'Madness' after the war in Bosnia and Herzegovina - challenging dominant understandings of distress

This article reports on the findings from a small-scale co-produced qualitative study on experiences of distress caused by the war in Bosnia and Herzegovina (BiH). Inspired by the emerging interdisciplinary field of Mad Studies, the study is novel and unique in two ways. First, it prioritises social understanding and interpretation of madness and distress. Second, an emphasis is placed on experiential knowledge. Beyond interviews with 20 people who experienced distress due to political conflict, this included contextualisation of the study in the knowledge generated through survivor research and within the field of Mad Studies. Study findings highlight the social causes and consequences of distress caused by conflict, such as war-related violence, gender-based violence, experiences of poverty and corruption. Participants stressed the importance of safety and support within their own home, mutual and supportive relationships with their families, friends, other people who experienced distress, the broader community and opportunities to do everyday activities they enjoy. In terms of professional support, the findings suggest that poverty alleviation and protection of people's right to self-determination through access to human rights advocacy and representation may be as relevant as non-coercive community-based services. This indicates that support for distress caused by political conflict need not be different from any other support for people who experience distress. Emphasis should be placed on survivor-run initiatives and non-coercive, community-based support which addresses social causes of distress and enables people to exercise self-determination.

Health risk assessment of heavy metals in PM2.5 and PM10 in Sarajevo air, Bosnia and Herzegovina

The concentrations of eight heavy metals (Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) associated with PM2.5 and PM10 in Sarajevo air, Bosnia and Herzegovina (BiH) have been studied. A total of 136 PM2.5 and PM10 samples were simultaneously collected from 21 February to 11 November 2020. Metal contents were determined by atomic absorption spectrometry, flame (FAAS) and electrothermal (ETAAS) techniques. The mean concentrations of metals in PM10 are 2.93 ng/m3 (Cd), 7.21 ng/m3 (Cr), 12.02 ng/m3 (Cu), 126 ng/m3 (Fe), 20.74 ng/m3 (Mn), 6.98 ng/m3 (Ni), 8.74 ng/m3 (Pb) and 128 ng/m3 (Zn). In PM2.5 samples the mean concentrations of Cd, Cr, Cu, Fe, Mn, Ni and Zn are 0.39, 4.06, 2.26, 110, 0.63, 1.93 and 5.28 ng/m3, respectively. Pb was not detected in PM2.5 samples. Strong correlation was obtained for metal pairs Mn-Cu in PM10 and moderate for Ni-Fe in PM2.5. The health risk assessment shows that the adult population of Sarajevo is at increased lifetime risk of experiencing cancer because of exposure to Cd concentrations in PM10.

Influence of immigrant background on the outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in 449 immigrants living in Sweden

BACKGROUND

Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS).

METHODS

Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups.

RESULTS

There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005).

CONCLUSIONS

Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.

Older migrants' perceptions of places to meet: Insights for social work practice

This study aimed to explore the experiences of older migrants' (70+) access to and participation in different meeting places. Qualitative interviews were conducted with participants originating from Finland and four countries in the Western Balkans: Bosnia- Herzegovina, Croatia, Montenegro, and Serbia. The participants used everyday places in the neighborhood, which were not primarily meant to be meeting places, to create and uphold social contacts. These meeting places contributed to experiences of community and trust. Both everyday meeting places and organized meeting places were used to establish and develop relationships that could result in an exchange of both practical and emotional support. Perceptions of "not belonging", limited proficiency in Swedish, and a strained financial situation created barriers to accessing some meeting places. The results of this study demonstrate the significance of meeting places that are not purposefully aimed at older people in general or older people from a specific country.

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

INTRODUCTION

The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources.

METHODS

An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions.

RESULTS

A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation.

CONCLUSION

The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries.

TRIAL REGISTRATION

All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

Radiation protection and estimate of commercial aircrew effective doses in Bosnia and Herzegovina

Cosmic rays are the primary source of the daily exposure of aircrew and passengers to ionising radiation. This study aims to estimate the effective doses of ionising radiation for aircraft crews in Bosnia and Herzegovina by taking into consideration factors such as flight duration and altitude, as well as the geographical position of airports. The CARI-7 algorithm and neural network method were used in the analysis of data obtained from the Sarajevo International Airport. The results show that the estimated annual effective doses in 2021 range from 0.06 to 10 mSv for flights to and from Belgrade and Dubai, respectively. Both linear regression and neural network models were developed to predict the effective dose based on flight duration, average altitude, latitude and maximum altitude. The findings reveal that flight duration is the most statistically significant factor, followed by average altitude, latitude and maximum altitude.

Correlation analysis of different optical remote sensing indices for drought monitoring: a case study of Canton Sarajevo, Bosnia and Herzegovina

Droughts are second to hurricanes the world's most costly weather events. Damage caused by droughts in certain countries is measured in tens of billions of dollars per year. Timely detection of drought and prediction of its occurrence has the potential to reduce costs and save a large number of people from its consequences. Numerous methods that serve this purpose exist in scientific research and practice. One group of drought monitoring methods belongs to the field of remote sensing, where it is possible to monitor drought indicators over large areas in almost real-time through satellite images. This paper is focused on the optical indices of remote sensing calculated by raster algebra. The intention was to reach conclusions about the quality of individual indices used for the Canton Sarajevo area in Bosnia and Herzegovina for each month of August in the period 2008-2021 through correlational and qualitative analysis and the use of meteorological indicators. Among the used indices, NDVI (normalized difference vegetation index) and NMI (normalized moisture index) proved to be the most reliable, and their mutual correlation was very strong (r = 0.99).

Multilocus sequence analysis (MLSA) of a Nocardia cyriacigeorgica strain causing severe bovine mastitis in Bosnia and Herzegovina

Nocardia cyriacigeorgica is a well-known agent of human nocardiosis and is considered an emerging pathogen, however, its identification to the species level is complex for many clinical laboratories. Available data on the clinical significance of N. cyriacigeorgica in veterinary medicine are sparse and mainly concern isolated reports of pyogranulomatous lesions in domestic animals. We report a case of severe bovine mastitis caused by N. cyriacigeorgica that did not respond to conventional antimicrobial therapy in a small holding in Bosnia and Herzegovina. After isolation of the pathogen, further identification by routine microbiological methods was not possible. Susceptibility to antimicrobials was tested using the disc diffusion method according to published recommendations. The sample was also tested by MALDI-ToF MS with inconclusive results. In addition, 16S rRNA sequence analysis, verified by multilocus sequence analysis (MLSA) using the gyrB, 16S rRNA, secA1, and hsp65 sequences, confirmed the species N. cyriacigeorgica. To our knowledge, this is the first report of isolation of N. cyriacigeorgica from a clinical case of bovine mastitis in a European dairy farm and the first MLSA method approach to distinguish a Nocardia spp. strain isolated from animals.

