The concept of proper nutrition implies meeting the needs of the body concerning daily energy intake and a sufficient amount of nutrients and protective substances necessary to maintain the physiological functions of the body and its health. Nutrients are divided into macronutrients (proteins, carbohydrates and fats) and micronutrients (vitamins and minerals). Accelerated growth and development during adolescence increase nutrient requirements. Therefore, energy and nutrition requirements must meet the needs of adolescents. During their growth and development, there is an increased need for vitamins and minerals, especially for calcium, iron, zinc and vitamin D. During intensive growth, adolescents require more vitamins, especially B-complex vitamins and vitamin C, the intake of calcium and phosphorus is necessary as well, and the insufficient needs for proteins affect the development of muscles and energy levels. Proper nutrition and eating habits during the period of growth are of the utmost importance for the appropriate physical, psychosocial and cognitive growth and development of a child. Eating disorders usually occur as a result of low or high energy intake, and the most common types of these disorders are anemia, anorexia and bulimia, obesity and comorbidities, and poor eating habits. When it comes to the implementation of various programs concerning the prevention of bad eating habits and eating disorders, the school management, expert teams and student parents should bear the overall responsibility. Once or twice a year, preventive check-ups and BMI measurements are recommended to identify eating disorders.

Introduction. The aim of the study was to examine the correlation between subjective well-being and quality of life of the elderly in relation to their demographic characteristics, health, social and financial status. Methods. The study sample was comprised of 159 subjects of both sexes and of older age. The respondents underwent research in Banja Luka in the premises of the Association of Pensioners of the Republic of Srpska, senior citizens' clubs when coming to some of financial institutions to get help, to open bank accounts etc., as well as in the premises where pensioners gather to socialize and communicate. The survey questionnaire developed for the purpose of the paper and adapted to this population was used in the study. The survey questionnaire consisted of the following elements: sociodemographic data, self-assessment concerning the quality of life and Quality of Life Scale for the Elderly. Results. The study included a total of 159 subjects, 56.6% males and 43.4% females, of whom the majority were 65-75 years old (67.3%). The average health status (M = 2.17; SD = 0.68) was higher than the expected value, while the social status (M = 1.93; SD = 0.60) and the social needs (M = 1.91; SD = 0.72) were slightly lower compared to theoretical mean. Furthermore, the financial status had an average value (M = 2.08; SD = 0.59). The distribution of social needs was unsatisfactory. The obtained value of the Self-Perceived Quality of Life Scale was within the range of the theoretical mean values (M = 5.54, SD = 2.47), indicating that the distribution of the obtained quality of life values was symmetrical. Conclusion. Financial status significantly affects the quality of life of the elderly. The distribution of social needs is unsatisfactory. The level of education significantly affects the quality of life: highly educated respondents have a better health, social and financial status compared to the elderly with a lower level of education.

Introduction: Cognitive abilities are defined as the awareness of immediate discovering, rediscovering, and recognizing information in various forms, understanding, and comprehension. Objective: To examine the cognitive impairment rate and its effect on the functional status of elderly persons, retirement home beneficiaries. Method: The research has been designed as a cross-sectional study, including 110 elderly persons. Research instruments comprised a general questionnaire, Katz index of independence in activity of daily living, Lawton instrumental activities of everyday life, and Mini-mental state examination. The statistical test used was the ch2 test, while Pearson's correlation analysis was used for correlation analysis. Results: Out of the total number of subjects, 60% had an impaired cognitive status. When it comes to functional status, assistance was necessary for 79.2% of the subjects. Statistically significant weak positive correlation existed between the subjects' cognitive status and their functional abilities (r = 0.331; p<0.001; r = 0.386; p<0.001). Conclusion: The cognitive deficit rate was high in the retirement home subjects. Cognitive deficit brings about a significant decline intellectual functioning and undermines the subjects' daily living activities.

Objectives To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina. Design Cross-sectional study. Setting Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina. Participants 300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer. Results According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65–74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65–74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65–74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65–74 years), 19.50 kgF (≥75 years for women). Conclusion HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in 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.

