The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska's Protector of Patients' Health Insurance Entitlements.

INTRODUCTION: Healthcare utilisation requires knowing one's entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients' Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas. METHODS: This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics. RESULTS: The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional. CONCLUSION: While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.

Comparative study of toxic heavy metal residues and other properties of honey from different environmental production systems.

Honeybees forage a large spatial area around the hives. In addition, honey production takes place in various environments, and polluted environment is often hard to detect. It impacts both human and beehive health, especially through honey which is used for human consumption. Pollen analysis was conducted by a novel approach through a multivariate principal component analysis where it was possible to obtain grouping patterns related to foraging plant species. Samples of honey were acquired from three different environmental production systems: (i) honey from the apiaries in the vicinity of thermal power plant, (ii) apiary of certified organic production and (iii) the conventional production with semi-controlled production. Significantly higher contents of the Pb, Cd and Zn are found in the analysed honeys taken near the thermal power plant compared with those of the other analysed honeys. The origin of Zn, Pb and Cd in the honey is the contaminated forage plants and foraging honeybees. Honey from certified organic production differentiated significantly from other two types of production by the water content, electrical conductivity and total soluble solids and notably it contained significantly less ash and lead. There is a clear advantage of certified organic honey in terms of heavy metal residues as the most prominent pollution factor in honey. Therefore, honey can be used as the broad range environmental pollution indicator, as bees will forage on polluted plants and bring the pollutant from a wide spatial range inside the hive, where it can be traced in the honey. Graphical abstract.

[Pathophysiology, Clinical Manifestation and Management of Angioedema - Our Experience].

INTRODUCTION: Angioedema is characterized by subcutaneous and/or submucosal swelling usually localized to the lips, eyelids, tongue, oral cavity, larynx and pharynx. Various types of angioedema, caused by different pathophysiologic mechanisms, can have the same or very similar clinical picture and require different diagnostic and therapeutic procedures. The immediate threat to life as a result of rapidly developed edema of the pharynx and larynx with airway obstruction requires endotracheal intubation or emergency tracheotomy. Standard therapy, which includes epinephrine, second-generation antihistamines and steroids, is not effective in the treatment of all types of angioedema. OBJECTIVE: On the basis of the clinical presentation and course of angioedema, this retrospective study was aimed at contributing to a better understanding of the etiopathogenesis of the disease and at helping determine the most effective available treatment modalities. METHODS: This retrospective study included patients treated under the diagnosis of angioedema of the upper aerodigestive tract between 2000 and 2012 in the Department of Otorhinolaryngology, Clinical Center of Banja Luka. RESULTS: A total of 76 subjects were included in the study. The average age was 62.8 years. There were 40 (52.6%) male and 36 (47.4%) female patients. The largest number of patients (44.7%) had type II angioedema. Almost half of the patients or 36 patients (47.4%) were on treatment with an angiotensin-converting enzyme inhibitor (ACEi), but there was no statistically significant difference under the total number of patients (p=0.678). CONCLUSION: Better understanding of pathophysiologic mechanisms and the adoption of diagnostic protocols contributes to more effective treatment of angioedema.