opening ceremony of the conference in the Linhart Hall was preceded by a group of Philip Piran whose performance has delighted all the present, and the Minister of Health of the Republic of Slovenia Mrs. Milojka Kolar Celarec, addressed to all attendees at the meeting and among other things 56
Prim. Dr. Lubin Šukriev
said: “The Government of the Republic of Slovenia, set the health care reform and Health Strategy 2015 as a key need, with priority given to the development of primary health care, and this area is one of my key priorities. Slovenia has 0.6 doctors per 1,000 patients, and compared to other OECD countries, this is at the lowest level. I am glad because another 314 physicians will complete family medicine specialization in summer 2018, “said Minister of Health of Slovenia, and added: “The conference is the place to acquire new knowledge, to exchange the ideas for the work and make it the best. I wish you a successful cooperation and enjoy the hospitality and beauty of Ljubljana”. Prim. Dr. Lubin Šukriev, president of the Association of General / Family Medicine of South-Eastern Europe, greeted the attendees, and in his speech among other things, he said: “Let the conference in Ljubljana be a place to exchange our experiences, and for mutual cooperation, to respect our differences, and make it closer, all that with unique goal of improving the status and rating of the family doctor, as well as strengthening and development of general / family
medicine in the region and taking that to a place where it belongs and deserves in society.” Eulogy for our, prematurely deceased professor, comrade and a friend Dr. Janko Kersnik was held by prof. Dr Igor Svab, who presented the final written presentation of prof. Dr. Kersnik “Contemporary Challenges in general / family medicine”. The working part of the conference took place in several halls, with numerous oral and poster presentations, workshops, symposia, divided into thematic sections: “Modern epidemic”; “Modern technologies”; “Palliative care”; “Aging“ and ”Open topics“. The speakers were: Dr John Broderson from Denmark with the theme “Quaternary Prevention” Doing more good than harm and prof. Dr. Leo Pas from Belgium with the theme “Family violence challenges to the society and the family physician”, who have focused the role and the place of the family doctor in their presentations. Doc.Dr. Tonka Poplas from Slovenia presented the “Family Medicine Model Practices Comprehensive Patients Care”, pointing out that, this model has
S M C - E x p e r t
Dr Dean Klančič
started to implement in 2011, with the support of the Ministry of Health, which introduces a new concept in the field of standard human resources (existing team, high graduate nurse), work competencies (use of protocols for the treatment of chronically ill patients, longterm and well-definition of preventive screening, to introduce the registers for the chronically ill and the fulfillment of indicators for quality and performance of the management of chronically ill patients. A pilot study began with the application in March 2015, and was financed by the Norwegian grant. Prof. Danica Rotar-PAVLIČIĆ from Slovenia, presented herself with “The challenges of palliative care at the primary level”, and pointed out that by the year 2050,it is expected that the number of people over 80 will double from 4.7% to 11.3% in more than 27 EU member states and from 3.9% to 9.1% in OECD countries. Palliative care is different in EU countries. In some countries it is organized with the help of teams of doctors and public health nurses, the other teams have palliative care, working in cooperation with general practitioners and other professionals, and in some countries stationary
M e e t i n g s
accommodation is organized for palliative approach. Doc. Dr. Catherine Stavrić from Macedonia presented the “Genetics and family medicine”, pointing out that family doctors play a key role in the identification of patients and families who will have the benefits of future referrals to services dealing with genetics. In postgraduate study, basic clinical genetics should subsequently include. Prof. Ljubomir Kirov from Bulgaria presented himself with “Modern approach to chronic diseases”, and, among other things said that, the activities in the prevention of chronic diseases will take place with a modern approach through activities, health promotion, early detection and timely access to successful and effective treatment. During the conference, the session had representatives of the movement
ment in Macedonia held a workshop associated with the modern challenges of young family doctors in Southeastern Europe. The workshop was a place where young doctors from several countries had the opportunity to exchange mutual challenge they face in their own countries but, at the same time they also discussed proposals for solving them. The working part of the conference ended June 6th 2015 at 17:30, and after that the conference was closed by the musical performance “Camerata Medica”, which was a pleasure to listen to. Attendees were addressed by President of the OC Dr. Dean Klančič, president of IT prof. Dr. Matthew Bulc, president of the Association of family medicine doctors of Slovenia prof. Danica Rotar-PAVLIČIĆ. President of the Association Dr. Šukrijev said: “As everything has its