Summary Introduction The aim of the study was to establish the association between oral health and malnutrition in people over the age of 65. Material and Methods Cross-sectional study included 146 respondents residing in gerontology center, and 300 respondents who lived in their own homes or with their families. Nutritional status was evaluated using the Mini Nutritive Scale and standardized questionnaire. Dental status was evaluated by clinical examination using inspection method. The presence and absence of teeth was evaluated in each dental arch (third molars were not taken into consideration). Also, the presence of prosthetic restorations (total and partial dentures) was noticed without analyzing their adequacy and functionality. Self-assessment of health with categorical components assessed the overall health status. The research was conducted in 2018. Results Most of respondents who had malnutrition or were at risk of malnutrition had worse dental status; they were completely or partially edentulous. There was high statistically significant difference in dental status of the upper (χ2=47,797; p < 0,001) and lower jaw (χ2 = 66,680; p < 0,001). The number of lost teeth had an impact on self-assessment of general health (χ2 = 47,270; p < 0,001). Conclusion Oral health status in elderly people had significant influence on nutritional status.

Aim: The aim of the study was to determine the differences in nutritional status and risk for malnutrition between nursing home and community-dwelling residents. Methods: Cross-sectional study included 146 nursing home residents and 300 community-dwelling elderly adults from four municipalities in Bosnia and Herzegovina. Anthropometric measurements, biochemical analyses, nutritive, functional and cognitive assessments were carried out. Nutritional status and risk for malnutrition were assessed by Mini Nutritional Assessment (MNA), Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (Screen II) and the food intake analysis for the past 24 hours. Functional status was assessed by the Lawton scale, the Katz Independence Index, Timed Up and Go test, the Functional Reach Test. Mini Cog test and Six-item cognitive impairment test were used for the evaluation of cognitive functioning. Results: The incidence of high nutritive risk by SCREEN II (100%) and being “at risk for malnutrition” by MNA (81.60%) was higher among nursing home residents compared to community-dwellers. Community-dwelling elderly people had higher BMI (27.94 ± 4.73), weight (78.40 ± 13.99), height (167.69 ± 9.74), waist circumference (97.77 ± 12.88), hip circumference (104.61 ± 11.47), mid-arm arm (27.54 ± 3.58), hip (27.54 ± 3.58) and calf circumference (34.02 ± 5.16 ). Statistical differences in regards to place of living were found in functional status (p<0.001), cognitive functioning (p<0.001) and hand grip strength (p<0.001). Conclusion: The frequency of malnutrition and high nutritional risk was higher in respondents who were living in the nursing homes compared to community-dwellers. The results of this study showed that health professionals involved in the care for institutionalized elderly people should implement routine screening of malnutrition within the comprehensive geriatric assessment in their daily practice.

INTRODUCTION The literature indicates different factors influencing recruitment of health professional students to work in rural areas. The purpose of this study is to explore the willingness of health profession students in the Faculty of Medicine Foca, University of East Sarajevo, Bosnia and Herzegovina to work in a rural area following graduation and the factors influencing incentives to pursue a rural career. METHODS The cross-sectional study included first-year through sixth-year students aged 18 years or older and enrolled in one of three study programs at the Faculty of Medicine: medicine, dentistry and nursing. The questionnaire was distributed at the beginning of the winter semester during the first required lecture for each year and study program class. Data was analyzed using student t-test, analysis of variance when appropriate, Kruskal-Wallis test and multivariate logistic regression analysis. RESULTS A total of 519 students participated, an 88.3% response rate. Three hundred and ninety-nine (77%) participants responded positively to the question 'When you complete your studies, would you be inclined to accept a job in a rural region?' Factors associated with willingness to practise in rural areas included being female (p=0.027) and having a rural upbringing (p=0.037). Significant differences between medicine, nursing and dentistry students were found in their opinion that willingness to work in rural practice depends greatly on the possibility to get residency more easily (p=0.001). Compared to their peers, nursing students had better opportunities to attend national courses cost-free (p=0.027) and to be involved in the education of new generations of health profession students (p=0.001). Getting a post in an urban area after a work period in a rural area was most valued as an incentive by dentistry students (p=0.037). The multivariate logistic regression model was used to analyze predictors of willingness to practise in rural areas. Students who had been raised in a rural community (p=0.042) as well as female students (p=0.016) were more likely to accept rural practice. Statistical significance at an alpha level of 0.05 was not reached for study program and year of study. CONCLUSIONS The results of the study showed a high willingness of medicine, dentistry and nursing students to work in rural areas following graduation. Female students and students who were raised in a rural community were more likely to choose a rural career. Stakeholders should be committed to strengthening the rural deployment of health professionals by creating a more attractive, rural environment.