In the Face of a Pandemic: "I Felt the Same as When the War Started"-A Qualitative Study on COVID-19 Vaccine Acceptance in Bosnia and Herzegovina

Objectives: To conduct qualitative study with different target groups in Bosnia and Herzegovina in order to explore their views on barriers and drivers for COVID-19 vaccination, and to see if and how barriers and drivers vary between urban and rural locations, and different professional roles. Methods: The theoretical framework underpinning the study is the capability-opportunity-motivation (COM-B) behavior change framework, which has been adapted to monitor vaccine related behavior and attitudes. Data was collected from June to September 2022 through moderated discussions in focus groups. The total of 162 participants participated in 16 focus groups. Results: Among the key barriers to successful immunization identified across target groups were insufficient knowledge about vaccines, pandemic fatigue, concerns about the rapid development of the vaccine and its effectiveness, lack of confidence in the healthcare system. Some of the main drivers of vaccination against COVID-19 were confidence in science and expert recommendations. Conclusion: The COVID-19 immunization policy undergoes continuous changes, as do the pandemic prospects; we encourage further research to track the evolution of vaccine related attitudes, inform immunization policy, and create evidence-based interventions.

Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina

Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.

The role of National Immunization Technical Advisory Groups in advising COVID-19 immunization policy during the pandemic: lessons from the Federation of Bosnia and Herzegovina

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of experts that provides evidence-based recommendations on immunizations to policy-makers to assist them in making immunization policy and program decisions. NITAGs faced challenges in making evidence-based recommendations for COVID-19 vaccines during the COVID-19 pandemic due to the new vaccine products available in a short time period and limited available data on vaccine effectiveness and vaccine safety. The authors reviewed the process used by the NITAG in the Federation of Bosnia and Herzegovina, called the expert body, to develop COVID-19 vaccine recommendations. The article reviews the evidence that was considered by the expert body when developing 23 recommendations on COVID-19 vaccination and describes the challenges and successes faced by the body. The expert body recommendations led to the successful roll-out of COVID-19 vaccines and provided guidance for COVID-19 vaccination during the pandemic. The expert body plans to improve its work and procedures for developing routine immunization recommendations with the support of the WHO Regional Office for Europe.

Health risk assessment of heavy metals in soil, plant, and water samples near "Gacko" power plant, in Bosnia and Herzegovina

This study assesses heavy metal content in soil, water, and plant material from sites located around the lignite mine and the power plant "Gacko", Bosnia and Herzegovina. The samples were collected, prepared, and analyzed for heavy metals content using the flame atomic absorption spectrophotometer. Samples were analyzed for cadmium, lead, copper, zinc, manganese, and iron. To identify the relationship among the metals in samples and their possible sources, Pearson's correlation and principal component analysis were performed. Health risk assessment was applied to establish potential health risks posed to humans caused by contaminants in different environmental compartments. The results of our analyses show that most soil samples contain copper, and one of those samples had a copper concentration of more than 70 µg/g, which is a critical upper value for agricultural use. In the soil samples that were analyzed, cadmium was also detected, and its concentration was greater than 2 µg/g. Lead, on the other hand, had a concentration that was higher than the maximum permissible for unpolluted soils in 40% of the soil samples that were analyzed. Lead and cadmium concentrations in surface waters mostly contribute to a non-carcinogenic risk in the scenario of recreational swimming exposure. The presence of Cd, a highly toxic element in water, may be explained by the leaching of artificial fertilizers used in the study area, whereas Pb's origin may be geological. The results of this study recommend routine heavy metal monitoring in samples of soil, water, and plants from the examined area so that, if metal concentrations continue increasing, remedial action should be advised to prevent accumulation in the food chain.

Ethnobotanical study of traditionally used plants in the municipality of Zavidovići, BiH

ETHNOPHARMACOLOGICAL RELEVANCE

Bosnia and Herzegovina (BiH) is a country with a highly diverse ecosystem, containing over 5000 confirmed taxa of vascular plants. The traditional medicinal use of plants has always played a crucial role and gained in importance in the time of war in the 1990s due to a lack of medical facilities. Still nowadays, the health care system is poorly developed, which altogether makes the region interesting for ethnopharmacological researches.

AIM OF THE STUDY

Focusing on the area of Zavidovići Municipality in the central part of the country, we aimed to document the diversity of the used medicinal plants and the knowledge of their therapeutic usages.

MATERIAL AND METHODS

Data was collected in individual open and semi-structured interviews. Therapeutic uses were classified into 14 disease categories following the International Classification of Primary Care-2 (ICPC-2), a classification system recognized by the World Health Organization's Family of International Classifications (WHO-FIC). Use reports have been used to evaluate the acquired knowledge.

RESULTS

The findings revealed a total of 113 species belonging to 46 families. 14 informants well respected for their knowledge in the area listed 77 therapeutic uses for the indicated plants. Based on a comparison with other ethnobotanical surveys of BiH and to other important relating literature, three taxa have not been previously reported in BiH and for 19 species, new medicinal uses were stated. Based on use reports, oral application of remedies is far more common (76,7%) than external application (23,3%), the dominant mode of preparation thereby is an infusion. Usages of most concern were digestive, urological and respiratory diseases, their consensus factor ranging between 0,63 and 0,71.

CONCLUSION

These results summarize the usage of traditional plants among people who are highly valued in their community of Zavidovići Municipality for their knowledge and thereby aim to preserve the indigenous knowledge associated with the medicinal plants of the area.

Psychological research and practice in former Yugoslavia and its successors

This paper presents a brief history of Yugoslav psychology and a review of the current state of psychological research and practice in the former Yugoslav countries. Bibliometric mapping was used to explore the knowledge domain and international visibility of psychological research in Bosnia and Herzegovina, Croatia, North Macedonia, Montenegro, Serbia, and Slovenia. Judging by the number of papers visible in Scopus, psychological research activity in these countries is similar to the other former communist countries. In a relative sense, it is even higher in Slovenia and Croatia. However, psychologists still rely heavily on national journals indexed in Scopus when publishing their papers. Regarding psychological practice, former Yugoslav countries are facing challenges that are more or less typical for all small countries in the global scientific and economic market. Keeping in mind all the obstacles and traumas in the past decades, it should be considered a success that psychology in the former Yugoslav countries is now a fully established profession and a recognized scientific discipline.

The role of high-income countries in the establishment and development of modern critical care in low resource settings: A Slovenian model

BACKGROUND

Critical care medicine is a young branch of medicine, of which the development was much faster in High Income Countries (HICs) than in Low Resources Settings (LRS). Slovenia, as one of the successor states of former Yugoslavia, passed the process of transition and joined the European Union successfully. On the contrary, Bosnia and Herzegovina (B&H) went through the extremely difficult process of transition (four years of civil war), which left a deep scar to the healthcare system, including critical care medicine.

OBJECTIVE

To examine the impact of HICs on the development of critical care in LRS.

METHOD

This review examined the process of growing up the first modern Medical Intensive Care Unit (MICU) in the Republic of Srpska.

RESULTS

The five-year process of transferring critical care knowledge from Slovenia to the health care system of Republic of Srpska has contributed to the existence of modern and state of the art MICU with tremendous social effects.