“Vasco de Gama” (Vasco de Gama Movement VdGM). It is a working network of residents and young family doctors within the European organization of family doctors (Wonca Europe). This movement now has representatives in 32 European countries, including Macedonia. Dr Kiril Soleski and Dr. Philip Lokvenec, representatives of this move-
end, so is our fourth meeting. What to say at the end? The conference met expectations and frankly, we have to be satisfied. I am proud that the organization was impeccably organized and everything went all right. In educational terms they meet everyone’s tastes because of the variety of topics and the speakers, with their presentations, gave full contribution to the education of the family doctors. We must say, thank You to our hosts and organizers for the successful organization of the Conference.” Next, the Fifth Conference of the Association, will be held in Budva, Montenegro in 2017, organized by the Association of doctors of general / family medicine of Montenegro. We split up feeling confident that we will see each other in the following events, organized by the Association of general / family medicine in Southeastern Europe. Prepared by: prim. Dr. Lubin Šukriev, President A OM/PM JIE
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IV Symposium on Addictions with international participation
A multi-sectoral response to addictions
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n the period from June 10th to 11th 2015 Banja Luka hosted the 4th Symposium on Addictions with international participation “Multi-sectoral response to the drug-addiction” on the theme “Challenges in the treatment of addiction in modern society”, organized by NGO “Viktorija “and the Commission for the Prevention of Drug Abuse of the Government of the Republic of Serbian. The symposium was opened by Chairman of the National Council of the Republic of Srpska prof. Nada Tesanovic and executive director of the NGO “Victoria” Sanja Stanic. Dr Milan Latinovic, as President of the Commission, addressed the gathering in front of the Commission for the Prevention of Drug Abuse of the Government of the
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n the occasion of June 26th International Day Against Drug Abuse and Illicit Trafficking at the Government of the Republic of Srpska, a joint press conference was held by the Ministry of Health and Social Welfare of the Republic of Srpska, Ministry of Internal Affairs of Republic of Srpska and NGO “Victoria”. Deputy Minister of Health and Social Protection of the Republic of Srpska in the Department for Health Protection, Dr Milan Latinovic said that they were working on the development of the Draft Strategy for Drug Control and Suppression of Drug Abuse in the Republic of Srpska last year, for the period 2015 to 2020, which would soon be forwarded to the Parliament of the Republic of Srpska. “Also, it is planned, with the of cooperation with the three ministries, the Ministry of Health and Social Welfare, Ministry of Interior and the Ministry of Education and Culture of the Republic of Srpska, to make the network of teams 58
International Day Against Drug Abuse and Illicit Trafficking this year, that will, using the funds for the rapid detection of the presence of drugs, to make unannounced school visits, and to control the possible presence of narcotics, “said Latinovic. He added that the topics and introduced, through the specific programming and regular education in the subject biology, suitable for the children, to
let them know, at an early age, about the harmful effects of narcotic drugs to the body. Member of the Commission for the Prevention of Drug Abuse in the Republic of Srpska, on behalf of the Ministry of Interior, Ilija Plavša said that the Ministry of Interior of the Republic of Srpska is located in the center of the
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mak, Prof. Dr Petar Nastasić, Dr Perisa Simonovic, Dr Andrej Kastelic, Dr Nusa Šegrec, Prof. Dr Sanja Radetić-Lovric, Dr Jasmin Softic and many others. Participants of this meeting were from the health, social and educational institutions as well as representatives of NGOs from Bosnia and Herzegovina, Serbia and Croatia. The symposium was attended by the students of the first grade of elementary school “Dositej Obradovic” from Banja Luka, who presented healthy lifestyles and values, whose promotion should be key in the development
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of prevention programs that deal with drug addiction. S.S.
