Time Management of Tuzla University Clinical Center Health Managers.

INTRODUCTION: Time management is an important aspect of successful leadership and involves mastering your own work and time instead of allowing them to master you. Time management is a daily process that is applied in order to rationally use time, work schedules, lists of tasks, delegation of responsibilities and everything else that helps to efficiently use time. MATERIAL AND METHODS: This research was prospective, descriptive, analytical and controlled. There was 100 medical worker involved, who have managing jobs of different levels and 100 medical workers who do not have managing jobs, who represented the control group. The questionnaire on "time stealers" according to Sewert. Demographic data was gathered according to the questionnaire on self construction. RESULTS AND CONCLUSIONS: Based on conducted research, it was established that there were differences in frequencies of certain "time stealers" in managers of different levels of University Clinical Center Tuzla; the "time stealers" are more frequent among these with shorter length of service; These differences are significantly more frequent (p<0.05) for some questions e.g. being distracted by phone calls, meetings that are held just for the sake of having a meetings, insufficient, one-way or bad communication with superiors, and have negative effects on management of business hours.

Suicidal ideation and thoughts of death in epilepsy patients.

BACKGROUND: Suicidal behavior is an important worldwide health problem. Psychiatric disorders, especially mood disorders, are the main risk factors for suicidal behavior. Suicide is an important cause of death in patients with epilepsy. The aim of this study was to analyze the presence of suicidal ideation in patients with epilepsy. SUBJECTS AND METHODS: The study included 50 epilepsy inpatients and outpatients of both genders, aged 18 years and older, treated at the Department of Neurology, Clinical Center University of Sarajevo in the period from 1(st) of April - October 1(st) 2007. The sample was selected randomly. Applied research instruments were general questionnaire, HAM-D-17, BHS and BSS. RESULTS: Suicidal ideation and thoughts of death were present in 38% epilepsy patients. Symptoms of depression as well as feelings of hopelessness were found in half of the participants (52% and 48%), and were significantly more common in epilepsy patients with suicidal ideation. There was a significant relation of suicidal ideation with the presence of chronic pain (3.86; p=0.49), sexual/physical abuse history (5.95, p=0.015), level of hopelessness (20.7; p=0.000) and severity of depression (14.48; p=0.000) in epilepsy patients. Multiple logistic regression analysis showed that unemployment (Exp(B) 33.9; p=0.007) and the level of hopelessness (Exp(B) 14.9; p=0.001) were independently related to suicidal ideation in these patients. CONCLUSIONS: The study has shown that the level of hopelessness and unemployment have a predictive value for appearance of suicidal ideation in epilepsy patients. In the prediction of suicidal ideation in this population of patients, there is no single variable that should be considered as specific and separate.

Environment and mental health.

Environments seen as the physical, chemical, and biological conditions to which organisms are subjected, define the ways we obtain various resources, their quantity and their quality. In interplay with our organisms, environments determine how 'fit' we are. An aspect of that fitness is the quality of mental functioning. Although there is a traditional view that there is something like an 'objective environment' and an 'effective environment', a part of the objective environment that actually affects the organism, the dividing line between the two is rather obscure. Environment in general cannot be defined without taking into account the behaviour of the organism, and it is especially challenging to define what environment means to humans, given the enormous variation and scope of human behaviours; what it is that we require and tolerate. Simultaneously, that physical environment is the broader context of what we usually term 'social environment'. This paper outlines the conceptual problems in determining and evaluating the relationship between environmental conditions and more proximal determinants of mental health, at the same time reviewing the assumptions of some of the well-known examples of that relationship.

Chronic illness and family: impact of schizophrenia and Crohn's disease on the family quality of life.

BACKGROUND: Quality of life assessments are increasingly present in health research. Chronic and progressive illness of a family member unavoidably affects quality of life of a family as a whole. The goals of this study were to gain insight into the family burden of chronic disorders, especially possible differences in family quality of life (FQOL) in families that have members suffering from either schizophrenia or Crohn's disease, and families in which none of the members have chronic somatic or mental illness, as well as to pilot an instrument for this purpose. SUBJECTS AND METHODS: The sample consisted of 53 families with a member suffering from schizophrenia, 50 families with a member suffering from Crohn's disease, and 45 families with no identifiable chronic illnesses. An informant from each family underwent a structured face to face interview, using a questionnaire specially adapted from Family Quality of Life Survey, an instrument widely used to assess FQOL in families with members with disabilities, and which addresses nine areas of family life. RESULTS: In the domain of health, both groups of families with chronic illnesses believe they have significantly different conditions when compared to members of the Control group. In the Crohn's disease group, families had a great deal more of challenges in accessing healthcare services; and see themselves at a disadvantage when compared to both other groups in the domain of finances. Control group offered lowest rating in the domain of support from others. Overall measures of FQOL show significant variation among the three groups, Crohn's disease group offering lowest ratings, followed by families of mental health service users. CONCLUSIONS: Overall, FQOL seems to be lower in families that have members diagnosed with Crohn's disease than in families with members suffering from schizophrenia. Illness-specific studies are required, as well as instruments with stronger psychometric properties and studies of determinants of FQOL. Qualitative approach should be emphasised when studying FQOL related to chronic illnesses.

