ABSTRACT Introduction The aim of the study was to assess the seroprevalence of SARS‐CoV‐2 in the Republika Srpska, Bosnia and Herzegovina, after five waves of COVID‐19 and 1 year after introduction of vaccination to better understand the true extent of the COVID‐19 pandemic in the population of the Republika Srpska and role of vaccination in achieving herd immunity. Methods The population‐based study was conducted from December 2021 to February 2022 in a group of 4463 individuals in the Republika Srpska. Total anti–SARS‐CoV‐2 antibodies were determined in serum specimens using the Wantai total antibody ELISA assay. Quantitative analysis, using Kantaro IgG assays, was performed in subsamples (1273 specimens) to asses and compare levels of IgG among vaccinated, recovered and participants with hybrid immunity. To adjust for age and gender distribution in sample, poststratification method is applied. Results The overall cumulative seroprevalence was 94.6% (95% CI = 93.9–95.3). Significantly higher seroprevalence rates were observed among vaccinated 97.8% (95% CI = 97.3–98.4) comparing to unvaccinated participants (89.5%, 95% CI = 88.0–91.0). Seroprevalence increases with the number of received doses. Among various professions, the highest seroprevalence was found in the service industry (98.1%), education (98.0%) and healthcare (96.9%). We found that 2.2% of vaccinated and 3.6% of participants with SARS‐CoV‐2 positivity during 2021 had no detectable IgG antibodies. Both seroprevalence (98.6%) and antibody titres (1094.4 AU/mL) were significantly higher among people with hybrid immunity. Conclusion Our findings reveal a 2.3‐fold increase in seroprevalence of SARS‐CoV‐2 antibodies due to infection and vaccination, comparing to the first study performed 1 year earlier. This study provides better understanding of the SARS‐CoV‐2 transmission and highlights the important role of the vaccination in achieving the population immunity. Periodically conducted population‐based seroprevalence studies are important to understand temporal trends and assess surveillance system performance and public compliance with vaccination policies.

<p><strong>Introduction. </strong>Antibiotic resistance is a major threat to public health globally. The aim was to examine the impact of the COVID-19 pandemic on the distribution and antimicrobial resistance of pathogenic microorganisms isolated from samples&nbsp;<br />obtained during standard hospital care in one hospital center. &nbsp;<br /><strong>Methods.</strong> Data were obtained retrospectively from a database of the hospital microbiology laboratory. Study sample consisted of 3012 samples tested before the pandemic in 2019 and 3130 samples from the pandemic period in 2021.&nbsp;<br /><strong>Results.</strong> There was no statistically significant difference in the occurrence of agents that were resistant to all antibiotics between the observed years, but there was the difference in the occurrence of those agents between departments, with the highest frequency in the intensive care unit and the COVID-19 department (p&lt;0.001). Isolation of Acinetobacter bacteria increased 2.7 times, and Clostridioides difficile 6.4 times during 2021 compared to 2019. Statistically significant differences were registered in resistance to: imipenem, piperacillin-tazobactam, ceftayidime, cefepime, glycopeptides, aminoglycosides, levofloxacin and ciprofloxacin in 2021 compared to 2019.&nbsp;<br /><strong>Conclusion. </strong>Our results suggest possible influence of COVID-19 on antimicrobial resistance and input a need for a new larger study addressing this issue.</p>

Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic’s second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

<p>Diabetic retinopathy (DR) is a chronic microvascular complication of diabetes. Due to the dramatic increase in the number of diabetes cases, the prevalence of DR has also risen, making it the leading cause of blindness among the working-age population worldwide, despite the availability of screenings and modern therapeutic options. Risk factors for the development and progression of DR (duration of diabetes, hypertension, hyperglycemia, dyslipidemia, and genetic factors) have been investigated in numerous epidemiological studies and clinical researches, but the research results were not consistent. In recent years, there has been considerable interest in the study of dyslipidemia in diabetes as one of the factors that could influence the onset and progression of DR, as well as apolipoproteins as potentially better biomarkers for DR. The results of our research also point in that direction. Identifying the risk factors for DR is crucial for enabling adequate prevention and raising awareness among individuals with diabetes about the importance of taking appropriate measures to prevent this microvascular complication.</p>

The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study aimed to identify knowledge, attitudes, and practices about AB use and AMR within the general population, stratified by age, gender, and urban/rural areas during the COVID-19 pandemic. This questionnaire-based cross-sectional study was conducted in April 2022 among patients who visited three health centers in the eastern region of Bosnia and Herzegovina. A high frequency of AB use was observed during the COVID-19 pandemic (64.2% of respondents were treated with AB). Age and place of residence have not been shown to be factors associated with AB use practices that pose a risk for AMR. However, female gender (β = 0.063; p = 0.041), better knowledge (β = 0.226; p < 0.001), and positive attitudes (β = 0.170; p < 0.001) about use of AB and towards to AMR proved to be factors associated with better practice by respondents. Women, younger respondents, and respondents from urban areas showed better knowledge, attitudes, and behavior about the use of AB and AMR during the COVID-19 pandemic.