Republic of Srpska. The main issues were analyzed at the three thematic sessions and a round table and the achievements and best practices in the field of drug addiction, alcohol dependence, prevention programs as psychotherapeutic modalities in working with addicts were presented at the symposium. In addition to topics, such as opioid substitution therapy, working with heroin addicts after detoxification, challenges and opportunities in the therapeutic approach to adolescent addicts, a partnership with patients through clinical guidelines and guides, significant attention was paid to the prevention of addiction, this year. Speakers at this time were the most eminent experts, Prof. Dr Tomislav Sed-
fight against drug abuse. He said that the Ministry of Interior of Republic of Srpska, does fifteen operative actions of international and regional character, per year, to break up organized crime groups. Plavša noted that, the Ministry of Interior has a coordinating role in the Commission for the Prevention of Drug Abuse in the Republic of Srpska and that
this Ministry, in cooperation with other institutions, monitor the occurrence of new types of drugs and, in this regard, they sent the initiative to the relevant authorities at the state level to amend the list of narcotics. A representative of the NGO sector in the Commission for the Prevention of Drug Abuse in the Republic of Srpska and president of the Association of Citi-
zens “Victoria” Sanja Stanic, said that the role of partnerships between NGOs and institutions through a long-term project activities is important. She said that since 2007, a series of activities and education were continuously carried out, emphasizing the important role of NGOs in the development of strategic documents. Based on the application of treated addicts in the Republic of Srpska, as of December 31th 2014, a total of 385 treated addicts were registered. Most common,among treated drug addicts in the Republic of Srpska, are heroin addicts (88.4%), and after heroin, cannabis is the most frequently used primary drug by users who started the specialized treatment. Heroin addicts, in the Republic of Srpska, have started with the consumption of any intoxicant at the age of 16, on average, and the first usage of heroin, usually occurred at 19 years of age. N.A.
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The Association of Endocrinology and Diabetes of the Republic of Srpska, symposium with international participation
Diabetes, obesity and metabolic syndrome Prof. Dr. Snezana Popovic-Pejičić, Primarius, endocrinologist Presidents of the Association of Endocrinology and Diabetes of the Republic of Srpska
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ssociation of endocrinologists and diabetologists of the Republic of Srpska organized the symposium with international participation “Diabetes, obesity and metabolic syndrome,” from June 26th to 27th 2015 in Banja Luka. The symposium was international and in its work, besides speakers from the Republic of Srpska, the eminent experts from the Republic of Serbia took part also. Speakers at the symposium were distinguished professors from the Republic of Serbia: Academician Nebojsa M. Lalic, Academician Dragan Micic, professor Dr.Dragan Zdravkovic, professor Dr. Katarina Lalic, prof. Dr. Alexander Jotić and Prim. PhD. Snezana Polovina. From the Republic of Srpska speakers were members of the Association of Endocrinology and Diabetes of the Republic of Srpska: Prof. Dr. Snezana Popovic-Pejičić, endocrinologist; PhD Dr. Gordana Bukara- Radujković, a pediatric endocrinologist; PhD. Dr. Alexander Grbic, endocrinologist; MSc.Dr. Milena Brkic, endocrinologist; Prim. Dr.Mladen Blagojevic, enodocrinologist; Dr. Valentina SoldatStankovic, endocrinologist. From the Health Center Banja Luka Department of Family Medicine, lecturer was PhD Dr. Kosana Stanetić, specialist in general and family medicine. The Symposium was interdisciplinary and intended for endocrinologists (internists and pediatricians), cardiologists, nephrologists, neurologists, eye specialist, a specialist in physical medicine and rehabilitation, family medicine specialists, as well as specialists of other areas of medicine, dealing with the complications of diabetes. The symposium is open to the festive atmosphere at June 26th 2015, in the conference hall of Hotel “Vidovic”. At the opening of this conference, the participants were addressed by Prof. Dr 60