CONCLUSION

The model of using the impact of HICs for improving critical care in LRS can be extrapolated to other similar settings.

"Today one partner, tomorrow another one, and no one is suspicious that you are gay": A Qualitative Study of Understanding HIV Related Risk Behavior Among MSM in Bosnia and Herzegovina

Men who have Sex with Men (MSM) are often exposed to stigma and discrimination, especially in developing countries. Discrimination might have an impact on their sexual behavior. The proportion of MSM among HIV positive persons is rising in Bosnia and Herzegovina (B&H). The aim of this qualitative study was to understand the country context and HIV-related risk behaviors among MSM in B&H. We found that MSM in B&H have a dominant fear of expressing their sexual orientation in the homophobic societal environment, including their own family. Disclosures are often connected with escalated family violence, followed by the silence and ignorance. The fear of being connected to one particular partner and being labeled as a gay lead to the need of "masking" their sexual orientation, and having sexual intercourse with non-steady sexual partners. Although most MSM were aware of the risk of HIV and other STIs, the fear of rejection and remaining alone, shapes their decisions to agree to have sex without condoms.

Overview of Patient Safety Culture in Bosnia and Herzegovina With Improvement Recommendations for Hospitals

OBJECTIVES

This study investigates the patient safety culture (PSC) in Bosnia and Herzegovina (BiH). We identify factors that contribute to higher patient safety and improved reporting of adverse events, thereby developing recommendations to improve PSC.

METHODS

The study used a correlation design based on cross-sectional surveys in the healthcare sector of BiH (N = 2617). We analyzed the correlation between 9 PSC factors, 4 background characteristics (explanatory variables), and 2 outcome variables (patient safety grade and number of events reported). We also analyzed the variance to determine perceived differences in PSC across the various staff roles in hospitals.

RESULTS

The highest rated PSC factors were Hospital handoffs and transitions and Hospital management support for patient safety and the lowest rated factor was Nonpunitive response to error. Each of the 9 factors showed considerable potential to improve from a hospital, department, and outcome perspective. A comparison of the various employee positions shows significant differences in the PSC perceptions of managers versus nurses and doctors as well as nurses versus doctors.

CONCLUSIONS

We found average scores for most PSC factors, leaving the considerable potential for improvement. Compared with the number of events reported and background characteristics, it is evident that PSC factors contribute significantly to patient safety. These factors are essential for the targeted development of PSC. We propose evidence-based practices as recommendations for improving patients' safety factors.

Medical personnel occupationally exposed to low-dose ionising radiation in Federation of Bosnia and Herzegovina: A cytogenetic study

Medical radiation exposures have been reduced significantly with modern equipment and protection measures. Biomonitoring of medical personnel can provide information concerning possible effects of radiation exposure. However, chromosome aberration (CA) analysis is now recommended only when the estimated effective dose is 200 mSv or higher. In this retrospective study in Bosnia and Herzegovina, we have measured the cytogenetic status of medical workers and healthy volunteers (controls). Peripheral blood samples from 66 medical workers exposed to low-dose ionising radiation and 89 non-exposed volunteers were collected for chromosome aberrations (CA) analysis and the cytokinesis-block micronucleus (CBMN) assay. Higher rates of chromatid and chromosome breaks, acentric fragments, double minutes, micronuclei, and micronucleated binuclear cells were observed in the control group, while the rate of nucleoplasmic bridges was higher in the medical workers group.

Measuring Resilience in the Context of Conflict-Related Sexual Violence: A Novel Application of the Adult Resilience Measure (ARM)

There is a rich body of research addressing the issues of conflict-related sexual violence, and a similar wealth of scholarship focused on resilience. To date, however, these literatures have rarely engaged with each other. This article developed from an ongoing research project that seeks to address this gap, by exploring how victims-/survivors of conflict-related sexual violence in three highly diverse settings - Bosnia-Herzegovina, Colombia and Uganda - demonstrate resilience. This research is the first to apply the Adult Resilience Measure (ARM), a 28-item scale that seeks to measure protective resources across individual, relational, and contextual subscales, to the context of conflict-related sexual violence. A total of 449 female and male participants in the three aforementioned countries completed the ARM (in the framework of the study questionnaire) as part of this research. This article presents some of the results of the analyses. Specifically, we first sought to establish through Confirmatory Factor Analysis whether the ARM was actually measuring the same construct in all three countries, by confirming the invariance (or otherwise) of the factor structure. The second aim was to explore how different resources function and cluster in different cultural contexts, to arrive at a more nuanced understanding of the different protective factors in the lives of study participants. We generated different factor structures for BiH, Colombia, and Uganda respectively, suggesting that a single factor structure does not sufficiently capture the diverse groupings of protective factors linked to the particularities of each country, including the dynamics of the conflicts themselves. Ultimately, we use the findings to underscore the need for policy approaches that move away from a deficit model and give greater attention to strengthening and investing in the (often overlooked) protective resources that victims-/survivors may already have in their everyday lives.

The clean development mechanism in Eastern Europe: an in-depth exploration

The Clean Development Mechanism (CDM), a partnership tool founded under the Kyoto Protocol, grants potential opportunities to help developing countries achieve sustainable development. The present research examines the CDM projects in Eastern Europe (Moldova, Serbia, Bosnia and Herzegovina, Montenegro, and Albania). Although there were far fewer projects in this region than, for instance, China or India, it has some specific features that make it worth studying. Major findings are that most CDM projects in Eastern Europe involved a changing combination of two or more sources of financing, and the distribution of projects in the region was uneven. Moreover, although there was a small number of projects overall, they were all cost-effective, long-term and large-scale. The findings of the research call for improvements to be made to the governance of the CDM, by strengthening the international and national regulation of projects and by aggregating the scales of decision-making and actions so that real multi-scalar transnational governance - from the global level down to the local level - is implemented in a coherent manner. It is also recommended to carry out ex-post project evaluations, following which readjustments could be made.

The Oncology Association of Bosnia and Herzegovina's recommendations for fertility preservation in oncologic patients

Malignancy is one of the major public health problems in Bosnia and Herzegovina. Along with breakthroughs in specific oncological therapy, improving the quality of life of cancer patients and management of therapy-induced side effects need to be recognized as a priority in the comprehensive cancer patient care. Fertility loss after cancer treatment is a field requiring special attention due to its various consequences on patients themselves.  Although oncofertility is well-recognized area of oncology, low- to middle-income countries are facing issues with its implementation in everyday practice. Increased awareness about fertility preservation is of high priority for all specialists who participate in the medical care of cancer patients. The absence of a systemic solution and lack of expertise led to the founding of Fertility Preservation Working Group of the Oncology Association of Bosnia and Herzegovina. We have made recommendationsas an expert consensus with the ultimate goal of making the first step towards enhancement of oncofertility implementation in Bosnia and Herzegovina.

Price and income elasticity of cigarette demand in Bosnia and Herzegovina by different socioeconomic groups

BACKGROUND

Tobacco tax policy in Bosnia and Herzegovina (B&H) assumes a gradual annual increase in specific excise taxes on cigarettes. However, it is insufficient to reduce significantly consumption. This paper examines effects of the increase in cigarette prices and disposable income on cigarette demand in B&H by different income consumer groups.