<p><strong>Introduction.</strong> Conflict is a process during which one person consciously and intentionally makes an effort to prevent the other person&rsquo;s efforts, some kind of blockade that will lead to interruption in achieving the goals and interests of the other person. Conflicts in the healthcare team are common and can lead to reduced productivity in the work of healthcare professionals, which can have a negative impact on the care and treatment of patients. <strong>Methods. </strong>This cross-sectional study involved 100 health professionals, nurses and doctors employed in the primary, secondary and tertiary levels of health care. The research was conducted from March to August 2020. A questionnaire on socio-demographic characteristics of respondents, a questionnaire on conflicts of health professionals, and a standardized scale of depression, anxiety and stress with 21 questions (DASS-21) were used to measure the level of subjective depression, anxiety and stress <strong>Results.</strong> Seventy-four health workers (74%) had experience of conflict in the workplace, doctors (95%) significantly more often than nurses (58%) (p=0.001). Forty percent of health workers stated that communication problems were the most common cause of conflict. Seventy-nine respondents (79%) chose cooperation and compromise as a style in conflict resolution. Doctors chose cooperation more often (84%) than nurses (74%) and the difference was statistically significant (p=0.048). Subjects who had experience of conflict had significantly higher average values of anxiety (8.01&plusmn;2.12) (p=0.026) and stress (10.32&plusmn;2.91) (p=0.008) compared to subjects who had no experience of conflict (6.13&plusmn;1.91; 6.12&plusmn;2.03). <strong>Conclusion.</strong> Doctors were significantly more likely to have conflict situations in the workplace. For conflict resolution doctors were more likely to choose a style of cooperation and compromise than nurses who were more likely to choose a style of conflict avoidance.</p>

Antibiotics are often misused, especially for the treatment of upper respiratory tract infections (URTIs) in children, where their use is unnecessary and leads to antimicrobial resistance. This study sought to explore the knowledge, attitudes and practices (KAP) of parents and pediatricians on the use of antibiotics among children and whether the level of education of parents has an impact on their KAP. The research was carried out among 1459 parents of children under 6 years of age and among 18 pediatricians. Sixty percent of pediatricians (61.1%) were prescribed antibiotics daily in their practice. Most of the surveyed parents (98.4%) state that doctors are their main source of information when deciding on the use of antibiotics in the treatment of their children. Parents with a higher level of education use television less often as a source of information when making this decision compared to parents with a lower level of education (p = 0.039, i.e., p = 0.003). The majority of parents (80.7%) knew that Panklav (amoxicillin/clavulanic acid) is an antibiotic, while 52.5% identified Pancef (cefixime) as an antibiotic. Parents with a higher level of education correctly identified antibiotics significantly more often (p < 0.001). This study shows that in the Republic of Srpska, parents have adequate knowledge about antibiotics, especially those with a higher level of education, who show better KAP when it comes to antibiotic use.

The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the consumption of antibiotics for systemic use in outpatients in the Republic of Srpska (RS), before and during the first year of the COVID-19 pandemic, as well as the association between antibiotic consumption and the rate of incidence and mortality of COVID-19. The total consumption of the antibiotics for systemic use (J01) in outpatients in the Republic of Srpska during 2019 was 19.40 DDD/TID, with an increase to 30.80 DDD/TID in 2020.Significantly higher use of penicillin (10.58 ± 11.01 DDD/TID in 2019 vs. 17.10 ± 13.63 DDD/TID in 2020), cephalosporins (2.68 ± 1.90 DDD/TID in 2019 vs. 5.93 ± 2.77 DDD/TID in 2020) and macrolides (2.14 ± 2.22 DDD/TID in 2019 vs. 3.40 ± 3.44 DDD/TID in 2020) was observed during the pandemic period. It is necessary to improve the prescribing practice of antibiotics at the primary health care level, public awareness about rational use of antibiotics, as well as the current antibiotic stewardship programs and control their implementation.

