Tozija, Fimka

Preferred name

Tozija, Fimka

Official Name

Tozija, Fimka

Translated Name

Тозија, Фимка

Alternative Name

Ф. Тозија

Тозија, Ф

Tozija, F

Fimka Tozija

F. Tozija

Тозија, Фимка

Фимка Тозија

Main Affiliation

ftozija@medf.ukim.edu.mk

ftozija@t-home.mk

Now showing 1 - 10 of 19

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The INHERIT Model: A Tool to Jointly Improve Health, Environmental Sustainability and Health Equity through Behavior and Lifestyle Change
(2018-07-07)
Van der Vliet, N.
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Staatsen, B.
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Kruize, H.
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Morris, G.
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Costongs, C.
The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration. View Full-Text
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Road safety and burden of Road Traffic Injuries in Republic of North Macedonia
(National Food Institute, Technical University of Denmark Kgs. Lyngby, Copenhagen, Denmark, 2020-02-18)
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Anica Milenkovska
Background Road traffic injuries (RTIs) are a serious public health problem in Republic of North Macedonia (Macedonia). The main objective was to analyze the burden of RTIs in Macedonia. Methods Burden of RTIs on national level has been estimated in a retrospective study for 2015 and 2017 applying WHO standard method and software application. Data from Ministry of Internal affairs, State Statistical Office and medical records for RTIs have been used. Results The estimated burden of RTIs in 2017 is 4.894 DALYs (3.157 YLLs and 1.737 YLDs) which is lower than in 2015 with 4 960 DALYs lost (3 134 YLLs and 1 826 YLDs). There is strong correlation with sex and age. The burden of RTIs is significantly higher in males, with three times more DALYs lost than in females in 2017 (χ2 = 28, df = 1, p < 0,01). The most vulnerable are younger at age group 15-29 years with the most DALYs lost or 4.4 DALYs per 1000 in 2017. There is no significant difference between Macedonia and Europe in RTIs participation in the total burden of disease and injury in 2017 (coefficient of determination r2 = 0.9784, correlation coefficient (r) = -0,6128 and p = 0.2671). Conclusion Road safety has been set as priority for the Government for evidence based policy interventions such as national strategy and legislation development, but still their enforcement should be strengthened to improve road safety. Key messages  Regular estimation of RTIs burden is crucial for evidence based road safety policy interventions  Monitoring of legislation endorsement to enhance road safety
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Multidrug-resistant tuberculosis in Moldova and the Former Yugoslav Republic of Macedonia: The importance of health system governance
(Jacobs Verlag, 2016-04-19)
R. Gregory Thomas-Reilly
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Viorel Soltan
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Dance G Nikovska
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Valeriu Crudu
Aim: Multidrug-resistant tuberculosis (MDR-TB) arises where treatment is interrupted or inadequate, when patients are treated inappropriately, or when an individual has impaired immune function, which can lead to a rapid progression from infection with an MDR-strain to disease. This study examines the role of health systems in amplifying or preventing the development of MDR-TB. Methods: We present two comparative studies, which were undertaken in The Former Yugoslav Republic of Macedonia (TFYR Macedonia) and Moldova. Results: The findings reveal several health systems-level factors that contribute to the different rates of MDR-TB observed in these two countries, including: pre-existing burden of disease; organization of the health system, with the existence of parallel systems; power dynamics among policy makers and disease programmes; and the accountability & effectiveness of programme oversight. Conclusions: The findings do not offer a universal template for health system reform but do identify specific factors that may be contributing to the epidemic and are worthy of further attention in the two countries.
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CHALLENGES FOR MIGRANT HEALTH POLICY IN THE REPUBLIC OF MACEDONIA
(Faculty of Medical Sciences - University of Tetova, 2019-05-31)
Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to analyze health policies affecting migrant integration related to migrants’ entitlements to health services; accessibility of health services for migrants; responsiveness to migrants’ needs; and measures to achieve change in Republic of Macedonia. Republic of Macedonia has health strand total score 38, lower than the highest score 70 in Switzerland, but much higher than the lowest score in Latvia 17 and higher than the neighboring countries Greece and Bulgaria. Republic of Macedonia is in the same score group with Turkey and Cyprus. Health care is a constitutionally-guaranteed universal right for citizens in Republic of Macedonia. As most Southeast European countries. Republic of Macedonia offers migrants legal entitlements to healthcare, but still little to adapt services to their needs. There is a need to create appropriate structures in health system accessible to refugees responsive to their needs and different cultures based on universal human rights