METHODS

Based on the Household Budget Surveys and microdata from 2007, 2011 and 2015, we employed logit model to estimate prevalence and Deaton's model to estimate intensity elasticity of cigarette demand for the sample of 21 424 households (9953 are smoking households) by different income groups. We used obtained elasticities and estimated the impact of tax increase on cigarette consumption and government revenue in three tax increase scenarios.

RESULTS

Ten per cent price increase would reduce the consumption of low-income households by 14%, as opposed to 9.9% for middle-income and 7% for high-income households. Low-income households would significantly increase the demand for cigarettes compared with high-income households if income increased. Increase in the specific excise tax by 25% would reduce cigarette consumption and increase government revenue, while the low-income group would experience a reduction in tax burden.

CONCLUSIONS

Changes in prices have different impacts on tobacco prevalence and consumption of low-income compared with middle-income and high-income socioeconomic groups. Low-income households are most responsive to changes in prices and income. Thus, the poor in B&H would benefit from an increase in tobacco excise taxes and price.

Street Food and Takeaway Food Purchasing Patterns in Bosnia and Herzegovina

This study aimed to describe street food and takeaway food purchasing patterns in Sarajevo and Banja Luka, throughout the day and by city location. A cross-sectional evaluation of street food and takeaway food customers was conducted in 2017. All eligible vending sites (n = 348) in the vicinity of selected markets and bus stops were included. Data on the food items purchased, and time and geographic location of the purchases were collected. A total of 755 customers purchased 929 food items. Takeaway venues showed higher customer influx (5.0 vs. 2.0 customers observed per 10 min of observation, p < 0.001) and buying rates (6.7 vs. 2.0 items bought per 10 min of observation, p < 0.001; 1.5 vs. 1.0 items bought per customer, p < 0.001) than street food sites. These rates were higher in city peripheries for street food venues, and in city centres for takeaway establishments. The purchase of industrial food products prevailed throughout the day in street food venues, whereas most takeaway purchases comprised homemade foods, with or without industrial beverages. The proportion of customers buying foods and beverages together was higher in takeaway venues (15.3% vs. 6.0%, p < 0.001), especially during lunchtime and in city centres. In street food vending sites, sweet and savoury snacks seemed to be preferred in the afternoon, whereas in takeaway food establishments, savoury pastries and main dishes were mostly purchased at breakfast or lunch, and bread during the morning. Soft drinks and industrial juices were frequently purchased in both types of vending site and at all hours of the day, particularly in the afternoon. Our findings provide an overview of street food and takeaway food buying habits and consumer demands in these cities, reflecting local food culture and dietary behaviours. The identification of the meal contexts and city sub-regions in which specific purchasing practices emerge point to potential priority targets. These insights can be useful when designing interventions adapted to the specificities of these food environments and the food habits of customers.

New Insight into the Measurements of Particle-Bound Metals in the Urban and Remote Atmospheres of the Sarajevo Canton and Modeled Impacts of Particulate Air Pollution in Bosnia and Herzegovina

The Sarajevo Canton Winter Field Campaign 2018 (SAFICA) was a project that took place in winter 2017-2018 with an aim to characterize the chemical composition of aerosol in the Sarajevo Canton, Bosnia and Herzegovina (BiH), which has one of the worst air qualities in Europe. This paper presents the first characterization of the metals in PM10 (particulate matter aerodynamic diameters ≤10 μm) from continuous filter samples collected during an extended two-months winter period at the urban background Sarajevo and remote Ivan Sedlo sites. We report the results of 18 metals detected by inductively coupled plasma mass spectrometry (ICP-MS) and electrothermal atomic absorption spectrometry (ETAAS). The average mass concentrations of metals were higher at the Sarajevo site than at Ivan Sedlo and ranged from 0.050 ng/m3 (Co) to 188 ng/m3 (Fe) and from 0.021 ng/m3 (Co) to 61.8 ng/m3 (Fe), respectively. The BenMAP-CE model was used for estimating the annual BiH health (50% decrease in PM2.5 would save 4760+ lives) and economic benefits (costs of $2.29B) of improving the air quality. Additionally, the integrated energy and health assessment with the ExternE model provided an initial estimate of the additional health cost of BiH's energy system.

What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study

OBJECTIVES

Global health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme.

DESIGN, SETTINGS AND PARTICIPANTS

This study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data.

OUTCOME MEASURES

Participants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end.

RESULTS

Many of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs.

CONCLUSIONS

The findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.

Acceptance, effects, and tolerability in the vaccination process against SARS-CoV-2 virus among cancer patients in Bosnia and Herzegovina: a single-center cross-sectional study

The SARS-CoV-2 pandemic has been the main public health issue since the end of 2019. The vaccination campaign in Bosnia and Herzegovina started in April 2021, with several vaccines available. Our study aimed to evaluate the acceptance, effects, and tolerability of vaccines against SARS-CoV-2 among cancer patients. We conducted a cross-sectional, observational study between 22 October and 30 November 2021, at the Clinic of Oncology, Clinical Center University of Sarajevo. Patients were enrolled during their regular visit to the Clinic of Oncology by agreeing to complete an individual paper questionnaire. The study included 1063 patients with malignant diseases, of whom 681 (64.1%) were adequately vaccinated patients. In the study population, 76.9% of patients reported that they did not experience any side effects due to vaccination, while only 0.5% had side effects, causing a delay in their treatment. Among adequately vaccinated patients, there were 40 patients (3.8%) who were infected with SARS-CoV-2 after the second or booster dose of the vaccine. Five patients (0.5%) were hospitalized due to COVID-19 after being adequately vaccinated. The findings of our study suggest that cancer patients have a higher acceptance of vaccines against SARS-CoV-2 than the general population in Bosnia and Herzegovina. Vaccination side effects are tolerable and do not cause major delays in specific cancer treatment. The protective effects of COVID-19 vaccines in the cancer patients presented in our study are comparable to available results of similar studies, which included the general population.

Regulatory aspects of biological medicines in Bosnia and Herzegovina

The use of the biological medicines, also called “biologics,” has contributed to the progress of the treatment of many chronic diseases, such as cancer, rheumatoid arthritis, Crohn’s disease, multiple sclerosis, and psoriasis. However, biologicals are expensive for healthcare systems in several countries. Their availability has been a global issue, which has affected many patients that suffer from various diseases. A biosimilar medicine, also called “biosimilar,” is a medicine with similar characteristics in terms of quality, biological activity, safety, and efficacy as the approved original biological medicine, known as “originator biologic.” Biosimilars generate competition within the market because they lower the prices of biologics and thus allow for an increase in patient access. However, there are barriers when it comes to the acceptability rate of biosimilars and how interchangeable they are with the originator biologic. In this review, we present a national regulatory framework for biologics along with its limitations, a system of monitoring the safety profile of biologics, the guideline for interchangeability, and a list of approved and available biologics in Bosnia and Herzegovina. Additionally, recommendations were made here in order to provide opportunities for greater acceptance of biosimilars and better access to biologics. These recommendations include, but are not limited to, strengthening the national regulatory framework for biologics, capacity building, increasing awareness among healthcare providers for reporting adverse drug events and active pharmacovigilance, and better definitions of interchangeability. Finally, awareness among healthcare providers regarding biosimilars and biologics should be raised through continuous education and workshops, and by including this important topic in the graduate and postgraduate curriculum programs in the country.

