Challenges in Collecting and Reporting Health Statistics in Kosovo.

Background: Statistical data play a crucial role in research, planning and decision making in the health system, especially in the formulation and implementation of health policies. Health policy, adequate health legislation and sustainable financing of the health system remain serious challenges for countries in transition and especially for the Republic of Kosovo. Objective: To analyze the challenges of collection, accuracy and accurate reporting and the impact of the accuracy of these health statistics on the creation of appropriate public health policies in Kosovo. Methods: This research is mainly based on a combination of qualitative, quantitative, deductive, analytical and comparative methods conducted by health workers at all three levels of the health organization and IT experts who were actively involved in some of the important components of our research. Results: It is interesting to note that respondents gave typical scores for the security and confidentiality of medical data and statistics during the cycle of their collection and processing, with one score being 3 and the other 5, and 50% of respondents gave a score of 5 for the successful fulfilment of the mission and tasks established by the Law on the rational use of medical data and statistics to support public health policy. Conclusion: The research and findings provide sufficient evidence that Kosovar health data and statistics system suffers from serious deficiencies ranging from the legal framework, organizational structure, functional organization, segregation of duties and responsibilities, to a pronounced lack of human resources, professional profiles in the health statistics service and the necessary technology to perform the basic tasks in a timely and high quality manner.

On the Occasion of 70th Anniversary of Life and 45 Years of Academic Work of Academician Izet Masic.

In the hilly Balkans, a folk proverb has been circulating for a long time, "It is most difficult to be a prophet in one's own village", which reflects the age-old mistrust of the population towards new ideas. This is not surprising in the least, because since the written history of the peoples of the Balkans has existed, a continuous series of conquerors and local rulers who subjugated the common folks and imposed their world view can be traced. Nevertheless, from time to time, people with great strength appear who not only break the shackles imposed by the powerful, but through their actions find a way to the souls of their compatriots and gain their unreserved trust. One of such spontaneous creators is professor Izet Masic, who achieved a miracle of medical publishing in his Sarajevo and Bosnia and Herzegovina and traced the path of medical science. There may be thousands of medical journals in the world, more or less reputable, and researchers from the Balkans can publish their work in them, but only domestic medical journals can initiate and direct domestic medical research, and educate young researchers in the right way. Professor Masic made it possible for authors from Bosnia and Herzegovina and other Balkan countries to present their results to the world and receive an incentive from impartial experts to continue their work and progress more and more by editing and publishing three domestic journals at once, which are visible in the most important world bases,. The progress in research then translated into improving medical practice and health care of the population. The following details from Professor Masic's biography tell us how this miracle happened. This year, academician Izet Masic, Editor-in-Chief of a few biomedical journals, including Acta Informatica Medica journal, celebrates his 70th birthday and also 45 years of his academic and scientific work.

Legal Regulations of the Health Statistics System and Reflections on the Creation and Implementation of Health Policy in Kosovo.

Background: Health professionals and health institutions document their professional activities with patients based on health policy and legal framework. This creates valuable medical records not only for health institutions at the three levels, but also for scientific research purposes and government agencies that design policies, laws and strategies and implement and monitor these policies based on the health statistics that form the basis of these policies, as well as for the health system not only at the national level, but also at the regional and local levels. Objective: To analyze the impact of the legal framework for health statistics in Kosovo on the planning of health system needs, human and financial resources and other components related to the collection, analysis and processing of data and health statistics, and on the basis of these statistics, to develop sectoral strategies, but also other key strategic documents for decision-making in the health system of Kosovo. Methods: Decision-makers and stakeholders, as well as other staff involved in the system of health statistics at the three organization levels of the health system in Kosovo, including inspectors from the Health Inspectorate, were interviewed through specific questionnaires. Results: The analysis of the laws, bylaws and other provisions that regulate and directly influence the data system and health statistics in Kosovo revealed that the institutional role is unclear, the legislation is insufficient and in many cases regulations are missing, which are an essential prerequisite for the implementation of the legislation and consequently influence the insufficient decision-making process. Conclusion: The research and findings provide sufficient evidence that the Kosovo's system for health data and statistics has serious shortcomings, starting with the legal framework, organizational structure, functional organization, segregation of duties and responsibilities, pronounced lack of staff, professional profiles and required technology, which in turn affects unreliable decision-making and health policy.