Polypharmacy in the treatment of schizophrenic patients in three University Centers in the Federation of Bosnia and Herzegovina (F/BH).

BACKGROUND: Polypharmacy in psychiatry is becoming the rule rather than the exception. Using more drugs at same time usually occurs where single drugs are considered insufficiently effective. SUBJECTS AND METHODS: The sample consisted of 216 patients: 85 from Sarajevo, and 44 and 87 respectively from Mostar and Tuzla. All schizophrenic patients who were hospitalised in three University Centers of F/BiH (Sarajevo, Tuzla, Mostar) on a particular day are included in the study. This included patients of both sexes (131 (60.65%) males and 85 females (39.35%)), 20-60 ages, who were on antipsychotic treatment with an established diagnosis of schizophrenia by the treating psychiatrist. The research was performed in the year 2004. The census of patients was conducted simultaneously in all three Centers, using a questionnaire in which all routine prescribed antipsychotics were registered, as the common method of the administration, and the doses as well saving as data for other medications that were simultaneously prescribed to the patients that day. RESULTS: Within the total sample the most frequently applied classical antipsychotics were haloperidol, promazine and from the group of new antipsychotics clozapine. The most frequently used other medications were biperidine and diazepam. The administration of all medication was followed through recording of individual doses, daily doses and frequency of administration. There are statistically significant differences regarding the frequency of biperidine use between the centers (p=0.008). CONCLUSION: In three University Clinical Centers of the Federation of Bosnia and Herzegovina (Sarajevo, Tuzla and Mostar), the applied rule is that more drugs in the treatment of schizophrenic psychosis and doing polypharmacy is the inevitable approach to treatment. The concept behind the polypharmacy is based on the fact that antipsychotic drugs do not cover all the symptoms of schizophrenic psychosis, and that additional medications may correct iatrogenic side effects caused by antipsychotic drugs. It is expected that the new atypical antipsychotics will treat much broader symptoms of psychosis and will not cause extrapyramidal side effects, as do the typical antipsychotics.

Antipsychotics and the quality of life of schizophrenic patients.

Patients' attitudes and values, their concept of illness and health as well as their previous experiences with medication may significantly affect the subjective response to antipsychotics. Quality of Life (QOL) has holistic concept that includes consideration of economic development, social vitality and environmental health. For most of the researches, QOL has an umbrella concept, which covers all aspects of life and includes physical and mental health, family relations, friendship, employment, leisure activities, medical treatment and quality of care, psychological and social benefit. In the domain of mental health, increasing the quality of treatment can be demonstrated through improvements of QOL of those using the mental health services. When measuring QOL in patients taking antipsychotics, it is important to acknowledge that a variety of factors may influence the QOL outcomes: these include side effects and daily dosage of the antipsychotic, depressive and negative symptoms, duration of treatment, and subjective tolerability.

Cannabis and psychiatric disorders.

There are connection between use of cannabis and many psychiatric disturbances in adolescents, especially "cannabis psychosis", depression, panic attacks and suicide. Negative effects could occur either as a result of a specific pharmacological effect of cannabis, or as the result of stressful experiences during the intoxication of cannabis in young people. Potentially is very dangerous high frequency suicidal ideation among cannabis users.

Psychiatrists between personal freedom to prefer antipsychotic in treatment of schizophrenic patients and algorithms and guidelines.

Algorithms and guidelines in treatment of schizophrenia behind which is the consensus of experts, institutions and associations are more and more in use among psychiatrists. However, the final conclusion about them will be possible only after their use in everyday practice with full freedom of psychiatrists to make changes according their personal judgment about risk and benefit of treatment.

Comorbidity in psychiatry: its impact on psychopharmacological treatment.

