Public Health Achievements and Challenges: Symposium of the University of Mostar Faculty of Health Studies.

Public health is an important area of health care that reflects the readiness of the state and society to provide the welfare of all citizens through the promotion of health and the preservation of a healthy environment - factors that directly affect the health of the population. The field of public health is very broad and its concept is changing over time, being defined in a narrower and wider sense. In short, public health is a science and practice that aims at ensuring the conditions in which people can preserve and improve their health and prevent health damage. The third millennium brings its specifics, needs and priorities according to challenges public health is faced by in the twenty-first century: the economic crisis, rising inequality, population aging, rising rates of chronic diseases, migration, urbanization, ecosystem change, climate change, etc. The role of public health is to protect, improve health, prevent diseases and injuries. Such a public health approach implies a multisectoral work focusing on "wider health determinants", and within this activity experts from various medical and non-medical profiles, whose field of public health is concerned, can be found. The development of inter-departmental co-operation skills contributes to a better understanding of health professionals and professionals of other profiles, and facilitates common, synergistic actions in addressing public health problems in the community. Symposium on Public Health Achievements and Challenges organized by the University of Mostar Faculty of Health Studies is just another indication of the obligation, the need and the desire for professional and scientific contribution to the fight for better health. Our faculty has so far organized other numerous symposia, and the aim of this symposium is to present public health achievements and challenges in our surrounding in order to protect, improve health, prevent diseases and injuries in a modern way.

HBV and HCV serological monitoring among injection drugs users in opiate substitution treatment in Bosnia and Herzegovina.

INTRODUCTION: Use of intravenous heroin carries a risk of serious medical conditions, including acquiring blood-borne infections. Therefore, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection represent a threat for people who inject drugs (PWID). The objectives of this study were to determine the extent and characteristics of risk factors for acquiring HBV and HCV infection in PWID included in opiate substitution treatment in the southern part of Bosnia and Herzegovina (B&H). METHODOLOGY: The study included 120 adult PWID of both sexes who participated in opiate substitution treatment. All participants were interviewed, and their blood samples were tested for the presence of the surface hepatitis B virus antigen (HBsAg) and hepatitis C virus antibodies (anti-HCV). Prevalence data were obtained and compared to the serological status. RESULTS: HBsAg prevalence among PWID was 0.8% (1/120), whereas seroprevalence of anti-HCV was 52.5% (63/120). PWID exposed to risk-behavior factors (such as unsafe sexual activity, serving prison sentence, and tattooing) were more frequently anti-HCV positive. Sharing drug paraphernalia was found to be the most significant risk factor. The highest predictive values for acquiring HCV-infection were attributed to PWID who used heroin for more than three years and who were unmarried. CONCLUSIONS: HBsAg prevalence among PWID is rare (0.8%), while HCV-infection (52.5%) presents an important health and social issue among PWID in B&H. Sharing drug paraphernalia and intravenous heroin use longer than three years were the most prominent risk-behavior factors among the patients we investigated.

Risk behaviour of prison inmates in relation to HIV/STI.

INTRODUCTION: Persons serving a prison sentence are identified as a population exposed to a higher risk of HIV/STIs due to a high incidence of risk behaviour, especially intravenous drug misuse. To show results of research on prevalence of HIV/STIs in relation to spread of risk behaviour and other risk factors. SUBJECTS AND METHODS: Cross-sectional study on a sample of 620 respondents in 10 prisons. A specially structured questionnaire was applied as a research instrument, together with blood sample taking for laboratory analysis of HIV, HBV, HCV and syphilis. RESULTS: Majority of respondents show insufficient knowledge about HIV/AIDS, ways of transmission prevention, especially knowledge on ways of HIV transmission. Every sixth respondent has experience of intravenous drug use, of which 58% exchanged drug injection equipment. Every fifth respondent with a tattoo had their tattoo done in prison. Below 2% of respondents quote being victims of sexual abuse, and having wilful anal sexual intercourse in prison. Test results in this research: HIV (0), HBV (1.5%), HCV (14.3%) syphilis (0.5%). CONCLUSION: Intravenous drug use presents the strongest risk factor for HCV, and therefore for HIV/ STIs. Other risk factors - tattooing with kit exchange, sexual risk intercourse, abuse, insufficient knowledge and information about HIV/AIDS, ways of transmission and way of protection, and lack of access to measures of prevention and "Harm reduction" programme.

Communication in crisis situations in the process of immunization.

Immunization is one of the most effective medical interventions in the prevention of the disease and represents the easiest and most cost-effective investment in health. The strategy of controlling contagious diseases that can be prevented through immunization has a long tradition in B&H. Mandatory immunizations are administered against ten diseases. Although the development of new technologies, the efforts of the pharmaceutical industry, the development of new vaccines provides better vaccines in terms of greater safety and effectiveness it should be pointed out that no vaccine is "absolutely effective and safe", and it will not achieve the immune response in 100% vaccinated, also there are possible side effects and unexpected reactions that could occur. Vaccination is often a media issue because previously unnoticed local, isolated events-side effects and complications of vaccination are now accompanied by media attention as there are now numerous and fast communication channels (internet, e-mail, TV1 etc.) and media evolved from being less "controlled" to more "commercial". Doubt in benefit of vaccination is growing even among health professionals who are expected to provide up-to-date, understandable information, and issue information about immunization benefits and potential risks. It is therefore important for health professionals to be well informed, to be a good source of authoritative, scientific and reasonable advice, and to speak openly about the benefits and risks of vaccination so that consumers fully understand both possible outcomes of vaccination. This takes communication skills, particularly in crisis situations connected with vaccination. Health professionals are thus faced with a changing attitude toward importance of immunization in the social climate where risk is less tolerated than ever before.