Types and Frequency of Errors in the Pre-Analytical Phase in the Clinical Laboratory - Single Center Study from Bosnia and Herzegovina

BACKGROUND

The pre-analytical phase, which includes all preparatory actions to the analytical procedure, is part of the process during which there is the greatest possibility of laboratory errors. This study was conducted to investigate the frequency and types of laboratory errors during work in the clinical laboratory as well as the frequency and types of laboratory errors in the pre-analytical phase of laboratory work.

METHODS

The retrospective, descriptive study covered the period from 01/01/2016 to 12/31/2016 within which the presence of 5 different indicators of quality of work, i.e., pre-analytical errors, was monitored: improperly drawn blood, coagulated blood sample, hemolyzed blood sample, improperly marked referral for analysis, and insufficient sample for analysis.

RESULTS

The most common error in the pre-analytical phase of our study was "coagulated sample", followed by: "improperly drawn blood", "improperly marked referral", "insufficient sample for analysis", and "hemolyzed sample". Using the chi-squared test, a statistically significant difference was found in the frequency of occurrence of certain types of indicators in different departments (p < 0.005).

CONCLUSIONS

Reduction of these errors can be achieved through analyzing and correcting the reasons for them, education, and by joint action of experts and international organizations, continual training of staff as well as to following the adopted guidelines and standards.

Cancer incidence among the NATO peacekeeping forces in Bosnia and Kosovo: a systematic review and metanalysis

BACKGROUND

A few cohort studies of the NATO peacekeepers in the Bosnia and Kosovo war reported inconclusive results on cancer risk. A systematic review and metanalysis of such studies might help to resolve the interpretative limitations.

METHODS

Relevant publications were retrieved through a PubMed search and from the list of references of the selected reports. Five epidemiological studies, one each from Denmark, Italy, the Netherlands, Norway, and Sweden, satisfied the selection criteria. Random and fixed effect estimators were calculated. Heterogeneity across studies was formally tested for all cancer outcomes.

RESULTS

Incidence of all cancers was below the expectation, as was the case for lung cancer and cancer at most other organs. The incidence of Hodgkin's lymphoma exceeded expectation in the first years after deployment in the Italian cohort but not in the subsequent years of follow-up. The risk of colorectal cancer and bone cancer was increased in the Danish cohort, and so was the risk of leukaemia in the Swedish cohort. Bladder cancer cases were non significantly more than expected in the three Scandinavian studies. The Cochrane's Q-test was indicative of significant heterogeneity across studies for total cancer, colorectal cancer, melanoma, and leukaemia. The meta-estimate of risk of bladder cancer was increased two-fold (fixed effect summary [FES] = 2.16 (95% CI 1.35 - 2.97), based on three studies.

DISCUSSION

Exposure to depleted uranium, metals, and ultrafine particles has been claimed as responsible for the cancer cases observed among peacekeepers. None of these would account for the excess of bladder cancer. The hypothesis of viral epidemics around the deployment area of the Italian military as contributing to the temporary excess of Hodgkin's Lymphoma cases would be worth exploring.

The detection and phylogenetic analysis of equine herpesviruses 1, 4 and 5 identified in nasal swab samples of asymptomatic horses from Serbia and Bosnia and Herzegovina

Nasal swabs originating from 112 apparently clinically healthy and unvaccinated horses of different age, breed and from diverse rearing conditions from Serbia and Bosnia and Herzegovina were examined for the presence of equine herpesviruses 1, 4 and 5 using multiplex nested PCR (Mn‑PCR) and virus isolation. The detected viruses were subsequently characterised by gB gene nucleotide sequencing and their phylogenetic analysis was performed. The infections with EHV‑1, EHV‑4, and EHV‑5 in the examined horse populations are apparently chronic, subclinical and persistent, whilst the shedding of EHV‑1 and EHV‑5 was confirmed by their successful isolation. A connection was established between the finding of EHVs and rearing conditions since horses kept together in stables were positive for at least one EHV in contrast to animals held free grazing or individually. EHV‑5 was found most often in younger horses, however descending in frequency in animals up to 10 years of age. The phylogenetic analysis showed that the identified EHV strains group mostly with Turkish and German strains of respective viruses. A certain degree of genetic heterogeneity was determined regarding the identified EHV‑5 strains in contrast to EHV‑1 and EHV‑4.

ANALYSIS THEORICO-PRACTICA DE VIRIBUS VIRUS FEBRIFERI, PESTIFERI, ATQUE SERPENTIN – THE FIRST MEDICAL ARTICLE BY AN AUTHOR FROM BOSNIA AND HERZEGOVINA

This review describes the first medical article written by an author from Bosnia and Herzegovina. The article was published by Fr. Franjo Gracić (1740-1799), in Latin, under the title: "Analysis theorico-practica de viribus virus febriferi, pestiferi, atque serpentin", and printed in Padua in 1795, translated as: "A Theoretical and Practical Presentation of the Effects of Fevers, Infectious Diseases, and Snake Poison". From today's standpoint, it may be said that it was a review article about some of the most frequent diseases of that time. The paper is of exceptional importance for the history of medicine in Bosnia and Herzegovina because it is the first documented medical article whose author was from Bosnia and Herzegovina. The paper contains observations of the course of diseases and treatment, in line with the medical insights of the time. The author refers to the authorities of that time, such as Samuel Auguste André Tissot, the Swiss physicist and doctor, Georg Bauer, the German doctor, and Lodovico Antonio Muratori, the Italian scholar, which makes this article a link between Bosnia and Herzegovina and the knowledge of the Europe of that time. This paper represents the beginning of medical writing in Bosnia and Herzegovina and has a very important place in the history of medicine in this country.

Adaptation of the Agency for Healthcare Research and Quality's 'Hospital Survey on Patient Safety Culture' to the Bosnia and Herzegovina context

OBJECTIVES

Measuring staff perspectives on patient safety culture (PSC) can identify areas of concern that, if addressed, could lead to improvements in healthcare. To date, there is no validated measure to assess PSC that has been tested and adapted for use in Bosnia and Herzegovina (BiH). This research addresses the gap in the evidence through the psychometric assessment of the Agency for Healthcare Research and Quality's: 'Hospital Survey on Patient Safety Culture' (HSOPSC), to determine its suitability for the health system in BiH.

SETTING

Nine hospitals.

PARTICIPANTS

Healthcare professionals (n=1429); nurse (n=823), doctors (n=328), other clinical personnel (n=111), non-clinical personnel (n=60), other (n=64), no response (n=43).

