Background: Sarajevo Canton reported large measles outbreaks in 2019 and 2024, highlighting the impact of the persistent gaps in immunisation coverage. Aim: To analyse 2 measles outbreaks in Sarajevo Canton in Bosnia and Herzegovina, identify populations at risk and assess the impact of vaccination coverage on disease transmission. Methods: We collected publicly available weekly case counts data for 45 weeks from the Public Health Institute of Sarajevo Canton and examined the vaccination coverage for 5 years to assess the impact of immunisation on outbreak dynamics. We conducted descriptive analyses using RStudio version 2024 and evaluated the differences between outbreaks using Mann-Whitney U test. P < 0.05 was considered statistically significant. Results: A total of 869 cases were reported in 2019 and 4505 in 2024, and children aged 1–4 years were mostly affected (42.1%). Most of the cases were either unvaccinated or had unknown vaccination status; 92.3% of cases in 2019 were unvaccinated, and 87.7% in 2024 were unvaccinated, while 9.9% had unknown vaccination status. The 2024 outbreak had a higher and longer peak (416 vs 91 cases) occurence than 2019, and one death was reported in each year. Conclusion: The declining vaccination coverage in Sarajevo Canton contributed to increased measles incidence. Strengthening mandatory immunisation, targeted catch-up campaigns and public communication are essential to achieve herd immunity, prevent future outbreaks and progress towards Universal Health Coverage.

Abstract Introduction Sepsis is a global health priority with nearly 50 million cases annually. Cardiovascular dysfunction is common, frequently manifesting as hypotension that persists despite fluid resuscitation. Most affected patients require the use of intravenous (IV) vasoactive agents, typically necessitating intensive care unit (ICU)-level monitoring, invasive interventions and contributing substantially to healthcare costs. Midodrine, an oral alpha-1 agonist approved for orthostatic hypotension, has increasingly been used off-label as a vasopressor-sparing (reducing IV vasopressor use) strategy in sepsis, despite limited and inconsistent evidence. This pragmatic, randomised, open-label trial evaluates the efficacy and safety of midodrine in patients with sepsis-associated hypotension. We hypothesise that, compared with standard care, midodrine administration will reduce the duration of IV vasopressor use. Methods and analysis A total of 308 adult patients with sepsis-associated hypotension will be enrolled (154 per arm). The intervention group will, in addition to standard of care, receive enteral midodrine 10 mg three times daily. Outcomes will be ascertained pragmatically via electronic health record-based data retrieval and adjudicated by research coordinators blinded to treatment assignment. The primary outcome is time alive and off IV vasopressors in the first 28 days (in hours) after randomisation. Secondary outcomes include cumulative vasopressor exposure; use and duration of central venous access; cumulative fluid balance over the first 48 hours and up to 7 days of ICU stay; ICU and hospital length of stay; and ICU-, hospital-, and organ support-free days through day 28. Safety outcomes include adverse events potentially attributable to midodrine during hospitalisation including acute kidney injury. Primary analyses will follow an intention-to-treat framework, including all randomised participants according to their assigned treatment groups. Primary and secondary outcomes will be compared using a van Elteren test stratified by randomisation factors. A predefined secondary Bayesian analysis of the primary outcome will provide complementary estimates of treatment effect. Safety outcomes will be summarised descriptively without formal between-arm hypothesis testing. Ethics and dissemination The Mayo Clinic Institutional Review Board approved this protocol and required written informed consent from all participants (IRB# 24–0 00 121). Findings will be disseminated through peer-reviewed publications and international conference presentations. Trial registration number NCT06319248.

Introduction: Job satisfaction of nurses is an important indicator of the safety and quality of healthcare and professional efficiency. Its level directly affects employee motivation and patient satisfaction. It is determined by financial and organizational factors, job content, and interpersonal relationships. The aim of this research is to assess the level of job satisfaction among nurses in public health institutions in Canton Sarajevo and to identify the factors that shape job satisfaction in this professional group to the greatest extent. Methods: A cross-sectional study was conducted from May to June 2025 on a sample of 504 nurses. The job satisfaction survey questionnaire was used to collect data. The overall score was classified into dissatisfaction, ambivalence, and satisfaction, and the associations with sociodemographic and work characteristics were assessed with the Chi-square test (p < 0.05). Results: Almost half of the respondents were dissatisfied with their job (47.6%), whereas 38.5% reported ambivalent attitudes and 13.9% were satisfied. Job satisfaction was significantly associated with length of service, compatibility of work with education, management function, working hours, type of institution, psychological job demands, and income level (p < 0.05). No statistically significant associations were found with gender, age, marital status, number of children, level of education, or job changes (p > 0.05). Conclusion: Job satisfaction among nurses stems from job content and relationships, and dissatisfaction from financial and organizational factors. Priority measures include fair valuation of work, clear reward systems, and development support to improve healthcare outcomes.