Abstract Aims There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at ‘high’ 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29–39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22–24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44–51 such individuals using original algorithms, in contrast to 37–39 individuals with recalibrated algorithms. Conclusion Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.

Introduction. Satisfaction with work and experiencing positive emotions at work is considered to be an important part of nursing professional life, and has a significant impact on patient safety, the quality of services provided, commitment and stay in the organization and profession. The aim of this paper was to examine the level of satisfaction with the work of nurses. Material and methods. The research is designed according to the type of cross section study. The research sample consisted of 200 nurses working at the University Hospital Foca, the Health Center Zvornik and the Health Center Istocno Sarajevo. The instruments used in this in research are: sociodemographic questionnaire and the Job Satisfaction Survey (JSS). Statistical analysis of data was made using the SPSS software statistical package. Of the statistical tests was used χ2-square test. As a level of statistical significance, the difference was taken as the usual value of p <0.05. Results. Statistically significant negative correlation was established between satisfaction with the work and socio-demographic characteristics of the respondents (r = -0,252; p = 0,017). The prospects for improvement are satisfied with 25% of the respondents, 37% had an ambivalent attitude, while 38% of respondents expressed dissatisfaction. Twenty-three percent of respondents are satisfied with communication in the organization of work, 35% are ambivalent, while 42% of respondents are dissatisfied. 21% of the respondents expressed satisfaction with the benefits and on the rewards for a well-done job, 45% were ambivalent, while 34% of the respondents were dissatisfied. Conclusion. The lowest ratings of our respondents in wage domains, rewards for well-designed work and working conditions are probably the result of the economic climate in which lives and works, fixed and inadequate wages and minimum benefits combined with the nature of the work.

Background The purpose of this study was to determine how American College of Cardiology/American Heart Association (ACC/AHA) 2013 and European Society of Cardiology 2016 guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) compare in reflecting the totality of accrued randomised clinical trial evidence for statin treatment at population level. Methods From 1997–2008, 7279 participants aged 45–75 years, free of atherosclerotic cardiovascular disease, from the population-based Rotterdam Study were included. For each participant, we compared eligibility for each one of 11 randomised clinical trials on statin use in primary prevention of CVD, with recommendations on lipid-lowering therapy from the ACC/AHA and European Society of Cardiology (ESC) guidelines. Atherosclerotic cardiovascular disease incidence and cardiovascular disease mortality rates were calculated. Results The proportion of participants eligible for each trial ranged from 0.4% for ALLHAT-LLT to 30.8% for MEGA. The likelihood of being recommended for lipid-lowering treatment was lowest for those eligible for low-to-intermediate risk RCTs (HOPE-3, MEGA, and JUPITER), and highest for high-risk individuals with diabetes (MRC/BHF HPS, CARDS, and ASPEN) or elderly PROSPER. Eligibility for an increasing number of randomised clinical trials correlated with a greater likelihood of being recommended lipid-lowering treatment by either guideline (p < 0.001 for both guidelines). Conclusion Compared to RCTs done in high risk populations, randomised clinical trials targeting low-to-intermediate risk populations are less well-reflected in the ACC/AHA, and even less so in the ESC guideline recommendations. Importantly, the low-to-intermediate risk population targeted by HOPE-3, the most recent randomised clinical trial in this field, is not well-captured by the current European prevention guidelines and should be specifically considered in future iterations of the guidelines.