Lung cancer incidence in Bosnia and Hercegovina is high. The implementation of evidence-based lung cancer screening based on low-dose computed tomography (LDCT) may detect lung cancer early and decrease mortality specific to lung cancer. However, LDCT receipt may be unsatisfactory in Europe due to a low distribution of scanners and radiologists or poor access to care. In this paper, we propose a framework for the implementation of lung cancer screening in primary healthcare of Bosnia and Herzegovina based on the United States Preventative Services Task Force recommendation from 2021 and the American College of Radiology Lung CT Screening Reporting & Data System from 2022.

Background: After the World Health Organization declared the outbreak of a new coronavirus on 30 January 2020 a public health emergency of international importance, health authorities in Bosnia and Herzegovinaas in other countries around the world, have ordered active surveillance, early detection, isolation and management, cases, contact monitoring and prevention of the spread of infection. Objective: The aim of this study was to describe and analyze of the organization of family medicine during COVID-19 pandemic in Canton Sarajevo with its positive and negative aspects. Methods: The case study design provided an ideal framework for systematic research into the organization of primary health care in Sarajevo Canton during the COVID-19 pandemic as it is an empirical study exploring a contemporary phenomenon within its real-life context when the boundaries between phenomenon and context are not clearly visible. Multiple sources of evidence are used. Data were collected in several different ways: analyzing policies, laws, regulations, decisions related to the COVID pandemic, insight into changes in the health information system, collecting data from reports, and through a group interview (Delphi exploratory) with eleven family medicine specialists. Results: Primary care was organized as two parallel systems with family medicine in the center. The first system was COVID-19 primary care and the second was regular care for non-COVID-19 patients. Family medicine physicians despite a numerus setbacks provide health care for 106346 COVID-19 cases. Discussion: Every principal (first contact access, person-centered care, comprehensiveness, continuity of care, community based, coordination of care, and holistic modeling) of family medicine was interrupted with consequences for patients and family physicians. Conclusion: Additional research is needed to examine all facets of the family medicine and primary health care response to the COVID-19 pandemic in Sarajevo Canton.

Introduction: The water pipe is a form of tobacco smoking that recently become very popular among youth in many countries all over the globe. Aim: To highlight recent data collected through Global Youth Tobacco Survey (GYTS) in the Federation of Bosnia and Herzegovina (FBiH) 2019, related to knowledge, attitudes and behavior of school children and youth to water pipe consumption. Methods: The GYTS questionnaire for the Federation of BiH 2019 contained 60 multiple-choice questions. The GYTS 2019 in the Federation of BiH was conducted in a total of 73 of the 75 sampled primary and secondary schools with a school response rate of 97.3%. From the 6,972 sampled students a total of 6,415 participated as eligible students in grades 8-9 of primary and 1st grade of secondary school, with a response rate for students of 92.0%. Results: Survey findings show that almost half (44.1%) of the school children confirm ever smoking the water pipe, while Current smoking of water pipe is confirmed by 16.1% school children. Conclusion: There is a substantial need for implementing of systematic and inter sectorial tobacco control measures that involves a water pipe as new public health challenge among youth.

Introduction: Although during undergraduate study students have a high opinion of family medicine and often praise it, during postgraduate studies they show little interest in this medical specialty. Aim: The study aimed to examine the interest of public medical school students in family medicine as a career choice, to establish whether it changed during the study and if there was a difference in that regard among students studying at medical schools in Bosnia and Herzegovina. Hypotheses: students’ attitudes change with learning about the way a family doctor works. Methods: Descriptive cross-sectional survey. This manuscript presents a nationwide survey (63% response rate) of public medical school students in Bosnia and Herzegovina regarding their likelihood of selecting Family Medicine as a specialty. An anonymous questionnaire was distributed to all medical students on all six state universities in Bosnia and Herzegovina. Data basis of all doctors who have completed specialization programs were taken from ministries of health. Results: In the period from 01/01/08 to 12/31/18, only 8.4% of all completed specializations were family medicine doctors in Bosnia and Herzegovina. Interest in family medicine, as a future career, was shown by 31% of medical students, of which over 75% were female students. The largest interest in family medicine was shown by the sixth-year medical students, stating their extensive knowledge of medicine as a reason. Conclusion: Students’ interest in FM specialization is changing through the years of study. Unfortunately, it is not only the lack of interest, that is the cause of the small number of family medical specialities among students but also poor health policy, which should be subjected to actual reform.