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Attitude of the Macedonian intensivists regarding withdrawal of therapy in intensive care patients: curriculum for policy development
(Academy of Medical Sciences of Bosnia and Herzegovina, 2011)
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Ethical confusion regarding withdraw of therapy led to the aim of the study in which the knowledge and attitude of the Macedonian Intensive Care Unit (ICU) doctors and their impact on decision making process were assessed. Methods: Knowledge, Attitude and Practice (KAP) study has been conducted on a national sample of 217 ICU doctors (response rate 83.87%), applying restructured EURELD 2002 questionnaire as study instrument. CHI-square test was used for cross tabulations. Results: 103 responders were females and 79 males with mean age 40, 2 years +/- 3 y. Significant percent of the doctors didn't know what is withdraw of therapy, chi-square 34.47 (p < 0.0001) and for most there was no difference between withdraw of therapy and euthanasia, chi-square 41.482 (p < 0.0001). Most of doctors didn't have any formal training (67%) and didn't know whether they had experience with withdraw or withhold. Similarly to other countries, for significantly higher percentage of the Macedonian intensivists patient's wishes and patient autonomy have to be main criteria for decision. Significantly higher group of doctors (p < 0.0001) would prefer to leave their own advanced directives. Conclusions: Legal principles in end of life care must be established in the country. Courts should have drawn a distinction between intentionally causing a patient's death (euthanasia) and allowing a patient to die as a result of the withdrawal of life support treatment. There is a need of additional improvement of postgraduate curriculum and continuous professional development of ICU doctors working with end-of-life patients.
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The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia
(Wiley Online Library, 2004-04)
Jeffery, Heather E
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Pop-Lazarova, Marina
The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje.
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Migrant Health Policy in European Union (EU) and a non EU country: Current situation and future challenges for improvement
(South Eastern European Journal of Public Health, 2020-03-16)
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Tona Lizana
Aim: The influx of refugees, asylum seekers and migrants in Europe is an ongoing reality and migrant health has become very important public health problem. The aim of this paper is to analyze and compare the health profile, migrant situation and migration integration health policy in Spain as a European Union (EU) country and Republic of North Macedonia as a country in process of European Union accession. Methods: Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to compare health policies for migrant integration in both countries. Results: There are differences between Spain and Macedonia in health care coverage and access to health services for migrants. Spain has health strand total score of 52 and is in the same group with Austria, Ireland, Belgium, Netherlands, Denmark and Sweden. Macedonia has lower health strand total score 38 and is in the same group with Turkey, Cyprus, Slovakia. Targeted migrant health policies are stronger and services more responsive in Spain compared to Macedonia which offers migrants legal entitlements to healthcare, but health services should be more culturally responsive to migrant health needs. Conclusion: Health migration policy in both countries is closely tied to the general immigration policy.
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Health Financing and Expenditures in Balkan countries: the case of North Macedonia, Serbia, Bosnia and Herzegovina and Montenegro
(Macedonian Medical Association = Македонско лекарско друштво, 2025-04)
Vasilevska, Hristina
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Filipche, Milcho