PRIMARY AND SECONDARY OUTCOME MEASURES

A translated version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis and confirmatory factor analysis (CFA). Comparison between the original HSOPSC and the newly adapted 'Hospital Survey on Patient Safety Culture for Bosnia and Herzegovina' (HSOPSC-BiH) was carried out.

RESULTS

Compared with the original survey, which has 12 factors (42 items), the adapted survey consisted of 9 factors (29 items). The following factors from the original survey were not included in their original form: Communication Openness, Feedback and Communications about error, Overall Perceptions of Patient Safety and Organisational learning-Continuous Improvement. The results of the CFA for HSOPSC-BiH showed a better model fit compared with the original HSOPSC. The absolute and relative fit indices showed excellent model adjustment.

CONCLUSIONS

The BiH version of Hospital Survey on Patient Safety Culture demonstrated satisfactory psychometric properties, with acceptable to good internal consistency and construct validity. Therefore, we recommend the HSOPSC-BiH as a basis for assessing PSC in BiH. This survey could provide insight into patient safety concerns in BiH so that strategies to overcome these issues could be formulated and implemented.

TECHNOLOGICAL, ECOLOGICAL AND ENERGY ASPECTS OF THE DEVELOPMENT OF BOSNIA AND HERZEGOVINA

Bosnia and Herzegovina has generally opted to join the European Union. Preliminary decisions have already been taken, but BiH needs to meet some of the standards/criteria contained in the 14 recom-mendations made by the European Commission before formal negotiations with the EU begin. One of the important assumptions of a successful path to the EU is that BiH accelerates economic development and modernizes the economic structure as a whole. In this regard, it is especially important that BiH advances technological development, improves its environmental policy and accelerates the energy transition. The text analysed the current development level of these areas and suggested some measures that should improve the current unsatisfactory situation in them. Particular attention was paid to measures to increase innovation capacity, the need for more vigorous inter-ventions in solving environmental problems and the energy transition as a precondition for entry into Industry 4.0, the introduction of the green economy and the acceptance of decarbonisation as long-term policies. It was stressed that these are the ultimate targets by 2050, in agreement with the long-term development orientation of the European Union.

SCIENCES, ARTS AND RELIGIONS: THE TRIAD IN ACTION FOR EMPATHIC CIVILIZATION IN BOSNIA AND HERZEGOVINA

From historical or traditional perspective sciences at one side and arts and religions on the other side are strictly divided epistemology fields with no much mutual engagement and understanding. Digital revolution is changing significantly all fields of science, art and religion changing regimes and methods of knowledge and values production, communication and relationships. Big Data approach promises to provide the scientific Holy Grail, a single overarching theory or multiple theories and models that unify all the scientific disciplines from biology snd neuroscience to music and spirituality. Brain is place where biological, psychological, social and spiritual mechanisms meet each other and interact. Global empathic civilization seems to be a key to the very survival of humankind and life on our planet. Spiritually integrated sciences, arts and religions in creative dialogues and synergy as allies can significantly contribute to the healing of our broken world and promoting compassionate society and empathic civilization.

Infantile Sacral Region Hemangioma and Combination Treatment with Propranolol and Topical Timolol: Case Review and Reference Review

BACKGROUND

Infantile hemangiomas (IH) are the most common vascular, benign tumors of childhood with a prevalence of 4-5%. Due to intense vasculogenesis, they proliferate during infancy, then involute at an unpredictable rate, extent of involution, and quality of residual tissue. Depending on the location, they may be associated with anomalies of other organ systems (PHACE, PELVIS syndroms). In recent decades, knowledge about hemangiomas has improved, and therefore therapeutic possibilities have improved. Today, the non-selective beta blocker-propranolol is considered the drug of first choice in the treatment of infantile hemangiomas. It is desirable to start treatment in the proliferative phase of hemangioma growth for the best possible effect. The dynamics of drug administration, time interval of dose increase and monitoring of patients during treatment vary from one Institution to another and are still the subject of discussion.

OBJECTIVE

We presented the case of a child with infantile hemangioma of the lumbo-sacral region, treated with combination therapy with systemic propranolol and topical timolol, with satisfactory effect in the end.

CONCLUSION

Propranolol is considered a drug with well-studied side effects and a safety profile. During 6 months of treatment, it leads to complete or almost complete withdrawal of the hemangioma. Treatment should be started in the hemangioma proliferation phase for the best possible therapeutic effect.

2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.

Surgical Treatment of the Patients with Cervical Disc Herniation at Clinical Center of University of Sarajevo, Bosnia and Herzegovina

BACKGROUD

Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect.

OBJECTIVE

The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias.

METHODS

This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White's classification of treatment outcomes.

RESULTS

The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients.

CONCLUSION

Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.

A Cross-Country Examination on the Fear of COVID-19 and the Sense of Loneliness during the First Wave of COVID-19 Outbreak

The aim of the current study is to examine gender, age. and cross-country differences in fear of COVID-19 and sense of loneliness during the lockdown, by comparing people from those countries with a high rate of infections and deaths (e.g., Spain and Italy) and from countries with a mild spread of infection (e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total of 3876 participants (63% female) completed an online survey on "Everyday life practices in COVID-19 time" in April 2020, including measures of fear of COVID-19 and loneliness. Males and females of all age groups in countries suffering from the powerful impact of the COVID-19 pandemic reported greater fear of COVID-19 and sense of loneliness. In less endangered countries, females and the elderly reported more symptoms than males and the young; in Spanish and Italian samples, the pattern of differences is considerably more complex. Future research should thoroughly examine different age and gender groups. The analysis of emotional well-being in groups at risk of mental health issues may help to lessen the long term social and economic costs due to the COVID-19 outbreak.

How Psychologists Experience and Perceive EMDR?

This qualitative, phenomenological study describes the perceptions and experiences of psychologists from Bosnia and Herzegovina and Turkey regarding an Eye Movement Desensitization and Reprocessing (EMDR) psychotherapy. In order to understand how psychologists perceive this treatment method, 20 psychologists from Bosnia and Herzegovina and Turkey were recruited through an online survey. The participants were asked to describe their perception and experience of EMDR. Qualitative analysis of the responses revealed five common themes, which described the phenomenon. These themes included: positive personal or anecdotal experiences with EMDR, perception that EMDR is primarily used for trauma, EMDR is used as an adjunct therapy, obstacles to EMDR training/certification, and limited knowledge and information about EMDR among psychologists and the general population. Findings from this study may provide a foundation for future research that may help in better understanding of psychologist perception and experience with the EMDR approach and especially about differences and similarities between psychologists in different countries such as Bosnia and Herzegovina and Turkey. Besides this, it can also help to gain an understanding of the variables involved in psychologists choosing to pursue training in different treatment modalities.