Zvezdana Rajkovača, in front of the University Hospital Clinical Center of Banja Luka, director of medical affairs of UBKC Banja Luka; in front of the Medical Fakulty of the University of Banja Luka Prof. Dr. Zoran Vujković, vice dean for education; in front of the Ministry of Health and Social Welfare of the Republic of Srpska Dr. Alen Šeranić, senior associate MSZS, coordinator of the “Diabetes Mellitus in the Republic of Srpska”. The president of the Association of Endocrinology and Diabetes of the Republic of Srpska, Prim. Dr. Mladen Blagojevic and President of the Association of Endocrinology and Diabetes of the Republic of Serbian prof. Dr. Snezana Popovic-Pejičić, welcomed guests and thanked them for their participation in the work of the symposium. The opening ceremony was followed by a scientific program of the symposium. The most current topics in diabetology, obesity and metabolic syndrome, were included in expert program and took place in four sessions. The first session was devoted to
news and dilemmas in diabetes and has drawn great attention of those present. The session was chaired by academician Nebojsa M. Lalic and prof. Dr. Snezana Popovic-Pejičić. During the first session, recent developments in the treatment of diabetes were presented. Prof. Dr. Snezana PopovicPejičić presented the “New recommendations ADA / EASD 2015 in the treatment of type 2 diabetes”; Academician Dr.Nebojsa M. Lalic “Incretin therapy in diabetes”; Prof. Dr. Alexander Jotić “Treatment of diabetes in pregnancy”; Prof.Dr. Katarina Lalic “Cardiovascular risk in diabetes.” Second session, which was devoted to obesity and metabolic syndrome, was chaired by academician Dr. Dragan Micic and prim. PhD. Dr. Kosana Stanetić. This very interesting sessions included: “Treatment of obesity: the current state” spoken of by academician Dr. Dragan Micic and “Bariatric surgery in the treatment of obesity”, presented by PhD.Dr. Snezana Polovina. The association between the metabolic syndrome, obesity and depres-
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sion was presented by prof. Dr. Snezana Popovic-Pejičić, and prim. PhD. Dr. Kosana Stanetić was speaking about possible prevention of obesity. The third session, Obesity and diabetes in children, was chaired by Prof. Dr.Dragan Zdravkovic and PhD.Dr. Gordana Bukara-Radujković. Prof.Dr.Dragan Zdravkovic, presented the topic “Obesity in children: diagnosis and clinical forms”, and PhD.Dr. Gordana Bukara-Radujković spoke about the “obesity and insulin resistance in children and adolescents”. Fourth session, Microvascular and neuropathic complications in diabetes, was chaired by prim.Phd.Dr. Aleksandra Grbic and prim.Dr. Mladen Blagojevic. Very interesting was the lecture “The pathogenesis of microvascular complications,” which has held by prim.Dr.Mladen Blagojevic. PhD. Dr. Alexander Grbic spoke about the possibility of prevention of diabetic retinopathy and nephropathy, and Mr.Sci. Dr. Milena Brkic spoke about possible prevention of diabetic neuropathy. The session was followed by a very fruitful discussion. The general conclusion is that the symposium has fully met its expectations. The symposium was evaluated by Commission for Continuing Medical Education of Medical Doctors of the Republic of Srpska with 9 points for lecturers and 5 points for the participants. The symposium has attracted much attention of physicians of all specialties, involved in diabetes and complications in the Republic of Srpska. There were 165 accredited participants. We owe a debt of gratitude to the esteemed professors from Serbia on engagement in the realization of this event. Perennial technical and scientific cooperation in the field of diabetology and endocrinology, between the Republic of Srpska and the Republic of Serbia, helped in the realization of ideas for organizing this symposium. This support is reflected in the fact that they responded to our invitation on this occasion to participate and contribute to the quality of our symposium. The international character of the symposium represents an additional wealth and we believe that this gathering will be a strong impetus for further development of diabetology and endocrinology in the Republic of Srpska and contribute to the improvement of our daily work and the quality of life of our patients.