Introduction: It is an undeniable fact that antidepressants can cause side effects. Antidepressants generally have a similar effect but they differ in their application safety, as well as their side effects. Aim: To determine differences in the frequency and intensity of antidepressant induced side effects in patients treated in primary care. Methods: The research was designed as a prospective, cross-sectional study, conducted on a voluntary and anonymous basis, and it included depression patients treated with antidepressant medications during 2013-2015 in Zenica-Doboj Canton using the Hamilton Depression Rating Scale and Toronto Side Effects Scale. Results: The total sample included 508 subjects. As a significant problem, abdominal pain was felt by 14% of subjects, indigestion by 19% of subjects, nausea by 15% of subjects, diarrhea by 9% of subjects, and constipation by 11% of subjects. 29% of subjects suffered from sweating, 20% suffered from a sudden heat stroke, 10% suffered from swelling, and 23% of them reported suffering from dry mouth as a significant problem. The prevalence of side effects in relation to how do they affect life and daily activities of subjects is statistically significant (P <0.000). Statistically significant side effects of SSRI antidepressants correlate with the duration of our subject’s treatment: perception of increased sleep (0.039) as well as decreased sleep (P = 0.009), sweating (P <0.001), sudden heat stroke (P <0.001), being without orgasm (P = 0.004), decreased libido (P <0.001), weight loss (P = 0.045). Conclusion: It is necessary to educate the patients about the nature and features of the depressive disorder, and to notify the patients of the expected course of recovery, as well as the need to adhere to the recommended therapy and the possible side effects of the medication.

Aim To assess obesity and weekly physical activity among medical students at the University of Banja Luka, Bosnia and Herzegovina, related to gender and years of study profile. Methods This is a prospective, descriptive study conducted among the student population across all six years, comprised of a validated survey instrument Youth Risk Behaviour Survey Questionnaires. The study was approved by the Ethics Committee of the School of Medicine and carried out as an anonymous survey, during the winter semester of the academic year 2017/2018. Results Of the total 601 students, the study included 543 students, 327 (60.2%) females and 216 (39.8%) males. The majority of students 337 (62.1%) had normal weight, and 13 (2.4%) had class 1 obesity. Most female students, 255 (75.7%) had normal weight, while 132 (61.1%) males were overweight. Physical inactivity was found among 349 (64.3%) students; 11 (2%) exercised regularly twice a week and 16 (2.9%) exercised five times a week. Conclusion This study should help better understanding and identifying the onset of obesity among the students of the School of Medicine in Banja Luka and promote awareness of the obesity problem among them that would have benefit for health of this population group.

Aim To determine the extent and characteristics of incidental injuries, primarily by needles and other medically sharp instruments and to recommend preventative activities to health care professionals. Methods The survey was conducted among 200 healthcare and non-healthcare employees of the Primary Health Care Centre Zenica (48% of the total number of employees). Care workers were surveyed, and the sample was randomly selected in proportion to the number of employees in institutional departments. Respondents answered questions about gender and age, work experience and qualifications; the number and type of exposure to incidents in the past year, number of career incidents, number of reported incidents; information on the manner and cause of the incident. Results The sample consisted mainly of females, 153 (83.2%). An exposure to incident during their work was experienced by 128 (69.6% ) respondents: needle-stick injury, 79 (42.9%), unforeseen patient response, 42 (22.8%), rush to perform the procedure, 34 (18,5%), and negligence, 18 (9.8%). The incidents most frequently occurred in gynaecology department (all respondents experienced an incident event), followed by department of family medicine, 47 (67%). The main reason for these incidents was rush to perform procedures, in 9 (12.5%). Of 128 experienced incident events, 21 (16.4%) were reported. Conclusion The low rate of reporting of exposure to incidents does not provide a realistic basis for risk assessment and preventive action. Primary task for improving safety of work processes at our setting will be to raise employee's awareness of the need to report exposure incidents.

1Primary Healthcare Center Banja Luka, The Republic of Srpska, Bosnia and Herzegovina 2University of Banja Luka, Faculty of Medicine, Department of Family Medicine, The Republic of Srpska, Bosnia and Herzegovina 3University of Zenica, Faculty of Medicine, Department of Family Medicine, Bosnia and Herzegovina 4University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Aim To systematically review the scientific evidence of biomarker validity, reliability, specificity and sensitivity in identifying malnutrition in the elderly. Methods Peer-reviewed journals were searched using PUBMED and EBSCO from January 1998 to April 2018. The articles included description of the association between malnutrition blood biomarkers and validated nutritional status assessment instruments and studies were conducted among community-dwelling elderly or nursing home residents. Results The research strategy identified a total of 293 studies. This literature review picked out seven articles for follow-up evaluation. A total of sixteen blood biomarkers were identified. Six studies found a significant association between the nutritional assessment score and albumin level. Conclusion Combining serum concentrations of malnutrition biomarkers with nutritional status assessment tools has a great potential in identifying the risk of malnutrition in the elderly, while also increasing sensitivity and specificity.