The existence of two or more diagnoses (psychiatric, or a combination with somatic) in one person leads to a dilemma when choosing psychopharmacs for the treatment of the patient. There are no acceptable and comprehensive guidelines or algorithms for the treatment of innumerable possible combinations of psychiatric and somatic disorders. A strategy for treatment of such conditions is needed.

The organisation of mental health services in post-war Bosnia and Herzegovina.

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two 'entities' - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

Integrative treatment in psychiatry.

Psychiatry is a medical discipline addressing the study, diagnosis, treatment and prevention of mental disorders. Psychiatric disorders, which may be seen in people of all ages, involve the emotions, the will, and intellectual processes, verbal and non-verbal behaviour. According to current knowledge we cannot speak about only one cause but of the interaction of several etiological factors, mutually pervading and causing the mental illness. Because of this the treatment of mental disorders involves the complex implementation of biological, psycho-therapeutic, and socio-therapeutic methods of treatment. The contemporary principle of integrative psychiatry immanently requires simultaneous treatment of three human components: body, mind, and spirit. The holistic approach emphasizes the importance of the wholeness of the human person, and the inter-dependence of his components.

How to manage in current treatment of schizophrenic patients.

Clinical guidelines briefly identify, summarize and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy, risk/benefit and cost-effectiveness. However, the final conclusion about them will be possible only after their use in everyday practice with full freedom of psychiatrists to make changes according their personal judgment about risk and benefit of treatment.

[War psychotrauma of pregnant women as prenatal factor of cerebral palsy]. / Ratna psihotrauma trudnica kao prenatalni faktor djecije cerebralne paralize.

UNLABELLED: Cerebral palsy is a pathological state characterized primarily with the damage of the motor functioning which can be accompanied by the other disorders such as: problems with sight and hearing, intellectual deficit, emotional problems, conduct disorders, speech disorders, epileptic seizures etc. According to the period of influence, causes of the cerebral palsy can be divided to prenatal, perinatal and postnatal. Prenatal period is defined as the period from the conception until beginning of the delivery, neonatal period as a period from the beginning of the delivery until age of 28 days, and postnatal period from 29th day of age until two years of age. THE AIM OF THIS STUDY: to determine characteristics of psycho trauma as possible prenatal etiological factor of cerebral palsy. Sample was consisted of 80 respondents, children and adolescents with cerebral palsy of Canton Sarajevo, age from 6 up to 20 years; mean age was 13,94 years years, 47 male (58,75 %) and 33 (41,25 %) female. Study of the influence of prenatal etiological factors on learning difficulties of children and adolescents with cerebral palsy in Canton Sarajevo is cohort, epidemiologically based and retrospectively prospective. In this study a Structural interview for the parents of children and adolescents with cerebral palsy was used. RESULTS: with prenatal etiological factors there are 35 (43,75 %) respondents, with perinatal 37 (46,25 %), postnatal 5 (6,25 %) and unknown factors 3 (3,75 %). From 11 mothers with diseases during pregnancies, who delivered in war years, 4 (36,36 %) recognized and underlined psycho trauma as major problem factor during pregnancy. CONCLUSION: War psycho trauma of pregnant women is present as possible prenatal etiological factor of cerebral palsy.

The relationship between suicidal thoughts and psychoactive substances.

In this study is represented the relationship between suicidal thoughts and psychoactive abuse. In study were involved 202 students of Banjaluka's secondary schools. By questioned for risky behaviour of adolescents was found 28.7% of them have suicidal thoughts, and 144 haven't suicidal thoughts. Students from both groups use alcohol but there are not statistically significant differences among groups. The representative sample was 202 students from Banjaluka's secondary schools. The results showed that 28.7% of them have suicidal ideas. From examined students 20.2% used cannabis, and 4% other psychoactive substances, 56.9% alcohol and 35.6% smoke cigarettes. In the group with suicidal ideas, use of psychoactive substances is 8.6%, alcohol use in 63.7% cases and cannabis 36.2%, and smoking cigarettes in 48.2% cases. We may conclude that misuse of psychoactive substances is more present in group with suicidal ideas, except in case of alcohol, which was also high in group with suicidal ideas, but without statistical significances. It is also possible to conclude that there is important connection between use of psychoactive substances and presence of suicidal ideas as first step toward a suicide in adolescents.

Models of treatment with antipsychotics of the schizophrenic patients.