Introduction. Obesity is a significant public health issue and a prevalent preventable nutritional disor- der. It can result from hereditary factors, prenatal conditions, environmental influences, metabolism, and lifestyle choices. This condition leads to an accu- mulation of adipose tissue and increased body mass.Aim. This study aimed to identify participants’ life- style habits, determine their nutritional status, and assess potential predictors of obesity.Methods. The cross-sectional study included 354 students from the Sarajevo High School of Medicine, of whom 236 (approximately 70%) were female. Par- ticipants were aged 14 to 18 years, with a mean age of 16.32 ± 1.74 years. The study involved collecting anthropometric data from physical education class records and administering a structured questionnaire (socio-demographic characteristics and assessment of life habits) designed for this study.Results. It was found that approximately one quarter of the subjects were overweight/obese. Unhealthy eating habits were prevalent, with around 50% of re- spondents consuming fruits and vegetables every day, 80% consuming sugar-sweetened beverages, snacks and fast food. The Pearson correlation test and linear regression determined that inappropriate eating hab- its, lack of physical activity and pronounced sedentary habits significantly affect the occurrence of excessive body mass/obesity in the subjects.Conclusion. Research shows many adolescents have unhealthy habits and obesity, which pose serious health risks. Early screening and prevention are crucial to reduce these risks and promote long-term health.

Aim To assess Qualitiy of life (QoL) in adults by comparing two groups, the one with diagnosed hearing loss (HL) and the other without hearing complaints. Methods This cross-sectional study included 110 consecutive voluntary adult  patients divided in two groups: patients with hearing loss and control group. All participants , after examination , answered to a questionnaires on sociodemographic, clinical data and the World health Organization Quality of Life- Short version (WHOQOL-BREF). Results: Among 110 adults  participants, 59  were with hearing loss (hearing loss group – HLG) and 19  in hearing loss  with hearing aid group (HLHAG) and 51 in control group.  Consistently  higher score  in the domains of physical health (p=0.036) and psychological health (p=0.024) in control group was found; other domains did not reach statistical significance Significant differences between the HLHAG and control group in physical health (mean difference = -11.3; p=0.036) and psychological health (mean difference = -11.3; p=0.029) was confirmed. Conculsion Hearing loss could decrease QoL. Therefore, it is very important to recognize hearing impairment in a timely manner and to take a serious approach to treatment.

Introduction: The impact of nutrition on human health has become a central topic in modern research. The Mediterranean diet, rich in fruits, vegetables, fish, whole grains, and olive oil, has been associated with a lower risk of cardiovascular diseases. However, the effects of non-Mediterranean diets, particularly among students, remain insufficiently explored. This study aimed to examine differences in the dietary habits of health sciences students in two cities in Bosnia and Herzegovina (Mostar and Sarajevo) and Split, Croatia. Methods: A cross-sectional descriptive study was conducted between February and November 2024, including 473 students (Mostar: 125, Sarajevo: 230, Split: 118). Dietary habits were assessed using a validated food frequency questionnaire and the Mediterranean Diet Adherence Screener. Statistical analysis included Pearson’s chi-square test, with significance set at p < 0.05. Results: Students from Split showed significantly higher adherence to Mediterranean dietary habits, including greater consumption of vegetables (p = 0.009), fish (p = 0.035), legumes (p = 0.036), and tomato sauce (p = 0.022). Students in Sarajevo reported the highest intake of sugary drinks (p < 0.01), while those in Split consumed the least margarine and cream-based fats (p = 0.003). No significant differences were found in fruit consumption. Conclusion: Given the importance of diet in preventing chronic diseases, targeted nutrition education programs are needed to promote healthier eating habits among students. Future research should explore the underlying causes of these dietary differences and their long-term health implications.