Operation of Medical Journal Citation Databases Without Control. Dilemma: Are They What They Want to Be in the Eyes of Scientific Community.

The decision of the citation database to include or not include a journal is not subject to the control of another entity, or the professional public, and there are no internationally established ethical standards that the citation database would have to apply. As a consequence of the absence of control, the already mentioned offensive reviews and arbitrary interpretation of the criteria for journal inclusion appear. Given that a journal's entry into the citation database is a condition for its long-term survival, people who make decisions in the citation databases gain the power to shut down or revive certain journals based on personal preferences. Any power that is not controlled is eventually abused. Therefore, our proposal is to urgently establish the principles of ethical behavior of citation databases at the global level and find ways to ensure compliance with such principles.

Macedonian Association of Medical Editors Initiatives to Advance the Integrity of Science and Publishing.

BACKGROUND: In the early 20th century some unfavorable conditions and trends in science and publishing in R. Macedonia and other countries in the South Eastern Europe (SEE) Region were recognized and it became necessary to act to protect the integrity of science and publishing. The increasing number of scientific journals in biomedicine and published papers in them has not always been matched by increased quality in publishing due to lack of information and education of the scientific community, especially of the young scientists, about ethical principles in research and publishing. In addition, some unethical behavior, fraud and attempts by experts for increasing their scientific productivity in research and publishing their results in scientific journals was recognized. OBJECTIVE: To present the initiatives, chronology of activities and leading role of Academician Momir Polenakovic towards the establishment and initial development of the Macedonian Association of Medical Editors (MAME) which has a mission for advancing the integrity of science and publishing. METHOD: A retrospective study based on review of the relevant literature, archive materials, minutes from organizational meetings and workshops and other documentation related to activities in the initial process for establishing and defining the mission and objectives of MAME. RESULTS: The expansion of higher education and inappropriate implementation of the Bologna Declaration and the European Credit Transfer System in R. Macedonia from 2004/2005 contributed to a decline of the study criteria for obtaining higher education diplomas and postgraduate education degrees, as well as numerous frauds in scientific research and publishing activities in biomedicine and other fields. The first meeting of the Initiative Board for organizing an SEE Conference on research and publishing integrity and a workshop for editors of scientific journals was held in the Macedonian Academy of Sciences and Arts (MASA) on Nov. 1st, 2013. In April 2014 two preparatory meetings of the Organizational Board were held and the Workshop for editors of scientific journals and the Constitutional meeting for establishing MAME were held on Apr. 25, 2014. The first President of MAME (with a two-year mandate) was Academician Momir Polenakovic and in 2016 he was elected as the first Honorary President of MAME. CONCLUSION: The establishment of MAME in April 2014 was an important initiative and strategic decision toward raising awareness among editors of scientific journals and other stakeholders for preventing scientific and publishing misconduct and for educating the scientific community for creating an ethical research environment.

Predatory Open Access Journals are Indexed in Reputable Databases: a Revisiting Issue or an Unsolved Problem.

INTRODUCTION: Pseudo journals, hijacked journals, fraudulent journals, fake journals, and predatory journals waste valuable research when authors publish their studies in them. AIM: This article described novel suggested features for the identification of fraudulent journals and aimed to explain this issue to help inexperienced scientists avoid publishing in predatory journals. METHODS: The articles related to this topic in were retrieved from PubMed and trustable Internet sources. RESULTS: Unfortunately, some fake journals have made their way into reputable databases, such as PubMed, PubMed Central, MEDLINE, SCOPUS, and Web of Science; thus, the serious question has been raised regarding how we should address this problematic phenomenon. We recommended 28 suggested characteristics of predatory journals for readers to take into consideration. CONCLUSION: Unaware of the detrimental effects associated with publishing in disreputable journals, inexperienced researchers can fall victim to them. Together, as both readers and writers, we should completely boycott predatory journals.