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Introduction. The health financing model and health spending should meet the population health needs. The aim of this paper is to analyze and compare the financing of the health systems in the selected Balkan countries: North Macedonia, Serbia, Bosnia and Herzegovina and Montenegro. Material and method. Data from World Health Organization HFA-DB and World Bank has been used as well as from Health in Action Reports for the selected countries. Desk review of official documents and websites of government and health institutions and the literature has been applied. Results. All countries had a socialist system in Yugoslavia and the same health system. The system was reformed later in the transitional period. The Bismarck model of mandatory health insurance is dominant in all countries with recent reforms in Montenegro. Montenegro introduced major health insurance reforms, shifting from a contributions-based system to a fully tax-funded system. In North Macedonia Healthcare spending is relatively low compared to European Union (EU) and Southeastern European countries, current health expenditure as % of GDP is 8.5% in 2021. The health expenditures in 2021 in Bosnia and Herzegovina with 9.6% of GDP, in Serbia 10.01%, and in Montenegro 10.5% are at the level of the average of the European region and EU countries (10.95%). Out-of-pocket (OOP) payments of health spending in 2021 are high, in North Macedonia is accounted for 41.7%, in Montenegro 38.08%, in Serbia 35,86% and in Bosnia and Herzegovina 30.71%. Conclusion. The financing of health systems in the Balkans has improved in the last decade following a series of transition reforms and socio-political challenges. However, inequalities in health systems between countries, as well as with EU countries, persist.
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Estimating health impacts and economic costs of air pollution in the Republic of 22-29 Macedonia
(Jacobs Verlag, 2015)
Craig Meisner
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Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia. Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost ofillness). Results: Fine particulate matter frequently exceeds daily and annual limit values and influences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs. Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goals.
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The Right of Access to Health Care for Migrants in the Republic of North Macedonia - Barriers and Challenges
(IISTE, 2020-01-31)
Jankulovska Angelka
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Introduction: In recent years hundreds of thousands of refugees and migrants who have left their homes in order to reach the EU member states have transited through The Republic of North Macedonia (RNM). The dynamics of the refugee crisis in this period continually tested the readiness of the state to fully respect the guarantees of basic human rights, cultural and social differences, as well as respect for human dignity. The R. of North Macedonia throughout the crisis has remained a country of transit, not a target destination for refugees and migrants. The increasing number of migrants makes much more pressure on health systems in countries. Access to health services is one of the most basic issues, because high-quality care and health care is not effective if people don`t have access to it.Purpose of the paper is to represent the right and access to health care for migrants in the Republic of Northern Macedonia, the restriction of the health system, as well as the policies for improving the availability of health services for migrants.Material and Methods: In this paper are used, a public health approach, an infromatic-analytical method and sinteses evidence, and a review of the existing legislation, strategic documents and other documents. The materials whish were used are electronic databases such as PubMed, HINARI, EBSCO, Google Scholar, Scopus, and special search strategies for each keyword database based on inclusion criteria. For a detailed and specific view, were used reports from the International Organization for Migration (IOM)Results and Discussion: With an overall assessment of MIPEX 38/100, the country's policies are barely conducive to social integration. These policies are the result below the European average and an average slightly better than other countries in the region. Migrants lack targeted state support to find the right job, improve their children's education or benefit from consultative bodies. After the adoption of the National Strategy for the Integration of Refugees and Migrants in 2017, as one of the key documents of the Ministry of Labor and Social Policy that regulates the country's policy in dealing with affirmed refugees and foreigners on its territory, in 2018, the Action plan for the integration of refugees and foreigners 2017-2027. Migrants and refugees have multiple barriers to access to health care, as well as discrimination in access to the asylum procedure - which indirectly affects the exercise of healthcare rights.Conclusion: Despite the efforts made to give a quick response to the migration-refugee crisis, the Republic of North Macedonia needs further improvement of the respect and protection of the human rights of migrants and refugees. Health system reforms are needed in order to provide a faster and more efficient response to the needs of vulnerable groups who are staying and transiting through the Republic of North Macedonia.

Tozija, Fimka

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