Objectives: To compare carotid endarterectomy patch angioplasty (p-CEA) with eversion carotid endarterectomy (e-CEA) and associated risks of early cardio-cerebrovascular complications. Methods: The study was a prospective randomized single-blind trial, monocentric, clinically applicable, descriptive analytical and comparative. From June 2021 to June 2023, 62 consecutive patients with symptomatic and asymptomatic stenosis of the internal carotid artery, admitted to our department and randomized into two groups: carotid endarterectomy with patch angioplasty and eversion carotid endarterectomy. Follow-up for 30 days after surgery. Results: During surgery e-CEA, 70% patients had an arrhythmia, and 24 hours after 66.7%, seven days after 46.7% and month after 13.3%. During surgery p-CEA, 33.3% patients had an arrhythmia, 24 hours later 33.3%, 7 days after 13.3% and 30 days after 13.3% patients. Statistically significant difference observed during surgery (Fishers p=0.004). One day after the surgery rate of patients with arrhythmia that were treated e-CEA has decreased, but it was still higher than after p-CEA (Fishers p=0.010). Conclusion: The frequency and categorization of postoperative cardiac arrhythmias after eversion carotid endarterectomy, the clinical implications of various postoperative heart rhythm disturbances and their long-term effects on patients need to be further investigate through sufficiently powered randomized controlled studies

Abstract Background During the first epidemic wave, COVID-19 surveillance focused on quantifying the magnitude and the escalation of a growing global health crisis. The scientific community first assessed risk through basic indicators, such as the number of cases or rates of new cases and deaths, and later began using other direct impact indicators to conduct more detailed analyses. We aimed at synthesizing the scientific community’s contribution to assessing the direct impact of the COVID-19 pandemic on population health through indicators reported in research papers. Methods We conducted a rapid scoping review to identify and describe health indicators included in articles published between January 2020 and June 2021, using one strategy to search PubMed, EMBASE and WHO COVID-19 databases. Sixteen experts from European public health institutions screened papers and retrieved indicator characteristics. We also asked in an online survey how the health indicators were added to and used in policy documents in Europe. Results After reviewing 3891 records, we selected a final sample of 67 articles and 233 indicators. We identified 52 (22.3%) morbidity indicators from 33 articles, 105 severity indicators (45.1%, 27 articles) and 68 mortality indicators (29.2%, 51). Respondents from 22 countries completed 31 questionnaires, and the majority reported morbidity indicators (29, 93.5%), followed by mortality indicators (26, 83.9%). Conclusions The indicators collated here might be useful to assess the impact of future pandemics. Therefore, their measurement should be standardized to allow for comparisons between settings, countries and different populations.

Background: Transplantation of cells, tissues, and organs enables many patients to regain impaired organ function, promoting healing or prolonging life and improving overall quality of life. Objective: The aim of this study was to assess the knowledge and attitudes of students in Federation of Bosnia and Herzegovina regarding organ donation and transplantation of organs. Methods: A cross-sectional study was carried out with 255 students from four different faculties in Federation of Bosnia and Herzegovina, with the majority enrolled in either the Faculty of Medicine or the Faculty of Health Sciences. The students collected data using a self-administrative questionnaire, providing sociodemographic characteristics, knowledge and attitudes about organ donation and transplantation. Statistical analysis was performed using Microsoft Excel version 3645 and R studio v2024.04.2, based on R 4.4.1. Results: Out of all students, 49 of them (19.3%) demonstrated poor knowledge, while 131 students (51.6%) exhibited average knowledge. Analyzing the data by Faculty type revealed significantly higher levels of knowledge among students in Medical and Health faculties compared to those in the Educational Science Faculty (χ2=10.196, p=0.006). Regarding attitudes, 56 students (22%) had a negative attitude, while 117 students (45.9%) had a highly positive attitude. Only 13 students (5.1%) owned a donor card. Conclusion: Students from Faculty of Medicine and Faculty of Health Sciences generally possess higher basic knowledge about organ donation, yet despite this knowledge, their attitudes toward organ donation often remain negative. It is essential to implement effective strategies aimed at raising awareness and fostering a positive attitude toward organ donation.