Safety and Efficacy of Methoxy Polyethylene Glycol-epoetin Beta in Anemia Treatment in Patients on Hemodialysis: a Macedonian Experience.

INTRODUCTION: Anemia in patients with chronic kidney disease (CKD) is present in about 50% in pre-dialysis and over 90% of patients on hemodialysis. Erythropoiesis-stimulating agent (ESA) is a standard therapy for renal anemia, but management of anemia in CKD still remains a challenge from the treatment point of view. AIM: To evaluate safety and efficacy of methoxy polyethylene glycol-epoetin beta as continuous erythropoietin receptor activator (C.E.R.A.) in maintenance of haemoglobin (Hb) concentrations in patients with chronic renal anemia in the routine clinical practice. METHODS: National, multicenter, observational, prospective study in patients with CKD on hemodialysis for maintenance of Hb levels with once-monthly therapy with C.E.R.A. In 8 dialysis centers 184 adult patients were observed and followed up every month during one year. Total number of enrolled patients was 185 from whom 184 patients were observed and 147 patients were followed for 12 months as 37 dropped out from the study earlier. RESULTS: Overall mean dose of C.E.R.A. was 115.2 µg with average 4.99 dose modifications per patient. Among 184 patients observed, total number of 121 adverse events (AEs) were identified in 49 of the patients. The most of the AEs were of mild or moderate severity. A few serious AEs were assessed and reported as not related to the drug administration. Mean Hb levels during the study varied but were maintained stable in the range of 100-120 g/l. CONCLUSION: Safety and tolerability of C.E.R.A. was as expected as the frequency and type of AEs was similar to the known pattern from the studies done in other countries and relevant literature. Hb levels as the primary efficacy parameter of C.E.R.A. treatment were maintained stable within the target range during the study.

New Developments in Publishing Related to Authorship.

AIM: To present the inappropriate types of authorship and practice, and the most recent developments related to basic principles and criteria to a fair system for allocating authorship in scientific publications. METHODS: An analysis of relevant materials and documents, sources from the internet and published literature and personal experience and observations of the author. RESULTS: Working in multidisciplinary teams is a common feature of modern research processes. The most sensitive question is how to decide on who to acknowledge as author of a multi-authored publication. The pertinence of this question is growing with the increasing importance of individual scientists' publication records for professional status and career. However, discussions about authorship allocation might lead to serious conflicts and disputes among coworkers which could even endanger cooperation and successful completion of a research project. It seems that discussion and education about ethical standards and practical guidelines for fairly allocating authorship are insufficient and the question of ethical practices related to authorship in multi-authored publications remains generally unresolved. CONCLUSION: It is necessary to work for raising awareness about the importance and need for education about principles of scientific communication and fair allocation of authorship, ethics of research and publication of results. The use of various forms of education in the scientific community, especially young researchers and students, in order to create an ethical environment, is one of the most effective ways to prevent the emergence of scientific and publication dishonesty and fraud, including pathology of authorship.

Balkan Clinical Research Registry: Established by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: From 2013 the World Medical Association's Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. OBJECTIVE: The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. METHODS: After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. RESULTS: Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. CONCLUSION: The AMSBH's decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

Guidelines for Editing Biomedical Journals: Recommended by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: Enormous number of medical journals published around the globe requires standardization of editing practice. OBJECTIVE: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). METHODS: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. RESULTS: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal's web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. CONCLUSIONS: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals' quality.

Quality of the Clinical Maternal and Neonatal Healthcare Assessment in a Tertiary Public Maternity Hospital in R. Macedonia.