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The round table, Banja Luka July 10th 2015
The prevention and early detection of diabetes
he Ministry of Health and Social Welfare of the Republic of Srpska organized a round table on the prevention and early detection of diabetes, which was attended by representatives of health institutions, professional associations and other organizations, associations of people with diabetes in the Republic of Srpska and representatives of the Health Insurance Fund, Institute of Public Health, medical schools and international organizations, conducting activities in the field of diabetic care in the Republic of Srpska. Some of the topics of the round table were, the programs of prevention and early detection of diabetes in the Republic of Srpska, prevention and early detection of gestational diabetes and the prevention and early detection of diabetes in children and adolescents.
overweight children by half, after taking health promotion and education activities, “said Dr. Lolić. She noted that the Institute of Public Health of the Republic of Srpska is executing the project “Nurseries - friends of a healthy diet”, which helps in the realization of these activities, and that the policy of improving the health of the population by 2020, emphasizes the importance of multi-sectoral work in the prevention of risk factors. “The main causes of type 2 diabetes are obesity, lack of exercise, stress, and all of these factors could prevent the change of lifestyle, a healthy diet and physical activity, said National coordinator for the control of diabetes in the Republic of Srpska, Snjezana Popovic-Pejičić. She added that he fact that the diabetes type 2, which mainly affects older than 40 years, occurs more frequently in children and adolescents, due to inadequate nutrition and insufficient physical activity is the fact to concern. According to pediatric endocrinologist Children’s Hospital at University Hospital Clinical Centre Banja Luka, Dr. Gordana Bukara-Radujković, prevention of diabetes has to start at the beginning of pregnancy and the mother must be aware of proper nutrition and proper care of pregnancy.
According to Deputy Minister of Health and Social Welfare of the Republic of Srpska, Amela Lolić, every ten people in the world have diabetes, and it is assumed that the same situation in the Republic of Srpska. “Unfortunately, we do not expect a reduction of the number, because all the trends and estimates are that it will be good if we maintain this level. However, we are actively working with all relevant institutions in the prevention of diabetes and we can say that the results are already visible, especially in children under five years, which is resulted by cutting the number of
“The Ministry of Health and Social Welfare of the Republic of Srpska carried out, for years, a project of promoting breastfeeding, which is very important in the first 4-6 months of life for prevention of diabetes type 1. Also, it is very important to introduce cow’s milk into the diet of infants, as later as possible, “said Dr. Bukara-Radujković. She added that, for the prevention of diabetes in children, a vaccination of children is necessary, correct use of antibiotics, as well as constant control within the medical examinations in kindergartens and schools.