Development of EMDR Therapy in Bosnia and Herzegovina - Education by Supervision to Accreditation

INTRODUCTION

Due to the increased needs of the citizens of Bosnia and Herzegovina (B&H) affected by the 1992-1995 war, after five basic EMDR (Eye Movement Desensitisation and Reprocessing) trainings and one EMDR training workshop for children and adolescents, Trauma Aid UK (former Humanitarian Aid Program UK and Ireland) continually provides supervision to mental health professionals in B&H, working towards European EMDR Association accreditation for the clinicians. To describe the experiences of education, clinical practice, and supervision of EMDR psychotherapy in the process of obtaining European accreditation of EMDR trainees from Bosnia and Herzegovina.

SUBJECTS AND METHODS

In order to understand how EMDR trainees perceive the process of supervision up to accreditation, nine questions were sent by email to 95 EMDR trainees about practicing EMDR, the number of patients with whom they use EMDR on a monthly basis, about their supervisors, and the number of completed supervisions, blocks to treatment while practicing EMDR, as well as positive experiences with EMDR practice and working with supervisors. 36 EMDR trainees answered these questions. The answers were analyzed using quantitative and qualitative methods.

RESULTS

Of the 36 participants in this short study, 30 (83.3%) are women. Most of them are from Sarajevo 14 (38.9%), Tuzla 8 (22.2%) and Mostar 3 (8.3%), 2 (5.6%) from Bihać, Brčko, Gradačac, one from Banovići, Jajce, Prnjavor, Pale and Zenica. Psychologists make up the highest number of participants 25 (72.3%), followed by 5 (13.9) neuropsychiatric specialists. 31 currently have a supervisor (86.1%), 6 have changed their supervisor, and these 31 do not want to change their existing supervisor. Of them, 5 (13.9%) asked to be assigned a new supervisor. A qualitative analysis of the respondents revealed that the greatest problem in practicing EMDR therapy is the lack of space and time in the institutions where they work, the inability to reach patients seeking EMDR treatment, the parallel use of psychotherapeutic guidelines that they have previously adopted, and insufficient determination to use EMDR. They are mostly satisfied with the experience they have gained in supervision which they deem very important in the process of accreditation. They highly appreciate the expertise and accessibility of the supervisors, to whom they are grateful for the help and support they received while presenting their cases from EMDR practice.

CONCLUSIONS

Findings from this study can serve as a basis for improving the supervisory process during the acquisition of European accreditation for EMDR practitioners in B&H. The findings can also aid in understanding the difficulties mental health professionals in BiH face practicing EMDR therapy while working towards the accreditation as practitioners of this very effective and necessary psychotherapeutic method.

Osteoporotic fractures among foreign-born individuals: a national Swedish study

In this national study of osteoporotic fractures in foreign-born individuals, we found a lower risk of osteoporotic fractures in general among foreign-born individuals compared with Swedish-born, especially in immigrants from southern Europe. A higher risk was found among some groups, i.e. men and women from Bosnia and Iraq and men from Lebanon.

INTRODUCTION

The aim of this study was to analyse risk of osteoporotic fractures in foreign-born individuals compared with Swedish-born individuals.

METHODS

This was a nationwide study of individuals 50 years of age and older (N = 2,775,736). Osteoporotic fractures were defined as at least one registered diagnosis of fractures in the hip, humerus, forearm or vertebrae, in the National Patient Register between January 1, 1998, and December 31, 2012. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 99% confidence intervals (CI)) of incident osteoporotic fractures in foreign-born compared with Swedish-born individuals. The Cox regression models were stratified by sex and adjusted for age, comorbidities and sociodemographic status.

RESULTS

A total of 362,899 osteoporotic fractures were registered (96,847 among men and 266,052 among women), with hip fractures dominating (54.0% among men, 42.6% among women). Fully adjusted HRs (99% CI) were for all immigrant men 0.75 (99% CI, 0.73-0.78) and women 0.83 (99% CI, 0.81-0.84), with significantly lower HRs among most groups but with higher HRs in certain countries. For the specific fractures, higher HRs were found for lower forearm fractures for men from Asia and for vertebral fractures among women from Asia.

CONCLUSIONS

We observed a generally lower risk of osteoporotic fractures among first-generation immigrants, with few exceptions.

Creative Psychopharmacotherapy in Child and Adolescent Psychiatry and Experiences from Bosnia and Herzegovina

INTRODUCTION

Paediatric psychopharmacology involves the application of psychotropic agents to the treatment of children and adolescents with mental disorders and gathered knowledge from child and adolescent psychiatry (CAP), neurology, paediatrics and pharmacology. Defining elements of this discipline are: the metabolism of drugs is different in children than in adults (pharmacokinetics), the developing brain reacts specifically to the drug (pharmaco dynamics), and psychopathology itself is not differentiated yet. To make and overview of specifics in psychopharmacological use in CAP and emphasize some experiences from Bosnia and Herzegovina in that field.

METHODS

Through insight in current literature, we presented comprehensive findings and compare it with situation in Bosnia and Herzegovina.

RESULTS

The most common conditions in which psycho pharmaceuticals are used in CAP were attention deficit hyperactivity disorders (ADHD), depressive and bipolar disorder, obsessive compulsive disorder and the treatment of early psychosis. Psycho pharmaceuticals were also used to treat agitated conditions in various causes. We made an overview of psycho pharmaceuticals use in Bosnia and Herzegovina CAP and emphasized the fact that psycho stimulants are not approved for the use yet, although they are mostly prescribed medicament in CAP over the world. That limits us in the effectiveness of the treatment in ADHD and put us in the situations to use other medicaments instead (anxiolytics, antipsychotics, mood stabilizers) which are not approved for that condition.

CONCLUSION

The use of psycho pharmacotherapy in CAP is justified in cases where it is necessary to reduce the suffering of children and to improve their functionality at the time when cognitive, social and emotional advancement is most pronounced. Further research and clinical monitoring of efficacy and safety in the use of psycho pharmaceuticals in youngsters are necessary.

The Effect of Shift Work on the Overall Health Status of Hospital-Employed Nursing Staff in Bosnia and Herzegovina: A Cross-Sectional Study

BACKGROUND

Nursing is a profession frequently organized around shift work in order to guarantee the continuity of care throughout the 24 hours. However, working in shifts is coupled with the desynchronization of circadian rhythms and may result in adverse effects on nurses' health. Our previous work has demonstrated the presence of increased stress levels, reduced coping abilities and diminished life enjoyment in shift work nurses in comparison to those working only in accordance with the daily schedule. Here we aimed to appraise the effects of shift work on their overall health status.

SUBJECTS AND METHODS

We used a comparative cross-sectional approach on a sample of 157 hospital nursing professionals at the University Clinical Hospital Mostar. Study subjects were divided into two groups: a total of 51% study subjects were included in a specific type of shift work (i.e., 12-hour day shift / 24 hours off / 12-hour night shift / 48 hours off), while the remaining 49% adhered to the conventional 7-hour daily schedule. The instrument used was a Standard Shiftwork Index (SSI), together with a comprehensive appraisal of participants' socio-demographic characteristics. Descriptive and inferential statistical methods were applied, and statistical significance was set at p≤0.05 (two-sided).