INTRODUCTION: Maternal and neonatal infections can be prevented, but they are still common in low and middle-developed countries. There is a connection between childbirth on one hand and postpartum and newborn care on the other. Globally, several efforts are being made to improve quality of childbirth by providing initial assessment of procedures, risk prevention and continuous monitoring of childbirth process and possible complications. The World Health Organization has developed Checklists for Safe Delivery with procedures to be implemented as routine care, in order to promptly detect and manage complications related to childbirth. MATERIAL AND METHODS: A retrospective study was conducted in the University Clinic of Gynecology and Obstetrics in Skopje, a maternity hospital in R. Macedonia from the tertiary level of the public health care system. In this study 300 obstetric and 307 neonatal histories from childbirths in February and March 2018 have been analyzed. The collected data refers to the care of the prepartum, intrapartum, early postpartum and early neonatal periods. RESULTS: An initial assessment at admission proved that 14.7% of pregnant women had existing infection, in 93% of them the body temperature was measured and in only 9.3% urine analysis was made, 10.3% of the women had arterial hypertension, and 66.5% of them with hypertension had a headache. In the continuous monitoring and prevention of potential risk, arterial tension was measured in 33% of all mothers. In all women the placenta quality was checked up, as well as vaginal bleeding, application of oxytocin and hemoglobin level before discharge. CONCLUSION: The quality and quantity of documented data in the maternity hospital medical histories is high. There were no standard protocols for assessment of pregnant women. Certain procedures are conducted in every woman during childbirth. Standardized procedures are needed to be applied during every childbirth.

Prof. Aleksandar Josifovich Ignjatovski, Founder and First Director of the Clinic for Internal Medicine and the First Head of the Department of Internal Medicine at the Faculty of Medicine in Skopje, R. Macedonia.

Aleksandar J. Ignjatovski was born in the Smolensk Region, Russia, on 18.03.1875. He graduated from the Faculty of Medicine in St. Petersburg in 1899 where he started specialization in internal medicine and continued in Berlin, Heidelberg, Munich and Paris. In 1905 he was elected assistant professor in St. Petersburg, continued as an associate professor in Odessa in 1908 and a full-time professor in 1912 in Warsaw. During the October Revolution, he was the Head of the Internal Clinic in Rostov, and in 1920 he emigrated to Belgrade. In 1922 he was appointed full professor and Director of the First Internal Clinic at the Faculty of Medicine in Belgrade, which he established, developed and managed until his retirement in 1946. In 1948 he moved to Skopje as a full professor and first Director of the Internal Clinic at the Faculty of Medicine in Skopje. He studied the pathogenesis of arteriosclerosis and first proved it experimentally, and published a paper in 1908, indicating that it was associated with higher blood cholesterol level. He also dealt with immunobiology and infectious diseases, in particular tuberculosis and tetanus. Prof. A. Ignjatovski was an excellent clinician, teacher and scientist, who published over 80 papers. His most important textbooks are "Clinical Semiotics and Symptomatic Therapy", in two editions, in Russian (1919) and in Serbian (1929-37), and "The Basics of Internal Propedeutics" in three volumes, published in Skopje in 1952, 1954 and 1963. The work of Prof. A. Ignjatovski, as a leading clinician and a great teacher and scientist, is embedded in the development of internal medicine, and medicine in general, in Russia, Serbia and Macedonia. The bright memorial of the founder and first director of the Internal Medicine Clinic and the first Head of the Department of Internal Medicine at the Faculty of Medicine in Skopje has been permanently incorporated in the history of medicine in R. Macedonia. Prof. A. Ignjatovski died on 18.08.1955.

Professor Anastas Kocarev, First Macedonian Oncologist with Worldwide Reputation and Pioneer in Cancer Diagnostics and Treatment with Radium.