Aim To determine the prevalence of depressive episodes and recurrent depressive disorders despite of the length of therapy and type of antidepressants. Methods The study was conducted among 508 patients aged 19-65 years who were treated for depression for at least 3 months (mild and moderate episodes were controlled and the effects of treatment monitored by family physicians, while severe episodes were controlled by a psychiatrist) during 2013- 2015 in Zenica-Doboj Canton using the Hamilton Depression Rating Scale (HDRS). Results The average age of the patients was 48.98±11.585 years. Depressive disorder was most commonly represented in patients with high-level education, 22%, more frequently in non-productive workers (non-productive vs. manufacturing 58%:35%). A significant number of patients who were treated for depression were unemployed (57%). All respondents were suffering from the most serious episode of depression with an average depression rate at the Hamilton scale 18.49±8.603, with a very serious depression level of 32%, severe 17%, moderate 21%, and mild 20%. Most patients were treated with paroxetine, 27%, fluoxetine 22% and sertraline 17%. Efficacy of depression treatment with different types of selective serotonin reuptake inhibitors antidepressants (SSRIs) was not significantly different (p=0.502). Conclusion Success of the treatment with the absence of symptoms of depression was achieved in 10% and the maintenance of depressive episodes occurred in 90% of cases. Adverse reactions with the most commonly prescribed SSRI in our country should be important in creating procedures and strategies for the future treatment of depression in family medicine.

Introduction: After family medicine’s famous beginnings in the early 60’s through introduction of the world’s first family medicine specialization, with transitional changes and war also come changes in former Yugoslavia’s healthcare systems. Aim: The primary aim of this article is to analyze frequency and causes of sanctioning of family physicians by Health insurance funds in the countries of former Yugoslavia. The secondary aim is to evaluate frequency and types of workplace violence family physicians experienced due to insurance boundaries for patients. Methods: The comparative, cross-sectional survey was carried out from October 2017 to February 2018. Study participants were general practitioners’ (GPs), family physicians (FPs) and those without a specialty designation but providing family medicine services in one of the five Western Balkans countries: Croatia, Slovenia, Serbia, Macedonia and Bosnia and Herzegovina (B&H). The questionnaire was designed for the purpose of the study. Results: Forty-nine percent of participating physicians have been sanctioned by Health Insurance Fund and 77. 5% has been exposed to workplace violence. The most common type of violence was verbal (76.6%). Financial penalties according to the scale had the highest rates in Macedonia (73.9%) and Slovenia (43.9%). Conclusion: It is necessary to educate creators of healthcare policies, doctors and patients for the purpose of establishing partner relations which would lead to strengthening of primary healthcare, but also to a more efficient healthcare system.

Aim To determine dietary habits of elementary school students in relation to a place of living and socio-economic status of the family. Methods A prospective study conducted in the Primary Health Center Zenica involved five family medicine teams in urban and five in rural settlement during 2015. Elementary school students aged 10-16 were interviewed by random selection using a questionnaire on the socio-economic status of parents and nutritional habits of adolescents. Results The survey involved 199 respondents, 103 from rural and 96 from urban area. There were significantly more pupils from employed parents who consumed non-carbonated drinks. Students from urban areas more likely consumed fruit every day than children from rural areas. More than half of the respondents did not or rarely consumed vegetables, in this case the village pupils, who consumed much less milk. It would be expected that rural students were more likely to consume fruits, vegetables and milk due to easier access to these foods in the countryside, but the results of this research did not confirm this assumption. Conclusion Changes in traditional family functioning (lower income, unemployment) could be linked with lifestyle changes (low consumption of fruits and vegetables, low consumption of milk both in rural and urban areas, consumption of carbonated drinks), especially in families in rural areas.

Aim To determine dietary habits of elementary school students in relation to a place of living and socio-economic status of the family. Methods A prospective study conducted in the Primary Health Center Zenica involved five family medicine teams in urban and five in rural settlement during 2015. Elementary school students aged 10-16 were interviewed by random selection using a questionnaire on the socio-economic status of parents and nutritional habits of adolescents. Results The survey involved 199 respondents, 103 from rural and 96 from urban area. There were significantly more pupils from employed parents who consumed non-carbonated drinks. Students from urban areas more likely consumed fruit every day than children from rural areas. More than half of the respondents did not or rarely consumed vegetables, in this case the village pupils, who consumed much less milk. It would be expected that rural students were more likely to consume fruits, vegetables and milk due to easier access to these foods in the countryside, but the results of this research did not confirm this assumption. Conclusion Changes in traditional family functioning (lower income, unemployment) could be linked with lifestyle changes (low consumption of fruits and vegetables, low consumption of milk both in rural and urban areas, consumption of carbonated drinks), especially in families in rural areas.