RESULTS

The results have shown that nurses in shift work were significantly more burdened with gastrointestinal disturbances (p<0.001); more specifically, there was a higher frequency of appetite loss (p=0.003), heartburn (p=0.03), nausea (p<0.01) and weight gain (p=0.05) when compared to nursing professionals in the day shift. Conversely, there were no statistically significant differences in cardiovascular health between these two groups. In addition, nurses in shift work more frequently presented with headaches (p=0.001) and varicose veins of lower extremities (p=0.037) in comparison to nurses working only in accordance with the daily schedule.

CONCLUSIONS

Shift work can adversely influence psychophysical homeostasis, resulting not only in substandard performance of nursing staff, but also potentially hazardous effects on their overall health status. More specifically, we recognized shift work as a substantial risk factor for gastrointestinal and metabolic disorders in nurses; likewise, the increased prevalence of headaches may consequently have a detrimental effect on social and family relationships. All of this should be tackled in a holistic and organized way, together with any additional psychological/sleep issues.

Prevalence of high-risk human papillomavirus infection and cervical cytology abnormalities among women up to age 40 in the Tuzla Canton, Bosnia and Herzegovina

INTRODUCTION

Cervical cancer is the second leading cause of female cancer in Bosnia and Herzegovina, and it is the most common female cancer in women 15 to 44 years old. Cervical cancer is etiologically associated with high-risk human papillomaviruses (HRHPV). Data on the prevalence of HRHPV in Bosnia and Herzegovina are scant. This study investigates the prevalence of HRHPV infection among women of reproductive age compared with cervical cytology in the Tuzla Canton.

METHODS

We analyzed the results of HRHPV testing and Papanicolaou (Pap) test results in women up to 40 years old diagnosed at the Tuzla University Clinical Center (UCC) from January 2019 to March 2020.

RESULTS

Among 880 women tested for HRHPV, 27.2% (n = 239) were ≤ 40 years. In this age group HRHPV was detected in 33.5% (n = 80) of women, and 23.8% (n = 19) were women < 30 years. Out of 239 women tested for HRHPV, 60.2% had an abnormal Pap smear result. Therefore, 40.7% (n = 59) of HRHPV-positive women had an abnormal Pap test result. Women with a normal Pap test result had an HRHPV-positive test in 22.3% (n = 21) of cases.

CONCLUSION

The results obtained contribute to the knowledge about HPV prevalence and the incidence of squamous cell abnormalities in the most populous canton in Bosnia and Herzegovina, possibly reflecting the situation nationally. The high prevalence of HRHPV in women of reproductive age calls for urgent implementation of an organized cervical cancer screening program and HPV vaccination.

Correlation Between Extracutaneous Microvascular Complications and Diabetic Foot Ulcers in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life.

OBJECTIVE

The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes.

METHOD

The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%.

RESULTS

Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p<0.001) had unregulated glycemia (HbA1c≥7.0). Polyneuropathy was present in 23.3% of patients with HbA1c≤7.0%, while 41.0% of patients had HbA1c≥7.0% (p<0.043). Nephropathy with HbA1c≤7.0% was present in 36.8% of cases compared to patients with HbA1c≥7.0 in whom the prevalence was 36.8% (p<0.004). Out of total, 25.6% had retinopathy with HbA1c≤7.0%, while in 41.9% of patients with HbA1c≥7.0% (p <0.067). Diabetic ulcer foot was present in 13 patients with HbA1c≥7 (11.1%) compared to patients with HbA1c≤7.0% where there was no occurrence of this complication 0.0% (p<0.021). At the same time, 5.6% of patients had a diabetic foot ulcer with polyneuropathy (p=0.010), 4.4% had neuropathy (p=0.058) and 5.6% had retinopathy (p=0.014).

CONCLUSION

The high incidence of extracutaneous microvascular complications and diabetic foot ulcer in patients with type 2 diabetes requires a multidisciplinary approach of medical professionals that includes prevention of risk factors and good regulation of glycemia.

A case series of chest imaging manifestation of COVID-19

Coronavirus disease 2019 (COVID-19) is caused by a infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 It started in Wuhan, China, in December 2019, after which quickly spread to many other countries around the world. Chest radiography (CXR) and computed tomography (CT) play key roles in managment and diagnosis of COVID-19. In this case series we are presenting three patients with predominant left-sided changes caused by COVID-19 infection.

Quality of Life and Mental Health in Multiple Sclerorsis Patients in Bosnia and Herzegovina Measured by Generc and Disease-Specific Questionaire

BACKGROUND

Multiple sclerosis (MS) as chronic neurodegenerative disease significantly impact patients' quality of life (QoL). QoL instruments can be generic (EQ-5D, SF-36) and disease-specific like MSQoL-54. Use of disease-specific instruments is preferred since it captures broader symptoms related to MS than generic instruments. Mental health is impacted by MS and different psychiatric conditions significantly impact QoL. We have conducted prospective non-interventional study among MS patients. Aim was to measure and compare MS patients QoL by generic and disease-specific instrument at baseline and after one year and to identify potential correlation between these two types of measurements and to assess mental health scores among MS patients in Bosnia and Herzegovina (B&H) and other countries.

SUBJECTS AND METHODS

Study included 62 patients diagnosed with MS and treated at Neurology clinic in Sarajevo from April 2016 to May 2017. Study was approved by Ethical Committee. QoL has been measured by EQ-5D and MSQoL-54. Measurement has been performed at baseline and after 12 months.

RESULTS

Average utility score measured by EQ-5D at the baseline and end of the study were 0.688 and 0.639 respectively with no significant difference (p=0.850). EQ-5D utility and MSQoL-54 score showed high correlation at baseline; rho=0.873 p=0.0001 for physical health and rho=0.711 p=0.0001 for mental health. At the end of the study no significant correlations have been found (p>0.05). High negative correlation found between EDSS and scores measured by EQ-5D and MSQoL-54; at baseline (rho=-0.744 p=0.0001) and at the end of the study (rho=-0.832 p=0.0001). Similar MS impact and loss of QoL found in B&H and other countries.

CONCLUSIONS

Both instruments can be used in measuring QoL but disease-specific are preferred since they capture broader symptoms impacting MS patient QoL. Using QoL instruments could drive clinician decision and patient-centric care as well as reimbursement and policy decision by recording treatment outcomes.

The Influence of Posttraumatic Stress Disorder of War Veterans on the Mental Status of Children and Younger Adolescents

Post-traumatic stress disorder (PTSD) is a spectrum disorder whose symptoms show psychological, neurobiological dysregulation and poorer functionality of a person on the social plane. PTSD characteristics are symptoms from four clusters: symptoms of intrusiveness, avoidance, negative changes in cognition and mood and changes in excitability and reactivity. Traumatic experiences of war veterans can have an impact on the development of psychopathology in their children's lives. The impact of posttraumatic stress disorder of war veterans is negatively manifested in a broader sense through secondary traumatization and is manifested differently in relation to the period of childhood and adolescence. The period of childhood and adolescence represents a delicate and dynamic period that requires adaptation and functionality in adulthood. The epidemiological studies so far indicate the link between the post-traumatic stress disorder of war veterans with the mental problems of their children.