The aim of the study was to assess the seroprevalence of SARS-CoV-2 in the Republic of Srpska, Bosnia and Herzegovina, and to analyse the knowledge, attitudes and practices of the population toward COVID-19. This population-based study was conducted in a group of 1,855 randomly selected individuals from all municipalities from 1 December 2020 to 15 January 2021. All individuals were asked to sign a consent form and to fill in a questionnaire, following which a blood samples were collected. Total anti-SARS-CoV-2 antibodies were determined in serum specimens using the total Ab ELISA assay. The overall seroprevalence rate was 40.3%. Subjects aged <65 years were 2.06 times more likely to be seropositive than those aged ≥65, and 30% of seropositive individuals presented no COVID-19 symptoms. The household members of seropositive individuals were 2.24 times more likely to develop COVID-19 symptoms than the household members of seronegative individuals. More than 95% of respondents believe that preventive measures are very important to control the infection transmission. Majority of respondents wear the masks properly, maintain the required physical distance whenever possible and wash hands with soap. Nearly 50% of individuals were of the opinion that the vaccine could prevent the infection. This study showed that an overall SARS-CoV-2 seropositivity rate by the middle of January 2021 was very high. Attitudes and practices regarding the COVID-19 indicate that additional efforts should be taken in order to improve the health education with a focus on preventive measures and vaccination.

Introduction. Visual-motor integration (VMI) is defined as the degree to which visual perception (VP) and finger-hand movements are well coordinated. The VMI consists of two components: VP and motor coordination (MC). The main goal of our research was to determine whether there are differences in age and gender categories in VMI, VP and MC scores, as well as whether there is a correlation between VMI and school success of younger school-aged children. Methods. Out of 103 student respondents, 52 were female (50.5%), aged 6 to 11 years (8.05 ± 1.44 years), divided into two groups according to age: 6-8 years (first, second and third grade) and 9-11 years (fourth to fifth grade). Data on the level of VMI were obtained by applying the following tests: Beery-Buktenica Developmental Test of VMI, VP test and MC test. Results. In the older age group of subjects, a significant difference was observed in the mean values of the score on the VMI (12.67 ± 1.92), VP (23.69 ± 3.21) and MC (24.34 ± 3.23) tests comparing to the younger group of subjects (9.98 ± 2.12; 20.80 ± 3.2; 19.65 ± 3.82) (p < 0.001), while the difference in the mean values of scores in relation to gender was not observed. A significant, positive and strong correlation was observed between the scores on the VMI, VP and MC test with the success of second to fifth grade students (p < 0.050). Conclusion. Given such a strong correlation between VMI and the success of younger students, we conclude that it is important that VMI disabilities are identified in time, so that these students can be referred for further assessment and receive the necessary support.

Background/Aim: Antibiotic use and resistance represent a growing public health issue, with a specific risk of uncontrolled use of antibiotics in children. The aim of the study was to examine differences in parental knowledge, attitudes and practices about antibiotic use in children between urban and rural areas of the Republic of Srpska. Methods: A cross-sectional study was conducted among 1459 parents of children under 6 years of age, out of which 1201 (82.3 %) lived in urban areas while 258 (17.7 %) lived in rural areas. The research is conducted among parents who brought their children to the selected primary healthcare centres and among parents of children in preschool institutions. Results: The majority of respondents (98.4 %) state that doctors are their main source of information. Only 61.2 % of respondents precisely know which drug is an antibiotic when offered different drugs and respondents from rural areas (54.3 %) more often (p = 0.012) gave more accurate answers when compared to respondents from urban areas (37.3 %). Among parents, 86 % agree with the statement that improper use of antibiotics reduces their effectiveness and leads to bacterial resistance, regardless of groups. More than a half of respondents (52.4 %) do not think that children with flu or common cold symptoms recover faster when they receive antibiotics, significantly more respondents from urban areas (p = 0.001). Respondents from rural areas significantly more often believe that antibiotics can produce harmful effects compared to respondents from urban areas (p = 0.049). Respondents from rural areas significantly more often think that antibiotic use can prevent complications caused by inflammation of the upper respiratory tract (p = 0.006). Parents from rural areas give their children antibiotics without a paediatrician's recommendation significantly more often (4.3 %) compared to respondents from urban areas (0.6 %) (p < 0.001). Conclusion: There are differences in parental knowledge, attitudes and practices regarding antibiotic use and antimicrobial resistance among parents in rural and urban areas. There is need for additional education of parents and for greater engagement of paediatricians in providing guidance and explanations regarding the use of antibiotics.