Health status of population in Federation of Bosnia and Herzegovina in 15 years of transitional period.

War in Bosnia and Herzegovina lasted from 1991 to 1995 and resulted in profound consequences marked by the large number of victims, increase in the diseases and disorders prevalence, that were not common before it occurred. The effects it had on health status of the entire population was reflected through many negative demographic trends, increasing prevalence of chronic diseases and the spread of a number of unhealthy behavioral patterns and a lot of migrations. All this presents a problem for institutions of health system which are attempting to control these negative influences especially during the transition period, marked by the direct adverse consequences of the 1991-1995 war. The present paper presents a summation of various sources which are attempting to provide a synthetic overview and provide basic information in relation to the health status of the population, and also to provide a baseline evaluation for deployment of public health interventions.

HIV/AIDS cases according to the year of diagnosis and selected characteristics of cases registered in the Federation of Bosnia and Herzegovina 1991-2004.

In the period between 1991-2004, in the Federation of Bosnia and Herzegovina there were altogether 59 registered HIV positive persons, out of those 43 were clinically diagnosed with AIDS. Gender-wise, 83% of the infected were male, and 17% female. The age groups with the highest risk of being infected with HIV are 20-24 and 40-44. The most frequent way of infection is heterosexual intercourse (46%), followed by intravenous drug use (31%), whilst 23% of the registered were infected through homosexual intercourse. Out of 43 diagnosed AIDS cases, 42% are heterosexuals, 35% intravenous drug users, whilst 21 % are homosexual or bisexual. Out of the total number of registered HIV/AIDS cases in the Federation of Bosnia and Herzegovina, thirty two died during the mentioned period (54%).

[Epidemiological characteristics of trichinosis in Federation of Bosnia and Herzegovina]. / Epidemioloske karakteristike trihineloze u Federaciji Bosni i Hercegovini.

The territory of Bosnia and Herzegovina, by its geographical setting and climate characteristics has the conditions for breeding and spreading the cause of trichinosis in environment. This, under certain conditions, in the context of different socio-economic, social and zoological-sanitary circumstances, can lead to the periodical epidemic outbreaks of the disease among people on a small or larger scale. Data on registered cases of human trichinosis collected during annual monitoring of trichinosis cases on the territory of Federation of Bosnia and Herzegovina in the past fourteen years, show its continual presence in this area, with a varying rate of morbidity, from 0,1 (2002) to 11,73 (1998) per 100.000 inhabitants. In the mentioned period, during 51 epidemics, 775 cases of trichinosis have been registered altogether, with approximately 10-15 cases per outbreak.

Eradication of typhus exanthematicus in Bosnia and Herzegovina.

Typhus exanthematicus in Bosnia and Herzegovina held in endemic areas from which especially quickly began spread after 1945. That year, in 1945, one hundred epidemics of typhus fever appeared, with the highest incidence rate in Europe of 215.04 per 1,000. Directions of unique program in the world were to eradicate lice of the body, but also establish monitoring of the recidivism, Brill-Zinsser disease. Since 1971, typhus exanthematicus (classical typhus) hasn't appeared in Bosnia and Herzegovina, so epidemic typhus can considered as an eradicated communicable disease.

Long term protection after hepatitis B vaccination.

A survey of persistence of anti-HBs after hepatitis B vaccination has shown that five years after vaccination on a sample of 152 persons, or 82.53%, stands at >10 IU/I. Long term immunogenicity of vaccinated children remained at 88.89%, health workers 79.41% and drug addicts 64.28%. The results of these studies in Bosnia and Herzegovina show the high level of protection hepatitis B vaccine against HBV infection. Vaccination against viral hepatitis B results in immunologic memory response among the vaccinated, and even after a decrease of anti-HB level following the third vaccine dose inoculation, a booster dose is not needed. Immunity remains steady and a booster dose is not recommended.

[Strategy for administering hepatitis B vaccine to newborns in Bosnia-Herzegovina]. / Strategija uvodenja neonatalne hepatitis B vakcine u Bosni i Hercegovini.

BACKGROUND: Neonatal hepatitis B vaccination is the best effective measure for prevention hepatitis B infection in the countries with intermediate to high levels of HB endemicity. METHODS: Epidemiological methods of research had the aim to follow the incidence rates of viral hepatitis B and HBsAg carriers and to determine influence on the risks of transmission hepatitis B infection in new-borns in Bosnia and Herzegovina. Serologic immunogenic quality of hepatitis B vaccine is researched. RESULTS: Bosnia and Herzegovina has high incidence of hepatitis B virus in the Europe. The incidence of HBsAg carriers is changing with increasing from 2000. to 2003. Data from this surveillance show in Bosnia and Herzegovina that in one notified case of hepatitis B there is 3.59 cases of HBsAg carriers. Hepatitis B vaccine induces anti-HBs antibodies titres > 10 IJ/ml, considered as seroprotective in 99, 10% vaccinated. CONCLUSION: Neonatal hepatitis B vaccination is new vaccine in national immunization program in Bosnia and Herzegovina. Hepatitis B vaccines are safe and effective in inducing neutralizing HBs antibodies play and have important role in protecting new-borns.