The aim of this study were to determine which antipsychotic are currently in use, to establish which doses are administrated to patients, to find out is there a practice of proscribing simultaneously more then one antipsychotic drug, to determine whether antipsychotic are proscribed in divided doses, to establish whether there is, besides antipsychotics, treatment with other medicaments (co-administration), especially with antiparkinsonics. The research (study) is epidemiological-clinical prospective, descriptive and analytical and it was conducted at University hospitals in Sarajevo, Tuzla and Mostar. Criteria for inclusion, non-inclusion and exclusion from the study were precisely defined as a mean for formation of sample. Based on this hypothesis were established, zero and alterative. According to zero hypothesis in the treatment of schizophrenia at University hospitals in FBiH new antipsychotic drugs are in use, small doses are proscribed (up to 20 mg), not more then one antipsychotic drug is used simultaneously, antipsychotics are administrated once a day and alongside with antipsychotics other medicaments are not co-administrated, especially antiparkinsons. The results of our study are showing that majority of patients are treated with classical antipsychotics. Minority of patients is treated with atypical neuroleptics like olanzapine, which is proscribed only in Sarajevo. Use of risperidone and ziprasidone is registered also only in Sarajevo, but only small number of patients is treated with these drugs. Most frequent antipsychotics were promazine and haloperidol. The range between minimal and maximal daily dose of promazine was from 50 to 450 mg/daily, and for haloperidol from 1 to 75 mg/daily. Above-mentioned drugs were administrated in an average from two to three times a day. Alongside with antipsychotics, other drugs were used. Most frequent was the use of biperidine in oral and parenteral formulation, as well as nitrazepam and diazepam. The importance of this study is following: data are useful for the current mental health care reform in FBiH, results will point out place and position of FBiH in contemporary world trends in the treatment of schizophrenia, they will contribute to rational use of antipsychotic therapy, they will point out possible ways in reduction of side effects, often dangerous adverse effects of antipsychotics, and they will give contribution to faster rehabilitation of schizophrenics with the reduction of financial means for the treatment of patients with schizophrenia.

[Cerebral palsy and epilepsy in children]. / Djecija cerebralna paraliza i epilepsija.

Cerebral palsy is a pathological state characterized primarily with the damage to the motoric functioning which can be accompanied by the other disorders such as: problems with sight and hearing, intellectual deficit, emotional problems, conduct disorders, speech disorders, epileptic seizures etc. Martin Bax defines this entity as a disorder of movements and postural balance due to defect or damage of the young brain (Gavrankapetanovic I. at all., 2001). Study of the influence of prenatal ethiological factors on learning difficulties of children and adolescents with cerebral palsy in Canton Sarajevo is cohort, epidemiologicaly based and retrospectively prospective. In this study a Structural interview for the parents of children and adolescents with cerebral palsy was used. Sample was consisted of 80 respondents, children and adolescents with cerebral palsy of Canton Sarajevo, age from 6 up to 20 years, mean age was 13.94 years, 47 male 858.75%) and 33 (41.25%) female. In the group of respondents with illnesses during pregnancy 16 (53.3%) have epilepsy, and 14 (46.7%) does not. In the group withaut illnesses during pregnancy 17 (34%) have epilepsy, and 33 (66%) does not. Risk ration is 1.59 which means that these respondents whose mothers had illnesses during pregnancy have 1.6 times larger probability of developing epilepsy.

[Perception of their social environment and their future in institutionalized school-age children]. / Percepcija socijalnog okruzenja i vlastite buducnosti u institucionalizovane djece skolske dobi.

Family home and institutions for children without parental care represent the rearing-environments where, from the early years, whole human development goes on. It's known today that despite the recognized importance of inborn traits, the influence of child-rearing environments dominates current models of development. The aim of the study was to investigate the satisfaction with the rearing-environment of school-aged institutionalized children, their dominating feeling and if institutionalization affects life optimism for now and for the future. The study was conducted in two institutions in Bosnia and Herzegovina who share the same care model imitating the traditional Bosnian families where the older children care for the younger siblings. We took as a sample 30 institutionalized children aged 8-12, and for the control group 60 children matched by age and sex. Parents, children and teachers who gave their informed consent answered the questionnaires. It was confirmed that children without parental care are vulnerable group and in a great risk who need urgent help of professional multidisciplinary team of their close and broad environment. Lack of social support cause the withdrawing and suffering and can lead soon or later to problematic behaviour.

Some historical remarks and current state of mental health services in bosnia and herzegovina.

In this paper we have presented historical overview of development of psychiatric services in Bosnia and Herzegovina. Special attention was given to the recent war destruction (l992-l995), as well as to the reconstruction and reform of mental health services within a frame of newly introduced mental health strategy.