PhD. Anastas Kocarev (Kotzareff in French) is one of the most prominent Macedonian doctors and experts, prolific contributor to the cancer research in Switzerland and France in the first decades of the 20th century. He was born in Ohrid on May 5th, 1889. He graduated from the Faculty of Medicine in Geneva where he defended a doctorate in medicine in 1915. In 1916 he was elected Assistant Professor (Private Docent) at that Faculty. He was a prominent scientist and professor of experimental medicine at the Faculty of Medicine in Geneva and the Sorbonne University in Paris, with a wide reputation in Europe and the United States. PhD. A. Kocarev is one of the pioneers of oncology and radiology in the world, a forerunner of modern nuclear medicine and positron emission tomography. He was a close associate of Nobel laureate in chemistry and physics Maria Sklodovska-Curie and at her invitation moved to Paris in 1925 to continue the research on the diagnosis and treatment of cancer using radium. He was fully devoted to science and published numerous scientific papers and books with high citations and dissemination in many medical libraries in Europe and beyond. In addition to his professional teaching and scientific work as a top oncologist-radiologist, he was a great patriot with advanced political ideas. He founded the Academic Society "Macedonia" in Geneva, in 1915, and united it with other Macedonian political associations from Zurich and Lausanne, in 1918, into a joint "Alliance of Macedonian Societies for Independent Macedonia", with commitments, activities and initiatives to the Society of Nations, based in Geneva, Switzerland, for the proper resolution of the Macedonian national issue by creating a united and independent state "Macedonia" or the formation of a "Balkan Federation". He died suddenly in Paris on March 29, 1931.

Intrapartum Procedures for Prevention of Infections and Complications in Mothers During Childbirth.

INTRODUCTION: Multiple factors can cause infection and other pathological conditions in mothers during childbirth. These risk factors and diseases/complications can be prevented or timely detected through the implementation of special protocols/procedures. The aim of this paper is to identify the implementation of procedures/measures for the prevention and detection of infections and risk factors for morbidity and mortality in four hospitals in the Republic of Macedonia, before and during childbirth. MATERIAL AND METHODS: A retrospective study was conducted in four hospitals in R. Macedonia, in December 2016, on certain days according to the same principle of selection in all institutions. The questionnaire used contained relevant and specific questions related to the application of procedures and protocols at the maternity clinic at the time of admission to the birthplace and immediately prior to delivery. RESULTS: The study analyzes the performed procedures from 137 obstetric histories. Cardiotocograph was taken after the admission in a hospital in 86% of the mothers; a temperature was measured at only 47.5%, and arterial tension at 89.8%. Immediately before delivery, the color and odor of the vaginal discharge in 98.5% of the mothers was checked, urine was analyzed only in 8% of the mothers, and the analysis of the time of rupture of the mammalian sheaths in 98.6% of the mothers. CONCLUSION: The study showed that part of the analyzed procedures was not sufficiently implemented, and the percentage distribution varied between hospitals. There is a need for introduction of organized programs with standard procedures in maternity wards in order to protect against infections and other pathological conditions during childbirth.

Ten Steps to Improve Quality of the Journal Materia Socio-Medica.

INTRODUCTION AND AIM: Materia Socio-Medica is one of the oldest public health journals in Europe, established in 1978, and among the most important journals for public health in South-Eastern Europe. The Journal covers all important public health professional, academic and research areas in this field. The aim of the paper is to analyze the journal articles and statistical facts in 2016 and to point out the directions for action and planned further activities for improving the quality of the published papers and visibility of the journal. METHODS: Review and analysis of documentation and production of the journal, evidence of submitted and rejected manuscripts and published papers in 2016. RESULTS: Total number of 111 articles was published in Materia Socio-Medica during 2016. The most of them were original articles (64,5%). Articles from the fields of Health promotion and prevention were predominant (82,7%), which is one of the primary scope of the journal. Authors of the published articles in 2016 are dispersed to three continents (Europe, Asia and North America) and 15 different countries. The largest number of articles was submitted by authors from the country of origin of the journal, Bosnia and Herzegovina. The acceptance rate of Materia Socioi-Medica in 2016 was 35.7%. Total number of 116 reviewers participated in the manuscript review process in 2016. CONCLUSION: Materia Socio-Medica will continue to improve the quality of the published papers in 2017 and beyond through education of potential authors, reviewers and Editorial Board members, quality selection of reviewers, supportive editing of articles, and clearly defining instructions and ethical standards of the journal.