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he Serbian Academy of Sciences and Arts and Serbian Clinical Center, organized the two-day symposium on innovations in cardiovascular interventional medicine on the topic: pathogenesis, diagnosis and treatment of complex atherosclerotic lesions of the coronary arteries branch. The participants were world’s leading cardiologists. The Belgrade symposium, which was held on July 3rd and 4th this year, brought together about three hundred cardiologists from Serbia, the region and the world, to follow the lectures which were given by ours and the world’s leading experts: prof.Dr.Ferald Verner, of the Clinical Center in Darmstadt, Germany (Director of the Department of Cardiology and Emergency Medicine); Dr. Iv Luvard, interventional cardiologist (Institute Jacques Cartier, Paris, France), Professor Dr. Suno Nakamura (University of Kumamoto, director of the Cardiovascular Center, Hospital in New Tokyo, Chiba, Japan), Professor Dr.David Taggart from the University of Oxford (cardiovascular surgeon, John Radcliffe Hospital, Oxford, UK), Professor Dr. Jens Flensted Lassen (interventional cardiologist and director of pre-hospital urgent cardiology, University
The best cardiologists of the world at a symposium in Belgrade
Innovations in cardio vascular medicine
Serbia, where, over ten complex interventions, has been conducted on chronically clogged arteries, or in the place of their fork, which is considered the most difficult conditions in the coronary blood vessels. Our interventional cardiologists assisted to world experts, who are trained to deal with the most difficult patients, in operating rooms. According to Professor Goran Stankovic, one of the organizers of this event, there is many changes in interventional cardiology in a year: “More flexible Academician Vladimir Kanjuh
Prof. Dr. Smiljko Ristic
Hospital of Copenhagen, Denmark), Professor Dr.Sasko Kedev (Medical Faculty in Skopje, Director of the Department of Cardiology at the University Hospital in Skopje, Macedonia), Professor of Internal Medicine, Dr.Maja Stroci (Head of the Institute for Disease sideburns congenital heart defects, Clinical Hospital Centre Zagreb, Croatia). Academician Vladimir Kanjuh (Serbian Academy of Sciences and Arts, Belgrade, Serbia), Professor Goran Stankovic (Clinical Center of Serbia, Belgrade, Serbia), Dr.Vladan Vukcevic (Clinical Center of Serbia, Belgrade, Serbia) and Professor Miroslav Zivkovic (Faculty of Mechanical Engineering, Kragujevac, Serbia), spoke about the innovation in interventional cardiovascular medicine in Serbia. In addition to education, the set also had a practical part, that took place in the operating rooms of the Clinical Center of 62
wires is being made which pass through the blood vessels, thinner or narrower balloons which expand the artery, but it is not enough only to learn the technique, The symposium, which was held in Belgrade, organized by Academician Vladimir Kanjuh (Serbian Academy of Sciences and Arts ) President of the Organizing Committee, Professor Petar Seferovic (corresponding member of Serbian Academy of Sciences and Arts), Professor Goran Stankovic, Professor Alexander N. Neskovic and Professor Arsen Ristic, was only a month after the European meeting in Paris, dealing with the same topic. President of the European Club for the treatment of blockage of the fork of the coronary arteries, Professor Goran Stankovic, was the main guest editor for a special publication, in which the doctors assembled 45 works by 150 authors from around the world. He pointed out the idea of coordinating the views of the professionals in all cardiology centers by this publication.
but and to understand the way the world’s most recognized interventional cardiologists think and solve problems in the coronary vessels“. The interventions, which are performed in the operating rooms by the world’s leading experts and assisted by Serbian interventional cardiologists, were recorded via video beam and they have been shown in several halls where they were accompanied by many cardiologists from Serbia and abroad. At a press conference, held at the end of the symposium, the host and one of the organizers, Professor Dr. Arsen Ristic, director of the Department of Cardiology Clinical Center of Serbia, talked about the success of the intervention conducted on patients and on this occasion, thanked the distinguished guests, who made possible for a number of colleagues, to gain insight, theoretically and practically, into the latest developments in the field of interventional cardiovascular medicine. On the other hand, the participants in this meeting, in their individually statements to the press, thanked the hosts for their hospitality and expressed the hope that this knowledge and experience will be successfully applied in the Serbian healthcare. In his address to journalists, Professor Smiljko Ristic, director of the Clinical Center of Serbia, said that the death rate from cardiovascular diseases in Serbia is in a very high percentage, even 57 per cent, and expressed the hope that the waiting lists for surgery will reduce as soon as possible, and this is, according to Dr Ristic, only possible when you empower more of our doctors, purchasing modern equipment and simultaneously educate the population. Dr Ristic extended his gratitude to all participants of the symposium on the contribution to the development of medicine in Serbia. Prepared by: Marko Rados
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